you", he said and added, "i saw people who basically were asleep for years." us president ronald reagan attributed the view that the "brutal treatment of soviet dissidents was due to bureaucratic inertia." residual problems in the opinion of the moscow helsinki group chairwoman lyudmila alexeyeva, the attribution of a mental illness to a prominent figure who came out with a political declaration or action is the most significant factor in the assessment of psychiatry during the 1960–1980s. the practice of forced confinement of political dissidents in psychiatric facilities in the former ussr and eastern europe destroyed the credibility of psychiatric practice in these countries. when the psychiatric profession is discredited in one part of the world, psychiatry is discredited throughout the world. psychiatry lost its professional basis entirely when it was abused to stifle dissidence in the former ussr and in the euthanasia program in nazi germany. there is little doubt that the capacity for using psychiatry to enforce social norms and even political interests is immense. now psychiatry is vulnerable because many of its notions have been questioned, and the sustainable pattern of mental life, of boundaries of mental norm and abnormality has been lost, director of the moscow research institute for psychiatry valery krasnov says, adding that psychiatrists have to seek new reference points to make clinical assessments and new reference points to justify old therapeutical interventions. as emmanuil gushansky states, today subjective position of a russian patient toward a medical psychologist and psychiatrist is defensive in nature and prevents the attempt to understand the patient and help him assess his condition. such a position is related to constant, subconscious fear of psychiatrists and psychiatry. this fear is caused by not only abuse of psychiatry, but also constant violence in the totalitarian and post-totalitarian society. the psychiatric violence and psychiatric arrogance as one of manifestations of such violence is related to the primary emphasis on symptomatology and biological causes of a disease, while ignoring psychological, existential, and psychodynamic factors. gushainsky notices that the modern russian psychiatry and the structure of providing mental health care are aimed not at protecting the patient's right to an own place in life, but at discrediting such a right, revealing symptoms and isolating the patient. the psychiatrist became a scarecrow attaching psychiatric labels. he is feared, is not confided, is not taken into confidence in the secrets of one's soul and is asked to provide only medications. psychiatric labels, or stigmas, have spread so widely that there is no such thing as the media that does not call a disliked person schizo and does not generalize psychiatric assessments to phenomena of public life. the word psikhushka entered everyday vocabulary. all persons who deviate from the usual standards of thought and behavior are declared mentally ill, with an approving giggling of public. not surprisingly, during such a stigmatization, people with real mental disorders fear publicity like the plague. vilnius psychologist oleg lapin has the same point that politicians and the press attach psychological, psychiatric and medical labels; he adds that psychiatry has acquired the new status of normalizing life that was previously possessed by religion. formerly, one could say: you are going against god or god is with us; now one can say: i behave reasonably, adequately, and you do not behave in that way. in 2007, alexander dugin, a professor at the moscow state university and adviser to state duma speaker sergei naryshkin, presented opponents of vladimir putin's policy as mentally ill by saying, "there are no longer opponents of putin's policy, and if there are, they are mentally ill and should be sent to prophylactic health examination." in the moscow regional psychiatric newspaper of 2012, psychiatrist dilya enikeyeva in violation of medical privacy and ethics publicized the diagnosis of histrionic personality disorder, which she in absentia gave kseniya sobchak, a russian tv anchor and a member of political opposition, and stated that sobchak was harmful to society. robert van voren noted that after the fall of the berlin wall, it became apparent that the political abuse of psychiatry in the ussr was only the tip of the iceberg, the sign that much more was basically wrong. this much more realistic image of soviet psychiatry showed up only after the soviet regime began to loosen its grip on society and later lost control over the developments and in the end entirely disintegrated. it demonstrated that the actual situation was much sorer and that many individuals had been affected. millions of individuals were treated and stigmatized by an outdated biologically oriented and hospital-based mental health service. living conditions in clinics were bad, sometimes even terrible, and violations of human rights were rampant. according to the data of a census published in 1992, the mortality of the ill with schizophrenia exceeded that of the general population by 4–6 times for the age of 20–39 years, by 3–4 times for the age of 30–39 years, by 1.5–2 times for the age over 40 years (larger values are for women). according to robert van voren, although for several years, especially after the implosion of the ussr and during the first years of boris yeltsin's rule, the positions of the soviet psychiatric leaders were in jeopardy, now one can firmly conclude that they succeeded in riding out the storm and retaining their powerful positions. they also succeeded in avoiding an inflow of modern concepts of delivering mental health care and a fundamental change in the structure of psychiatric services in russia. on the whole, in russia, the impact of mental health reformers has been the least. even the reform efforts made in such places as st. petersburg, tomsk, and kaliningrad have faltered or were encapsulated as centrist policies under putin brought them back under control. throughout the post-communist period, the pharmaceutical industry has mainly been an obstacle to reform. aiming to explore the vast market of the former ussr, they used the situation to make professionals and services totally dependent on their financial sustenance, turned the major attention to the availability of medicines rather than that of psycho-social rehabilitation services, and stimulated corruption within the mental health sector very much. at the turn of the century, the psychiatric reform that had been implemented by franco basaglia in italy became known and was publicly declared to be implemented in russia, with the view of retrenchment of expenditures. but when it became clear that even more money was needed for the reform, it got bogged down in the same way the reform of the army and many other undertakings did. russia is decades behind the countries of the european union in mental health reform, which has already been implemented or is being implemented in them. until russian society, gushansky says, is aware of the need for mental health reform, we will live in the atmosphere of animosity, mistrust and violence. many experts believe that problems spread beyond psychiatry to society as a whole. as robert van voren supposes, the russians want to have their compatriots with mental disorders locked up outside the city and do not want to have them in community. despite the 1992 russian mental health law, coercive psychiatry in russia remains generally unregulated and fashioned by the same trends toward hyperdiagnosis and overreliance on institutional care characteristic of the soviet period. in the soviet union, there had been an increase of the bed numbers because psychiatric services had been used to treat dissidents. in 2005, the russian federation had one of the highest levels of psychiatric beds per capita in europe at 113.2 per 100,000 population, or more than 161,000 beds. in 2014, russia has 104.8 beds per 100,000 population and no actions have been taken to arrange new facilities for outpatient services. persons who do not respond well to treatment at dispensaries can be sent to long-term social care institutions (internats) wherein they remain indefinitely. the internats are managed by oblast social protection ministries. russia had 442 psychoneurologic internats by 1999, and their number amounted to 505 by 2013. the internats provided places for approximately 125,000 people in 2007. in 2013, russian psychoneurologic internats accommodated 146,000 people, according to the consolidated data of the department of social protection of moscow and the ministry of labour and social protection of the russian federation. it is supposed that the number of beds in internats is increasing at the same rate with which the number of beds is decreasing in psychiatric hospitals. lyubov vinogradova of the independent psychiatric association of russia provides the different figure of 122,091 or 85.5 places in psychoneurologic institutions of social protection (internats) per 100,000 population in 2013 and says that russia is high on europe's list of the number of places in the institutions. vinogradova states that many regions have the catastrophic shortage of places in psychoneurological internats, her words point out to the need to increase the number of places there and to the fact that the independent psychiatric association of russia is forcing transinstitutionalization—relocating the mentally ill from their homes and psychiatric hospitals to psychoneurological internats. one of the buildings of the pavlov psychiatric hospital in kyiv at his press conference in 2008, semyon gluzman said that the surplus in ukraine of hospitals for inpatient treatment of the mentally ill was a relic of the totalitarian communist regime and that ukraine did not have epidemic of schizophrenia but somehow ukraine had about 90 large psychiatric hospitals including the pavlov hospital where beds in its children's unit alone were more than in the whole of great britain. in ukraine, public opinion did not contribute to the protection of citizens against possible recurrence of political abuse of psychiatry. there were no demonstrations and rallies in support of the mental health law. but there was a public campaign against developing the civilized law and against liberalizing the provision of psychiatric care in the country. the campaign was initiated and conducted by relatives of psychiatric patients. they wrote to newspapers, yelled in busy places and around them, behaved in the unbridled way in ministerial offices and corridors. once gluzman saw through a trolleybus window a group of 20-30 people standing by a window of the cabinet of ministers of ukraine with red flags, portraits of lenin and stalin and the slogan coarsely written on the white cardboard: "get the gluzman psychiatry off ukraine!" activists of the dissident movement far from the nostalgia for the past also participated in the actions against changes in the mental health system. but in general, it should be remembered that all these protest actions have been activated by nomenklatura psychiatrists. the whole ukrainian psychiatric system actually consists of the two units: hospital for treatment of acute psychiatric conditions and internat-hospice for helpless "chronic patients" unable to live on their own. and between hospital and internat-hospice is desert. that is why about 40 percent of patients in any ukrainian psychiatric hospital are so-called social patients whose stay in the psychiatric hospital is not due to medical indications. a similar pattern is in internats. a significant part of their lifelong customers could have lived long enough in society despite their mental illnesses. they could have lived quite comfortably and safely for themselves and others in special dorms, nursing homes, "halfway houses". ukraine does not have anything like that. a barrack of a concentration camp seen from outside is of a type of buildings in which russian psychiatric hospitals have often been located a barrack of a concentration camp seen from inside in the soviet times, mental hospitals were frequently created in former monasteries, barracks, and even concentration camps. sofia dorinskaya, a human rights activist and psychiatrist, says she saw former convicts who have been living in a russian mental hospital for ten years and will have been staying there until their dying day because of having no home. deinstitutionalization has not touched many of the hospitals, and persons still die inside them. in 2013, 70 persons died in a fire just outside novgorod and moscow. living conditions are often insufficient and sometimes horrible: 12 to 15 patients in a big room with bars on the windows, no bedside tables, often no partitions, not enough toilets. the number of outpatient clinics designed for the primary care of the mentally disordered stopped increasing in 2005 and was reduced to 277 in 2012