In the United States, a young man named Hinckley who was obsessed with a certain Hollywood movie star shot Pres. Ronald Reagan in order to impress the young actress. At the trial, after Hinckley's mental condition was put on display, the jury found him not guilty by reason of insanity.
It is unusual for a jury in America to find a defendant NGI. Usually the way it works, as I've seen it over the dedades of criminal practice in San Francisco, is that the defense attorney moves to have the client examined psychiatrically and the court appoints two psychiatrists to perform an evaluation. If they agree that the defendant did not know what he was doing, or that it was wrong, which is the legal test for insanity under the M'Naghton Rule, the prosecution and defense submit the matter for trial on the psychiatric reports, after discussing the matter first with the judge in chambers. The judge finds the defendant NGI and he is sent off to a psychiatric hospital for the criminally insane, but not for longer than the prison term prescribed for the offense charged. After that, the defendant is eligible for release.
If the psychiatrists are in disagreement, the issue of sanity can be tried to a jury. In the first murder case I was assigned to try as a young prosecutor in 1972, the stabbing in a crowded Tenderloin bar by a newly released ex-convict of his new girlfriend, the defense entered a plea of NGI at the start of trial after the jury had been sworn in, which interrupted the jury trial for weeks while the psychiatrists did their thing. They disagreed. At the resulting trial, which took three months, we had a battle of the shrinks. I was forced to do a lot of medical research out at San Francisco General Hospital and U.C. San Francisco. This is where I learned not to be afraid of doctors, or their alleged learning. When a doctor enters a courtroom, he's forced to explain in English, and his opinions are as subject to challenge as a lay witness or police officer. He's on my turf, in other words. I'm okay as long as I've done my homework. It's a terrible thing to see a doctor opining wrong and displaying the flaws in the facts or the analysis, or his pre-existing ideology, on the witness stand.
One of the difficulties with psychiatry for courtroom purposes is that, unlike illnesses caused by bacteria, viruses, and physical wounds, it depends on arguments. Is homosexuality a mental disease or disorder? It was back then, but was later voted out of existence. You can't vote the flu out of existence as a disease, but you can as to homosexuality, depending on the political winds.
What kind of medical science is this?
It's the kind of science which holds that if you cannot get along in society there must be something wrong with you. In many cases this is true. Individuals who believe that God is telling them to drown their children or to enter school houses with guns (we've experience three such cases in the past two weeks alone, one in Amish Pennsylvania), have often experienced a break with reality, unable to see the world the way normal people do. Or there may be other factors, such as the Goth-like boys at Columbine H.S., Littleton, Colorado a decade ago.
How much differentness is within normal limits (WNL) as the psychiatrists call it, and how much is over the line.
In the former Soviet Union, today's Russia in large measure, the official view was that if you were, or remained a dissident, defined as a person who thought differently, meaning from the view that this was a Socialist Paradise, clearly there was something wrong with you. For conducting anti-Soviet activity you could be sent to the Gulag, the remote system of prisons, or instead to a psychiatric hospital where you would be drugged into conformity, medically lobotomized. This is seen as a human rights abuse.
But now that the Soviet Union is no more and Russia is a democratic paradise we no longer have to worry about this, right?
Wrong.
It's baaack! Psychiatric abuse may never have gone away. These Russians are a curious folk. They remind me of us in some ways. No one would ever say that our president is crazy just because he often seems to make no sense despite being a Yale grad. But I have heard sane citizens say that they thought he was totally nuts. Bush, Cheney, Rumsfeld, Rice, seem to be workng off a different agenda than the rest of the world. I hope they're right. We don't make our top leaders take a personality test before being appointed, or after they show disturbing characteristics on the job.
What would we do if we ever had a president who went insane, I wonder. Would removing him be lawful or on the order of staging a coup? Usually when a president becomes too ill to function we hide it. Pres. Woodrow Wilson's wife and his doctor kept him hidden while they ran the show. Which is more unconstitutional, declaring president physically or mentally incompetent, or allowing these unelected people to govern for him?
Amendment 25, ratified 1967, regulating presidential disability and succession, provides that
Whenever the Vice-President and a majority of either the principal officers of the executive departments or such other body as Congress by law may provide, transmit to the President Pro Tempore of the Senate and the Speaker of the House of Representatives their written declaration that the president is unable to discharge the duties of his office, the Vice-President shall immediately assume the powers and duties of the office as Acting President. Sec. 4.
Section 5 provides that the president may contest the above finding and action by transmitting a declaration in opposition in which case he shall resume the powers and duties of his office unless the Vice-President and a majority or either of the above officers or body shall determine otherwise within four days and transmit this finding to the House and Senate as above prescribed. Congress then has 21 days in which to make a finding of incompetence by a 2/3 vote during which the VP continues to act as Acting President, otherwise the president resumes his office.
You can imagine the constitutional crisis this may present such as in a case where the president believes there are people in the world out to get us and the country is divided on what to believe. Reality is defined by more than psychiatrists. It's defined by what you, I, and the other voters believe.
Why leave the important decisions to shrinks, I say, when we have politicians.
Look, no one said the world wasn't a crazy place. It's our job as lawyers to provide the element of sanity between a crazy world and a crazy government. Sometimes we have to use the technique of paradoxical intervention, telling Napoleon in the modern mental ward to clean his room because that's what all good generals do.
The report on the Russian use of psychiatry to cure the mental disease or disorder of political incorrectness is below.
Psychiatric abuse creeps back into Russia
Soviet-style ploy returns as weapon to repress dissent
- Peter Finn, Washington Post
Sunday, October 8, 2006
(10-08) 04:00 PDT Dubna , Russia -- On March 23, police and emergency medical personnel stormed Marina Trutko's home, breaking down her apartment door and quickly subduing her with an injection of haloperidol, a powerful tranquilizer. One police officer put her 78-year-old mother, Valentina, in a storage closet while Trutko, 42, was carried out to a waiting ambulance that took her to the nearby Psychiatric Hospital No. 14.
The former nuclear scientist, a vocal activist and public defender for several years in this city 70 miles north of Moscow, spent the next six weeks undergoing a daily regimen of injections and drugs to treat what was diagnosed as a "paranoid personality disorder."
"She is also very rude," psychiatrists noted in her case file.
In person, Trutko presents a different profile, reserved and formal as she recounts her legal and psychiatric ordeal and invokes the minutiae of Russian law without having to refer to texts. An independent evaluation found that although she did not have an "ordinary personality," she was "very gifted and creative" and displayed no psychiatric symptoms.
Trutko is new evidence that Soviet-style forced psychiatry has re-emerged in Russia as a weapon to intimidate or discredit citizens who tangle with the authorities, according to human rights activists and some mental health professionals. Despite major reforms in the early 1990s, some officials are again employing this form of repression.
"Abuse has begun to creep back in, and we're seeing more cases," said Lyubov Vinogradova, executive director of the Independent Psychiatric Association of Russia, an advocacy group. "It's not on a mass scale like in Soviet times, but it's worrying."
In those years, tens of thousands of dissidents were wrongfully subjected to forced hospitalization, sometimes for years, based on trumped-up diagnoses of schizophrenia. Dissidents were said to exhibit inflexibility of convictions and nervous exhaustion brought on by anti-government activities. "Reformist delusions," the Soviets called it. If you were against communism, in other words, you were insane.
Some of the new cases have been abetted by institutions or doctors involved in it during the Soviet period. Trutko, who is originally from Uzbekistan, was diagnosed at the Serbsky Institute for Social and Forensic Psychiatry in Moscow, one of the most infamous of the Soviet institutions that imprisoned dissidents. It remains a secretive institution that has never faced up to its repressive past, according to human rights groups.
As recently as 2001, the institute's director, Tatyana Dmitriyeva, denied that the Soviet Union engaged in any more psychiatric abuse than Western countries, according to the report "Human Rights and Psychiatry in the Russian Federation" by the Moscow Helsinki Group.
One of signatures on Trutko's official evaluation, which declared she had paranoid personality disorder, is that of Yakob Landau, a longtime Serbsky psychiatrist who headed the institute's notorious Unit No. 4 during Soviet days.
Officials at the institute, a walled and forbidding complex in central Moscow, said no one was available to comment for this article. Investigators in Trutko's case declined to comment.
The charge that psychiatry is again being abused is not universally accepted within the profession. "The problem of forced treatment or psychiatric persecution existed more than 20 years ago, but it was solved. And since then, I haven't heard of any case of forced psychiatric examination or treatment," said Vladimir Rotstein, president of Public Initiative on Psychiatry, an advocacy group.
The Independent Psychiatric Association, however, says that the number of activists being wrongfully hospitalized in mental facilities totals dozens of cases in recent years and is increasing. Doctors and the courts are complicit with investigators who insist on a forced psychiatric evaluation or treatment, it says. Activists also have documented an increase of family or business disputes in which wrongful hospitalization provides an opening to seize a person's property, Vinogradova said.
Most of the targeted activists are not affiliated with major human rights groups. Rather, like Trutko, they are stubborn gadflies who are involved in long-running feuds with local authorities. Their sometimes intemperate complaints against authorities are used to open criminal investigations for slander. This allows authorities to seek hospitalization. Unlike Soviet dissidents, these activists are put away for relatively short periods of a week to several months.
Roman Lukin, a businessman in the Volga River city of Cheboksary, was hospitalized last year for "unexplainable behavior" after he held up a sign on a public square calling three judges "creeps." Seeking redress for a bad debt that ruined him, Lukin felt he had not received justice from the courts. He spent two weeks in the local psychiatric hospital, which recommended that he undergo further examination at a specialized clinic in Moscow for possible "paranoid personality disorder." Independent Psychiatric Association specialists evaluated Lukin and found no sign of mental illness.
Nikolai Skachkov, who protested police brutality and official corruption in the Omsk region of Siberia, was ordered to undergo a psychiatric evaluation last year because investigators said they suspected he was suffering from "an acute sense of justice." He spent six months in a closed psychiatric facility where he was diagnosed as paranoid. The association, which conducted a separate evaluation earlier this year, found that he was healthy.
"Psychiatry in this country has always been a tool of the authorities, a tool for managing people and pressuring people. And it still is," said Boris Panteleyev, head of the St. Petersburg Committee for Human Rights.
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