Hospitals of No Return

You have no regrets?”

“What is there to regret? That I took an interest in politics?” 

This conversation between psychiatrist Galina Zhukovskaya and Olga Suvorova, a 56-year-old activist and human rights defender from Krasnoyarsk, took place in late December 2023. An investigator had brought Suvorova to Zhukovskaya to be evaluated after she was charged with the crime of knowingly falsely accusing someone of breaking the law (Suvorova had accused a member of law enforcement of rough treatment).

Their conversation lasted no more than an hour and a half, the activist recalls. The doctor questioned Suvorova in detail about her criminal case, about her human rights activities (“I protect the rights of, as Chekhov put it, the little people,” she explained), as well as about her feelings toward Vladimir Putin and Russia’s “special military operation.” This was Suvorova’s first experience with psychiatry. In addition to her activism, she had for many years led excursions along the Volga and Yenisey Rivers. She also enjoys knitting. But the psychiatrist was not interested in any of that. 

In her report, the doctor wrote that Suvorova had “frequently engaged in social activism since high school,” was “obsessed with the desire to help others,” and “categorically denied” her guilt in the criminal case before her. But most importantly, “she shows signs of mixed personality disorder, with non-specific symptoms (coded F61.9 in the 10th edition of the International Classification of Diseases).” To confirm her diagnosis, Zhukovskaya recommended that Suvorova be hospitalized and given a more in-depth evaluation.

“The main goal was to put me away in a mental institution, so that I would become more compliant,” Olga asserted. Before assigning her that “thorough evaluation,” investigators repeatedly told her that she should “plead guilty, and it will all be over.”

The First Step

Since Russia’s full-scale invasion of Ukraine, persons accused in “political” cases have increasingly been declared mentally incompetent. Instead of punishment, they are required to undergo “compulsory measures of a medical nature,” i.e., involuntary commitment to a mental institution.

“In 2023, such sentences increased fivefold over the 2021-2022 averages,” wrote Agentsvo, a media outlet that studied data compiled by the human rights organizations OVD-Info, First Department, and Memorial, and by the summer of 2024 the group had already identified 36 such cases since the war began. According to the publication 7x7, there were at least 53 cases of activists and oppositionists being sentenced to forcible psychiatric treatment during 2022-2024. But, if you survey the website data of Russian courts, the number is far greater: 86.

“This is a feature of our time that has more to do with the socio-political situation than with psychiatry,” said clinical psychologist and human rights activist Lyubov Vinogradova, who served for many years as executive director of Russia’s Independent Psychiatric Association.

After Russia's February 24, 2022, invasion, it adopted many repressive laws. And, according to OVD-Info, the number of politically motivated court cases rose sharply. “Law-abiding, mentally normal individuals are trying to watch their step and understand that today it is unsafe, for example, to write something on social media,” said Vinogradova. “But there are other people who don’t think about this. So they often end up in the clutches of investigators, and they wind up being put through a forensic psychiatric examination.” 

Outpatient forensic psychiatric evaluations are fairly common in criminal cases (and when certain crimes are involved, they are mandatory). For example, investigators can request such an evaluation if they receive a report from a clinic that said person has been receiving treatment (even talk therapy, said lawyer Anastasia Pilipenko). They can also request such an exam if someone involved in a case seems to be behaving irrationally. 

“An investigator considers the system to be infallible. And he cannot understand some of the things that people with oppositionist inclinations may want to do – say going out and standing in public all day with a protest sign,” said Rustam Mukhamadeyev, a lawyer from Rostov-on-Don.

One of his Moscow colleagues, Katerina Tertukhina, said that any recommendation by an investigator is supposed to be “motivated and justified… You cannot simply write: ‘I am an investigator who has decided to require an evaluation.’ You’re supposed to write: ‘I have such and such reasonable doubts, or such doubts based on this, that, and the other.’” Tertukhina, who has been working as a lawyer since 2010, said she “has never seen a single case with a formal recommendation of this sort.”

A “five-minuter,” as the outpatient psychological examination is nicknamed, can last anywhere from several minutes to several hours. In addition to standard questions about one’s life and the criminal case, a person can be asked to take psychological tests – for example, an intelligence test.

Doctors must determine the answer to three questions:

Does the person have a mental disorder?

Was the person, at the time of the crime, able to understand what they were doing and able to assess how their actions might cause danger to society?

If not, does the person need compulsory treatment?

If the experts cannot answer these questions, they may recommend sending the person to undergo a longer-term observation – about a month – in a psychiatric hospital. Such an observation, Tertukhina said, became at some point the “first step on this path.”

“It’s more of a diagnostic signal,” Pilipenko said, “that the legal proceedings could be heading in the direction of compulsory measures of a medical nature.”

The Evaluation

“They asked me whether I was aware of where I was, the date, my last name, first name, and patronymic.” This is how Olga Suvorova’s daily interaction with the psychiatrist at Krasnoyarsk Krai Psychoneurological Dispensary No. 1 would begin. In mid-May, officers had picked her up while she was at a physiotherapy appointment for an injured leg and checked her into the dispensary for the evaluation that psychiatrist Galina Zhukovskaya had recommended.

Every day in the psychiatric clinic was strictly regimented. Wake up at six in the morning, breakfast in an hour and a half, lunch in another five hours, dinner at half past five. “I’ve never seen crap like the rotten, moldy bread they served at the dispensary,” Suvorova complained.

The time between meals is devoted to meetings with doctors, rest (with a two to four p.m. “quiet hour,” when it is forbidden to leave the ward), short walks, and meetings with relatives. Sharp and breakable objects (even a ceramic cup) are prohibited. Patients are given access to their mobile phones three times a week and only for a few hours. For entertainment, there is a small library and a TV, which is turned on in the evening. At ten o’clock, the overhead lights are turned off in the ward, leaving only the night lights. Bedtime. 

During the observation period, no medications are supposed to be given, but, according to Suvorova, they still gave her unidentified tablets every day: “They didn’t check your mouth to see if you had swallowed them or not. I decided not to raise a fuss and simply hid my tablets, then flushed them down the toilet.”

At the same time, Olga said that orderlies – for whom cursing and rudeness are the “normal way of communicating” (when there are no doctors nearby) – monitor their every step in the clinic.

“Our room had a partition,” she said, describing the ward that she shared with 10 women (there were 15 men in a neighboring ward). “Behind it were two toilets and a bathroom. There were doors, but they didn’t close. Not a single handle, not a single lock.” Her co-warders included one person accused in an “antiwar” case, another who was a victim of fraudsters, and another who was a former prisoner.

There were also young women in the ward who had been sent for evaluation from a psychoneurological boarding school for adults. “They were orphans,” Suvorova said. “When they turn 18, the state is required to give them an apartment. But they don’t give them apartments, and, when they are released from the orphanage, they receive a diagnosis of ‘mentally incompetent.’”

In order to have this diagnosis lifted, they have to undergo an inpatient evaluation. Suvorova said the nurses exploited the helplessness of the orphanage graduates. Daily they were assigned tasks such as doing repairs at the clinic, washing floors, and doing dishes.

“We asked [the girls] why they were doing this,” Olga said. “And they replied ‘We’re trying to get on their good side.’” 

Once, Suvorova also had to work in the wards: she washed floors in the corridor in order to get hot water for tea from an orderly outside of the usual time. She complained about all of this to the head doctor, after which hot water was allowed whenever she liked, and the orphans’ forced labor activity was covered up. Soon afterward, Suvorova was released from the clinic. 

This was on June 6, the 22nd day of her evaluation. Doctors gathered as a commission and asked Suvorova if she considered herself to be sane. “I said that, prior to my incarceration in the clinic, I was certain that I was sane,” Suvorova said. “But now I find it a bit hard to say.”

When asked if she was able control her actions and, for example, if she would be able to organize some event or other if the desire arose, Suvorova said: “It’s something anyone could do, it’s a question of the result and what goal you want to achieve.”

“In general,” Suvorova said, “our discussion took a turn in a bit of a different direction.”

It is still unknown what sort of conclusion the experts arrived at. But immediately after leaving the clinic, Olga was served with two subpoenas to appear for questioning before the Investigative Committee.

Activism = Illness

“Malicious litigious tendencies,” “an exaggerated sense of justice,” “an active civic position.” Recently, said lawyer Katerina Tertukhina, phrases like this are “all over the place” in the written conclusions of forensic psychiatric examinations. It is how some experts make the case that an activist is mentally incompetent. At the same time, others (“independent” experts, Tertukhina emphasized) do not see any medical significance in these designations .

One of Tertukhina’s clients, Moscow environmental activist Olga Kuzmina, was judged by doctors to have a propensity for “pettifoggery” and “protest actions.” In August 2021, Kuzmina protested construction taking place as part of renovations around the city’s Babushkin Park. After arming herself with an inoperative crossbow, she climbed a tree and tied herself to it.

The authorities labeled her protest “hooliganism.” But in August 2023, after two years of criminal prosecution, the court sentenced Kuzmina to compulsory psychiatric treatment. Her defense team is appealing.

Kuzmina spent just a few days under observation at Psychiatric Clinical Hospital No. 5 in Chekhov (a town outside Moscow).[1] She refused to speak with doctors, yet they still diagnosed her with “schizotypal personality disorder”[2] and concluded she was mentally incompetent. The experts, Tertukhina said, based their findings on the evidence in the criminal case but failed to consider Kuzmina’s “extreme degree of desperation.” She had long petitioned to have the construction work designated illegal, and only after losing her case in court did she decide to take action.

In the paperwork surrounding any criminal case, according to Yekaterinburg lawyer Roman Kachanov, the guilt of the accused is always treated as a given, and doctors go into an evaluation with this in mind. In the case of one of his clients, Kachanov believes that the fact that he had been charged with “discrediting” the Russian army influenced the decision to declare him “mentally incompetent.”

“This man has been under psychiatric observation since childhood. It is obvious that he has some mental problems. But he behaves normally and earns money. We honestly thought he wouldn’t be given that diagnosis. Just because a person has mental problems does not mean he’s incompetent.” (Kachanov and his client are appealing the experts’ finding.) 

In the fall of 2022, “bad offenses” led a doctor at Nizhny Novgorod Clinical Psychiatric Hospital No. 1 to refuse to release activist and Pastafarian[3] Alexei Onoshkin from the hospital. Onoshkin had been sent to the hospital “pending the conclusion of the investigation” into charges of “fakes” and “advocating terrorism.” A year later, the court ordered Onoshkin to undergo compulsory treatment. 

“It is quite difficult to draw a line between illness and character traits,” said lawyer Mikhail Biryukov. At the same time, he believes that diagnoses are not made solely on the basis of someone’s opposition to what the government is doing: “Otherwise, all our clinics would be jammed full,” he said.

Human rights activist Vinogradova, from the Independent Psychiatric Association, agreed: “Absolutely healthy people in our country are not recognized as mentally ill and are not locked up in psychiatric hospitals.” 

She emphasized that “experts have enough self-respect not to allow people to be wantonly suppressed.” But she qualified this by noting that doctors are also “human beings” and “can sense what way the wind is blowing.” Therefore, in “borderline” cases, when someone could be justifiably diagnosed as either competent or incompetent – doctors may be inclined to take the path of least resistance – the one that they realize investigators would prefer.

Pilipenko agreed: experts often “cut corners” when answering the key question of whether or not someone is sane – can they evaluate their own actions and predict their consequences. “They write that there is such and such a disorder, and when someone has this disorder, their critical thinking and predictive abilities are grossly impaired,” she said. Doctors do not explain their conclusions, she said. Even when they’re questioned in court, they simply repeat: “In the case of such a disease, these abilities cannot not be impaired.” 

But it also happens, Pilipenko said, that experts’ conclusions boil down to the idea that: “If a person has committed an illegal act, his critical thinking is clearly impaired.” Biryukov called this approach “a very dangerous trend.” Pilipenko said that psychiatrists use the formula not only in “political” cases, but everywhere.

In the System’s Clutches

“I was standing in front of the presidential offices, not holding any sign. Police officers approached… I showed them my passport; they took my passport and didn’t return it to me… I asked the police officer who wouldn’t give it back whether he was a moron. And, actually, that’s what they nabbed me for and took me in. There, at the station, they called for the orderlies.”

There’s a video, secretly filmed at Novokuznetsk Psychiatric Hospital, that shows Igor (Ingvar) Gorlanov, a 21-year-old raised in an orphanage, explaining how, in December 2019, he traveled to Moscow to seek a personal meeting with Putin. Gorlanov said he was confident that only the president could restore his mother’s parental rights.

That visit to the building of the Presidential Administration ended in detention. Gorlanov underwent “involuntary hospitalization.”

Gorlanov’s lawyer, Alexei Pryanishnikov, related what happened: “At the station, according to the police reports, he kept citing Article 51 of the Constitution and demanded that the officers state their name and rank, and he wrote down their badge numbers. The police concluded he should be sent to the hospital.”

Pryanishnikov said that doctors are easily intimidated when dealing with the police. “If the police have a dog with them when they bring someone in, that must mean there are grounds to institutionalize him. What if he kills someone, and we’d be responsible?”

Over the next two months, Gorlanov spent time in three psychiatric hospitals – in Moscow (at the P.B. Gannushkin Psychiatric Hospital), Kemerovo, and Novokuznetsk. Gorlanov said he was beaten and tied to a bed in the Moscow hospital. He was also forced to take large doses of haloperidol (a drug used to treat schizophrenia). That treatment continued in Kemerovo. 

“He changed radically,” according to a Kemerovo activist who visited Gorlanov. “His will was completely crushed; his memory was shot, and he didn’t show any emotion. He was totally out of it.”

Doctors diagnosed Gorlanov with “chronic delusional disorder.” Just 10 percent of the psychiatric report was devoted to medical issues. Pryanishnikov said that the rest commented on his client’s civic activism and the idea that he “stands in opposition to society.” In describing the deterioration of Gorlanov’s condition, the report stated: “With increasing frequency he took part in the opposition’s protests, including those organized by Navalny’s headquarters, and he organized individual protest actions, put up a tent across from Novokuznetsk’s city government building with the legal demand that, as an orphan, he be provided housing.”

In April 2023, lawyers managed to overturn Gorlanov’s hospitalization, and he was awarded R100,000 ($1,000) in compensation. But by that time Gorlanov had again been sent to a psychiatric hospital – this time for evaluation as part of a criminal case accusing him of “inciting hatred towards the government.” Launched in March 2023, the case charged Gorlanov for social media posts critical of judges and police officers. At that point he was added to a list of “terrorists and extremists.”

In early 2024, after having been released from that hospitalization, Gorlanov was detained at a Novokuznetsk shopping center, forcibly taken to a mental hospital, and charged with “insulting a policeman” (at the shopping center).

“Igor was in a daze,” Pryanishnikov reported on his Telegram channel after a visit to his client. “He had been given an injection because, according to the hospital staff, he ‘started a rally in the ward in support of Navalny.’”[4] At the end of April, while his lawyers were trying get him released from the hospital, the court sentenced him to “compulsory measures of a medical nature.” 

“Considering that he’d already been through involuntary hospitalization,” Pryanishnikov said, “it wasn’t hard for experts to identify signs of insanity. After all, everyone knows how it works: ‘once the system gets its hands on you, it won’t let go.’” 

Over the past two years, lawyer Kristina Tyurina has had three clients charged with “political” crimes sentenced to “compulsory measures of a medical nature.” This was not the first time these clients had been diagnosed with mental disorders: “These are people who, in some cases, were seeing a psychiatrist way back in the 1990s but then moved on and no longer needed treatment or, in others, have chronic conditions or even psychiatric disabilities.” 

One of Mikhail Biryukov’s clients who was indicted for “fakes” about the Russian army had been diagnosed with schizophrenia back in 2005 (he thought he was being followed by the FSB). Since then he had been on medication and was in stable condition. In fact, he had been thriving professionally (as a “successful inventor and department head at a major company,” according to Biryukov). Yet the doctors who conducted the outpatient examination nonetheless diagnosed him as being mentally incompetent and recommended treatment in a psychiatric hospital.

This decision, Biryukov explained, was influenced, among other things, by two statements his client made. First, he asserted that what he had said about the criminal actions of Russian soldiers in Ukraine was true. Second, he claimed that in two years he would be released as a “hero.”

Lawyer Tertukhina noted that “many people are currently seeking psychiatric treatment. Psychiatrists prescribe drugs. And when it happens that a criminal case is initiated against such a person, he, unaware of the trap he’s falling into, says: ‘I have medicines, I have to take them every day.’ As soon as an investigator hears this, it’s off to the races – and off to a psychiatric evaluation for the accused. It also makes psychiatrists’ job easier.”

Dangers to Society

According to a 2016 report issued by the Agora human rights group titled “Political Psychiatry in Russia,” using psychiatric evaluations in criminal cases is “a convenient way to delegate decisions on the question of guilt to psychiatrists.”

The Agora report continues: “Closing a case with ‘compulsory measures of a medical nature’ is just as good as an indictment and does not have a negative impact on the track record of either the investigator or the judge. At the same time, it takes significantly less effort to prove the circumstances or charges.” 

Pilipenko agreed. “If a person is mentally incompetent, what are we supposed to make of his testimony? That he’s not to blame if, for example, all he did was disseminate information that happens to be true? We won’t even take anything he says into account.” 

In such cases, Pilipenko said, the dispute between the parties generally lasts only a couple of court sessions and boils down to the question of whether a person needs treatment and what kind. “It makes the task much easier,” she added. “And why not make it easier when you’re dealing with a political case? When supporters show up in the courtroom, the media publish something after each hearing, and each side is putting its own spin on things. And here’s an opportunity to speed the trial along, plus it can be immediately closed to the public” (since a diagnosis of mental illness is grounds for closed proceedings).  

Court-ordered treatment can be either outpatient or inpatient. In the case of the former, people have to make regular visits to a psychiatric clinic, anywhere from once to several times a month. In the latter, they are confined to a facility. The inpatient facilities themselves fall into three categories (general-care, specialized, and specialized with intensive monitoring), and they differ in how tightly patients are monitored and controlled. In a general-care facility, conditions are closer to that of a hospital, while in a specialized facility with intensive monitoring, the conditions more closely resemble incarceration: patients are guarded by FSIN [Federal Service for Carrying Out Punishment, the agency that oversees prisons] employees. 

It is up to doctors to prescribe what “medical measures” should be taken. As human rights activist Vinogradova explained, their decision generally depends on the danger that a person, in their opinion, poses to themselves and others, that is, “can they commit another criminal act?”

The “gravity” of the crime the person has been charged with is also often taken into account. “If doctors write that he is dangerous, that must be documented: he stuck his head in a noose or chased people with a knife,” said lawyer Pryanishnikov. “But again, conclusions are drawn on the basis of ‘oppositionality,’ ‘crazy reformist ideas,' and so on.’” 

According to Tertukhina, in the past, courts often chose outpatient treatment for “compulsory measures of a medical nature.” But that changed with the proliferation of “political” cases: “Information on such cases is usually not published, so we don’t have access to statistics. But I haven’t heard in recent political cases of people being sent for outpatient treatment.” Doctors now tend to prescribe inpatient treatment – and not just in general-care facilities but in specialized ones where conditions are harsher.”

Other lawyers also describe a trend toward ruthlessness in the courts. For one thing, it is extremely difficult to dispute medical experts’ findings and recommendations. “In 90 percent of cases, not only do judges fail to make any effort to understand what’s written in medical reports and treat everything like a formality, they also refuse to let the defense submit an evaluation from an independent expert,” said Pryanishnikov.

In defending their refusals, the lawyer added, judges often use the wording: “There is no reason not to trust the findings of experts from such-and-such a medical institution.” “It’s always the same,” he said. “When police officers come to court, they usually write that there is no reason not to trust them. They’ve got epaulets and an insignia on their hats, so everything is fine.”

Unintentional Intention

“I wouldn’t wish for anyone to end up in a psychiatric hospital,” wrote Anastasia Pilipenko on her Telegram channel in November 2023,. 

In the same post, the lawyer described what her client, 29-year-old Viktoria Petrova, had to endure for a week in St. Petersburg’s Skvortsov-Stepanov Psychiatric Hospital No. 3 (a general-care facility). This is just a short extract:

“She was tied by her hands and feet to the bed and given some drug that made her practically unable to speak for two days – meaning she was unable to complain. While Vika was tied up, they threw her clothes onto her face. Apparently, just for the pleasure of watching how helpless she was.”

This attitude, Pilipenko said later, is something all patients experience in psychiatric hospitals (not just those sentenced to treatment in connection with a criminal case). “People have similar stories – the same demands to undress, to take a shower in front of employees of both sexes, having their arms twisted, being tied up. That’s how they break people’s will. There is no rational need for this.”

Another lawyer, who spoke on condition of anonymity, confirmed that in psychiatric hospitals, the criminal defendants’ rights are regularly violated. Another recounted the story of a client who was forced into treatment even before the court reached its verdict. “He complained that they were giving him drugs under the threat that, if he refused, they would use force, including tying him to the bed.” In the same hospital, the lawyer said, his client faced harassment by other patients: “Fornication is rampant there, even though it’s a same-sex environment.”

Few dare to share such stories publicly. Even fewer are ready to do it under their own name, as Viktoria Petrova did. In the fall of 2023, the St. Petersburg resident was accused of “fakes” and admitted to Skvortsov-Stepanov Hospital. Doctors recommended transferring her there from her pre-trial detention center (according to her lawyer, Petrova complained that what she said during her evaluation was “grossly distorted”). A month later, the court sentenced her to “compulsory measures of a medical nature,” even though the defense counsel argued that this requirement was not valid in this instance.

According to both doctors and the court, at the time that she “committed the crime” (she posted criticism online of Russia’s War on Ukraine and of Putin’s “genocide against the Ukrainian people”), Petrova was not cognizant of what she was doing. But at the same time, the court concluded that she had intentionally spread “fakes,” that is, she “knowingly spread false information” under the guise of “reliable reports.”

“That implies that a person is supposed to be able to distinguish reliability even if they are not cognizant of their own actions,” Pilipenko commented.

The same contradiction was pointed out by lawyers Kristina Tyurina and Katerina Tertukhina. “This is a story about something impossible,” Tyurina said. “The courts treat everything like a formality and do not take into account that cognizance has to be proven.”

Tertukhina said that spreading “fakes” is not the only crime for which, theoretically, the imposition of compulsory measures makes no sense. Another is, for example, the crime of “hooliganism” leveled against her client Olga Kuzmina, who staged the protest with a crossbow. “[Hooliganism] is, by definition, a conscious violation of public order, a moral norm, principles,” the lawyer said. “That presumes that the offenders understand that they are intentionally setting themselves in opposition to society.” 

It is unclear how lawyers are supposed to handle this contradiction. Neither the Supreme Court nor the Constitutional Court have yet offered guidance.

Pilipenko suggests looking at how similar crimes involving intentionality are treated, such as the crime of “knowingly making a false accusation.”

“I have seen with my own eyes court cases where the imposition of medically compulsory measures was annulled precisely because the defendant could not knowingly make an accusation if he was not cognizant of his actions.”

But in the case of Viktoria Petrova, it has not yet been possible to challenge the court’s decision. Meanwhile, the courts have ordered compulsory psychiatric treatment for at least nine other defendants in “fake” cases. “A mentally healthy person always reads the Ministry of Defense press releases and is guided only by them,” quipped lawyer Mikhail Biryukov. “Only a mentally ill person could reach his own conclusions [about the war]. Perfectly logical.”

Keep Quiet or Get a Shot

The main psychiatric hospital for Sverdlovsk Oblast has a branch tucked away in the countryside, just outside a forest. Danil Shepelev first went there in May 2024, to see his father. By that time, Rafail Shepelev had been under court-ordered confinement in the specialized hospital for about a month.

In 2015, according to his son, Shepelev Sr. became interested in what was going on in the country. His once good crane operator’s salary had been drastically reduced. “He started asking questions, looking for answers, asking ‘why, how?’” Danil said. In the end, he connected the reduction of his salary with the annexation of Crimea: “This is where his activism began,” Danil said. 

Over the next few years, Rafail was frequently detained at protests. For example, in 2017 he was assigned 33 hours of compulsory labor for reading the Constitution aloud at a “He’s not Dimon to you” [5] protest organized by Alexei Navalny’s team (later, the European Court of Human Rights ruled that Rafail was entitled to €3500 in compensation, however Russia does not comply with ECHR rulings). In November of the same year, Shepelev was detained for taking part in the “Maltsev Revolution”[6] and was jailed for two days and fined. 

In 2021, Rafail Shepelev moved from Yekaterinburg to Georgia. He took this step, Danil said, because he feared criminal prosecution in Russia: “It was vaguely hinted that they were planning to arrest him,” Danil said.

Rafail settled in Tbilisi and rarely communicated with his son. Then, in the fall of 2023, Danil suddenly got a call from one of his father’s colleagues informing him that his father had disappeared.

On the morning of October 12, Rafail Shepelev left the hostel where he was living and where he worked as an administrator. He told a colleague, “I’ll be back soon,” but nothing more was heard from him. On the following day, a notice appeared on the website of a district court in Vladikavkaz, North Ossetia
(a part of Russia), that a case had been opened against Shepelev. He was accused of “petty hooliganism” (Part 1 of Article 20.1 of the Code of Administrative Offenses).

According to the official version provided by the Georgian Ministry of Internal Affairs, Shepelev had arrived by taxi in the village of Kirbali, near the border with Russian-controlled South Ossetia (a break-away region in northern Georgia). Eyewitnesses allegedly told the police that some “Russians” – presumably FSB border guards – had taken Shepelev over to the Russian-controlled territory.

Only in early December did lawyers from the human rights project First Department manage to find Rafail. He had ended up in a detention center in Nizhny Tagil, accused of “justifying terrorism” and “participating in the activities of a terrorist organization.” 

The medical commission of the Sverdlovsk Oblast Psychiatric Hospital, which conducted his evaluation, concluded that Rafail has a chronic disorder, due to which he “cannot recognize the factual nature and public danger of his actions.” Danil said his father had never previously been under psychiatric treatment. He is convinced that the doctors misinterpreted his words and world views.

Rafail himself insisted on his mental competence. Despite this, on April 16, 2024, the court placed him in a specialized hospital for the duration of the investigation.

“It appears to be a closed hospital that you can’t just walk in and out of,” said Danil.

It is an old building but a clean one. Each department has its own small courtyard, where patients can stroll. There are 15 people in each ward, but sometimes more.

“It looks like an army barrack,” Danil said, “filled with beds.” During the day they get treatments; in the evening there is free time. Rafail’s section has a TV and board games, but usually patients prefer to sleep. Here, as in a general-care facility, letters are permitted. On Thursdays, Danil said, his father is given access to a mobile phone for ten minutes. Also on these days, half-hour in-person visits are allowed, but relatives and friends must sign up for them in advance.

During his first meeting with his son, Rafail complained about the food: “The gruel in the pre-trial detention center was better,” he said. At the same time, Danil said, his father’s speech was slurred and it seemed as if “he was generally having difficulty thinking.”

“They gave him some injections,” Danil said. “He was talking to the other patients about the situation in the country, and the hospital staff did not like that. They even said, ‘We don’t need rallies here.’”

When, a week after his visit, he called his father, Rafail already sounded cheerful: “He realized that if he says something oppositional, they would give him a shot, and if he keeps quiet, they won’t. Now he’s getting a feel for the rules.” 

What exactly they’re treating Rafail Shepelev with is a mystery. But Danil feels that a psychiatric hospital is better than a lengthy – more than 20-year – term for “terrorism.”

No Clear Endpoint

When a person is sentenced to “compulsory measures of a medical nature,” the court does not specify how long the treatment will last. This question, like many others in similar cases, “is farmed out to doctors,” said lawyer Rustam Mukhamadeyev (his client, charged with the crime of spreading military “fakes,” was required to undergo outpatient treatment). 

The medical commission meets every six months. If a patient’s condition improves, a milder form of treatment can be recommended. For example, they can be transferred from a specialized facility with intensive monitoring to a less-restrictive specialized facility, or from there to a general-care facility or from a general-care facility to outpatient treatment. Compulsory treatment ends only when doctors decide that a person no longer needs observation. And when the court agrees. 

But you cannot skip a stage, and when patients’ condition is seen as deteriorating, they are subjected to harsher conditions. “In prison, you can count down the days till your term is up,” said lawyer Alexei Pryanishnikov. “Here, nobody knows when they’ll get out.” 

Lawyer Pilipenko said she has had clients who were treated in a general-care psychiatric hospital, and the length of time was different in every case. For example, for drug cases it could be from one and a half to two years. Storing narcotics is punishable by up to three years in prison, and up to 10 years when large amounts are involved. “On the other hand, I know many people charged under Article 105 [for murder] who have been institutionalized longer than they would have been in prison,” she added.

As for the “political” defendants of the past two years, who should have already been released from hospitalization, neither Pilipenko nor the other lawyers have any idea when they will finally get out.

Certain conditions must be met before treatment can be eased or concluded. Most importantly, patients have to admit that they’re sick and need treatment. “Normal people capable of thinking critically who find themselves in a psychiatric hospital establish good relations with the nursing staff. Then, the notations in their file will be favorable,” said Biryukov. “In practice, doctors do not talk to patients daily. They question them once every six months, they look at the history of behavior in the hospital, how patients communicate with their ward-mates, with the medical staff, etc., and they draw their conclusions accordingly.” 

Another no less important criterion is “demonstrating remorse for what you’ve done.” In other words, Pilipenko explained, patients are supposed to admit their guilt. “In every conversation with a psychiatrist, they should say: ‘I realize that what I did was wrong, and I won’t do it again.’ And they have to keep saying that as long as they’re in treatment, so that after a year or a year and a half, doctors finally conclude that it no longer makes sense to institutionalize you.” 

But for “political” arrestees, this isn’t easy. “I can understand if a person has committed some socially harmful act: rape or theft,” said lawyer Roman Kachanov. “But what about here? A person is asked: ‘Are you for or against the war?’ And if he is against it, they say, ‘That means you still haven’t gotten better.’

“In essence,” he said, “it’s a psychological conundrum.” 

In mid-June 2024, the Primorsky Krai Court refused to transfer Yakut shaman Alexander Gabyshev to a general-care facility, even though doctors at the Ussuriysk’s Regional Psychiatric Hospital No. 1 (a specialized facility with harsher conditions), where Gabyshev is now located, first requested this two years ago.

Over nearly five years of persecution, the shaman has faced every “method of punitive psychiatry,” said his lawyer Pryanishnikov. In September 2019, Gabyshev, who had been on his way to Moscow to “exile Putin,” was taken immediately upon his arrest to the Yakutsk Republican Psychoneurological Dispensary.

Although the shaman spent less than a day there, doctors managed to diagnose him. According to his lawyer, Gabyshev was diagnosed as suffering from “delusional ideas of reform,” that is, the shaman was confident that power in Russia needed to be changed.

After that, Gabyshev was involuntarily hospitalized twice more: in May 2020 (he was kept for two months) and in January 2021. While he was hospitalized the second time, they opened a criminal case against him for violence against a representative of the authorities. Allegedly, during his detention Gabyshev “used an 84-centimeter-long knife to inflict a stab wound” on a member of the Russian Guard.

Gabyshev was brought to court straight from the psychiatric hospital. “He was in an appalling state,” Pryanishnikov said. “In addition to more or less benign medications, they [the clinic doctors] had overused haloperidol. And they stopped doing so only after he lost consciousness in court, in front of the judge.” 

For this case, the medical commission of the same Yakutsk psychiatric clinic again conducted a psychiatric evaluation and deemed Gabyshev to be mentally incompetent. In addition, experts pronounced him a danger to himself and others.

“Speaking at his trial,” Pryanishnikov said, “he asked them to ‘Give me five years in prison, but not in a mental hospital.’” Instead, the court sentenced him to the harshest treatment conditions – a specialized facility with intensive monitoring.

There are only eight such hospitals in Russia. In October 2021, Gabyshev ended up at one in Novosibirsk.

“There are rapists and murderers there. This is a strict regime facility, very tight control,” Pryanishnikov said. “The facility is guarded by FSIN employees, that is, it’s just like a pre-trial detention jail or a penal colony. In addition, there is round-the-clock surveillance.”

“Patients are kept in wards, but they are in fact cells,” said human rights activist Vinogradova. “Metal doors with peepholes. Inmates aren’t allowed to move around the hospital, even within the wards, without a guard escort. They’re even lined up and marched to the bathroom.” 

According to Pryanishnikov, typically a person spends at least two and a half to three years in an intensive-monitoring specialized facility . But doctors at the Novosibirsk Psychiatric Hospital requested Gabyshev’s transfer to less harsh conditions after just three months.

“In private conversations,” the lawyer said, “the attending physician told me: ‘He’s not the kind of patient we deal with. I don’t understand what he’s doing here.’” Pryanishnikov saw this as confirmation that his client was being subjected to “absolutely unfounded and illegal” treatment. 

After his first evaluation at the Primorsky Krai Mental Hospital in Ussuriysk – where Gabyshev ended up in April 2022 – it was recommended that he be transferred to a general-care facility. The shaman was supposed to return to his native Yakutsk soon, but, according to Pryanishnikov, after a few weeks, other doctors at the same Ussuriysk hospital issued new findings for the court. In it, they said that “there was no stable improvement to his mental state,” which meant that Gabyshev needed to more time in a specialized facility. The court concurred.

Since then, Pryanishnikov said, his client has gone before the commission several times, and each time the doctors recommended easing his treatment conditions. “And now it’s ridiculous – the prosecutor and judge are making decisions that should be the purview of doctors,” he said. “They don’t agree with the doctors’ conclusions and, moreover, they make up their own findings, saying that [Gabyshev] hasn’t stayed [in the hospital] long enough and there is danger of his condition worsening. This is all written by a judge who has no psychiatric expertise.” 

Pryanishnikov said that the doctors disagree. They say that a long stay in a hospital would only worsen his client’s condition. The lawyer recalls one day asking the prosecutor in the courthouse corridor: “What are you doing?” To which he received the answer: “Just let him get better here.” 

“Why a psychiatric hospital? I was told that they are doing this precisely to suppress his consciousness and shamanic abilities,” Pryanishnikov said. “That may sound funny, but there is a belief in the shamanic community that it’s harmful to be away from one’s homeland for a long time. And this is one explanation for why they are dragging their feet on transferring him [to the hospital in Yakutsk].” 

Over his years working with Gabyshev, Pryanishnikov has gone from a person who does not believe in shamanism to the conviction that his client is being persecuted precisely because he is “feared as a shaman.”

“Unfortunately,” Pryanishnikov said, “this is apparently true. Unfortunately, because it’s all idiotic. After all, these are people who control nuclear weapons, a country.”

As of this writing, Gabyshev’s lawyers continue to challenge the court’s refusal to transfer him to Yakutsk.

The number of people subjected to “punitive psychiatry” in the Soviet Union is still unknown – the figure was probably in the hundreds of thousands. Researchers often do not have access to hospital records, explained historian Alexei Makarov, however it is known that, between 1962 and 1974, the number of beds in such facilities increased from 222,600 to 390,000. And, in the late 1980s, throughout the Soviet Union, more than a million people were released from compulsory psychiatric treatment.

According to Makarov, in the 1970s, about every sixth defendant charged under laws relating to “anti-Soviet agitation and propaganda” and “knowingly spreading falsehoods damaging to the state and public order” was declared mentally incompetent and subjected to compulsory treatment.

If the information from the websites of Russia’s courts is to be trusted, that figure in today’s Russia would be one in every 24 defendants facing analogous charges. Makarov put the actual figure at one in 10. As in the Soviet years, there are no precise data. 

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This article was originally published in Russian in Bereg.

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