Snezhnevsky, Andrey Vladimirovich

In 1925 he graduated from the medical faculty of Kazan University . He began his medical career in 1925-1926 as head of the department of the Kostroma Psychiatric Hospital.

After serving in the Red Army in 1927–1930 , he was a psychiatrist at the Kostroma boarding school, in 1930–1932 he was a psychiatrist at the dispensary , and from 1932 to 1938 he worked as head physician at the Kostroma Psychiatric Hospital.

Since 1938 - Deputy Director and Senior Researcher at the P. B. Gannushkin Research Institute of Psychiatry in Moscow ^{[note 1]} .

In 1940 he defended his thesis on the topic “Late symptomatic psychoses” ^[2] .

During the Great Patriotic War he took part in the defense of Moscow , in battles on the North-Western and Second Baltic Fronts , was awarded the Order of the Red Star ^{[2] [3]} .

In 1945-1950 he returned to Moscow, where he worked as an assistant professor in the Department of Psychiatry at the Central Institute for the Advancement of Physicians (TsIUV).

In 1949 he defended his doctoral dissertation on the problem of senile dementia ^[2] .

In 1950-1951 he headed the Institute. Serbsky , after which he returned to TsIUV, where he headed the department, whose head he remained until 1964 .

On October 11–15, 1951, at a joint meeting of the enlarged presidium of the Academy of Medical Sciences of the USSR and the Plenum of the All-Union Society of Neuropathologists and Psychiatrists, made a ^{note [Note 2]} with the report “The State of Psychiatry and Its Tasks in the Light of IP Pavlov’s Teaching,” in which he criticized a number of prominent Soviet psychiatrists ( M.O. Gurevich , A.S. Shmarian , R.L. Golant , etc.) for deviating from the teachings of I.P. Pavlov . Criticized psychiatrists were forced to "repent, renounce, as heresy, years of hatched scientific ideas, promise to reform, confess only the teachings of I. P. Pavlov in the form presented by A. G. Ivanov-Smolensky " ^[15] . Despite this, however, in the closing remark, Snezhnevsky stated that they “were not disarmed and continue to remain in the old anti-Paul positions,” causing “heavy damage to Soviet scientific and practical psychiatry,” and N. N. Zhukov , vice president of the USSR Academy of Medical Sciences Verezhnikov accused them of “relentlessly falling into the dirty source of American pseudoscience” ^[16] .

Since 1952 he was editor in chief of the Journal of Neuropathology and Psychiatry. S. S. Korsakova ” ^[2] .

In 1962 he became director of the Institute of Psychiatry of the Academy of Medical Sciences of the USSR, where he worked until the end of his life ^[17] .

In 1962, Snezhnevsky diagnosed " sluggish schizophrenia " V. Bukovsky . According to an interview with Bukovsky,

... sluggish schizophrenia is a diagnosis invented by our domestic, respected psychiatrist Professor Snezhnevsky, and the idea is that schizophrenia can develop so imperceptibly and for so long that only he, Snezhnevsky, can notice it. He diagnosed me with sluggish schizophrenia in the sixty-second year. I am happy to report that it still flows sluggishly ^[14] .

Bukovsky was later examined by Western psychiatrists and declared healthy:

The same thing, he said, applies to dissident Vladimir Bukovsky, who was also declared insane in the USSR and healthy in the West: “I would like you to see his medical history. If we, four or five specialists from our two countries, sat down and studied them together, you would understand that he was sick. ”

I objected. If Grigorenko and Bukovsky really suffered from diseases that he was diagnosed with in the USSR, at least some signs of these ailments should have manifested even after a long time and in a changing social environment.

Original text

The same was true, Vartanyan said, of the dissident Vladimir Bukovsky, who had also been found ill in the Soviet Union and well in the West. “I'd like you to see his hospital records. If we sat down, four or five of us from our two countries, and looked at them, you'd see that he was sick. " I demurred. If Grigorenko and Bukovsky had really suffered from the illnesses that had been diagnosed in the Soviet Union, at least some signs of those illnesses should have been recognizable even after a long period of time and a change in their social surroundings.

- The New York Times , “The World of Soviet Psychiatry” ^[11]

In 1964, a forensic psychiatric examination conducted under the chairmanship of Snezhnevsky recognized the former Major General P. G. Grigorenko , who criticized the Soviet order, as mentally ill. Later, Grigorenko was examined by Western psychiatrists and recognized as healthy ^[11] .

In 1966 in Madrid at the IV World Congress of Psychiatrists A. V. Snezhnevsky in his report on “Classification of forms of schizophrenia” presented to Western psychiatrists the concept of a new form of latent schizophrenia , which is the debut form of the disorder, according to the Eigen Bleiler latent schizophrenia model, however, unlike it, which does not develop, remaining clinically limited only by the initial manifestations, little characteristic of such psychosis as schizophrenia ^[18] . This concept was considered unacceptable by Western psychiatrists, since it significantly expanded the concept of schizophrenia compared with the criteria adopted in other national psychiatric schools. Patients who were diagnosed with latent schizophrenia in Moscow were not considered schizophrenics in the West ^[19] .

In 1972, an expert commission chaired by Snezhnevsky conducted an examination of dissident Leonid Plyushch and confirmed the previous conclusion - a chronic mental illness in the form of schizophrenia ^[13] . Ivy was later examined by Western psychiatrists and recognized as healthy. ^[20]

In 1977, at the congress of the World Psychiatric Association in Honolulu , Hawaii, Andrei Snezhnevsky and his delegation were harshly criticized, and those present majority condemned "the systematic abuse of psychiatry for political purposes in the USSR " ^{[8] [11]} . The resolution , which was aimed at condemning Moscow, was only two votes ahead (90 versus 88) and only because the Polish delegation was absent, and the Soviet representatives who were late in paying the dues were not allowed to use all of the votes allocated to them ^[11] . Snezhnevsky himself at the same congress declared that in the USSR there was not a single case of a healthy person being placed in a psychiatric hospital ^[21] .

In 1980, Snezhnevsky was invited by the Royal College of Psychiatry (UK), of which he was an honorary member, to respond to criticism regarding his role in the examination of Ivy and other dissidents. Snezhnevsky did not accept the invitation, and also announced his refusal of honorary membership in the college ^{[22] [23]} .

He died in Moscow. He was buried at Kuntsevsky cemetery .

A. V. Snezhnevsky made a considerable contribution to understanding the interconnections of various pathological mechanisms in the human psyche. Of greatest interest to him were endogenous ^{[note 3]} (functional) mental disorders and specifically the problem of schizophrenia, which he investigated using a multidisciplinary method involving specialists in the field of clinical psychology , neurophysiology , biochemistry , immunology , pathoanatomy, and neurogenetics ^[24] . The clinic of the most diverse forms of schizophrenia was described comprehensively, conclusions were drawn about the stereotypes of the course of psychoses , the patterns of the general pathological development stereotype, which, according to Snezhnevsky, manifests itself in a consistent and regular change of syndromes , their gradual complication as the disorder progresses ^[25] .

Snezhnevsky and his followers postulated and absolutized the idea of ​​a strictly regular course inherent in the disease process, due to the very nature of the pathogenetic mechanisms underlying it, and independent in the direction of development and sequence of stages from various exogenous and endogenous influences ^[26] . According to Snezhnevsky, each of the psychopathological syndromes expresses a certain level of severity of a mental activity disorder: the most mild is asthenic syndrome , with which all types of mental disorder begin; followed by affective ( depressive and manic ), followed by neurotic syndromes ( hysterical , obsessive , senestopathic - hypochondria , depersonalization , dysmorphophobic ); subsequent deepening of the disorder leads - sequentially - to the development of paranoid , hallucinatory , hallucinatory-paranoid , paraphrenic , catatonic syndromes, dizziness syndromes, convulsive syndromes and a number of psycho-organic disorders. This scale of positive disorders was considered by Snezhnevsky in the framework of the doctrine of a single psychosis ^[27] , however, he noted that the range of syndromes is specific for each nosological unit ^[25] . Positive disorders, in accordance with his concept, exist and are identified in unity with negative ones, and for all mental illnesses the variability of the former and the invariance of the latter are equally found ^[27] .

Snezhnevsky’s concept of symptom complexes and its broad interpretation of sluggish schizophrenia were further developed in the works of A. B. Smulevich : for example, in the book “Low-progressive schizophrenia and borderline states” there is a convergence of sluggish schizophrenia and borderline disorders to justify the assignment of certain borderline states [ to the group of psychoses ^{28] [29]} .

Sluggish schizophrenia

In the West, Snezhnevsky’s personality gained fame thanks to his views on the problem of schizophrenia and schizophrenic spectrum disorders - the expansion of diagnostic boundaries, expressed in practice in expanding the contingent of persons recognized as mentally ill, and increasing the repressiveness of psychiatry ^{[11] [28]} . Thanks to Snezhnevsky, the concept of sluggish schizophrenia proved to be widespread both in the USSR and in a number of other socialist countries ^{[23] [30]} . This concept was not recognized by the international psychiatric community ^[5] and was criticized both by Western ^{[9] [11]} and Soviet psychiatrists ^{[30] [31]} . Proponents of other trends in Soviet psychiatry (especially representatives of the Kiev and Leningrad schools) strongly opposed the concept of Snezhnevsky and the associated overdiagnosis of schizophrenia ^[31] , but the concept of Snezhnevsky gradually prevailed ^[32] .

The concept of sluggish schizophrenia has found wide application in forensic psychiatric examinations of dissidents - examinations that usually ended with conclusions about insanity and forced hospitalizations in special psychiatric hospitals of prison type ^{[9] [11] [28]} . These examinations were carried out not only by colleagues Snezhnevsky from the Institute. Serbsky (followers and students of Snezhnevsky, representatives of the so-called Moscow School of Psychiatry), but also Snezhnevsky himself, in particular, his examination in 1964 by Pyotr Grigorenko ^{[11] [33]} ; participation in the examinations of Zhores Medvedev , Leonid Ivy ^{[11] [31]} , Natalia Gorbanevskaya ^[30] , Vladimir Bukovsky ^{[14] [30]} . In dozens of cases, Snezhnevsky personally signed commission decisions on the insanity of mentally healthy dissidents ^[30] .

Other criticism

According to the editors of the Independent Psychiatric Journal , Snezhnevsky played an active role in opposing various theoretical areas in psychiatry: in the “defeat” of the psychomorphological one (represented by M. O. Gurevich , R. Ya. Golant , A. S. Shmaryan , etc.) and somato-infectious (A. Chistovich, A. Epstein) directions, in "demeaning the psychotherapeutic direction" ^[33] . Representatives of the Independent Psychiatric Association noted that A. V. Snezhnevsky was the leading author of the program report at the devastating Pavlovsk session of 1951 ^{[16] [33]} , which became the climax of the ideological interference of Soviet power in science; as a result of the Pavlovsk sessions, the development of genetics , physiology , psychology, and psychiatry was interrupted for several decades ^[34] .

As noted by the famous Australian psychiatrist S. Bloch and American political scientist P. Reddaway , after the 1951 session, anti-Pavlovian psychiatrists were removed from important posts and either transferred to the province or retired, and the wave that crushed the defeated brought to the top of the medical hierarchy A. V. Snezhnevsky ^[31] .

Psychiatrist Y. Savenko , head of the Independent Psychiatric Association, writes that Snezhnevsky in his writings admitted unmotivated harsh criticism of K. Jaspers and other classics of German psychiatry; in particular, Yu Savenko claims:

In 1952, Snezhnevsky published a monograph by V. Kh. Kandinsky on pseudo-hallucinations , arbitrarily shortening the text, omitting more than a hundred references to foreign authors and quotes from them on the grounds that Russian authors are “much earlier and more progressive,” and “Jaspers with chauvinism characteristic of it ”(!) I’m ready to call sperrings with vestibular disorders of Kloos’s seizures ^{[note 4] [34]} .

Yu Savenko also noted that in 1961, at the direction of Snezhnevsky, the circulation of the scientific collection was destroyed under the editorship of prof. A. L. Epstein ^[34] .

According to Yu. Savenko, excessive biologism was characteristic of Snezhnevsky’s position; Snezhnevsky was the leader of the vulgar-physiological version of psychiatry, the archaic dictionary of which has not changed and has not been updated for several decades. Being a supporter of the Pavlovian direction in psychiatry, he ignored the achievements of modern physiology , the language of which is fundamentally different from the language of the Pavlovian direction, and even the subject of research is understood by them differently. According to Yu. Savenko, Snezhnevsky used not just an outdated concept, but already at that time obviously pseudoscientific views of A. G. Ivanov-Smolensky as a dogma during the seizure of power at the Pavlovsk session in 1951 ^[35] .

Psychiatrist Yuri Nuller pointed out that, despite the wide scope of the studies conducted by the Snezhnevsky school and a number of accumulated clinical observations, this direction later came to a standstill. According to him, Snezhnevsky’s views on the strictly regular course of the disease process, independent of various endogenous ^{[Note 5]} and exogenous ^{[Note 6]} influences, contradict modern ideas about the course of psychosis as the result of many influences and factors; эти представления подтверждаются психофармакологическими и биохимическими исследованиями, а также работами, в ходе которых были использованы методы многомерной статистики. Изучение течения психозов Снежневским и его последователями сводилось, по словам Ю. Нуллера, к сугубо механистическому расчленению клинической картины расстройства на очень большое количество синдромов и попыткам обнаружить строгую закономерность в их смене. ^[26]

Как отмечал Нуллер, гипотеза Снежневского, не будучи достаточно обоснованной даже до уровня теории , превратилась в догму и получила широкое распространение среди советских психиатров, создавая иллюзию полного знания, овладения материалом. В рамках концепции Снежневского и представителей его школы те или иные непсихотические расстройства (например, психопатии ) рассматривались как ранние, замедленные в развитии этапы неизбежного прогредиентного процесса , что приводило к гипердиагностике шизофрении, создавая тем самым возможности для вольных и невольных злоупотреблений психиатрией ^[26] .

По утверждению американского психиатра Уолтера Райха , качество исследований, проводившихся сотрудниками Снежневского, вызывает сомнения. Взгляды Снежневского о строгой наследуемости каждой из выделяемых им трёх форм шизофрении (приступообразно-прогредиентной, непрерывной и рекуррентной) теоретически подтверждались обследованиями многих пациентов и их родственников; но методика исследования страдала существенными изъянами. Диагнозы родственникам ставили те же врачи, которые обследовали и первого пациента, поэтому эксперимент проводился не «вслепую»: врачам-исследователям было известно, кто с кем находится в родстве. Проверяя гипотезу собственного директора, который зачастую выступал непосредственным разработчиком или вдохновителем методики исследований, участники находились под значительным психологическим давлением, их карьера нередко зависела от успешных результатов работы. Эти факторы могли влиять на качество диагностики и обусловливать её необъективность, даже если не было сознательного стремления к подтасовке результатов эксперимента. Райх также отмечал, что сходные исследования в Европе (исследования, основанные на классификации различных форм шизофрении по их клиническим характеристикам) не показали строгой наследуемости тех или иных форм ^[11] .

According to R. van Voren , head of the Global Initiative in Psychiatry organization The 1950 decision to grant a monopoly in psychiatry to the Snezhnevsky Pavlovsk school became one of the factors that determined the use of psychiatry for political purposes in the USSR, and the conditions of the totalitarian regime allowed him to freely implement his plans: well-known psychiatrists who did not agree with him lost their jobs, " some of them were even exiled to Siberia ” ^[36] .

Replies to Criticism

The French psychiatrist J. Garrabe, in his book Histoire de la schizophrénie (History of schizophrenia), emphasizes:

Today, when A. V. Snezhnevsky is no longer there, and he can no longer defend himself, one can easily make him solely responsible for all the evil that arose from the essence of what he described; this, however, was done by some authorized representatives of the Soviet Psychiatric Association at the Athens Congress ^[28] .

The psychiatrist and Honored Doctor of Russia, Doctor of Medical Sciences, Professor F.V. Kondratyev notes that:

The history of Russian psychiatry and personalities is clearly biased, and sometimes slanderous, if you look at materials on the Internet resources coming from Savenko. As an example, you can show that the outstanding figure in psychiatry, the Hero of Socialist Labor acad. A. V. Snezhnevsky is portrayed in Savenko's materials as an unprincipled careerist, anti-Semite , organizer and inspirer of punitive psychiatry. Savenko categorically rejects the conclusion of a commission of stationary examination chaired by Acad. A. V. Snezhnevsky in relation to General P.G. Grigorenko, contrasting him as the "only true" conclusion about the general’s mental health, which was given by a psychiatrist with an experience of only 3 years and not having any training in forensic psychiatry, and this despite the fact that this “examination” was carried out individually, in absentia and, of course, without familiarization with the materials of the criminal case, which is necessary for the examination.

- Kondratiev F.V. Yu.Savenko - detractor of Russian psychiatry // Russian Society of Psychiatrists. - 02/23/2014. Archived December 28, 2014. .

In the Russian educational and methodological literature, the most negative consequences of the psychiatric scientific views of the school of A. V. Snezhnevsky are the loss of people living with a diagnosis of “sluggish schizophrenia” from the social life; hospitalization without their consent during the holidays and state events, as well as the opportunity to receive the stamp “ socially dangerous ” in the history of the disease if a person commits minor offenses . The declaration of dissidents as “insane” and their detention in psychiatric hospitals (places of isolation) is not blamed on Snezhnevsky, since this is the usual practice of the authorities throughout history ^[37] .

A.V. Snezhnevsky himself is credited with allegations that the actions of Soviet psychiatrists helped save a large number of people from prisons, camps, and also from inevitable death, which German psychiatrists did not manage to do at the time of Hitler . With an allusion to justify their own actions, the words of Snezhnevsky are cited: “Both dissenters are alive, and society is cleaner!” ^[37] .

According to an interactive survey conducted in 2005 , a significant percentage of Russian psychiatrists believed that A. V. Snezhnevsky was the author of the psychopathological concept of dividing into positive and negative symptoms. In fact, the modernly accepted concept of positive-negative psychopathological symptoms was proposed at the end of the 19th century by the English neurologist and theorist of medicine John Hewlings Jackson ( 1835 - 1911 ). Even before Jackson, another English doctor, Reynolds, suggested that negative and positive symptoms be distinguished ^[38] .

• About late symptomatic psychoses (1940).
• On the clinical laws of the treatment of mental illness // Bulletin of the Academy of Medical Sciences of the USSR. - 1962. - No. 1.
• Psychiatry. 2nd ed. - M., 1968 (et al.).
• Schizophrenia. Clinic and pathogenesis. - M., 1969 (et al.).
• Schizophrenia. Multidisciplinary research (1972).
• Schizophrenia. - M., 1972 (ed.).
• Handbook of Psychiatry . - M., 1974, 1985 (ed.)
• Guide to Psychiatry (1983).
• General Psychopathology: Lecture Course. - M.: MEDpress-inform, 2001.
• Schizophrenia (lecture series of 1964). - M., 2009. - ISBN 5-98322-408-5 .

• State Scientific Center for Social and Forensic Psychiatry named after V.P. Serbsky
• World Psychiatric Association

Notes

Sources

• Snezhnevsky, Andrey Vladimirovich (Russian) . Site " Heroes of the country ".
• Andrei Vladimirovich Snezhnevsky - 100th anniversary // Journal of the Independent Psychiatric Association. - 2004. - No. 1.
• A. V. Snezhnevsky // " Health ". - 1974. - No. 11.
• Medical necropolis // Grave of A. V. Snezhnevsky at Kuntsevsky cemetery .
• General psychopathology (lecture course) .