National Medical Research Center for Psychiatry and Narcology named after V.P. Serbian. Institute. Serbian (Prechistenskaya psychiatric hospital for prisoners) Research Institute of Serbian official

Federal State Budgetary Institution of Public Health "Federal Medical Research Center for Psychiatry and Narcology named after V.P. Serbsky" (old name until 2014: State Scientific Center for Social and Forensic Psychiatry named after V.P. Serbsky) was founded in 1921 at the initiative of the People's Commissariat health and judiciary. The main activity is the conduct of complex forensic psychiatric examinations and the development of the scientific foundations of forensic psychiatry. The center is named after the professor. The center building is located at: Moscow, Kropotkinsky pereulok, 23; near the metro station "Kropotkinskaya".

As of 2009, about 800 employees worked at the center, including 3 academicians of the Russian Academy of Medical Sciences, 48 ​​doctors of sciences and 120 candidates of sciences.

History of the scientific center.

In May 1921, the Prechistenskaya Psychiatric Hospital in Moscow, originating from the Central Police Admission Center for the Mentally Ill, established in 1899, was transformed into the Prechistenskaya Psychiatric Hospital for Prisoners. Subsequently, the names of the institution changed in the following order:

1. Central Institute of Forensic Psychiatry in Moscow.
2. Moscow Research Institute of Forensic Psychiatry named after V. P. Serbsky.
3. All-Union Research Institute of General and Forensic Psychiatry named after V. P. Serbsky.
4. State Scientific Center for Social and Forensic Psychiatry named after V. P. Serbsky.
5. Federal Medical Research Center for Psychiatry and Narcology.

The names of psychiatrists were associated with the activities of the center - professors I. N. Vvedensky,

ABOUT INSTITUTE IM. SERBIAN

Institute of Forensic Psychiatry. prof. Serbsky was organized on the basis of a former police reception center in 1923 and was first under the jurisdiction of the justice and internal affairs bodies, and later under the Ministry of Health of the USSR. From a research institution that studied the problems of forensic psychiatric examination and complexes of issues related to it (sanity, capacity), the institute by the mid-30s (that is, by the period of the creation of executive bodies for psychiatric repressions) turned into a monopoly uncontrolled body that carried out (conducting until now) forensic psychiatric examination in all the most important cases (and, of course, in cases related to the so-called counter-revolutionary activities). Such a monopoly body, isolated from other medical psychiatric institutions by a veil of special secrecy, became an obedient tool in the hands of the investigation and state security, fulfilling their political orders. This was facilitated by the still relevant Instruction of the NKJU of the USSR, the People's Commissariat of Health of the USSR, the NKVD of the USSR and the USSR Prosecutor's Office dated February 17, 1940, according to which “the methodological and scientific management of forensic psychiatric examination is carried out by the People's Commissariat of Health of the USSR through the Scientific Research Institute of Forensic psychiatry them. prof. Serbian (art. 2)”. In accordance with article 4 of this instruction, “during the forensic psychiatric examination of persons sent for examination by the NKVD (and the police), the participation of a doctor from the Sanitary Department of the NKVD, as well as a representative of the body conducting the investigation, is allowed.” (The participation of the representative of the interests of the expert and his lawyer was not provided.)

Employees, especially the secret department of the Institute. Serbsky, who conducted an examination in criminal cases related to state security, were involved in investigative measures. Thus, the method of “caffeine-barbituric disinhibition” was widely practiced at the institute, during which the subjects, who were in a state of lethargy and refused speech contact due to their reaction to the forensic-investigative situation, became talkative and, in a state of drug intoxication, gave one or another testimony that was used during the investigation. Moreover, in the 1930s, a special laboratory (closed shortly after Stalin's death) was organized at the institute, the purpose of which was to develop special medications that dull the self-control over statements of persons who were under examination.

The expert opinions of such a monopoly body were dictated, as a rule, by the interests of the investigation and over the years became less and less objective and evidentiary. At the same time, depending on the will of the "customer", either the medical or the legal criterion of sanity prevailed, often without any attempt to reduce them to compliance.

From a note by Professor V. Gilyarovsky to the CPC under the Central Committee of the CPSU dated January 12, 1956:

“There is no special forensic psychiatry as some kind of self-contained isolated discipline, cut off from general psychiatry. Forensic psychiatry has some specific features in the clinical characterization of mental disorders, with which the expert most often has to deal.

Its main feature lies in the fact that a forensic psychiatrist, having studied mental disorders in both cases, must give them not only a clinical interpretation, not only indicate their place in the general system of psychoses, but also determine exactly what violations provided for by law speak in this particular case and at the same time give an exact answer whether the deed of the test subject can be blamed on him, in other words, decide the question of sanity and punishment.

The conclusion about the offenses committed by the mentally ill themselves usually does not present any particular difficulties. The main difficulties are encountered in the examination of reactive states and psychopathy. The area of ​​reactive states and psychopathies in psychiatry in general is the most complex and difficult to study.

A psychiatrist who gives a forensic psychiatric examination has to solve two main questions: what was the state of the offender at the time of the commission of the act incriminated to him and does he have a mental illness at this time, and, if so, what kind?

In order to give a correct conclusion about the mental state, both during the offense and during the period of the examination, the psychiatrist must take into account everything that has been accumulated by psychiatry in general on issues of diagnosis, distinguishing one disease from others that are similar to it. In order for the psychiatrist to remain at the right height when solving these issues, he needs a deep acquaintance not only with reactive states, psychopathy and schizophrenia, but also with all psychoses and psychiatry in its entirety.

As can be seen from the foregoing, the one-sidedness of the painful disorders that psychiatrists working at the Institute. Serbian, may not provide a sufficiently complete outlook, may interfere with the correct assessment of the case and resolve the issue of diagnosis not in full accordance with the actual state of affairs. Therefore, I believe that the activities of the institute can be effective only if the institute works not only on one-sided observations related to limited areas of psychiatry.

It follows from this that the institution must get away from its one-sidedness and isolation, must be in close connection with other psychiatric institutions and with psychiatric hospitals..

It is difficult to judge whether the professor knew about the use of forensic psychiatry in the USSR for political purposes, but the one-sidedness of the psychiatric examination carried out by the institute testifies to the master’s anxiety about the tragic consequences of such a “narrow” examination for the subjects.

“The practically important case of forensic psychiatric examination is currently in an unsatisfactory state, which is largely due to defects in the work of the Central Institute in this area. prof. Serbian.

For 30 years of its existence as a research institution, which cost the state many millions of rubles, the institute endlessly chews on the issues of sanity-insanity and comments on several articles of the Criminal Code that are related to the examination.

Arrogance, self-confidence, a conscious detachment from general psychiatry, constant throwing dust in the eyes, intimidation by the special importance, complexity, secrecy of one's work, monopolization and the desire to establish one's dictatorship both in the field of theory and practice of psychiatric examination - these are the main features that characterize the line of leadership institute for many years.

The Institute approaches its subjects not from a medical standpoint, being preoccupied with one issue - sanity.

Doctors of the Zagorodnaya Psychiatric Hospital (Stolbovaya station) have repeatedly complained to me about the unsatisfactory quality of the expert opinions of the institute, where the compulsory treatment of persons declared insane is carried out. In the years when I consulted in this hospital, doctors showed me people who were mistakenly recognized at the institute as schizophrenics, insane.

I worked at the Institute Serbian in the first, difficult years of its existence. For 34 years (including 4.5 years on the fronts of the Great Patriotic and Japanese wars) I constantly faced questions of forensic psychiatric examination that were close to me. And with all responsibility I summarize my opinion that the matter of forensic psychiatric examination and management of it needs a decisive healing effect. It is necessary to change the whole style of work of the institute, linking it with the medical community. I believe that this can best be achieved through the organizational unification of the Institute. Serbsky with the Institute of Psychiatry of the Ministry of Health of the USSR, which will certainly have a positive impact on the quality of scientific, theoretical, pedagogical and practical expert work in the field of forensic psychiatry.

On the issue of the expediency of the existence of independent psychiatric hospitals in the system of the Ministry of Internal Affairs.

At present, there is hardly a serious need for them, with the exception, of course, of especially dangerous patients with active delusions of political content, as well as a certain number of patients with a plentiful and difficult criminal and criminal past.

It is difficult for me to judge the number of those and others, but I believe that they are few. Taking into account the current state of psychiatric hospitals, their overcrowding, the inability to allocate and provide with male personnel special strong departments for the compulsory treatment of especially difficult and dangerous patients, one or two such special hospitals should be temporarily left in operation, improving psychiatric supervision, regimen and treatment in them. The best representatives of domestic psychiatry have always spoken out in favor of the dispersal of "criminal" mental patients among the general mass of such patients (foreign practice is different here: for example, in England all "criminal" mental patients are sent for an indefinite period to a gloomy prison - Broadmoor Hospital). In any case, whoever is in charge of institutions or departments for “criminal” mental patients, they should be psychiatric institutions and the methods of treatment and the length of stay of individual patients in them should be determined primarily by the state of the disease.

Among the so-called "criminal" mentally ill, the percentage of real mentally ill is low, and more often come across deep psychopaths, etc. - here the cautious approach of experts to recognizing a number of so-called borderline patients as mentally ill and insane is of great importance, not to mention practically healthy people with psychopathic and other personality traits.

Insisting on the need to isolate "criminal" mentally ill people from "quiet" ones, A. Rapoport, apparently, deliberately avoids recognizing that he is aware of the fact that healthy people are kept in special hospitals of the USSR Ministry of Internal Affairs for their political convictions. This is the right of the scientist. It must be remembered that not all experienced people believed in the irreversibility of Khrushchev's democratic "thaw" and therefore were restrained in their political statements, especially before the Central Committee of the CPSU.

In the reference, A. Rapoport is confused by his statement about the need to keep “especially dangerous patients with active delusions of political content” and patients with a severe criminal past in prison psychiatric hospitals of the Ministry of Internal Affairs. Who are dangerously ill with active delusions of political content? Why are they dangerous? The fact that they rush at the normal people around them, or the fact that they are conscious fighters against the Soviet regime? The wise scientist already knew the answer to this question in those years, and now we know it too.

BANSHCHIKOV V., Professor of the 1st Moscow Medical Institute. I. M. Sechenov.

From the certificate of V. Banshchikov to the CPC under the Central Committee of the CPSU dated February 15, 1956: “Over the past two decades, the institute has gradually lost its ties with general psychiatry (the mother who gave birth to it), neuropsychiatric institutions, the public and the psychiatric press.

In view of the secrecy of the work of the institute, its activities, in fact, were, for many years, uncontrolled by the USSR Ministry of Health.

Having thus created a “monopoly” position for itself, having isolated the scientific team from the progressive development of Soviet psychiatry, the Institute did not scientifically solve a single problem of forensic psychiatry, lowered the quality of forensic psychiatric examination, as evidenced by significant discrepancies in the diagnoses established at the Institute and in subsequent various psychiatric institutions where patients from the institute were admitted.

I consider it expedient to reorganize the Institute into a special department of the Scientific Institute of Psychiatry, and also significantly relieve it of practical work on forensic psychiatric examination by organizing appropriate departments in a number of psychiatric hospitals.

There is an interesting definition in V. Banshchikov's note. Speaking about the close connection of the institute in the past with general psychiatry, the author emphasizes that all this "was of significant importance in determining the mental state of political and criminal offenders and persons who committed crimes due to one or another mental illness."

The professor, like the Chekists, once again has political and criminal criminals next to him. It is difficult to assume whether V. Banshchikov really believed that in many cases one could become a political criminal only when he was mentally ill, he showed prudent personal caution in his statements, knowing full well, like his colleague A. Rapoport, that in prison psychiatric hospitals among " criminal” (that is, political) prisoners were too many mentally healthy people.

A. G. ABRUMOVA, doctoral student of the psychiatric clique of the 1st MOLMI.

“Particular attention is drawn to the so-called special department, which is actually headed by D. R. Lunts (and not by Professor Vvedensky, a fictitious figure, Vvedensky is more than 80 years old).

In this department, where no one, even from among the secret senior researchers, has access, people who are the closest directorates (Smirnova, Taltse, Sologub) are concentrated.

In this department, even the most difficult cases are not discussed in the order of conferences, but are decided personally by Buneev and his close associate Lunts. Thus, a large section of practical exporting is left without any minimum control at all. It is only known that the follow-up control is carried out by the same Lunts during his trips to the Kazan Special Hospital. It is quite clear that with such a system of staging the case, the “honor of uniform” will always be observed.

Characteristic of this inaccessible department is that all the subjects, despite the fact that they are kept in a medical institution - the Serbsky Institute - for some reason are only under the corresponding letters (initial letters - A, B, C, etc.) . Moreover, the doctor on duty at the institute has no idea about the state of health of special subjects, since he does not have the right to get acquainted with their medical histories.”

A. Abrumova gave a number of examples of the bias of the acts of forensic psychiatric examinations conducted at the institute, emphasizing that “in the multitude of acts coming out of the department of prof. N. I. Felinskaya, the description of the condition of the subjects is adjusted to fit the necessary " to prove the reactive state, i.e. "objectively existing complaints and psychotic phenomena are thrown out, one way or another contradicting or not coinciding with the alleged conclusion."

And in A. Abrumova's statement, we will not find facts of the use of psychiatry as a means of repression against political opponents of the Soviet regime. Nevertheless, now we know that the prisoners kept in prisons, including psychiatric ones, under conditional codes and designations, were, as a rule, “counter-revolutionaries”, although it is possible that in the view of A. Abrumova and her other colleagues they were dangerous state criminals, "enemies of the people."

From the reference “ABOUT THE INSTITUTE OF FORENSIC PSYCHIATRY IM. SERB, compiled by members of the special Commission of the CPC under the Central Committee of the CPSU, director of the Institute of Psychiatry of the USSR Ministry of Health D. FEDOTOV and head of the science department of the newspaper "Medical Worker" PORTNOV dated August 31, 1956:

“The Institute has exaggerated its importance and has placed itself in the position of the highest body of the SPE, turning into a kind of “supreme judge”. There was no body that would control this responsible work connected with the fate of people, since the judicial authorities could not do this due to the lack of qualified doctors in their states, and psychiatrists from the general psychiatric network were not allowed for reasons of "special secrecy". Any criminal can be exempted from liability at the conclusion of the institute and, conversely, a mentally ill person can be subjected to judicial responsibility.

The Institute has placed itself in the position of the highest forensic psychiatric arbiter and is, in a significant proportion of cases, the last resort. It has become the largest hospital in which an examination is carried out from all over the USSR, although this is not necessary. This creates congestion, queues waiting for examinations for many months. At the time of the examination, the queue for a stationary examination was about 300 people.

To a certain extent, the queue is created artificially and as a result of the unreasonable delay of the subjects in the institute's clinics.

The Institute conducts an examination in isolation from the judicial psychiatric commissions not only in the periphery, but also the city judicial psychiatric commission in Moscow.

During repeated examinations, there is no continuity, employees of city expert commissions are not invited to the institute even in cases where it is a question of revising the expert opinions they had previously given.

A tradition has been established at the institute - to exclude from the SEC a doctor whose opinion disagrees with the majority of the members of the commission. A dissenting opinion is not recorded in the examination certificates.

If in one of the departments, after a second examination, opinions differ, i.e., the diagnosis is not established, then the patient is transferred to another department, where the examination is brought to a consensus without any participation of the doctors of the previous department and reference to their opinions.

Minutes of the discussion during the examination are not kept. In the case history, there are also no traces of discussion and opinions of doctors about this patient. As a result, in some cases there is a gap between the written medical history and the conclusion of the commission. A striking example of this is the case history of Pisarev, who, according to the records in the case history, looks like a person with an orderly behavior, except for some data from the anamnesis, and the act indicates a diagnosis of schizophrenia with a protracted development and the need for isolation (!).

In the conclusions of the institute, there is always a “single” opinion, even in the most difficult and controversial cases. This greatly complicates the defense of the subject in court, and sometimes makes it completely impossible.

It should be emphasized that during the examination, the qualification of the corpus delicti often prevailed. This was expressed in the fact that for many years the mentally ill, prosecuted under Art. 58 were almost automatically sent to compulsory treatment in isolation (according to the old instructions) or to compulsory treatment in a special psychiatric hospital (according to the instructions of 1954), regardless of their mental state.

Employees of the Institute Kalashnik, Lunts, Talze and others refer to one of the points of the instruction of 1954 (i.e., the corpus delicti, and not the condition of the patient (!) and its real danger to others, decided the fate of the patient). It also is one of forms of pressure of a consequence on examination.

Thus, there was a certain influence of the investigating authorities in interpreting the instructions, which created conditions when a person only suspected or unjustly accused of a crime under Art. 58, being recognized as sick, fell into a prison environment and was completely isolated from the outside world. It was in this way that the sick Pisarev ended up in prison, which he rightly points out in his statements.

Until recently, the institute did not conduct any methods of active therapy at all. Even the head of the institution, A. N. Buneev, was of the opinion that medical intervention could “spoil the purity” of the clinical picture of the subject’s condition (!!).

The attitude towards the subjects leaves much to be desired. A number of patients are kept in insulators that do not have beds, and this is explained by the alleged aggressiveness of the patients. This motive cannot be justified. It is characteristic of psychiatric hospitals of the distant past.

Cases of rough treatment of patients are noted, primarily by the “key” ones (Ministry of Internal Affairs employees). In the hospital of the institute, there is a beating of patients by security officers, including the use of such an unacceptable method as taking “on a collar”. Undoubtedly, the result of rough treatment on the part of the key Shamrina was the death of the sick AI Kozlova on February 6, 1956 in the 5th department. The sick Bolotin and the sick Sazonov were beaten.

Individual guards cynically declare (to the doctors): “You have a false idea of ​​humanity. We beat and will continue to beat, but we won’t go to your department, let the sick beat you.”

V. Fedotov concludes that it is necessary to stop the practice of training narrow psychiatrists - specialists in matters of sanity, to unite TsNIISP them. Serbsky with the Institute of Psychiatry of the USSR Ministry of Health, which, in his opinion, will provide "the unity of the further development of general psychiatric and expert theory and practice in the USSR".

Archival documents testify to the close interconnected work of the punitive authorities and the Institute. Serbsky to suppress the anti-Soviet activities of citizens who violated their own criminal legislation.

For many years, from 150 to 480 remand prisoners were constantly waiting in Moscow prisons for 2-3 months, and only because the same prison authorities in Moscow refused to accept prisoners who had passed the SPE and were declared insane, on the grounds that, according to the Criminal Code RSFSR, they could not be detained. Therefore, such prisoners, while waiting for their cases to be heard in court and sent for compulsory treatment, spent many months in the TsNIISP, which turned into a kind of prison psychiatric hospital. That is why the TsNIISP was guarded by the personnel of the troops of the USSR Ministry of Internal Affairs, maintained at the expense of the USSR Ministry of Health.

Unable to timely and accurately comply with the Criminal Code of the RSFSR on the application of measures of social protection of a medical nature, irritated by the slowness of the Serbsky Institute in the production of examinations and the stubborn position of the prison authorities, the Prosecutor of the RSFSR A. Kruglov sends a surprisingly cynical document to the Minister of Internal Affairs of the RSFSR N. P. Stakhanov .

“The conclusion of a forensic psychiatric examination cannot serve as a basis for refusing to admit these persons (who have passed the examination) back to prisons. According to the law (!) the conclusion of a forensic psychiatric examination of insanity does not automatically lead to the release of those arrested from custody. Judicial-investigative bodies may not agree with the conclusion of the examination and appoint a repeated examination. Finally, the court may, without appointing a re-examination, pass a guilty verdict, rejecting the conclusion of the examination on insanity, motivating it accordingly (!).

The possibility of keeping in prison those arrested who have been declared insane until they are transferred to hospitals for treatment is also provided for in Art. 8 instructions of the USSR Ministry of Health of July 31, 1954 ...

I ask you to instruct the relevant authorities on the unhindered and immediate admission back to prisons of those arrested who have passed an examination at the Serbsky Institute, regardless of its results.

The directive of the Prosecutor of the RSFSR unwittingly exposes the subordination and dependence of the EIT conducted by TsNIISP, if it could be so easily neglected. The prosecutor of the RSFSR was well aware of the inconsistency of many acts of examination of the Serbsky Institute with the true mental state of the subjects under investigation. And that this was so is evidenced by some of the facts I cite about the diagnoses and conclusions about the sanity of repeated examinations of the subjects of the period 1951-1955.

Convicted under Art. 58 of the Criminal Code of the RSFSR, D. M. Markeev was diagnosed by an examination conducted at the LTPB: "reveals residual effects of traumatic brain injury with features of increased excitability, but no change in intelligence."

The subject was declared sane. But such a diagnosis and conclusion did not satisfy the central forensic psychiatric commission of the prison department of the USSR Ministry of Internal Affairs, and Markeev was sent to the TsNIISP for a second examination, which recognized him as insane due to the fact that he showed signs of a traumatic lesion of the central nervous system with pronounced changes in the psyche. “The degree of these changes is so significant that the condition of the subject can be equated to mental illness. He needs to be sent to a psychiatric hospital of the Ministry of Internal Affairs of the USSR for forced treatment with isolation.

The same fate befell prisoners M. ZABOTKINA, K. MURATOV, I. ​​ZUDOV, K. UUSTALU, V. AVDEEV, P. LADUTKO, V. PETROV, L. NEDRUCHENKO (all were convicted for political reasons).

On the territory of modern Moscow there are many institutions that provide not only clinical care in all existing areas, but also conduct extensive scientific activities. Numerous metropolitan research institutes and centers operate in this area, also carrying out scientific activities in the field of medicine. All Moscow centers and research institutes have been operating for decades; the history of the oldest has about a century. Many of them are also known abroad. In most cases, research institutes consult difficult patients from other cities of Russia.

In the list of the most significant institutions working in this area, one of the first places is occupied by the Serbsky Center. The main activity of the institution is the conduct of forensic medical examinations, as well as the development of methods in this area.

The center provides clinical care to patients with mental disorders, as well as children and adults who have been affected by emergencies. One of the activities of the Serbsky Psychiatry Center in Moscow is the provision of professional medical care for alcoholism, tobacco smoking, drug addiction and gambling; at the same time professional consultations of specialists in psychology are carried out. The clinical department also provides sexologist consultations and psychological examinations, functional and laboratory tests.

The history of the creation of the Center for Forensic Psychiatry. Serbian dates back to 1921. In those days, the Prechistenskaya hospital for the mentally ill was reorganized into a mental hospital for prisoners. Much attention began to be paid to the personality of the prisoner and the motivation of the acts committed by him, which required a professional and impartial forensic analysis. During the first decade, the Center specialized mainly in scientific activities; meetings, conferences, hearings for students and attending courses were held. By the end of the 1930s, the Serbsky State Scientific Center had become a monopoly institution that conducted forensic examinations on the most important cases.

By the end of the 1980s, departments for those suffering from drug addiction and alcoholism were opened here, and large-scale changes took place in the methodological foundations of forensic psychiatry. Currently, the Serbsky Psychiatry Center, whose official website can be found on the Internet, is the largest institution in Russia that conducts a forensic medical examination, as well as providing psychiatric care to the population. Large-scale scientific and research activities are carried out here, active cooperation with institutions of the Near and Far Abroad is carried out.

Serbsky Psychiatry Center: Structure

The institution has a clinical service, a scientific department, a dissertation council, postgraduate studies and residency; there are also professional development courses. The most voluminous is the scientific department, which includes:

Educational-methodical department;
- laboratory of psychology;
- criminal and civil departments of forensic examination;
- department of psychiatric and judicial problems of minors;
- department of forensic psychiatric prevention;
- department of problems of alcoholism and drug addiction;
- department of frontier psychiatry;
- Department of Behavioral and Mental Disorders Therapy;
- Department of emergency psychiatry in case of catastrophes;

and others.

Serbsky Moscow Center - about a hundred years of successful practice in the field of psychiatry!

Mikhail Kosenko left the psychiatric hospital, who was sent there by the court on the basis of the expertise of the Center. V.P. Serbian. Now three psychiatric institutions in Moscow are united under its roof

On the website of the Ministry of Health of the Russian Federation, it is easy to find order No. 219 dated May 17, 2014 “On the reorganization of the Federal State Budgetary Institution “State Scientific Center for Social and Forensic Psychiatry named after I.I. V.P. Serbian<…>FGBU "Moscow Research Institute of Psychiatry"<…>and the Federal State Budgetary Institution "National Scientific Center for Narcology" in the form of joining the second and third institutions to the first."

It is already known that the combination of these institutions will result in a large corporation, for which the name is ready: “Federal Medical Research Center for Psychiatry and Narcology” of the Ministry of Health of Russia.

“The psychiatric community was stunned by the decision to merge the three psychiatric centers into one institution,” Yuri Savenko, president of the Independent Psychiatric Association of Russia, wrote in an open letter to Russian Minister of Health Veronika Skvortsova, “but even more so by the wording of the order “on joining the Moscow Research Institute of Psychiatry and the National Narcology Center” to the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbian. In the full sense of the word, there has been a prospect when the tail will twist the dog, that is, when the sub-specialty serving the topic of the day will become dominant.

Further events developed very clearly and diplomatically: the Minister of Health found time to meet with an independent psychiatrist, Professor Savenko. She listened to him attentively and the very next day she arrived with her colleagues at the Moscow Research Institute of Psychiatry. On the website of this institute, the meeting is described quite favorably: “... the Minister noted that<…>the key direction here is the transfer of all public health institutions to single-channel funding, which should be carried out at the expense of the health insurance system ... With this approach, federal-scale scientific institutions may be at a disadvantage, since funds for the development of scientific research will not be enough. In the current circumstances, the ministry decided to create a number of joint scientific centers, removed from the insurance mechanism, with targeted funding ... According to the minister, the merger of three scientific institutions sets itself precisely these tasks and completely excludes any administrative subordination, absorption or reduction personnel".

But the situation does not seem favorable to Yuri Savenko:

— If a merger of institutions is really necessary, then the dominant position of the Moscow Research Institute of Psychiatry would be natural for the successful development of domestic psychiatry and its international reputation.

Director of the Moscow Research Institute of Psychiatry, Professor Valery Krasnov, in my opinion, is more peaceful. To my direct question: “What threatens the merger of three different psychiatric centers into one?” - answers with fascinating but long stories about each of the institute's clinics and about the news of scientific psychiatry. For example, it says:

- There is a medical rehabilitation department, which we ourselves prescribed in the order of necessary assistance, it is necessary for our patients. We have 8 clinics, there is a children's department, which is in great demand, patients are brought from all over Russia - from Siberia, from the North Caucasus, from everywhere. There is urgent-convulsive therapy. There is a department for the spectrum of depressive and manic disorders ... I am a doctor and, in the worst case, I will remain a doctor, the administrative chair weighs me down. But I have a certain reputation in the world.

- Probably, as an independent psychiatrist, it will be easier for me to explain the significance of the Moscow Research Institute of Psychiatry, - Yury Savenko cannot stand such a tone of conversation. - The Serbsky Center does not have a clinical character and multidisciplinary nature fundamental to psychiatry, but has an international reputation that is diametrically opposed to that of the Research Institute of Psychiatry. At the Serbian Center, it is simply terrible, I would even say shameful. And the Research Institute of Psychiatry has many years of professional respect and recognition. I can say this with full responsibility, because I was an employee of this institute from 1963 to 1974. And he completed his postgraduate studies here, and here he defended two dissertations - a candidate's and a doctor's. I was a chronicler of the institute, worked in the archives, I know the whole story, perhaps better than anyone else. This is the only institute in Moscow that has a real school of clinical psychiatry. It was his versatility that allowed him to remain in Soviet times beyond the shame of political diagnoses by dissidents. Let's remember the deadly joker diagnosis - "schizophrenia", which was almost the only topic of Academician Snezhnevsky. Subsequently, he himself and many of his colleagues became hostages of this phenomenon: what you do is what you spread. These are the black pages of Russian psychiatry, but the history of all its most worthy and significant milestones has passed through the Moscow Research Institute of Psychiatry, which will turn 95 next year. He really has the highest international authority, a high citation rating in the scientific world. And now this most unique institution joins an institution of the same age, but with a completely different purpose. The Serbsky Institute was organized in 1920 to fulfill political and social orders and has a tarnished history.

- But you are talking about the past, didn't the perestroika years change the situation?

- No, although Tatyana Dmitrieva, who was in charge of the Serbsky Institute in those years, had to publicly repent. Even the well-known writer and human rights activist Vladimir Bukovsky, who went through all the tortures of forced psychiatric treatment for dissent, was fascinated by this repentance, he believed in it. They met in 1992, and Dmitrieva then admitted that the department she heads had a criminal policy of punitive psychiatry. But all this was said in the outside world, but inside Russia it sounded exactly the opposite. She claimed that all dissidents who ended up in the West ended their lives in psychiatric hospitals. This is an absolute lie.

“Of course, some of the dissidents had mental disorders, but the point is not that the Serbsky Institute simply recognized this fact,” Lyubov Vinogradova, executive director of the Independent Psychiatric Association, enters into the conversation. - And the fact that on this basis verdicts were mechanically put: “Compulsory treatment in a hospital is necessary.” This was a crime: people with some peculiarities, and even with some disorders, were declared dangerous to society, treated by force.

— Then it was the general style. We are talking about the scale of the crime,” says Yuriy Savenko. - More than a million (!) People were deregistered from 1990 to 1992, on the eve of the adoption of the law on psychiatric care. These people, a whole city of people, could be victims of police psychiatry. I prefer this term, known in Russia since tsarist times, to the stable expression "punitive psychiatry". The Serbsky Center is the embodiment of police psychiatry, this style will now be extended to the entire Moscow psychiatry - that's the wildness. Such unification will cut down the competitiveness of the institutions.

- But the website of the research institute quotes the words of the minister that "... the merger of three scientific institutions ... excludes any administrative subordination, absorption ..."

- Many people had the feeling that the meeting of the Minister of Health with the staff of the research institute was of a psychotherapeutic nature. She told people for an hour and a half that no one would lose anything, that everything would be preserved, but ... This is not a guarantee. We read an order in which it is written in black and white that two specialized scientific institutions are attached to a special center,” explains Lyubov Vinogradova. “There is a big danger here, because in the Serbsky Center there are not only no clinics, there is simply a different attitude towards people by definition. The doctor and the expert have fundamentally different attitudes. The first heals, and for this he builds a trusting relationship with his patient. The second does not have a goal to help a person, he solves expert problems.

Ease of management is more important than the mental health of people, and now they will have no choice. The atmosphere of forensics will, in one way or another, affect everything that happens in affiliated medical institutions. The leadership of the Serbsky Center does not accept those who criticize their decisions. Dare to criticize - you are the enemy. This is illustrated by the recent story of the condemnation of Professor Savenko.

- It's true, - confirms Yuri Savenko. - The ethics commission of the Russian Society of Psychiatrists was literally forced to “condemn Dr. Yu.S. Savenko for discrediting domestic psychiatry. And I “discredited” science by categorically disagreeing with the experts of the Serbsky Center about the fact that the “prisoner of May 6” Mikhail Kosenko is dangerous for society. And that schizotypal disorder and schizophrenia are the same thing. And that a person who has voluntarily and carefully taken light maintenance therapy on an outpatient basis for many years is suddenly subject to involuntary inpatient treatment. I spoke about all this in the press, saying that behind this is the monopolization of forensic psychiatry at the State Center for Social and Forensic Psychiatry. V.P. Serbian. And that what is happening is nothing but the destruction of the adversarial expertise that was born in the early 1990s.

— What does the ethics commission of the Russian Society of Psychiatrists have to do with the Serbsky Center?

- The decision says that the reason for the investigation of my behavior was “the statement of the chief freelance psychiatrist of the Ministry of Health of the Russian Federation, director of the State Scientific Center for Social and Forensic Psychiatry named after V.I. V.P. Serbian prof. Z.I. Kekelidze,” explains Savenko. - Moreover, on the website of the Russian Society of Psychiatrists, for several months in a row, there was an article by Kondratyev, a former employee of this center, under the heading “Yu. Savenko is a detractor of Russian psychiatry.” I am there, among other things, also declared a CIA agent ...

P.S. Press Service of the Center for Social and Forensic Psychiatry. Serbsky informed me that there would be no comment on the merger of psychiatric institutions.

Under the text

I am now thinking about how two events coincided in time: the death of a unique, talented person, Valeria Novodvorskaya, who was sent to a "psychiatric hospital" in Soviet timelessness. She told about how bright, highly intelligent people came out of there as feeble-minded people in the book “The Catcher in Lies”, and right now it is important to read or re-read it ... Because right now, and not in the distant 70s, I spent six months Mikhail Kosenko, who could live at home quite calmly, receiving outpatient treatment. And the basis for this was the expertise of the Serbsky Center. To which the medical and scientific institutions of psychiatry in Moscow are now joining.

Over the 85 years of its existence, the Institute, as already noted, has turned from a small regional hospital into a large research center. Currently, a territorial model for assessing the mental health of the population has been developed; a methodology for multivariate analysis of the causes affecting the level of mental health of the population has been prepared. Scientific approaches to the development of a program for the prevention, therapy and rehabilitation of patients with neurotic and somatoform disorders and clinical diagnostic evaluation of borderline mental disorders are substantiated.

Psychoprophylactic examinations of gas industry workers and the formation of a data bank on the state of their mental health were continued. A system for organizing psychoprophylactic care at gas industry enterprises is being developed. The principles of organizing medical and psychological care and differentiated therapy for patients with mental disorders arising in emergency situations, including victims of violence and terrorism, are being introduced into practice. For the first time, a department for the treatment of children and their parents who became victims of a terrorist act in the city of Beslan was deployed on the basis of the Center.

When developing a system of social and psychiatric assistance to minors in risk groups in order to prevent vagrancy and delinquency in children and adolescents, a new form of advisory and rehabilitation assistance to children with borderline mental disorders was proposed, which made it possible to organize a special Center for Correctional Pedagogy in Moscow.

The issues of differential and functional diagnosis in mental illness in forensic psychiatric practice, as well as the principles of an individual approach to determining the border and the corresponding reactions within the country, are clarified. Human rights activists have appeared, representatives of different political views, causing concern among the authorities, but enjoying the support of foreign politicians. The previous tactics of ruthless terror against one's own people were no longer possible, and therefore, in relation to many dissidents, the authorities tried to limit themselves to discrediting them as mentally ill. At the same time, the existing Criminal Law considered such persons as especially dangerous criminals and allowed them to be sent for forensic psychiatric examination.

According to the data of the analysis, almost half of them were recognized as mentally ill and insane. According to the criminal law then in force, compulsory treatment of such patients was to be carried out in specialized psychiatric hospitals of the Ministry of Internal Affairs. It should be noted that in these cases the actions of expert psychiatrists were determined by law. Therefore, criticism and accusations of punitive activity of psychiatry were essentially directed against the punitive policy of the state as a whole. Psychiatry was chosen as a more convenient target for accusations.

Perestroika has begun. The work of international commissions to verify the activities of domestic psychiatry, which was carried out at the end of the 80s, showed that psychiatrists and forensic psychiatrists are well-trained professionals in their daily work. At the same time, shortcomings of the legal framework in the field of psychiatry were noted.

The result of the existing criticism were,

First, the transfer of specialized psychiatric hospitals with strict supervision from the system of the Ministry of Internal Affairs to the Ministry of Health in 1988,

Secondly, the adoption in 1992 of the country's first Law "On Psychiatric Care for Citizens and Guarantees of Citizens' Rights in Its Provision". These legislative acts now form the legal basis for the activities of the entire psychiatric service in the country. It should be noted that the employees of the Center took an active part in their development, as well as in the development of the recently adopted Law "On State Forensic Expert Activities".

In 1990, Professor Tatyana Borisovna Dmitrieva was elected director of the Institute, and then appointed by the Ministry of Health. Under her leadership, the Institute was transformed into the State Scientific Center for Social and Forensic Psychiatry. V. P. Serbian. This new name has become a reflection of the actually established new functions of our institution, the consolidation of its role and significance in Russian psychiatry.

In various periods, along with the development of issues of forensic psychiatry, the Center studied a wide range of problems of social and clinical psychiatry, including reactive psychoses and other psychogenies, alcoholism and drug addiction, personality disorders, depression, traumatic brain lesions, pathogenesis and therapy of mental disorders. diseases. The specificity of the Center was an integrated approach to research in social and forensic psychiatry.

In the field of forensic psychiatry in the 1990s, the attention of researchers was focused on the development of criteria for the expert assessment of "limited sanity" - a new legal institution in our country, problems of forensic sexology, forensic victimology, issues of expertise in civil proceedings.

In recent years, the structure of the Center has been replenished with many new divisions:

• Educational and Methodological Department,
• Department of Social Psychiatry for Children and Adolescents,
• Department of Emergency Psychiatry and Emergency Assistance,
• Department of Prevention of Mental Disorders and Rehabilitation of Victims of Industrial Accidents and Catastrophes,
• Division of Environmental and Social Mental Health Issues,
• Laboratory of children and adolescents.

In the structure of the Scientific and Organizational Department, a department of scientific problems of the organization of forensic psychiatric services, a department for working with WHO, created to solve the problems of social, general and forensic psychiatry, appeared. On the basis of the Center, the Department of Social and Forensic Psychiatry of the MMA named after M.V. I. M. Sechenov.

The problems of prevention and treatment of borderline mental disorders are being successfully solved, methods of medical and psychological assistance are being developed for children and adolescents who are victims of abuse and violence; substantiates the solution of legal, ethical and organizational issues of psychiatric care to the population; environmental, cultural and ethnic problems of mental health of the population are studied.

All changes taking place in the country are reflected in the activities of the Center. In recent years, one of the main areas of scientific activity of the Center has been the study of aggressive behavior in society. Tragic events related to terrorism, hostage-taking, population migration and internally displaced persons, environmental disasters and disasters are the problems that the departments of the Center deal with.

Employees of the Center took part in the liquidation of the consequences of the accident at the Chernobyl nuclear power plant, provided assistance to victims of earthquakes, man-made and natural disasters, carried out medical and expert work in various hot spots in Chechnya, flew out to provide psychological support to pilots in Kandahar, in 2004-2005 . in the city of Beslan. This activity of the Center is highly appreciated by the government and the public of the country.

According to the Charter of the Federal State Institution “State Scientific Center for Social and Forensic Psychiatry named after N.I. V.P. of the Serbian Federal Agency for Health and Social Development” the objectives of its activities are:

• Development of scientific and organizational problems of social and forensic psychiatry (including legal, ethical, diagnostic and therapeutic issues of providing psychiatric care to the population), improving the organization of the activities of the forensic psychiatric expert service;
• Scientific substantiation of the system for the prevention of socially dangerous actions of the mentally ill and the organization of treatment for persons released from criminal liability or punishment due to mental disorders;
• Substantiation and practical implementation of methods of medical and psychological prevention of mental disorders and pathological forms of behavior in minors;
• Scientific and methodological substantiation and development of a system of medical, psychological and psychiatric assistance to victims of natural disasters and catastrophes;
• The study of environmental, industrial, professional and cultural factors in the etiopathogenesis of mental disorders and the development of principles for their prevention and treatment;
• Development of modern methods of differential diagnosis, prevention and therapy of borderline mental and psychosomatic disorders based on the study of their pathogenesis and clinical manifestations;
• The study of the mechanisms of development of mental illness, the development of new means and methods of therapy;
• Experimental modeling of neuropsychiatric disorders using laboratory animals.

Medical services.