Psychiatrists are always at risk of becoming agents of social control. In most U.S. states, we have the power to force people, under specific conditions, into psychiatric hospitals. (Washington State is one of the few states where psychiatrists cannot do this. We have to call someone else with that authority.)
A Very Important Person in the U.S. government has said, “… we live in a world, in the real world … that is governed by strength, that is governed by force, that is governed by power.” The federal government has manifested this intention in both internal and external affairs.
As a result, I have growing concerns that the U.S. government will use psychiatrists as tools for force. This has happened before. How have psychiatrists in the past resisted these pressures? How can I prepare myself to do the same?
The Lancet published a paper in 1981, “Unwilling Patients“, by Soviet psychiatrist Anatoly Koryagin. Dr. Koryagin (stationed in the then state of Ukraine…) wrote this paper
to analyze the conditions in which healthy people in the U.S.S.R. are pronounced mentally ill and are condemned to exist as such.
Dr. Koryagin describes conditions that encouraged psychiatrists to become extensions of the government:
The government passed laws that recognized “anti-Soviet” speech and activities as crimes.
Law enforcement officials at all levels of government picked up people for violating these laws. They then brought them to psychiatric hospitals for observation or evaluation. If psychiatrists diagnosed them as mentally ill, then compulsory treatment followed.
Some people, brought in by law enforcement, were detained even though no psychiatrist ever evaluated them. This means one of two things happened:
- psychiatrists in the community signed detention orders without ever meeting the person, or
- hospital psychiatrists automatically signed detention orders when law enforcement arrived.
Psychiatrists shifted clinical definitions.
At that time in the U.S.S.R., the clinical meaning of “socially dangerous” was a person “in danger of committing acts which would endanger his own health or that of people around him.” This is largely consistent with the detention threshold now in the United States.
However, some U.S.S.R. psychiatrists began detaining people because they were “capable of harming the social system as a whole”. This was a judicial interpretation of “socially dangerous”. Thus, for detention to occur, both the referring psychiatrist and accepting hospital psychiatrist substituted the judicial definition for the clinical one.
Even though the only symptoms these patients exhibited were “‘anti-Soviet’ attitudes, expressions, and actions”, most people were diagnosed as “psychopaths (70%) or schizophrenics (30%)”. (A.I. tells me that the DSM-5 equivalent of “psychopath” in the Soviet Union in the late 1970s is antisocial personality disorder.) One Soviet forensic psychiatrist wrote of a patient, “No normal person can be opposed to the Workers’ and Peasants’ State.”
Psychiatrists acquiesced and transformed hospitals into sites of punishment, not treatment.
Once people were hospitalized, “the main aim of these confinements to hospital was the isolation of the patient and not treatment of mental illness”. Gallows humor emerged: The term for this was apparently “wall therapy”.
For those who received medical interventions, they were severe:
- “insulin comas”
- “intensive course of injections with neuroleptic drugs for a week”
A 16 year-old girl reported that she was “severely beaten by the medical staff” after she tried to escape. She then was “subjected to treatment with neuroleptic drugs”.
Psychiatrists gave up on patient care and abandoned their professional duties.
Dr. Koryagin notes:
Not one of these people has said that the health authorities or, more particularly, the doctors at psychiatric clinics, have helped them in any way whatsoever.
Given the context, these were not disgruntled patients. Doctors almost always have more power than patients. It is easier to identify abuses of power, like when doctors inflict harm on their patients.
However, not using the power one has is also a misuse of power. Pressure and coercion from the government are always overwhelming. To yield to that pressure creates a vacuum that those who covet strength, force, and power race to fill.
The psychiatrists Dr. Koryagin describes abandoned their power and authority as physicians. Their “patients” suffered the consequences. Thus, Dr. Koryagin reminds us (emphasis mine):
A doctor is obliged to take an active interest in all the patients on his list, so that he may help them in legal and social, as well as medical matters.
In my view this guidance applies not only to the patients who are under our care now, but also to those who were and those who will be. This is why it is vital to advocate for the health and well-being of all. Even—and especially—if the government thinks some people are undeserving.
Maria Yang, MD 