gaps in the legislation. in the 1988 and 1989, about two million people were removed from the psychiatric registry at the request of western psychiatrists. it was one of their conditions for the re-admission of soviet psychiatrists to the world psychiatric association. yury savenko has provided different figures in different publications: about one million, up to one and a half million, about one and a half million people removed from the psychiatric registry. mikhail buyanov provided the figure of over two million people removed from the psychiatric registry. theoretical analysis in 1990, psychiatric bulletin of the royal college of psychiatrists published the article "compulsion in psychiatry: blessing or curse?" by russian psychiatrist anatoly koryagin. it contains analysis of the abuse of psychiatry and eight arguments by which the existence of a system of political abuse of psychiatry in the ussr can easily be demonstrated. as koryagin wrote, in a dictatorial state with a totalitarian regime, such as the ussr, the laws have at all times served not the purpose of self-regulation of the life of society but have been one of the major levers by which to manipulate the behavior of subjects. every soviet citizen has constantly been straight considered state property and been regarded not as the aim, but as a means to achieve the rulers' objectives. from the perspective of state pragmatism, a mentally sick person was regarded as a burden to society, using up the state's material means without recompense and not producing anything, and even potentially capable of inflicting harm. therefore, the soviet state never considered it reasonable to pass special legislative acts protecting the material and legal part of the patients' life. it was only instructions of the legal and medical departments that stipulated certain rules of handling the mentally sick and imposing different sanctions on them. a person with a mental disorder was automatically divested of all rights and depended entirely on the psychiatrists' will. practically anybody could undergo psychiatric examination on the most senseless grounds and the issued diagnosis turned him into a person without rights. it was this lack of legal rights and guarantees that advantaged a system of repressive psychiatry in the country. according to american psychiatrist oleg lapshin, russia until 1993 did not have any specific legislation in the field of mental health except uncoordinated instructions and articles of laws in criminal and administrative law, orders of the ussr ministry of health. in the soviet union, any psychiatric patient could be hospitalized by request of his headman, relatives or instructions of a district psychiatrist. in this case, patient's consent or dissent mattered not. the duration of treatment in a psychiatric hospital also depended entirely on the psychiatrist. all of that made the abuse of psychiatry possible to suppress those who opposed the political regime, and that created the vicious practice of ignoring the rights of the mentally ill. according to yuri savenko, the president of the independent psychiatric association of russia (the ipa), punitive psychiatry arises on the basis of the interference of three main factors: the ideologizing of science, its breakaway from the achievements of world psychiatry, the party orientation of soviet forensic psychiatry. the lack of legal basis. the total nationalization of mental health service. their interaction system is principally sociological: the presence of the penal code article on slandering the state system inevitably results in sending a certain percentage of citizens to forensic psychiatric examination. thus, it is not psychiatry itself that is punitive, but the totalitarian state uses psychiatry for punitive purposes with ease. according to larry gostin, the root cause of the problem was the state itself. the definition of danger was radically extended by the soviet criminal system to cover "political" as well as customary physical types of "danger". as bloch and reddaway note, there are no objective reliable criteria to determine whether the person's behavior will be dangerous, and approaches to the definition of dangerousness greatly differ among psychiatrists. richard bonnie, a professor of law and medicine at the university of virginia school of law, mentioned the deformed nature of the soviet psychiatric profession as one of the explanations for why it was so easily bent toward the repressive objectives of the state, and pointed out the importance of a civil society and, in particular, independent professional organizations separate and apart from the state as one of the most substantial lessons from the period. according to norman sartorius, a former president of the world psychiatric association, political abuse of psychiatry in the former soviet union was facilitated by the fact that the national classification included categories that could be employed to label dissenters, who could then be forcibly incarcerated and kept in psychiatric hospitals for "treatment". darrel regier, vice-chair of the dsm-5 task force, has a similar opinion that the political abuse of psychiatry in the ussr was sustained by the existence of a classification developed in the soviet union and used to organize psychiatric treatment and care. in this classification, there were categories with diagnoses that could be given to political dissenters and led to the harmful involuntary medication. according to moscow psychiatrist alexander danilin, the so-called "nosological" approach in the moscow psychiatric school established by snezhnevsky boils down to the ability to make the only diagnosis, schizophrenia; psychiatry is not science but such a system of opinions and people by the thousands are falling victims to these opinions—millions of lives were crippled by virtue of the concept "sluggish schizophrenia" introduced some time once by an academician snezhnevsky, whom danilin called a state criminal. st petersburg academic psychiatrist professor yuri nuller notes that the concept of snezhnevsky's school allowed psychiatrists to consider, for example, schizoid psychopathy and even schizoid character traits as early, delayed in their development, stages of the inevitable progredient process, rather than as personality traits inherent to the individual, the dynamics of which might depend on various external factors. the same also applied to a number of other personality disorders. it entailed the extremely broadened diagnostics of sluggish (neurosis-like, psychopathy-like) schizophrenia. despite a number of its controversial premises and in line with the traditions of then soviet science, snezhnevsky's hypothesis has immediately acquired the status of dogma which was later overcome in other disciplines but firmly stuck in psychiatry. snezhnevsky's concept, with its dogmatism, proved to be psychologically comfortable for many psychiatrists, relieving them from doubt when making a diagnosis. that carried a great danger: any deviation from a norm evaluated by a doctor could be regarded as an early phase of schizophrenia, with all ensuing consequences. it resulted in the broad opportunity for voluntary and involuntary abuses of psychiatry. however, snezhnevsky did not take civil and scientific courage to reconsider his concept which clearly reached a deadlock. according to american psychiatrist walter reich, the misdiagnoses of dissidents resulted from some characteristics of soviet psychiatry that were distortions of standard psychiatric logic, theory, and practice. according to semyon gluzman, abuse of psychiatry to suppress dissent is based on condition of psychiatry in a totalitarian state. psychiatric paradigm of a totalitarian state is culpable for its expansion into spheres which are not initially those of psychiatric competence. psychiatry as a social institution, formed and functioning in the totalitarian state, is incapable of not being totalitarian. such psychiatry is forced to serve the two differently directed principles: care and treatment of mentally ill citizens, on the one hand, and psychiatric repression of people showing political or ideological dissent, on the other hand. in the conditions of the totalitarian state, independent-minded psychiatrists appeared and may again appear, but these few people cannot change the situation in which thousands of others, who were brought up on incorrect pseudoscientific concepts and fear of the state, will sincerely believe that the uninhibited, free thinking of a citizen is a symptom of madness. gluzman specifies the following six premises for the unintentional participation of doctors in abuses: the specificity, in the totalitarian state, of the psychiatric paradigm tightly sealed from foreign influences. the lack of legal conscience in most citizens including doctors. disregard for fundamental human rights on the part of the lawmaker and law enforcement agencies. declaratory nature or the absence of legislative acts that regulate providing psychiatric care in the country. the ussr, for example, adopted such an act only in 1988. the absolute state paternalism of totalitarian regimes, which naturally gives rise to the dominance of the archaic paternalistic ethical concept in medical practice. professional consciousness of the doctor is based on the almost absolute right to make decisions without the patient's consent (i.e. there is disregard for the principle of informed consent to treatment or withdrawal from it). the fact, in psychiatric hospitals, of frustratingly bad conditions, which refer primarily to the poverty of health care and inevitably lead to the dehumanization of the personnel including doctors. gluzman says that there, of course, may be a different approach to the issue expressed by michel foucault. according to michael perlin, foucault in his book madness and civilization documented the history of using institutional psychiatry as a political tool, researched the expanded use of the public hospitals in the 17th century in france and came to the conclusion that "confinement answer to an economic crisis... reduction of wages, unemployment, scarcity of coin" and, by the 18th century, the psychiatric hospitals satisfied "the indissociably economic and moral demand for confinement." in 1977, british psychiatrist david cooper asked foucault the same question which claude bourdet had formerly asked viktor fainberg during a press conference given by fainberg and leonid plyushch: when the ussr has the whole penitentiary and police apparatus, which could take charge of anybody, and which is perfect in itself, why do they use psychiatry? foucault answered it was not a question of a distortion of the use of psychiatry but that was its fundamental project. in the discussion confinement, psychiatry, prison, foucault states the cooperation of psychiatrists with the kgb in the soviet union was not abuse of medicine, but an evident case and "condensation" of psychiatry's "inheritance", an "intensification, the ossification of a kinship structure that has never ceased to function." foucault believed that the abuse of psychiatry in the ussr of the 1960s was a logical extension of the invasion of psychiatry into the legal system. in the discussion with jean laplanche and robert badinter, foucault says that criminologists of the 1880—1900s started speaking surprisingly modern language: "the crime cannot be, for the criminal, but an abnormal, disturbed behavior. if he upsets society, it's because he himself is upset". this led to the twofold conclusions. first, "the judicial apparatus is no longer useful." the judges, as men of law, understand such complex, alien legal issues, purely psychological matters no better than the criminal. so commissions of psychiatrists and physicians should be substituted for the judicial apparatus. and in this vein, concrete projects were proposed. second, "we must certainly treat this individual who is dangerous only because he is sick. but, at the same time, we must protect society against him." hence comes the idea of mental isolation with a mixed function: therapeutic and prophylactic. in the 1900s, these projects have given rise to very lively responses from european judicial and political bodies. however, they found a wide field of applications when the soviet union became one of the most common but by no means exceptional cases. according to american psychiatrist jonas robitscher, psychiatry has been playing a part in controlling deviant behavior for three hundred years. vagrants, "originals," eccentrics, and homeless wanderers who did little harm but were vexatious to the society they lived in were, and sometimes still are, confined to psychiatric hospitals or deprived of their legal rights. some critics of psychiatry consider the practice as a political use of psychiatry and regard psychiatry as promoting timeserving. as vladimir bukovsky and semyon gluzman point out, it is difficult for the average soviet psychiatrist to understand the dissident's poor adjustment to soviet society. this view of dissidence has nothing surprising about it—conformity reigned in soviet consciousness; a public intolerance of non-conformist behavior always penetrated soviet culture; and the threshold for deviance from custom was similarly low. an example of the low threshold is a point of donetsk psychiatrist valentine pekhterev, who argues that psychiatrists speak of the necessity of adapting oneself to society, estimate the level of man's