In the previous material, we were very briefly and op-ed rolled a group tour of the ideology of the Third Reich, stopped on the way back not for long in the USSR. Continue our tour of the world's clusters of bastards of the 20th-21st century. The Germans,…

Meanwhile, punitive psychiatry is not famous fascist Germany, but fascist in the fantasies of communism Soviet Union. 

In the USSR, people could be forcibly sent to a madhouse under a far-fetched pretext and come up with a diagnosis. In addition, soviet psychiatric hospitals practiced sophisticated punishment of patients. 

Psychiatrist and PhD candidate Peter Kamenchenko talks about how the psychiatric service was arranged in the USSR.

Outs of Psychiatry

In 1983, the All-Union Scientific Society of Neuropathologists and Psychiatrists voluntarily withdrew from the World Psychiatric Association (WPA). Had this not happened, the USSR would have been expelled from the VPA at the nearest international congress in Austria with a scandal. Vitaly Fedorchuk, chairman of the KGB of the USSR, informed the Central Committee of the Communist Party of the Soviet Union that the organizing committee of the Congress had already made such a decision with a memo "On the preparation of the special services of the opponent of the new anti-Soviet action in connection with the upcoming World Congress of Psychiatrists in Austria in 1983."

Silent and exuberant. Patient figure PB N15

Picture: from the collection of P.Kamenchenko

The reason for the exclusion of Soviet psychiatry from the VPA was the conclusions of the international committee investigating cases of psychiatry abuse, which collected numerous evidence of "systematic abuse of psychiatry for political purposes in the USSR". In the Soviet Union, the use of psychiatry as a tool to persecute dissidents was not recognized until 1988.

On 5 January 1988, a decree of the Presidency of the Supreme Council of the USSR adopted a "Regulation on Conditions and Mental Health Care" designed to exclude the use of psychiatry as a tool for extrajudicial persecution of citizens for political reasons.

"State" was the first in Soviet history a regulation regulating the activities of psychiatric services

Before that, everything was determined only by departmental instructions, which were not published in the press and were not known to the public.

In the same year, 11 psychiatric hospitals of a special type, previously under the control of the Ministry of Internal Affairs of the USSR, were transferred to the Ministry of Health of the USSR, and five more hospitals were liquidated. 776,000 patients were removed from the psychiatric register. Next year, about a million more. At the same time, the rules of hospitalization in psychiatric hospitals were changed.

I had a chance to work in psychiatry for about a decade and a half. Six of them (from 1982 to 1988) - a psychiatrist in the Moscow City Clinical Psychiatric Hospital No.15 - "spot, as it was called. At once I will say: the topic of abuses in Soviet psychiatry I have never specifically engaged in, so I will tell only about what I personally witnessed.

Figure of a patient with anxiety-depressive disorder

Picture: from the collection of P.Kamenchenko

From a mental hospital to a construction site

In the USSR, it was much easier to put a person in a psychiatric hospital than it is now. No consent was required from him for voluntary treatment.

In normal cases, the future patient was referred for hospitalization in a psychoneurological dispensary (PND), after which he went to the hospital on his own or accompanied by relatives. A "preliminary diagnosis" was indicated in the direction and the reason for the need for hospital treatment was substantiated.

In the waiting room, the doctor on duty examined the patient, gave him a "diagnosis upon admission" and chose a monitoring regimen: "strict" or "general" - depending on the condition and danger of him to others or himself. In the presence of suicidal thoughts, the "suicide" was marked.

After that, the patient was washed, sheared (as needed), changed into a hospital room and taken to the ward

The departments were divided into male and female, and those, in turn, into "sharp," "sanatorium," "gerontological" (for the elderly) and "adolescent."

When I first started working, there were also "alcoholic" departments in the structure of psychiatric hospitals, where chronic alcoholics were treated. There were also issued referrals to medical and labor dispensaries (LTP), where they were forcibly treated for alcoholism and at the same time forced to work. For example, on the SIL.

Later, all "alcoholic" departments were transferred from psychiatry to specially created drug hospitals. But before that I had time to work and for some time even served as the head of the "alcoholic" department "spots" designed for a hundred beds.

In order to legally send a person to the LTP for a year, a number of conditions were needed: the diagnosis of chronic alcoholism II or III stage, two or three courses of treatment that did not lead to the result, getting into a sobering-up, a statement from the police and a bad characteristic from the place of work.

There was no ceremony with non-working alcoholics at all, and no one asked the rest of the consent to the premises in the LTP. So I, a boy who had just graduated from the institute, had to decide the fate of hardened men. I tried to do it according to my conscience: I persuaded, treated, sewed, coded...

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Hallucinations in the patient alcoholic delirium. Patient's drawing

Picture: from the collection of P.Kamenchenko

The incorrigible sent to the LTP. They went like nice, replenishing the ranks of builders of developed socialism. Where were they going to go? There was little push from LTP. Usually, the course of medical and labor prevention was disrupted immediately after discharge.

"The Rubble of the Chopping" and the Commissioner's Hand

So, most of the patients came in for treatment voluntarily. But there was also forced hospitalization. Psychiatric transportation could be called to the exuberant and already registered patient. The doctor on duty was prescribing a referral, the paramedics knitted the client and immediately sent him to a psychiatric hospital.

Psychiatric transportation could be called to the police station, to the sobering-up, to the state institution.

In special cases, the patient was taken to a psychiatrist on duty in the city, who personally prescribed a referral for hospitalization

Thus, the mental hospital got non-1- goroders: homeless, complainants, inventors, seekers of justice, who were often taken from the streets, railway stations or directly from the reception of the relevant state institutions.

One day in the spring of 1985, during my duty from the reception of the Ministry of Culture, a dishevelled man with a suitcase of old newspapers was brought in. The visitor was from the Kostroma region, and in Moscow brought a project of a monument for the 40th anniversary of the Victory, which carved out of old newspapers life-size. The height of the monument, according to his calculations, was about a hundred meters.

Under the supervision of paramedics, I asked the folk artist to show some fragment of the planned monument. After about half an hour in the waiting room, leaning and swaying, a strange paper structure. According to the creator, this was what the commissioner's hand, which had been squeezed by the nazi-shot party ticket, should have looked like.

Self-Portrait of "FakeMonets" by Bori

Picture: from the collection of P.Kamenchenko

It should be noted that I do not have a spatial imagination, so I could not appreciate the masterpiece - the hapless inventor went to the "sharp" department, and the domestic monumental art may have lost the future masterpiece.

On another occasion, the police caught and brought to the waiting room a "malicious counterfeiter". The poor man got caught trying to pay with homemade money. On the rectangles neatly plucked from the newspaper with a ballpoint pen it was written "Borins of the rubles." Borya did not admit any guilt, but he was determined for treatment.

Where homeless people were hidden in the USSR

Have you ever wondered why there were no homeless people on the streets in the USSR? It's simple: the police collected them and took them to a mental hospital on duty that day. There the homeless man was washed and identified in the department, where the doctor found out where this poor man came from. After several non-residents gathered in the hospital, they were sent by stage to the historical homeland.

In the local hospital, the homeless man was returned to relatives or arranged for a boarding school for psychochronics, if the relatives were not.

It was not a problem to come up with a diagnosis

Was it a concussion? Was! We write: "Organic defeat of the central nervous system, complicated by chronic alcoholism."

Those who did not want to be treated were brought to the hospital "on bindings" - fixing wide tarpaulin belts. No one used straitjackets in my memory.

In the department of the rioter was identified in the observation room, he was given a sedative injection in the ass - usually aminazine (2.0 intramuscularly) and, if necessary, tied to the bed. Waffle towels were used for knitting: two legs and two hands were fixed to the frame of the bed. Reliable and safe.

Drug delirium. Creativity of a patient of the adolescent department of PB N15

Picture: from the collection of P.Kamenchenko

There were no doors in the observation wards for 8-12 beds and a paramedic was constantly on duty. In the women's department - a nurse. In the "spot" nurses traditionally worked women from Serpukhov (the hospital was located on the Kashir highway, to get from the area was convenient).

Women 50-60 years were all as a selection of strong, stocky, superbly learned and brave. They rolled and knitted violently. Behind the incoming patients the doors of the department were closed to the control key, and its fate completely depended on the qualifications and human qualities of the attending physician.

The vast majority of patients of Soviet mental hospitals were in them on direct testimony, which today would be recognized as absolute. These are acute and chronic psychosis of different etiology, depression, neuroses, psychopathy, reactive states, organic CNS lesions, epilepsy, all kinds of congenital and acquired dementia and so on. And today, after a number of diagnoses have been revised, they would all need hospital treatment. Unfortunately, there were others.

By conduct and status

Most of my medical psychiatric practice came from working in the women's teen ward. The office was large - one hundred beds - and occupied two floors. The medical rate was three and a half. So for each of the three doctors there were 30-plus patients.

The patients were girls 14-18 years old with a variety of psychopathology. Since there were no other specialized adolescent psychiatric departments in the country (either children or adults), we were brought to the most difficult patients from all over the country.

The load was high - sometimes there were 110-120 patients in the department, but the staff was trained, and there were enough medicines. The system of socialist integration worked - Hungary and the GDR had a very strong pharmacological industry and supplied the Soviet Union and other countries of the Council of Economic Mutual Assistance (SEV) with the necessary quantity of high quality medicines.

Creativity of a patient of the adolescent department of PB N15

Picture: from the collection of P.Kamenchenko

The problem was that a significant number of teenagers came to us because of asocial behavior. Walking at school, leaving home, alcoholism, sexual relations, problems with the police were considered sufficient reason to put them in a madhouse.

At first, the teenager, often from a dysfunctional family, got on the register in the children's room of the police in the place of residence, then collected several drives to the police.

They could have been detained simply for the fact that after nine o'clock in the evening the minor was sitting in the company at the entrance, in the playground or in the gazebo, rudely answered or something did not like the precinct

Then they called their parents to the police. After several warnings, the juvenile inspector took a referral to the PND and took the teenager to the hospital. And it's good if he's not in the adult ward, he's getting to us.

Formally "asocial" hospitalized for examination. If the teenager was diagnosed (it was impossible to discharge without diagnosis - the doctor simply could not file the medical history without specifying it), the police officers removed all responsibility for the "psych" and at the same time improved the statistics.

And what was to be done with them? On the one hand, young psychopaths, sexually dissized hooligans, alcoholics and tear-off. On the other hand, almost children who were forcibly brought to a madhouse and mixed with quiet depressive domestic girls, demented oligofrenks, excellent students with severe anorexia nervosa, patients with schizophrenic psychosis and with neurosis of obsession, vicious epileptics, hysterics with suicidal behavior and other,

As a result, junior medical staff and the patients themselves were divided into those who were "behaviour" and those who were "as of"

For the first stay in the hospital was a punishment, the second had to be treated, and sometimes rescued.

It was almost impossible to completely isolate some from others in conditions of great crowding. As a result, those who "behaved" of those who "as of." Secretly from the staff mocked them, teased, took away the transmissions, beat. You come in the morning to bypass, and the whole "quiet" room instead of noses blue "plums." It is clear that neither the sick, nor their relatives, nor the staff did not like it. We had to take measures - to punish.

Sulfosine cross

The most serious misdemeanors were attempted escape, assault on other patients, theft and smoking in the ward. For misdemeanors could be deprived of a walk or delayed discharge. But it often didn't help. After all, "on the outside" could not cope with them neither parents, nor teachers, nor police officers. In addition, it was necessary to protect the really sick and the staff.

The most effective means of correcting behavior was sulfosine, a sterile weight of sulfur in peach oil. Sulfosine was originally shown as a shock therapy for the treatment of protracted and psychotropic forms of schizophrenia.

Intramuscular injections of sulfosine caused a pronounced pie effect. The body temperature increased sharply, against which the metabolic processes accelerated and, as a result, psychotropic drugs were better absorbed. But much more often sulfozin was used as a punishment.

Obsessive images of schizophrenia. Creativity of a patient of the adolescent department of PB N15

Picture: from the collection of P.Kamenchenko

He did not cause any physical harm to a healthy organism, but the temperature under 40 and sharp soreness in the injection sites for a long time relieved the separation from the offenders of behavior. They were told that this was an important part of their treatment. There were whole sulphosine wards of 8-10 people. In the toilet and in the dining room patients "on the sulf" moved on the wall, and to violate the regime they had neither desire nor strength.

Usually injections were made in the buttocks, less often - in both buttocks or under the shoulder blade.

There was also the so-called "sulfosine cross" - four injections at the same time: under the shoulder blades and in the buttocks

This has never been practiced in our department. But I know that in "acute" adult departments it was used as punishment.

The worst thing I had to deal with was the combination of "sulf" with haloperidol without a proofreader. Sulfosine caused high temperature and severe pain in the injection sites, and from haloperidol reduced muscles. It's a hell of a combination! And so in this way punished the patients head of the "acute" men's department, where I briefly got at the very beginning of my medical practice.

After the course of sulfozin, the behavior of patients changed radically: parents, police, teachers, doctors, they promised to be the best and most obedient in the world, to study only for fives and never again to get to the hospital. Many people had a long-term memory of treatment, and it helped them to behave "in the wild" decently. Or at least not to get caught again.

"Learn them! Marry... Everyone needs to be treated!"

Our patients, regardless of whether "by behavior" they got to us or "to the state", we regretted and tried to help them as much as possible. But it wasn't always easy.

Once I prepared a large discharge for the first of September, so that everyone went to school with the beginning of the school year. Otherwise, it would have been a lot of catch-up, and it would be easier to walk.

At the morning conference, which we cleverly called "the glider roofers", the chief doctor of the hospital, learning about the large discharge, was furious - it happened to him. It turned out that in the summer the hospital did not fulfill the plan for bed days, and he forbids any discharge.

To my remark that children need to learn, the head doctor, all blushing and stomping feet, squealed: "Learn them! Marry... Everyone needs to be treated!"

But I still let them go: someone - on rehab leave, someone - completely, continuing to lead a fictitious medical history, which was essentially a crime.

A serious problem was to come up with a diagnosis for those who had no diagnosis. Above, I wrote that when discharged it was necessary to pass the medical history in the archive and be sure to specify the diagnosis of the patient. Moreover, for statistics it had to be encrypted with a code taken from the official classification of mental illness.

The code "mentally healthy" did not exist in it, that is, the principle "would be a person, and a diagnosis will be found." I had to make sure that the person was not registered, and at the same time not to be substituted himself.

There was, for example, such a case. The 17-year-old girl worked in the summer after the 10th grade as an assistant caseworker in court. The team was squabbling, and the girl was bullied.

After another snatch, she went crazy and, leaving the last job, set fire to the archive

Then I tried to put it out, but I couldn't. In hysterics, smeared with soot and with charred red hair she was brought to a madhouse.

The girl was nice, and I knew she was in a lot of trouble. As a result, he made such a cunning diagnosis that it would be difficult to bring her to criminal responsibility, and put on the record in the PND like nothing. The diagnosis read: "Acute adaptive reaction in a teenager with impaired behavior and emotions." I even managed to encrypt it with the appropriate code from the classification. And there were many such cases.

KGB branch and snitch doctors

In the early 1980s, Western human rights organizations constantly accused Soviet psychiatry of persecuting dissidents. As a result, the All-Union Scientific Society of Psychiatrists and Neurologists was excluded from the World Psychiatric Association (although formally ours came out of there themselves). I don't know how much truth there was in these accusations and how much propaganda there is.

On the topic I can tell the following.

On the fourth floor of the first building of the "spots" was the "KGB branch"

At least that's what the hospital called him. Formally, it belonged to PB No.15, but enjoyed some special status. Ordinary doctors were not allowed to enter the first door.

Even at night, during the round, the doctor on duty at the hospital made a record in the magazine, standing between the first and second locked doors. It was believed that the state security officers who had gone off the rail were being treated there. I don't know if there were any dissidents in this department.

Even after the perestroika from reliable sources it became known that almost every department of the "spots" had their own snitch, writing regular reports about everything that was happening behind the doors of the psychiatric hospital locked from the outside world. The main sexot of the hospital was a local party. For services, he regularly received free trips abroad and went there as a group leader.

Self portrait. Illustration of the patient of the 6th department of PB N15

Picture: from the collection of P.Kamenchenko

The Prisoner of Conscience

Once in the dissident history got and I. In 1984 or in 1985, to be exact, the teenage department enrolled a girl of 16 years. Her name was Nastya. I don't remember my last name. She was brought to the waiting room by the police, accompanied by her mother.

Nastya has been behaving inappropriately for about a year. In the lessons at school constantly entered into discussions with teachers, calling the USSR an empire of evil, the Soviet system - a fascist concentration camp, the leaders of the country - idiots.

After receiving her passport, she immediately painted it with swastikas, painted it with mother's words and took it to the police, where she demanded that she be arrested, and even better - immediately sent to prison as an enemy of the people

The attendant called his mother and sent the "dissident" home, twisting his finger where it should be. After that, Nastya stopped going to school, went to Arbat, where she had a company, became sloppy, stopped to wash, for a few days did not sleep at home, considered herself a hippie.

At home I ate only soup from tea bags, refusing to cook my mother's food, took things away from the house, told that the KGB was watching her. She cut her hand with a razor. Eventually my mother took the referral to the hospital and with the help of the police brought her daughter to the hospital.

In the department, Nastya was excited, aggressive, rude, threw the used pads, claimed that she was "locked in a madhouse on the orders of the KGB", and all the staff of the hospital - employees of this organization, told how she hates the Soviet regime, and so on.

Explaining why she eats only sachets soup at home, Nastya said that "when my mother cooks food, she can think of something bad, so you can't eat the food she cooked."

There was no doubt that the girl was ill and needed to be treated, and I prescribed the necessary therapy.

One day during visits to her came a few friends. Asked for an appointment. I explained to them what the disease is and how serious it is. A few days later, the radio station "Svoboda" told about how in the 15th psychiatric hospital in Moscow forcibly detained "prisoner of conscience", which on the instructions of the KGB forcibly charged strong psychotropic drugs. Well, personally, I was called a representative of punitive psychiatry.

I don't know who convinced Nastina's mother, but she demanded that her child be discharged from the hospital immediately. Which I regretted and did. Such in my practice was punitive psychiatry.

***

In conclusion, I must say a few words in defense of a case that has been engaged in a significant part of his life. When Soviet psychiatry is indiscriminately slandered, called criminal or punitive, it is at least unfair.

It is impossible to judge the actions of people who lived in another time and in another country, in terms of today's laws and morals. Much of what today seems to us terrible and unnatural in the USSR was considered quite normal, and vice versa - much of what today we quite accepted, at that time would be considered deeply immoral and unacceptable.

I was lucky to work with many wonderful specialists and wonderful people, whom I remember with great gratitude. Thousands of patients they helped to return to normal life. Unfortunately, there were very different examples.

Continuation follows.

Petr Kamenchenko

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