Home Smell from the mouth Yuri Savenko about punitive psychiatry. Yuri Sergeevich Savenko: biography

Smell from the mouth

Yuri Savenko about punitive psychiatry. Yuri Sergeevich Savenko: biography

Russian psychiatrist, President of the Independent Psychiatric Association of Russia since 1989, Candidate of Medical Sciences, editor-in-chief and one of the regular authors of the Independent Psychiatric Journal, published since 1991

Yuri Savenko's scientific interests and views are characterized by a phenomenological approach to mental disorders and a broad social, historical and cultural orientation.

The main works are devoted to anxiety psychotic syndromes, problems of " psychotic level", the subject of psychiatry, classification of mental disorders, phenomenological method, new scientific paradigm in psychiatry, compensatory personal mechanisms, social danger of the mentally ill, etc. Represented domestic psychiatry at the Congresses of the World Psychiatric Association in Madrid, Hamburg, Yokohama, Cairo, Prague, organized the first domestic symposiums at the congresses of the American and German psychiatric associations.

In 2009, Yuri Savenko addressed the President of the Russian Federation D. A. Medvedev with an open letter, in which he stated a sharp drop in the level of forensic psychiatric examinations as a result of the nationalization of forensic psychiatric expert activities, the lack of competition, and suggested that the President submit a bill to the State Duma for consideration. prepared by members of the Independent Psychiatric Association of Russia.

Case of Yuri Budanov

In 2002, another forensic psychiatric examination was ordered in Budanov’s case. Unlike the previous examination, the commission included not only psychiatrists from the Serbsky Center, but the commission included the former director of the Serbsky Institute G.V. Morozov, under whose leadership political abuses of psychiatry were committed in the 70s and 80s. After public outrage and a protest sent by the Independent Psychiatric Association to the Rostov court, Morozov and three other employees of the Center named after. Serbsky recused himself.

On February 28, 2003, Yuri Savenko, at the request of lawyer E. Kungaeva, presented his conclusion on the validity and balance of the three inpatient comprehensive psychological and psychiatric examinations of Yuri Budanov.

On May 12, 2003, one of the representatives of the Independent Psychiatric Association, Professor of the Moscow Research Institute of Psychiatry, Doctor of Medical Sciences A. G. Gofman, was included in the commission of experts to conduct a repeated comprehensive forensic psychological and psychiatric examination.

In connection with the examinations of Yuri Budanov, Yu. Savenko noted:

Larisa Arap case

In 2007, it became known about the forced hospitalization of an activist Civil Front Larisa Arap. On August 10, Larisa Arap was visited by a commission of doctors from the Independent Psychiatric Association. Yuri Savenko, who headed the commission, confirmed in an interview with the BBC that Arap was indeed ill, but not so sick that her treatment required hospitalization. Savenko noted that Arap does not pose a danger to others and, in his opinion, there were no grounds for involuntary treatment in a hospital. Subsequently, Savenko gave interviews on this matter both in the press and in popular blogs - clinical psychologist Vaughan Bell (MindHacks blog) and journalist

Yuri Savenko defended his doctoral dissertation “Anxious psychotic syndromes”, in which he developed clinical and experimental criteria for the psychotic level for anxiety and melancholic syndromes, but it was not approved by the Higher Attestation Commission due to, as V.N. Krasnov notes, “the then attitudes and atmosphere in the country ". According to Savenko, the dissertation was not approved due to the reform of the Higher Attestation Commission, which politicized the requirements for a doctoral degree: the requirements began to include party membership, a clean dossier and the presence of an appropriate official position.

Member of the development commission (1991-). A consistent opponent of punitive psychiatry.

Savenko represented domestic psychiatry at the Congresses of the World Psychiatric Association in Madrid, Hamburg, Yokohama, Cairo, Prague, and organized the first domestic symposiums at the congresses of the American and German psychiatric associations.

Yuri Savenko is a member of the steering committee of the International Network of Philosophy and Psychiatry.

The scientific interests and views of Yuri Savenko are characterized by a phenomenological approach to mental disorders, a broad social and historical-cultural orientation.

Phenomenological psychiatry requires, according to Savenko, “inner silence”, oblivion of everything not related to this act of comprehension, lack of activity (it is often more productive to “watch and listen from the side” to the conversation of another doctor with a patient), complete concentration of attention on the subject - “not only moment of direct perception, but all “before” and “after”, all hidden, potential, expected sides of an object, that is, on an object taken in its entire semantic field.” An “arbitrary modification of the subject of consideration in various aspects is carried out by mentally placing it in various positions, situations, depriving or adding various characteristics, establishing unusual connections, interacting with other objects, etc. The task is to grasp the invariance of variable characteristics in this game of possibilities, to discern essence “in the form of the constitution of a phenomenon in consciousness during the gradual “crystallization” of its form.”

Finally, a phenomenological description requires care in lexical choice, in particular the selection of terminology, attention not only to the semantics of words, but also to their etymology, their sound and visual image. A later addition to the phenomenological method is the interpretation of hidden meanings, hermeneutics - in fact independent method, which goes beyond phenomenology in the proper sense of the word.

According to Savenko, the method of phenomenological description in clinical psychiatry is the most difficult because it requires " high level critical reflection, integration of phenomenological and inductive units of analysis and consideration in various dimensions." The book by Yu. Savenko “Introduction to Psychiatry” is devoted to the phenomenological method. Critical Psychopathology", published in 2013.

The concept of “mental disorders,” according to Savenko, includes two different dimensions: “norm - pathology” and “health - disease”. The “norm - pathology” continuum represents a measurement of stable internally balanced characteristics and natural age-related, situational development and self-development. The concept of “pathology” includes certain types of reactions that are characteristic of normal life, but within the framework of the pathological they acquire a grotesque, distorted character. The boundaries of the pathological are set by the historically specific social and cultural environment. Within the framework of pathology, in particular, personality disorders, mental retardation, pathological types of sexual behavior, acquired defective conditions resulting from various injuries, intoxications, somatoneurological and mental illness, and so on.

In contrast to “pathology,” the concept of “disease” is considered by Savenko as predominantly medical and biological, differing from “health” primarily qualitatively, not quantitatively; as a destructive process that has its own course: precursors, onset, manifestation, etc. The disease occurs against a certain background, often pathological, but is qualitatively different from it. While the “norm - pathology” spectrum “has the character of a continuum, smooth transitions from one state to another are observed,” the “health - disease” spectrum “is not a continuum and one can note the step-like transitions.”

According to the decision of the Khoroshevsky Intermunicipal People's Court of the North-West Administrative District of Moscow dated May 21, 1997, on the claim of G. P. Yakunin, L. S. Levinson and M. S. Osadchev against A. L. Dvorkin, Yu. S. Savenko, who acted as a witness at the trial on the part of the plaintiffs, stated that there is no connection between the occurrence of mental disorders in individuals and their entry into non-traditional religious organizations. As confirmation, Savenko referred to studies conducted by the Independent Psychiatric Association on the psyche of individual members of the non-traditional religious organization - “Aum Shinrikyo”. At the same time, according to the court decision, Savenko was forced to admit that members of the Aum Shinrikyo organization were selected for assessment of their psyche, although by the doctors themselves, but from among the dossiers on Aum Shinrikyo members presented by the leaders of this religious organization. Psychiatrists of the NPA did not find out the real number of members of the organization; they also do not know on what grounds the information of these particular members of Aum Shinrikyo was selected. In addition, Savenko was unable to explain to the court to what extent the data from the surveyed small number of members of the organization can be extended to the entire group, the total number of which is also unknown to him. At the same time, Savenko admitted that the expert research was carried out on the order of Aum Shinrikyo, which also paid for the work of NPA experts. The court noted that under such circumstances there is no reason to recognize as justified either the testing methods or the conclusions of the Independent Psychiatric Association about the influence of a non-traditional religious organization on the human psyche. The court stated that Savenko’s testimony in this trial was opposed by the testimony of Yu. I. Polishchuk, a professor at the Moscow Research Institute of Psychiatry of the Ministry of Health of the Russian Federation, who relied on the findings of the commission indicating severe mental damage to many members of the sects. Polishchuk together with witness Ph.D. E. N. Volkov showed that open and hidden methods are applied to members of totalitarian sects psychological abuse, manifested in methods of suggestion and induction of certain states, which, according to them, is the basis for sects to control the consciousness of their adherents. The work of the Commission, chaired by Polishchuk, was determined by the court as “truly independent of non-traditional religious organizations and their orders and funds.”

After the court hearing on March 6, 1995, Savenko organized an examination of 30 monks of AUM Shinrikyo by psychiatrists at the request of the “Committee for the Defense of Religion” (president - D. A. Saprykin). In fact, this committee existed under the roof of AUM Shinrikyo, and its president was an active figure in this organization, the personal translator of S. Asahara. The surveys concerned mental state monks The conclusions made by Yu. Savenko do not relate to the mental state of those examined, but to the activities of AUM Shinrikyo: Activities of AUM. in the part we encountered, calling it “antisocial” is inadequate. […] The examinations were not of a commission nature; the protocols of the mental state of the monks did not contain any sociological conclusions. The general conclusion that Savenko drew up was not discussed by the meeting of signatories... psychological pressure was exerted on them by the president of the NPA.

And in his article “Yu. Savenko is a detractor of Russian psychiatry” he noted the following:

Attacks on official psychiatry were clearly evident in the trial of the AUM Shinrikyo sect created by Shoko Asahara. At the same time, in the materials of the prosecutor's office in the Aum Shinrekyo case there is a letter dated May 18, 1995, addressed to the Moscow Research Center for Human Rights by B. L. Altshuler by the former vice-president of the NPA, head of the NPA expert program E. Gushansky. This letter states that “... the activities of Yu. Savenko in defending AUM Shinrikyo is an example of gross politicization of psychiatry and its abuse, which is incompatible with the principles of the Independent Psychiatric Association and the human rights movement. There is no transparency in the legal acts; no reports are carried out on financial activities, the arbitrariness of its chairman, his distrust and ambition reign, gossip is spread and dossiers are collected on its members who are independent in their judgments…. I am dissociating myself from the actions of its president related to the implementation of the order of AUM Shinrikyo... In retaliation for such “dissent,” the NPA unanimously expelled me from the membership of the association.”
At the same time, Yu. S. Savenko clearly showed himself as an expert falsifier. According to the testimony of the same E. Gushansky, Savenko organized an examination of 30 monks of AUM Shinrikyo, prepared by the “Committee for the Defense of Religion” by its president D. A. Saprykin. Savenko was not embarrassed by the fact that this committee existed under the roof of AUM Shinrikyo, and its president was an active figure in this organization and the personal translator of S. Asahara. E. Gushansky writes: “It would seem that the examination should have concerned only the mental state of the monks, however, the conclusions made by Yu. Savenko relate not to the mental state of those examined, but to the activities of AUM Shinrikyo: “The activities of AUM, in the part with which we encountered, calling it “antisocial” is inadequate.” Further, E. Gushansky adds: these “examinations were not of a commission nature, the protocols of the mental state of the monks did not contain any sociological conclusions. The general conclusion that Savenko drew up was not discussed by the meeting of signatories... psychological pressure was exerted on them by the president of the NPA.”

My comment regarding Budanov’s alcoholism was withdrawn at the last moment in the Izvestia newspaper, and the clear argumentation of the leading psychiatrist-prosector, Doctor of Medical Sciences I. A. Oifa, convincingly showing the complete inconsistency of refusing to accuse Budanov of rape, was not added to the case by the court.<…>...The old days have returned... psychiatry is again being used according to scenarios that are not yet old and have not been forgotten. Moreover... this is done by veterans, the very anti-heroes of our subject, who made a somersault forward, publicly repenting of recognizing the “political” as crazy, and then did it back.

Doctor of Psychological Sciences, Professor F. E. Vasilyuk, considering two methods of systematization of “the main transformations of the psychological world” associated with helping a person overcome a critical situation, considers Savenko’s method “more productive” for the reason that “as units of systematization within This approach does not take elementary mechanisms, but “dimensions” of personality, each of which corresponds to a whole cycle of transformations of the psychological world.”

Candidate of Psychological Sciences A.V. Chetverikov considers Savenko’s heuristic approach, used in “solving problems of the internal structure of experiences,” to be “worthy of attention.”

Doctor of Legal Sciences, Doctor of Medical Sciences, Professor of the Russian Medical Academy of Postgraduate Education A. N. Pishita, considering Savenko’s statement that “full protection of the rights of patients is possible only if the doctor’s rights are protected,” indicated that this approach “appears justified.” Subsequently, Pishita also noted the following words of Savenko from an article in 1999: “meanwhile, the rights of a doctor and the very social status of this profession have been reduced to a level unprecedented anywhere and never in history.”

Board Commission Russian society psychiatrists on issues professional ethics consisting of: doctor of medical sciences, professor and head of the department of the Northwestern State Medical University named after I. I. Mechnikov E. V. Snedkov (chairman), chief physician of the St. Petersburg psychiatric hospital (inpatient) of a specialized type with intensive observation V. D. Styazhkin, Chief Physician of City Psychiatric Hospital No. 6 (inpatient facility with dispensary) Ph.D. A. I. Gurina, and invited experts members of the Presidium of the Russian Society of Psychiatrists - Doctor of Medical Sciences, Professor and Head of the Department of Psychiatry, Narcology and Medical Psychology of the ChSMA, Honored Doctor of the Russian Federation N. V. Govorin and Director of the Moscow Research Institute of Psychiatry, Doctor of Medical Sciences. n., Professor V.N. Krasnov, at a meeting on December 12, 2013, having considered the application received by the Board of the ROP of the chief freelance psychiatrist of the Ministry of Health of the Russian Federation, director of the Federal State Budgetary Institution “State Scientific Center for Social Protection of the Russian Federation named after. V. P. Serbsky,” Honored Doctor of the Russian Federation, Doctor of Medical Sciences, Professor Z. I. Kekelidze dated 10/14/2013 and an open letter from the President of the Independent Psychiatric Association of Russia (IPA) Yu. S. Savenko dated 10/31/2013 noted that Savenko, in his numerous appearances in the media, “actively used medical terminology, which listeners of Echo of Moscow, viewers of the Dozhd TV channel, and readers of his numerous statements and appeals cannot evaluate,” and “all texts of Savenko Y.S. are accompanied by intelligible and accusations that are understandable to an inexperienced audience, insults against experts, the expert institution, and the entire psychiatric community,” to which the Commission included the following:

“falsified the type of treatment for the disease”, “deliberately changing the diagnosis […] this is immoral”, “the expert cynically and grossly misled the court”, “... this is what the experts wrote, and rudely, contrary to what they were dealing with”, “this is obvious custom cases", "manipulative use professional knowledge"," "pseudo-expertise", "this verdict was programmed long ago, there was no doubt about it, it is a foregone conclusion", "instead of a neutral position, they take a pro-police position, obediently following the lead of the investigator […] we are faced with yet another pressure from the investigation [... ] corruption of experts,” “this is a case of resurrecting old Soviet practice, reprisals against political opponents […] experts constantly misled the court,” “the gross inconsistencies that I see in the expert report cannot be attributed to unprofessionalism, illiteracy, they are too crude and obvious […] it’s obvious to me that this is such a cruel reprisal that others would be discouraged from wagging their fingers. Like this!"

The Commission also noted that “in her speeches, Savenko makes similar accusations against the psychiatric commission where Kosenko will be treated”: “She is also enslaved. But I think this is a matter of violent shaking, to wag a finger at everyone.” Based on this, the Commission concludes that “The given examples are not the only ones and indicate unacceptably offensive, biased, and sometimes openly slanderous statements by Yu. S. Savenko, who deliberately misinforms society, distorts public opinion, attributing special political goals when experts perform their usual job responsibilities" In addition, the Commission notes that Savenko also admits bias and distortion of meaning in his Open Letter to the Commissioner for Human Rights, where he “defends the essentially absurd opinion that experts should be given the right to assess for themselves whether a crime has occurred or not, and not rely blindly on the facts set out in the court’s ruling” and draws attention to the fact that “Yu. S. Savenko’s accusations against the experts seem false that they”: “considered Kosenko “dangerous to himself and others” on the basis of the exclusively imputed him and unproven guilt”, as well as his statement “over the last 20 years I don’t know of a case when the Center named after. Serbsky admitted his expert error.” The commission also notes that “Similarly, Savenko’s statement about the absence of adversarial experts in court, contained in the open letter, appears to be untenable and erroneous.” The Commission indicates that

Speaking exclusively with his opinion, Yu. S. Savenko declares that he expresses the judgment of the psychiatric community. But who and in what form authorizes him to contact various international institutions with accusations against domestic psychiatrists, conclusions that “psychiatry in Russia is in this moment, as in Soviet times, becomes an instrument of repression,” a demand “to intervene in this case in order to establish the true state of health of M. A. Kosenko and prevent the methods of “punitive medicine” against him and thereby prevent lawlessness and repression.” Such statements discredit domestic psychiatry and insult all specialists working conscientiously in the field mental health.

Savenko Yu. S. grossly violated the norms of professional ethics in his public speeches. Numerous statements, appeals, and speeches by Yu.S. Savenko in the media indicate unacceptable, offensive statements that belittle the honor, dignity and business reputation of both individual experts and the expert institution of the Federal State Budgetary Institution “SSCSP named after. V.P. Serbsky,” and at the same time undermining the authority of the psychiatric community as a whole.

The history of Russian psychiatry is clearly depicted in a tendentious and sometimes slanderous manner based on personalities, if you look at materials on the Internet resources coming from Savenko. As an example, it can be shown that an outstanding figure in psychiatry, a hero socialist labor acad. A.V. Snezhnevsky is depicted in Savenko’s materials as an unprincipled careerist, anti-Semite, organizer and inspirer of punitive psychiatry. Savenko categorically rejects the conclusion of the commission inpatient examination chaired by Academician. A.V. Snezhnevsky in relation to General P.G. Grigorenko, opposing him as the “only correct” conclusion about the mental health of the general, which was given by a psychiatrist with only 3 years of experience and who did not have any training in forensic psychiatry, and this despite the fact that this “examination” was carried out individually, in absentia and, of course, without familiarization with the materials of the criminal case, which is mandatory for the examination.
[…]
And lastly, I, as a Russian psychiatrist, am humiliated by Yu. S. Savenko’s statements that I confessed to him that I was dealing with the problem of sects due to the need to “earn bread”, and - which is completely insulting - after the “false denunciation” of him “every time I tried to kiss him "with him (from "20 years of NAP"). It is bitterly surprising how one can stoop so low for 30 pieces of silver.

Chairman of the Board of the Adyghe Republican (regional) Society of Psychiatrists D.V. Isaeva, according to F.V. Kondratyev in an interview, describes Savenko as follows:

"The position of Mr. Savenko Yu. S., his speeches, articles, at first glance, are bold, almost revolutionary, democratic, and pursue good goals. But... !!! There is a serious speculative, demagogic touch to all this. And sometimes it resembles the position "hunted pursuer." Very advantageous position, criticize everyone, while not being responsible for anything. This is “criticism”. I don’t believe Mr. Savenko Yu. S. Excuse me!

Doctor of Medical Sciences V. Pashkovsky, according to F.V. Kondratyev in an interview, describes Savenko as follows:

“One gets the impression that Savenko was born at the 1948 session of the VASKhNIL, and learned to speak at the Pavlovian session of 1951. Compare. Savenko disagrees with the conclusion of Professor A.G. Sofronov - and immediately a blow to the skull: “by and large, this is a monumental camouflage , hiding the essence of the matter, in relation to which everything else is just an appendix,” Savenko does not agree with the opinion of a number of psychiatrists about the harmful influence of totalitarian sects on mental health - he immediately shouted: “The level of anti-cultist argumentation of professors F.V. Kondratyev, Yu.I. Polishchuk, then P.I. Sidorov - an obvious sign of the decline of domestic psychiatry." "Savenko's Bolshevik fervor does not even keep him from kicking brilliant scientists" ..., "I don’t think that Savenko is a CIA agent, but if so, then I don’t envy his director. CIA agents work more subtly."

In the response of the leadership of the NPA of Russia to the resolution of the Ethics Commission of the ROP Savenko notes that his request to postpone the meeting of the commission, which took place the day before the anniversary congress of the NPA, and to meet together with the Ethics Commission of the Independent Psychiatric Association was not satisfied. Savenko learned about the decision of the Ethical Commission of the Russian Society of Psychiatrists only when it was posted on the ROP website.

According to Savenko, the initial correspondence with the chairman of the Ethical Commission of the ROP, prof. E.V. Snedkov was of a business nature, and only the erroneous sending of a letter concerning the situation with Kosenko and addressed to the World Psychiatric Association to the ROP website led to a “full of indignation” response letter from Snedkov.

Savenko notes that the chairman of the Ethics Commission, prof. E.V. Snedkov ignored the fact that the government had failed for twenty years to comply with Article 38 of the “Law on Psychiatric Care...” (guaranteeing the creation of a Service for the Protection of the Rights of Patients in medical organizations who provide psychiatric care in inpatient settings), which was the subject of the first half of the NPA’s letter to the World Psychiatric Association:

As Savenko points out, the Commission did not take into account a number of facts that, in his assessment, are obvious (“A sharp increase in the severity of the diagnosis made over 12 years and made by experts”, the absence of “evidence of Kosenko’s public danger” and the fact that “the degree of apato -abulsic defect did not prevent Kosenko from withstanding the investigation’s coercion to cooperate”). According to Savenko's conclusion, there is "reason to talk about the return of the Soviet interpretation of schizophrenia, which was three times wider than in the whole world, which facilitated the use of this diagnosis for police purposes."

According to Savenko, a direct violation of the law is the disclosure of the contents at a press conference by Professor Z. I. Kekelidze medical documentation M. Kosenko, since Kosenko did not give consent to this. Meanwhile, representatives of the NPA initially did not name Kosenko in their 2012 publication in the Independent Psychiatric Journal, although they had his personal written permission to “comment on all available information.” It is also indicated that representatives of legal entities had sufficient complete information about the state of Kosenko’s mental health, since the conclusion of the commission of forensic experts (its ascertaining part) is usually drawn up as completely as possible; if “there is something diagnostically highly significant in the medical documentation that is not reflected in the conclusion of the SPE, then this is most likely a falsification, of which we know many examples.”

According to Savenko, “the Soviet spirit is resurrected in this decision of the ROP, which was eloquently not signed by the top officials.”

In conclusion, Savenko makes the following conclusion about the accents present in the “Resolution” and which directly contradict the principles of the NPA:

He also notes that the condemnation of his position by the Ethical Commission of the ROP took place a day after Savenko was awarded the prize by the Moscow Helsinki Group in the nomination “For historical contribution to the protection of human rights and the human rights movement” - in this light, the decision of the ROP looked, according to Savenko, “directly still demonstratively."

Executive Director of the NPA of Russia L.N. Vinogradova spoke about the commission’s decision as follows: “What kind of Ethics Commission is this that considers it possible to consider a case in the absence of one of the parties? Even an incompetent citizen is invited to the court to participate in the hearing.” Vinogradova believes that “the Ethics Commission took care in advance to be able to resolve issues in absentia, unilaterally, the way it needs.” Savenko’s absence at the commission meeting, according to Vinogradova, led to the fact that “the Ethics Commission took on faith everything that its chairman, prof. E.V. Snedkov, including obvious lies,” namely, the absence in the Open Letter of the NPA of Russia to the World Psychiatric Association of those phrases that were attributed to the Independent Psychiatric Association.

L.N. Vinogradova also notes the fact that while the members of the Ethics Commission and invited experts took care of preserving the business reputation of the Center. Serbsky and the “authority of the psychiatric community as a whole,” Savenko maintained contact with Kosenko’s sister and his lawyers, used every opportunity to ensure that a person who, without any doubt, was not dangerous either to himself or to others, had inpatient treatment replaced with outpatient treatment - actions , which are likely to be unethical in the opinion of the Commission.

In an open letter to the Chairman of the Board of the ROP N. G. Neznanov, members of the Ethics Committee of the NPA, famous psychiatrists A. G. Gofman, M. E. Burno and B. A. Voskresensky argue that the “Resolution” of the Ethics Commission of the ROP turned out to be inconsistent and unconvincing due to for the inability to really discuss the topic, analyze the arguments of different sides and exchange opinions, and not just listen to the “indictment” of prof. E. V. Snedkova.

A. G. Goffman, M. E. Burno and B. A. Voskresensky indicate that in their analysis of Savenko’s statements, members of the ROP Ethical Commission used the titles of articles and programs given by journalists (“Kosenko’s diagnosis was taken from the air and deceived the judge,” “The case of Mikhail Kosenko: the return of punitive psychiatry?”, etc.), and cited quotes from articles in which Savenko’s statements could have been changed or sharpened. At the same time, Savenko’s own texts, contained on the NPA website and in the Independent Psychiatric Journal, contain criticism, but do not contain offensive statements. Direct falsification, as stated by the authors of the open letter, is the attribution contained in the “Resolution” to Savenko with the statement that he “expresses the judgments of the psychiatric community.”

The authors of the letter also claim that over the 25 years of the existence of the Independent Psychiatric Association, the organization has constantly contributed to the strengthening and humanization of Russian psychiatry, and express doubt about the conclusion of the Ethical Commission of the ROP, according to which Savenko allegedly “undermines the authority of the psychiatric community as a whole.”

The Duma proposes to forcibly hospitalize people in psychiatric clinics. Today the law allows this to be done only by court decision, but parliamentarians believe that statements from neighbors, relatives and police officers can also become sufficient grounds. Deputy Vadim Solovyov has already sent a corresponding appeal to the leadership of the Prosecutor General’s Office, the Ministry of Internal Affairs and the Ministry of Health. The deputy initiative sends us back to the recent Soviet past, when a person could equally easily be sent to a sobering-up center or a psychiatric clinic. It is no secret that the authorities willingly took advantage of this opportunity in the fight against dissidents. Lenta.ru talked to the developer of the law on how appropriate such initiatives are today and whether they will become the first step towards punitive psychiatry. psychiatric care, President of the Independent Psychiatric Association Yuri Savenko.

Lenta.ru: You came to psychiatry in the mid-1970s, and not just anywhere, but at the Serbsky Institute. How did punitive psychiatry work?

Savenko: On the one hand, in the Criminal Code there was an article on defamation of Soviet power, but even Soviet courts, for various reasons, could not send to the camps everyone who was dissatisfied with something and spoke about it louder than others. But in those years, extensive diagnosis of schizophrenia was practiced. That is, the diagnosis of low-grade schizophrenia could be given to almost anyone whose behavior differed from the norm. Therefore, anyone who spoke critically about the authorities could end up, if not in the dock, then in a forensic psychiatric examination. There, the person was diagnosed with “delusions of social reformism” or “litigious delusions” and sent for compulsory treatment. And believe me, this was not always the lesser of evils. Then the person was released, but the diagnosis remained with him. And as soon as the competent authorities had any suspicions regarding his intentions, the person was sent to a hospital without unnecessary formalities.

Should we fear a return to this practice?

It’s difficult to answer unequivocally. On the one hand, there is no article about slandering the authorities, but low-grade schizophrenia disappeared from the International Classification of Diseases (ICD). Instead, it is now schizotypal disorder, and this diagnosis presupposes fundamentally different social consequences. But slander against the Soviet regime was successfully replaced by articles about extremism and separatism. Their rubber formulations provide our bodies with great capabilities.

So now you can cope without psychiatrists?

In general, yes, but with psychiatrists it’s somehow more familiar. You never know, but the examination is it... But, as practice shows, investigators resort to the services of psychiatrists when their case falls apart. When it is not possible to prove a person’s guilt, but the honor of his uniform or other circumstances require that he be punished. And then the matter is turned towards psychiatry. This is an old trick.

Are there more such cases today?

Their number has gradually increased over the past ten years. We analyze examinations, including those issued by such an authoritative institution as the Serbsky Institute, and in some cases we note a clear order. As sad as it is, this situation is beginning to take on features that are already familiar to us. All this does not yet have a mass character and political overtones, but the mechanisms have long been worked out in numerous property cases. Once the authorities give a signal, this repressive mechanism will fall on those who do not recognize unanimity and unanimity.

It must be hard for them without sluggish schizophrenia?

Not really. We know how to write conclusions. If only there was a person, as they say, there would be a diagnosis. In fact, there are no clear parallels between the diagnosis and social danger. Any psychiatric diagnosis must contain additions regarding risks. Including the risks of aggressive actions. There are, however, absolutely monstrous absurdities, and then the court comes to the aid of such examinations. Our independent expert points out violations and conclusions that contradict basic truths. And the judge says: “You have no right to criticize government experts, and the court has no reason not to trust them.”

How does Deputy Solovyov’s initiative look against this background?

As an attempt to publicize the tragic events in Nizhny Novgorod. Outrageous, hypocritical, cynical. The Mental Health Care Act is a major democratic achievement new Russia. And the core of it is the use of any involuntary measures by court decision.

Let me tell you, this solution is inexpensive...

And yet, this is the line that separates individual unjust decisions and outright lawlessness, when they start arresting everyone with a psychiatric diagnosis for any reason. There is a misconception in society that mentally ill people are dangerous. In fact, they commit crimes less often than healthy people. Another thing is that these crimes look more monstrous.

So, is it normal that the Nizhny Novgorod murderer was walking free? Was there nothing to judge him for?

No, this is not normal. But, firstly, there is no need to confuse two different things. There is compulsory treatment when the court finds a person guilty of a crime and insane. And there is forced hospitalization with court approval, when a person has not committed anything, but simply needs treatment due to a deterioration in his condition. And now, if there is an exacerbation of psychosis in one of our patients, then at the request of relatives, neighbors or passers-by, the police are called, the person is taken to the dispensary, and there a specialist will figure out whether it really makes sense to hospitalize him. If so, then the patient is taken to a psychiatric clinic, and there the emergency department doctor again conducts an examination. And if a person really needs help, he is left in a hospital.

Where is the court?

But if he is left in the hospital, then within five days a judicial commission arrives and makes a decision. Everything has already been thought out and written down. And this parliamentary initiative pushes us to ensure that psychiatry performs purely police functions - protecting society from mentally ill people, while this category is considered the most unprotected and itself needs protection.

It turns out that Deputy Soloviev did not read the law?

It turns out that way. But I don’t know what they are guided by, what they mean by forced hospitalization upon application. If what is already written in the law, then it is stupid. If they are going to exclude the participation of the court, limiting it only to a statement, then it looks so wild that our entire professional community will unanimously protest.

I see you have a good opinion of the professional community.

(Laughs.) There are such questions - they are like a red line. You can't step over it. This is a special case. Everyone understands this.

But if the law is good, why didn’t it work in Nizhny Novgorod? Who made a mistake - psychiatrists or the police?

Neither one nor the other. Our legislators are to blame. With one hand they are trying to correct the law, turning it into a repressive mechanism. And the other gives the go-ahead for health care reform. As a result, psychiatry, which needed doubling its funding, lost half of what it had. Even first aid psychiatric teams halved. The number of beds, the amount of time available for patient treatment, and medications have been reduced. As a result, the prevention of mental illness is catastrophically ineffective, and patients who do end up hospitalized are discharged untreated. So the psychiatrists themselves are the least to blame here.

Who decides how long a person spends in a mental hospital?

Only professionals. The judge only authorizes involuntary treatment. But modern standards are a month. Without any individualization. And all treatment takes place in a shortened mode. Express methods, cheaper drugs, and so on. This is service destruction. After all, a mental disorder is not appendicitis. It takes a long time to heal. And if a person leaves untreated, then there is no point in such treatment: he will very quickly return to his previous state.

Is a psychiatric diagnosis given to a person for life?

No. In a third of cases, even schizophrenia is cured and the diagnosis is removed. But serious diagnoses, of course, accompany a person for many years.

It must be hard to be a dissident with a psychiatric diagnosis?

With such a diagnosis it is not easy at all. Many employers use this argument to refuse applicants. There are other difficulties and limitations. But it will become even worse if a person can be hospitalized without special formalities. The oppositionist was about to hold a protest - and immediately a statement was received complaining about his behavior. Yeah, he's a schizophrenic... Well, then it's worth spending some time in a hospital. For his own good. In general, this proposal is stupid, ill-conceived and extremely dangerous for us.

+ - “Antipsychiatry” by Olga Vlasova (book review) [unavailable]
Unfortunately, the author distances himself from psychiatrists. O.A. refused the offer to speak at our 2010 congress dedicated to the antipsychiatric movement, ignored in her texts the problematic objections and comments of foreign psychiatrists (for example, A. Eya) regarding this movement, passed over our interpretation in silence in 1970 (publication 1991) and in a report at the conference “Philosophy and Psychiatry” in Nice, which Wolfgang Blankenburg in a personal conversation called interesting (NPZh, 1998), and our attempt to outline the theoretical foundations of psychiatry (“Introduction to psychiatry. Critical psychopathology.” - M., 2013) . It is clearly seen that the author in the first volume of “Antipsychiatry” did not even briefly familiarize herself with the domestic psychiatric literature. As a result, even the traditional transcription of names famous psychiatrists was distorted beyond recognition: Jurgen Bleuler instead of Evgeniy or Eugen, Yu. Minkovsky instead of Ezhen Minkovsky, Sakel instead of Zakel, Shash instead of Sas, etc. This is especially clear from the chronological table, careless and completely arbitrary. What is this? Reluctance to engage in discussion? Some kind of purism of a purely philosophical approach? But no, the text is devoid of such character. This is rather a review of the work of leading figures in the antipsychiatric movement.
// NPZh Issue No. 3, 2014
The publication is currently unavailable. http://npar.ru/vypusk-3-2014-g/#otk1
+ - Latent forms of antipsychiatry as main danger
The historically unprecedented scale of use of psychiatry by the authorities to suppress dissent in the Soviet Union led to the fact that the topic of anti-psychiatry was perceived as anti-Soviet. 35 years ago, one of us gave a report at the Moscow Institute of Psychiatry on the system of career guidance and selection in the United States, on dictionaries of professions and professiograms in the language of psychotechnics, that is, based on the results of a study using special batteries of tests. This picture contrasted so much with the Soviet practice of professional selection that the leadership of the Institute considered this report “politically immature” and proposed, as a means of self-rehabilitation, to make a report on anti-psychiatry. In the conditions of that time, this meant denying the psychiatric repression that was obvious to our circle. It was possible to maintain dignity by repeating the pathos and logic of Henri Hey’s famous article “Why am I an anti-anti-psychiatrist?” With the publication of this report, we began publishing the “Independent Psychiatric Journal” in 1991 in order to dissociate ourselves not only from repressive psychiatry, but also from radicalist anti-psychiatry.

// Independent Psychiatric Journal No. 4 2005

Http://www.npar.ru/journal/2005/4/latent.htm
+ - New paradigm in psychiatry
The widespread use of the term paradigm in relation to very different-scale objects leads to the devaluation of this concept. This happens, in particular, when it is used in plural, in relation to various particular representations. The essence of the concept of a paradigm in general and in psychiatry in particular becomes significantly clearer when considering Kuhn's definition and what turned out to be unsatisfactory in it. According to Kuhn, the paradigm is “a standard model for posing problems and solving them, generally recognized in the period between scientific revolutions.” This clear, concise formula contains a fundamental gap. We see in this definition the most eloquent example of how one can pose and solve a problem - in this case, the problem of the scientific paradigm itself - while remaining entirely in the positions of the old paradigm... The fact is that posing problems is the second, and solving problems is the third step any research.

// Independent Psychiatric Journal

Http://psyberia.ru/biblio/psyparadigm.rar http://www.narcom.ru/cabinet/online/102.html
+ - Different understandings of the main problem of psychopathology
The problem that Karl Jaspers called the main problem of psychopathology, with which he actually began his work as a psychiatrist, happily came across the clinical material of delusions of jealousy (1910), which became his pea, not a hawk, and the work on which initiated “ General psychopathology"(1), i.e. contribution to psychiatry comparable to the comparison used - this problem: “personal development or process?” does not appear in the most authoritative modern Russian manual on psychiatry, edited by A.S. Tiganov, either as the main one or even as a problematic one. Meanwhile, it was this question that became the key for distinguishing between paranoid personality development and paranoid delusions, the confusion of which, wittingly or unwittingly, opened the way for psychiatric repression in the 1960-1980s. Moreover, this question leads to a general formulation of psychosis as such.

// Independent Psychiatric Journal No. 1 2006

Http://npar.ru/journal/2006/1/comprehension.htm
+ - Only psychopathologically derived social danger is the subject of psychiatry
The problem of the public danger of persons with mental disorders is usually discussed even by specialists in general view, not only in popular publications, but also in professional literature. Meanwhile, this problem has a fundamentally different meaning in general and forensic psychiatry. It is characteristic that disputes regarding this problem express the tendency of each side to make its position universal, regardless of the completely different empirical basis of this confrontation. The danger to others is:...

// Independent Psychiatric Journal No. 1 2008

Http://www.npar.ru/journal/2008/1/06-savenko.htm
+ - Lessons from Jaspers
Karl Jaspers is not only a transformer of psychiatry, who gave it, paradigmatically, the most modern look; not only the creator of a new type of philosophizing, which widely expanded the philosophical horizon by addressing the most intimate experiences and relationships between people in “borderline situations” of death, suffering, and failure; this is a man who, despite illness and physical weakness, showed an example of fortitude, who lived with dignity even in the conditions of constantly increasing danger and complete powerlessness during the 12 years of Nazism; and who never shied away from a clear answer to the most burning questions of our time, resolutely rejecting the slavish spirit of a totalitarian society.

// Independent Psychiatric Journal No. 3 2003

Http://npar.ru/journal/2003/3/jaspers.htm
+ - Phenomenological interpretation of the unconscious and psychopathology [unavailable]
"Unconscious mental activity“covers such a huge and heterogeneous class of all kinds of processes that there is a danger of devaluation of the term. Moreover, attempts to highlight its universal feature or mechanism are extremely vulnerable. For example, the assertion that the essential positive characteristic of the unconscious is “the fusion of the subject and the world into one indivisible whole” (A.G. Asmolov) conflicts with the detailed arguments of K.G. Jung's idea of a constant dynamic balance in the unconscious of an adult individual of introjection (as an assimilative process leading to the specified unity) and projection (as a dissimilative process). It is enough to point out two types of dreams and two types of disturbances of consciousness (delirium and oneiroid), where the subject is either a participant or an outside observer of the unfolding action. All the more urgent is the need for greater differentiated gradations of the unconscious, regardless of the commitment of many authors to triads...
The publication is currently unavailable. http://anthropology.rinet.ru/old/3/savenko.htm

The President of the Independent Psychiatric Association of Russia, Yuri Savenko, explained to Pavel Lobkov how Russian psychiatric examination is similar to the Soviet one and how the court that sentenced Mikhail Kosenko was wrong.

Lobkov: You took part in the Kosenko case, and as I understand, you had your own expertise.

Savenko: No. In our country, any independent examination, which we understand as adversarial, has been gradually completely destroyed, because all over the world there is competition between experts before the court. But our state expert is a giant uncle, and we are midgets who have no right to evaluate and criticize state experts.

Lobkov: You were at the trial because Ksenia Kosenko told me that you were attracted.

Savenko: As a medical specialist who is invited by a lawyer and asked to comment on an expert opinion.

Lobkov: That is, you were not given expert status?

Savenko: No, only a state forensic psychiatric institution has the right to give it.

Lobkov: How did you evaluate the results of the work of the Serbsky Institute, which conducted an examination, according to the results of which the diagnosis of sluggish schizophrenia was changed to paranoid schizophrenia? Is this a much more serious diagnosis?

Savenko: Certainly. This trial demonstrated the resurrection of old Soviet practice, because an expert from the Serbsky center, summoned to court, spoke quite frankly that sluggish schizophrenia is still schizophrenia, and sooner or later there will be schizophrenia, because this is its stage. Meanwhile, at the end of the 90s, our country joined the international classification of diseases, which shortened the previous practice of three times more frequent diagnosis of schizophrenia by three times, highlighting schizotypal disorder, chronic delusional disorder as independent diseases, as completely independent from schizophrenia diagnoses.

Lobkov: Well, we are not talking about delirium at all in this case, it was not recorded anywhere.

Savenko: Yes Yes.

Lobkov: What was the expertise of the Serbsky Institute, did he report to the court?

Savenko: The fact is that their examination is an outpatient conversation of less than an hour, as it turned out. While he was observed for 12 years at a psychoneurological dispensary, there was a complete development of his disease. He honestly and carefully took his medications, went to the dispensary, and checked in. And suddenly the experts, violating the international classification, do not indicate the type of course, but at the end they write that it is continuous with exacerbations, while he was always diagnosed with sluggish schizophrenia.

Lobkov: Tell me to take a medicine called Sonapax or Thioproperazine for 2 years if this paranoid schizophrenia with exacerbations, would this help keep the patient stable?

Savenko: Of course not. That’s just it, that we find out what colleagues think about a diagnosis not by the diagnosis that is given, but by the treatment, first of all. Treatment was carried out with the mildest children's antipsychotic and a strong antidepressant. And now in Butyrka, in pre-trial detention center No. 2, he is also taking drugs of a completely different kind - mood stabilizers, not antipsychotics. That is, indirectly, doctors admit that there is no nonsense.

Lobkov: By type of service, type of activity, were you in those special psychiatric hospitals, where can they send Mikhail Kosenko?

Savenko: Yes, we visited all the hospitals several times.

Lobkov: What it is?

Savenko: First of all, it must be borne in mind that he has been given a measure of inpatient compulsory treatment general type. This means that he will not end up in these famous hospitals with a strict regime, but in the fifth Moscow city hospital, colloquially Stolbovaya, Troitskaya, which provides compulsory treatment from all over Moscow. But the fact is that the court acted in a highly inhumane manner, because it had the opportunity to prescribe compulsory outpatient treatment rather than inpatient treatment.

Lobkov: Moreover, there was no evidence that he violated the schedule for taking medications; this is reflected in his medical history.

Savenko: Certainly.

Lobkov: That is, the court acted more repressively than required by law, if we take into account that his offense was proven, that if he really threw stones, if he was insane, then there was the possibility of an outpatient determination, right?

Savenko: The court followed the experts’ lead, that’s what the experts wrote, and rudely, contrary to what they were dealing with.

Lobkov: Why do experts need this, do you think? These are independent people, these are psychiatrists with experience, this is the Serbsky Institute, this is the leading psychiatric institute in the country.

Savenko: It is incorrect to say superior-inferior in relation to experts. It's a scam when they rattle this. In fact, due to the congestion in the center of Serbian general level expert opinions are higher, but in landmark cases, high-profile cases, political cases, in cases with VIPs, the opposite is true. A gross violation of elementary rules, and it is impossible to suspect unprofessionalism, how gross it is. A student gets a bad grade for doing this. These are clearly custom cases.

Lobkov: The case of Colonel Budanov can be recalled when at the same institute he was reclassified depending, as I understand it, on political circumstances: either he was sane or he was insane.

Savenko: Yes. We participated in this process.

Lobkov: Did you find traces of a political order there?

Savenko: Not only we, but even Professor RAAS, a member of the editorial board of a Russian psychiatric journal, was forced to publish an open letter in which it is directly stated that it is enough for me to know that there were more than two examinations, there were six of them, to say that your forensic psychiatry is weather vane of power. I can completely agree with this.

Lobkov: The Kosenko case received a lot of attention because it was a capital case and there was a lot of press at the trial. Are there psychiatric repressions in the provinces?

Savenko: They always exist; another thing is that they are designed differently. We went to Yoshkar-Ola a few years ago, it was also a political matter. The young man who announced the rally was taken by the arms of people in civilian clothes these days and held for two days. When we arrived, he had already been released. We talked to him and made sure that he did not need such actions.

Lobkov: Was he simply held for two days, or was he treated with strong drugs, after which even the psychiatrist may not understand whether there was a diagnosis or not?

Savenko: They just held it.

Lobkov: And in the case of the use, as it was written in the memoirs of the 70s, of drugs as punishment, I mean the old antipsychotics, do they exist, or is this story already in the past?

Savenko: Four-point sulfur is prohibited, Majeptyl is not used, Haloperidol is used. But I must tell you that it is still an excellent drug if given adequately as directed and with correctors. And if without correctors, then it really is like torture.

Lobkov: And this is used as torture?

Savenko: No, there is no need to imagine psychiatrists as villains; they are more extreme in these situations. This is our native government, the courts, the anticipation of the development that the authorities want.

Lobkov: But in the situation with Kosenko, do you think the psychiatrists themselves will not run ahead of the locomotive and try to serve the authorities, as often happened in the 70s?

Savenko: Knowing the fifth hospital, I don’t think they will agree to this. There is a general rule there - to review cases every six months, so he is guaranteed to be there for six months. The internal commission reviews, petitions the court, and the court decides again.

Lobkov: Is the commission sufficiently objective?

Savenko: She is also a slave. But I think that this is a matter of violent shaking, in order to wag a finger at everyone.

Lobkov: Today we ask the question of the day: what does sending Mikhail Kosenko for compulsory treatment mean? The first option: punitive psychiatry for dissidents is returned to the country. Second option: Kosenko is a special case, he is really sick and needs to be treated. The third option: it is still unknown what is better - a camp or a hospital, so he was still lucky. And fourth: a system is being tested in which each person can be diagnosed and given an article. The overwhelming majority - 58% - chose the last answer option, the second most popular answer was about dissidents - 36%. What do you think?

Savenko: The fact is that in routine, apartment, property matters, this is a widespread practice of using psychiatry in non- medical purposes, the corruption environment rules the roost here. And political affairs, this is another qualitative difference from the Soviet era, this is not of a mass nature, but of a targeted nature.