Sluggishly progressing schizophrenia
Encyclopedia
Sluggishly progressing schizophrenia or sluggish schizophrenia was a category of schizophrenia
diagnosed
by psychiatrist
s in the Soviet Union
. At the time, Western psychiatry recognized only four types of schizophrenia: catatonic
, hebephrenic, paranoid
, and simple.
The diagnostic criteria for this fifth category were so vague that it could be applied to virtually any person not suffering from mental function impairment and having interests beyond survival needs. The diagnosis was sometimes applied to dissidents who were not in fact mentally ill
, so that they could be forcibly hospitalized in mental institution
s and subjected to treatments including powerful antipsychotic
s and electroconvulsive therapy
.
Sluggish schizophrenia is not included in
the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) but its Russian version is adapted by adding sluggish schizophrenia to schizotypal disorder in F21 of chapter V.
According Robert van Voren, the political abuse of psychiatry in the USSR arose from the conception that people who opposed the Soviet regime were mentally sick since there was no other logical rationale why one would oppose the sociopolitical system considered the best in the world. The diagnosis ‘sluggish schizophrenia,’ a longstanding concept further developed by the Moscow School of Psychiatry and particularly by its chief Andrei Snezhnevsky
, furnished a very handy framework for explaining this behavior.
Although majority of experts agree that the basic group of psychiatrists that developed this concept did so on the instructions of the Soviet secret service KGB
and the party and understood very well what they were doing, this seemed to many Soviet psychiatrists to be a very logical explanation as they were not able to explain to themselves otherwise why someone would be willing to abandon his happiness, family, and career for a conviction or idea which was so different from what most individuals believed or made themselves believe.
Professor A. 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.
The Soviet model of schizophrenia is based on the hypothesis that a single fundamental characteristic, by which schizophrenia spectrum disorders are distinguished clinically, is their longitudinal course. The hypothesis implies that there are three main types of schizophrenia:
This systematization of schizophrenia types attributed to Snezhnevsky is still used in Russia and refers sluggish schizophrenia to the continuous type.
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 referred to as 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 scanty symptoms.’
According to Snezhnevsky, patients with sluggish schizophrenia could present as quasi sane yet manifest minimal but clinically relevant personality changes which could remain unnoticed to the untrained eye. Thereby patients with non-psychotic mental disorders, or even persons who were not mentally sick, could be easily labelled with the diagnosis of sluggish schizophrenia. Along with paranoia
, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters.
As per the theories of Snezhnevsky and his colleagues, schizophrenia was much more prevalent than previously considered since the illness could be presented with comparatively slight symptoms and only progress afterwards. As a consequence, schizophrenia was diagnosed much more often in Moscow than in other countries, as the World Health Organization Pilot Study on Schizophrenia reported in 1973.
In particular, the scope was widened by sluggish schizophrenia because according to Snezhnevsky and his colleagues, patients with this diagnosis were capable of functioning almost normally in the social sense. Their symptoms could be like those of a neurosis or could assume a paranoid character. The patients with paranoid symptoms retained some insight into their condition but overestimated their own significance and could manifest grandiose ideas of reforming society. Thereby, sluggish schizophrenia could have such symptoms as ‘reform delusions,’ ‘perseverance,’ and ‘struggle for the truth.’
As V.D. Stayzhkin reported, Snezhnevsky diagnosticated a reformation delusion for every case when a patient ‘developes a new principle of human knowledge, drafts an academy of human happiness, and many other projects for the benefit of mankind.’
In the 1960s and 1970s, theories, which contained ideas about reforming society and struggling for truth, and religious convictions were not referred to delusional paranoid disorders in practically all foreign classifications, but Soviet psychiatry, proceeding from ideological conceptions, referred critique of political system and proposals to reform this system to delusional construct. Diagnostic approaches of conception of sluggish schizophrenia and paranoiac states with delusion of reformism were used only in the Soviet Union
and several Eastern European countries
.
Someone of those present at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute once asked him a rather provocative question: “Tell us, Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?” Since the question was asked with ironical smile, in the debate, Morozov replied, smiling ironically as well, “You know, dear colleagues, this is a very peculiar disease: there are not delusional disorders, there are not hallucinations, but there is schizophrenia!”
American psychiatrist Alan A. Stone
stated that Western criticism of Soviet psychiatry aimed at Sneznevsky personally, because he was essentially responsible for the Soviet concept of schizophrenia with a ‘sluggish type’ manifestation by ‘reformerism’ including other symptoms. One can readily apply this diagnostic scheme to dissenters.
Snezhnevsky was long attacked in the West as an exemplar 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, including those of the biologist Zhores Medvedev
, the mathematician Leonid Plyushch
, and Vladimir Bukovsky
whom Snezhnevsky diagnosed as schizophrenic on 5 July 1962.
According to Moscow
psychiatrist Alexander Danilin
, the so-called ‘nosological’ approach in the Moscow psychiatric school established by A.V. Snezhnevsky boiles down to the ability to make an only diagnosis, schizophrenia; psychiatry is not science but such a system of opinions and people by the thousands are falling victims to these opinions—millions of lives were crippled by virtue of the concept ‘sluggish schizophrenia’ introduced some time once by Andrei Vladimirovich Snezhnevsky, academician, whom Danilin called a political offender.
St Petersburg academic psychiatrist professor Yuri Nuller
notes that the concept of Snezhnevsky’s school allows, for example, to consider schizoid psychopathy or schizoidism as the early, sluggishly progressing stages of an inevitable progredient process rather than the personality characteristics of an individual, which may not develop along the path of schizophrenic process at all. That results in the extreme expansion of diagnosing sluggish schizophrenia and the harm it has done. Nuller adds that within the scope of the sluggish schizophrenia concept, any deviation from the norm evaluated by a doctor can be regarded as schizophrenia, with all the ensuing consequences for an examinee. That creates ample opportunity for voluntary and involuntary abuses of psychiatry. However, neither A.V. Snezhnevsky nor his followers, according to Nuller, found civil and scientific courage to review their concept that clearly reached a deadlock.
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
diagnosed
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
by psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
s in the Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
. At the time, Western psychiatry recognized only four types of schizophrenia: catatonic
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
, hebephrenic, paranoid
Paranoia
Paranoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
, and simple.
The diagnostic criteria for this fifth category were so vague that it could be applied to virtually any person not suffering from mental function impairment and having interests beyond survival needs. The diagnosis was sometimes applied to dissidents who were not in fact mentally ill
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
, so that they could be forcibly hospitalized in mental institution
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
s and subjected to treatments including powerful antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
s and electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
.
Sluggish schizophrenia is not included in
the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) but its Russian version is adapted by adding sluggish schizophrenia to schizotypal disorder in F21 of chapter V.
Usage
Psychiatric diagnoses such as the diagnosis of ‘sluggish schizophrenia’ in political dissidents in the USSR were used for political purposes. It was the diagnosis of ‘sluggish schizophrenia’ that was most prominently used in cases of dissidents. The leading critics implied that Snezhnevsky had designed the Soviet model of schizophrenia and this diagnosis to make political dissent into a mental disease.According Robert van Voren, the political abuse of psychiatry in the USSR arose from the conception that people who opposed the Soviet regime were mentally sick since there was no other logical rationale why one would oppose the sociopolitical system considered the best in the world. The diagnosis ‘sluggish schizophrenia,’ a longstanding concept further developed by the Moscow School of Psychiatry and particularly by its chief Andrei Snezhnevsky
Andrei Snezhnevsky
Andrei Vladimirovich Snezhnevsky was a Soviet psychiatrist notorious for expanding the diagnostic criteria for schizophrenia, a step that allowed for arbitrary labeling of political dissidents as having sluggishly progressing schizophrenia...
, furnished a very handy framework for explaining this behavior.
Although majority of experts agree that the basic group of psychiatrists that developed this concept did so on the instructions of the Soviet secret service KGB
KGB
The KGB was the commonly used acronym for the . It was the national security agency of the Soviet Union from 1954 until 1991, and was the premier internal security, intelligence, and secret police organization during that time.The State Security Agency of the Republic of Belarus currently uses the...
and the party and understood very well what they were doing, this seemed to many Soviet psychiatrists to be a very logical explanation as they were not able to explain to themselves otherwise why someone would be willing to abandon his happiness, family, and career for a conviction or idea which was so different from what most individuals believed or made themselves believe.
Professor A. Snezhnevsky, the most prominent theorist of Soviet psychiatry and director of the Institute of Psychiatry of the USSR Academy of Medical Sciences
USSR Academy of Medical Sciences
The USSR Academy of Medical Sciences is the highest scientific and medical organization founded in the Soviet Union in 1944.Its successor is the Russian Academy of Medical Sciences founded in 1992....
, developed a novel classification of mental disorders
Classification of mental disorders
The classification of mental disorders, also known as psychiatric nosology or taxonomy, is a key aspect of psychiatry and other mental health professions and an important issue for consumers and providers of mental health services...
postulating an original set of diagnostic criteria.
The Soviet model of schizophrenia is based on the hypothesis that a single fundamental characteristic, by which schizophrenia spectrum disorders are distinguished clinically, is their longitudinal course. The hypothesis implies that there are three main types of schizophrenia:
- the continuous type that is defined as unremitting, proceeding with either a rapid (“malignant”) or a slow (“sluggish”) progression and has a poor prognosis in both instances;
- the periodic, or recurrent type that is characterized by an acute attack followed by full remission with minimal progression, if any;
- the mixed, or shift-like, type (“schubweise” — in German “schub” means phase or attack), a mixture of continuous and periodic types that occurs periodically and is characterized by only partial remission.
This systematization of schizophrenia types attributed to Snezhnevsky is still used in Russia and refers sluggish schizophrenia to the continuous type.
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 referred to as 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 scanty symptoms.’
According to Snezhnevsky, patients with sluggish schizophrenia could present as quasi sane yet manifest minimal but clinically relevant personality changes which could remain unnoticed to the untrained eye. Thereby patients with non-psychotic mental disorders, or even persons who were not mentally sick, could be easily labelled with the diagnosis of sluggish schizophrenia. Along with paranoia
Paranoia
Paranoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters.
As per the theories of Snezhnevsky and his colleagues, schizophrenia was much more prevalent than previously considered since the illness could be presented with comparatively slight symptoms and only progress afterwards. As a consequence, schizophrenia was diagnosed much more often in Moscow than in other countries, as the World Health Organization Pilot Study on Schizophrenia reported in 1973.
In particular, the scope was widened by sluggish schizophrenia because according to Snezhnevsky and his colleagues, patients with this diagnosis were capable of functioning almost normally in the social sense. Their symptoms could be like those of a neurosis or could assume a paranoid character. The patients with paranoid symptoms retained some insight into their condition but overestimated their own significance and could manifest grandiose ideas of reforming society. Thereby, sluggish schizophrenia could have such symptoms as ‘reform delusions,’ ‘perseverance,’ and ‘struggle for the truth.’
As V.D. Stayzhkin reported, Snezhnevsky diagnosticated a reformation delusion for every case when a patient ‘developes a new principle of human knowledge, drafts an academy of human happiness, and many other projects for the benefit of mankind.’
In the 1960s and 1970s, theories, which contained ideas about reforming society and struggling for truth, and religious convictions were not referred to delusional paranoid disorders in practically all foreign classifications, but Soviet psychiatry, proceeding from ideological conceptions, referred critique of political system and proposals to reform this system to delusional construct. Diagnostic approaches of conception of sluggish schizophrenia and paranoiac states with delusion of reformism were used only in the Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
and several Eastern European countries
Eastern Europe
Eastern Europe is the eastern part of Europe. The term has widely disparate geopolitical, geographical, cultural and socioeconomic readings, which makes it highly context-dependent and even volatile, and there are "almost as many definitions of Eastern Europe as there are scholars of the region"...
.
Someone of those present at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute once asked him a rather provocative question: “Tell us, Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?” Since the question was asked with ironical smile, in the debate, Morozov replied, smiling ironically as well, “You know, dear colleagues, this is a very peculiar disease: there are not delusional disorders, there are not hallucinations, but there is schizophrenia!”
American psychiatrist Alan A. Stone
Alan A. Stone
Alan A. Stone is a professor of law and psychiatry at Harvard University. Stone also maintains an interest in cinema, and serves as the film critic for the Boston Review....
stated that Western criticism of Soviet psychiatry aimed at Sneznevsky personally, because he was essentially responsible for the Soviet concept of schizophrenia with a ‘sluggish type’ manifestation by ‘reformerism’ including other symptoms. One can readily apply this diagnostic scheme to dissenters.
Snezhnevsky was long attacked in the West as an exemplar 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, including those of the biologist Zhores Medvedev
Zhores Medvedev
Zhores Aleksandrovich Medvedev is a Russian biologist, historian and dissident. His twin brother is the historian Roy Medvedev.-Biography:Zhores Medvedev and his twin brother Roy Medvedev were born on 14 November 1925 in Tbilisi, Georgia, USSR....
, the mathematician Leonid Plyushch
Leonid Plyushch
Leonid Plyushch is a mathematician and Soviet dissident.- Early life and career :Leonid Plyushch was born into a Ukrainian working-class family in 1939 in Naryn, Kirghizia. His father worked as railway foreman, and was killed at the front 1941...
, and Vladimir Bukovsky
Vladimir Bukovsky
Vladimir Konstantinovich Bukovsky is a leading member of the dissident movement of the 1960s and 1970s, writer, neurophysiologist, and political activist....
whom Snezhnevsky diagnosed as schizophrenic on 5 July 1962.
According to Moscow
Moscow
Moscow is the capital, the most populous city, and the most populous federal subject of Russia. The city is a major political, economic, cultural, scientific, religious, financial, educational, and transportation centre of Russia and the continent...
psychiatrist Alexander Danilin
Alexander Danilin
Alexander Gennadievich Danilin is a Russian psychiatrist and physician-narcologist, author of nine books, numerous articles, lectures and trainings on addiction psychology and existential psychotherapy.He is married and has two sons....
, the so-called ‘nosological’ approach in the Moscow psychiatric school established by A.V. Snezhnevsky boiles down to the ability to make an only diagnosis, schizophrenia; psychiatry is not science but such a system of opinions and people by the thousands are falling victims to these opinions—millions of lives were crippled by virtue of the concept ‘sluggish schizophrenia’ introduced some time once by Andrei Vladimirovich Snezhnevsky, academician, whom Danilin called a political offender.
St Petersburg academic psychiatrist professor Yuri Nuller
Yuri Nuller
Yuri Lvovich Nuller was a Soviet and Russian psychiatrist and professor. He spent many years investigating the problem of anxiety....
notes that the concept of Snezhnevsky’s school allows, for example, to consider schizoid psychopathy or schizoidism as the early, sluggishly progressing stages of an inevitable progredient process rather than the personality characteristics of an individual, which may not develop along the path of schizophrenic process at all. That results in the extreme expansion of diagnosing sluggish schizophrenia and the harm it has done. Nuller adds that within the scope of the sluggish schizophrenia concept, any deviation from the norm evaluated by a doctor can be regarded as schizophrenia, with all the ensuing consequences for an examinee. That creates ample opportunity for voluntary and involuntary abuses of psychiatry. However, neither A.V. Snezhnevsky nor his followers, according to Nuller, found civil and scientific courage to review their concept that clearly reached a deadlock.
See also
- Andrei SnezhnevskyAndrei SnezhnevskyAndrei Vladimirovich Snezhnevsky was a Soviet psychiatrist notorious for expanding the diagnostic criteria for schizophrenia, a step that allowed for arbitrary labeling of political dissidents as having sluggishly progressing schizophrenia...
, a major Soviet psychiatrist who created the concept of sluggish schizophrenia - DrapetomaniaDrapetomaniaDrapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. Today, drapetomania is considered an example of pseudoscience, and part of the edifice of scientific racism...
- Excited deliriumExcited deliriumExcited delirium is a condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature, and superhuman strength...
- Political abuse of psychiatry in the Soviet Union
- The Protest Psychosis: How Schizophrenia Became a Black DiseaseThe Protest Psychosis: How Schizophrenia Became a Black DiseaseThe Protest Psychosis: How Schizophrenia Became a Black Disease is 2010 book written by psychiatrist Jonathan Metzl , and published by Beacon Press, covering the history of the 1960s Ionia State Hospital—located in Ionia, Michigan and now converted to a prison...
External links
- Soviet archives, collected by Vladimir Bukovsky.
- And the Wind Returns, 1978 (И возвращается ветер, in Russian)
- Leonard Ternovsky. (Леонард Терновский): Леонид Плющ. In the book:"ТАЙНА ИГ" (in Russian).