Skip to main content Accessibility help
Hostname: page-component-559fc8cf4f-z4vvc Total loading time: 0.708 Render date: 2021-02-26T21:23:53.119Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Forensic psychiatry in Russia: past, present and future

Published online by Cambridge University Press:  02 January 2018

Harvey Gordon
Broadmoor Hospital Authority, Crowthorne, Berkshire RG45 7EG
Clive Meux
Oxford Clinic Medium Secure Unit, Littlemore Mental Health Centre, Littlemore, Oxford OX4 4XN
Rights & Permissions[Opens in a new window]


Image of the first page of this article
Creative Commons
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright © Royal College of Psychiatrists, 2000

At the beginning of the 20th century Russian psychiatry had entered a more humane phase, with the leading psychiatrist Korsakow having campaigned against the use of physical restraints for the mentally ill (Reference Bloch and ChodoffBloch & Reddaway, 1977). A successor of Korsakow, Vladimir Serbsky, played a key role in founding the Russian Association of Psychiatrists, campaigned for better social and economic conditions and saw the origins of mental illness as rooted in unjust social and economic conditions in Russian society. In the USSR there was then a new socialisation process aimed at the creation of the new Soviet atheist man (Reference AndersonAnderson, 1994). The Russian Association of Psychiatrists was among the first of the professional bodies to offer its support to the newly formed Soviet Government (Reference LaderLader, 1977). The main forensic psychiatric centre, the Serbsky Clinic, opened in Moscow in 1922 and has assumed a dominant role to this day. Based on Marxist philosophy, crime was seen as a product of capitalism, which would subside under communism (Reference MikheyevMikheyev, 1996). The Soviet view also held that mental illness would decline under communism — hence its ongoing presence was seen as implying a lack of full socialist development of man (Reference FryFry, 1969).

With the passage of time, however, the early humanitarian ideals of the communist system were obscured by the totalitarian aspects of the regime. Repression during the Stalinist period resulted in millions of people being killed or imprisoned (Reference RummelRummel, 1997). Allegations of the abuse of psychiatry for political purposes began to emerge in the 1960s (Reference Bloch and ReddawayBloch & Reddaway, 1977). However, the first case of such misuse in Russia dates from Tsarist times in 1836 with the detention of a Russian philosopher, Peter Chaadayev, who was critical of the regime (Reference Smith and OleszczukSmith & Oleszczuk, 1996). In early post-revolutionary times, psychiatric abuse was also used sporadically to silence political critics. In the mid-1950s a special Soviet commission found that repressive misuse of psychiatry had been occurring for some years, especially in the special hospitals in Kazan and Leningrad (Amnesty International, 1975). During the 1960s with the détente period, however, such abuse had escalated, the Soviet Government requiring methods more acceptable than killing its opponents. Other factors implicated in such misuse have included the application of unduly wide concepts in the diagnosis of schizophrenia, (and the infamous ‘delusions of reform’), the problems within psychiatry itself of defining the boundaries of mental illness, the degree to which some prominent Soviet psychiatrists were influenced by the KGB, and the extent to which they genuinely believed the diagnosis they were making (Reference Smith and OleszczukSmith & Oleszczuk, 1996).

With increasing international concern about Soviet psychiatric practice in regard to dissidents, the Soviet All-Union Society of Psychiatrists resigned in 1983 from the World Psychiatric Association rather than risk expulsion, being readmitted subsequently in 1989 (Reference Bloch and ChodoffBloch & Chodoff, 1991). During the Gorbachov era, political dissenters were released and their potential to be arrested was reduced by amendment of the articles of the criminal code relating to anti-Soviet activity and propaganda. In 1988 the Soviet special hospitals, which had previously been administered by the Ministry of the Interior, were transferred to the Ministry of Health. Even before the fall of communism in 1991 attempts to rectify the aberrant psychiatric practices had been initiated.

During the last eight years the transition from the communist system has not been easy. Economic and political complexity, rising levels of crime (Reference DashkovDashkov, 1992), increases in drug misuse (Reference FlemingFleming, 1991) and a general decline in the health of Russia's general population have been recorded (Reference IngramIngram, 1996). Conditions in Russia's prisons are known to be well below the international standards, and the rectification of this situation will require huge sums of money Russia does not have (Reference LaderKing, 1994).

A link, however, between Britain and Russia in forensic psychiatry has been evolving for over a decade (Reference IngramGordon & Meux, 1994; Reference MikheyevMeux & Gordon, 1996; Reference Bowden and SnowdenBowden & Snowden, 1996). Psychiatrists and other health professionals in forensic psychiatry from both countries have undertaken a series of exchange visits to relevant centres. The visits to Russia have included high, medium and low secure and corrective labour colonies, a medical school and government ministry allowing an unequalled contemporary insight into forensic psychiatry in Russia. The links have culminated most recently in a joint conference in Moscow in October 1998, sponsored by the British Council, and attended by over 160 personnel from throughout Britain and Russia. British psychiatry played a prominent and appropriate role in the condemnation of earlier Soviet practice in regard to the dissidents and it now seems equally appropriate to rebuild the professional relationship. To this end, one Russian forensic psychiatric trainee has attended and completed the Diploma in Forensic Psychiatry course held at the Institute of Psychiatry in London, while another Russian forensic psychiatrist lectured at the Annual Meeting of the Royal College of Psychiatrists, when it was held in Glasgow in 1994 (Reference KachaevaKachaeva, 1995). British psychiatrists have lectured at Russian conferences and broader medical links have been fostered via medical school liaisons. The Russian project coordinator, a professor of forensic psychiatry, recently spent a period as Minister of Health for Russia.

In 1992, the Russian Federation adopted a new law on Psychiatric Care and Guarantees of Citizens' Rights, while in April 1994 the Russian Society of Psychiatrists produced a Code of Professional Ethics (Reference Polubinskaya and BonniePolubinskaya & Bonnie, 1996). The new code is more consistent with international guidelines. Indeed, in this regard Russian psychiatry may be ahead of its British counterpart which has no such specific code. Within the new code the psychiatrist's main role is the health of the patient, while concurrently contributing to the promotion and protection of the mental health of the population as a whole. This contrasts with the perspective during communist times when the doctor gave an oath to communist morality and his responsibilities to the state (Alexeyeff, 1976). The Code seeks to overcome, therefore, the Soviet heritage of the professional community being the agent of State control. Acceptance in the Code of the concept of informed consent is a remarkable reform in Russian psychiatry, requiring psychiatrists to change their attitudes towards their patients and their treatment practices and respect the autonomy of the patient. Stricter guidelines on disclosure of medical information are also encompassed as well as on the use of psychiatric patients in research. Additionally, Russian law now incorporates greater safeguards for the detained patient to appeal against his detention and treatment.

Soviet and post-Soviet practice on the issue of criminal responsibility has evolved in stages during this century. In the early Soviet period, the Serbsky Institute found the mentally ill and many ‘psychopaths’ to have been ‘non-responsible’ for their offences (Reference Bloch and ReddawayBloch & Reddaway, 1977). However, by the 1930s the concept of individual responsibility became more emphasised and far lower numbers of ‘psychopaths’ were felt to be nonresponsible. The Russian special hospitals, known as ‘strict security’ hospitals, mostly contain patients diagnosed as suffering from mental illness, and have fewer ‘psychopaths’ than their equivalents in England and Wales. Up until 1996 an offender could be found to be either responsible or non-responsible, but in the last two years a new law has introduced the notion of diminished responsibility. Unlike the English concept, which applies only to cases of homicide, the Russian law applies to all offences (further details available from the author upon request).

The future of forensic psychiatry in Russia depends on a range of factors, not least of which is the stabilisation of the economy. However, Russia is now also a member of the Council of Europe and a signatory to its convention concerning the prevention of torture and inhumane and degrading treatment. This associated European Committee for the Prevention of Torture and Inhumane or Degrading Treatment or Punishment (CPT) was instrumental in resolving chronic deleterious conditions in certain British prisons within recent years despite all efforts to do so by British professionals (Reference LaderKing, 1994). The first CPT visits to Russia have recently occurred and will seek to identify issues relating to Russian police cells, prisons, psychiatric hospitals and other places of detention, which may be regarded as resulting in brutal, inhumane or degrading treatment. It will, as a result of its visit which has the cooperation of the Russian government, make comments and recommendations for positive change and evolution in these areas. The rising crime levels in Russia will impose great strain on Russia's prisons and the death penalty remains an issue. Russia will need time to reposition itself effectively in the international economic and political community. We have, however, learnt from our professional contacts with Russian psychiatric colleagues that they have a strong desire to be fully integrated in the world psychiatric community. In our view this is best achieved by links being continued, nurtured and enhanced in order to avoid any risk of slippage back into professional isolation. Within Russia itself, the training of psychiatrists and other psychiatric clinicians, particularly nurses, needs to be further fostered. Some decentralisation from the dominance of the Serbsky Institute and other leading centres is also being encouraged, while bearing in mind the forensic psychiatric experience accumulated in such centres. Ultimately however, albeit within an international context, it will be for the Russian psychiatrists themselves, and indeed the Russian people, to fashion for themselves a system of forensic psychiatry of which they can feel proud. Various events and inquiries in Britain over the last two decades have shown just how complex such a process can be.


Thanks to Broadmoor Hospital and the British Council Moscow for practical and financial assistance with this project.


Alexeyev, S. (1976) Abuse of psychiatry as a tool for political oppression in the Soviet Union. Medical Journal of Australia, 1, 122123.Google Scholar
Amnesty International (1975) Prisoners of Conscience in the USSR: Their Treatment and Conditions. London: Amnesty International.Google Scholar
Anderson, J. (1994) Religion, State and Politics in the Soviet Union and Successor States. Cambridge: Cambridge University Press.Google Scholar
Bloch, S. & Chodoff, P. (1991) Psychiatric Ethics (2nd edn). Oxford: Oxford University Press.Google Scholar
Bloch, S. & Reddaway, P. (1977) Russia's Political Hospitals: The Abuse of Psychiatry in the Soviet Union. London: Victor Gollancz.Google Scholar
Bowden, P. & Snowden, P. (1996) Russian forensic psychiatry: Arkhangelsk and Kursk. Journal of Forensic Psychiatry, 7, 13.CrossRefGoogle Scholar
Dashkov, G.V. (1992) Quantitative and qualitative changes in crime in the USSR. British Journal of Criminology, 32, 160166.Google Scholar
Fleming, P.M. (1991) Substance misuse services in the USSR. Psychiatric Bulletin, 15, 689691.CrossRefGoogle Scholar
Fry, J. (1969) Medicine in Three Societies: A Comparison of Medical Care in the USSR, USA and UK. Aylesbury: MTP.Google Scholar
Gordon, H. & Meux, C. (1994) Forensic psychiatry in Russia: a renaissance? Journal of Forensic Psychiatry, 5, 599606.CrossRefGoogle Scholar
Ingram, M. (1996) Russia's health declines. British Medical Journal, 312, 1319.CrossRefGoogle Scholar
Kachaeva, M. (1995) Russian literature and psychiatry. British Journal of Psychiatry, 167, 403406.CrossRefGoogle ScholarPubMed
King, R. D. (1994) Russian prisons after perestroika: end of the Gulag. British Journal of Criminology, 34, 6282.Google Scholar
Lader, M. (1977) Psychiatry on Trial. Harmondsworth: Penguin.Google Scholar
Meux, C. & Gordon, H. (1996) Forensic psychiatry in Russia – further international collaboration required. Criminal Behaviour and Mental Health, 6, 127131.CrossRefGoogle Scholar
Mikheyev, D. (1996) Russia Transformed. Indianapolis, IN: Hudson Institute.Google Scholar
Polubinskaya, S. V. & Bonnie, R. J. (1996) The Code of Professional Ethics of the Russian Society of Psychiatrists. International Journal of Law and Psychiatry, 19, 143172.CrossRefGoogle ScholarPubMed
Rummel, R. J. (1997) Death by Government. London: Transaction Publishers.Google Scholar
Smith, T. C. & Oleszczuk, T. A. (1996) No Asylum: State Psychiatric Repression in the Former USSR. London: MacMillan Press Limited.CrossRefGoogle Scholar
Submit a response


No eLetters have been published for this article.

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 22
Total number of PDF views: 176 *
View data table for this chart

* Views captured on Cambridge Core between 02nd January 2018 - 26th February 2021. This data will be updated every 24 hours.

Open access

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Forensic psychiatry in Russia: past, present and future
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Forensic psychiatry in Russia: past, present and future
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Forensic psychiatry in Russia: past, present and future
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *