Political dissent and "sluggish" schizophrenia in the Soviet Union.

MEDICAL JOURNAL Political dissent and "sluggish" schizophrenia in the Soviet Union "It is considered by some governments that if a person does not agree with the views of the state, his sanity must be called into question. Extensive documentation exists on the misuse of psychiatry and psychiatric drugs in the Soviet Union."' Amnesty International, Bloch and Reddaway, and the International Association on the Political Use of Psychiatry are others to have cited several hundred people who have recently been confined to psychiatric hospitals in the Soviet Union for "dissident" activities rather than for medical reasons.-In November 1985 the last of these published a booklet containing details of "all dissenters believed to be currently interned in psychiatric hospitals for political reasons," in which they listed 133 cases in the Soviet Union ("probably only a small proportion of the true total, as most cases never become known in the outside world"). In response to these widely publicised reports of the misuse of psychiatry in the Soviet Union for the repression of political dissent, a motion for the expulsion of the Soviet All-Union Society of Neurologists and Psychiatrists was tabled for the meeting of the World Psychiatric Association in 1984; however, the Soviet body resigned from the World Psychiatric Association in 1983, thus preempting debate.8 The issues surrounding this tortuous and emotive subject are raised again in a discussion of the political hazards in the diagnosis of "sluggish" schizophrenia-a diagnostic concept virtually limited to the Soviet Union and some other East European countries.9 Mersky and Shafran review articles on sluggish schizophrenia from Soviet publications between 1980 and 1984. Though they acknowledge that the diagnosis may be "genuine," they conclude that: "under the influence of an unscrupulous regime the observations put forward could serve as a ready means to label as psychotically ill many energetic and capable citizens who were in disagreement with authority.... They allow for psychiatric disposal, without much other justification, of anyone whose social activism is unacceptable to the psychiatrist who believes in the officially approved system." In fact, this charge has been laid before34 1012; more specifically, Koryagin has reported that the "healthy people" he examined "were diagnosed in one of two ways, as psychopaths (70%) or schizophrenics (30%). 13 In the classification of schizophrenia developed at the Institute of Psychiatry of the Academy of Medical Sciences of Co BRITISH MEDICAL JOURNAL 1986. All reproduction rights reserved. the USSR, the …