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Institute of fools: Notes from the Serbsky, by Viktor Nekipelov
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Memoir, Soviet Studies, Psychiatry
- Sales Rank: #4355085 in Books
- Published on: 1980
- Number of items: 1
- Binding: Hardcover
- 292 pages
Language Notes
Text: English, Russian (translation)
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Psychiatry as a tool of government control
By N.. Martin
Nekipelov was imprisoned in a psychiatric institution (hence Institute of Fools) for evaluation after authoring some mild criticism of Soviet officials. In this memoir he describes his own predicament, that of his fellow inmates, and the nature of his psychiatric prison wardens, as well as providing some general insight into Soviet psychiatry.
Nekipelov sees that few if any of the psychiatric prisoners are mad. In many cases they are attempting to avoid responsibility -- for their lives or for criminal behavior -- that would have them in brutal conventional prisons or simply bereft. He notes that
"there were almost no real fools at the Institute of Fools. The doctors realized this, of course, and knew that their main job was exposing malingerers and not diagnosing illness. They approached each inmate as a potentially sane person who was trying to con them, and this naturally determined both their attitude and their medical techniques. It was a case of who could outwit whom."
Soviet psychiatry is a division of the legal system, then, not a legitimate medical enterprise.
"The doctors did their job -- the government's job -- and winnowed out candidates for the psychiatric paradise. They were particularly vigilant with people who embezzled state property, for if they were ruled not responsible, the government would risk not getting its due from them. Hooligans, rapists, even murderers found it significantly easier to get into the promised cuckoo land, thereby lowering the Soviet crime rate."
Nekipelov's view of Soviet psychiatry is quite similar to that of some critics of Western psychiatry, who have characterized it as a pseudoscience that functions both as a punitive arm of the legal system and a method of relieving people of responsibility. Unlike, say, Thomas Szasz, Nekipelov's criticisms are not of psychiatry per se, but of the Soviet system, which he believes lacks the scientific validity of Western psychiatry. Still, some of his observations stray close to a debunking of the entire psychiatric enterprise. Of the evaluations conducted by the doctors who diagnosed and treated him and his fellow inmates, Nekipelov writes, "I must state right away that the objective examinations were useless and vague, since in psychiatry there are no precise and infallible diagnostic methods." The institutionalized were subjected to exams "of the sort usually conducted in clinics," but a "digression from general clinical examinations was the cranial X-ray, which everyone was given even though it has no diagnostic significance. After all, you cannot see schizophrenia on an X-ray plate." Though it is widely diagnosed throughout the world, you cannot "see" schizophrenia through any sort of physiological test. In fact, it is still the case, as it has always been, that no psychiatric diagnosis can be confirmed by any objective physiological test. Even psychiatrist Allen Frances, lead editor of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (sometimes called the "psychiatric bible") admits that "there is no definition of a mental disorder. It's bulls***. I mean, you just can't define it."
Soviet psychiatry was denounced for its "abuses" (though not often our loudly by Western psychiatrists), but Nekipelov inadvertently reveals that it was really quite similar to Western psychiatry, which is now the global norm. It functions as a powerful means of social control by medicalization of behavior.
"In Soviet criminal theory, responsibility and nonresponsibility are legal concepts. Responsibility -- awareness on the part of the person who has committed a crime of both its circumstances and its social implications -- is a prerequisite of guilt and therefore entails criminal punishment. When a person is nonresponsible -- when he does not realize what he is doing and is not aware, because of mental illness, of the danger of his actions -- criminal amenability and guilt are precluded."
"Thus, the person is unwell rather than a criminal."
Nekipelov probably never knew that the most influential post-WWII American psychiatrist had published a book called The Crime of Punishment fourteen years before his own book was published, and that Western psychiatrists were aggressively expanding the medicalization of behavior, which they argued was more humane and compassionate than punishment based on outdated notions of justice. Nekipelov observes that the "legal machinery is cranked up and those who have committed crimes are referred to an ordinary or special treatment psychiatric hospital. But this is not deemed by Soviet law to be criminal punishment, even though it is ordered by a court and executed through the apparatus of repression. Rather it is considered to be merely a `compulsory government measure.'" That is something John Hinckley, who attempted to Kill President Reagan, can perhaps appreciate.
In his 1980 review for the British Medical Journal, prominent British psychiatrist Malcolm Lader criticizes Nekipelov for writing a book that "hardly rises above gossip and tittle-tattle." Lader predictably defends the notorious Serbsky Institute, saying that the author "presents no real evidence but invariably places the most sinister connotation on events..." Elsewhere Lader also criticizes Thomas Szasz for his opposition to the power of psychiatrists to cause people to be detained and imprisoned on psychiatric pretexts.
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