Russian and Soviet forensic psychiatry: troubled and troubling.

International Journal of Law and Psychiatry 37 (2014) 71–81

Contents lists available at ScienceDirect

International Journal of Law and Psychiatry

Russian and Soviet forensic psychiatry: Troubled and troubling☆ Dan Healey ⁎ St Antony's College, University of Oxford, 62 Woodstock Rd, Oxford OX2 6JF, United Kingdom

a r t i c l e

i n f o

Available online 12 October 2013 Keywords: Russia Soviet Union Stalinism Criminal responsibility Gulag Psychiatric abuse

a b s t r a c t Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent “totalitarian” regime, reformed and stagnated under “mature socialism” and then embraced capitalism and “managed democracy” at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the second half of the nineteenth century debates about the role of psychiatry in criminal justice took place against a backdrop of increasingly alarming terrorist activity, and call for revolution. While German influence, with its preference for hereditarianism, was strong, Russian psychiatry was inclined toward social and environmental explanations of crime. When revolution came in 1917, the new communist regime quickly institutionalized forensic psychiatry. In the aftermath of revolution, the institutionalization of forensic psychiatry “advanced” with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. The abuses of Soviet psychiatry under Stalin and more intensively after his death in the 1960s–80s remain under-researched and key archives are still classified. The return to democracy since the late 1980s has seen mixed results for fresh attempts to reform both the justice system and forensic psychiatric practice. © 2013 Elsevier Ltd. All rights reserved.

1. Introduction Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. This banal historical fact distinguishes it from several jurisdictions examined in this volume, such as the United Kingdom, Sweden, Canada, the United States and the Netherlands, where society and government interacted in a relatively uninterrupted, democratic and peaceful fashion; even Nazi occupation failed to disrupt the long continuity of the Dutch state. In the modern era, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent “totalitarian” regime, reformed and stagnated under “mature socialism” and then embraced capitalism and “managed democracy” at the end of the twentieth century. ☆ While researching and writing this chapter I had much good advice from Irina Sirotkina, Ivan Crozier, Harry Oosterhuis, and the anonymous reviewers. Ben Zajicek kindly lent me a copy of his fascinating doctoral dissertation. Kirill Rossiianov assisted me in obtaining some archival materials used here. The assessments and errors in this chapter are those of the author alone. This chapter is based in part on research conducted under Wellcome Trust grant no. 054869 (on Soviet forensic medicine) and grant no. 085948 (on medicine in the Soviet Gulag); I am very grateful to the Trust for its support. ⁎ Tel.: +44 1865 284700. E-mail address: [email protected]. 0160-2527/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijlp.2013.09.007

These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the twentieth century in particular, the institutionalization of forensic psychiatry “advanced” with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. These physicians campaigned to make their expertise relevant and necessary to the administration of justice in tsarist Russia of the nineteenth and early twentieth centuries. Some felt that revolution held out the best hope for the profession and its concerns. They were particularly angry about political abuses of psychiatry, already manifest in tsarist Russia. Others, especially after the abortive 1905 Revolution, considered it wiser to work within existing structures to reform the administration of justice and the care of the mentally ill criminal. When World War I and the 1917 Revolutions came, psychiatrists began to realize the threat to their very existence posed by the complete breakdown of order. A substantial cohort of psychiatrists eagerly seized the opportunity presented by Vladimir Lenin's Bolsheviks who in October 1917 formed the world's first “socialist” regime. Many bourgeois professionals

72

D. Healey / International Journal of Law and Psychiatry 37 (2014) 71–81

recognized that Lenin's regime was determined to reconstitute the state upon modern and technocratic lines, even if according to an unfamiliar and unsympathetic ideology. Such “fellow travelers,” including medical experts, would make common cause with Bolshevism. As the Soviet regime became increasingly interventionist and violent, psychiatrists as a profession could do little to challenge its inhumanity. Paradoxically, the period of Joseph Stalin's rule (1929–1953) saw a major expansion of investment in forensic psychiatric personnel and institutions. As other forms of state violence waned after Stalin's death, opportunists and careerists collaborated in distortions of psychiatric medicine, culminating during the 1960s–1980s in the well publicized abuses against Soviet dissidents. This paper examines three broad periods in this history, beginning with the origins of Russian psychiatry and its institutionalization amid the “Great Reforms” of Tsar Alexander II in the 1860s. This era launched the discipline of forensic psychiatry, which often expressed an oppositional stance up to the February liberal-democratic and October socialist 1917 Revolutions. During 1917 to 1953, the second significant period in this history, the radicalized Soviet legal and institutional landscape offered psychiatric experts opportunities to “come inside,” to build new institutions, and to abandon opposition in an embrace that severely curtailed medical autonomy until Stalin's death in 1953. The third period, from 1953 to 1985, opened with de-Stalinization that fostered political dissent, and the neo-Stalinist response that institutionalized the abusive penal psychiatry of the late-Soviet years. This approach was not formally repudiated until democrats revised regulations affecting the discipline in 1992 under the Russian Federation's first postCommunist president, Boris N. Yeltsin.1 2. Russian forensic psychiatry's origins (ca. 1600 to 1917) 2.1. Clerical and medical beginnings 1600–1861 Russian historians of psychiatry customarily refer to the preEnlightenment roots of the discipline in the Russian Orthodox Church's monastic tradition, which offered space for the pacification and treatment of the “deranged.” From the time of the Kievan state (established in the tenth century CE) to the reign of Ivan the Terrible from 1533 to 1584, and then seventeenth-century Muscovy under the Romanov dynasty (founded 1613), lawgivers and ecclesiastics stated that the monastery with its hospital was the place for the individual who had lost his reason, and called upon clerics to watch and examine them. From the seventeenth century, with reinvigorated secular courts, monks might also be asked to comment in investigations about the criminal responsibility of the insane sent to their care. Some fortunate suspects escaped punishments such as execution or (more usual after the mid-seventeenth century) branding and exile to Siberia, and were confined to the relatively humane monastery instead. There was little system to these procedures. Administrators and government officials also undertook the examination of suspects themselves; as elsewhere in Europe the use of torture was integral to the inquisitorial process, especially for the most serious crimes, and death in custody was not uncommon (Gentes, 2008; Iudin, 1951; Morozov et al., 1976). Russia's first emperor, Peter the Great (reigned 1682–1725), grasped the potential of Western science and statecraft, and implemented radical and violent reforms to transform weak Muscovy into a Russian Empire which participated in the European state system. Medicine played its role in Peter's construction of a modern army and navy, and a justice system modeled on European cameralism. Peter's Military Statute of 1716 established a modern Russian medical profession as a group of government servitors, licensed, supervised and regulated by the state, 1 In the text I use simplified Russian transliteration without soft-sign marks and the usual English spelling for common names; in references modified Library of Congress transliteration is used. All translations are the author's own.

rather than by a corporate or professional body. During the eighteenth and early nineteenth centuries, with the state's establishment of the first universities, medical education was increasingly available to men of middling ranks, and the state ensured that forensic medicine formed part of the medical curriculum. The predominant forensic duty of the eighteenth-century physician was explaining cause of death in doubtful or criminal cases. Yet the need for judgments about the living subject was also felt, and the century saw an accelerating secularization of such assessments. Peter had already decreed in 1723 in his activist state where military or government service was compulsory, that any noble claiming incapacity on grounds of damage “in their reason” had to be examined by the Senate, not by monks. By 1767 the Orthodox Church's Synod (itself a state body) recognized the distinction between cases of mental infirmity to be handled by a doctor, and souls affected “by evil spirits” and in ecclesiastical care. Suicide had long been explained in religious terms but was now acquiring secular glosses: it was the result either of rationality (the preservation of one's honor, the pursuit of some political goal) or mental illness (and Peter's Military Statute anticipated that suicide might be the result of “madness”). By the end of the eighteenth century, medical investigation of suicides was commonplace in St. Petersburg, and perhaps a third were ascribed to mental torments: melancholy, madness or despair (Iangoulova, 2007; Iangulova, 2001; Iudin, 1951; Morrissey, 2006; Morozov et al., 1976). The emergence of psychiatry as a discipline, and forensic psychiatry as a sub-field, took place in Russia in the nineteenth century as engagement with European political, military and intellectual life intensified. This engagement often destabilized the state, when for example Napoleon invaded and occupied Moscow in 1812, or when liberal army officers staged the Decembrist Revolt against autocracy in 1825. In response, the autocratic monarchy sought to strengthen the armed forces and government, often with European “technologies” divorced from their socio-political roots. It was also not averse to refining “traditional” methods such as Siberian exile, which was formalized as a penal system in the 1820s (Gentes, 2008). Under Nicholas I (1825–1855) the state significantly refined legal and policing mechanisms to combat liberalism even as it expanded education and technical training. Nicholas is credited with confining Russia's first political prisoner to be detained on the speciously concocted grounds of derangement, the philosopher Peter Chaadaev. This tsar's social vision relied on serfdom combined with a deep suspicion of modernization and civil society. Nevertheless, Russia's elite jurists and medical experts often had experience studying in German and other jurisdictions; they were aware of European developments in both the adversarial and inquisitorial systems, and this was the era when Russians acquired the intellectual habit of automatic selfmeasurement against European trends. Russian medical experts might be well trained to a “modern” standard, but they were kept on a tight leash (Becker, 2011; Wortman, 1976). Reflecting wider debates about free will and determinism percolating in Russia's heavily censored press in the 1840s, professors of law and medicine began to debate the validity of legal responsibility (in Russian, vmeniaemost', imputability). Even if the personality of the criminal mattered less in old Russia's inquisitorial process than the facts of the crime, legal refinements implied a closer examination of the offender's state of mind at the time of the act (Becker, 2011). Forensic-medical regulation was codified in 1828, and new criminal and procedural codes with provisions regarding imputability were enacted in the 1830s and 1840s (Becker, 2011). Medical observation of the insane who committed crimes was given legal form in 1835: they were to be sent for two years' observation by doctors in “houses for the insane” (relatively few such asylums then existed). This legislation first mentioned temporary insanity (umoistuplenie, delirium) as a mitigating factor in crime, and mandated a six-week period of medical observation in asylums. In 1845 the last tsarist penal code elaborated these provisions for the criminally insane and the


temporarily insane. These laws remained the principal framework of forensic-psychiatric procedure until 1917 (Iudin, 1951).2

2.2. Legal reform and the rise of psychiatry 1861–1917 When defeat in the Crimean War revealed Russia's weaknesses, Nicholas' son Alexander II (1855–1881) emancipated the serfs and restructured the state in his “Great Reforms.” The justice system was one critical site of reform. Pre-reform justice lacked transparency and was easily corrupted. Trials took the form of inquisitorial investigations conducted by state officials following Roman-canonical traditions that divided evidence (confessions, oaths, expertise) into classes of unequal weight. Proceedings were not public and testimony – including medical evidence – was presented in writing. Following canonical tradition, medical opinions were assigned a very high value in the evidentiary hierarchy; as in other inquisitorial systems, non-experts could not challenge medical evidence. In Russia however, in contrast to Germany, judges who doubted medical opinions could not refer them to universities (which in Russia had scant independence anyway), but had to request clarification from state officials, ultimately from the Medical Council of the Ministry of the Interior (Becker, 2011). Alexander's legal reforms adapted a heterodox distillation of European practices to Russian conditions. The adversarial trial system was the model for new oral and public courtroom hearings, with prosecution and defense battling to persuade new juries of the merits of their case. From 1866 when the new trials were launched, courtroom dramas became popular spectacles and aroused intense interest. All professional participants in trials realized that this publicity required a significant improvement in professional skills. Men of medicine now had to explain and defend their expertise in laymen's terms, where before their learned opinions lay unexposed in a case file. The early Reform era was a moment of deep anxiety for the Russian medical expert in part because of this exposure to scrutiny; Becker (2011) defines it as the time when “expertise” as a scientific concept was born in Russia, with physicians and later psychiatrists claiming authority resting explicitly on objectivity and science.3 Simultaneously, reforms established organs of local government, the zemstva (sg. zemstvo) which began constructing a rudimentary health service, including asylums and rural colonies for the mentally ill. From the 1870s to the end of the tsarist era, a psychiatric profession expanded as the zemstva hired staff to run these facilities and as city hospitals expanded. Russian psychiatrists were part of a wider cohort of stateemployed professionals who felt the tension between allegiance to their disciplines and their dependence on government. Associations of psychiatrists were formed in St. Petersburg and Moscow, and the first national congress of psychiatrists was held in 1887 (Brown, 1981, 1990). By this time two key questions defined the profession's relationship to the state, and they were both at the core of forensic psychiatric practice. Debates about criminal responsibility and the claim of insanity as mitigation or grounds for diversion to therapy, raged from the opening moments of the newly reformed court system, and would carry on to the end of the regime. A second and more painful issue that emerged as the asylum network developed was the use of mental facilities by police and other authorities to detain the awkward, inconvenient, or politically “dangerous.” 2 Article 95 of the penal code (Ulozhenie o nakazaniiakh) provided for the nonimputability of criminals judged undoubtedly insane at the time of the offence and thus incapable of understanding the crime; they were to be examined and confined to asylums. The legal text did not state who conducted the examination, but in practice, police, court administrators and physicians, did this, and in the 1870s and after, psychiatrists increasingly assumed the medical role (Iangoulova, 2007; Ippolitov, 1910). 3 Becker notes that the courtroom trial was the second of a two-stage, “layered,” process; the first stage was the criminal investigation conducted along secretive inquisitorial lines. Experts' rights in this stage were limited and battles to improve them marked later decades. On the jury, see Bhat (1997).

73

As a principle the notion that a deranged person could not be tried in court had been accepted as early as 1801, when Alexander I declared that “for the mad person there is no court and no law,” in a ruling on a murder case. Police and medical authorities were then made jointly responsible for ensuring prospective defendants were fit to be tried, and police dominated this decision-making although doctors increasingly advanced claims of competence to assess the suspect of dubious rationality (Becker, 2011; Iangoulova, 2007; Iudin, 1951). The Reformera open courtroom enabled prosecutors and defenders to call upon expert testimony, and this expertise, including psychiatry, became an inalterable feature of the late tsarist judicial system (Becker, 2011). Nevertheless, open adversarial trials exposed the fractious nature of expertise; early cases with their bids to persuade the new juries and the public were dissected in the professional journals and popular press. Doctors called upon to evaluate the sanity of a suspect in courts often used diagnoses of “melancholy” in the 1860s and 1870s to explain the actions of those accused of crimes. An 1866 assassination attempt against the “Tsar Liberator” Alexander II coincided with the opening of the new courtroom trials: the “melancholic” would-be regicide was found to have been under observation in a Moscow clinic and then treated by Petersburg physicians before his attempt on the life of the tsar. Advocates' attempts to invoke a defense of a temporary “abnormal state” of mind, were rejected, and he was quickly convicted and executed (Becker, 2011; Verhoeven, 2009). The question of criminal responsibility, and the temporary insanity defense, was thus almost immediately tied to fears about national security and the rise of terrorism against the Imperial state. Terrorist violence only increased in subsequent decades, as the psychiatric profession was establishing itself in Russia. Conservatives, including Fyodor Dostoevsky in his greatest novels dissecting criminal motive (Crime and Punishment in 1866, and Brothers Karamazov, serialized in 1879–80), flayed the pretensions of medical men to explain the workings of the human heart when it came to crime (Verhoeven, 2009). Ultimately, in tsarist Russia debates about imputability took place not in an optimistic era of peaceful reform, but against a backdrop of increasingly alarming terrorist activity, which made the diagnosis of political madness a contentious claim, while many preferred to hold the line against any attenuation of notions of free will (Miller, 2007). The state's response was to curb reform; the assassination of Alexander II by “People's Will” terrorists in 1881, and the accession of “counter-reformer” Alexander III (1881–1894), cemented limits to the use of juries and halted the granting of further rights to medical experts in criminal investigations. In the 1880s and 1890s criminal responsibility was a resonant battleground in Russian psychiatric conferences and joint meetings between medical and legal experts. As psychiatrists increased in numbers and gained confidence – often, by citing European authorities – they reproduced calls heard elsewhere for greater custodianship over the criminal. Their medicalization of criminality was tied as in Europe to attacks on classical notions of free will and penal responsibility, which in Russia were most vividly defended against medicalization by novelists; in this argument Dostoyevsky was followed by Leo Tolstoy (Beer, 2008; Brintlinger & Vinitsky, 2007; Sirotkina, 2002). Psychiatrists countered this classical literary reading of crime as human evil with the new conviction that degeneration theory demonstrated the organic wellsprings of offending. Followers of Cesare Lombroso's theories of inborn criminality (such as Praskovia N. Tarnovskaya, 1848–1910, who furnished Lombroso with data on women murderers), and proponents of degeneration who rejected Lombrosian “atavism” and sided with French critics (such as the jurist and penal expert Dmitry A. Dril', 1846– 1910), all advanced schemes for medical supervision of the criminal (Beer, 2008; Engelstein, 1992; Kowalsky, 2009). Some (for example, Vladimir F. Chizh of Kazan University, and Vladimir K. Sluchevsky of St. Petersburg) proposed that “reduced criminal responsibility,” not recognized in Russian law, should be applied to “borderline” mentally ill or psychopathic offenders, and that courts should send them to special asylums for extended or even indefinite “treatment.” One commission

74


of 1894 issued a typical report recommending all criminals be examined by psychiatrists and that a national bureau for the “psychiatric study of the criminal class” be established.4 Medical, psychiatric and juridical commissions of the 1880s and 1890s endlessly proposed revisions to contradictory and overlapping penal legislation (Russia's penal code and forensic-medical statutes dated from the 1840s, while the criminalprocedural code, often at odds with these, dated from 1864) (Becker, 1999). These calls included modernized definitions of criminal responsibility, but after the tsar's assassination in 1881 the government smothered legal redrafting in successive committees and the 1845 penal code remained in effect until 1917.5 Despite historians' probing of the published debates, we have scant sense of how criminal responsibility was interpreted in the practice of psychiatric experts working for tsarist courts; the archival trawls and comparative work remain to be done. Naturally, a significant barrier to psychiatrists' extension of the principle of non-responsibility on insanity grounds was the weak scientific basis for their diagnoses. Their failure to explain and cure insanity in large numbers of patients was as responsible for the modest esteem they commanded, as was their failure to persuade courts and juries of the utility of their assessments. As Brown (1990) notes, “psychiatric theories at this time were clearly congruent with prevailing social values” and so asylums were deemed useful new institutions of the Reform era, yet “psychiatrists' colleagues within the medical profession remained skeptical of the legitimacy and the utility of psychiatric medicine” as a form of medicine. The fact that in Russia all medicine was administered by the police's Ministry of the Interior came to be seen as another obstacle to autonomous forensic expertise (Healey, 2009). Government and police however, found “uses” for psychiatric care in these years, and this “use” of the asylum ignited the other great question animating psychiatrists in the late tsarist period: who should control the asylum, and to what ends? From the 1870s and into the 1890s, government measures rendered it increasingly difficult for the psychiatrists who ran local and regional asylums to control these spaces autonomously. The zemstva were forbidden from refusing to admit persons to the asylum in 1875; the majority of inmates were handed to asylums by the police (Brown, 1990; Iudin, 1951). During the 1890s, when social discontent was on the rise, rule changes compelled the asylum to devote its limited beds to “dangerous” patients only; peaceful ones were to be farmed out to their families or, in a model derived from Belgian and Scottish practice, patronage networks of rural households (which in Russia meant subsistence-peasant ones, a significant departure from the Western European model (Brown, 1981)). Psychiatrists were forced to admit and monitor “dangerous” patients sequestered officially and presented to asylums by the police. In a system lacking any special psychiatric prisons, the line between therapy and confinement for other purposes was becoming difficult to discern. By 1900, psychiatrists and their critics complained that this “medicine” had effectively been colonized by police and officials. The works of some Russian critics of this era anticipate the critiques of modern anti-psychiatry. One articulate ex-patient, Alexei E. Mokshantsev, supported by Tolstoy, wrote that healthy people were held against their will in police-inspired asylums. A 700-page indictment of the Russian asylum by psychiatrist Pavel Yakoby caused more consternation with its catalog of official and popular abuses of the asylum system (Brown, 1990). Stronger indictments were to come. The 1905 Revolution which nearly toppled the autocracy ended with a combination of concessions (a national legislature, the State Duma, was established) and repression (worker and peasant uprisings were 4 On Chizh, see Iudin (1951); Sluchevskii took the lead in organizing an 1894 joint commission of psychiatrists and jurists to discuss medical views of criminality, which recommended a national criminological bureau (Soedinennoi kommisii S.-Peterburgskikh obshchestv psikhiatrov i iuridicheskogo, 1894). 5 Becker argues that Russian psychiatrists and jurists worked together more closely than their analogs in Europe and America because of their persistent determination to transform a resistant state machinery; see Becker (1999, 2011); for a comprehensive view of late tsarist criminology and impulses to reform see Beer (2008).

quelled with military force and summary justice). During and after the upheaval, the authorities exploited the asylum's role as convenient location for preventative custody of “political” prisoners and this practice became the focus for ever louder complaints from the psychiatric profession. At the second national congress of psychiatrists in Kiev, in August 1905, the prisoner-patient brought by police to the asylum in shackles, without a medical file or diagnosis, a “patient” the psychiatrist was responsible for guarding rather than curing, was the focus of ire directed at the authorities. Subsequent commissions and appeals to the tsarist authorities to recognize psychiatric autonomy in the asylum, and allow doctors to remove manacles and leg-irons in the name of therapy, went unheeded. Brown (1981, 1990) concludes that in the post-1905 decade psychiatrists ruefully gave up trying to persuade the police that they should be able to handle the “dangerous” insane. A bitter stalemate set in over this second burning question occupying the forensic psychiatric profession. Despite this oppositional mood in the psychiatric profession there were many state-employed doctors of the mind who endeavored to work with the tsarist regime rather than subvert it. Moscow professor and author of authoritative forensic psychiatric manuals Vladimir P. Serbsky (1858–1917) counseled realism in the face of the dispute over asylum control; there would always be dangerous criminally insane subjects, he noted, even as he agreed with much of the oppositional critique and took part in its protests (Sirotkina, 2002). Psychiatrists continued to press the case, as in earlier generations, for their expertise in “criminal anthropology.” By the late Imperial era, criminologists in Russia displayed the full spectrum of schools of thought typical of their European colleagues, from degeneration theorists to sociological and socialist-inspired promoters of environmental explanations for crime. Sirotkina (2002) writes that Russia's psychiatrists felt their “provincial” status but nevertheless they consciously approached European models as “something exotic that should be adjusted to Russian conditions”; she says they actively synthesized what they found. Germany's universities wielded great influence over the late tsarist medicine, being the places where young graduates often finished their training by studying under the experts whom their professors in Moscow and St. Petersburg regarded as masters of medical science. Yet practitioners found some inescapable distinctions between Russian and German psychiatry. The German profession's inclination to favor hereditarian etiologies for criminality (Wetzell, 2000) contrasted with a notable but never absolute preference among Russian psychiatrists for social and environmental explanations of crime (Beer, 2008; Engelstein, 1992; Kowalsky, 2009). It was a preference that originated in social and political realities. Eighty percent of Russia's population was a subsistence-level peasantry, and much of the urban populace were impoverished proletarians; all were governed by an obscurantist autocracy that seemed blind to scientific enlightenment. Before 1905 Russia had no parliament, only a tiny middle class, and no “politics” as understood even in the authoritarian German or Austro-Hungarian empires. Government relied upon a rigid social and religious patriarchalism and routinely used violent punishment against the lower orders. Prior to the 1905 crisis, the Russian medical profession tended to see their society as one that “fostered pathology,” and argued that political and social transformation was the most urgent remedy (Brown, 1981, 1990). The German adoption of “borderline” disorders, neurosis, and psychopathy as criminological conceptual tools represented a medicalization of problems that Russian counterparts tended to view as social and political issues. Until the last ten years of the tsarist regime (ca. 1906–1917), when a handful of urban, independent psychiatrists began to serve a private clientele, there were few Russian psychiatrists actively studying neuroses or “borderline” psychiatric states (Wetzell, 2000).6 Perhaps the most striking difference between German and Russian doctors before and after the World War I was the greater optimism 6 On the rhetorical applications of psychopathy, see Bershtein (1999); on the late rise of interest in neurosis and psychopathy in Russia, see Sirotkina (2002); on the infrastructural context, see Healey (2009).


about social change that prevailed in the Russian profession.7 Even given the huge socioeconomic gap between Germany and Russia, psychiatrists studying the Russian criminal, regardless of the theories they espoused, firmly believed that the etiologies of crime were knowable through psychiatric medicine and that crime could one day be prevented in a rational, modern social order. That belief in social renewal had been a talisman for generations of educated Russians; their chance to prove this conviction would soon come (Beer, 2008; Kowalsky, 2009). Pockets of creativity and innovation seemed to show what was possible if experts were given freedom to practice. Although modest in number, independent psychiatrists began to take up the new tools of psychotherapy and psychoanalysis in the final decade of tsarist rule, and “minor psychiatry” – the study of borderline states – gained a foothold in the Russian discipline (Beer, 2008; Brown, 1987; Etkind, 1997; Sirotkina, 2002). Psychiatrists working with the state had made pioneering contributions to military medicine during the ill-fated Russo-Japanese War (1904), although much of their work would have to be reconstituted from scratch a decade later in more onerous conditions (Sirotkina, 2010). To contemporaries it probably seemed that the future could only be better than the corrupted present. Under the reactionary and antiSemitic last tsar, Nicholas II (1894–1917), a forensic psychiatrist colluded in a gross miscarriage of justice, damaging the international reputation of Russian psychiatry. In 1913 in Kiev a Jew, Mendel Beilis, was accused of the ritual murder of a Christian boy; the tsar's Minister of Justice steered the investigation to promote anti-Semitism as political ideology (Rogger, 1966). The fabricated charges were given credence by an emeritus psychiatrist from Kiev University, Ivan A. Sikorsky (1845–1918), who eagerly asserted “on considerations of a historical and anthropological character” that the killing was typical of Jewish ritual murders known in Russia and other countries. His lurid claims in written testimony melted into weasel-words on the witness stand. Unable to point to a single forensic textbook that explained “a specific Jewish method of murdering children,” he argued that “censorship” by Jewish forces made it impossible to publish such material. Within Russia, psychiatrists led by Vladimir M. Bekhterev (1857–1927) mobilized to condemn Sikorsky's claims, suffering threats from their state employers when they formed committees and issued protests. In Germany, France, Britain and elsewhere medical experts lined up to attack Sikorsky's abuse of science; Russian psychiatrists were castigated at conferences and there was an international boycott of one gathering to be held in Moscow (Brown, 1994; Samuel, 1966).8 Beilis was ultimately acquitted, but his trial showed that in a state where the rule of law was so debased, forensic psychiatry was dangerously open to abuse. In tsarist Russia we see that the origins of its corruption long antedated Soviet “totalitarianism.” 3. War, revolution and the establishment of Soviet forensic psychiatry (1914–1953) 3.1. State collapse, re-constitution, and the search for new blueprints, 1914– 1930 Russia entered the First World War in the summer of 1914 as a weak industrial power reliant upon conscript peasant soldiers used as cannon fodder. The casualties and losses of such a strategy were enormous, and psychiatrists working for the various military services were just one of many professions in despair as they witnessed first hand the chaos created by tsarist mismanagement (Sirotkina, 2007, 2010). Psychiatrists, like their colleagues in other branches of medicine at the front and in the rear, were overwhelmed with patients from the battlefield and 7 Wetzell (2000) characterizes the German psychiatric mood as pessimistic when contemplating social change — a significant impulse toward hereditarian explanations for crime. 8 The professor of forensic medicine, D. P. Kosorotov, also served the prosecution as a rather more reluctant but handsomely paid forensic expert (he gave opinions on the victim autopsy). Despite official Soviet condemnation of the Beilis Case in the revolutionary era, Kosorotov's textbook of legal medicine was revised posthumously and reprinted in 1928.

75

among refugees, while army and civilian organizations squabbled over responsibilities and failed to provide care where it was needed. When the February 1917 revolution came it took the tiniest of pushes to rally the streets against the autocracy. A liberal-democratic Provisional Government stepped into the power vacuum left when Nicholas abdicated, and there was an outpouring of patriotic feeling, with many professional conferences – medical ones included – discussing the long-anticipated moment and what it meant for a Russia free of autocracy. Historians have noted that the dominant mood among physicians was for autonomy and greater decentralization (Hutchinson, 1990). With the accelerating collapse of all authority through the summer and autumn of 1917, these aspirations had little chance of realization. When the Bolshevik Party engineered a coup in the name of the Soviets (workers' councils) in October 1917, the stage was set for an abrupt change of tack.9 Drawing on the European Marxist and Enlightenment heritage, and their determination to hold disintegrating Russia together as a fortress for socialism, the Bolsheviks centralized authority and inaugurated the country's first “People's Commissariat” (ministry) of public health, under the charismatic leadership of Bolshevik physician Nikolai A. Semashko (1874–1949). Forensic medicine was now “emancipated” with the transfer of all medical matters away from the interior commissariat (police). Psychiatrists were among the first to rally to commissar Semashko and his radical visionaries (Healey, 2009). The very first Soviet forensic medical institutions were psychiatric facilities for the assessment of criminal suspects. In November 1918, barely five months after the founding of the health commissariat, the Diagnostic Institute of Forensic Neurology and Psychiatry was established in Petrograd under the direction of Lev G. Orshansky (born 1866), a long-serving psychiatrist in the former capital (Iudin, 1951).10 In Moscow, the new capital of the Soviet state, a similar establishment opened in 1919, and was soon renamed after the recently deceased Serbsky; it would become the Serbsky Forensic Psychiatric Institute so infamous in the 1970s as the engine-room of repressive psychiatric abuse (Iudin, 1951). These facilities were closely tied to the central health commissariat. Around the country, smaller bureaus and “cabinets” of forensic-psychiatric experts operated in regional university psychiatry departments, asylums, or health authorities. They acted as local versions of the big-city diagnostic facilities, and consciously mirrored similar facilities in Germany and elsewhere, supplying expert opinions to the police and courts and conducting research on the criminal personality (Gernet, 1925; Kowalsky, 2009; Solomon, 1980; Wetzell, 2000). The health commissariat, which had representatives in Berlin and Paris until the early 1930s, fostered and filtered ties with international psychiatric and criminalanthropological expertise (Solomon, 2006). There was also a network of police-run criminology bureaus, pursuing more sociologically oriented studies of criminality.11 In this early period, the health commissariat provided medical services to Soviet prisons, and psychiatric care was offered, especially in larger facilities.12 Reflecting the typical Soviet practice of experts holding multiple posts simultaneously, some of the leading 9 The Bolsheviks renamed themselves the Communist Party in 1918; following convention I refer to the Party into the 1930s using both names. 10 St. Petersburg was renamed Petrograd in 1914, and would be renamed Leningrad from 1924 until 1991. 11 The State Institute for the Study of Crime and the Criminal (Moscow) was run by the People's Commissariat of Internal Affairs (i.e., the regular police commissariat) and had branches in other major cities of European Russia; psychiatrists participated in its work, and certain branches, notably Rostov-on-Don's, preferred a psychiatric approach, but the main orientation of this network was socioeconomic and tied to the policing functions of its sponsor (Kowalsky, 2009). 12 The earliest decree setting out provision was April 1920: Gosudarstvennyi arkhiv Rossiiskoi Federatsii (State Archive of the Russian Federation, hereafter GARF), fond (“fond”, hereafter, f.) A482, opis' (“inventory”, hereafter, op.) 1, delo (“file”, hereafter, d.) 164, listy (“page/s”, hereafter l. or ll. plural) 3-3 ob. (ob., reverse). Medical commissions consisting of two visiting psychiatrists and one doctor internal to the prison inspected prisoners suspected of mental illness, and petitioned for their transfer to medical facilities if required. The principle of secure wards in civilian hospitals was accepted in these financially constrained years — a continuation of tsarist practice.

76


prison psychiatrists were also the most active founders of Soviet forensic psychiatry: Yevgeny K. Krasnushkin (1885–1951), an expert witness at the Nuremburg Trials; Yevgeny N. Dovbnia (1880–1947), the first director of the Serbsky Institute; and Nikolai P. Brukhansky (1893–1937), an expert on forensic sexology whose career ended in arrest and execution during the Great Terror. In striking contrast to the tsarist justice machinery, the new Soviet arrangements accorded forensic psychiatry a parity of esteem with more established forms of legal medicine. The oppositional doctor of the mind was “brought inside.” This was perhaps the most radical Bolshevik innovation in any branch of forensic affairs, and it repositioned psychiatry as a key discipline explaining human behavior. The early Bolsheviks shared the Russian intelligentsia's reverence for science, and it appeared that psychiatric science filled a gap in the Bolsheviks' increasingly impoverished epistemic universe.13 Psychiatrists partook of the full panoply of rights granted to other medical experts in criminal investigations: to view the entire police file, to set limits to or extend the range of questions discussed in an expert opinion, and to attend the full court trial. The Soviet criminal codes (1922 and 1926), procedural code (1922), and derivative regulation directed police and investigators to seek medical expertise when they suspected that an accused person was mentally ill. All forensic medical expertise – whether first or second opinions – had to be sought from the health commissariat's designated experts. As in the tsarist era, Soviet law recognized only “imputability” or “non-imputability”: “diminished responsibility” had no status in law and was vigorously resisted by police and judicial authorities. Courts reviewed expert opinions and investigators' arguments, and ultimately judges were responsible for diverting the criminally insane from the penal system to “compulsory treatment” in an asylum (Healey, 2009). In the 1920s, despite frequent calls from forensic psychiatrists, budget constraints prevented the opening of “special facilities under psychiatric supervision” for criminals sent by courts to “compulsory treatment” (Brukhanskii, 1928a). Measures of “medical social defense” generally took place in civilian asylums, and could include “isolation” under guard; Moscow's Serbsky Institute and Leningrad's Diagnostic Institute did not have chronic care beds (Gurevich & Sereiskii, 1928). Ambitious psychiatrists took the new dispensation as an invitation to renew their bids for authority over the criminal by explaining motives and offering prescriptions to re-forge the criminal personality. In the 1920s, the dominant paradigm was biosocial, combining psychiatric knowledge or hypotheses about the biological wellsprings of human behavior with sociological or Marxist readings of the criminal's situation in society. Much criminological writing returned to ideas already proposed before the revolution, and also reflected the continued influence during the 1920s of central European psychiatry and criminology on Russian experts. Early Soviet forensic psychiatrists were not alone in developing criminology: sociologists, statisticians, police bureaucrats, and forensic experts in other disciplines (gynecologists, ballistics and chemical experts, dactylographers) all contributed to the “golden age” of Soviet criminology in the 1920s (Kowalsky, 2009). In their published work, psychiatric experts displayed intense interest in psychopathy as a “borderline” state that yielded criminal personalities, and they explored constitutional and biosocial models eclectically.14 Psychiatry with its many applications lent itself to schemes for the creation of the “new 13 Non-marxist sociology and philosophy university departments inherited from the old regime were closed, and a group of irreconcilable academics was deported in 1922. The Bolsheviks were radical atheists and used violence and propaganda against all religions in a bid to enforce a “materialist” worldview. They refuted all other explanations for human behavior that failed to incorporate at least a Marxist veneer. As the Bolshevik party membership widened its educational attainment narrowed; many workers and peasant rank and file had little schooling but would be raised to significant authority especially under Stalin. Later in the 1930s official attitudes toward psychiatry as interpreter of human behavior radically shifted, as discussed below. 14 The Soviet literature on psychopathy in the 1920s was prodigious and remains to be studied by historians; for a few key titles, see Brukhanskii (1928b), Iudin (1926), Krasnushkin (1929), and Lents, 1927. For a discussion of the wider historical context that fostered this flourishing attention to deviance, see Beer (2008).

Soviet man and woman” and many non-Bolshevik psychiatrists and psychoanalysts found that their interests coincided with the new regime's ambitions to modernize Russia. Forensic psychiatry's diagnoses and prescriptions partook of the revolutionary dream to reshape humanity, and seemed to answer questions about how to transform “defective human material” after years of war and famine (Beer, 2008; Bernstein, 2007; Etkind, 1997; Healey, 2009; Kowalsky, 2009; Solomon, 2006). There was a distinct tinge of revolutionary optimism: Krasnushkin (1926) dreamt of prisons as places that, like mental hospitals, would transform the criminal into a healthy citizen “with physical exercise, schooling, a cinema, a theater, a library, with well organized medical surveillance in all specializations, striving to develop the initiative and inclination of the prisoners to social habits.” Despite this optimism about psychiatry's contributions to the understanding of criminality, it is hard to gauge the impact that forensic psychiatrists had on the administration of justice in the formative 1920s. More research into the practices of Soviet police and prosecutors turning to the psychiatrist to provide expert opinions is needed. My own study of sexual crime in the 1920s suggests that psychiatrists had less involvement in routine investigations than is sometimes thought, especially before a criminal was convicted; prison psychiatrists wrote case studies of the criminal personality based on felons they met behind bars, and less often of suspects under investigation (Healey, 2009). Soviet critics looking back at the “experimental” 1920s from the perspective of the Stalinist 1930s and 1940s charged that these early psychiatrists over-diagnosed psychopathy and deemed too many criminal suspects non-responsible for their crimes. Stalinists also slated this founding generation for importing the ideas of Lombroso or Sigmund Freud into Soviet forensic psychiatric practice; ideologists had already begun to target “biologizing” Lombrosianism and “bourgeois” psychoanalysis before the end of the 1920s (Feinberg, 1934, 1947).15 Based on a frankly limited sample in Petrograd and Sverdlovsk, my impression is that these accusations were tendentious. If psychiatrists deemed numerous sex criminals “psychopaths” in the 1920s, they also largely judged these subjects to be responsible for their crimes; only the severely mentally ill were designated “non-imputable” in the cases I observed (Healey, 2009). Stalinist charges of bourgeois humanitarian liberalism, “biologizing” or psychoanalytic idealism seem to be a reaction to forensic psychiatrists' musings in print rather than their contributions in criminal investigations. It would be instructive to have a close-grained study of practice in criminal investigations and psychiatric facilities during the 1920s, and how far these practices differed from or matched those of the Stalinist 1930s.16 3.2. Stalinist paradoxes: an expanding profession under violent terror 1930–1953 Stalin's “revolution from above,” beginning in 1929 and carrying on to the start of the Second World War, brought rapid, wrenching change to the Soviet Union at huge human cost. The goal was massive industrialization to overtake capitalist rivals Germany, France and Britain, achieve the Marxist dream of socialism, and prepare for war. In the drive to build new cities and factories, all resources were squeezed. Budgets for medical care, including psychiatry, were channeled to favor urban workers and research priorities were set by planners, not developed from laboratory or clinical initiative. Scientific training, including medical education, was rapidly expanded to meet the demand for 15 Similar criticisms lie behind an account of the 1920s, written by collaborators in Brezhnev-era abusive psychiatry: Morozov, Lunts, and Felinskaia (1976). On the proscription of Freud, see Etkind (1997) and Miller, 1998. 16 Beer (2008) argues persuasively that “liberal” medicine including early Soviet psychiatry supplied the Bolsheviks with metaphors and arguments that justified “coercive therapy” and ignored individual rights; one can draw similar conclusions from the general argument about disciplinary power in Engelstein (1993). However persuasive these arguments look at the discursive level, we still lack knowledge of routine Soviet psychiatric practice and the uses made of so-called “coercive therapy”.


experts. These were so-called “red experts” whose political and class credentials, and training deprived of the critical humanism that accompanied pre-revolutionary education, made them more loyal to the regime than the “bourgeois experts” inherited from the past. Academic disciplines were flooded with young Bolsheviks who intimidated and denounced older teachers schooled under the ancien régime (Bailes, 1978; Fitzpatrick, 1979; Krementsov, 1997). General psychiatry sustained a major shift in 1936, when the Party intervened to ban psychological testing in schools and industry (“pedology” and “psychotechnics”), indirectly signaling to psychiatrists the end of “mental hygiene” and the medical analysis of psychological problems. Psychiatrists turned to concentrate on major psychiatric illnesses and on the new “shock therapies” (chemical and electrical) that seemed to promise materialist solutions to apparently biological disorders (Zajicek, 2009). In forensic psychiatry, a new generation of compliant practitioners replaced many of the discipline's founders, and lambasted them for the sins of evolutionary-degenerationist Lombrosianism, idealist Freudianism, and for having promoted the proscribed concept of “reduced criminal responsibility” (Joravsky, 1989). This critique mirrored the strictures imposed on general psychiatry as it defined forensic work by a narrow focus on the significantly deranged. Cecelia (Tsetsiliia) M. Feinberg (1885–1973), a rare leading woman in the profession, assumed direction of the Serbsky Institute from 1931 to until she was sidelined in the virulent anti-Semitic campaign of the late Stalin era in 1950 (Spencer, 2000; Zajicek, 2009). At the same time, with increased numbers of new physicians and psychiatrists, the forensic specialist professions expanded significantly, gradually completing a national network of expertise available to police and courts around the country during the 1930s and 1940s.17 During the political terror of the 1930s criminal justice was grossly and violently distorted, and forensic psychiatry apparently played its part in this criminality, although the degree of cooperation is difficult to establish, and there were humane practitioners too. The Stalinist leadership used police, prosecutors, courts and punishment to promote coercive social transformation. In 1930, the secret police established a vast network of corrective labor camps, the Gulag system, to exploit resources in remote regions of the Far North and Far East. From 1930 to 1934, the regular police merged with the secret police (NKVD). Prosecutors and courts helped to force millions of peasants into collective farms, and rooted out “socially harmful elements” and later “enemies of the people” in the towns. Successive campaigns against enemies culminated in the “Great Terror” of 1937–1938, when 681,692 persons were shot outright and many more were confined to the Gulag for long sentences. The victims were a mixture of genuine common criminals, and “politicals” whose offenses were usually fabricated (Applebaum, 2003; Solomon, 1996). While the extent to which psychiatrists contributed to the baseless incrimination of victims during the Terror is difficult to assess, in print the discipline's Stalinist leaders were unashamed to admit that they eschewed the “rotten liberalism” of an early generation and deemed a much larger proportion of suspects sent to them for observation as answerable for their crimes (Feinberg, 1934, 1947). Forensic institutions lost any residual autonomy from police organs, although the veil of control by health officials was generally preserved for appearance's sake. Between 1932 and 1938, the Serbsky Institute was taken over by the Commissariat of Justice (which ran courts); it was returned to the Health Commissariat in 1938, but this “return” did not signal a decline in police oversight (Feinberg, 1947). New rules in 1935 formulated by experts in the Justice and Health Commissariats made explicit a clear distinction between criminals who merited “compulsory therapy with 17 No statistics for the number of forensic psychiatrists seem to exist; to give a sense of the scale of growth in medical infrastructure, note the following: between 1935 and 1940, the number of beds in Soviet psychiatric hospitals rose from 47,295 to 67,571; in 1946, there were about 144,000 physicians in the USSR, and 1900 psychiatrists (at a time when the USA had 3500 psychiatrists); see Zajicek (2009); cf. Field (1957).

77

isolation” in closed institutions like the Serbsky Institute, and those criminally insane who might be safely confined to civilian psychiatric hospitals (Baltasheva, 1960). The confinement of handfuls of sane citizens in the Serbsky Institute as “non-responsible” or “insane” subjects, for unabashedly political motives, reportedly began during this interval, under the direction of the USSR's chief prosecutor, Andrey Ya. Vyshinsky (Bloch & Reddaway, 1978; Pisarev, 1970). It was also at this time that the secret police established its own “special psychiatric hospitals” in Kazan (750 km east of Moscow), Leningrad, and later in remote areas of the Soviet Union. The first such facility commandeered a specially rebuilt section of the Kazan civilian psychiatric hospital for over one hundred patients sent from the Serbsky Institute in Moscow in 1939, who had committed “especially dangerous crimes” (Baltasheva, 1960). Again, it is difficult without access to secret police archives to gauge how far psychiatric abuse actually took place during this period; the logic of Stalinist terror did not seem to require the fig-leaf of medical expertise. Some argue that confinement to an asylum was in many ways preferable for the sane dissenter than the alternatives (Spencer, 2000). At the peak of the Terror there was little call for psychiatric assessments of “defendants.” In the operation of NKVD “special boards” empowered to sentence “enemies of the people,” their cases were often reviewed in absentia and the victim was quickly executed or deported to a labor camp. Yet the routine functioning of ordinary Soviet courts ran parallel to the terror system, and forensic psychiatric assessments were conducted for the courts in increasing numbers in facilities with a growing number of beds.18 Expert opinions in prosecutions for male homosexuality (a crime from 1934) show that the Serbsky Institute might designate a suspect as “psychopathic,” but still fit to stand trial (Buneev & Feinberg, 1947; Healey, 2001). As in the 1920s, in the 1930s, designation as a non-responsible subject, and compulsory treatment were generally reserved for the most severely mentally disordered (Healey, 2009).19 Individuals tried to get mitigation on grounds of mental illness as the system expanded and its routines grew more regular. In 1948, Yuri Fidelgolts, a 19-year-old student accused of anti-Soviet agitation, spent a month under observation in the Serbsky Institute. His father, a medical academic, hired an elite defense lawyer and told him to apply for this examination of his son's mental health. Fidelgolts spent an uneventful stay in the Serbsky's secure observation ward and had a brief interview with a psychiatrist. There was no medical treatment. The experience was comfortable, unlike the prison detention he had experienced up to that point. Fidelgolts was pronounced mentally fit and returned to the courts, where he was given a ten-year sentence in the Gulag (Yuri Fidelgolts, personal communication, March 23, 2009).20 World War Two in the Soviet Union (1941–1945) began with the German invasion and occupation in the western part of the country and evacuation of Soviet institutions deep into the east; the Serbsky Institute was transferred until the end of the war from Moscow to Ufa, and the value of moving at least some of the “especially dangerous” criminally insane to Kazan's special hospital became clear (Feinberg, 1947). After 1945 the Stalinist state, despite victory on the battlefield, was deeply unstable at home as a result of the wartime shocks and concessions to society. From 1947 to 1953 the leadership tightened the screws on intellectual life. Foreign contacts were condemned and Russian chauvinism (“Soviet patriotism”) was imposed as the Cold War started. The

18 For example, the number of forensic-psychiatric beds in dedicated forensic facilities increased from 613 in 1939 to 1006 in 1940 (Morozov et al., 1976). 19 For a 1951 psychiatric assessment of a homosexual and rapist as psychopathic but fit to be tried, see Leningradskoi Oblastnoi Gosudarstvennyi Arkhiv v g. Vyborge (Leningrad Provincial State Archive in the city of Vyborg, LOGAV), f. 3820, op. 2, d. 3235. 20 Fidelgolts reports that in a month, he had only one interview with an unnamed psychiatrist who asked him elementary questions to determine his state of mind. The ward he was in was under constant surveillance by nurses and orderlies as well as psychiatrists; many subjects were disruptive and some were hardened criminals “simulating” mental illness. His experience confirms that of 23-year-old poet Naum Korzhavin who was also held under observation at the Institute in 1948 (Bloch & Reddaway, 1978).

78


life sciences were made to genuflect before the cult of physiologist Ivan P. Pavlov in a series of “Pavlov sessions” including one for psychiatrists in October 1951; all now had to renounce Western influences and tie their research to supposed insights of Pavlovian science. Many psychiatrists fell foul of this campaign and the simultaneous thinly disguised anti-Semitic campaign that brought down so many Soviet doctors and other experts (Windholz, 1999; Zajicek, 2009). Forensic psychiatric regulation was toughened up in this era with decrees formalizing the position of the secret police network of special psychiatric hospitals and directing that mentally ill prisoners guilty of committing “especially dangerous crimes” be sent to them for “compulsory therapy and isolation”.21 After 1948 the regime at Kazan special psychiatric hospital became much stricter with the arrival of Daniil R. Lunts, later a leader of Soviet psychiatric abuse; and a similar change came at the Serbsky Institute with the appointment of Andrei V. Snezhnevsky (1904–1987) who briefly replaced Feinberg (Bloch & Reddaway, 1978; Spencer, 2000). Party member Snezhnevsky was a rising star in general as well as forensic psychiatry, and would become a key defender of the Soviet discipline from international critics (Zajicek, 2009). A little known aspect of Stalinist legal medicine that had an impact on later developments was the work of psychiatry inside the Gulag labor camps. The secret police network of mines, timber camps and factories, where between 2 and 2.5 million inmates toiled by the 1940s, was supported by a large-scale medical service, with approximately 40,000 beds in 1939 and 120,000 by 1952. Only a handful of these were for psychiatric patients: 301 in 1938, when there were reportedly 34.5 (sic) psychiatrists employed in the entire Gulag, compared to 1830 doctors in all.22 Psychiatric care expanded in the camps after the war but never satisfied demand.23 Perhaps half of the Gulag's doctors were prisoners, plucked from general labor and put to work in the penal system's local and regional hospitals, the largest of which had neurological and psychiatric wards.24 Doctors assessed and classified camp inmates according to their work capacity every six months, and a series of decrees regulated schemes for early release on grounds of poor health. Severe mental illness was one recognized form of disability: in one survey of 45 camps during the critical war year 1942, over 33,000 invalids with “political” convictions, of whom 297 were listed as mentally ill, were counted as non-laboring. Despite their “serious crimes,” it was proposed to release them into the civilian medical system. As a costcutting measure, early release programs continued to the end of the Gulag system with psychiatric illness always featuring among the eligibility criteria.25 Gulag psychiatrists observed extremes of behavior and wrote learned treatises about them; the chief subjects were the widespread phenomena of self-inflicted injuries (chopping off fingers, hands, toes and feet were desperate acts to escape exhausting “general labor” in mines and forests) and the simulation of mental and physical illnesses.26 The “simuliant” (malingerer) was a figure of derision in early Gulag propaganda aimed at inmates; his resistance to the authorities made him a hero in prisoners' survivor accounts (Kult'urnovospitatel'nyi otdel, 1936; Shalamov, 1990). Psychiatrists in the Gulag

21 The 1945 decree on special psychiatric hospitals is discussed in Torubarov, 1960. On the 1948 decree see Baltasheva, 1960; and GARF f. 8009, op. 32s, d. 434, for comments on the draft decree by Health Ministry officials. 22 Statistics for 1939, see GARF f. 9414, op. 1, d. 2750, ll. 1-4ob. Statistics for 1952, see GARF f. 9414, op. 1, d. 326, ll. 127–129. 23 For plans to build a single, 500-bed psychiatric hospital for GULAG prisoner-patients in 1946–1947, see GARF f. 9414, op. 1a, d. 619a, l. 11. Psychiatrists were among a long list of specialists still reported to be in short supply in Gulag medical facilities in 1952; GARF f. 9414, op. 1, d. 326, ll. 127–129. 24 GARF f. 9414, op. 2, d. 165, ll. 85–87. 25 GARF f. 9414, op. 1a, d. 366, l. 80. Of course, in certain regions there scarcely existed any civilian medical provision, and these invalids were sent huge distances and often turned away from hospitals. 26 On self-inflicted wounding, and simulated illness, see e.g. K. P. Bogolepov, “Opisanie metodov organo- i chlenovreditel'stva sredi prestupnogo mira,” GARF f. 9414, op. 2, d. 174. (Smolensk regional corrective-labor colony, 1948).

brought their discipline's extensive learning about simulation to bear on this phenomenon; they found that the Gulag was a forcing-ground for this syndrome, like so many other extreme health conditions such as malnutrition and tuberculosis. One prisoner-psychiatrist, Lev G. Sokolovsky (1907–1987), founded mental health services in the Gulagbuilt city of Ukhta in the 1940s. In three years he studied over 400 mental patients, and wrote a study of malingering; he presented his findings at a Gulag medical conference and “published” a hand-written treatise describing 23 individual cases of long- and short-term fakery of epilepsy, delirium and madness (Sapolnova, Vekshina, & Kanev, 2009).27 Such studies enabled the Gulag's poorly qualified medical commissions to identify genuine mentally ill prisoners from would-be ones; they also stand as record and indictment of the extreme cost of forced labor on prisoner mental health. By the time of Stalin's death in 1953, Soviet forensic psychiatry had transformed itself radically. From one perspective, it was now a recognizably “modern” profession embedded in a technically sophisticated justice and penal system. It had achieved genuine parity of esteem with other forensic disciplines such as gynecology, pathology, and ballistics. Formally, its practitioners were autonomous “judges of the scientific facts” in criminal investigations, health ministry employees working alongside the police. The country was better served by a much more extensive and standardized network of increasingly well qualified forensic psychiatric specialists, often housed in regional institutes of forensic psychiatry or medicine. The justice system and the penal network referred to the profession as a matter of procedural routine, and psychiatric assessment was no longer the rarity it often seemed to be earlier in the century. From another perspective, the profession's achievements were scarred by the same violence, criminality and intellectual distortions that prevailed in the state and society that formed it. The profession's proximity to the police and judiciary during a period of extreme lawlessness perpetrated by these authorities left its stamp on forensic-psychiatric experts. Psychiatry would be open to fresh abuse in the future.

4. Soviet forensic psychiatry in reform and reaction after Stalin: 1953–1985 4.1. The turn to “socialist legality” 1953–1964 Stalin's successors sought to restrain terror and the “cult of personality” associated with the dictator's rule. A thorough reform of Soviet legislation began in the 1950s and culminated in new criminal and procedural codes. The Gulag was dismantled: its factories and mines were handed over to economic ministries, its towns were given “normalized” administration to replace secret police rule, prisoners' and exiles' cases were reviewed and millions set free, and a conventional penal system began to emerge. Between 1957 and 1964, under the volatile leadership of Communist Party First Secretary Nikita S. Khrushchev, criticism of Stalin was official policy, but the Party struggled to preserve its authority and restrain popular political debate. Reflecting these ambiguities, developments in forensic psychiatry moved in two contradictory directions. Legal reform (the vaunted return to “socialist legality”) included moves to strengthen forensic expert authority and investigate abuses. At the same time, the Party became increasingly alarmed at the force of political dissent that its “new course” had unleashed, and psychiatric confinement for certain kinds of dissidents took on a fresh and inviting logic. A May 1954 joint instruction of the Justice and Interior Ministries, “confirmed” by the Ministry of Health, reflected the new emphasis on “socialist legality” by reiterating the health authorities' “operational control” of the psychiatrist as expert, and requiring these experts to comply with all legal norms. The expert's various rights to access police 27

GARF f. 8009, op. 32s, d. 1441, ll. 53–56, 88–89.


files and witnesses were affirmed. Psychiatrists were further entitled to give a dissenting opinion in rare cases of disagreement with the general view of forensic expert commissions which might include more than one psychiatrist, or experts from other medical or scientific disciplines if judged relevant (Martynova, 1967). In 1958 and 1961 new legislation set out what the refreshed Soviet medical encyclopedia called “objective” procedures for conducting expertise, declarations of non-responsibility, and imposing compulsory therapy with measures to prevent escape, in civilian psychiatric hospitals. All these reformed procedures were supervised by courts and theoretically gave psychiatrists acting as forensic experts, before the hearing and after the determination of nonresponsibility, sole responsibility for the medical assessment and treatment of these prisoner-patients (Buneev, 1962). Meanwhile, in 1955–1956, the Party's Central Committee organized a commission led by Party functionaries, with leading psychiatrists including Dmitry D. Fedotov (1907–1982), head of the USSR's central Research Institute of Psychiatry, to investigate charges of psychiatric abuse under Stalin. Rehabilitated loyal Communists raised concerns that could not be ignored in the atmosphere of de-Stalinization. The commission paid several inspection visits to the special psychiatric hospitals in Kazan, Leningrad and the Serbsky Institute in Moscow. The Party shelved its report, and it has not since been released, although traces of it appear in declassified Health Ministry archives. The commission reportedly exposed the use of the Kazan and Leningrad facilities as places of confinement for sane persons spuriously accused of “counterrevolutionary crimes” and recommended a total overhaul in operations between these two hospitals and the Serbsky Institute that controlled them (Grigorenko, 1983; Pisarev, 1970). The commission examined prisoner-patients in spring 1956 and ordered transfers to civilian psychiatric facilities, to the guardianship of relatives, or full release; it also ordered forensic psychiatric experts in Leningrad to work under health ministry and not under police supervision and budgets.28 As well, there were some discreet changes in personnel and for a time, regional hospitals began to take a line more independent of the Serbsky Institute (Bloch & Reddaway, 1978; Pisarev, 1970). In the 1950s and early 1960s debate percolated in the Soviet psychiatric world over the increasingly powerful Snezhnevsky's concept of “sluggish schizophrenia,” a “latent” form with few symptoms said to give rise to “grandiose ideas of reforming society.” Opponents in Leningrad and other centers expressed concern about the expansion of diagnoses of schizophrenia, which later would be used to pathologize political opposition (Bloch & Reddaway, 1978).

4.2. New forms of “social danger” and the abuse of psychiatry, 1959–1985 The impulse to reform forensic psychiatry running in parallel with official de-Stalinization was apparently weak, and it encountered considerable anxiety in some police and Party quarters about new types of “socially dangerous” citizens with supposed mental illnesses. One such new type was the returning Gulag inmate. For the most part our limited picture of the Gulag returnee has been shaped by an elite stratum of intelligentsia survivors, who bore witness through memoir accounts. These survivors documented an extreme experience that gave rise to extreme responses, including mental illness. Few survivors came home without displaying some form of chronic depression, paranoia or traumatic disorder, and family estrangement was commonplace. Countless ordinary returnees were somehow to be treated by civilian Soviet mental health facilities, but there was little or no political guidance on managing this process (Adler, 2002; Dobson, 2009; Solzhenitsyn, 1974–1978). Another such type of the new “socially dangerous” was the citizen protesting against injustice, who later became labeled the Soviet “dissident.” In the majority of cases such citizens were sane by any conventional definition; some were Gulag survivors and their children, 28

GARF f. 8009, op. 32s, d. 1441, ll. 53–56, 88–89.

79

responding to their experience with political activism. Their nonconformity could be judged eccentric or “abnormal” by conservative standards, and this doubtless led to misdiagnoses. Khrushchev seems to have given the green light to such views when he equated anti-Soviet protest with mental abnormality in 1959.29 Many protesters were targeted as political subversives by the security police (now known as the KGB) and were silenced by the use of psychiatric committal and “therapy.” These practices apparently evolved under Khrushchev's volatile leadership, as the never fully de-Stalinized KGB and Party sought ways to suppress opposition without a return to violent terror. During the Cold War it was difficult to say precisely what motives lay behind the corruption of Soviet forensic psychiatry. For Sidney Bloch, a key Western critic of Soviet psychiatry, its abuse was perhaps a fortuitous “arrangement” made possible by psychiatrists such as Snezhnevsky who yielded to “political pressure” for career reasons (Bloch, 1989). By contrast, a US critic of the Western campaign against Soviet psychiatric “terror” suggested that in committing some dissidents, Soviet psychiatrists perhaps acted to spare them the greater harm of imprisonment (Stone, 1984).30 KGB and police pressure on Soviet psychiatry, and within the psychiatric profession, is now well documented. It was during the 1960s that dissidents first reported that some doctors handling their “cases” in the Serbsky Institute appeared to have Interior Ministry police ranks, and after the collapse of the USSR more evidence accumulated.31 Once again, at a key moment of political transition, forensic psychiatry “benefited” from its proximity to the state. Psychiatric confinement of the political protester acquired a more systematic and deliberately abusive character under Khrushchev's successor, Leonid I. Brezhnev, in power from 1964 to 1982. The dissident movement reached its peak in 1971; by then the Party's Politburo had already discussed plans to expand the network of special (prison) psychiatric hospitals after an alarmist KGB report claimed that in one Russian province alone there were 700 “socially dangerous” mental patients needing secure hospitalization.32 Additional special psychiatric hospitals were built to house these dangerous “antisocials” during the 1970s; they had watchtowers, barbed wire, and prison regimes. Amnesty International (1980) counted twelve scattered around the USSR by the end of the 1970s. Treatment was harsher than in civilian psychiatric hospitals, but even those confined to civilian institutions after less serious actions also suffered medical and civil rights abuses. In particular the special hospitals became infamous for their indiscriminate and brutal use of drugs to punish and neutralize “patients,” often causing permanent harm (Amnesty International, 1980).33 From the late 1960s, the dissident movement publicized these abuses abroad, notably the cases of human rights activists Natalia Gorbanevskaya, Leonid Pliushch, Zhores Medvedev and Vladimir Bukovsky, who all suffered compulsory therapy in psychiatric institutions for their political activities. The World Psychiatric Association (WPA), spurred on by its Canadian, US, and British member organizations, launched a cautious inquiry, a hostage to conflicting Cold War intrigues. On the Soviet side, Snezhnevsky led the defense, condemning reports of abuse as “outrageous fabrications.” The KGB organized visits 29 Insisting that the USSR no longer confined “political prisoners,” Khrushchev did however claim that “people with abnormal minds…might start calling for opposition to Communism on this ‘basis’” and they clearly needed to be restrained (Bloch & Reddaway, 1978; Dobson, 2009). 30 In a later discussion of Soviet psychiatric abuse, Stone (2002) ignores the by then proven police pressure put on psychiatry. 31 A classic account of incarceration by psychiatrists under police supervision, by some practitioners with police ranks, is Nekipelov (1980). Note also Prokopenko (1997), Smith and Oleszczuk (1996), and Van Voren (2010). Conclusive evidence comes from copies of Politburo minutes and KGB reports acquired during the chaos of late 1991: Bukovskii (1999); see also Bukovskii (1996). 32 Report to Politburo from Krasnodar krai KGB on mentally ill “bearing terrorist and other socially dangerous intentions,” Bukovskii, 1999, item no. 0200. 33 Note Nobel laureate Andrei Sakharov's 1971 protest to the Ministry of Health on the use of these drugs against dissident “patients,” Bukovskii, 1999, item no. 0201. The drugs most frequently used were aminazin (largactil), haloperidol and triftazin (trifluoperazin).

80


to the USSR of sympathetic “fraternal socialist” and “capitalist” psychiatrists, ordered that conferences be held, and fresh histories of Soviet psychiatry be written; in 1978 it was even suggested that a law on “the rights of mentally ill patients” be drafted as part of the government's propaganda strategy. The Soviet authorities attempted to rally support in the WPA and other world forums; however by the end of the 1970s, the number of political activists detained in psychiatric institutions had risen into the several hundreds and their cases were increasingly well publicized. In the WPA, the Soviets lost the public relations battle and unilaterally withdrew from the association on the eve of expulsion, in 1982 (Poloshij & Saposhnikova, 2001).34 5. Democratization and forensic psychiatry since 1985 Little changed in Soviet forensic psychiatry until the arrival of reformist lawyer Mikhail S. Gorbachev as leader of the USSR in March 1985, and the transformations that led to the collapse of Communist rule in 1991. That year also saw the largely peaceful break-up of the Soviet Union into fifteen independent republics; the Russian Federation remained by far the largest of the successor states. As in previous moments of political transition, forensic experts found that in a state and society shaken to their foundations, their relationship with power and with the populations they served was correspondingly turbulent. As part of Gorbachev's broader policies of press freedom, democratization, and the release of dissidents, sharp and sustained media criticism of psychiatry erupted in 1986–1987. (Until this point, Soviet professionals had felt little of the democratizing and anti-paternalistic currents that had buffeted experts in Western Europe since the 1960s.) According to insiders, the public's “anti-psychiatric” mood caught psychiatrists off guard, and not all were willing to admit responsibility for abuses despite confrontations with patients and families (Poloshij & Saposhnikova, 2001). Reform did come; the Soviet psychiatric association admitted and abjured collaboration in politicized abuses and was readmitted to the WPA in 1989. The Health Ministry began drafting reform legislation, emerging after the collapse of the Soviet Union in 1991, as the 1992 Russian Federation law “On psychiatric care and guarantees of citizens' rights in its provision” (Poloshij & Saposhnikova, 2001; Polubinskaia, 1991; Polubinskaya & Bonnie, 1996). Professionals responded to and attempted to shape these developments. The Russian Society of Psychiatrists adopted a code of professional ethics, drafted in part by forensic psychiatrists, and with close attention paid to international standards. The need felt by many to speak explicitly in this code about forensic psychiatry prevailed against a minority on the drafting panel. The code asserted “the moral duty of the forensic psychiatrist to inform the legal authorities when compulsory treatment is not medically indicated” (Polubinskaya & Bonnie, 1996). New initiatives at the Serbsky Institute (now styled a center for research in forensic and social psychiatry) attempted to bring patients, their families and other interested parties together with psychiatrists to encourage a dialog between “experts” and society. The institute opened a new “ethics and psychiatry” division. Foreign researchers began to visit and use the Institute's library, although archival collections remained inaccessible (Dmitrieva, 1993; Poloshij & Saposhnikova, 2001; Spencer, 2000). Some Russian psychiatrists have accused the Serbsky Institute of continuing malfeasance against patients the state wishes to silence. In response, Tatiana B. Dmitrieva (1951–2010), for twenty years until her death the Serbsky Institute's director and briefly Russian health minister, argued in fashionably nationalist terms that the Western emphasis on patients' rights conflicts with the Russian concept of “mercy” when one sees so many homeless mentally ill in the streets in the West. 34 Strategy documents on “the anti-Soviet campaign inspired by the West against the ‘use of psychiatry for political purposes’” by KGB chief Iurii Andropov, 10 September 1976, Bukovskii, 1999, item no. 0204; and by Party officials, 13 April 1978, Bukovskii, 1999, item no. 0207.

Domestic proponents of the “anti-psychiatry” movement pose a threat to Russia's psychiatric profession, she and others contended as they batted away charges that they remained too close to the state (Brown, 2007). The rapid plunge in living standards during the transition to capitalism in the 1990s, two wars in Chechnya (1994–1996, 1999–2009), and the return to prosperity and semi-authoritarian government since 2000 (“managed democracy” under President Vladimir V. Putin and the United Russia Party), have challenged forensic psychiatric skills and independence. In particular, judicial independence and the rule of law remain elusive goals in Russia and other post-Soviet republics. Manipulation and influence-peddling in legal and administrative decision-making continues, with reports of cases of criminals buying expert psychiatric opinions of non-imputability (Van Voren, 2006). Russia continues the search for stable, democratic prosperity that it embarked upon over a century ago. If the current regime brings stability and prosperity at the expense of a degraded democracy, that raw bargain is accepted by many as a guarantee of the continuity of this fragile and complex state. Securing and strengthening the continuity of the state and its justice system represent an accomplishment after generations of collapse, revolution, and violent transformation. The fact of this state's irreversible if contested openness to globalization also represents an enormous advance on the previous regime's isolationist impulses. Forensic psychiatrists in Russia and the former USSR have re-joined the international community and adopted international ethical standards against a backdrop of wider state commitments to human rights norms. Yet the Soviet legacy has not been entirely detoxified. Fundamental bureaucratic and legal structures established under Stalin, perverted by political manipulation during the Khrushchev and Brezhnev eras, and reformed half-heartedly during the democratic years of Gorbachev and Yeltsin, still retard transformation. The relationship between the forensic psychiatrist and the Russia state remains a troubled and troubling one.

References Adler, N. (2002). The Gulag survivor: Beyond the Soviet system. New Brunswick & London: Transaction Publishers. Amnesty International (1980). Prisoners of conscience in the USSR: Their treatment and conditions. London: Amnesty International Publications. Applebaum, A. (2003). Gulag: A history of the Soviet camps. London: Allen Lane. Bailes, K. E. (1978). Technology and society under Lenin and Stalin: Origins of the Soviet technical intelligentsia, 1917–1941. Princeton, NJ: Princeton University Press. Baltasheva, A. I. (1960). O prinuditel'nom lechenii, osushchestveliaemom v spetsial'noi psikhiatricheskoi bol'nitse MVD. In M. P. Andreev, A. I. Baltasheva, & P. V. Blinov (Eds.), Voprosy sudebnoi psikhiatrii. Sbornik nauchnykh trudov konferentsii vrachei spetsial'nykh psikhiatricheskikh bol'nits MVD. (pp. 25–36). Moscow: Gos. izd. Iuridicheskoi literatury. Becker, E. M. (1999). Judicial reform and the role of medical expertise in late imperial Russian courts. Law and History Review, 17(1), 1–26. Becker, E. M. (2011). Medicine, law, and the state in imperial Russia. Budapest & New York: CEU Press. Beer, D. (2008). Renovating Russia: The human sciences and the fate of liberal modernity, 1880–1930. Ithaca & London: Cornell University Press. Bernstein, F. L. (2007). The dictatorship of sex: Lifestyle advice for the Soviet masses. DeKalb, Il.: Northern Illinois University Press. Bershtein, E. (1999). ‘Psychopathia sexualis’ v Rossii nachala veka: politika i zhanr. In M. Levitt, & A. Toporkov (Eds.), Eros i pornografiia v russkoi kul'ture/Eros and Pornography in Russian Culture (pp. 414–441). Moscow: Ladomir. Bhat, G. (1997). The moralization of guilt in late imperial Russian Trial by jury: The early reform era. Law and History Review, 15(1), 77–113. Bloch, S. (1989). Soviet psychiatry and Snezhnevskyism. In R. Van Voren (Ed.), Soviet psychiatric abuse in the Gorbachev era (pp. 55–61). Amsterdam: International Association on the Political Use of Psychiatry. Bloch, S., & Reddaway, P. (1978). Russia's political hospitals: The abuse of psychiatry in the Soviet Union. London: Futura Publications. Brintlinger, A., & Vinitsky, I. (Eds.). (2007). Madness and the mad in Russian culture. Toronto: University of Toronto Press. Brown, J. V. (1981). The professionalization of Russian psychiatry: 1857–1911. Unpublished Ph.D. Thesis, University of Pennsylvania, Philadelphia. Brown, J. V. (1987). Revolution and psychosis: The mixing of science and politics in Russian psychiatric medicine, 1905–13. Russian Review, 46, 283–302. Brown, J. V. (1990). Social influences on psychiatric theory and practice in late imperial Russia. In S. G. Solomon, & J. Hutchinson (Eds.), Health and society in revolutionary Russia. Bloomington & Indianapolis: Indiana University Press.

D. Healey / International Journal of Law and Psychiatry 37 (2014) 71–81 Brown, J. V. (1994). Heroes and non-heroes: Recurring themes in the historiography of Russian–Soviet psychiatry. In M. S. Micale, & R. Porter (Eds.), Discovering the history of psychiatry. New York & Oxford: Oxford University Press. Brown, J. V. (2007). Afterword. In A. Brintlinger, & I. Vinitsky (Eds.), Madness and the mad in Russian culture (pp. 283–299). Toronto: University of Toronto Press. Brukhanskii, N.P. (1928a). Sudebnaia psikhiatriia. Moscow: M. i S. Sabashnikovy. Brukhanskii, N.P. (1928b). Ocherki po sotsial'noi psikhopatologii. Moscow: M. i S. Sabashnikovy. Bukovskii, V. (1996). Moskovskii protsess. Paris and Moscow: Russkaia mysl' - Izdatel'stvo MIK. Bukovskii, V. (1999). Soviet archives collected by Vladimir Bukovskii. [Online document archive] URL. http://bukovsky-archives.net/buk.html Buneev, A. N. (1962). Psikhiatriia: Sudebnaia psikhiatriia. (2nd ed.)Bol'shaia meditsinskaia entsiklopediia, Vol. 27. (pp. 207–219)Moscow: Medgiz. Buneev, A. N., & Feinberg, T. M. (1947). Sudebnaia psikhiatriia (2nd ed.)Moscow: Iuridicheskoe izdatel'stvo Ministerstva iustitsii SSSR. Dmitrieva, T. B. (1993). VNII Obshchei i sudebnoi psikhiatrii im. V. P. Serbskogo: Istoriia i sovremennost'. In T. B. Dmitrieva (Ed.), Aktual'nye problemy obshchei i sudebnoi psikhiatrii. Moscow: NII obshchei i sudebnoi psikhiatrii im. V. P. Serbskogo. Dobson, M. (2009). Khrushchev's cold summer: Gulag returnees, crime, and the fate of reform after Stalin. Ithaca & London: Cornell University Press. Engelstein, L. (1992). The keys to happiness: Sex and the search for modernity in Fin-de-Siècle Russia. Ithaca & London: Cornell University Press. Engelstein, L. (1993). Combined underdevelopment: Discipline and the law in imperial and Soviet Russia. American Historical Review, 98(2), 338–353. Etkind, A. (1997). Eros of the impossible: The history of psychoanalysis in Russia. Boulder, CO: Westview Press. Feinberg, T. M. (Ed.). (1934). Psikhopatii i ikh sudebno-psikhiatricheskoe znachenie. Moscow: Sovetskoe zakonodatel'stvo. Feinberg, T. M. (1947). Sudebno-psikhiatricheskaia ekspertiza i opyt raboty instituta sudebnoi psikhiatriia im. prof. Serbskogo za XXV let. Moscow: Tsent. n.-i. institut sudebnoi psikhiatriia im. prof. Serbskogo MZ SSSR. Field, M. G. (1957). Doctor and patient in Soviet Russia. Cambridge: Harvard University Press. Fitzpatrick, S. (1979). Education and social mobility in the Soviet Union 1921–1934. Cambridge: Cambridge University Press. Gentes, A. A. (2008). Exile to Siberia, 1590–1822. Basingstoke & New York: Palgrave Macmillan. Gernet, M. (1925). Pervye zagranitsei i pervaia v SSSR laboratoriia po izucheniiu prestupnosti. In Kabinet po izucheniiu prestupnosti i prestupnika (Ed.), Izuchenie lichnosti prestupnika v S.S.S.R. i za granitsei (pp. 16–20). Moscow: Kabinet po izucheniiu prestupnosti i prestupnika. Grigorenko, P. G. (1983). Memoirs. London: Harvill Press. Gurevich, M.O., & Sereiskii, M. I. (1928). Uchebnik psikhiatrii. S predisloviem P. B. Gannushkina. Moscow-Leningrad: Gos. izdatel'stvo. Healey, D. (2001). Homosexual desire in revolutionary Russia: The regulation of sexual and gender dissent. Chicago: University of Chicago Press. Healey, D. (2009). Bolshevik sexual forensics: Diagnosing disorder in the clinic and courtroom, 1917–1939. DeKalb, Il.: Northern Illinois University Press. Hutchinson, J. F. (1990). Politics and public health in revolutionary Russia 1890–1918. Baltimore & London: Johns Hopkins University Press. Iangoulova [Iangulova], L. (2007). The Osvidetel'stvovanie and ispytanie of insanity: Psychiatry in tsarist Russia. In A. Brintlinger, & I. Vinitsky (Eds.), Madness and the mad in Russian culture (pp. 46–58). Toronto: University of Toronto Press. Iangulova, L. (2001). Iurodivye i umalishennye: genealogiia inkartseratsii v Rossii. In O. Kharkhordin (Ed.), Mishel' Fuko i Rossiia. St. Petersburg-Moscow: Evropeiskii Universitet v Sankt-Peterburge - Letnii Sad. Ippolitov, S. N. (1910). Sbornik zakonopolozhenii o sudebno-meditsinskikh izsledvaniiakh. St Petersburg: K. L. Rikker. Iudin, T. I. (1926). Psikhopaticheskie konstitutsii. Moscow: Izdanie M. i K. Sabashnikovykh. Iudin, T. I. (1951). Ocherki istorii otechestvennoi psikhiatrii. Moscow: Medgiz. Joravsky, D. (1989). Russian psychology: A critical history. Oxford & Cambridge, MA: Basil Blackwell. Kowalsky, S. A. (2009). Deviant women: Female crime and criminology in revolutionary Russia, 1880–1930. DeKalb, Il.: Northern Illinois University Press. Krasnushkin, E. K. (1926). Chto takoe prestupnik? Prestupnik i prestupnost'. Sbornik, I, 6–33. Krasnushkin, E. K. (1929). Prestupniki psikhopaty. Moscow: Izd-vo pervogo Moskovskogo gos. universiteta. Krementsov, N. (1997). Stalinist science. Princeton: Princeton University Press. Kult'urno-vospitatel'nyi otdel (1936). Kanaloarmeitsy plakat. Dmitlag: Izdanie Dmitlaga NKVD SSSR. Lents, A. K. (1927). Kriminal'nye psikhopaty (Sotsiopaty). Leningrad: Rabochii sud. Martynova, N.P. (1967). Sudebnaia psikhiatriia. Uchebnik. Moscow: Iuridicheskaia literatura. Miller, M. (1998). Freud and the Bolsheviks: Psychoanalysis in imperial Russia and the Soviet Union. New Haven & London: Yale University Press.

81

Miller, M.A. (2007). The concept of revolutionary insanity in Russian history. In A. Brintlinger, & I. Vinitsky (Eds.), Madness and the mad in Russian culture (pp. 105–116). Toronto: University of Toronto Press. Morozov, G. V., Lunts, D. R., & Felinskaia, N. I. (1976). Osnovnye etapy razvitiia otechestvennoi sudebnoi psikhiatrii. Moscow: Meditsina. Morrissey, S. K. (2006). Suicide and the body politic in imperial Russia. Cambridge: Cambridge University Press. Nekipelov, V. (1980). Institute of fools: Notes from the Serbsky. New York: Farrar Straus Giroux. Pisarev, S. (1970). Soviet mental prisons. Survey: A journal of Soviet and east European studies(77), 175–187. Poloshij, B., & Saposhnikova, I. (2001). Psychiatric reform in Russia. Acta Psychiatrica Scandinavica, 104(Supplement 410), 56–62. Polubinskaia, S. V. (Ed.). (1991). Pravo i psikhiatriia: Tupik, povorot, vzgliad, vozvrashchenie, poisk. Moscow: Iuridicheskaia literatura. Polubinskaya [Polubinskaia], S. V., & Bonnie, R. (1996). The code of professional ethics of the Russian society of psychiatrists: Text and commentary. International Journal of Law and Psychiatry, 19(2), 143–172. Prokopenko, A. S. (1997). Bezumnaia psikhiatriia: Sekretnye materialy o primenenii v SSSR psikhiatrii v karatel'nykh tseliakh. Moscow: Sovershenno sekretno. Rogger, H. (1966). The Beilis case: Antisemitism and politics in the reign of Nicholas II. Slavic Review, 25(4), 615–629. Samuel, M. (1966). Blood accusation: The strange history of the Beilis case. London: Weidenfeld and Nicolson. Sapolnova, S. F., Vekshina, T. A., & Kanev, F. G. (2009). Liudi v belykh khalatakh. Ukhta, Syktyvkar: Komi respublikanskaia tipografiia. Shalamov, V. (1990). Shock therapy. In V. Shalamov (Ed.), Kolyma tales (pp. 29–39). London: Penguin. Sirotkina, I. (2002). Diagnosing literary genius: A cultural history of psychiatry in Russia, 1880–1930. Baltimore: Johns Hopkins University Press. Sirotkina, I. (2007). The politics of etiology: Shell shock in the Russian army, 1914–1918. In A. Brintlinger, & I. Vinitsky (Eds.), Madness and the mad in Russian culture (pp. 117–129). Toronto: University of Toronto Press. Sirotkina, I. (2010). Toward a Soviet psychiatry: War and the organization of mental health care in revolutionary Russia. In F. L. Bernstein, C. Burton, & D. Healey (Eds.), Soviet medicine: Culture, practice, and science (pp. 27–48). DeKalb, Il.: Northern Illinois University Press. Smith, T. C., & Oleszczuk, T. A. (1996). No asylum: State psychiatric repression in the former USSR. New York: New York University Press. Soedinennoi kommisii S.-Peterburgskikh obshchestv psikhiatrov i iuridicheskogo (1894). Doklad Soedinennoi kommisii S.-Peterburgskikh obshchestv psikhiatrov i iuridicheskogo po voprosu ob organizatsii psikhiatricheskogo izucheniia prestupnogo klassa. : St Petersburg. Solomon, P. H., Jr. (1980). Soviet penal policy, 1917–1934: A reinterpretation. Slavic Review, 39(2), 195–217. Solomon, P. H., Jr. (1996). Soviet criminal justice under Stalin. Cambridge: Cambridge University Press. Solomon, S. G. (Ed.). (2006). Doing medicine together: Germany and Russia between the wars. Toronto: University of Toronto Press. Solzhenitsyn, A. (1978). The Gulag archipelago 1918–1956: An experiment in literary investigation. London: Collins & Harvill Press. Spencer, I. (2000). Lessons from history: the politics of psychiatry in the USSR. Journal of Psychiatric and Mental Health Nursing, 7, 355–361. Stone, A. A. (1984). Law, psychiatry, and morality: Essays and analysis. Washington, DC: American Psychiatric Press. Stone, A. A. (2002). Psychiatrists on the side of the angels: The Falun Gong and Soviet Jewry. Journal of the American Academy of Psychiatry and Law, 30(1), 107–111. Torubarov, S. V. (1960). K nekotorym voprosam praktiki naznacheniia i sniatiia prinuditel'nogo lecheniia. In M. P. Andreev, A. I. Baltasheva, & P. V. Blinov (Eds.), Voprosy sudebnoi psikhiatrii. Sbornik nauchnykh trudov konferentsii vrachei spetsial'nykh psikhiatricheskikh bol'nits MVD. (pp. 5–19). Moscow: Gos. izd. Iuridicheskoi literatury. Van Voren, R. (2006). Reforming forensic psychiatry and prison mental health in the former Soviet Union. Psychiatric Bulletin, 30, 124–126. Van Voren, R. (2010). Cold War in psychiatry: Human factors, secret actors. Amsterdam: Rodopi. Verhoeven, C. (2009). The odd man Karakozov: Imperial Russia, modernity and the birth of terrorism. Ithaca & London: Cornell University Press. Wetzell, R. (2000). Inventing the criminal: A history of German criminology, 1880–1945. Chapel Hill: University of North Carolina. Windholz, G. (1999). Soviet psychiatrists under Stalinist duress: The design for a ‘new Soviet psychiatry’ and its demise. History of Psychiatry, 10(39), 329–347. Wortman, R. S. (1976). The development of a Russian legal consciousness. Chicago: University of Chicago Press. Zajicek, B. (2009). Scientific psychiatry in Stalin's Soviet Union: The politics of modern medicine and the struggle to define ‘Pavlovian’ psychiatry, 1939–1953, Unpublished Ph.D. Thesis, University of Chicago, Chicago.

Kazanetz, schizophrenia, and Soviet psychiatry.

Bioethics and forensic psychiatry.

Forensic psychiatry.

Forensic psychiatry in iran.

Forensic psychiatry in Pakistan.

Forensic evaluations in psychiatry.

Forensic psychiatry in Iceland.

[Perspectives of forensic psychiatry and psychotherapy].

Reading about forensic psychiatry.

Schizophrenic Patients between General and Forensic Psychiatry.

[Ethical aspects of forensic psychiatry].

Gray areas in forensic psychiatry.

Forensic psychiatry: anatomy of a service.

The expert witness in forensic psychiatry.

France's forensic psychiatry provision: the long and winding road.

Neurodegenerative disorder masquerading as psychosis in a forensic psychiatry setting.

[Use of virtual reality in forensic psychiatry. A new paradigm?].

Forensic psychiatry: profiles of two types of sex offenders.

[Multimorbid Patients in Forensic Psychiatry: Chances of Being Discharged].

A Thorn in the Flesh? Forensic Inpatients in General Psychiatry.

Treatment as punishment: forensic psychiatry in The Netherlands (1870-2005).

Forensic psychiatry in Europe: The perspective of the Ghent Group.

The NHS practice of forensic psychiatry in one region.

Transfusions, troubled breathing, and transient neutropenia.