When medical psychiatrists in Western democracies use neuroleptics on their own patients they claim it is a relatively safe, necessary and effective therapy. However, when the same mainstream psychiatric professionals observed Soviet psychiatrists using the same drugs on people diagnosed with schizophrenia during the last decades of the communist era, they loudly proclaimed that the drugs were being used as a form of punishment and torture. This was despite evidence that Soviet psychiatrists approached the concept of mental illness in almost identical ways to those of Western psychiatrists. An investigator of Soviet psychiatry at the end of the communist era found that:
"The dopamine hypothesis of schizophrenia and amine hypothesis of depression are widely quoted. There is a more intense approach to treatment in the early stages of an illness, and the range of drugs used is similar to that in the West. Interestingly, clozapine [an atypical neuroleptic] was used in the Soviet Union long before it became available in Western countries."[50]
The World Psychiatric Association, the professional body representing psychiatrists at an international level, was very prominent in the early 1980s in a campaign of condemnation of Soviet psychiatry. There was a widespread perception in the West that Soviet psychiatrists were using neuroleptics as a form of torture on dissidents who had been diagnosed with schizophrenia.
Leonid Plyushch, a Russian scientist and political dissident of the 1970s who eventually fled to the United States, told how he had been drugged in a Soviet psychoprison on small doses of the neuroleptic Haldol: ‘I was horrified to see how I deteriorated intellectually, morally and emotionally from day to day. My interest in political problems quickly disappeared, then my interest in scientific problems, and then my interest in my wife and children.’[51] Haldol is not a Soviet invention. It is manufactured in the United States by McNeil Pharmaceuticals. In 1995 Haldol had 24 per cent of the neuroleptic market in the United States.[52]
The professional body representing Soviet psychiatrists resigned from the WPA under pressure in 1983, and in 1989 a Time article warned about the dangers of allowing Soviet psychiatrists to rejoin the WPA. The article canvassed the opinion that psychiatric methods remained essentially unchanged in the Soviet Union and reviewed some of the abuses of the past. At its supposed worst, Soviet psychiatry was dominated by Dr Andrei Snezhnevsky, the director of the Institute of Psychiatry of the USSR Academy of Medical Sciences. Snezhnevsky had died in 1987 but he had been the leading figure in Soviet psychiatry since the early 1950s and his influence was still felt. It was Snezhnevsky who,
"broadened the definition of schizophrenia by adding the category ‘sluggish schizophrenia.’ He defined the disorder as a slow-developing illness without the hallucinations that are a classic element in the Western definition of many schizophrenias. Instead, the ‘symptoms’ could be nearly all forms of behaviour—unsociability, mild pessimism, stubbornness—that deviated from the social or political ideal."[53]
This description of schizophrenia could easily be derived from the current DSM-IV diagnostic criteria, in which ‘hallucinations’ are only one of five possible Criterion A symptoms and are not an essential feature of schizophrenia. Evidence of ‘unsociability, mild pessimism, stubborness, that deviated from the social ideal’, could easily trigger a diagnosis of schizophrenia using DSM-IV guidelines. Disorganised behaviour (Criterion A4) combined with negative symptoms such as affective flattening (Criterion A5) and social dysfunction (Criterion B) would probably be sufficient. If a person was troublesome to their family or a social nuisance in a Western country, there is little doubt that the Soviet criteria could be used for at least a tentative schizophrenia label such as schizophreniform disorder (DSM-IV) or simple schizophrenia (ICD-10).
The same Time article described the torture/punishment imposed on Soviet dissidents as being ‘hospitalised for years under prison-like conditions and put on powerful drugs that turned them into zombies’.[54] But the powerful drugs that violated human rights by turning Soviet dissidents into zombies are the same neuroleptics used on similar types of people by Western psychiatrists.
Another indignant description of Soviet psychiatry describes sluggish schizophrenia again: ‘One manifestation of this novel ailment was “stubbornness and inflexibility of convictions”; the usual treatment consisted of megadoses of powerful tranquillisers such as Thorazine for “prophylactic” purposes’.[55] Once again, ‘inflexibility of convictions’ is just another way of describing ‘delusions with lack of insight’, which is a common feature of schizophrenia diagnosis in the West. ‘Prophylactic purposes’ is called ‘maintenance treatment’ by Western psychiatrists and, as with Haldol in the earlier description, the drug used to supposedly ‘punish’ Soviet dissidents, Thorazine, is routinely applied to schizophrenics by Western psychiatrists. Thorazine is the brand, and chlorpromazine the generic name, of a commonly used neuroleptic that had 12 per cent of the market for neuroleptics in the United States in 1995.[56] In Britain this drug is known as Largactil.
Thomas Szasz argues that the spectacle of the Western psychiatric profession loudly condemning Soviet psychiatrists for their abuse of professional standards was largely an exercise in hypocrisy. Szasz maintains that it is psychiatric power that is the problem from which psychiatric abuse arises, and that psychiatric power is just as prevalent in democratic societies as it was in the Soviet Union: ‘Psychiatric abuse, such as we usually associate with practices in the former Soviet Union, is related not to the misuse of psychiatric diagnoses, but to the political power intrinsic to the social role of the psychiatrist in totalitarian and democratic societies alike’.[57] If one accepts the argument that neuroleptic treatment was a form of torture when it was used by Soviet psychiatrists, there is little reason to have a different opinion about its current usage by Western psychiatrists.
Lawrence Stevens, a lawyer in the United States who represents victims of psychiatric injustice, goes beyond the punishment/torture model for forced treatment with neuroleptics. He compares the practice to rape:
"In both cases, the victim’s pants are pulled down. In both cases, a tube is inserted into the victim’s body against her (or his) will. In the case of sexual rape, the tube is a penis. In the case of what could be called psychiatric rape, the tube is a hypodermic needle. In both cases, a fluid is injected into the victim’s body against her or his will."[58]
Descriptions given by patients of the treatment they have received sometimes gives confirmation of Stevens’s assertion, despite his hyperbole. One woman patient, who had read a number of books about psychiatric theories of schizophrenia before her incarceration, had the temerity to demand of the hospital staff that they test her dopamine levels before giving her neuroleptic medication, in order to confirm that she did indeed have a chemical imbalance in her brain.
"When I was demanding testing at Shellharbour [a psychiatric hospital in New South Wales, Australia], I refused to lay on the bed for an injection unless they tested my levels first. The hospital brought in the hospital security men who forced me around to the TV room via a back corridor. They held me down and forced the injection on me."[59]
This same former patient goes on to describe how neuroleptics affect patient behaviour by the same ‘fear therapy’ principle as earlier forms of treatment:
"When the side effects of the drugs started taking effect I told staff that the side effects were totally unacceptable and that the drugs were toxic. Worse, they were forcing untested drugs on untested patients. The psychiatrist ‘treating’ me was furious. She said in response that I wasn’t allowed to leave the ward with the other patients. I was therefore effectively put in isolation on the ward. I had to endure the side effects etc in silence because there is always ECT down the corridor. Staff then naively believed that I had calmed down because of the drugs. One psychiatric nurse said ‘Look how much better you are now’. This woman honestly believed that I had calmed down because of biological intervention. I hadn’t changed my attitudes or feelings one skerrick. It was just that I was too terrified to say anything because this woman ‘treating’ me was vicious. She meant business. I gave up the fight out of fear of an increased risk of brain damage from increased doses over a longer period of time."[60]
The fear of ‘ECT down the corridor’ is a particularly noteworthy element in the fear therapy that was applied to this patient. She further clarified the therapeutic principle: ‘Because biopsychiatrists dehumanise and depersonalise schizophrenics they can’t comprehend the fact that we respond rapidly to abuse like anyone else. If someone puts the fear of God into you, you shut up. Because of the silence they think the patient has calmed down and recovered because of biological intervention’.[61]
The history of treatment for schizophrenia reveals a long tradition of applying torture and cruel punishment as forms of ‘fear therapy’. In the past psychiatrists have candidly described the principle of fear therapy as giving patients a choice between better behaviour or more pain. Contemporary treatment in the form of neuroleptic medication, while still clearly retaining the same fear therapy principle, also restricts a person’s liberty by acting as a chemical straitjacket. In this way, neuroleptic medication appears to violate human rights which protect against the loss of liberty as well as human rights which protect against torture and cruel punishment.
This is all bad enough, but the situation is now worsening. Not content with the 1-2 percent of the population traditionally caught in the diagnostic dragnet, the psychiatric profession is now engaged in a project to expand the numbers. In what appears to be a strategy largely developed by the pharmaceutical industry, psychiatrists are now embarked on a preventive medicine campaign to detect and treat schizophrenics who are still in a supposed pre-psychotic stage. Given that there is no disease to prevent—and the implementation of a preventive medicine campaign is therefore far more likely to increase rather than reduce the number of people who receive a diagnosis—the reasoning behind this campaign is doubtful. However, it is not difficult to guess at the outcomes, whether intended or not. These will be an extension of psychiatric precautionary control measures together with an expansion of the market for the new generation of atypical neuroleptics.
Next: 9. Early Psychosis: expanding the market for preventive medicine
[50] Francis I. Dunne, ‘Soviet and Western Psychology: a comprehensive study’, p. 374.
[51] Peter Breggin, Toxic Psychiatry, pp. 71–2.
[52] Norman L. Keltner, ‘Antipsychotic Drugs’, in Norman Keltner et al., (eds.), pp. 230–1.
[53] John Langone, ‘A profession under stress; long ostracised by colleagues around the world, Soviet psychiatrists try to show that they are not instruments of oppression’, pp. 94–6.
[54] Ibid.
[55] Victoria Pope, ‘Mad Russians: victims of Soviet “punitive psychiatry”continue to pay a heavy price’, pp. 38–43.
[56] Keltner, op. cit., pp. 230–1.
[57] Thomas Szasz, ‘Psychiatric Diagnosis, Psychiatric Power and Psychiatric Abuse’, pp. 135–9.
[58] Lawrence Stevens, Psychiatric Drugs: cure or quackery?
[59] Heather Nolan, personal communication (letter to Richard Gosden), 26 February 1998.
[60] Ibid.
[61] Ibid.