A star treatment for digoxin overdose?

and characteristic schizophrenic anomalies, present or past, have been manifest. The terms indicate that this is the best place to classify some other poorly defined varieties of schizophrenia."" Although some Soviet psychiatrists manifestly resist what they find to be abuses of their profession,"3 9 in Britain and the West there is a range of opinion among psychiatrists, from belief that their colleagues in the Soviet Union will knowingly incarcerate perfectly sane dissidents to belief that at least some Soviet psychiatrists genuinely think that some dissidents are suffering from a mental disorder. In the absence of independent information many will probably agree with Windholz's assessment that "No final conclusion about the extent of political motivation in psychiatric commitment cases in the Soviet Union can be made without a well documented analysis of contemporary Soviet commitment practices."' Two general aspects of this problem are, however, clear. Firstly, the ethical controversies aroused in allcountries by the compulsory detention and treatment of people in psychiatric institutions are heightened when the Soviet Union is considered, because literary2' and historical20 parallels-as well as contemporary accounts2-7 10" -suggest that the misuse of psychiatry there is deep rooted and long established; because of the cultural, political, legal, and social conditions in that country; because of the lack of knowledge about Soviet medical22 23 and psychiatric practices,2"' especially those regarding compulsory confinement in "special" as well as "ordinary" psychiatric hospitals2 23; and, particularly, because of the close relationship between psychiatry and the state in the Soviet Union. Secondly, the use ofdiagnoses such as sluggish schizophrenia exposes fundamental deficiencies in the reliable and valid definition and classification of psychiatric disorders. This is underlined by the fact that in 1983 the World Psychiatric Association published no fewer than 15 different diagnostic criteria for schizophrenia, including that used in the Soviet Union. Overall, the reliability, concordance, and prediction of outcome of such criteria are unsatisfactory, though afew"emerge as relativelyeffective.""' Doctors and medical science canmake remedial interventions in both these domains; firstly, by continuing to encourage international professional inquiry and enlightenment; and, secondly, by promoting the collaborative research that is still required.3' 32 GREG WILKINSON Honorary Lecturer, Genera Practice Research Unit, Institute of Psychiatry, London SE5 8AF