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