dissenters in mental hospitals. Premises for using the diagnosis According to the Global Initiative on Psychiatry chief executive Robert van Voren, the political abuse of psychiatry in the USSR arose from the concept that people who opposed the Soviet regime were mentally ill (since there was no logical reason to oppose the sociopolitical system considered the best in the world). The diagnosis of sluggish schizophrenia furnished a framework for explaining this behavior. This seemed to many Soviet psychiatrists a logical explanation for why someone would be willing to abandon his happiness, family, and career for a conviction so different from what most individuals seemed to believe. 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 (; 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