At the end of this fascinating study, Rebecca Reich cites a couple of dissidents who used striking metaphors to describe the Soviet State's attempts to conceal its own madness: Viktor Fainberg talked about the “fig leaf of psychiatry” covering over the regime's confinement of those who dared to think differently (223). Elsewhere, Vladimir Bukovskii and Semen Gluzman referred to the child from Hans Christian Anderson's tale who proclaims that the Emperor has no clothes. That boy is like the dissident who refuses to accept the truths imposed by power (217). Both metaphors involve a body—the reality of what the Soviet regime is or does—concealed by an inadequate or unreal covering, which was in this case the discourse of Soviet psychiatry. Dissident writers used metaphors openly. Reich explores the way Soviet psychiatric discourse relied on its own unacknowledged rhetorical and performative devices to dress up a reality—of Soviet citizens thinking differently—that the regime could not tolerate. Reich shows how authorities after Stalin weaponized a more general Soviet practice of using artistic forms in political ways (most obviously in Socialist Realism) not simply to reflect reality, but to transform it. In an early chapter on the “Art of Diagnosis,” Reich looks at statements by leading psychiatric physicians and elaborate diagnostic schemes designed to guide doctors through highly structured encounters with patients, in order to impose psychiatric sentences on dissenters. In many of these cases, calling patients mentally ill did not reflect a preexisting condition so much as impose that category onto individuals who could then be confined, medicated, and denied any authority to speak.

The Soviet dissident protest against this practice differed from Michel Foucault's critique of psychiatry in western countries. Reich notes: in the Soviet Union, the absence of liberal structures and the rule of law led to systemic abuse. While socially and politically specific, the exploration of psychiatric abuse and dissident responses also benefits in Reich's interdisciplinary study from a longer perspective that considers the theme of madness in the Russian literary tradition, going back to Aleksandr Pushkin's The Bronze Horseman and his lyric poem “God grant that I not lose my mind”; Nikolai Gogol΄’s “Notes of a Madman”; Fedor Dostoevskii's The Double; and through to Anton Chekhov's influential story “Ward No. 6.” The late Soviet authors who are the subjects of further chapters in Reich's book draw on this heritage of classic literary works in which characters who go mad channel the insanity of the social system, while authors reflect also on the links between creativity and madness and the fear of losing the ability to communicate. Reich performs her own close and contextually sensitive analyses of literary works by late Soviet authors, including poems by Aleksandr Vol΄pin and Joseph Brodsky, prose works by Andrei Siniavskii, and the drama of Venedikt Erofeev. She recalls, for example, how the official parity of psychiatric and aesthetic norms allowed Brodsky's psychiatrist to read his poems against the “healthy” standards of Socialist Realism (107). Then, in her subtle close reading of Brodsky's relatively neglected long poem “Gorbunov and Gorchakov” (1970), Reich shows how the poet's fear of the confinement and silence to which his dissenting use of words may consign him foreshadows the dilemmas of exile. Reich's theme facilitates her insights into the work of another major late Soviet author: in Venedikt Erofeev's play Walpurgis Night, protagonist Gurevich turns to his physician in the mental hospital who wondered whether Gurevich respected medical science sufficiently.

As Reich points outs, Gurevich's playful invocation of the body and soul of medical science subverts the seriousness on which psychiatric diagnosis relied for its terrible power. Here and elsewhere, however, the drama that compels us comes from seeing the liberation inherent in the dissidents’ creative wordplay teetering precariously over the abyss of coercive tyranny and silence.