 According to Semyon Gluzman, abuse of psychiatry to suppress dissent is based on condition of psychiatry in a totalitarian state. Psychiatric paradigm of a totalitarian state is culpable for its expansion into spheres which are not initially those of psychiatric competence. Psychiatry as a social institution, formed and functioning in the totalitarian state, is incapable of not being totalitarian. Such psychiatry is forced to serve the two differently directed principles: care and treatment of mentally ill citizens, on the one hand, and psychiatric repression of people showing political or ideological dissent, on the other hand. In the conditions of the totalitarian state, independent-minded psychiatrists appeared and may again appear, but these few people cannot change the situation in which thousands of others, who were brought up on incorrect pseudoscientific concepts and fear of the state, will sincerely believe that the uninhibited, free thinking of a citizen is a symptom of madness. Gluzman specifies the following six premises for the unintentional participation of doctors in abuses:
