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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Sluggish schizophrenia | 2/4 | https://en.wikipedia.org/wiki/Sluggish_schizophrenia | reference | science, encyclopedia | 2026-05-05T03:38:02.694805+00:00 | kb-cron |
== Popularity of diagnosis == Because of diagnoses of sluggish schizophrenia, Russia in 1974 had 5–7 cases of schizophrenia per 1,000 population, compared to 3–4 per 1,000 in the United Kingdom. In the 1980s, Russia had three times as many schizophrenic patients per capita as the US, twice as many schizophrenic patients as West Germany, Austria and Japan, and more schizophrenic patients than any Western country. The city with the highest diagnosed prevalence of schizophrenia in the world was Moscow. Along with paranoia, sluggish schizophrenia was the diagnosis most frequently used for the psychiatric incarceration of dissenters. Darrel Regier of the National Institute of Mental Health, one of the U.S. experts who visited Soviet psychiatric hospitals in 1989, testified that a "substantial number" of political dissenters had been recognized as mentally sick on the basis of such symptoms as "anti-Soviet thoughts" or "delusions of reformism". According to Moscow psychiatrist Alexander Danilin, the nosological approach in the Moscow psychiatric school established by Andrei Snezhnevsky (whom Danilin considered a state criminal) boiled down to the ability to diagnose schizophrenia.
== Systematics by Snezhnevsky == The Soviet model of schizophrenia is based on the hypothesis that a fundamental characteristic (by which schizophrenia spectrum disorders are distinguished clinically) is its longitudinal course. The hypothesis implies three main types of schizophrenia:
Continuous: unremitting, proceeding rapidly ("malignant") or slowly ("sluggish"), with a poor prognosis Periodic (or recurrent): characterized by an acute attack, followed by full remission with little or no progression Mixed (German: schubweise; in German, schub means "phase" or "attack"): mixture of continuous and periodic types which occurs periodically and is characterized by only partial remission. The classification of schizophrenia types attributed to Snezhnevsky is still used in Russia, and considers sluggish schizophrenia an example of the continuous type. The prevalence of Snezhnevsky's theories has particularly led to a broadening of the boundaries of disease such that even the mildest behavioral change is interpreted as indication of mental disorder.
=== Conditions posed as symptoms === A carefully crafted description of sluggish schizophrenia established that psychotic symptoms were non-essential for the diagnosis, but symptoms of psychopathy, hypochondria, depersonalization or anxiety were central to it. Symptoms considered part of the "negative axis" included pessimism, poor social adaptation and conflict with authorities, and were themselves sufficient for a formal diagnosis of "sluggish schizophrenia with few symptoms". According to Snezhnevsky, patients with sluggish schizophrenia could present as seemingly sane but manifest minimal (and clinically relevant) personality changes which could remain unnoticed by the untrained eye. Patients with non-psychotic mental disorders (or who were not mentally ill) could be diagnosed with sluggish schizophrenia. Harold Merskey and Bronislava Shafran write that many conditions which would probably be diagnosed elsewhere as hypochondriacal or personality disorders, anxiety disorders or depressive disorders appear liable to come under the banner of slowly progressive schizophrenia in Snezhnevsky's system. The incidence of sluggish schizophrenia increased because, according to Snezhnevsky and his colleagues, patients with this diagnosis were capable of socially functioning almost normally. Their symptoms could resemble those of a neurosis or paranoia. Patients with paranoid symptoms retained insight into their condition, but overestimated their significance and had grandiose ideas of reforming society. Sluggish schizophrenia could have such symptoms as "reform delusions", "perseverance" and "struggle for the truth". As Viktor Styazhkin reported, Snezhnevsky diagnosed a reform delusion in every case where a patient "develops a new principle of human knowledge, drafts an ideal of human happiness or other projects for the benefit of mankind". During the 1960s and 1970s, theories which contained ideas about reforming society, struggling for the truth, and religious convictions were not considered delusional paranoid disorders in nearly any foreign classifications; however, Soviet psychiatry (for ideological reasons) considered critiques of the political system and proposals to reform it as delusional behavior. The diagnoses of sluggish schizophrenia and paranoid states with delusions of reform were used only in the Soviet Union and several Eastern European countries. An audience member at a lecture by Georgi Morozov on forensic psychiatry in the Serbsky Institute asked, "Tell us, Georgi Vasilevich, what is actually the diagnosis of sluggish schizophrenia?" Since the question was asked ironically Morozov replied ironically: "You know, dear colleagues, this is a very peculiar disease. There are not delusional disorders, there are not hallucinations, but there is schizophrenia!" The two Soviet psychiatrists Marat Vartanyan and Andrei Mukhin in their interview to the Soviet newspaper Komsomolskaya Pravda issued on 15 July 1987 explained how it was possible that a person might be mentally ill, while people surrounding him did not notice it, for example, in the case of "sluggish schizophrenia". What was meant by saying that a person is mentally ill? Marat Vartanyan said, "... When a person is obsessively occupied with something. If you discuss another subject with him, he is a normal person who is healthy, and who may be your superior in intelligence, knowledge and eloquence. But as soon as you mention his favourite subject, his pathological obsessions flare up wildly." Vartanyan confirmed that hundreds of people with this diagnosis were hospitalized in the Soviet Union. According to Mukhin, it took place because "they disseminate their pathological reformist ideas among the masses." A few months later the same newspaper listed "an exceptional interest in philosophical systems, religion and art" among symptoms of sluggish schizophrenia from a Manual on Psychiatry of Snezhnevsky's Moscow school.
== Recognizing method, treatment and study ==