|Psychiatry in Russia and the USSR|
Russian Mental Health Law
Sluggish schizophrenia or slow progressive schizophrenia (Russian: вялотеку́щая шизофрени́я, vyalotekushchaya shizofreniya) is an independent diagnostic category that is characterized by a slowly progressive course and included in the systematics of schizophrenia developed by Soviet psychiatrist Andrei Snezhnevsky and his Soviet colleagues. The diagnosis was the most infamous of diagnoses used by Soviet psychiatrists. The term "sluggish schizophrenia" was invented by Snezhnevsky. This diagnostic concept was limited to the USSR and some other East European countries. This notion of sluggish schizophrenia allowed for the diagnosis of schizophrenia to be made even in the total absence of symptoms or signs of psychosis. Theory of "sluggish schizophrenia" is so hazy that it can be applied to any individual, whether mentally sick or healthy, and it has been rejected by the world psychiatric community. The application of the theory to political dissidents has been internationally condemned. The fall of communism brought an end to Snezhnevsky's theories in Ukraine as well.
The suspiciously elastic condition denoted by the diagnosis of sluggish schizophrenia is not recognized by Western psychiatry and the World Health Organization. Sluggish schizophrenia is not included in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) used in western countries; however, its Russian version, which has long been used throughout present-day Russia and excludes sluggish schizophrenia from schizophrenia, adds sluggish schizophrenia to schizotypal disorder in section F21 of chapter V.
According to Sergei Jargin, the same Russian term "vyalotekushchaya" for sluggish schizophrenia continues to be used and is now translated in English summaries of articles not as "sluggish" but as "slow progressive." Thomas Plante notes that after being discharged from a hospital, persons diagnosed with sluggish schizophrenia were deprived of their civic rights, employability, and credibility.
The diagnosis as a basis for political abuse of psychiatry
Psychiatric diagnoses such as the diagnosis of sluggish schizophrenia in political dissidents in the USSR were used for political purposes; the diagnosis of sluggish schizophrenia was most frequently used for Soviet dissidents. Sluggish schizophrenia as one of new diagnostic categories was created to facilitate the stifling of dissidents and was a root of self-deception among psychiatrists to placate their consciences when the doctors acted as a tool of oppression in the name of a political system. American psychiatrist Peter Breggin provides detail by pointing out that the term “sluggish schizophrenia” was created to justify involuntary treatment of political dissidents with drugs normally used for psychiatric patients.
Professor Andrei Snezhnevsky, the most prominent theorist of Soviet psychiatry and director of the Institute of Psychiatry of the USSR Academy of Medical Sciences, developed a novel classification of mental disorders postulating an original set of diagnostic criteria. Critics implied that Snezhnevsky designed the Soviet model of schizophrenia (and this diagnosis) to make political dissent a mental illness. Snezhnevsky and his colleagues who developed the concept of sluggish schizophrenia in the 1960s were supported by Soviet psychiatrists Fedor Kondratev, Sergei Semyonov, and Yakov Frumkin.
St Petersburg academic psychiatrist professor Yuri Nuller notes that the concept of Snezhnevsky’s school allowed psychiatrists to consider, for example, schizoid psychopathy and even schizoid character traits as early, delayed in their development, stages of the inevitable progredient process, rather than as personality traits inherent to the individual, the dynamics of which might depend on various external factors. The same also applied to a number of other personality disorders. It entailed the extremely broadened diagnostics of sluggish (neurosis-like, psychopathy-like) schizophrenia. Despite a number of its controversial premises and in line with the traditions of then Soviet science, Snezhnevsky’s hypothesis has immediately acquired the status of dogma which was later overcome in other disciplines but firmly stuck in psychiatry. Snezhnevsky’s concept, with its dogmatism, proved to be psychologically comfortable for many psychiatrists, relieving them from doubt when making a diagnosis. That carried a great danger: any deviation from a norm evaluated by a doctor could be regarded as an early phase of schizophrenia, with all ensuing consequences. It resulted in the broad opportunity for voluntary and involuntary abuses of psychiatry. But Snezhnevsky did not take civil and scientific courage to reconsider his concept which clearly reached a deadlock.
On the covert orders of the KGB, thousands of social and political reformers—Soviet "dissidents"—were incarcerated in mental hospitals after being labelled with diagnoses of "sluggish schizophrenia", a disease fabricated by Snezhnevsky and the "Moscow school" of psychiatry. Snezhnevsky was long attacked in the West as an example of psychiatric abuse in the USSR. He was charged with cynically developing a system of diagnosis which could be bent for political purposes, and he himself diagnosed or was involved in a series of famous dissident cases, and, in dozens of cases, he personally signed a commission decision on legal insanity of mentally healthy dissidents including Vladimir Bukovsky, Natalya Gorbanevskaya, Leonid Plyushch, Mikola Plakhotnyuk, and Pyotr Grigorenko. American psychiatrist Alan A. Stone stated that Western criticism of Soviet psychiatry was directed at Snezhnevsky personally, because he was responsible for the Soviet diagnosis of sluggish schizophrenia with "reformism" and other symptoms. This diagnosis could be applied to dissenters. Revaz Korinteli, a professor of the Grigol Robakidze University, says Snezhnevsky broadened the borders of schizophrenia, and in this connection there was legal and theoretical justification for employing compulsory, involuntary treatment of dissenters in mental hospitals.
Premises for using the diagnosis
According to Robert van Voren, the political abuse of psychiatry in the USSR arose from the concept that people who opposed the Soviet regime were mentally ill (since there was no logical reason to oppose the sociopolitical system considered the best in the world). The diagnosis of sluggish schizophrenia (a concept developed by the Moscow School of Psychiatry and its chief, Andrei Snezhnevsky) furnished a framework for explaining this behavior.
Although a majority of experts agree that the psychiatrists who developed this concept did so under instructions from the Soviet secret service KGB and the Communist Party (and understood what they were doing), this seemed to many Soviet psychiatrists a logical explanation why someone would be willing to abandon his happiness, family, and career for a conviction so different from what most individuals believed (or made themselves believe).
Systematics by Snezhnevsky
The Soviet model of schizophrenia is based on the hypothesis that a fundamental characteristic (by which schizophrenia spectrum disorders are distinguished clinically) is its longitudinal course. The hypothesis implies three main types of schizophrenia:
- Continuous: unremitting, proceeding rapidly ("malignant") or slowly ("sluggish"), with a poor prognosis
- Periodic (or recurrent): characterized by an acute attack, followed by full remission with little or no progression
- Mixed (German: schubweise; in German, schub means "phase" or "attack"): mixture of continuous and periodic types which occurs periodically and is characterized by only partial remission.
The classification of schizophrenia types attributed to Snezhnevsky is still used in Russia, and considers sluggish schizophrenia an example of the continuous type. The prevalence of Snezhnevsky’s theories has particularly led to a broadening of the boundaries of disease such that even the mildest behavioral change is interpreted as indication of mental disorder.
Conditions posed as symptoms
A carefully crafted description of sluggish schizophrenia established that psychotic symptoms were non-essential for the diagnosis, but symptoms of psychopathy, hypochondria, depersonalization or anxiety were central to it. Symptoms considered part of the "negative axis" included pessimism, poor social adaptation and conflict with authorities, and were themselves sufficient for a formal diagnosis of "sluggish schizophrenia with few symptoms". According to Snezhnevsky, patients with sluggish schizophrenia could present as seemingly sane but manifest minimal (and clinically relevant) personality changes which could remain unnoticed by the untrained eye. Patients with non-psychotic mental disorders (or who were not mentally ill) could be diagnosed with sluggish schizophrenia. Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters.
Harold Merskey and Bronislava Shafran write that many conditions which would probably be diagnosed elsewhere as hypochondriacal or personality disorders, anxiety disorders or depressive disorders appear liable to come under the banner of slowly progressive schizophrenia in Snezhnevsky’s system. According to Snezhnevsky and his colleagues schizophrenia was more prevalent than previously thought, since the illness could present with relatively mild symptoms and progress later; schizophrenia was diagnosed more often in Moscow than in other countries, as the World Health Organization Pilot Study on Schizophrenia reported in 1973. The city with the highest prevalence of schizophrenia in the world was Moscow.
The incidence of sluggish schizophrenia increased because, according to Snezhnevsky and his colleagues, patients with this diagnosis were capable of socially functioning almost normally. Their symptoms could resemble those of a neurosis or paranoia. Patients with paranoid symptoms retained insight into their condition, but overestimated their significance and had grandiose ideas of reforming society. Sluggish schizophrenia could have such symptoms as "reform delusions", "perseverance" and "struggle for the truth". As Viktor Styazhkin reported, Snezhnevsky diagnosed a reform delusion in every case where a patient "develops a new principle of human knowledge, drafts an ideal of human happiness or other projects for the benefit of mankind".
During the 1960s and 1970s, theories which contained ideas about reforming society, struggling for the truth, and religious convictions were not considered delusional paranoid disorders in nearly all foreign classifications; however, Soviet psychiatry (for ideological reasons) considered critiques of the political system and proposals to reform it as delusional behavior. The diagnoses of sluggish schizophrenia and paranoid states with delusions of reform were used only in the Soviet Union and several Eastern European countries.
An audience member at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute asked, “Tell us, Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?” Since the question was asked ironically Morozov replied ironically: “You know, dear colleagues, this is a very peculiar disease. There are not delusional disorders, there are not hallucinations, but there is schizophrenia!”
The two Soviet psychiatrists Marat Vartanyan and Andrei Mukhin in their interview to the Soviet newspaper Komsomolskaya Pravda issued on 15 July 1987 explained how it was possible that a person might be mentally ill, while people surrounding him did not notice it, for example, in the case of "sluggish schizophrenia". What was meant by saying that a person is mentally ill? Marat Vartanyan said, "… When a person is obsessively occupied with something. If you discuss another subject with him, he is a normal person who is healthy, and who may be your superior in intelligence, knowledge and eloquence. But as soon as you mention his favourite subject, his pathological obsessions flare up wildly." Vartanyan confirmed that hundreds of people with this diagnosis were hospitalized in the Soviet Union. According to Mukhin, it took place because "they disseminate their pathological reformist ideas among the masses." A few months later the same newspaper listed "an exceptional interest in philosophical systems, religion and art" among symptoms of sluggish schizophrenia from a Manual on Psychiatry of Snezhnevsky’s Moscow school.
Recognizing method, treatment and study
Only specially instructed psychiatrists could recognize sluggish schizophrenia to indefinitely treat dissenters in a "Special Psychiatric Hospital" with heavy doses of antipsychotic medication. Convinced of the immortality of the totalitarian USSR, Soviet psychiatrists, especially in Moscow, did not hesitate to form "scientific" articles and defend dissertations by using the cases of dissidents. For example, Snezhnevsky diagnosed dissident Vladimir Bukovsky as schizophrenic on 5 July 1962 and on 12 November 1971 wrote to writer Viktor Nekrasov that the characteristics of Bukovsky's mental disease were included in the dissertation by Snezhnevsky's colleague. All the paper products were available in medical libraries. As Semyon Gluzman recollects, when he returned to Kiev in 1982 after his absence of ten years, he was amazed to see all this "scientific" literature in open storage at the Kiev medical library and was even more amazed to read all the ridiculous stuff hardly put into scientific psychiatric terminology. In their papers and dissertations on treatment for litigiousness and reformism, Kosachyov and other Soviet psychiatrists recommended compulsory treatment for persons with litigiousness and reformism in the same psychiatric hospitals of special type as used for murderers:
Compulsory treatment in psychiatric hospitals of special type is to be recommended in cases of brutal murders committed on delusional grounds as well as in cases of persistent litigiousness and reformism with an inclination to induce surrounding persons and with a tendency to repetition of the illegal acts.
Darrel Regier of the National Institute of Mental Health, one of the U.S. experts who visited Soviet psychiatric hospitals in 1989, testified that a "substantial number" of political dissenters had been recognized as mentally sick on the basis of such symptoms as "anti-Soviet thoughts" or "delusions of reformism."
Recurrence in post-Soviet Russia
According to the warning made in 2010 by the president of the Independent Psychiatric Association of Russia Yuri Savenko, prof. Anatoly Smulevich, author of the monographs Problema Paranoyi (The Problem of Paranoia) (1972) and Maloprogredientnaya Shizofreniya (Continuous Sluggish Schizophrenia) (1987), which had contributed to the hyperdiagnosis of "sluggish schizophrenia", again began to play the same role he played before. Recently, under his influence therapists began to widely use antidepressants and antipsychotics but often in inadequate cases and in inappropriate doses, without consulting psychiatrists. This situation has opened up a huge new market for pharmaceutical firms, with their unlimited capabilities, and the flow of the mentally ill to internists.
In their joint book Sociodinamicheskaya Psikhiatriya (Sociodynamic Psychiatry), Doctor of Medical Sciences professor of psychiatry Caesar Korolenko and Doctor of Psychological Sciences Nina Dmitrieva note that Smulevich's clinical description of sluggish schizophrenia is extremely elusive and includes almost all possible changes in mental status and partly conditions that occur in person without psychopathology: euphoria, hyperactivity, unfounded optimism, irritability, explosiveness, sensitivity, inadequacy and emotional deficit, hysterical reactions with conversive and dissociative symptoms, infantilism, obsessive-phobic states, stubbornness. At present, the hyperdiagnosis of schizophrenia becomes especially negative due to a large number of schizophreniform psychoses caused by the increasing popularity of various esoteric sects. They practice meditation, sensory deprivation, special exercises with rhythmic movements which directly stimulate the deep subconscious and, by doing so, lead to the development of psychoses with mainly reversible course. Smulevich bases the diagnosis of continuous sluggish schizophrenia, in particular, on appearance and lifestyle and stresses that the forefront in the picture of negative changes is given to the contrast between retaining mental activity (and sometimes quite high capacity for work) and mannerism, unusualness of one's appearance and entire lifestyle. In his 2014 interview, Anatoly Smulevich says, “Now everything has slightly turned in a different way, sluggish schizophrenia has been transformed into schizotypal disorder, etc. I think it is not the end of his [Snezhnevsky's] teaching, because after a while, everything will get back into a rut, but it will not be a simple repetition but will get some new direction.”
In 2009, Tatyana Dmitrieva, the then director of the Serbsky Center, said to the BBC Russian Service, "A diagnosis is now made only according to the international classification, so called ICD-10. In this classification, there is no sluggish schizophrenia, and therefore, even this diagnosis has not just been made for a long time." However, according to the 2012 interview by the president of the Ukrainian Psychiatric Association Semyon Gluzman to Radio Liberty, there is not just the diagnosis of "sluggish schizophrenia" in Ukraine, Ukrainians are fully adapted to the international classification of mental disorders, but in Russia, as far as he knows, this diagnosis still exists and has been given to Mikhail Kosenko, one of the accused in the Bolotnaya Square case. The prosecution’s case for his forced hospitalization rested on confirmation of the diagnosis of sluggish schizophrenia that he has been treated for over the last 12 years, until 2013 when the diagnosis was changed to that of paranoid schizophrenia by the Serbsky Center experts who examined Kosenko and convinced the court to send him for compulsory treatment to a psychiatric hospital. Zurab Kekelidze (ru), who heads the Serbsky Center and is the chief psychiatrist of the Ministry of Health and Social Development of the Russian Federation, confirmed that Kosenko was diagnosed with sluggish schizophrenia.
According to the commentary by the Independent Psychiatric Association of Russia on the 2007 text by Vladimir Rotstein, a doctrinist of Snezhnevsky's school, there are sufficient patients with delusion of reformism in psychiatric inpatient facilities for involuntary treatment. In 2012, delusion of reformism was mentioned as a symptom of mental disorder in Psychiatry. National Manual edited by Tatyana Dmitrieva, Valery Krasnov, Nikolai Neznanov, Valentin Semke, and Alexander Tiganov. In the same year, Vladimir Pashkovsky in his paper reported that he diagnosed 4.7 percent of 300 patients with delusion of reform. As Russian sociologist Alexander Tarasov notes, you will be treated in a hospital so that you and all your acquaintances get to learn forever that only such people as Anatoly Chubais or German Gref can be occupied with reforming in our country. According to Raimond Krumgold, a member of the party of The Other Russia since 2010, he was examined because of his delusion of reformism, which gave rise to an assumption of slow progressive schizophrenia. In 2012, Tyuvina and Balabanova in their joint paper reported that they used Sulpiride to treat slow progressive schizophrenia.
Because of this form of schizophrenia, Russia in the 1980s had three times as many schizophrenic patients per capita as the USA, two times as many schizophrenic patients as West Germany, Austria and Japan. There were not as many schizophrenic patients in any other country (of Western ones). According to Moscow psychiatrist Alexander Danilin, the nosological approach in the Moscow psychiatric school established by Andrei Snezhnevsky (whom Danilin considered a state criminal) boiled down to the ability to diagnose schizophrenia; psychiatry was not science, but a system of opinions by which millions of lives were affected by a diagnosis of "sluggish schizophrenia".
- Andrei Snezhnevsky, a major Soviet psychiatrist who created the concept of sluggish schizophrenia
- Excited delirium
- Female hysteria. Hysteria was a common medical diagnosis in the 19th century.
- Political abuse of psychiatry in the Soviet Union
- The Protest Psychosis: How Schizophrenia Became a Black Disease
- Jargin 2011.
- Smulevich 1989.
- Robertson & Walter 2013, p. 84.
- Korolenko & Kensin 2002.
- Wilkinson 1986; Merskey & Shafran 1986; Gluzman 2013a; Korotenko & Alikina 2002, p. 18
- Sfera 2013.
- Gershman 1984.
- Targum, Chaban & Mykhnyak 2013.
- Moran 2010.
- RIANovosti 2013.
- Non-Russian unadapted version of the ICD-10.
- Savenko 2008.
- Russian adapted version of the ICD-10.
- Plante 2013, p. 110.
- Katona & Robertson 2005, p. 77.
- Reich 1983.
- Tobin 2013.
- Breggin 1993.
- Ougrin, Gluzman & Dratcu 2006.
- Stone 2002.
- Korotenko & Alikina 2002, p. 46.
- Nuller 2008, p. 17.
- Nuller 2008, p. 18.
- Healey 2011.
- Gluzman 2013b.
- Stone 1985, p. 11.
- Stone 1985, p. 8.
- Korinteli 2013.
- Voren (2010b, 2013)
- Voren 2010b.
- Lavretsky 1998, p. 543.
- Bleikher 1984, p. 278.
- Zharikov & Tyulpin 2000, p. 371.
- Tiganov 1999, p. 414.
- Bloch & Reddaway 1985, p. 40.
- Merskey & Shafran 1986.
- Park et al. 2014.
- Styazhkin 1992, p. 66.
- Voren 2010a, p. 497.
- Korotenko & Alikina 2002, p. 19.
- Korotenko & Alikina 2002, p. 18.
- Gluzman 2009.
- Voren (2010a, p. 492, 2013)
- Voren 2010a, p. 492.
- Fainberg 1975.
- Gluzman 2013a.
- Popov 1992, p. 70.
- Snezhnevsky (2012, p. 287, 2014)
- UPA Herald 2013.
- Moseley 1989.
- Savenko 2010.
- Korolenko & Dmitrieva 2000, p. 18.
- Korolenko & Dmitrieva 2000, p. 21.
- Smulevich 2009.
- Smulevich & Morozov 2014.
- Fedenko 2009.
- Pavlova & Polyakovskaya 2012.
- Davidoff 2013.
- Safina 2011.
- Kekelidze 2013.
- NPZ 2007.
- Dmitrieva, Krasnov & Neznanov 2012, p. 322.
- Pashkovsky 2012.
- Tarasov 2006.
- Krumgold 2012.
- Tyuvina & Balabanova 2012.
- Vasilenko 2004, p. 33.
- Danilin 2008.
- The ICD-10 Classification of Mental and Behavioural Disorders. F21 Schizotypal Disorder.
- МКБ-10: Классификация психических и поведенческих расстройств. F21 Шизотипическое расстройство [The ICD-10 Classification of Mental and Behavioural Disorders. F21 Schizotypal Disorder]. Russian.
- Проблема социальной опасности психически больных [The problem of the social danger of the mentally ill]. Nezavisimiy Psikhiatricheskiy Zhurnal [The Independent Psychiatric Journal]. 2007 [Retrieved 18 February 2014];(№ 4):12–17. Russian.
- Цитатник номера [Quote set of the issue]. Вестник Ассоциации психиатров Украины [The Herald of the Ukrainian Psychiatric Association]. 2013;(5). Russian.
- RIA Novosti. Russian Protester Committed to Psychiatric Hospital Over Riot; 8 October 2013 [Retrieved 13 January 2014].
- Bleikher, Vadim [Вадим Блейхер]. Эпонимические термины в психиатрии, психотерапии и медицинской психологии. Словарь [Dictionary of eponymous terms in psychiatry, psychotherapy and medical psychology]. Kiev: Головное издательство Издательского объединения «Вища школа» [Headquarters publishers of Publishing Association "Higher school"]; 1984. Russian.
- Bloch, Sidney; Reddaway, Peter. Soviet psychiatric abuse: The shadow over world psychiatry. Westview Press; 1985. ISBN 0-8133-0209-9. p. 40.
- Breggin, Peter. Psychiatry's role in the holocaust. International Journal of Risk & Safety in Medicine. 1993;4(2):133–148. doi:10.3233/JRS-1993-4204. PMID 23511221.
- Danilin, Alexander [Александр Данилин]. Тупик [Deadlock]. Russkaya Zhizn. 28 March 2008 [Retrieved 21 April 2011]. Russian.
- Davidoff, Victor. Soviet Psychiatry Returns. 13 October 2013 [Retrieved 9 January 2014].
- Dmitrieva, Tatyana; Krasnov, Valery; Neznanov, Nikolai; Semke, Valentin; Tiganov, Alexander [Татьяна Дмитриева, Валерий Краснов, Николай Незнанов, Валентин Семке, Александр Тиганов] (eds.). Психиатрия: Национальное руководство [Psychiatry: National manual]. Moscow: ГЭОТАР-Медиа [GEOTAR-Media]; 2012. Russian. ISBN 5970420301. p. 322.
- Fainberg, Victor. My five years in mental hospitals. Index on Censorship. 1975;4(2):67–71. doi:10.1080/03064227508532427.
- Fedenko, Pavel [Павел Феденко]. The BBC Russian Service. Был бы человек, а диагноз найдется [A diagnosis is quickly found to attribute a person with]; 9 October 2009. Russian.
- Gershman, Carl. Psychiatric abuse in the Soviet Union. Society. July–August 1984;21(5):54–59. doi:10.1007/BF02695434. PMID 11615169.
- Gluzman, Semyon [Семён Глузман]. История психиатрических репрессий [The history of psychiatric repression]. Вестник Ассоциации психиатров Украины [The Herald of the Ukrainian Psychiatric Association]. 2013a;(2). Russian.
- Gluzman, Semyon [Семён Глузман]. Снежневский [Snezhnevsky]. Вестник Ассоциации психиатров Украины [The Herald of the Ukrainian Psychiatric Association]. 2013b;(6):79–80. Russian.
- Gluzman, Semyon [Семён Глузман]. Рисунки по памяти, или воспоминания отсидента [Pictures drawn from memory, or the released dissident’s memories]. Kiev: Издательский дом Дмитрия Бураго [Dmitry Burago's publishing house]; 2012. Russian. ISBN 978-966-489-121-6. Snezhnevsky, Andrei [Андрей Снежневский]. Письмо Виктору Некрасову от 12 ноября 1971 [The letter to Viktor Nekrasov of 12 November 1971]. p. 284–289.
- Gluzman, Semyon [Семён Глузман]. Украинское лицо судебной психиатрии [The Ukrainian face of forensic psychiatry]. Новости медицины и фармации [Medicine and Pharmacy News]. 2009;15(289). Russian.
- Healey, Dan. Book Review: Robert van Voren, Cold War in Psychiatry. History of Psychiatry. June 2011;22(2):246–247. doi:10.1177/0957154X110220020802.
- Jargin, Sergei. Some aspects of psychiatry in Russia. International Journal of Culture and Mental Health. 2011;4(2):116–120. doi:10.1080/17542863.2010.519485.
- Katona, Cornelius; Robertson, Mary. Psychiatry at a glance. Wiley-Blackwell; 2005. ISBN 1-4051-2404-0. p. 77.
- Kekelidze, Zurab [Зураб Кекелидзе]. Independent Psychiatric Association of Russia. Кому выгоден миф о карательной психиатрии? (Пресс-конференция проф. З.И. Кекелидзе в связи с направлением на принудительное лечение оппозиционера Михаила Косенко) [For whom is the myth of punitive psychiatry profitable? (Press conference of prof. Z.I. Kekelidze in connection with sending oppositionist Mikhail Kosenko to compulsory treatment]; 22 October 2013 [Retrieved 9 August 2014]. Russian.
- Korinteli, Revaz. Psychotherapy in Georgia: Past, present and future. European Scientific Journal. December 2013;3:257–263.
- Korolenko, Caesar; Dmitrieva, Nina [Цезарь Короленко, Нина Дмитриева]. Социодинамическая психиатрия [Sociodynamic psychiatry]. Moscow: Академический проект [Academic project]; 2000. Russian. ISBN 5829100150.
- Korolenko, Caesar; Kensin, Dennis. Reflections on the past and present state of Russian psychiatry. Anthropology & Medicine. 2002;9(1):51–64. doi:10.1080/13648470220130017.
- Korotenko, Ada; Alikina, Natalia [Ада Коротенко, Наталия Аликина]. Советская психиатрия: Заблуждения и умысел [Soviet psychiatry: fallacies and wilfulness]. Kiev: Издательство «Сфера» [Publishing house "Sphere"]; 2002. Russian. ISBN 966-7841-36-7.
- Krumgold, Raimond [Раймонд Крумголд]. Экспертиза [Examination]. In: Prilepin, Zakhar [Захар Прилепин] (ed.). Лимонка в тюрьму [Limonka to a prison]. Moscow: Центрполиграф [Centerpoligraf]; 2012. Russian. ISBN 978-5-227-03569-1.
- Lavretsky, Helen. The Russian Concept of Schizophrenia: A Review of the Literature. Schizophrenia Bulletin. 1998 [Retrieved 21 April 2011];24(4):537–557. doi:10.1093/oxfordjournals.schbul.a033348. PMID 9853788.
- Merskey, Harold; Shafran, Bronislava. Political hazards in the diagnosis of 'sluggish schizophrenia'. The British Journal of Psychiatry. March 1986;148(3):247–256. doi:10.1192/bjp.148.3.247. PMID 3719218.
- Moran, Mark. Psychiatric Abuses Once Led to Cold War Confrontation. Psychiatric News. 5 November 2010.
- Moseley, Ray. U.S. Group Blasts Soviet Mental Wards. Chicago Tribune. 13 July 1989.
- Nuller, Yuri [Юрий Нуллер]. Структура психических расстройств [The Structure of Mental Disorders]. Kyiv: Сфера; 2008. Russian. ISBN 966-8782-44-5. p. 17–18. See also: Nuller, Yuri [Юрий Нуллер]. О парадигме в психиатрии [On paradigm in psychiatry]. The Bekhterev Review of Psychiatry and Medical Psychology. 1991;(№ 4).
- Ougrin, Dennis; Gluzman, Semyon; Dratcu, Luiz. Psychiatry in post-communist Ukraine: dismantling the past, paving the way for the future. The Psychiatrist. December 2006 [Retrieved 26 January 2011];30(12):456–459. doi:10.1192/pb.30.12.456.
- Pavlova, Svetlana; Polyakovskaya, Elena [Светлана Павлова, Елена Поляковская]. Radio Liberty. Дело Косенко: лечение и возмещение [The case of Kosenko: treatment and compensation]; 28 November 2012 [Retrieved 12 December 2012]. Russian.
- Park, Young Su; Park, Sang Min; Jun, Jin Yong; Kim, Seog Ju. Psychiatry in Former Socialist Countries: Implications for North Korean Psychiatry. Psychiatry Investigation. October 2014;11(4):363–370. doi:10.4306/pi.2014.11.4.363. PMID 25395966. PMC 4225199.
- Pashkovsky, Vladimir [Владимир Пашковский]. О клиническом значении религиозно-архаического бредового комплекса [The clinical meaning of religious-archaic delusions]. Социальная и клиническая психиатрия [Social and Clinical Psychiatry]. 2012;22(2):43–48. Russian.
- Plante, Thomas. Abnormal Psychology across the Ages. ABC-CLIO; 2013. ISBN 0313398372. p. 110.
- Popov, Yuri. Diagnosis of a "Severe Personality Disorder" as a Cause of Criminal Inresponsibility: V.K. Bukovsky. In: Popov, Yuri (ed.). The Bekhterev Review of Psychiatry and Medical Psychology. Washington, DC: American Psychiatric Press; 1992. ISBN 978-0-88048-667-5. p. 69–73.
- Reich, Walter. The world of Soviet psychiatry. The New York Times. 30 January 1983 [Retrieved 1 January 2011].
- Robertson, Michael; Walter, Garry. Ethics and Mental Health: The Patient, Profession and Community. CRC Press; 2013. ISBN 1444168649. p. 84.
- Safina, Nailya [Наиля Сафина]. Нет здоровья без душевного здоровья [There is no health without mental health]. 23 December 2011 [Retrieved 21 March 2012]. Russian.
- Savenko, Yuri [Юрий Савенко]. Латентные формы антипсихиатрии как главная опасность [Latent forms of anti-psychiatry as a major threat]. Nezavisimiy Psikhiatricheskiy Zhurnal [The Independent Psychiatric Journal]. 2010 [Retrieved 26 February 2014];(4):13–17. Russian.
- Savenko, Yuri [Юрий Савенко]. Навстречу МКБ-11 [Toward the ICD-11]. Nezavisimiy Psikhiatricheskiy Zhurnal [The Independent Psychiatric Journal]. 2008 [Retrieved 9 March 2014];(3).
- Sfera, Adonis. Can psychiatry be misused again?. Frontiers in Psychiatry. 9 September 2013;(4):101. doi:10.3389/fpsyt.2013.00101.
- Smulevich, Anatoly. Sluggish schizophrenia in the modern classification of mental illness. Schizophrenia Bulletin. 1989;15(4):533–539. doi:10.1093/schbul/15.4.533. PMID 2696084.
- Smulevich, Anatoly [Анатолий Смулевич]. Малопрогредиентная шизофрения и пограничные состояния [Continuous sluggish schizophrenia and borderline conditions]. Moscow: МЕДпресс-информ [MEDpress-inform]; 2009. Russian. ISBN 5983224891. Глава 1. Клиническое сходство малопрогредиентной шизофрении и пограничных состояний [Chapter 1. Clinical similarity between continuous sluggish schizophrenia and borderline conditions].
- Smulevich, Anatoly; Morozov, Pyotr [Анатолий Смулевич, Пётр Морозов]. Психиатрию нельзя выдумать из головы или из учебников [Psychiatry cannot be invented in mind or textbooks]. Дневник психиатра [The Psychiatrist's Diary]. 2014:1–4. Russian.
- Snezhnevsky, Andrei [Андрей Снежневский]. Письмо Виктору Некрасову от 12 ноября 1971 [The letter to Viktor Nekrasov of 12 November 1971]. Дневник психиатра [The Psychiatrist's Diary]. 2014:12–13. Russian.
- Stone, Alan. Law, Psychiatry, and Morality: Essays and Analysis. American Psychiatric Pub; 1985. ISBN 0-88048-209-5. p. 8.
- Stone, Alan. Psychiatrists on the side of the angels: the Falun Gong and Soviet Jewry. The Journal of the American Academy of Psychiatry and the Law. 2002;30(1):107–111. PMID 11931357.
- Styazhkin, Viktor. Diagnosis of a Paranoiac (Delusional) Personality Development in the Forensic Psychiatric Expert Examination. In: Popov, Yuri (ed.). The Bekhterev Review of Psychiatry and Medical Psychology. Washington, DC: American Psychiatric Press; 1992. ISBN 978-0-88048-667-5. p. 65–68.
- Tarasov, Alexander [Александр Тарасов]. Психиатрия: контроль над сознанием или тем, что от него осталось [Psychiatry: the control over consciousness or what is left of it]. Альманах "Неволя" ["Bondage" Almanac]. 2006 [Retrieved 10 March 2014];(9). Russian.
- Targum, Steven; Chaban, Oleh; Mykhnyak, Serhiy. Psychiatry in the Ukraine. Innovations in Clinical Neuroscience. April 2013;10(4):41–46. PMID 23696959.
- Tiganov, Alexandr [Александр Тиганов] (ed.). Руководство по психиатрии [A manual on psychiatry]. Vol. 1. Moscow: Медицина [Medicine]; 1999. Russian. ISBN 5-225-02676-1.
- Tobin, John. Editorial: political abuse of psychiatry in authoritarian systems. Irish Journal of Psychological Medicine. June 2013;30(2):97–102. doi:10.1017/ipm.2013.23.
- Tyuvina, N,; Balabanova, V. [Н. Тювина, В. Балабанова]. Патокинез эндогенных депрессивно-ипохондрических нарушений непсихотического регистра на фоне терапии сульпиридом [Pathokinesis of endogenous depressive-hypochondriacal disorders of a non-psychotic register in therapy by sulpiride]. Современная терапия психических расстройств [Modern therapy of mental disorders]. 2012;(4):22–26. Russian.
- Vasilenko, N.Y. [Н.Ю. Василенко]. Основы социальной медицины [Fundamentals of social medicine]. Vladivostok: Издательство Дальневосточного университета [Publishing house of Far Eastern Federal University]; 2004. Russian.
- Voren, Robert van. Abuse of Psychiatry for Political Purposes in the USSR: A Case-Study and Personal Account of the Efforts to Bring Them to an End. In: Helmchen, Hanfried; Sartorius, Norman (eds.). Ethics in Psychiatry: European Contributions. Springer; 2010a. ISBN 90-481-8720-6. p. 489–508.
- Voren, Robert van. Political Abuse of Psychiatry—An Historical Overview. Schizophrenia Bulletin. 2010b;36(1):33–35. doi:10.1093/schbul/sbp119. PMID 19892821. PMC 2800147.
- Voren, Robert van [Роберт ван Ворен]. От политических злоупотреблений психиатрией к реформе психиатрической службы [From political abuses of psychiatry to the reform of psychiatric service]. Вестник Ассоциации психиатров Украины [The Herald of the Ukrainian Psychiatric Association]. 2013;(2). Russian.
- Wilkinson, Greg. Political dissent and "sluggish" schizophrenia in the Soviet Union. British Medical Journal. 13 September 1986;293(6548):641–642. doi:10.1136/bmj.293.6548.641. PMID 3092963. PMC 1341504.
- Zharikov, Nikolai; Tyulpin, Yuri [Николай Жариков, Юрий Тюльпин]. Психиатрия: Учебник [Psychiatry: a textbook]. Moscow: Медицина [Medicine]; 2000. Russian. ISBN 5-225-04189-2.
- Bukovsky, Vladimir. To build a castle: my life as a dissenter. Deutsch; 1978b. English. p. 194–223, 259–272, 355–391. Russian text: Bukovsky, Vladimir [Владимир Буковский]. И возвращается ветер… [And the wind returns…]. New York: Хроника [Khronika]; 1978a. Russian. p. 172–198, 233–244, 314–343.
- Ternovsky, Leonard [Леонард Терновский]. Тайна ИГ [The secret of the IG]. Карта: Российский независимый исторический и правозащитный журнал [Karta: Russian Independent Historical and Human Rights Defending Journal]. 1999 [Retrieved 4 February 2014];(№22–23):68–96. Russian.
- Lavretsky, Helen. The Russian Concept of Schizophrenia: A Review of the Literature. Schizophrenia Bulletin. 1998;24(4):537–557. doi:10.1093/oxfordjournals.schbul.a033348. PMID 9853788.
- Voren, Robert van. On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the "Soviet Union" of Vladimir Putin. Amsterdam—New York: Rodopi; 2009. ISBN 978-90-420-2585-1.