‘Compulsory medical measures’ How punitive psychiatry returned to Russia in wartime

With Russian political prisoners making headlines for going free, it’s important to shine a light on those still stuck in the system. Hundreds of people are languishing in prisons for opposing Russia’s war against Ukraine, not to mention the thousands of Ukrainian civilians and prisoners of war Moscow is holding hostage. What’s more, amid this wartime crackdown on dissent, Russia has witnessed the return of punitive psychiatry, one of the darkest means of repression in the Soviet toolkit. For the independent media cooperative Bereg, journalist Kristina Safonova set out to investigate how political prisoners in Russia end up in the psychiatric system and why it’s so hard to get them out. This translation of her reporting has been abridged for length and clarity.

The following is an abridged translation that appeared in The Beet, a weekly email dispatch from Meduza covering Central and Eastern Europe, the Caucasus, and Central Asia. Sign up here to get the next issue delivered directly to your inbox.

In December 2023, 56-year-old human rights activist Olga Suvorova was arrested at the Krasnoyarsk airport. She had just returned from Moscow, after taking part in a meeting in support of anti-war candidate Yekaterina Duntsova’s presidential campaign. Investigators charged Suvorova with making a knowingly false denunciation — a felony offense that carries up to three years in prison. Then, they took her to a psychiatrist for an outpatient examination.  

Her conversation with the psychiatrist, Galina Zhukovskaya, lasted no more than half an hour. The doctor asked Suvorova detailed questions about the criminal charges, her human rights work, and her attitude towards Vladimir Putin and the “special military operation” (the Kremlin’s preferred euphemism for Russia’s full-scale invasion of Ukraine).

In her notes, Zhukovskaya wrote that Suvorova was “fixated on her desire to help others” and “categorically denied” the charges against her. But most importantly, she wrote that Suvorova showed “signs of an unspecified mixed personality disorder” and recommended admitting her to a psychiatric clinic so doctors could diagnose her properly. 

“[Their] main task was to put me in a mental hospital so I’d become more compliant,” Suvorova maintained. Before the psychiatric evaluation, the investigators had told her the same thing several times: “You plead guilty, and all this is over.” 

‘A feature of our time’

Since the February 2022 invasion of Ukraine, Russia has adopted a raft of repressive laws and sharply ramped up politically motivated criminal prosecutions. In a growing number of these cases, judges have declared the defendants mentally incompetent and ordered “compulsory medical measures” — Russian legalese for involuntary psychiatric treatment. 

“The frequency of such rulings grew five-fold in 2023 compared to the average number in 2021–2022,” the investigative outlet Agentstvo reported in May, citing data from the human rights groups OVD-Info, Department One, and Memorial. According to online court records, Russian judges have ordered involuntary treatment in at least 86 cases since February 2022. “This is a feature of our time that’s associated not with psychiatry but with the socio-political situation,” said clinical psychologist and human rights activist Lyubov Vinogradova.

Though forensic psychiatric evaluations are only mandatory for certain crimes, Russian investigators can order them at their discretion. These outpatient examinations — colloquially referred to as a pyatiminutka, which literally translates as “five minutes” — can take anywhere from a few minutes to a few hours and sometimes involve psychological tests. The doctors, in turn, have to answer three questions:

• Does the person have a psychiatric disorder?
• At the time the crime was committed, could the person understand what they were doing and take into consideration the public danger of their actions?
• If not, does the person require compulsory medical treatment?

If the doctor can’t provide answers based on the outpatient examination, they refer the defendant to a psychiatric hospital for a weeks-long evaluation. “This is an early diagnostic sign that the criminal process may go the way of compulsory medical measures,” said lawyer Anastasia Pilipenko. 

Per Zhukovskaya’s recommendation, investigators brought Olga Suvorova to a Krasnoyarsk psychiatric hospital in mid-May 2024. The 22 days she spent there followed a strict schedule. Wake-up was at 6:00 a.m., and the time between meals (served three times a day) was divided between doctor’s appointments, short walks outdoors, visits from relatives, and “quiet hours” (during which the patients were prohibited from leaving the ward). “I’ve never seen anything like the rotten and moldy bread they gave out in the psychiatric clinic,” Suvorova said.

Sharp and breakable objects were forbidden, including ceramic cups, and the patients were given their phones for just a few hours three times a week. Their main sources of entertainment were a small library and a television, which was switched off in the evenings. Lights out was at 10:00 p.m. 

Doctors aren’t supposed to administer any treatment during these evaluations. But according to Suvorova, she was given mystery pills daily. “They didn’t check our mouths [to see if] we swallowed them. I decided not to make a fuss and just hid the tablets and then threw them in the toilet,” she said. 

Suvorova was placed in a ward with 10 other women, including a suspect in an “anti-war case,” a fraud victim, a former prisoner, and several teenage girls who, upon aging out of orphanages at 18, had been declared mentally incompetent and were undergoing evaluations to have this status overturned. “A partition separated the common space. The bathroom had two toilets; there were doors, but they didn’t close. There wasn’t a single handle or lock,” Suvorova recalled. 

The attendants watched the patients’ every move and made the teenage girls clean floors and wash dishes in exchange for “perks.” On one occasion, Suvorova herself cleaned the floors in the corridor in exchange for a cup of hot water at an unscheduled time. She later complained to the head doctor, after which the patients were allowed hot water whenever they wanted. 

Before she was discharged on June 6, the hospital’s medical board asked Suvorva if she considered herself sane. “I said that before I was admitted to the hospital, I was sure I was sane, but now it’s hard to say,” she recalled. 

Suvorova still doesn’t know what conclusion the medical board reached. But immediately after her discharge, investigators sent her two summonses for questioning. 

In the hands of the system

Environmental activist Olga Kuzmina spent nearly a year under house arrest before she was sent for an inpatient evaluation at Psychiatric Clinical Hospital No. 5 in Chekhov, a town south of Moscow. She was facing up to seven years in prison on felony hooliganism charges for tying herself to a tree in a Moscow park to protest a construction project in her neighborhood. 

Kuzmina refused to speak to the doctors at the clinic, and the evaluation only lasted a few days. Nevertheless, they diagnosed her with “schizotypal personality disorder,” declaring the activist mentally incompetent. 

According to psychiatrist Vladimir Mendelevich, “schizotypal personality disorder” is Russia’s modern-day equivalent of “sluggish schizophrenia” — an obsolete diagnosis used against dissidents in the Soviet Union and the Eastern Bloc from the 1960s until Communism’s collapse. 

Kuzmina’s medical records said she has a “tendency towards litigiousness and remonstration.” According to her lawyer, Katerina Tertukhina, such “symptoms” have become increasingly common in forensic psychiatric evaluations, with doctors using traits such as a “heightened sense of justice” or an “active civic position” as grounds for declaring activists mentally incompetent. 

A Moscow court sentenced Kuzmina to involuntary psychiatric treatment in August 2023, a ruling Tertukhina is still trying to overturn. According to the attorney, the doctors relied on materials from the criminal case as part of the psychiatric evaluation but failed to take into account the “extreme degree of desperation” that drove Kuzmina to protest in the first place. 

Yekaterinburg-based lawyer Roman Kachanov argued that because case materials present the defendant as proven guilty (before a verdict has been reached), they may lead psychiatrists to make biased evaluations. 

“It’s quite difficult to draw a line between illness and personality traits,” said lawyer Mikhail Biryukov. If doctors made their diagnoses solely based on a person opposing the Russian government’s actions, he argued, “all our clinics would be full.” Vinogradova also rejected the notion that Russian psychiatrists are institutionalizing “absolutely healthy” people, though she admitted that in murkier cases, doctors may be more inclined to declare suspects mentally unfit. 

In this context, any history of mental illness can be a gateway to institutionalization. 

Last April, a court in the Siberian city of Novokuznetsk ordered Russia’s Finance Ministry to pay activist Igor (Ingvar) Gorlanov 100,000 rubles ($1,165) in compensation for an unlawful involuntary hospitalization in December 2019. At the time of the ruling, however, Gorlanov was undergoing an inpatient psychiatric evaluation in connection with another criminal case launched over his Telegram posts criticizing judges and police officers. In early 2024, Gorlanov was involuntarily hospitalized yet again after getting arrested for allegedly insulting a police officer. 

Gorlanov’s lawyers petitioned for his release from the hospital but to no avail. In late April, a Novokuznetsk court sentenced him to compulsory psychiatric treatment. “Given the fact that he was subjected to involuntary hospitalization before, it wasn’t difficult for the experts to find evidence of insanity,” said Gorlanov’s lawyer, Alexey Pryanishnikov. “You know what they say: If you fall into the hands of the system once, it won’t let you be.” 

According to lawyer Kristina Tyurina, three of her clients charged with “political” crimes have been sentenced to involuntary psychiatric treatment in the last two years. “These individuals either saw psychiatrists way back in the 1990s and then [...] never reached out to specialists again, or they have a chronic illness or even a psychiatric disability,” she said. 

One of Biryukov’s clients, charged with spreading “falsehoods” about the Russian army, was diagnosed with schizophrenia in 2005 but had successfully managed his condition with medications. Nevertheless, the doctors who conducted his outpatient evaluation declared him mentally incompetent and recommended committing him to a psychiatric hospital. 

“As soon as an investigator hears [that a person takes medication], it’s like a red flag — they need to be sent for a psychiatric evaluation,” Tertukhina said. “And it seems this is a red flag for psychiatrists, too.”

‘Deliberate’ crimes

In a 2016 report, the Agora human rights group wrote that in the Russian justice system, forensic psychiatric evaluations are “a convenient way to delegate the determination of guilt to psychiatrists.” 

According to Pilipenko, these evaluations can reduce a trial to one or two hearings focused on what type of treatment the defendant needs or whether they need treatment at all. “It makes [the judge’s] job a lot easier,” the lawyer said. “Not only can the proceedings be accelerated but they can also be closed to the public.”

The court can order outpatient treatment or inpatient treatment at a variety of hospitals, ranging from general psychiatric clinics to specialized institutions with intensive supervision. (The latter is more like a prison than a hospital, complete with guards from the Federal Penitentiary Service.) In the past, the courts often chose outpatient treatment, Tertukhina said. But in recent years, “political” cases have proven to be the exception to this rule. 

“Information about such cases usually isn’t published, you can’t look at the statistics. But I haven’t heard of anybody being sent for outpatient treatment in recent political proceedings,” she said, adding that doctors usually recommend inpatient treatment at a specialized clinic.

Other lawyers also said the courts have become stricter, making it extremely difficult to appeal medical experts’ evaluations and recommendations. “It’s not just that, in 90 percent of cases, the judges don’t try to understand what's written in the medical reports [...] but also that they refuse to allow the defense to conduct an independent evaluation every time,” Pryanishnikov said. 

Those who experience abuse in psychiatric hospitals also have little recourse. The case of Viktoria Petrova is one of the few in which a victim has gone public. Arrested on charges of spreading “knowingly false information” about the Russian military, Petrova underwent a week-long inpatient evaluation at St. Petersburg’s Skvortsov-Stepanov Psychiatric Hospital No. 3 and recounted the harrowing experience to her attorney. 

“She was made to understand that here, in the hospital, she was no longer human,” Pilipenko wrote in a Telegram post about Petrova’s case in November 2023. “They tied her arms and legs to the bed and injected her with medications, which left her practically unable to speak for two days and, therefore, unable to complain.” (Other lawyers, who spoke on condition of anonymity, said their clients also experienced similar abuse in psychiatric hospitals.)

According to Pilipenko, a combination of publicity and official complaints helped improve Petrova’s situation. But in the end, she was still sentenced to involuntary psychiatric treatment — even though declaring her mentally incompetent contradicts the logic of her supposed crime. 

Pilipenko argued that prior rulings on other “deliberate” crimes — such as “making a knowingly false denunciation” — could serve as a precedent for throwing out such cases. “I’ve seen with my own eyes court decisions where they overturned rulings imposing compulsory medical measures precisely because a person can’t knowingly make a denunciation if they’re not aware of their own actions,” she explained. 

Petrova’s lawyer still hasn’t managed to get her institutionalization overturned. At least eight other people have also been sentenced to involuntary psychiatric treatment for allegedly spreading “falsehoods” about the Russian military.

Update: On August 12, the Net Freedoms Project reported that a St. Petersburg court had transferred Viktoria Petrova to outpatient treatment. According to the rights group, the court ruled that Petrova no longer required inpatient psychiatric treatment because her “mental state had significantly improved and stabilized, and she developed a critical attitude towards the disease and the crime committed.”

READ MORE ABOUT VIKTORIA PETROVA

’No longer a human being’ How a woman was sentenced to compulsory psychiatric treatment for spreading ‘fake news’ about the Russian army

8 months ago

READ MORE ABOUT VIKTORIA PETROVA

’No longer a human being’ How a woman was sentenced to compulsory psychiatric treatment for spreading ‘fake news’ about the Russian army

8 months ago

‘You haven’t recovered yet’

Last December, lawyers from the rights group Department One located Rafail Shepelev in a remand prison in the Russian city of Nizhny Tagil. A former Russian opposition activist residing in Georgia since 2021, Shepelev had gone missing in the fall. The rights group said FSB agents had lured Shepelev to breakaway South Ossetia, where they arrested him, transported him across the border to Vladikavkaz, and jailed him on a misdemeanor charge of “disorderly conduct.”

Once Shepelev was in custody, the Russian authorities opened a criminal case, charging him with “justifying terrorism” and “participating in the activities of a terrorist organization.” If convicted, he could go to prison for upwards of 20 years. 

But in April 2024, a court placed Shepelev in a specialized psychiatric hospital for the remainder of the investigation. The medical board at the Sverdlovsk Regional Psychiatric Hospital had declared him mentally incompetent, claiming that Shepelev suffered from a chronic condition that left him “unable to recognize the actual nature and public danger of his actions.” 

When Danil Shepelev visited his father in May, he noticed that Rafail spoke slowly, as if it were “difficult for him to think.” “He was given some kind of injections. He had spoken to patients about the situation in the country, and the hospital staff didn’t like that. They even told him: ‘We don’t need rallies here,’” Danil recounted. When he phoned his father a week later, however, Rafail sounded cheerful. “He understood that if he said something oppositional, they’d give him an injection. If he doesn’t say [anything], they won’t inject him.”

The Shepelevs don’t know what Rafail is being “treated” with, but Danil thinks a stint in a psychiatric hospital is better than 20 years in a Russian prison. 

But unlike when handing down prison sentences, Russian courts don’t limit compulsory psychiatric treatment to a specific length of time. This decision is “farmed out to the doctors,” said Rustam Mukhamadeev, a lawyer whose client was sentenced to outpatient psychiatric treatment for allegedly spreading “false information” about the Russian army. 

A medical board assesses the patient’s case every six months. If the doctors find their condition has improved, they might recommend downgrading treatment, including transferring the patient to a less restrictive facility or even outpatient treatment. Involuntary treatment only ends when the doctors and the court agree the person no longer needs it. “In prison, there’s a countdown to the end of one’s term,” said Pryanishnikov. “But [with compulsory psychiatric treatment] the person doesn’t know when they’ll get out.” 

None of the lawyers interviewed for this story knew of any political prisoners who had been discharged from a psychiatric hospital in the last two years. In order for the doctors to downgrade or end compulsory treatment, they explained, the patient must not only admit that they are sick and need medical help but also “reflect critically on their actions.” According to Pilipenko, this effectively means admitting they are guilty of the charges against them, which can pose a problem for political prisoners. “They ask the person, ‘Are you for or against the war?’ And if he’s against it, they say, ‘That means you haven’t recovered yet,’” Kachanov said. 

The courts can also extend a particular course of involuntary treatment even if medical experts recommend otherwise. Doctors at the Primorsky Regional Psychiatric Hospital in Ussuriysk first advised transferring Yakut dissident Alexander Gabyshev to a less restrictive facility two years ago. But the courts have repeatedly ruled against moving him (mostly recently, in mid-July). 

Pryanishnikov, who represents Gabyshev, said his client has encountered all “methods of punitive psychiatry” over the past five years. The self-described shaman — who first made headlines in 2019 when he was arrested while en route from Siberia to Moscow on a mission to “expel Putin” from the Kremlin — has been confined to psychiatric hospitals since 2021. Initially, he was sent to a specialized psychiatric hospital with intensive supervision in Novosibirsk, one of eight such institutions in all of Russia. 

“There are rapists and murderers there. It’s maximum security — Federal Penitentiary Service staff guard the hospital, like in a remand prison or a correctional facility,” Pryanishnikov explained. 

Gabyshev was moved to the Primorsky Regional Psychiatric Hospital in Ussuriysk at his doctors’ recommendation in April 2022, just six months after he arrived at the Novosibirsk facility. According to Pryanishnikov, the shaman’s attending physician at the high-security clinic said he was “not our [type of] patient at all.” 

Pryanishnikov is convinced the authorities are persecuting Gabyshev because they “fear him as a shaman” — and that they’re keeping him in Ussuriysk to separate him from his native land and thereby “suppress his shamanistic abilities.” “Unfortunately, this appears to be the case. [I say] unfortunately because it’s idiotic. After all, these are the people who control our country and nuclear weapons,” the lawyer said. 

The hospital’s medical board is set to review Gabyshev’s case again in October. His lawyers are still appealing the court’s refusal to transfer him to a hospital in his native Yakutsk. 

* * *

The number of people subjected to punitive psychiatry in the USSR remains unknown to this day, but there were likely thousands. As historian Alexey Makarov explained, researchers often can’t access hospital records, but we know that more than a million people across the Soviet Union were discharged from psychiatric treatment in the late 1980s. 

According to Makarov’s calculations, in the 1970s, one in six defendants charged with “anti-Soviet agitation and propaganda” and “disseminating knowingly false fabrications defaming the state and social system” were declared mentally incompetent and sentenced to involuntary psychiatric treatment. 

Online court records indicate that one in 24 defendants in politically motivated cases suffer this fate in modern-day Russia. But according to Makarov’s calculations, it’s more likely one in 10. Just as in the Soviet period, there is no reliable data. 

Hello, I’m Eilish Hart, the editor of The Beet. Thanks for taking the time to read our work! Our newsletter delivers underreported stories like this one to subscribers every Thursday. Like all of Meduza’s reporting, it’s free to read but relies on support from readers like you. Please consider donating to our crowdfunding campaign.