Belt-Tightening Psychiatry

After we posted his recent series of articles about punitive psychiatry in Yaroslavl Oblast, Grigory Pasko received the following from a resident of Rybinsk who has been following the Novikov case closely and wanted to share his own thoughts on the subject. We have been informed that the author has personally never had any encounters with the Russian mental health system, and would very much like things to stay that way, hence he has asked that his article appear under a pseudonym. We have honored this request, and are pleased to post the article, as we believe the whole issue of the resurrection of punitive psychiatry in Russia is an alarming trend that to be urgently addressed. We hope to continue posting more material on the topic in the future.

BELT-TIGHTENING PSYCHIATRYNikolai MinkovPeople first started talking about changes in the Rybinsk psychiatric hospital in the middle of 2007. A bit later, in the Upper Volga Federal District edition of «Rossiyskaya gazeta» [the official newspaper of the Russian Federation government—Trans.], there appeared a correspondence with the utterances of the heads of the psychiatric structures of several of the Oblasts entering into this region. They were discussing a reduction in the number of hospital beds and the opening of daytime outpatient facilities.Two ambulances arrive on 18 December 2007 to pick up beds from the Rybinsk psychiatric hospital (photo by Grigory Pasko)The introduction of more humane, kinder and gentler forms of treatment within the framework of overall liberalization can only be welcomed, as long as this benefits the ill. But the planned transformations demand the resolution of certain problems. Thus, the head psychiatrist of Yaroslavl Oblast, A.V. Petrov, lamented the shortage of space. What to do in such a situation?In Rybinsk, and probably not only in this second-largest city of the Oblast, they found a simple solution. In order to accommodate the new service in the local infirmary they closed the central departments Nos. 3 and 4 – men’s and women’s – found in the field of vision of the townspeople and the most convenient for visiting. Here, in the building of a former pre-school day care center, they held first-time and other mental patients in need of immediate help, as well as those referred for compulsory treatment by court order. Now a part of them have simply been discharged, others have been referred to outpatient treatment with visits to an outpatient clinic; among them – the columnist Andrey Novikov, convicted for his writings (after 11.5 months of compulsory treatment in an inpatient facility, the court transferred him – under pressure from society and the mass media, from «Novaya gazeta» to «Canal 2», A.R.T., etc. – to compulsory outpatient treatment). Yet others were referred to those same “daytime sojourn” suites that have been set up in the place of the liquidated departments. And finally, a fourth group, who, in the opinion of doctors and judges, are still in need of inpatient observation, have been evacuated to the boondocks of the region beyond the Left Bank of the Upper Volga, to 1st and 2nd departments that are already, even without this, overflowing with chronic patients with no hope for recovery.Inasmuch as alcoholism, drug abuse, criminality and the incidence rate of diseases, especially mental ones, are social ills, under the current “stabilization of growth” – the growth of socio-economic inequality – they can only increase. So there is no need to expect a reduction in psychiatric clientele. What is more, the “executors” from the Serbsky Institute are trying to turn back the democratic achievements of the Law of the year 1992 «On psychiatric assistance». “In particular”, says president of the Independent psychiatric association Yu.S. Savenko, “they tried to remove the determination ‘immediate’ from the concept of ‘immediate danger’, which makes the boundary lines of danger rubber.” But even after the collapse of these attempts, “Article 29 of the Law is being interpreted just as if though these amendments had been introduced.”And here’s an example of the politicized verdict of a forensic psychiatric expert examination: “The grandiose affections of the subject have acquired a religious tinge, (he) has begun to preach Islam, has called in his articles for extremist activity… A.V. Novikov represents a social danger to society and is in need of compulsory treatment in a psychiatric inpatient facility.” Thereby, criticism of the powers that be and public oppositional appearances are once again being included in the number of illicit acts necessitating compulsory treatment. The difference is merely in the vocabulary: “those who disagree” instead of dissidents (nonconformists) and “extremist activity” instead of anti-Soviet. Thus correctional-retributive functions, appropriate in relation to maniacs and suicide survivors, is expanding on account of opponents of the currently functioning power – to the detriment of the principal therapeutic function of psychiatry.So to whose advantage are the latest innovations? First and foremost to the state budget, which saves on the inpatient contingent: “walk-in” patients – after deduction of meals and servicing – cost less. As concerns real and potential patients, their situation is not promising. As has been shown above, the practice of compulsory hospitalization has by no means declined, so the reduction will impact precisely those who are in need of care and constant observation. The “compaction” that has begun increases crowding, stuffiness, and the potential for conflict in the wards. In such a manner, the conditions in which real and supposed mental patients are kept, both those who have committed crimes and those who are not guilty of anything, are making ordinary psychiatric hospitals more like special inpatient facilities [high-security psychiatric hospitals, akin to prisons; the kind of facility to which dissidents and other socially dangerous mental patients are sent—Trans.] and prison torture chambers.