An international organization of psychiatrists took an unusual step by adopting standards directed at the use of psychiatry for political purposes. Resolutions took particular aim at Soviet psychiatric practices.
In the 1970’s, growing concerns regarding human rights led psychiatrists to debate the proper role for their professional organizations. Should they emphasize cooperation with their colleagues from other countries, or should they condemn the use of psychiatry for political purposes? Two major milestones in the cautious weighing of these concerns were the drafting and adoption of the Declaration of Hawaii by the World Psychiatric Association (WPA).
Many delegates to the WPA’s Fifth World Congress, held in Mexico City in 1971, were concerned about the misuse of psychiatry for political purposes. Soviet dissidents had called WPA members’ attention to such practices as compulsory hospitalization, involuntary drug injections, beatings, and isolation.
The sponsors of the Declaration of Hawaii were the members of the Ad Hoc Committee on Ethics: Gerdt Wretmark, Clarence D. D. Blomquist (the declaration’s primary author), and Leo Eitinger. The committee opted to emphasize duties of psychiatrists, indirectly promoting the human rights of their patients. The secretariat circulated several versions of the declaration to the member societies of the WPA (then seventy-nine in number). At the 1977 World Congress held August 28 to September 3 in Honolulu, the more than forty-five hundred psychiatrists in attendance received copies of the declaration’s ninth draft. It was debated and adopted by the general assembly, which included delegates, apportioned according to section membership, from the national sections.
The Declaration of Hawaii provides ten guidelines, and its preamble makes clear that these are for “psychiatrists all over the world.” The first guideline declares that “the aim of psychiatry is to promote health and personal autonomy and growth.” This emphasis on autonomy is present throughout the document.
For those cases in which compulsory treatment might be necessary, because of a patient’s lack of capacity, the declaration mandates review by an independent and neutral body. The patient is to be kept fully informed. In the absence of mental illness, psychiatric treatment is forbidden. The declaration includes a feature of the U.S. and Soviet national codes of medical ethics, acknowledging that doctors have a societal responsibility.
The theme of the congress’s opening plenary session was “Ethical Aspects of Psychiatry.” Blomquist’s presentation described the declaration as a blend of the American concern for individual rights with European concern for the common good. Soviet delegate Eduard Babayan emphasized the virtues of his country’s legislation on psychiatry.
The declaration was adopted unanimously and without much debate. By supporting the declaration, the Soviet delegation and members of the secretariat indicated that it provided guidelines that the national sections were responsible for implementing. The Soviet delegation took issue, however, with two other resolutions passed by the assembly.
A lobby critical of Soviet practices had been active well before the Honolulu meeting. Members of the Women’s Campaign for Soviet Jewry picketed WPA secretary-general Denis Leigh’s office and performed a skit depicting Soviet practices. Sidney Bloch
A resolution proposed by the British Royal College of Psychiatry dealt solely with Soviet abuses. The Australasian College of Psychiatry’s substitute proposal condemned all political abuse of psychiatry but made specific reference to Soviet practices. American Psychiatric Association president Jack Weinberg specifically criticized Soviet psychiatry and won passage of a resolution to form an ethics committee to monitor “the misuse of psychiatric skills, knowledge and facilities for the suppression of dissent wherever it occurs.”
The most divisive fight was over the Australasian resolution’s clause condemning the systematic abuse of psychiatry for political purposes in the Soviet Union. Most countries’ delegations opposed it, but because the congress’s voting structure favored the large Western delegations, it passed by a vote of ninety to eighty-eight. The United States cast thirty votes, and the Soviet Union cast twenty-six. Fifty-two of the national psychiatric associations in attendance voted, nineteen in favor of condemning Soviet practices and thirty-three against. Had the Polish delegation shown up, the resolution would have failed. An American resolution urging establishment of a WPA monitoring committee passed by a vote of 121 to 66.
Members of the WPA secretariat were embarrassed by these resolutions. Leigh proposed that national chapters be given discretion in implementing general ethical principles: “Thus we avoid problems connected with religion, national policies, forms of political belief and so forth, and can concentrate on the principles.” He indicated that the U.S. Central Intelligence Agency was participating in a sophisticated disinformation campaign against the Soviet Union. Declaration of Hawaii coauthor Clarence Blomquist also preferred a cautious approach, suggesting that “information and negotiations are better than expulsion and closed doors.”
The world psychiatric community had difficult judgments to make. Would discussion and negotiation persuade Soviet delegate Georgy I. Morozov, chair of the All-Union Scientific Society of Neuropathologists and Psychiatrists (AUSSNP), and his colleagues? The Soviet psychiatrists warned of problems that would be created by “pathological prophets” and “morbidly passionate idealists” who had “delirious ideas of persecution and grandeur, messianism or delusions that they are great reformers or inventors” but who exhibited a “hallucinatory-paranoic syndrome.” Were such claims sincere, or were Soviet psychiatrists simply pawns of the Communist Party and the KGB?
The Declaration of Hawaii’s unanimous adoption made it appear that there was a general consensus among the world’s psychiatrists. The accompanying conference sessions and debates over related resolutions, however, indicated that there was great division.
The Declaration of Hawaii was followed by additional, more specific human rights actions by the WPA. Soviet dissidents used the declaration to illuminate the hypocrisy of the Soviet mental health profession, which endorsed the declaration but violated its guidelines. For example, the declaration requires that patients be kept informed, but operant forms and procedures indicated that important information could not be shared with patients or their families.
Proponents of stronger action included some who wished to nudge the Soviets and others who wished to ostracize them. Amnesty International stated that the WPA’s resolutions condemning political abuses of psychiatry were of major significance. The British Royal College of Psychiatrists set up its own committee to monitor psychiatric abuse in any country. Opponents of stiff measures included the Soviet government and some Western members of the international scientific community. They argued that the WPA resolutions of condemnation criticized the Soviet Union while ignoring other countries’ abuses.
The WPA established a Committee to Review Abuses of Psychiatry, as urged by the Honolulu Congress. The Declaration of Hawaii was one standard used for evaluation. Other standards included the World Medical Association’s Declaration of Helsinki and a Council of Europe recommendation on the mentally ill. Twenty-eight cases were referred to the committee, all concerned with Soviet practices. Many of the individuals’ records had been independently examined, some by consultants to Moscow’s Working Commission for the Investigation of the Use of Psychiatry for Political Purposes
By 1981, the leaders of Britain’s Royal College of Psychiatrists were convinced that Soviet expulsion from the WPA was warranted. At their general assembly a resolution was approved condemning Soviet failure to cooperate with the review committee and recommending expulsion from the WPA until political abuse of psychiatry was ended. Similar sentiments were voiced by the Danish, Australasian, American, and Swiss psychiatric associations. One concern was whether suspension might be more appropriate than expulsion. In January of 1983, the AUSSNP withdrew from the WPA. Every member of the AUSSNP’s board signed a letter castigating the WPA for its alleged campaign of political slander against the Soviet Union.
At the Seventh World Congress, held in Vienna in 1983, delegates acknowledged the withdrawal of the Soviet chapter. Many of them expressed the sentiment that the WPA should return to a focus on scientific exchanges, rather than pursuing matters of politics and human rights. A resolution encouraged the Soviets to return but also indicated an expectation of “evidence beforehand of amelioration of the political abuse of psychiatry.” Honorary membership was given to Dr. Anatoly Koryagin,
Did the WPA measures make a difference? Some observers have argued that once the WPA acted, it prevented escalation of Soviet psychiatric abuse and deterred other Eastern European countries from creating “psychoprisons.” Mikhail Gorbachev’s
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Bloch, Sidney, and Peter Reddaway. Russia’s Psychiatric Hospitals: The Abuse of Psychiatry in the Soviet Union. London: Victor Gollancz, 1977. Provides extensive coverage of the conditions that prompted the WPA to act and of Western responses to Soviet psychiatric practices. Appendixes include a register of victims of Soviet psychiatric abuse, recommendations for combating abuse, and official as well as dissident perspectives on Soviet psychiatry. Index. -
_______. Soviet Psychiatric Abuse: The Shadow over World Psychiatry. Boulder, Colo.: Westview Press, 1984. Thorough discussion of developments in the WPA, from adoption of the Declaration of Hawaii through the Soviet withdrawal in 1983. Appendixes include the Declaration of Hawaii, with the changes made in 1983, and the Soviet psychiatrists’ letter explaining the decision to leave the WPA. Index. -
Blomquist, Clarence D. D. “From the Oath of Hippocrates to the Declaration of Hawaii.” Ethics in Science and Medicine 4 (1977): 139-149. Describes Blomquist’s intentions in drafting the declaration. Compares it with the Hippocratic oath, finding it less paternalistic and less guild-oriented. -
Fireside, Harvey. Soviet Psychoprisons. New York: W. W. Norton, 1979. A readable account of Soviet misuse of psychiatry and of the debate within the World Psychiatric Association. Useful, lengthy appendixes describing Soviet mistreatment. Index. -
Lader, Malcolm. Psychiatry on Trial. London: Penguin Books, 1977. Psychiatrist and former adviser to the WPA attributes many abuses of psychiatry to the imprecision of the discipline’s concepts. Index. -
Psychiatric Annals 8 (January, 1978). Special issue on “ethical aspects of psychiatry” includes articles from the Honolulu congress that are accessible to a general readership. Blomquist discusses some of the concerns incorporated in the declaration; Soviet and German perspectives are also included. -
Smith, Theresa C., and Thomas A. Oleszczuk. No Asylum: State Psychiatric Repression in the Former USSR. New York: New York University Press, 1996. Presents a detailed study of psychiatric abuses in the former Soviet Union based on more than seven hundred cases. -
Wynn, Allan. Notes of a Non-conspirator: Working with Russian Dissidents. London: Andre Deutsch, 1987. A London physician who was active in campaigns against psychiatric abuse describes the actions taken at the Mexico City, Honolulu, and Vienna WPA congresses. Index. -
Ziman, John, Paul Sieghart, and John Humphrey. The World of Science and the Rule of Law. New York: Oxford University Press, 1986. Discusses how different types of scientists have taken part in human rights discussions. Includes a useful list of tactics that professional associations might employ to advance human rights. Suggests that publicizing Soviet psychiatric abuse was successful. Index.
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