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Institute of Fools

Notes From The Serbsky

by Victor Nekipelov (1928-1989)
Farrar, Straus, and Giroux. 1980

A brief review by Nicolas S. Martin
September 2014

Nekipelov was imprisoned in a psychiatric institution (hence Institute
of Fools) for evaluation after authoring some mild criticism of Soviet
officials. In this memoir he describes his own predicament, that of his
fellow inmates, and the nature of his psychiatric prison wardens, as
well as providing some general insight into Soviet psychiatry.

Nekipelov sees that few if any of the psychiatric prisoners are mad. In
many cases they are attempting to avoid responsibility for their lives
or for violations of law that would otherwise have them in brutal
conventional prisons or simply bereft. He notes that

there were almost no real fools at the Institute of Fools. The doctors realized this, of course,
and knew that their main job was exposing malingerers and not diagnosing illness. They
approached each inmate as a potentially sane person who was trying to con them, and this
naturally determined both their attitude and their medical techniques. It was a case of who
could outwit whom.

Soviet psychiatry is a division of the legal system, then, not a legitimate medical enterprise.

The doctors did their job the governments job and winnowed out candidates for the
psychiatric paradise. They were particularly vigilant with people who embezzled state
property, for if they were ruled not responsible, the government would risk not getting its
due from them. Hooligans, rapists, even murderers found it significantly easier to get into
the promised cuckoo land, thereby lowering the Soviet crime rate.

Nekipelovs view of Soviet psychiatry is quite similar to that of some critics of Western
psychiatry, who have characterized it as a pseudoscience that functions both as a punitive arm of
the legal system and a method of relieving people of responsibility. Unlike, say, Thomas Szasz,
Nekipelovs criticisms are not of psychiatry per se, but of the Soviet system, which he believes
lacks the scientific validity of Western psychiatry. Still, some of his observations stray close to a
debunking of the entire psychiatric enterprise. Of the evaluations conducted by the doctors who
diagnosed and treated him and his fellow inmates, Nekipelov writes, I must state right away
that the objective examinations were useless and vague, since in psychiatry there are no precise
and infallible diagnostic methods. The institutionalized were subjected to exams of the sort
usually conducted in clinics, but a digression from general clinical examinations was the
cranial X-ray, which everyone was given even though it has no diagnostic significance. After all,
you cannot see schizophrenia on an X-ray plate. Though it is widely diagnosed throughout the
world, you cannot see schizophrenia through any sort of physiological test. In fact, it is still the
case, as it has always been, that no psychiatric diagnosis can be confirmed by any objective
physiological test. Even psychiatrist Allen Frances, lead editor of the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders (sometimes called the psychiatric
bible) admits that there is no definition of a mental disorder. Its bullshit. I mean, you just
cant define it.

Soviet psychiatry was denounced for its abuses, though not often or loudly by Western
psychiatrists, but Nekipelov inadvertently reveals that it was really quite similar to Western
psychiatry, which is now the global norm. It functions as a powerful means of social control by
medicalization of behavior.

In Soviet criminal theory, responsibility and nonresponsibility are legal concepts.
Responsibility awareness on the part of the person who has committed a crime of both its
circumstances and its social implications is a prerequisite of guilt and therefore entails
criminal punishment. When a person is nonresponsible when he does not realize what he
is doing and is not aware, because of mental illness, of the danger of his actions criminal
amenability and guilt are precluded.

Thus, the person is unwell rather than a criminal.

Nekipelov probably never knew that the most influential post-WWII American psychiatrist had
published a book called The Crime of Punishment fourteen years before his own book was
published, and that Western psychiatrists were aggressively expanding the medicalization of
behavior, which they argued was more humane and compassionate than punishment based on
outdated notions of justice. Nekipelov observes that the legal machinery is cranked up and
those who have committed crimes are referred to an ordinary or special treatment psychiatric
hospital. But this is not deemed by Soviet law to be criminal punishment, even though it is
ordered by a court and executed through the apparatus of repression. Rather it is considered to
be merely a compulsory government measure.

In his 1980 review for the British Medical Journal, prominent British psychiatrist Malcolm
Lader criticizes Nekipelov for writing a book that hardly rises above gossip and tittle-tattle.
Lader predictably defends the Serbsky Institute, saying that the author presents no real
evidence but invariably places the most sinister connotation on events... In another venue
Lader also criticizes Thomas Szasz for his opposition to the power of psychiatrists to cause
people to be detained and imprisoned on psychiatric pretexts.
Inside the battle to dene mental illness, by Gary Greenberg, Wired, December 27, 2010.
Prisoners of psychiatry, by Malcolm Lader, Br Med J. Jul 26, 1980; 281(6235): 298299.
Words to the Wise: A Medical-Philosophical Dictionary, by Thomas S. Szasz, Transaction Publishers, 2004. p. 154.