Coercive psychiatry and human rights: An assessment of recent changes in the Soviet Union

Conclusion In light of the historical context in which the visit of the United States delegation took place, the emphasis was on the political abuse of psychiatry. It should be clear, however, that the repression of dissidents is only the most visible manifestation of a system of psychiatric control that has been, and continues to be, profoundly insensitive to human rights. Although some tentative steps have been taken to subject coercive psychiatry to the rule of law, these limited initiatives have not yet become operational. Implementation of the legal reforms recommended by the delegation would help to reduce the likelihood that the pattern of psychiatric repression will reemerge. But the proposed reforms have a larger purpose—to assure that the practice of psychiatry in the Soviet Union is properly respectful of fundamental human rights, whether or not the patients have engaged in political or religious dissent.This is a revised and expanded version of the Fifth Samuel and Kathryn Yochelson Lecture, delivered at Yale Law School, New Haven, Connecticut, U.S.A., September 28, 1989, and of a paper presented to the Second International Conference on Health Law and Ethics, London, England, July 21, 1989, which paper was reprinted in 18Law, Medicine, and Health Care 123 (1990).B.A., Johns Hopkins University 1966; LL.B., University of Virginia 1969. The author was one of two lawyers who served on an official United States Department of State delegation that visited the Soviet Union (February 26–March 12, 1989) at the request of the Soviet government to assess recent changes in psychiatry there. The U.S. delegation was led by Loren H. Roth, M.D., M.P.H. (psychiatric team leader) and Daniel A. Regier, M.D., M.P.H. (scientific director).This article summarizes the delegation's findings and, in so doing, draws heavily on its report, which was drafted by the delegation as a whole. However, the opinions expressed in this article are the author's and should not be attributed to the delegation.