An interview with prominent Russian psychiatrist Yuri Savenko – Part 1 By Grigory Pasko, journalist [Right: Photo of Larisa Arap, a dissident held against her will in psychiatric confinement by Russian authorities] Plato regarded creativity as “madness given us as a gift by the Gods”. Lunacharsky wrote: “In deep antiquity, the artist or poet was without fail a platonic type”. Francis Galton said that genius is a deviation from the norm… How many different mental disorders there are today! Reading disorder, disruptive behavior disorder, disorder of written expression, mathematics disorder, caffeine intoxication, nicotine withdrawal disorder, sexual disorders… These are but a few of the 374 mental disorders enumerated in the «Diagnostic and Statistical Manual of Mental Disorders» («DSM-IV») of the American Psychiatric Association (APA). I recall a caricature from the distant past. Two beefy orderlies are taking away a man in a straitjacket. The man is yelling: “You can’t understand Russia with the mind”! It’s not enough for our dear Russian power that on Russian soil – with its eternal social cataclysms and perestroikas (an unkind Chinese wish: “May you live in an epoch of changes”) there are plenty of people with mental disorders already. No, they’re also inventing their own kinds of “deviancies”. For example: whoever criticizes the power must be mad.
And who criticizes, for example, Putin? Well, how about the 13th world chess champion, Garry Kasparov? The once-popular singer of the once-popular rock group «Mashina vremeni» [Time Machine], Andrei Makarevich, has called Kasparov insane. That’s exactly what he said: “Kasparov gives the impression of a person who is not well…”. In this regard, the journalist Natella Boltyanskaya gave the following example: One-time world champion Kasparov sold his chess crown with its nearly three hundred precious stones, and for the money he got for it, he built a multiple-apartment house for refugees outside Moscow. This was long before Russia learned the name of Putin. Is Kasparov sick?”I recently had a chance to talk about who in today’s Russia is healthy and who isn’t exactly so with the president of the Independent Psychiatric Association of Russia, member of the World Psychiatric Association, member of the expert Council under the Human Rights Ombudsman in Russia, doctor Yuri Savenko.Doctor Yuri Savenko (photo by Grigory Pasko)Yuri Sergeyevich, does Russian psychiatry, including forensic psychiatry, answer contemporary requirements and achievements?I would say that it is found in a state of a very contradictory process. On the one hand, Russia has come out of international isolation, associated with the use of psychiatry for political aims in the 1960s-80s, has moved the psychiatric service onto a legal path, has adopted a law «On psychiatric assistance and guarantees of the rights of citizens during the rendering thereof», has signed a series of international agreements, for example the Mental Health Action Plan for Europe, but on the other hand – is for 16 years already not carrying out a fundamental article of the law on psychiatric assistance on the creation of a service for the protection of the rights of patients. On the one hand, international contacts have significantly expanded, professional journals have multiplied, on the other hand, a drain and dispersion of cadres have taken place. On the whole, it can be said that domestic psychiatry is going in step with the times. We too have all the basic therapeutic means that are used in psychiatry. Pre-revolutionary traditions have also been preserved, from when our psychiatry was on a level with European psychiatry. But these traditions are dwindling away precipitously. Political psychiatry has returned – when the state is one again on the threshold of using this field of medicine to “take care of” those it regards as “unwanted”. But after all, all the classics of psychiatry, including Vladimir Serbsky, fought against political psychiatry [ironically, Moscow’s Center for Social and Forensic Psychiatry named after V.P. Serbsky (discussed below) gained notoriety as a place where many Soviet dissidents were incarcerated and tortured; the institution’s doctors came up with the diagnosis of “sluggishly progressing schizophrenia” to describe “patients” who “suffered” from vague “ideas about a struggle for truth and justice”—Trans.].Of particular concern are the egregious fall in the level of forensic psychiatric expert studies, the annihilation of independent psychiatric expert studies, and the complete monopolization of forensic psychiatry by the state center named after Serbsky.If many police state methods are making a comeback, then why not come back to police psychiatry too?Indeed. But there’s no need to go jump from one extreme to another – police psychiatry is good in its place. For example, when it is dealing with murderers. But these principles are often extended to everyone. Recently, on radio «Liberty», there sounded an interview of doctor M.V. Vinogradov from the Center named after Serbsky. He declared that all medicine – is police medicine and must be that way. It is being proposed to extend a model calculated for particularly dangerous infections to all diseases. This is complete savagery. And this is what we’re fighting against. But this line is becoming ever more audacious, unabashed. If the center named after Serbsky once expressed remorse for the use of psychiatry for non-medical, political aims, then after 1995 it started to deny abuses even in the past. This is being done in spite of the fact that during the course of the years 1989-90, around a million people were taken off psychiatric registry.The psychiatric hospital in Rybinsk (photo by Grigory Pasko)It is known that the state has adopted a federal targeted programme for the development of the psychiatric service for the years 2007-2011 and has allocated 80 bln. rubles for this. In what is the essence of the program?Nobody has been able to formulate distinctly just what exactly the essence of the reform is and what concretely is being proposed to be done in order to raise the quality of service of patients.The fact of the matter is that the reform was conceived on the European model in the hope of saving on costs, sharply reducing the in-patient service, closing down or reprofiling psychiatric hospitals into semi-inpatient facilities and switching over in the main to outpatient assistance.But the reform was prepared as usual behind closed doors, without a real discussion, totally in the dark, which from the already painful experience of the East European countries an outpatient service with its multi-profile brigade method of serving the population, getting as close as possible to the population, is much more expensive. As a result, we’ve got to do everything we can to put a brake on the plans for the dissolution of the psychiatric hospitals, because there’s no place to put the patients except only perhaps by swelling the army of street people with them. The first-order tasks is the construction of dormitories and the training of the necessary cadres. The funds allocated for five years for the reform are truly paltry for such a country as Russia; in this regard we are in last place in Europe.From the latest loud cases that have received resonance as political ones, we can recall the cases of Larisa Arap from Murmansk, the journalist Andrei Novikov from Rybinsk, and a young person, a former National-Bolshevik, Artem Basyrov, from Yoshkar-Ola. I know that you have studied these cases well and are participating in examining these people in the capacity of an independent expert.Yes, all these cases are very instructive and very disturbing for us all, like some kind of signal. The case of Larisa Arap [photo at the top of this post] initially wasn’t political; it became such to the extent of the international noise around it. The two others – are already clearly political.Remind our readers, please, of the essence of this case.On 5 July 2007, activist of the United Civic Front (OGF) Larisa Arap was forcibly delivered to the inpatient facility at the psycho-neurological dispensary of the city of Murmansk in the company of police “in an armed state” from the office of the district psychiatrist, to whom she had turned for a certificate for driving a car. According to the assertion of representatives of the Front, Larisa Arap is mentally healthy and was not in need of the assistance of psychiatrists. Nevertheless, she was hospitalized in involuntary procedure in accordance with item «а» of Article 29 of the Law on Psychiatric Assistance as representing an immediate danger to herself and those around her.On 18 July, the Lenin District Court of the City of Murmansk sanctioned this decision. On 26 July, unexpectedly for relatives and her herself, Larisa Arap was transferred to the Murmansk Oblast Psychiatric Hospital, which is situation 250 km from Murmansk in the city of Apatity. On 6 August against the background of a mighty protest campaign the administration of the hospital turned to a court with a request to extend the compulsory treatment of Larisa Arap under item «c» of Article 29, according to which leaving without psychiatric assistance can bring “substantial harm to health in consequence of a deterioration of mental state”. Over the time of sojourn in the inpatient facility Larisa Arap on numerous occasions express protest against her involuntary treatment, announced hunger strikes.At the suggestion of the Independent Psychiatric Association of Russia, Human Rights Ombudsman Vladimir Lukin founded a special commission for the independent certification of Larisa Arap and assessment of the substantiation for her involuntary inpatient admission.We visited Larisa Arap in August of the year 2007. Our commission established that Arap indeed does have mental disorders, requiring treatment, and confirmed a diagnosis that had been put out in the year 2004. However, the actions of the psychiatric service of Murmansk Oblast significantly violated the rights of Larisa Arap. First and foremost, the compulsory inpatient admission to a psychiatric inpatient facility on 5 July 2007 was unjustified, inasmuch as she did not represent an “immediate danger” neither to herself, nor to those around her.It remains to be added that at the present time, human rights ombudsman in the Russian Federation Vladimir Lukin has taken the case of Larisa Arap under his personal control and is providing her support. In August of the year 2007, she was discharged from the hospital.The case of Basyrov is also not simple? (photo below)Yes, not simple. A young man… Mother died, they live on a microscopic pension with a brother. In the past a National-Bolshevik… Participated in a dissenters’ march in Samara. After this he filed an application to conduct a march in Yoshkar-Ola. They placed him in a psychiatric hospital. Supposedly he had been harassing women with sexual intent. We certificated Basyrov and studied the medical documents and came to a conclusion about the groundlessness of inpatient admission. The charges presented against him in a decisive manner contradicted his psychological symptomatics – this was a typical scenario of mopping up a troublemaker before the elections.For reference:Yuri Sergeyevich Savenko — president in perpetuity of the Independent Psychiatric Association of Russia (NPAR). The NPAR was founded in 1989 and was immediately accepted into the World Psychiatric Association (the official Russian Society of Psychiatrists was accepted into this main professional international community of psychiatrists two years later). At the present time, the NPAR unites more than 600 professional psychiatrists, working in the majority of the subjects of the federation.Yu. Savenko defines the three priorities in the activity of the NPAR thus: first, purely professional — nurturing an appropriate notion among doctors of the subject matter of psychiatry, developing modern methods of clinical practice; second, the legal foundations of psychiatry; third, partial de-statification of the psychiatric service.