Sluggish schizophrenia

Sluggish schizophrenia (or slow progressive schizophrenia) was a fictional diagnosis used (or rather misused) in the former Soviet Union in the decades following the Second World War[1]. It was a political tool that the government employed to oppress anti-Soviet dissenters. The Western psychiatric institutions never recognized the diagnosis.

Doctors used it to describe a supposed form of schizophrenia with a slow, progressive course. However, people could receive a diagnosis even if they showed no symptoms of schizophrenia or psychosis, as doctors would allege that symptoms could appear at any time.

The Institute of Psychiatry of the Academy of Medical Sciences of the USSR defined three forms of schizophrenia depending on whether the condition was continuous, recurrent, or mixed.

According to dubious Soviet research from that era, people with sluggish schizophrenia experienced psychopathy, hypochondria, depersonalization or anxiety. Symptoms included pessimism, poor social adaptation, and conflict with authorities. These were themselves sufficient for a formal diagnosis of 'sluggish schizophrenia with few symptoms'. Patients with sluggish schizophrenia could present as seemingly sane but manifest minimal (and clinically relevant) personality changes which could remain unnoticed by the untrained eye. As recent as 2012, delusion of reformism was mentioned as a symptom of mental disorder in the Russian version of the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM): the 'Психиатрия: Национальное руководство' ('Psychiatry: National Manual').

The term 'sluggish schizophrenia' was introduced in the 1930s by Dr. Grunya Sukhareva (1891-1981), who used the term in a 1933 article in which she described a type of schizophrenia that developed slowly in children beginning before puberty[2]. Next, Andrei Snezhnevsky (1904-1987) 'developed' the diagnostic criteria for sluggish schizophrenia in the 1960s. Psychiatrists and doctors in the USSR and some other Eastern Bloc countries used it until 1989, when the Soviet Union collapsed.

Many experts in the West believe that Snezhnevsky developed the concept of sluggish schizophrenia under instructions from the KGB and the Communist Party. The theory was that anyone who opposed the Soviet regime must be mentally ill, because there was no other reason for their antisocial behaviour. Furthermore, diagnosing individuals with sluggish schizophrenia quickly became a tool for handling political dissent.

The Soviet Union’s approach to mental illness, in general, was quite different from that of the Western world. In the USSR, systemic political abuse of psychiatry took place, and authorities used false psychiatric diagnoses as a tool to suppress political dissent.

Especially individuals, involved in the publication or distribution of anti-state literature (samizdat) or political activism, were targets. Psychiatrists would incarcerate these individuals in maximum security mental institutions or in the Soviet forced labour camp system, better known as the Gulag Archipellago.

Once doctors discharged someone with sluggish schizophrenia, they would have lost their civil rights and would be unable to find employment.

Today, the misuse of psychiatry is making a comeback in Russia. Nothing ever changes, especially in Russia. The same misuse of psychiatry to 're-educate' dissenters is now common practice in China and North Korea.

[1] Zajicek et al: Soviet psychiatry and the origins of the sluggish schizophrenia concept, 1912–1936 in History of the Human Sciences - 2018. See here.
[2] Sukhareva: К проблеме дефектности при мягких формах шизофрении [On the problem of defectiveness in mild forms of schizophrenia] in Nevropatol Psikhiatriia Psikhogigiena - 1933