A Russian court has sentenced a protester to mandatory psychiatric treatment in a case that has been widely criticized by human rights watchdogs. Mikhail Kosenko, who has been voluntarily seeking mental-health treatment for much of his life and is a productive member of society, was accused of assaulting a police officer during the Bolotnaya riots last May. While Kosenko attended the protests before they were disrupted, the officer whom the court says Kosenko assaulted could not identify him. The testimony of the police officers has been widely criticized, as has the fact that the Russian prosecutors are only saying that two protesters were injured in the riot, despite the fact that the real number is over 60.
A leading Russian psychiatrist has argued that Kosenko is not dangerous, has a treatable medical condition, and has been misdiagnosed by the “experts” called as witnesses for the government.
This article, originally entitled “Reporting from the Madhouse,” was published in The New Times, an independent newspaper. – Ed.
What awaits Michael Kosenko? The New Times tried to find out, in the famous Kaschenko clinic, and in the mental hospital in the village of Troitskoye, in the Chekhov district of the Moscow region, where he is likely to be sent for compulsory treatment.
Moscow psychiatric hospital №1, named after N.A. Alekseev (commonly known as Kashchenko), is almost 25 acres of parkland with a number of red brick buildings scattered around it, some of the structures were built under Nicolay Alexeyev (who was in charge of Moscow in 1885-1893), who collected money from merchants for the construction of the hospital (ironically it was a mental patient who shot Alekseev in his office in 1893).
The wards haven’t been repaired for ages, over the years the yellow paint on the walls has turned gray, vinyl floor covering has holes in many spots and is coming off, although in general it’s quite clean inside, almost no smell of medications: just your typical hospital, except for the bars on some windows. At the entrance there are standard shoe covers, the door to the ward is locked, you must knock and say who you came to visit. No lists or passport checks: nurses know everybody by last name, like kindergarten teachers. They also behave like educators: they all have two faces – the one for visitors is sweet and polite, and the other one, for insubordinate children, is serious and stern. “Rogov, what are you doing over there? Stop making those rattling noises!””Shnurov, you have visitors, come over here.”
It’s just that now, instead of children, unshaven men wearing standard plaid flannel pajamas are wandering through the corridors. They roam around like animals in a cage: back and forth, with no apparent purpose, looking down or staring into space. Visitors cannot go further than half way up the corridor, where three nurses sit on the bench in front of the cafeteria: they don’t let visitors to go any further, calling the patients and sending them into the cafeteria. Here’s where they can take their food: they can take apples and bananas with them to the room, but not grapes. “They always promise to eat everything, but they hide the food and don’t eat it. Food is going bad, and we are checked by health inspectors,” – explains a young nurse wearing an orange robe.
The cafeteria – a not so comfortable room about 30 meters long with plywood panels on the walls and a distribution station covered by white flaps. No bars on the windows, but no handles either, so you can’t open them. At the six tables patients sit with their visitors, and between the tables a handsome guy, who looks like Jack Nicholson, strolls back and force aimlessly. Under one of the tables are packages that had been apparently brought to him. Some of this food he won’t be able to take with him to the ward, and he doesn’t know what to do with it, so sometimes he shifts cookies and fruit from one package to another, steps back, looks at them, comes close again, pulls out a bar of “Babaevsky” dark chocolate, unwraps it, stares at it, but does not eat it, then wraps it up again, and puts it back in the plastic bag. At the next table an elderly couple is sitting. An imposing man with slicked-back gray hair, wearing a suit and holding a cane, and his fussy wife who brought a thermos of soup for her son, a thin, intellectual-looking man, wearing big ridiculous glasses that make him look like a nerd from a movie about a high school. As expected from a nerd, he has a loser buddy, a bald… rowdy kind of guy he invited to the table to share this homemade soup with him. The parents do not mind, only a trace of disappointment on the father’s face. At the window a heavy woman of about 50 came to visit her 30-year-old son, who is saying something very loudly and very incoherently, but the mother understands every word. She learned this language. “You must be hot, she says, take off your t-shirt, you are wearing too much of everything.” The son gets up and drops his chair. It’s not the first time he does it. The Loser at the next table shouts at him, the guy shuts up and cringes, in frightful shudders. Jack Nicholson walks towards a corner, looking down at the floor. Suddenly a big dark-haired guy, sitting at the next table and speaking Armenian to his mother, turns around and says angrily to the Loser: “Leave him alone, don’t touch him,”. The Loser snaps back at him: “What do you care?”. It’s obvious he does it only to save face, not to start a fight. The Armenian turns around and stares at him, the Loser shuts up. Jack Nicholson sits back down at his table and pulls out a chocolate from a plastic bag.
Come visit us again
The patient we’ve come to visit, Alexei, had been transferred here, in Kashchenko, not so long ago. Before he was in a different hospital, Gannushkin. “It was better in Gannushkin , he says, they showed compassion for me, the staff was not so strict, they did not lock the rooms.” Here the rooms are locked during the day. As a nurse explains, this is done because the patients who sleep all day long do not sleep at night, walking around and smoking all night long. “I used to lay in bed and think about my frail life,” says Alexei. “Now there isn’t even a place to sit down, since morning you have to walk up and down the hall all day long.” Here they get up at seven in the morning and go to breakfast. Then it’s time for treatment procedures or free time, walking under the supervision of medical staff, lunch at about 1 pm, dinner at half past five, and at 10 pm everybody has to be off to bed. “The food is not tasty,” complains Alexei. While he speaks, he greedily eats grapes, which are not allowed in the room, picking berries with nervous slender fingers with long nails broken off at the edges: he cannot cut his nails himself, just like he cannot brush his teeth or shave. Alexei is 54, his parents died, he was declared insane and institutionalized. Now he is in custody of the state, waiting for a place in a hostel, but there is no place available, and his apartment was confiscated by the state.
The wards are for 12 people, everyone has a bedside table and a personal place in the refrigerator. Although, of course, food brought by relatives is not accounted for, so it’s like in a prison: those who are stronger, get more. Shower time is once a week. Each ward has its day assigned: if for one it’s Monday, the next one showers on Tuesdays, and so on. Bedsheets and pajamas are changed once a week as well, and the wards are cleaned daily. Smoking is not allowed, but you can get cigarettes from a nurse, cell phones are not allowed, but you can make a call from the doctor’s office. “I do not call anybody,” says Alexei, “even if I really needed to, I would still be afraid to ask her, she might get furious.”
Finally, the visitation time is over. “Okay, you fed yours, now let us feed ours,” says the nurse entering the cafeteria. We walk out into the hallway. “Rodionov!” the nurse suddenly shouts angrily. “What do you have there in your bag?” Jack Nicholson turns around, comes back and shows her what’s in the bag: sandwiches with salami and the half-eaten chocolate bar. “Okay, tomorrow I’ll come to check on you to make sure you ate it all,” says a nurse, “now go.” Nicholson slumps and walks away. Alexei stares at me and says: “Have you ever been a patient in a mental hospital?” — “No”. — “Oh, okay. Well, you know… come visit us again.”
Hospital Number Five
However, Mikhail Kosenko will never end up in the showcase hospital named after Alexeyev. There are no patients here who have been sentenced to compulsory treatment. But what makes special hospitals different from the ordinary ones is the security and a special visitation regime, that in turn depends on whether the institution is of a general type or specialized, where high-risk patients or those who committed serious crimes are placed. According to Yuri Savenko, the president of the Independent Psychiatric Association of Russia, Kosenko is likely to be sent to the psychiatric hospital №5, located 50 km away from Moscow in Troitskoye.
Troitskoye is a typical village outside Moscow, with dachas (summer houses) and five-floor apartment buildings, dilapidated industrial structures and a renovated white church. The hospital is located in the center of the village. Next to the entrance there are rows of employees’ cars and a bus stop. From here you can get to “Yuzhnaya” metro station. On the outside the hospital in Troitskoye looks very much like Kaschenko: a high brick fence, behind which you can see facades of last century brick buildings between yellow fall foliage. No watchtowers, no barbed wire over the fence – just a strict pass entry system. The patients can only be visited by their immediate family.
However there are no relatives in sight. Most come during the weekend – it’s an hour drive from Moscow in light traffic. The hospital employees leave the building in small groups – it’s a shift change. Many of them walk towards the bus stop, some of them get in the taxis waiting nearby, some are picked up by their husbands. “We have a good hospital, it’s clean, says one, the food is good, plenty of doctors, at the first sign of someone getting sick, a doctor comes to check the patient, outside walks are twice a day, each ward has its own garden. If you have a question about your patient, come another day directly to the administration, all issues can be resolved.” “My wife works here”, explains a man, waiting for his wife at the wheel of an Audi SUV. “It’s a great hospital, do not worry. In the turbulent nineties, the mobsters used to lay low here, to avoid getting locked up, or being shot. My mother-in-law also used to work here. She would bring home such robes, you can’t find in stores.” In general, everybody is happy with their job: it’s clean, great food, most advanced medications. They say you can even use a personal computer, if the administration permits.”Of course, we have people here with three university degrees.” Next to the entrance is a small grocery store. Ludmilla, has been working here for the last 10 years, and her father also worked in the hospital. “Things happen, she says, we had escapes too, of course. But people being tortured, or malpractice – that is something that never happened here. The only problem is too many people, but the availability of beds is limited.”
Overcrowding at the hospital in Troitskoye was also pointed out by experts from the Independent Psychiatric Association of Russia, who visited the facility in December 2010. Their report stated that at the time of their visit for 2,000 hospital beds (1,540 are for compulsory treatment in a specialized-type ward, and 420 for a general type, where Kosenko will be placed) there were almost 2,300 people. In the rooms 16 to 28 beds stood right next to each other, many patients had to sleep in the corridor. Instead of the legally mandated 7,5 m2 per patient there were just 3 m2. One of the biggest problems for many patients was the shortage of bedside tables. When you don’t have any personal space, and you have to share a single bedside table with your neighbor, it becomes an endless source of irritation and conflict. Since more than half of the patients had committed violent crimes, from time to time there are fights between the patients, even attacks on the personnel and doctors. In 2005, one of the patients of the hospital, armed with a kitchen knife, took hostage a barmaid, and barricaded himself in the cafeteria. During the assault carried out by law enforcement officers, the patient was shot and killed, and later the barmaid told reporters that the assailant had sharpened his knife all night long, and kept saying that if he would stab her with a sharp knife, it wouldn’t hurt. However, it is unlikely that Kosenko will end up next to killers: they are kept in a high-security specialized ward.
The New Times was able to talk with one of the doctors working in the Hospital №5, who asked not to be identified, because contacts with the press are strictly prohibited. According to the psychiatrist, despite the fact that the conditions in the hospital are not as comfortable as in Kaschenko, relatives can visit every day. In general the regime is not very strict, especially since they are understaffed, and the security guards are on duty only at the specialized ward (which is why escapes are not uncommon). According to the same doctor, no major changes should be expected in the treatment course for Kosenko: if over the last 12 years he has been taking light medications, like weak neuroleptic drugs such as Sonopax, and antidepressants like Zoloft, it is unlikely that he will be prescribed some more potent drugs.
Birds of a feather
Yuri Savenko is sure: experts who evaluated Kosenko disregarded every conceivable standard of medical ethics, when they substituted the diagnosis of sluggishly-progressing neurosis-like schizophrenia for paranoid schizophrenia, “In the Soviet Union, to be diagnosed with schizophrenia was three times more likely than in the rest of the world, says the psychiatrist. But in the late 90s Russia adopted the international classification of diseases, where schizophrenia is roughly divided into three categories: sluggishly-progressing neurosis-like schizophrenia was renamed schizotypal disorder, paranoid schizophrenia was reclassified to chronic delusional disorder, and the third one was schizophrenia proper. So in the international classification of diseases, that we have adopted as a standard, it is clearly stated, that sluggishly-progressing schizophrenia is not even a schizophrenia, and its old name is mentioned only in a footnote. This schizotypal disorder, in particular, did not imply hospital treatment.” According to Savenko, by stating that it is not within the competence of an expert to decide whether Kosenko’s condition would get worse while he is institutionalized, the expert from the Serbsky Center displayed an extremely high degree of cynicism: “It’s about the general context of how it is perceived. Kosenko takes this sentence as punishment, as punitive, rather than curative psychiatry. So anything that a person who ended up there voluntarily would perceive as medical treatment, for Kosenko would be torture. He is accustomed to solitude, to a different way of life, for him this reprisal would be an ordeal.”
In addition, there is a danger that constant contacts with patients with more severe abnormalities may result in the condition of Michael Kosenko getting worse. There is a medical concept of induced delirium, when a patient is kind of “infected” with other patients’ delusions, and starts to behave exactly the same. “All these stories that in the Soviet Union psychiatrists were saving dissidents from labor camps are complete nonsense, says Yuri Savenko. We asked some people back then, and the vast majority would say they’d rather end up in prison. There is only one explanation: there you know exactly for how long you are there, but in a hospital your life is a total uncertainty, and this is the worst.”
It’s not so simple. As The New Times found out, many of today’s criminals, on the contrary, try to be placed in a hospital, rather than prison: you don’t have to work, you can escape therapy, and you would typically be released much earlier than if you were serving time in prison (for example, in Chekhov hospital patients were discharged on average in 2.5-3 years, however this was estimated from the data on actually discharged patients, as there are patients who have been there for 15-20 years). However we are not talking about dissidents, but rather about defendants in criminal cases. For example, Evgeni P., who in 2000 was charged under Article 208 of the Criminal Code (organizing an illegal armed formation or participation therein), was found insane and sent to the Kaluga regional psychiatric hospital, where he spent about a year, “If you have a short prison term, like 2-3 years, it is certainly better to serve it. But if you got more, a hospital might be a better option, Evgeni told us. You come to Serbsky Center, and a doctor asks you: “So, where do you want to be, in prison or with doctors?” I chose the doctors, and they sent me there. And in Kaluga, where my doctor was a friend of a friend, they didn’t treat me there at all, they just waited until the first inspection and then released me.”
According to Yuri Savenko, psychiatrists who are also human rights activists will be watching Michael Kosenko and how he is treated, and will make every effort to ensure that he goes home after the first medical panel. So far, however, it looks that political prisoners in Russia are joined again by political mental patients, and Michael Kosenko has just joined the club of such famous patients, as Pyotr Chaadayev, General Pyotr Grigorenko and Vladimir Bukovsky.
“And the wind returns”
“In a short time dozens of people were declared mentally incompetent, usually the most persistent and consistent. Something that the troops of the Warsaw Pact, prisons and camps, interrogations, searches, loss of work, blackmail and intimidation could not do, became real thanks to psychiatry. Not everyone was willing to lose his mind, to end up in a madhouse for the rest of his life, subject to barbaric treatment. At the same time, in this way the authorities managed to avoid exposing trials. The insane are tried in absentia, behind closed doors, and the merits of a case are not even considered. It was almost impossible to struggle for the release of an insane person. Even the most unbiased person, who is not familiar with such a “patient” would always have doubts as to that person’s mental competence. Who knows? Anybody can go crazy /… / ”
“On special psychiatric hospitals (“madhouses”)
“What is scary about a psychiatric hospital for a mentally healthy person is the fact that he is placed among people with a deformed psyche. But no less terrible are complete powerlessness and hopelessness. A SPB (special psychiatric hospital. – The New Times) “patient” is even deprived of those meager rights that are available to prisoners. He has no rights at all. Doctors can do to him whatever they want, and no one will interfere, no one will help, none of his complaints or complaints of those who are with him, will ever leave the hospital. He has only one hope – that the doctors are honest.
/… / It is especially hard to realize this total uncertainty [over the amount] of time a person will spend in this position. The doctors have some minimum standards. They are not known to me. However, I know for sure that murderers are kept there for at least five years. They say that in this regard political patients are put in the same category with murderers. But if they do not repent, they might never be released.”
“The Catcher in the lie”
“Three times a day I was given Triftazin and quickly brought to neuroleptic shock. Why did I take it? If you refuse to take pills you are subject to injections. If you resist, it would mean that you will be held, bound and undressed by male nurses. After one such experiment, I realized that if it happens again, I will not live. Triftazin would trigger a deep depression, total loss of appetite, I did not eat for three weeks. I was always sleepy, but could not sleep. I could not lie down, sit, walk, stand /… / I could neither read nor write. Handwriting has changed beyond recognition, letters wouldn’t come out well. There were memory lapses. To somehow get distracted, I was making pens together with the “loonies” during occupational therapy, but could not sit for a long time.” (On treatment by psychiatrists in 1986)
Photos: Ruslan Krivobok / RIA Novosti, Vladimir Filonov / Fotoimedia