10Chapter 8. A Dark Page in Soviet Psychiatry

In 1971, an examination took place at the Serbsky Institute in Moscow—the leading forensic psychiatry institution in the Soviet Union. The patient was Ukrainian mathematician Leonid Plyushch. He was charged under Article 70 of the RSFSR Criminal Code—“anti-Soviet agitation and propaganda.” He had written several letters in defense of dissidents, participated in samizdat, and signed protest petitions.

The commission, led by Academician Andrei Vladimirovich Snezhnevsky, diagnosed Plyushch with “sluggish schizophrenia.” Based on this diagnosis, he was sent to the Dnipropetrovsk Special Psychiatric Hospital of the USSR Ministry of Internal Affairs—one of the harshest psychiatric prisons in the Soviet Union. There, he was injected with sulfosin, high doses of haloperidol, trifluoperazine, and insulin.

Plyushch spent nearly three years in the psychiatric hospital. He was released only after a widespread international campaign and pressure from Western psychiatrists, politicians, and mathematicians. When he was finally freed in 1976 and emigrated to France, independent psychiatrists examined him. None of them found any signs of schizophrenia—neither sluggish nor any other form.

Plyushch’s case was one of many. In the 1970s, in the Soviet Union, the diagnosis of “sluggish schizophrenia”—an invention of Snezhnevsky’s Moscow school—became a tool of political repression. By various estimates, hundreds of dissidents passed through Soviet psychiatric hospitals of “special” and “general” types during that decade. Engineers, writers, priests, workers, Crimean Tatars, Baptists, Jewish activists, Ukrainian nationalists—all received psychiatric diagnoses simply for expressing opinions that diverged from the Party line.

It was the most horrifying perversion in the history of Soviet medicine. And it didn’t come from some external source or political institutions. It emerged from within psychiatry itself.

To understand how this became possible, we need to start with the figure of Andrei Vladimirovich Snezhnevsky (1904–1987).

Snezhnevsky was not a political functionary. He was a scientist. From 1962, he served as director of the Institute of Psychiatry at the USSR Academy of Medical Sciences, an academician, and a Lenin Prize laureate. A distinguished clinician. A strict organizer. One of the most influential psychiatrists of the Soviet era. His works were translated into many languages, and students from across the socialist world came to learn from him.

Snezhnevsky developed his own concept of schizophrenia. It fundamentally differed from Western views. Schizophrenia, in his theory, was not an isolated episode. It was a continuum. An endless spectrum with varying degrees of severity and dynamics. He identified three forms: continuous, episodic (recurrent), and, most importantly, sluggish, low-progressive. What lay behind this dry term? A mystery that turned the fates of thousands. Patients exhibited no vivid hallucinations. No delusions. No acute episodes. Their bodies did not writhe in convulsions. Their minds did not shatter into screaming fragments. Everything appeared quite normal. But Snezhnevsky saw it differently. Beneath this normality, he discerned a diagnosis. According to his concept, sluggish schizophrenia was characterized by subtle, barely noticeable symptoms: “a peculiar way of thinking,” “strange interests,” “increasing emotional impoverishment,” “incorrect assessments of reality.” And thus—schizophrenia.

This is where things get really interesting. Western psychiatry is the DSM, the ICD, it’s lists. Four pillars hold up the diagnosis of schizophrenia: hallucinations, delusions, disorganized thinking, negative symptoms. Remove even one—and the diagnosis falls apart. That’s how the entire Western world operates. Now watch closely. In the Soviet concept, none of these symptoms was required. Not one. A person might hear no voices, might have no delusions, might think coherently and logically, might lose neither will nor emotion. By every Western textbook—he’s healthy. But by the Soviet concept—he’s already ill. So what remained? What was sufficient? Just two things: a “strange character” and “reformist ideas.” Two words—and the diagnosis of “sluggish schizophrenia” is stuck on for good.

This was precisely the loophole the Soviet system seized upon.

If “reformist ideas” serve as a diagnostic criterion, then any dissident could be deemed mentally ill—and not just ill, but suffering from schizophrenia, a lifelong condition requiring compulsory treatment, safe only within the walls of a specialized hospital.

In 1969, the KGB, in an official memorandum to the CPSU Central Committee signed by Yuri Andropov, proposed using psychiatry as a tool to bypass the judicial system. The thing was that open political trials, especially after the Sinyavsky–Daniel case in 1966, had begun drawing the attention of the Western press and damaging the reputation of Soviet justice. A psychiatric examination turned out to be far simpler. No open court needed. No international observers needed. The diagnosis is made by a commission of psychiatrists. The decision—formally—is not legal but medical. A patient declared insane is sent to a special psychiatric hospital for an indefinite term—until the commission decides he has “been cured.”

The practice flourished. In the special psychiatric hospitals of the Ministry of Internal Affairs in Dnepropetrovsk, Sychevka, Kazan, Blagoveshchensk, Orel, Leningrad, and Chernyakhovsk, there ended up dozens—and by some estimates hundreds—of dissidents. Among the best known are the writer Vladimir Bukovsky, the mathematician Leonid Plyushch, General Pyotr Grigorenko, the poet Viktor Nekipelov, and the human rights activist Natalya Gorbanevskaya, who was held in the Dnepropetrovsk special hospital with a diagnosis of “sluggish schizophrenia.”

Treatment weapons in these hospitals included the full arsenal of 1960s-1970s Soviet psychiatry. Sulfosin. High-dose haloperidol inducing brutal extrapyramidal side effects—agonizing muscle rigidity, tremors, severe dystonia. Triftazine. Majeptil. Massive doses of Aminazine. Electroconvulsive therapy—administered without anesthesia or muscle relaxants, using the primitive 1930s method where hellish convulsions shattered bones and tore muscles. Insulin comas.

Plyushch’s testimony after his release, Bukovsky’s accounts in his book “And the Wind Returns” (1978), Grigorenko’s recollections in his memoir “In the Underground One Can Meet Only Rats” (1981), Natalya Gorbanevskaya’s reports—all of them describe the same horror. Medications were used not as treatment but as an instrument of control. Sulfazine was a tool of torture—a three-cc injection caused pain after which the patient could not move for several days. Haloperidol in large doses without correctors caused akathisia—a tormenting motor restlessness in which it is impossible to stand, sit, or lie down. Some patients would have preferred physical pain.

This was chemical torture. It left no visible marks. It masqueraded as “treatment.” It was cloaked in medical jargon.

But in reality, it was torture. Without any of the ethical neutrality that a medical context lends.

In 1971, Vladimir Bukovsky, who had himself repeatedly been through Soviet psychiatric institutions, managed to smuggle to the West documents containing the case histories of six dissidents who had become vic•••• of Soviet punitive psychiatry. These materials were translated and published, which caused an enormous international resonance.

In 1977, at the congress of the World Psychiatric Association (WPA) in Honolulu, the Soviet delegation faced severe criticism. The Honolulu Declaration was adopted—the first formal ethical code in WPA’s history, explicitly condemning the use of psychiatric methods for political purposes.

Soviet psychiatry ignored the criticism and the declaration. It went on “treating” dissidents.

In 1983, at the WPA Congress in Vienna, the All-Union Society of Psychiatrists (the professional organization of Soviet psychiatrists) was compelled to withdraw from the WPA under threat of expulsion. This marked an unprecedented event in the history of global psychiatry. An entire national school of thought found itself cast out of the international professional community.

The Soviet side did not return to the WPA until 1989 — by then in the perestroika era, after partial admissions and promises of reform.

In 1984, at hearings held by the Commission on Security and Cooperation in Europe (CSCE) in the United States, former Soviet émigré psychiatrists provided insider accounts of the system. In 1989, a delegation from the American Psychiatric Association (APA) visited Soviet psychiatric hospitals. Their report became one of the most significant documents of the era. The American psychiatrists confirmed they had found numerous instances of psychiatry being abused for political purposes.

The collapse of the USSR in 1991 brought a formally new era to the post-Soviet space. The concept of “sluggish schizophrenia” in its Soviet form was officially rejected. The ICD-10, introduced in the 1990s, contains no such diagnosis. Political repression through psychiatry, in its open and mass form, came to an end.

Yet, the inertia persisted.

The year was 2001. Saint Petersburg. The V. M. Bekhterev Psychoneurological Institute. One of the leading psychiatric institutions in the post-Soviet space. It was here that I arrived to begin my specialization. The Bekhterev Institute. A place with a colossal history. A place where the walls remember everything. The late 19th and early 20th centuries. These very corridors had once been walked by Vladimir Mikhailovich Bekhterev himself as he taught. His shadow still lingered invisibly here. But he wasn’t the sole driving force. Eminent psychiatrists of the Soviet era had left their mark: Ivan Sluchevsky, Mikhail Kabanov, Raisa Golant, Boris Voskresensky. Their names were etched into the memory of this institution. Even now, students from the CIS, Eastern Europe, and Asia come here to learn. What draws them? Knowledge? Experience? Or the secrets hidden within these walls?

In Bekhterev’s institution, I witnessed the finest aspects of the Soviet psychiatric school. Thoughtful, sometimes exceptional clinicians. In-depth clinical analyses. A careful and considerate approach to patients. A humanistic tradition traced back to Bekhterev himself. I learned a great deal from my mentors, and I am deeply grateful to them.

But in the Bekhterev hospital — as everywhere in the post-Soviet world — there was a darker side too, which I have no right to pass over in silence in this book.

The clinic. A quiet corridor, splattered with green paint. On the wall, a crack resembling a lightning bolt. Behind the office door, a man in his mid-thirties stares out the window, fists clenched. He was brought here an hour ago after shouting and gesticulating on the street. Perhaps it’s a reaction to a divorce. Perhaps an overdose. Perhaps a manic episode. Yet, in forty minutes, his file will bear a neatly written note: “F20.0 – Paranoid Schizophrenia.” Ink stamp. No room for correction. A Western psychiatrist will re-examine the diagnosis five years later. Here, it will remain a stigma. This diagnosis is not just a line in a medical record. It will cost him his job. Revoke his driver’s license. Cut through his marriage contract like a scalpel. A cardboard cover. A blue stamp. A verdict.

No, there was no punitive psychiatry here in the literal sense. But this is the legacy of the same culture, one in which a diagnosis functions less as a scientifically grounded clinical judgment than as a social label.

Second – the practices of restraint. In the wards, I saw patients strapped to beds for extended periods—sometimes entire days. Officially, this was a “necessary measure for agitation.” In reality, it often stemmed from staff shortages and a habitual reliance on mechanical restraint rather than gentle sedation or attentive care.

Third—language. The staff often spoke about patients in a depersonalized manner. “The patient from room 12.” “The schizophrenic from room 14.” Not by name. Not as individuals. As statistical units within their assigned group.

Fourth – the practices of ECT (Electroconvulsive Therapy). Here, it’s worth pausing. At the Bekhterev Institute, ECT was used, and it was professionally justified—as I will demonstrate in the next chapter, ECT has proven effective for certain conditions. But how exactly was it applied? The answer is enough to make one shudder. The methodology in post-Soviet clinics lagged ruthlessly behind global standards. Anesthesia? Not always. Muscle relaxants to protect the body from violent convulsions? Not always. Voltage and current parameters, the force striking the brain? Often outdated. Even the number of sessions in a course was frequently arbitrary. Why? How could the system allow this? A mystery whose answer lies in the very mechanics of psychiatry at the time.

Fifth. Perhaps the most important of all. The culture of unasked questions. A young doctor would cross the threshold of the ward — and walk straight into a trap. He was not allowed to ask inconvenient questions. He could not demand an answer: why is this patient being given such a massive dose of haloperidol? He could not argue with the department head. He could not propose alternative approaches he had read about in foreign journals. And if he did ask — he felt it instantly, in his skin: next time, better to keep quiet.

This culture of not asking questions is a direct legacy of the Soviet system. A system where hierarchy mattered more than truth. Where the experience of one’s elders ranked above research data. Where “that’s just how things are” counted as justification enough.

And it is precisely in this culture that all the mistakes I write about in this book take root. Not because people are evil. But because they have grown accustomed to silence.

Looking back now from 2026, I want to say something important about Soviet psychiatry and its legacy.

Not all of Soviet psychiatry was punitive. To call it nothing but an instrument of torture is to grossly distort the truth. Millions of patients passed through the country’s psychiatric institutions, and many of them did receive help. Free, accessible, and — within its rigid constraints — conscientious. The USSR had a developed network of psychiatric services and produced excellent clinicians. But there were others too — those who refused to stay silent, who resisted the system’s abuses and paid for it with their own careers. The dissident psychiatrists Semyon Gluzman and Alexander Voloshanovich — their names became a challenge flung at the empire of white coats.

But Soviet psychiatry did not protect itself from internal abuse. It did not create effective ethical mechanisms. It did not build a culture in which a young doctor could challenge a senior colleague’s decision. It adopted the concept of “sluggish schizophrenia” without proper methodological scrutiny, and that concept became a tool in the hands of a repressive state.

The blame doesn’t rest solely on the KGB, or on Snezhnevsky, or on the psychiatrists who signed the “expert opinions” at the Serbsky Institute. It rests on the entire profession. On the millions of doctors who knew, or could have known, what was happening—and stayed silent.

I too was part of that chain of silence. In the early 2000s I saw things that should never have happened, and I stayed silent because I was young, had no voice, was afraid. Even now I know many colleagues who continue to stay silent — in wards where outdated methods are used, where patients are denied a voice, where hierarchy matters more than truth.

This book is my belated statement. My confession of keeping silent when I should have spoken. And now, my attempt to finally give voice—not just to the past, but to the present. Not just to the Soviet era, but to what we inherited from it, and what still lingers within these walls.

Snezhnevsky died in 1987, at the very start of perestroika. He did not live to see the official editions of the ICD abandon the concept of “sluggish schizophrenia” in the 1990s. He did not live to see his legacy come under revision.

But his influence did not disappear. Many psychiatrists trained by his students, or by his students’ students, still think in his categories. Post-Soviet psychiatry has gone through a full-fledged reform process only partially. In some institutions and in some countries of the former USSR, elements of the old culture persist to this day.

And this isn’t an abstract issue. This is the reality for patients who come daily for consultations with psychiatrists trained in the Soviet paradigm, receiving diagnoses, treatments, and stigmas shaped by that very framework.

Overcoming the Soviet legacy in psychiatry is not a task for a single generation. It is the work of several generations. It is a long, arduous, and deeply professional cultural endeavor. And it must be done—otherwise, the ghosts of punitive psychiatry will linger in our wards. They will not leave on their own. They must be banished—deliberately, grounded in science, ethics, and courage.

This is our own exorcism of demons—not medieval, but modern. Not through rituals, but through reforms.

In the chapters that follow — once we pick up the trail of the modern pandemic of madness — an exposé awaits us. We will see: Soviet psychiatry left us as its inheritance not just methods. It passed on a virus. The culture of silence. The culture of false hierarchy. The culture of blind “that’s how it’s done.” And this virus works not only against patients. It works in favor of those who today peddle mystical services. Because silence is a universal resource. An anonymous resource. Absolute. Anyone can make use of it.

And as long as we psychiatrists stay silent about our own sins, we have no moral right to demand that society speak up about the sins of constellation practitioners, regression therapists, and peddlers of manufactured happiness.

From ourselves. Let’s start with ourselves.