III. HISTORICAL OVERVIEW

Law and Psychiatry Prior to 1949

Chinese historical records from the past two millennia contain occasional references to cases of insane persons who committed violent crimes but were pardoned or treated leniently by the courts on account of their mental disorders; also recorded are the cases of several famous individuals who successfully avoided punishment by feigning insanity. Over the last few hundred years of the imperial era, however, more systematic legal norms were gradually applied in this area of the criminal justice system. According to one scholarly account,

The Ch'ing government came to grips with the problem of criminal insanity soon after the consolidation of its rule in the late seventeenth century. It initially relied on the voluntary efforts of the families and neighbors of insane persons to keep them under control, but this soon gave way to the more interventionist measure of registration and confinement, designed to isolate the insane from the rest of society. Mandatory confinement of all insane persons was soon followed by the introduction of prison sentences for insane killers.⁴⁶

Where family members were ordered to take charge of the care and custody of a mentally ill person, they assumed collective legal responsibility for their ward's good conduct and could be punished by up to forty blows with a bamboo stave if he or she subsequently committed an offense.⁴⁷ Moreover, according to a contemporary Western observer, "Lunatics are in general required to be manacled, and the relatives must not remove the manacles without proper authority."⁴⁸ The death penalty for murder, normally mandatory in such cases, was not applied in cases where the offender was shown to be insane at the time of the crime, even when the victim was one of the offender's own parents. An exception to this rule of clemency was made, however, if the victim was one of the grandparents.⁴⁹ The death penalty was applied also in the case of multiple homicides by the insane.

After the founding of the Republic in 1911, a new criminal law was passed stipulating that punishment was to be waived or reduced in the case of crimes committed by the mentally ill. China's first specialized mental hospital was established in Guangzhou in 1898, with others following in Beijing (1906), Suzhou (1929), Shanghai (1935) and Nanjing (1947). In 1922, the country's first teaching center for psychiatry was established at the Xiehe Hospital in Beijing; and in 1932, the Nationalist government established an Institute of Forensic Medicine, headed by Lin Ji, who is today renowned as the father of the discipline in China. Also in the early Republican era, a new and more specialized type of institution known as the "psychopathic hospital" gradually began to appear in major Chinese cities. The earliest such institution was apparently located in Guangzhou (Canton), where opium addiction, syphilis, vagabondage and concubinage were among the more common social causes of crime-related mental illness. According to a contemporary Western account,

The only separate psychopathic hospital in China up to 1933 was a mission hospital in Canton, the John G. Kerr Hospital for the Insane. In 1924 this institution had 726 patients, half of whom were men... There are special psychopathic wards in a few general hospitals, such as in Soochow, Peiping⁵⁰ and Shanghai but these are small. China urgently needs modern special hospitals for mental disease in the large centers. In 1930 the [KMT] Ministry of Justice announced its intention to erect special reformatories and "lunatic asylums" in various large cities. There is a dearth of trained psychiatrists in China.⁵¹

The equivalent institution in the Chinese capital, the Peiping Municipal Psychopathic Hospital, was by 1935 responsible for the custody and care of around 250 criminally insane and other mentally disordered persons of various types. Of these, around a third had been referred to the hospital by "families, institutions or relatives," while as many as two thirds had been directly placed there by the police authorities.⁵² The average length of stay for inmates was between one month and eighteen months, and hospitalization (especially for the "police cases") was essentially compulsory,⁵³ although there seems to have been no formal legislation in this area at the time.

The psychopathic hospitals differed in two important respects from the earlier forms of compulsory custody for the mentally ill practiced during the pre-Republican period. First, their main purpose was to provide medical care and treatment, whereas the previous legal measures had simply been a prolonged form of preventive detention. Second, however, the scope of admissions was now considerably broader, with the types of offending behavior ranging from "killing mother with an axe," "attacking parents," "attempted suicides," "lying on the street and scolding people" and "appearing naked in public" at one end of the spectrum, all the way through to "ideas of grandeur," "burning of incense," and "restless patients with reports of jumping around, singing, laughing, [and] clapping hands" at the other.⁵⁴ Significantly, contemporary accounts give no indication that expressions of political deviance or heterodox thinking, whether as a symptomatic manifestation of mental pathology or otherwise, were seen or used by the authorities as grounds for imposing psychiatric incarceration at this time.

If anything, the law tilted more towards a lackadaisical approach in its construal of the "dangerousness" criterion, sometimes even in the most violent of cases. For example,

The police will loosen the control of any mental patient if his family is willing to bear the responsibility. One of the best examples of this kind is found in case No. 513, in which the patient chopped up more than ten people fatally with a knife during one of his attacks, but was allowed by the police to be discharged against the advice of the hospital because the patient's wife repeatedly petitioned the Bureau [of Public Security] that she would take all possible care to guard against the recurrence of a similar incident.⁵⁵

It should be noted in passing that, in the 1980s and 1990s, it remained a common complaint within the Chinese psychiatric profession that once a determination of "absence of legal responsibility" on the grounds of mental illness had been made, even the most violent of offenders could still, in many cases, be released straight back into society.⁵⁶ While the reasons for this hazardous practice stem mainly from the country's lack of secure psychiatric facilities, it contrasts sharply, nonetheless, with the apparent frequency with which those involved in "cases of a political nature" are officially deemed to be in need of custodial care.

The Early Years of the People's Republic

By 1949, after several decades of virtually continuous warfare and national revolution, there were no more than fifty or sixty qualified psychiatrists to be found in the whole of China.⁵⁷ As the Communist Party began rebuilding the country, it turned primarily to the Soviet Union for scientific and technical assistance throughout the 1950s. While many of the earlier trained psychiatrists, some of whom had studied in the West, played a key role in expanding the professional infrastructure during these early years, they increasingly became a target of official suspicion for their alleged "bourgeois ideology." As one psychiatric journal succinctly put the matter: "With the arrival of advanced Soviet medical science, China's psychiatric workers were liberated from the ideological influence of the reactionary academic doctrines of Europe and America."⁵⁸ The new generation of psychiatric professionals that emerged in China after 1949 was thus overwhelmingly influenced by Soviet psychiatric theory and doctrine. And in particular, according to one of China's leading authorities on the subject, "Soviet forensic psychiatry exerted a very great influence after it was first introduced into China."⁵⁹ Within a few years, forensic-psychiatric assessment centers organized along Soviet lines had been set up in the cities of Nanjing, Beijing, Shanghai, Changsha and Chengdu;⁶⁰ clinical practice in the area of forensic psychiatry developed steadily thereafter. While psychiatry in general received relatively little support from the authorities, legal assessment work appears to have been given (perhaps unsurprisingly, considering the government's clear emphasis at this time on national and public security-related matters) significant priority.

It was during this same period that the Soviet psychiatric establishment began to apply, especially in the field of forensic assessment, the now widely deplored range of unorthodox clinical theories whereby particular forms of political and religious dissent were seen as being attributable to certain specific (though in other contexts, oddly rare) varieties of "dangerous" mental illness. The most frequently used diagnosis of this type was "sluggish schizophrenia," a diagnostic concept that was first formulated and used briefly by American psychiatrists during the 1930s, and then later adopted and radically developed by Academician Andrei Snezhnevsky, the leading figure in Soviet psychiatry from the 1940s until his death in 1987. Under the directorship of Georgi Morozov, a key student and follower of Snezhnevsky who applied the latter's doctrine of "sluggish schizophrenia" with increasing enthusiasm to cases of alleged ideological deviance, the notorious Serbski Institute for Forensic Psychiatry in Moscow served, from 1953 until the late 1980s, as the main theoretical and practical stronghold for the political abuse of psychiatry in the USSR.⁶¹

The key features of "sluggish schizophrenia," so called because of its slow rate of progression, which more often than not gave outsiders the impression that the reform-minded "sufferer" was mentally quite normal, were described as follows by Sidney Bloch, a Western psychiatrist and co-author of one of the major studies on Soviet psychiatric abuse:

Characteristically, patients given this diagnosis are able to function almost normally in the social sense. The symptoms may resemble those of a neurosis or take a paranoid quality. The patient with paranoid symptoms retains some insight into his condition, but overvalues his own importance and may exhibit grandiose ideas of reforming society... The concept of sluggish schizophrenia [thus] facilitated the application of a label of disease of the most serious kind to people whom psychiatrists in the West would regard as either normal, mildly eccentric, or at worse neurotic. In other words, it does not require much to be labeled as mad by the Snezhnevsky-trained psychiatrist.

Professor Georgi Morozov...states: "Schizophrenia is a disease in which patients are with rare exceptions deemed not responsible." Yet he concedes that: "Forensic psychiatrists often experience difficulties when...symptoms are mild and the presence or absence of schizophrenia must be established." The diagnosis may then be made on a history of psychiatric symptoms in the past, that is long before the offense was committed, and, also possibly in the absence of symptoms at the time of the offense. Thus, the defendant may appear normal when under psychiatric examination, but according to the Snezhnevsky school, still harbor the disease.⁶²

Another catch-all diagnosis that was commonly applied to people detained for particularly "puzzling" or "flagrant" acts of ideological dissent in the Soviet Union from the 1950s onwards was "paranoid psychosis." A wide repertoire of nonconformist behaviors was, however, shared between both sets of sufferers. These included: "reformist delusions," "litigation mania," "overvalued (or excessive) religiosity," "serious illegal acts [such as] the writing of complaints," "slander and dissemination of false information," "persistent ideas of reform that tend to be convincing to others and tend to cause recurrent illegal actions" and even "an interest in poorly-understood and bizarre foreign fashions and trends in art, literature and philosophy, and discussion of such interests."⁶³ The State's medico-legal punishment for such activities, moreover, was severe. According to a report on the authorities' handling of nineteen such cases:

Their pattern of adaptation changes to such a degree that their life undergoes a fundamental change; they dedicate their activities entirely to the struggle for their idea, which they often characterize as a "struggle for justice"... [However,] environmental change, the strict regime of a psychiatric ward, the impossibility of a continuation of their pathological litigious activity, sedative and neuroleptic medication, all served to normalize their behavior rather quickly.⁶⁴

The standard Soviet textbooks on forensic psychiatry were required reading for Chinese legal psychiatrists from the mid-1950s onwards, and full Chinese translations of Morozov's works were widely available in China from at least the early 1960s and possibly earlier. Even in the 1990s, favorable references to the Soviet school of forensic psychiatry were quite commonly found among the pages of the Chinese professional literature. Several recently published textbooks, moreover, still contain the full or partial texts of the main Soviet-era laws and regulations on the compulsory hospitalization of mentally ill offenders.⁶⁵ In classifying the schizophrenic conditions, the Russian term vyalotekushchaya can be rendered in English as either "sluggish" or (more broadly) as "latent"; the Chinese medical lexicon lists latent or sluggish schizophrenia as qianyinxing jingshenfenliezheng.⁶⁶ As late as 1994, the condition was still listed as being one of several officially acknowledged "borderline states,"⁶⁷ but from the 1980s onwards, it rarely appears in the relevant literature.⁶⁸ In the earliest known examples of political-style psychiatric diagnosis in China, which date from the early 1960s, the less specific term "schizophrenia," in either an undifferentiated or a "paranoid" form, appears to have been the most prevalent label used.

In China, as in the former Soviet Union, the diagnosis of schizophrenia was and continues to be made in a far higher proportion of mental illness cases than in most other countries. Moreover, where diagnosed schizophrenics commit crimes and are brought for forensic psychiatric assessment in China, a finding of "absence of legal responsibility" - leading to the high likelihood of compulsory forensic hospitalization - is almost invariably made. For example, among 386 cases of schizophrenic offenders forensically assessed in the Beijing and Tianjin areas between 1978 and 1987, no fewer than 97.5 percent of the examinees were found to be "not legally responsible" for their actions.⁶⁹ Furthermore, other studies indicate that "cases of a political nature" have accounted for a very high proportion of the targets of assessment. In a study of 181 cases of schizophrenic offenders forensically examined at the Harbin No.1 Special Hospital between 1976 and 1980, political cases involving "reactionary speeches," "sticking up posters with absurd content" and "shouting reactionary slogans" amounted to 59 in number, or 33.3 percent of the total.⁷⁰ Another authoritative account from the same period, moreover, put the figure for the country as a whole at an overwhelmingly high level: "In [psychiatrically appraised criminal] cases involving political speech and expression, schizophrenia sufferers accounted for 91 percent of the total, and 70 percent of these were chronic schizophrenics who had been living at large in society."⁷¹ The shadow of Soviet-era political psychiatry looms conspicuously in all these reports.

From the late 1970s and early 1980s onwards in China, the diagnosis of choice in political cases appears to have shifted towards "paranoid psychosis" and its various sub-categories (e.g., "litigious mania"), although schizophrenia continued also to be diagnosed. As we shall see, while the medical connotations are substantially different, the diagnosis of "paranoid psychosis" shares many of the characteristic features of vagueness, non-specificity and "apparent normality" found in the case of Soviet-style "sluggish schizophrenia."⁷²

A brief outline of the therapeutic regime that came into being in the Chinese psychiatric field in the 1950s may also be useful. In light of the intense controversy that exists in the West over several of these therapies, it is important to bear in mind that the therapeutic resources available to psychiatrists throughout the world at that time were highly limited in both range and effectiveness, especially with respect to the major psychiatric diseases such as schizophrenia. Until the early part of the twentieth century, psychiatrists everywhere were largely helpless to relieve the catastrophic symptoms of these illnesses, and sufferers were for the most part simply warehoused in primitive insane asylums. During the inter-War period, however, several new treatments marked a major turning point in psychiatric clinical practice. One was insulin coma therapy, discovered in 1927 by Manfred Sakel, a Polish neurophysiologist and psychiatrist;⁷³ another was electroconvulsive shock therapy (ECT), discovered by the neurologists Ugo Cerletti and Lucio Bini in Rome in 1937; a third was the psychosurgical technique of prefrontal lobotomy, discovered in 1936 by Egas Moniz, a Portuguese neuropsychiatrist. The history of psychiatry is replete with major instances and patterns of the abuse of all these forms of treatment, especially in America and Europe in the 1940s and 1950s.⁷⁴ With the next important breakthrough in the treatment of mental illness - the synthesis and widespread dissemination from the early 1950s onwards of major antipsychotic medications such as chlorpromazine - the use of these earlier therapies greatly declined in most countries.

It is clear from the Chinese psychiatric literature of the late 1950s and early 1960s that ECT and insulin coma therapy were in widespread clinical use in China (as in the U.S. and other Western countries) by that time, and that the theory and practice of these techniques had been learned directly from the Soviets.⁷⁵ Viewed in historical context, and when used for genuine therapeutic purposes, neither therapy would appear to be particularly controversial. According to reports from former victims of political psychiatric abuse in China, however, both insulin coma treatment and ECT (without concomitant use of sedatives or muscle relaxants) were often used by psychiatric staff from the 1960s onwards as methods of punishment rather than of treatment. ECT remains in widespread use in Chinese mental hospitals today.

Regarding the use of psychosurgery, an official source states that Chinese neurosurgeons carried out numerous cases of human prefrontal lobotomy between 1949 and 1955 at hospitals in Tianjin, Nanjing, Shanghai, Beijing and Xian, but that the practice was discontinued for many years thereafter.⁷⁶ This was due to the fact that psychosurgery was banned from the mid-1950s onwards in the Soviet Union, where it was seen as contravening the "conditioned reflex" orthodoxies of the Pavlov school. The same source adds, however, that in 1986 a number of Chinese hospitals began to perform such operations once again, reportedly of a kind involving less drastic surgical intervention than had been required in the earlier series of operations.⁷⁷ Other studies indicate a further rise in the use of psychosurgery in China in recent years.⁷⁸ As one Western scholar writes,

Psychosurgery is also reemerging. During a visit to Guangzhou in 1988 I was told that one hospital had provided 20 patients to undergo this kind of surgery in the previous two years. In a visit to a hospital in Beijing in 1989, I discovered that doctors in Beijing and Tientsin [Tianjin] were collaborating on a psychosurgery project. It was clear from reading some of the files of the patients, who had had psychosurgery in Guangzhou, that selection and monitoring before or after the operation, as well as the procedure itself, gave great cause for concern.⁷⁹

Most worryingly, according to a reliable eyewitness report, the Ankang forensic-psychiatric facility in the city of Tianjin had by 1987 established a large and technically advanced unit for carrying out psychosurgical operations; the director of the institute at the time was a neurosurgeon, and dozens of lobotomies and similar brain operations were reportedly being performed on inmates there each year.⁸⁰

Three general varieties of ethically suspect or abusive psychiatry will be singled out for attention in the following discussion. The first involves a phenomenon known within the psychiatric profession as "hypo-diagnosis," or the under-diagnosing of mental illness. In China, within the legal or forensic domain, this was most often seen in the cases of people who apparently were suffering from some form of mental illness, but whose symptoms included random or disconnected "political ravings" of a kind that the police viewed as being reactionary or "anti-government." Owing to the extreme sensitivity of political discourse in post-1949 China, forensic psychiatrists came under strong implicit pressure from the authorities to interpret such utterances in a literal, or face-value, sense; the "offenders" would then be found "legally responsible" for their acts or statements, and duly sentenced as political enemies of the State. This represents one important instance (or medico-legal trope) of the "totalitarian" distortions of psychiatry found first in the Soviet Union and later, especially during the Cultural Revolution, in China.

The second relevant category is that of "hyperdiagnosis," or the excessively broad clinical determination of mental illness. Within the legal domain in China, this has been reflected in a tendency on the part of forensic psychiatrists to diagnose as severely mentally ill, and therefore legally non-imputable for their alleged offenses, certain types of dissident or nonconformist detainees who were perceived by the police as displaying a puzzling "absence of instinct for self-preservation" when staging peaceful political protests, expressing officially banned views, pursuing legal complaints against corrupt or repressive officialdom, etc. This particular ethical distortion, which was perhaps the main hallmark of Soviet-era "totalitarian-style" psychiatry, is the one that has been most conspicuously in evidence, or readily apparent, in China for the past two decades and more.

A third category of politically motivated ethical abuse within the field of Chinese legal psychiatry can be summed up under the heading of severe medical neglect. In certain respects, the problem of hypo-diagnosis can be seen as one major sub-form of the latter, since it resulted in numerous mentally ill individuals being sent to prison as political "counter-revolutionaries" and then denied all medical or psychiatric care for many years in an environment bound only to worsen their mental condition. But there was also a much broader aspect to the phenomenon, reflected both in the absence of medical-care provision for mentally ill prisoners in general, and, more specifically, in the deliberate withholding of such care from political offenders whom the authorities had already clearly diagnosed as being mentally ill.⁸¹

One of the best-documented examples of the latter form of abuse arose in the late 1950s and concerned a prominent Chinese writer named Lu Ling. From 1952 to 1955, a group of leading figures on the Chinese literary scene, including Lu Ling and led by the famous writer Hu Feng, came under increasing attack from the Party's cultural commissars for their alleged repudiation of Mao's doctrine that arts and literature should follow the path of "socialist realism" and serve the interests of the workers and peasants, and for their stubborn adherence to such "bourgeois notions" as the literary genre of "subjective inner realism." In July 1954, both Hu and Lu issued long written rebuttals of the charges against them, and the following year, the Party launched its first major political crackdown against China's intellectual establishment since 1949. Hu Feng was sent to jail for more than twenty years and many of his associates received lesser prison terms.

Lu was married, with three daughters, and was thirty-three years old at the time of his initial arrest in June 1955. During his first few years in detention, his refusal to admit any serious wrongdoing led to ever-harsher treatment at the hands of the authorities, and he eventually began to show clear signs of mental disturbance. In June 1959, after four years of solitary confinement without formal charge, during which he had been forced by his inquisitors to write endless screeds of self-denunciatory material, he finally exploded and wrote a second major rebuttal of all the charges against him. For this "odious act of resistance," he was transferred to China's primary detention facility for high-ranking political criminals, the secretive and much-feared Qincheng Prison, located just north of Beijing. For further resisting "ideological reform" and for moaning or shouting incoherently, he was often left bound and handcuffed by his jailers, although still held in solitary confinement. Finally, in early 1961, his sanity deteriorated to the point where the authorities decided to transfer him for secure custody and treatment to the capital's Anding psychiatric hospital. After three years of intensive medication, he was deemed ready for release and allowed to return home on conditions of medical bail. For a year, he sat quietly at home, in an apparently catatonic state of post-traumatic stress, then in 1965 he began writing a long series of "petition letters" to the authorities seeking redress for his treatment at their hands. According to a recently published account of Lu's case, these writings were largely incoherent:

Oh, but what letters they were! Some were left unaddressed, others had no recipient's name written on them; most of them were incomprehensible, or filled with random abuse as if written by a small child; some were even marked for the attention of "Queen Elizabeth" and suchlike, bringing to mind the various mad characters of Chekhov's plays. They were filled with a cold and remote sense of despair...⁸²

The security authorities, however, interpreted these sad scribblings differently, and in November 1965 Lu was rearrested and sent back to Qincheng Prison on charges of engaging in "active counterrevolutionary activities." He was to remain there, in continuous solitary confinement and reduced to spending most of his waking hours muttering incoherently at the cell wall, until June 1974, by which time he had lost all semblance of sanity. In 1979, after several years spent sweeping the streets of the capital "under supervision by the masses," he received an official letter of rehabilitation from the Beijing Intermediate People's Court:

This Court has carried out a review and determined the following. On the question of Lu Ling's participation in the Hu Feng [Anti-Party] Clique, the Ministry of Public Security reached a conclusion on the matter in 1969 and thus no further action will be taken. As regards the more than thirty counterrevolutionary letters that Lu Ling wrote and mailed out between July and November1964: since these actions resulted from the fact that he was afflicted by mental illness at the time, he should not be held criminally responsible for them.⁸³

Some months later, Lu received a second letter from the court, stating: "Regardless of whether [you were] sane or insane, the expression of `politically hostile'⁸⁴ language should never be seen as grounds for bringing charges of counterrevolution." This statement probably marked the high point of official efforts to reform China's highly repressive laws on political dissent; as we shall see, however, it proved to be little more than an ephemeral blip on the country's law enforcement horizon.⁸⁵

For several decades in China, therefore, two distinct but closely related forms of political abuse have coexisted within the broad domain of Chinese law and psychiatry: on the one hand, an official reluctance to extend appropriate medical care to mentally ill prisoners convicted of political offenses, on the implicit grounds that the heinous nature of their offenses rendered them ineligible for even the most basic humanitarian consideration; and on the other, a parallel and rather more sophisticated tendency, inherited from the Soviet psychiatric tradition, according to which the uninhibited expression of ideologically unorthodox views was seen, in certain cases, as indicative of "mental pathology" in an ostensibly legal and medical sense. Indeed, where the politically sensitive field of forensic psychiatry is concerned, there appears to have been little, since 1949, in the way of a stable middle-ground between these seemingly divergent tendencies, both of which were equally disreputable from the point of view of international standards. With the onset of the Cultural Revolution, however, the distinction in China between "political crime" and "political insanity" was lost entirely.

The Cultural Revolution

Political cases: These are very seldom mentioned in the literature of other countries. According to a survey done by this author of forensic psychiatric appraisal cases carried out at the Shanghai Municipal Mental Health Center over the period 1970-71, however, political cases accounted for 72.9 percent of the total. This had to do with the particular historical circumstances of that time.

- Zheng Zhanpei, 1988⁸⁶

On the afternoon of January 7, 1967, as China sank ever deeper into the social and political turmoil of the Cultural Revolution, a bizarre conversation took place at the Anding Hospital, Beijing's foremost psychiatric institution, between a group of Red Guard activists and two of Chairman Mao's closest colleagues in the new ultra-leftist Party leadership, Qi Benyu and Wang Li. The topic of discussion was a group of mental patients who had earlier been detained for treatment at the hospital after making "reactionary statements" about President Liu Shaoqi, Mao's erstwhile senior colleague but now principal adversary in the Party leadership, and whom the Red Guards had recently "liberated" from their confinement. The conversation went, in part, as follows:

Qi Benyu: You Red Guards are the pioneers of rebellion in China's mental asylums, you are rebels against Revisionism; in the future, the Soviet Union will need to carry out a cultural revolution and do the same kind of thing!

Red Guard: I request permission...to conduct similar revolutionary liaison activities in mental asylums throughout the country.

Wang Li: Our purpose in coming here today is to support you.

Qi Benyu (to a recently discharged mental patient): Are you mad?

Wang Fuxian: No...I just had different views and opinions from other people; I was in the minority. When I rebelled against the authority of my local Party Secretary, they said I was mentally ill.

Qi Benyu: How does that make you mentally ill? They're the ones who are mad! ... If the revisionists ever came to power, they'd have Wang Li and me declared "mentally ill" too!⁸⁷

This obscure incident from over thirty years ago provides a rare glimpse into the elusive history of political psychiatry in China. The central figure in the Anding Hospital incident was one Chen Lining, a Party member who had incurred the wrath of Mao's political opponents in the early 1960s by writing articles and wall-posters criticizing the "revisionist" policies of President Liu Shaoqi. As a result, between 1962 and 1966, Chen was incarcerated seven times in mental hospitals and placed under secret arrest by the security police. By January 1967, however, the political tables had been turned. Liu was being attacked nationwide as China's "No.1 Capitalist Roader," and Chen was duly released from the mental asylum and proclaimed by Red Guards to be the "Madman of the New Era" (xin shidai de kuangren). In a speech given at the Chinese Academy of Sciences two months later, Chen described a part of his ordeal in forensic-psychiatric detention as follows:

During my political persecution at the Hunan Provincial Mental Hospital, I was subjected to numerous bouts of drug interrogation,⁸⁸ given electro-convulsive therapy more than 40 times and insulin-coma shock therapy altogether 29 times, and was fed large quantities of chlorpromazine. They treated me like an experimental object and it was all a disguised form of physical torture. It was extremely painful, and by the end, I was left trembling and sweating all over and my memory had started to go.

The details of Chen's medical record from that time are highly revealing. According to an entry made by a psychiatrist in December 1963: "The patient's mental illness has recurred; his counterrevolutionary statements are none other than a pathological mental symptom of his longstanding reactionary views. Diagnosis: schizophrenia." The following year, a psychiatrist at Anding Hospital added a further entry: "Patient's mental condition: thinking clear and alert, interacts well with others, answers questions appropriately... But lacks self-knowledge and is unclear as to why he was placed under criminal investigation in the first place. Initial diagnosis: schizophrenia (paranoid type.)"⁸⁹

A number of key pointers to the history of psychiatric abuse in China can be discerned from the above account. First, as the quotation from People's Daily cited at the start of this article showed, the Chinese leadership was aware of the main facts about Soviet political psychiatry by at least the early 1960s. Second, it transpires that very similar abuses were also to be found in Chinese forensic psychiatry by around the same period. Finally, it appears that a significant campaign, albeit a highly politicized and ultimately destructive one, of public exposure of such practices took place in China well before the existence of Soviet political-psychiatric abuse was even known about in the West or had become a focus of Soviet dissident concern.

As the Cultural Revolution unfolded, however, the distinction between political crime and mental illness - one that had apparently been tenuous even at the best of times - was effectively abandoned in Chinese public life. For a decade and more, until roughly 1978, both legal and medical specificity were discarded outright in favor of an essentially pre-modern concept whereby, much as in Europe during the middle ages, the political or religious dissenter was viewed as being possessed by a deeply wicked, or "counterrevolutionary," form of madness; for their part, the genuinely mentally ill were all too often condemned and punished as dangerous political subversives.

As a direct consequence of Qi Benyu's "important directives" at the Anding Hospital meeting of January 1967, a sinister campaign of persecution - later dubbed the "tide of reversing psychiatric verdicts" (jingshenbing fan'an feng) - was launched and carried out by Red Guards around the country. A certain number of mental patients were, as in Wang Fuxian's case, released after being found to have the requisite "revolutionary thinking," while others, mostly senior cadres or their relatives, were accused by the ultra-leftists of having been diagnosed as mentally ill and admitted to the hospital solely as a means of protecting them from the political purges then underway. In many more cases, however, genuinely mentally ill people, especially those whose symptoms had included pseudo-political "ravings" against Mao, were dragged out of mental asylums and brutally coerced into "confessing" that they had been sane all along. These unfortunate individuals were then officially reclassified as counterrevolutionaries and either jailed or summarily executed. As Guan Xin, an official of the Zhejiang High People's Court, explained in a restricted-circulation official report of 1981.

In the course of reviewing trumped-up cases and miscarriages of justice [yuan jia cuo an] from that period, numerous cases have been discovered of people who were obviously mentally ill but who were wrongfully imprisoned or even executed as "political lunatics."

During the ten years of the Cultural Revolution, owing to interference and sabotage from the ultra-leftist line, the issue of the forensic-scientific evaluation of mental illness was for the most part consigned to the rubbish heap. Mentally ill people were convicted of crimes on the basis of their strange utterances and wild language, thereby creating the notion of the so-called "political lunatic" [zhengzhi fengzi] - a hodgepodge of the two unrelated terms "politics" (signifying class struggle) and "lunatic" (a state of biological pathology.)⁹⁰

Similarly, Yang Desen, one of China's leading forensic psychiatrists, noted in 1985: "During the ten years of chaos, a minority of mentally ill people were wrongfully executed or imprisoned as `counterrevolutionaries.'"⁹¹ One example serves to convey the extent of the medico-legal confusion that prevailed during those years and of the judicial absurdities that resulted. According to Shen Zheng, another leading authority on forensic psychiatry, during the period 1960-76, even among an unspecified number of mentally retarded people who were submitted for forensic-psychiatric evaluation for alleged criminal offenses, "the main subgroup (31.2 percent) consisted of political cases."⁹²

The profound crisis into which China's entire psychiatric profession was thrown during the Cultural Revolution led to the effective dismantling of mental healthcare institutions across the country. Also, numerous Chinese psychiatric professionals, possibly a majority, were labeled as "bourgeois academic authorities" and either purged outright from their positions or sent down to the countryside, often for many years, to perform manual labor and "learn from the peasants." Medicine in general, and psychiatry in particular, had long been a low-status profession in China, but during these years psychiatrists ranked close to the very foot of the social and political ladder. Virtually the entire intellectual domain of psychiatry and human psychology was officially repudiated, to be subsumed under a crude Maoist universalism whereby "correct political ideology" served not only as the key to social survival, but was moreover equated with mental health in general - and vice versa. Thus, in what little remained at that time of the country's mental healthcare institutions, official wall slogans proclaimed to mental patients: "Without a correct political standpoint, one has no soul."⁹³ Under this reductionist doctrine, psychiatry and psychiatrists became superfluous, and therapy for the mentally ill consisted largely, until the late 1970s, of group "study sessions" on the works of Mao.⁹⁴

The extreme political pressures of this era inevitably led to pervasive ethical corruption within the field of psychiatry and forensic medicine in general. As one writer put the matter, "In the past, owing to the influence of the extreme `leftist' line, [forensic psychiatrists] overemphasized `putting class struggle to the fore' and `making vocational work serve politics,' to the extent that issues of an academic or technical nature were sometimes turned into a question of one's basic political standpoint."⁹⁵ According to another official account,

During those years when class struggle was at the forefront of everything, some [forensic doctors] paid no attention to the principle of seeking truth through facts, and instead took the slogans `Always be highly conscious of the class struggle' and `Maintain the highest level of revolutionary vigilance" as their basic guiding ideology for performing forensic evaluations... Some forensic doctors who insisted on upholding the truth were taken in for interrogation, thrown into jail and branded as counterrevolutionaries... Others, however, submitted to political pressure and went against their own consciences, making wrongful forensic evaluations... Still others went so far as to use their scientific knowledge to turn truth and lies upside down, saying black was white, and acting entirely in the service of particular individuals or groups.⁹⁶

In the winter of 1978, a young man named Wei Jingsheng, who was to become China's best-known dissident and who later spent seventeen years in prison for advocating greater human rights and democracy, wrote an article in China's samizdat pro-democracy press describing conditions at Qincheng Prison during the Cultural Revolution. His account was probably the first to reveal that psychiatric techniques were being misused in China for purposes of political repression:

The most common form of torture is simple beating. The prisoner is summoned and surrounded by a group of men who slug and kick until he is bruised, bloody, and completely breathless. Even more common is for prisoners to be so heavily drugged that they become mentally unstable. The justification for administering these drugs is to cure "mental illness." Sometimes people are sent to the hospital for further "treatment." One person who had received the treatment recalls that after taking the medication he had talked to himself constantly for days on end. Naturally, such monologues were recorded for use during the next interrogation. Among the hospitals that participate in such practices are the Fuxing Hospital, Hospital 301, and Anding Hospital.⁹⁷

Subsequent testimonies from high-ranking government officials who had been incarcerated at Qincheng Prison authoritatively confirmed Wei's general account. According to one former inmate, for example: "Especially inhuman was the practice of...force-feeding you a kind of drug that induced hallucinations."⁹⁸ The most vivid and detailed account is that of Mu Xin, a former editor of the Guangming Daily, who was arrested in 1968 and held for several years at Qincheng Prison on trumped-up charges of conducting an "anti-Party conspiracy." In his memoir of this period, Mu wrote,

In the nearly four years from the moment I was thrown into Qincheng Prison to the downfall of Lin Biao, they continuously gave me stimulants. This would happen at least ten to fifteen days every month... They did this with the intention of destroying my brains, not just to impair my memory but also to make me unable to write anything anymore... Even after I returned to my home, having suffered several years of this continuing drugging and poisoning, my brain was severely damaged and traumatized.⁹⁹

As mentioned earlier, many mental patients, especially senior cadres or their relatives, were accused during the Cultural Revolution of having feigned their illnesses as a means of avoiding punishment for their political opposition toward Mao. One such case involved a woman named Yan Weibing, wife of the then Minister of Propaganda, Lu Dingyi, who was one of the first senior victims of the Cultural Revolution purges. This little-known case bears more than a passing resemblance to the infamous "doctors' plot" concocted in the Soviet Union shortly before Stalin's death.¹⁰⁰ It claimed numerous senior political casualties and delivered a traumatic blow to China's psychiatric profession in general. According to an account of the case compiled by Red Guards in June 1968,

The active counterrevolutionary element Yan Weibing, wife of the counterrevolutionary revisionist clique leader Lu Dingyi, over the six-year period from March 1960 to January 1966 wrote dozens of anonymous counterrevolutionary letters that insanely attacked Deputy Commander Lin Biao, the close comrade-in-arms of our most dearly beloved leader Chairman Mao, and members of his family; she insanely opposed Comrade Lin Biao, and is [thus] an active counterrevolutionary element who has committed towering and heinous crimes.¹⁰¹

In fact, Yan had been under psychiatric diagnosis and treatment, including frequent insulin coma therapy, for several years for a mental condition that senior Chinese psychiatrists had determined to be some form of paranoid behavioral disturbance.¹⁰² She suffered frequent outbursts of uninhibited anger, much of which was apparently aimed at Lin Biao's wife, Ye Qun, and to whom she had been sending copious amounts of politically colored "hate mail" in recent years. In the months leading up to the full-scale outbreak of the Cultural Revolution in May 1966, her husband Lu had been considering having her compulsorily admitted to the Anding Hospital for treatment. In the event, all of the psychiatrists and senior government officials responsible for Yan's earlier care and treatment (including Shen Yucun, who survived to become the principal editor of the major PRC textbook on psychiatry after 1978 and head of the WHO's mental health liaison office in Beijing) were branded by Red Guards as having been centrally involved in a "counterrevolutionary conspiracy" to falsely diagnose Yan as mentally ill so that she could be spared punishment for her "insanely hostile" letters against Lin Biao and his wife; at least one of them committed suicide as a result.¹⁰³

The real target of the Red Guards' displeasure, of course, was Lu Dingyi himself, and the evidence of his wife's letters formed a crucial plank in their efforts, soon thereafter successful, to have him dragged from power. Yan's persecutors thus had little time for diagnostic niceties and their final verdict on her mental state was as follows: "What was Yan Weibing's real mental illness? A counterrevolutionary disease of the heart!¹⁰⁴ Her mind was extremely alert...and her state of anxiety [reflected only] her high degree of counterrevolutionary vigilance." She had been under investigation by the Ministry of Public Security for many months on account of the letters to Lin Biao's family, and on April 28, 1966, the central authorities ordered her arrest on charges of counterrevolution. Yan and her husband were to spend the next twelve and a half years in solitary confinement at Qincheng Prison, during which time they were denied even a single meeting together.¹⁰⁵

Accounts from senior-level cadre victims of the Cultural Revolution purges go only a small way toward explaining, however, the extremely widespread incidence of forensic-psychiatric "cases of a political nature" that was later reported to have occurred during those years. A perhaps more typical story was one related many years later to a Western human rights organization by a former political prisoner, identified only as "Mr. C," who spent a total of more than sixteen years in various labor camps, detention centers and prisons for the "mentally disordered" in China. His account conveys with great clarity the grotesque ironies and injustices that characterized legal psychiatry at that time:

Summer 1969. After I was arrested as a counterrevolutionary, I was interrogated three times. I did not want to accept any charge for a crime that I had not committed, nor did I want to name any person as having committed any crime. Therefore I was sent to Jiangwan Number 5 [in Shanghai]. This place was known as the "Institute for Diagnosing Mental Disorder" - the setting of my most terrifying experiences during my entire 16 years of imprisonment.

The whole "institute" was a large cage from within which one could not see the skies. Inside this large cage there were many small cages, which were only half as high as an average person. One could only squat or lie in them, and I had to crawl in and out of mine. They were no better than chicken houses. All those detained in the "institute" were suspected of mental disorder, but being there would truly drive a mentally normal person insane. There, one could constantly hear frightening screams. The wardens tried to stop people from screaming and, when failing to do so, would administer drugs to cause people to lose consciousness and thus become silenced. Once awakened from the drug, one felt very dull, depressed and uncomfortable.

People sent to this institute were mostly those who had committed serious counterrevolutionary crimes such as shouting anti-Mao slogans in public. In order to avoid sentencing of death, these people pretended to be mentally abnormal by screaming nonsense, only to be cruelly beaten and drugged. They were allowed to go out of their small cages to be "aired" once a day, and were given two meals of very thin porridge each day.

Whenever the wardens appeared, I would tell them that I was not mentally disordered and that I would like to talk to them about my problems if only they would let me out of the "institute." Usually, people insisted on their lunacy in order to receive a reduced sentence. Therefore, when I very soberly proclaimed that I was normal, they truly believed me to be a madman.

I did not know how long I would be treated like an animal in a place where fear alone could suffice to drive a person crazy. Many of the inmates I met had been there for more than ten years; some had been imprisoned there for over twenty years. Worse still, when an inmate was diagnosed to be a normal person, he or she would either be executed, given a more severe sentence, or shut up in the cage forever as a "politically insane" criminal.

I was there for only about 100 days. A good-hearted warden, knowing that I was a college student from reading my personal files, secretly released me. I hid for a while, then was arrested again soon after.¹⁰⁶

The place where Mr. C was held - "Jiangwan No. 5" - is believed to be the same institution that in 1987 was renamed as the Shanghai Public Security Bureau's Ankang Center for the Custody and Treatment of the Mentally Ill, located just south of the Fudan University campus on Guoquan North Road. Apart from the appalling conditions of detention that Mr. C describes, what is most striking about his story is the Orwellian complexity and intricacy of the classification of the inmates. Most were arrested "counterrevolutionaries" who had shouted banned political slogans and then been suspected of mental illness. Others, presumably "genuine" counterrevolutionaries, had adopted the survival stratagem, after their arrest, of feigning mental illness in order to avoid being executed for shouting such slogans. Meanwhile Mr. C himself, another political offender, was regarded as indisputably insane by the warders because he had actively chosen to reject this stratagem by declaring himself quite sane. The normal language and conceptual armory of forensic-psychiatric science would seem to be of little direct use as a means of understanding or construing a situation of such utter medico-legal absurdity as this one.

One further issue that should be briefly addressed here concerns the extent and quality of psychiatric care available to criminal offenders in general in China since 1949. The focus here is on the theme, as noted above, of medical neglect, rather than of either hypo-diagnosis or hyperdiagnosis; in practice, though, these various divergent themes were often complexly intermingled. The U.N.'s basic document in this area, the Standard Minimum Rules for the Treatment of Prisoners, stipulates that seriously mentally ill persons are not to be held in prisons and that less severely disturbed inmates are to be given appropriate medical care.¹⁰⁷

Since prison systems in most countries are notoriously under-resourced in terms of their ability to provide psychiatric treatment for mentally ill offenders, in practice these provisions are often widely ignored. China's shortcomings in this respect should thus, in principle, occasion little surprise or blame. For decades after 1949, however, the PRC prison authorities applied a policy of actively withholding appropriate medical care in the case of major political prisoners suffering from mental illness. According to Article 37 of the 1954 PRC Regulations on Reform Through Labor, prison authorities were not permitted to take custody of offenders suffering from mental illness or other serious diseases, "except in the case of major counterrevolutionary criminals."¹⁰⁸ Since the great majority of all convicted prisoners in China during the 1950s and 1960s were "counterrevolutionaries," this discriminatory policy inevitably meant that large numbers of mentally-ill political prisoners were denied access to proper care throughout their imprisonment. Another abusive practice that seriously compounded this general problem was that, until fairly recently, both sentenced counterrevolutionaries, irrespective of their mental state, and common criminals suffering from mental illness were frequently held in solitary confinement cells throughout their term of imprisonment.¹⁰⁹ An extreme example of the conditions of squalor and misery that could result from this practice was related in a 1983 directive from the Ministry of Public Security:

In December 1980, the authorities at Yingshan Prison, Guangxi Province, placed a mentally disturbed prisoner in solitary confinement and kept him there for more than two years. They afforded him neither medical treatment nor ideological education. No one cleared away the prisoner's excrement and urine, with the result that a mound of fecal matter thirty-five centimeters high accumulated inside the cell. During the winter of 1982, the prisoner was not supplied with any additional clothing or bed quilt, and as a result of the extreme cold and the noxious gases created by the fermentation of the decaying excrement, the prisoner died in January [1983] from the combined effects of cold exposure and gas poisoning.¹¹⁰

The same directive ordered that mentally ill prisoners were henceforth not to be placed in solitary confinement and must be given proper medical care and attention. In March 1998, however, a leading southern Chinese newspaper reported the case of a violent prisoner suffering from chronic schizophrenia who had been kept locked by police in an outdoor cage for at least the previous five years. As a result of the publicity, the man was subsequently freed from the cage and placed in a secure mental asylum. According to the newspaper account,

Reporters found Deng Qilu, the "man in the cage," at Beitan Village, Nanxiang Township, Xuwen County last weekend. The cage had been made [by the police] by welding together reinforced steel pipes and had an area of approximately two square meters inside but had no exit. It was situated in an open yard at the side of the village. The caged man looked to be a little over 40 years old, had grown long whiskers, and was stark naked. When we strangers walked close to the cage, his eyes showed fear and panic.¹¹¹

A related issue concerns the question of prisoners who went insane or were driven mad during their time in prison. This type of phenomenon, known as "prison psychosis," is common to prison systems around the world, but it was especially frequent and severe in China during the Cultural Revolution.¹¹² In particular, the police pressure on those arrested for alleged political offenses was often so great that many people began to believe that they actually had committed "towering crimes against the people," notably conspiracy, espionage and political subversion, and in the course of their daily forced-confessional writing sessions in prison, they began to reinterpret large sections of their own pasts in lurid and entirely fabulatory terms. In some cases, this unusual and highly specific form of "politically induced" prison psychosis was driven, at some vestigial level of the person's sanity, by a realization that it was only by constantly amplifying the scale and seriousness of the imagined crimes that one might hope to prolong the police investigation and thereby postpone the day of eventual punishment, which not infrequently meant death.¹¹³ Clinically speaking, the people concerned were already acutely mentally disturbed, but their flights of confessional fantasy, of whose veracity they themselves were quite convinced, would frequently be given blanket credence by the authorities and taken as grounds for criminal conviction.

In 1979, soon after Deng Xiaoping's return to power, the judicial authorities issued a directive instructing that - "in the interests of revolutionary humanism and so that these offenders do not die in prison" - a nationwide review be carried out of the cases of all "aged, weak, sick and disabled or mentally ill prisoners," and that the majority of such persons be set free.¹¹⁴ As late as the 1990s, however, reports from the legal-medical literature indicated that many severely mentally ill prisoners in China continued to be held in solitary confinement cells in regular prisons, watched day and night by a roster of prison guards and assigned prisoner "trusties," due to the continued widespread lack of secure psychiatric treatment facilities.¹¹⁵

The total number of mentally ill prisoners falling within the scope of the government's 1979 amnesty order was officially said to be 4,600, many of whom were over eighty years old and one third of whom had already been in prison for ten years or more. Among this large group of prisoners were no doubt many of those former mental patients from the early 1960s whose psychiatric symptoms had included "strange political utterances" and who had been harassed and beaten into "confessing their sanity" during the Cultural Revolution. The main lesson of experience drawn by the authorities in the late 1970s, however, was not that "political lunatics" of this sort should never have been criminally detained in the first place. Instead, the new and reform-minded viewpoint was simply that they should henceforth be relieved of their "criminal liability" and placed in police-run psychiatric custody, rather than in regular prisons as before.

Psychiatric Abuse in the Post-Mao Era

In some countries in the West, the relationship between law and human rights often ends up in a self-contradictory predicament. The so-called human rights of the mentally ill, such as the right to refuse treatment and the right to refuse hospitalization, are clear examples of the kind of phony human rights advocated by Western jurisprudence.

- Chinese textbook on forensic psychiatry, 1989¹¹⁶

If the political misuse of psychiatry had ended with the inauguration of the Deng Xiaoping era in 1978, the above account of the first thirty years of forensic psychiatry in China would be of primarily historical interest. The official repudiation of the Cultural Revolution in the late 1970s and the commencement of the policy of "opening and reform," however, did not bring an end to such practices. Over the next two decades, China's forensic psychiatrists continued to diagnose certain categories of dissident-type individuals as being "dangerously mentally ill" and to send them to long-term custody in special mental asylums. According to official accounts, there was a substantial decrease in the overall scale and incidence of these practices after the Cultural Revolution. For example, a retrospective study of forensic psychiatric assessments carried out at the Hangzhou No. 7 People's Hospital, published in June 1987, reported:

According to this hospital's statistics, cases of antisocial political speech and action accounted for 54 percent of all cases [examined] during the year 1977; currently, the proportion of such cases has fallen to a level of 6.7 percent. This shows that the present situation of stability and unity in China has resulted in a marked fall in the number of cases arising from such factors.¹¹⁷

While highly welcome, this reduction in the overall scale of political psychiatric abuse in China needs to be viewed and evaluated in an appropriate conceptual context. The statistics generally cited for the incidence of "cases of a political nature" in Chinese forensic psychiatry during the Cultural Revolution decade (in this case, 54 percent) are, by any objective standard of assessment, quite staggeringly high. They point to a situation whereby miscarriages of legal and medical justice were so widespread and pervasive as to be almost mind-boggling in their ethical implications. By contrast, the 1987 figure of 6.7 percent for such cases appears low. However, even the latter statistic would suggest a rate of political psychiatric abuse in China during the past two decades that is at least comparable to, and quite possibly higher than, that reported in the case of the former Soviet Union.¹¹⁸ Furthermore, official sources give alternative statistics on this count for China during the period since 1978 that go substantially beyond 6.7 percent. The problem thus appears to remain serious.

A brief outline of the research methodology adopted in the remainder of this article may be useful. In a book published in 1989, Dr. Semyon Gluzman, a Soviet psychiatrist who famously broke ranks with his colleagues in the early 1970s to speak out against the political abuses within his profession and then spent several years in prison as a consequence, proposed three different ways to approach the study of the political misuse of psychiatry.¹¹⁹ Gluzman's "three methods of collecting evidence and analyzing the situation" have direct methodological relevance for our present topic:

The first approach is to personally and objectively examine those who were found non-imputable by reason of insanity after being charged with political and religious crimes... During such an examination, at least the following should be established. 1) Was the victim in fact persecuted for political or religious crimes? 2) Did the victim show any signs or symptoms of psychiatric illness? ... 5) What is the internationally accepted standard of psychiatric practice in such cases (including the finding of "diminished capacity" in countries where it is in use? ...

In Gluzman's view, this approach to establishing and proving abuse of psychiatry was both procedurally very difficult and also "not in itself effective."¹²⁰ However, he argued, "This work must be done: real people, victims of abuse, need protection and help, not academic discussion about humanism and justice." He continued:

The second approach should combine a systematic study of the precepts of Soviet psychiatric theory, consideration of the differences among different school[s] of thought, and serious discussions in which specific disagreements can be focused on, and expert statisticians can be consulted. In my view, this is a very effective approach. But I doubt that such a discussion is feasible because it would require commitment and patience on both sides."

Gluzman's other proposed methodology was as follows:

The third approach is very complex and laborious. It is necessary to examine an enormous number of Soviet psychiatric publications that are available in open libraries, administrative norms, regulations, professional guidelines, monographs, collections of articles, scientific journals, dissertations, etc. As far as I know, nobody in the USSR or abroad has ever undertaken such a study. The advantages of such an approach are self-evident; no "discovery" can be disputed and such "content analysis" will inevitably show who abused their profession and when. It will also reveal their theoretical justifications.

In the case of the Soviet Union, in practice, it was largely by means of the first of these methods, the individual case-based approach, that the problem of political psychiatry first became known in the West,¹²¹ and this remained largely true throughout the subsequent campaign to end psychiatric abuse in the Soviet Union.¹²² In China, the practical difficulties associated with this approach are at least as great, and probably much greater, than was the case even in the former Soviet context. In particular, the task of carrying out objective and independent psychiatric assessments of Chinese individuals who have been placed in forensic psychiatric custody solely, apparently, on account of their political or religious views is something that may only become feasible at some point in the future, if and when the Chinese government begins to allow direct outside scrutiny of its practices in this field. At present, in most cases, we do not know even the names of the individuals discussed in the official documents excerpted below. The Falun Gong cases are important exceptions, though by no means the only ones.

Similarly, in the case of China, Gluzman's second approach, that of initiating a direct and sustained theoretical dialogue between Chinese psychiatrists and their Western counterparts over allegations of politically-directed psychiatric practice, represents a highly desirable aim but one that is unlikely to be practically attainable in the immediate to near future. While all appropriate efforts should certainly be made toward establishing this kind of intra-professional dialogue, the key determinant to the success of any such efforts, and more importantly, to ending the abusive psychiatric practices at issue, will undoubtedly remain the political will and attitude of the Chinese government.¹²³

Since the relatively closed nature of official Chinese society renders, for the meantime, alternative avenues of investigation largely impracticable, the principal methodology used in compiling the evidence of psychiatric abuse in China presented below has conformed, in the main, to the third approach advocated by Gluzman. The principal source of information relied upon has been the wide range of professional legal and psychiatric publications issued officially by the Chinese government since the early 1980s. These include a series of major textbooks and manuals on forensic medicine and psychiatry, legal studies dealing with the psychological dimensions of crime, journals and periodicals dealing with all aspects of law and jurisprudence, various national, provincial and municipal-level laws and regulations on the handling of mentally ill offenders, including rules for the involuntary committal of those viewed as especially "dangerous" to society, and several specialized medical periodicals, notably the Chinese Journal of Psychiatry and the Chinese Journal of Nervous and Mental Diseases.¹²⁴ In addition, a number of first-hand accounts written by former inmates of the Ankang system and other Chinese psychiatric detention facilities have been examined.

Although the officially published sources contain little in the way of detailed individual case material and offer scant insight into the prevailing conditions of treatment and incarceration in China's police-run secure psychiatric facilities, they manifest in full measure the advantages referred to by Gluzman above. First, unlike victim or refugee accounts for example, they are, by virtue of their provenance, not amenable to disputation or refutation by the authorities. Second, they provide a productive source of information for a content analysis-based examination of the issues. Finally, they afford major insight into the various theoretical justifications used by Chinese psychiatrists, in their collaborative endeavor with the security authorities to medically criminalize certain forms of dissent.

⁴⁶ Vivien W. Ng, "Ch'ing Law Concerning the Insane: An Historical Survey," Ch'ing Shi Wen-t'i (Problems in Ch'ing History), vol. 4, no.4 (December 1980), p.84.

⁴⁷ Technically, the maximum number of blows with a heavy bamboo stave prescribed by law was one hundred; in practice, however, this would often have been fatal, so the lesser number was used as a maximum instead. See Derk Bodde & Clarence Morris, Law in Imperial China (University of Pennsylvania Press, 1967), p.77.

⁴⁸ Ernest Alabaster, Notes and Commentaries on Chinese Criminal Law (Luzac & Co., 1899), p.93. See also Andrew H. Woods, M.D., "A Memorandum to Chinese Medical Students on the Medico-Legal Aspects of Insanity," Journal of the National Medical Association of China, vol. 9 (September 1923), pp.203-212.

⁴⁹ "And the sentence (slicing to pieces) is [in such cases] to be carried out in all its horror, even though the lunatic be already dead" (Alabaster, Notes and Commentaries, p. 96).

⁵⁰ The name used for Beijing during much of the Republican era.

⁵¹ H.D. Lamson, Social Pathology in China, (Shanghai: The Commercial Press, 1935), p.434.

⁵² Francis L.K. Hsu, "A Brief Report on the Police Co-operation in Connection with Mental Cases in Peiping," in R. Lyman et al., ed., Social and Psychological Studies in Neuro-Psychiatry (Beijing: Henri Vetch, 1939), pp.202-230.

⁵³ "The police considers it a custodial place" (Ibid, p.225).

⁵⁴ Ibid., pp.210-211.

⁵⁵ Ibid., p.222.

⁵⁶ See, e.g., Zhang Jun, Xingshi Cuo'An Yanjiu (Research on Miscarriages of Criminal Justice), (Beijing: Qunzhong Chubanshe, 1990), pp.110-111.

⁵⁷ See Shen Yucun, ed., Jingshenbingxue (Psychiatry) 3^rd Edition (Beijing: People's Health Publishing House, May 1997), p.16. Other official sources give a figure of as low as thirty psychiatrists for the whole country. Sixty psychiatrists for the population of China at that time works out at approximately one per eight million inhabitants. The figure for general physicians was approximately 670 for every one million inhabitants (see "Fifty Years of Progress in China's Human Rights," Xinhua News Agency, February 17, 2000, p.1). There are currently said to be around 12,000 psychiatrists in China (see Psychiatric News, June 16, 2000, available at http://www.psych.org/pnews/00-06-16/china.html). And according to an official Chinese news source, there are currently altogether 575 hospitals and 77,000 doctors and nurses dealing with mental diseases in China (see "Nation's Mentally Ill Need More Care," China Daily, November 27, 2000; available at http://www.chinadaily.com.cn/cndydb/2000/11/d2-1ment.b27.html).

⁵⁸ See Li Xintian, "One Decade of the Clinical Application of Artificial Hibernation Therapy in China," Zhonghua Shenjing Jinshenke Zazhi (Chinese Journal of Nervous and Mental Diseases), No. 6 (1959), p.351.

⁵⁹ See Jia Yicheng, ed., Shiyong Sifa Jingshenbingxue (Applied Forensic Psychiatry), (Anhui Renmin Chubanshe, September 1988), p.10.

⁶⁰ See the Internet site of the Beijing Institute of Forensic Medicine and Science (Beijing Shi Fating Kexue Jishu Jianding Yanjiusuo) at http://www.fmedsci.com/sfjs/sfjs6.htm.

⁶¹ Underlying the strange complicity between law and psychiatry in the Soviet Union was the official view that, since socialist society was inherently superior to capitalist countries and thus the former social sources and causes of crime had mostly been eradicated, the continued occurrence of criminal or dissenting acts must be due to flaws in the offender's mental state. As Nikita Khrushchev explained: "A crime is a deviation from the generally recognized standards of behavior [and is] frequently caused by mental disorder. Can there be diseases, nervous disorders among certain people in Communist society? Evidently yes. If that is so, then there will also be offenses which are characteristic of people with abnormal minds.... To those who might start calling for opposition to Communism on this basis, we can say that...clearly the mental state of such people is not normal" (Pravda, May 24, 1959).

⁶² Sidney Bloch, "Soviet Psychiatry and Snezhnevskyism," in Robert van Voren, ed., Soviet Psychiatric Abuse in the Gorbachev Era, p.56.

⁶³ This list of symptoms is taken from a series of translations from official Soviet forensic psychiatric reports that appear in Semyon Gluzman, On Soviet Totalitarian Psychiatry (International Association on the Political Use of Psychiatry [IAPUP] Amsterdam, 1989), pp.39-44.

⁶⁴ L.N. Diamant, "Issues in Clinical Evaluations and Compulsory Treatment of Psychopathic Personalities with Paranoid Delusions and Overvalued Ideas," cited in Gluzman, On Soviet Totalitarian Psychiatry, p.40.

⁶⁵ For example, the now discredited Soviet laws on forensic psychiatric hospitalization are extensively quoted in two Chinese textbooks published in 1992 (when the Soviet Union was finally collapsing). See Li Congpei, ed., Sifa Jingshenbingxue, pp.404-406. See also Chen Weidong et al., "Chapter 9: Litigation Procedures for the Adoption of Coercive Medical Measures," in Xingshi Tebie Chengxu de Shijian yu Tantao (Practice and Explorations in Special Criminal Procedure) (People's Court Publishing House, 1992), pp.467-505. See also Shen Zheng, ed., Falü Jingshenbingxue (Legal Psychiatry) (China Politics and Law University Press, 1989), pp.64-68.

⁶⁶ The Chinese term "qianyinxing jingshenfenliezheng" was specifically used, for example, by the leading forensic psychiatrists Jia Yicheng and Ji Shumao in a brief account of criticisms made against Soviet political psychiatry at an international academic conference in 1977 (see Jia Yicheng, ed., Shiyong Sifa Jingshenbingxue, p.15). Note that the Chinese term for "sluggish schizophrenia" is not to be confused with that used for "chronic schizophrenia": "manxing jingshenfenliezheng."

⁶⁷ See Zhai Jian'an, ed., Shiyong Fayixue Cidian (A Dictionary of Applied Forensic Science), (People's Health Publishing House, September 1994), p.18.

⁶⁸ Where "sluggish schizophrenia" is mentioned in Chinese sources, it is usually accompanied by cautionary remarks about the need to avoid "over-diagnosing" the condition. The principal objection, however, seems not to stem from any concerns about the possible use of political psychiatry, but is rather that the diagnosis of this "borderline condition" in the case of criminal offenders, and a resultant finding of non-imputability, can lead to their escaping punishment for serious crimes. One author, for example, recounts the case of a rapist who was diagnosed as having "sluggish schizophrenia" and was then promptly released by the police, to the consternation of the victim's family; a fresh forensic appraisal was arranged and the man was eventually ruled to bear "partial legal responsibility" for his crime (Jia Yicheng, Shiyong Sifa Jingshenbingxue, pp.196-198).

⁶⁹ Li Congpei, et al., "An Analysis of Forensic Psychiatric Evaluations in Cases of Schizophrenia," Chinese Journal of Nervous and Mental Diseases, vol. 20, no.3 (1987), pp.135-138. Incidentally, one of the scholarly sources referred to in this article is a book by Georgi Morozov.

⁷⁰ Wu Xinchen, "An Exploration of the Hallmarks of Criminal Behavior Among Schizophrenics," Chinese Journal of Nervous and Mental Diseases, vol.16, no.6 (1983), pp.338-339.

⁷¹ Luo Dahua, ed., Fanzui Xinlixue (Psychology of Crime), (Qunzhong Chubanshe [volume marked "for internal distribution only"], 1984), p.216. The Chinese phrase "living at large in society" (sanju zai shehuishang) is a somewhat pejorative term generally used in respect of "socially undesirable elements" whom the authorities feel should be placed under some form of supervision or restriction; in this case, it probably signifies that the alleged schizophrenics had not previously been institutionalized in any way.

⁷² As two expert observers of the Soviet psychiatric scene later remarked, a diagnostic shift in a broadly similar direction also occurred in the Soviet Union around the same period. According to one of the experts, Richard J. Bonnie, a legal academic who participated in a 1989 visit to the USSR by an American psychiatric delegation that examined a number of psychiatrically-detained Soviet dissidents,

In the mid-1980s, Soviet psychiatric officials began to acknowledge that a pattern of "hyperdiagnosis" had resulted in inappropriate psychiatric labeling and unnecessary hospitalization in the USSR. It was therefore noteworthy that Soviet psychiatrists who interviewed the twenty-seven patients concurrently with the U.S. team in 1989 found no current evidence of schizophrenia in the cases of fourteen patients who were thought to be without mental disorder by the U.S. psychiatrists. However, it is also noteworthy that the Soviet psychiatrists nonetheless still retained some psychiatric diagnosis for most of these patients. In this respect, the U.S. delegation found continuing evidence of "hyperdiagnosis," particularly in the tendency to characterize these patients as having "psychopathy," a term that seems to be roughly equivalent to the general concept of personality disorder. Specific examples of "psychopathic" symptoms identified in the interviews by Soviet psychiatrists included "unitary activity," which related to a high level of commitment to a single cause, such as political reform, and "failure to adapt to society," which was used to describe a dissident patient who was "unable to live in society without being subject to arrest for his behavior." One of the Soviet psychiatrists was asked whether a patient who had been sent to a special hospital for distributing anti-Soviet leaflets presented a danger to society. "Of course not," he responded, "everything the patient distributed can be read in the newspapers now." As this observation implies, what had changed was the meaning of a socially dangerous act, not the meaning of mental disorder. (Richard J. Bonnie and Svetlana V. Polubinskaya, "Unraveling Soviet Psychiatry," The Journal of Contemporary Legal Issues, no.10 (1999), pp.285-286.)

⁷³ In the course of treating diabetics, "Sakel discovered accidentally, by causing convulsions with an overdose of insulin, that the treatment was efficient with patients afflicted with psychosis, particularly schizophrenia" (Renato M.E. Sabbatini, "The History of Shock Therapy in Psychiatry," Brain and Mind, no. 4 (Dec. 1997-March 1998) (electronic magazine on neuroscience, found at http://www.epub.org.br/cm/history_i.htm).

⁷⁴ The best overview of the extensive misuse of somatic therapies in the West is Elliot S. Valenstein, Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments (Basic Books, February 1986). Tens of thousands of lobotomies were performed in the United States from 1936 until around 1952. The most egregious practitioner was the American neurologist Walter Freeman, who invented a technique known as "ice-pick lobotomy," which took no more than a few minutes to perform. According to one account, "This procedure was so ghastly, however, that even seasoned and veteran neurosurgeons and psychiatrists could not stand the sight of it, and sometimes fainted at the `production line' of lobotomies assembled by Freeman." Moreover, "[Lobotomies were] widely abused as a method to control undesirable behavior, instead of being a last-resort therapeutic procedure for desperate cases...Families trying to get rid of difficult relatives would submit them to lobotomy. Rebels and political opponents were treated as mentally deranged by authorities and operated [upon]" (Sabbatini, The History of Shock Therapy). The use of psychosurgery did not really end in the U.S. until the 1970s (partly as a result of the influence of the film "One Flew Over the Cuckoo's Nest"), and since then there have continued to be voices (so far, mainly in the wilderness) seeking to bring it back. Finally, according to a leading authority on medical ethics, "ECT stands practically alone among the medical/surgical interventions in that its misuse was not so much an overzealous effort to cure patients but to control them so as to benefit hospital staff." (David J. Rothman, Director of the Center for the Study of Society and Medicine at the Columbia College of Physicians and Surgeons, New York; personal communication to the author, July 11, 2002,)

⁷⁵ For example, while acknowledging insulin coma treatment to be a "radical therapy with very severe side effects," one study reported that at the Nanjing Mental Hospital in 1958 (the peak year of Mao's "Great Leap Forward," when the entire nation was being urged to make "greater, faster, better and more economical" strides towards Communism), doctors had begun applying the therapy to some 500 patients "on a continual daily basis...omitting the [previous] weekly rest day" (Tao Guotai et al., "Clinical Observations on 2,663 Cases of Insulin Shock Treatment," Chinese Journal of Nervous and Mental Diseases, no.1,1960, pp.19-24; Bao Zhongcheng et al., "Clinical Observations on 400 Cases of Electro-shock Therapy," Chinese Journal of Nervous and Mental Diseases, no.1, 1960, pp.28-30; and Wang Jingxiang, "China's Achievements Over the Past Decade in Insulin Shock Therapy Work," Chinese Journal of Nervous and Mental Diseases, no.6, 1959, pp.349-351.) Another form of treatment that was apparently widely used in Chinese mental hospitals at this time was "artificial hibernation therapy" (dongmian liaofa), a prolonged state of deep sleep induced by means of either chlorpromazine hydrochloride or wintermin (dongmian ling); a less radical version of this treatment was known simply as "sleep therapy" (shuimian liaofa).

⁷⁶ Shen Zheng, Falü Jingshenbingxue, pp.1016-1017; and Zhu Qihua et al., eds., Tianjin Quanshu (An Encyclopedia of Tianjin) (Tianjin People's Publishing House, December 1991), p.630.

⁷⁷ Technical advances in recent decades have led to the widespread use internationally of less invasive forms of psychosurgery than those generally used before. Known as "stereotactic" techniques, these allow more precise and less damaging surgical interventions (for example, leucotomy and cingulotomy) to be carried out in place of the former "broad spectrum" lobotomy procedure.

⁷⁸ See, e.g., "Observations on the Effectiveness of Stereotactic Brain Surgery in Cases of Schizophrenia with Aggressive Behavior," Chinese Journal of Nervous and Mental Diseases, vol. 18, no. 3 (1992), pp.153-155; and "A Follow-up Review of Stereotactic Brain Surgery in Cases of Chronic Schizophrenia," Zhonghua Shenjing Waike Zazhi (Chinese Journal of Neurosurgery), vol. 8, no. 4 (1992), pp.263-265.

⁷⁹ Veronica Pearson, "Law, Rights and Psychiatry in the People's Republic of Psychiatry," p. 420. Pearson continues by saying, "Other matters for concern are the lack of consent to treatment, (particularly hazardous and irreversible practices), the custodial nature of most settings, the lack of any effective protection against compulsory detention, the summary removal of civil status, and the lack of an appeal mechanism." It should be noted, however, that she then states: "Reading through hundreds of case files, I have found no evidence that sane people are being detained for political offenses. When the direct question has been put as to why this does not happen in China, the consensus is that there is no need. There are other ways of dealing with dissidents that do not require the inappropriate utilization of a scarce and expensive hospital bed." Pearson continues, "There are undoubtedly people in psychiatric hospitals whose breakdowns have been precipitated by political events, or persecution for political reasons, but that is a different matter." Although a correct and reasonable observation in itself, the latter point by no means exhausts the wide repertoire and typology of "cases of a political nature" found in China since 1949. In particular, it misses the core question of why, in China, such people are commonly dealt with on the forensic (criminal) psychiatric track, rather than under normal mental healthcare procedures. The more sinister variations on this theme are discussed in detail below.

⁸⁰ The source is a doctor who wishes to remain anonymous; however, official confirmation that a lobotomy unit had been established at the Tianjin facility appeared in "Gong'an Xitong Jingshenbing Guan-Zhi Gongzuo Chengxiao Xianzhu (Public Security System's Work of Custody and Treatment of the Mentally Ill Achieves Conspicuous Results)," Renmin Gong'an Bao (People's Public Security News), May 18, 1990, p.1.

⁸¹ The nature and significance of such medical neglect appears to have been different during the two main historical periods since 1949. Prior to 1978, it seems mainly to have resulted from a policy of deliberate official discrimination against mentally ill political offenders, who were seen as being too "heinous" in their crimes to merit any humanitarian attention, let alone proper psychiatric care; at that time, somewhat ironically, the fact that China's mental healthcare resources were much scarcer and even less well-developed than they nowadays are seems to have been a factor of secondary importance in the absence or denial of psychiatric care. In the post-Cultural Revolution period, by contrast, there is little evidence to suggest that psychiatric care has continued to be withheld from mentally ill prisoners on solely political grounds, and it is instead the persistent scarcity of such resources more generally that mainly explains the continuing problem of widespread medical neglect within the country's prison system. However, for the apparently small minority of psychiatrically incarcerated offenders in the post-1978 era who may, in fact, have been mentally ill at the time of committing their "political crimes," forced psychiatric custody also represents an abusive type of treatment that might best be described as a politically-motivated form of medical neglect. In such cases, the authorities' fallacious ascription of a criminal nature and purpose to the acts of mentally disordered speech or behavior in question means that the sufferer, whilst being denied access to proper and appropriate forms of medical care, is also placed in a coercive judicial setting that can only exacerbate his or her mental condition, especially if the underlying illness is of a paranoid nature.

⁸² Zhu Hengqing, Lu Ling: Wei Wancheng de Tiancai (Lu Ling: A Talent Unfulfilled), (Shandong Wenyi Chubanshe, April 1997), pp.112-113. This book provides the most detailed account to date of all aspects of Lu Ling's case.

⁸³ Ibid., p.113.

⁸⁴ The Chinese term used was gongji: technically, this means simply "hostile" or "attacking," but when used in Chinese legal discourse (especially in the phrase "e'du gongji" - "viciously attacking") in connection with proscribed acts of speech or writing, it invariably means "politically hostile."

⁸⁵ The same sentiment as that expressed in the court decision on Lu Ling's case appeared in March 1979 in one of the country's main daily newspapers: "In order genuinely to protect the democratic rights of the Chinese people, the following must be clearly and unequivocally written into the Constitution and the law: `Speech shall not be taken as a grounds for the crime of counterrevolution. Whoever determines the crime of counterrevolution on the basis of a person's acts of expression shall himself be guilty of a criminal offense'" (Guangming Ribao, March 10, 1979). (For the full background story on the publication of this remarkable article, see Xu Bing and Min Sheng, "Reminiscences on the Article `Speech is No Crime and Making Speech a Crime'," in Guo Daohui et al., eds., Zhongguo Dangdai Faxue Zhengming Shilu [A Record of the Contention on the Science of Law in Contemporary China], [Hunan Renmin Chubanshe, 1998], pp.183-189.) Ten years later, however, this bold opinion was roundly dismissed in the following terms in a textbook on criminal law: "Viewpoints such as this run contrary to the stipulations of China's Criminal Law and are therefore wrong" (Gan Yupei, ed., Xingfaxue Zhuanlun [Essays on Criminal Law] [Beijing University Publishing House (volume marked: "for internal use only"), November 1989], p.512).

The locus classicus post-Cultural Revolution document on why "hostile speech or statements" (especially those directed against State and Party leaders) were still to be dealt with as a criminal offense is the CPC's Central Political-Legal Commissions' Opinion on the Question of Whether Viciously Attacking or Slandering Central Leading Comrades Constitutes a Crime, December 17, 1981; a full translation (by Donald C. Clarke) can be found on the Internet at http://faculty.washington.edu/dclarke/public/clpc-opinion.htm.

⁸⁶ Shen Zheng, ed., Falü Jingshenbingxue, p.314. According to an official biography of Zheng Zhanpei published in 1999, "He has worked at the Shanghai Municipal Institute for the Prevention and Treatment of Mental Illnesses (now called the Shanghai Municipal Mental Health Center) from 1960 up to the present" (Xie Bin, "Sifa Jingshenbingxuejia Zheng Zhanpei Jiaoshou," in Falü Yu Yixue Zazhi [Journal of Law and Medicine], vol. 6, no. 3 [1999], p.99). Among many other posts Zheng now holds, he is concurrently Chairman of the Shanghai Municipal Experts Committee for Psychiatric Judicial Appraisals and Adviser to the Shanghai Municipal Bureau of Reform Through Labor.

⁸⁷ Transcript taken from "Red Guard Publications: Part III - Special Issues," vol. 16, Center for Chinese Research Materials, Association of Research Libraries, Washington D.C. (1975), pp.5186-5187 (conversation edited here for purposes of conciseness). Grateful acknowledgement is due to Lalagy Pulvertaft for providing source materials on the Anding Hospital incident and also (as discussed below) the cases of Chen Lining and the wife of Lu Dingyi.

⁸⁸ Mazui fenxi is a practice whereby patients were drugged and questioned in an attempt to find out if they were feigning symptoms of mental illness. Most Chinese psychiatrists now regard this practice as "inhumane and contrary to human rights," but Li Congpei - the eminence grise of Chinese forensic psychiatry - was still advocating its use as of 1990 (Li Congpei, ed., Sifa Jingshenbingxue, pp.73-74).

⁸⁹ See "Red Guard Publications: Part III - Special Issues." Less than a year later, however, when Chen Lining was found to have also said "crazy" things about Chairman Mao, the Red Guards swiftly repudiated him as a political role model and once again branded him a "heinous counterrevolutionary element." A detailed account of this dramatic reversal in Chen's political fortunes (and also in those of his erstwhile patron, Qi Benyu) can be found in "Cong Chen Lining Anjian Kan Bianse Long Qi Benyu zhi Liu de Fan'geming Zuilian (The Case of Chen Lining Shows Us the Counterrevolutionary Features of the Chameleon-like Qi Benyu and His Ilk)," published in the Red Guard journal Xin Bei-Da - Changcheng (New Beijing University - Great Wall, March 20, 1968), pp.1-4. It is not known what eventually became of Chen.

⁹⁰ Guan Xin, "How to Discern Mental Illness and Ascertain Legal Capacity," "Renmin Sifa" Xuanbianben 1981 Nian (A Compilation of Articles from "People's Judiciary" 1981) (volume marked "for internal use only"), (Law Publishing House, 1983), p.590. As Guan concludes from this grotesque record: "Professional experience has clearly shown us that in order to avoid the wrongful conviction and execution of the mentally ill, it is vital that we should disseminate basic knowledge about forensic psychiatry with a view to correctly identifying the mentally ill and ascertaining the question of their [legal] responsibility."

⁹¹ Yang Desen, "On the Legal Responsibility of Mentally Ill Persons for Their Illegal Conduct," Chinese Journal of Nervous and Mental Diseases, vol. 11, no. 5 (1985), pp.310-312. Yang Desen (also known as Young Derson) is head of the psychiatry department at Hunan Medical College. As the American psychiatrist and anthropologist Arthur Kleinman observed in his landmark 1986 study of Chinese psychiatry, Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in Modern China, p.9, Yang was himself the target of political attacks during the Cultural Revolution: "During these years, Dr. Young, Professor Ling's [i.e., Ling Ming-yu, then head of the HMC psychiatry department] former student and successor, received equally harsh treatment from the Red Guards because of his defense of the core psychiatric position that mental illness is an illness, and not wrong political thinking as the Maoists held."

⁹² Shen Zheng, Falü Jingshenbingxue, p.217. Even in the late 1990s, mentally impaired or disabled people were still being arrested on political charges and then subjected to forensic psychiatric assessment. For example, a study published in April 2000 examining the question of crimes committed by epileptics noted that the sample group included one person detained for making "anti-social speeches" (Wei Qingping et al., "Dianxian Huanzhe Weifa de Sifa Jingshen Yixue Jianding Fenxi [An Analysis of Expert Psychiatric Testimony on Epileptic Patients' Illegal Actions]," Chinese Journal of Nervous and Mental Diseases, vol. 26, no.2 [2000], pp.65-67).

⁹³ "Meiyou zhengque de zhengzhi guandian, jiu dengyu meiyou linghun." This quotation from Chairman Mao appears in his 1957 article "On the Correct Handling of Contradictions Among the People," in Selected Works of Mao Tse-tung, Vol. 5 (Beijing, 1977), pp.384-421; the official translation of the quoted sentence differs slightly from that given above.

⁹⁴ Given the virtual collapse of the country's mental healthcare system at that time, it is surprising to learn that in the legal or forensic area of psychiatric work, things apparently continued much as they had before the Cultural Revolution. As can be seen from the passages cited above, large numbers of "dangerously mentally ill offenders" apparently continued to be arrested, brought before panels of forensic-psychiatric assessors and then dispatched to secure mental hospitals around the country during the Cultural Revolution. But Communist dictatorships sometimes behave in very strange ways. Pol Pot, for example, in planning his new, improved version of Stalinism and Maoism, made provision for a mental hospital in his Democratic Kampuchea utopia. Construction of this facility for the treatment of insanity was planned in 1976, before his Communist Party had reached the conclusion that everything that was going wrong with the revolutionary society it was trying to build was the result of CIA-KGB-KMT-Vietnamese plots. This paranoid delusion on the part of Pol Pot and other Party leaders led them to decide to apply mass execution, rather than psychiatry, to solve social and political problems, and the hospital was never built. For the plans, see David A.T. Chandler, ed., "The Party's Four-Year Plan to Build Socialism in All Fields, 1977-1980," Pol Pot Plans the Future, Yale University Southeast Asian Studies Monograph No.33 (New Haven: 1988), p.109. With thanks to Dr. Stephen R. Heder, Lecturer in Politics at the School of Oriental and African Studies, London, for this information.

⁹⁵ Jia Yicheng et al., "On Several Basic Concepts in Forensic Psychiatry," Chinese Journal of Nervous and Mental Diseases, vol. 9, no. 2 (1983), p.119.

⁹⁶ Zhao Haibo, "On the Fundamental Principles and Methods of Forensic Medical Investigation," in Cui Jian'an, ed., Zhongguo Fayi Shijian (China's Forensic Medical Practice), (Police Officers' Educational Press, August 1993), pp.47-48.

⁹⁷ Wei Jingsheng, "A Twentieth-Century Bastille," in James D. Seymour, ed., The Fifth Modernization: China's Human Rights Movement, (New York: Human Rights Publishing Group, 1980), p.217. Wei's article originally appeared in the March 1979 issue of Tansuo (Explorations), a dissident journal founded and edited by Wei the previous winter.

⁹⁸ Wang Li, "Wang Li's Testament," Chinese Studies in Philosophy, vol. 26, nos. 1-2 (Fall-Winter 1994-95), p.5.

⁹⁹ Mu Xin, "Inmate No. 6813 in Qincheng Prison," Mao's Great Inquisition: The Central Case Examination Group, 1966-1979; Chinese Law and Government, vol. 29, no. 3 (May-June 1996), pp.74-75. The bizarre lengths that prison guards at Qincheng went to in order to manipulate and control the inmates was related by Mu as follows:

Before they delivered the newspaper that carried the news of the death of Mr. Dong [Biwu] [one of the founders of the People's Republic, who had fallen from official grace during the Cultural Revolution], they surreptitiously gave me a drug that suppresses tears (in fact, many of the female "prisoners" were given this drug before they met with their children who came to meet them in prison). This drug makes it impossible, somehow, for a person to shed tears, no matter how badly he or she might feel. On the other hand, before they delivered the newspaper that carried the news of [the death of] Chiang Kai-shek, they deliberately doped me with some drug that had the opposite effect of the first one. In spite of all this, however, it was most certainly unlikely that I would feel the slightest bit of "grief" at the death of a public enemy of the people like Chiang Kai-shek, and I most certainly would not be able to bring myself to shed tears on his account. Those people were able, in fact, to sense this, and so they ordered the "guard" to pour some liquid sulfuric acid - which attacks one's eyes severely and makes one's eyes all runny - on the ground right outside the door of my cell, and then they tried to fan the fumes into my room in an effort to force me to shed tears, thus allowing them to make a report on my "counterrevolutionary sentiments." (Ibid., pp.92-93.)

¹⁰⁰ The Encyclopedia Britannica provides the following summary of this incident:

Doctors' Plot: (1953), alleged conspiracy of prominent Soviet medical specialists to murder leading government and party officials; the prevailing opinion of many scholars outside the Soviet Union is that Joseph Stalin intended to use the resulting doctors' trial to launch a massive party purge. On Jan. 13, 1953, the newspapers Pravda and Izvestiya announced that nine doctors, who had attended major Soviet leaders, had been arrested. They were charged with poisoning Andrey A. Zhdanov, Central Committee secretary, who had died in 1948, and Alexander S. Shcherbakov (d. 1945), who had been head of the Main Political Administration of the Soviet army, and with attempting to murder several marshals of the Soviet army. The doctors, at least six of whom were Jewish, also were accused of being in the employ of U.S. and British intelligence services, as well as of serving the interests of international Jewry. The Soviet press reported that all of the doctors had confessed their guilt. The trial and the rumored purge that was to follow did not occur because the death of Stalin (March 5, 1953) intervened. In April Pravda announced that a reexamination of the case showed the charges against the doctors to be false and their confessions to have been obtained by torture. The doctors (except for two who had died during the course of the investigation) were exonerated. In 1954 an official in the Ministry of State Security and some police officers were executed for their participation in fabricating the cases against the doctors. In his secret speech at the 20th Party Congress (February 1956), Nikita S. Khrushchev asserted that Stalin had personally ordered that the cases be developed and confessions elicited, the "doctors' plot" then to signal the beginning of a new purge. Khrushchev revealed that Stalin had intended to include members of the Politburo in the list of victims of the planned purge. (See http://www.britannica.com/seo/d/doctors-plot/.)

¹⁰¹ Documentation Group of the Revolutionary Committee of Beijing College of Politics and Law and Documentation Group of the Capital Red Guards Committee's Politics and Law Commune, "A Shocking Case of Counterrevolution: An Investigative Report into the Attempt by Peng Zhen, Lu Dingyi and their Sinister Lieutenants to Concoct a Counterrevolutionary Phony Medical Diagnosis Aimed at Shielding the Active Counterrevolutionary Element Yan Weibing," Xingxingsese de Anjian: Liu Deng Peng Luo Shixing Zichanjieji Zhuanzheng de Yangban (All Types of Cases: Model Examples of the Bourgeois Dictatorship Exercised by Liu, Deng, Peng and Luo), June 1968, pp.18-33. A whole separate study could fruitfully be done on the topic of the close convergence of political and popular-psychological language during the Cultural Revolution, and on the wholesale semantic degradation that resulted. When the Red Guards accused Mrs. Yan of "insanely attacking" Lin Biao, for example, they meant it both as a serious political allegation and also, more randomly, as a form of sheer political abuse. On a deeper discursive level, however, they seem also to have been acknowledging that she probably was mentally ill, and the phrase "insanely attacking" may thus have been intended as a kind of pseudo-medical, politically reductionist explanation for her allegedly deviant mental behavior. On a much simpler level, of course, the question inevitably arises: who was the more "crazy," she or they?

¹⁰² The precise diagnosis, made by psychiatrists two weeks after Yan was formally arrested, was: "Paranoid state on the basis of a sub-acute hysterical personality type" (Ibid., p.31).

¹⁰³ The psychiatrist was Shi Shuhan, an official at the Ministry of Health; he took an overdose of barbiturates on August 25, 1966. Among the numerous senior psychiatrists and health officials denounced and punished as "counterrevolutionary conspirators" as a result of the Yan Weibing "false diagnosis" case were: Qian Xinzhong, Minister of Public Health; Huang Shuze, deputy Minister of Public Health and head of the ministry's healthcare bureau; Xue Bangqi, director of the East China Hospital in Shanghai; Shen Yucun, a psychiatrist in the brain medicine department of Beijing Hospital (and wife of Qian Xinzhong); Su Zonghua, director of the Shanghai Hospital for the Prevention of Mental Diseases; Xu Yunbei, a former Party Secretary at the Ministry of Health; Zhang Ziyi, former deputy head of the Party's Propaganda Department; Zheng Xuewen, head of the medical treatment department of the Ministry of Health; and Geng Dezhang, the personal physician of Lu Dingyi.

¹⁰⁴ "Fan'geming de xin-bing."

¹⁰⁵ For a detailed account of Lu Dingyi's and Yan Weibing's persecution during the Cultural Revolution, see Chen Qingquan and Song Guangwei, Lu Dingyi Zhuan (A Biography of Lu Dingyi), (Zhonggong Dang Shi Chubanshe, Beijing, December 1999). Prior to the publication of this book, it was not known what became of Yan following her arrest in April 1996 (Ibid., p.541).

¹⁰⁶ "Shanghai Detention Center for the Mentally Disordered: An Interview with Mr. C," Human Rights Tribune (journal of the New York-based monitoring group Human Rights in China), vol. 1, no. 5 (October 1990), p.16; HRIC's journal is now called China Rights Forum.

¹⁰⁷ See especially Article 82 of the Standard Minimum Rules and Procedures for the Effective Implementation of the Rules, (United Nations [New York: Department of Public Information, 1984]), adopted by the United Nations on August 30, 1955: "(1) Persons who are found to be insane shall not be detained in prisons and arrangements shall be made to remove them to mental institutions as soon as possible. (2) Prisoners who suffer from other mental diseases or abnormalities shall be observed and treated in specialized institutions under medical management. (3) During their stay in a prison, such prisoners shall be placed under the special supervision of a medical officer. (4) The medical or psychiatric service of the penal institutions shall provide for the psychiatric treatment of all other prisoners who are in need of such treatment."

¹⁰⁸ See also Xu Shoubin, "The Legal Protection and Restriction of Rights of the Mentally Ill," Fazhi Shijie (World of Legality), no.6 (1994), p.26. The prohibition on penal institutions taking in mentally ill prisoners was reiterated by the Ministry of Public Security (whose No.11 Bureau ran all such facilities until July 1983 when jurisdiction was transferred to the Ministry of Justice) in Article 9 of the Ministry's 1982 "Detailed Rules on the Disciplinary Administration of Prisons and Labor-Reform Detachments (Trial Draft)," in A Compilation of Standard Interpretations of the Laws of the People's Republic of China: Supplementary Volume (Jilin People's Publishing House, 1991), p.798. However, the provisions of Article 37 of the 1954 Regulations remained in force.

¹⁰⁹ Even common criminals with mental illnesses were rarely dealt with according to the provisions of the 1954 Regulations, since virtually no mental healthcare facilities were to be found anywhere in the country's prison system; as late as 1988, the penal network reportedly still contained only two specialized mental hospitals ("Penal-System Medical and Health Work Has Been Greatly Strengthened and Developed in Recent Years," Fanzui Yu Gaizao Yanjiu [Research in Crime and Reform], no.4 [1994], pp.53-55).

¹¹⁰ "Notification of Bureau No. 11 of the Ministry of Public Security On Strengthening and Reorganizing the Management of Solitary Confinement Cells (July 12, 1983)," Zhonghua Renmin Gongheguo Falü Guifanxing Jieshi Jicheng (A Compilation of Standard Interpretations of the Laws of the People's Republic of China), (Jilin People's Publishing House, October 1990), pp.1591-1593. (A heavily censored version of the same directive appears in: Zhonghua Renmin Gongeheguo Jiancha Yewu Quanshu (A Compendium of PRC Procuratorial Work), (Jilin People's Publishing House, July 1991), pp.1496-1497.) The directive ordered an immediate tightening up of the administration of solitary confinement units throughout China. For a full translation of China's regulations at that time on the administration of solitary confinement cells (Articles 60-64 of the Ministry of Public Security's February 1982 "Detailed Rules for the Disciplinary Work of Prisons and Labor Reform Detachments"), see Asia Watch (now Human Rights Watch/Asia), "Democracy Wall Prisoners: Xu Wenli, Wei Jingsheng and Other Jailed Pioneers of the Chinese Pro-Democracy Movement," vol. 5, No. 6, March 1993, pp.21-23.

¹¹¹ "Man Detained in Iron Cage for Ten Years in Guangdong," Yangcheng Wanbao, March 28, 1998; translation from BBC Summary of World Broadcasts, April 13, 1998. (Chinese press reports on the case varied on whether the man had spent five or ten years in the cage.) The background to the case was described in another news report as follows:

On 29^th May, 1999, Deng was detained for investigation after he suddenly stabbed and inflicted serious injury upon a police officer with a sharp weapon measuring 80 cm in length. On 30^th July of the same year, the Zhanjiang City Hospital for the Prevention and Treatment of Mental Disease and a forensic psychiatry appraisal team of Zhanjiang City determined: "Deng Qilu has been suffering from dementia praecox for a period of 16 years... In this connection, it is suggested that he be placed under long-term, intensified custody to prevent him from committing violence and injuring others." ("`Caged Man' Set Free," Yangcheng Wanbao, March 29, 1998; also in BBC Summary of World Broadcasts, April 13, 1998.)

¹¹² Recent data, however, show that the condition was rarely if ever diagnosed in China until fairly recently. According to one local study published in 1998, no cases were recorded during the 1980s, but during the 1990s the condition was said to have accounted for 9.2 percent of all cases of forensic psychiatric examination (Zheng Chengshou et al., "80 Niandai yu 90 Niandai Sifa Jingshenbingxue Jianding Anli de Duizhao Yanjiu [A Comparative Study on the Case Expertise of Forensic Psychiatrics Between the 1980s and 1990s]," Zhonghua Jingshenke Zazhi [Chinese Journal of Psychiatry], no.4 [1998], pp.228-230).

¹¹³ One such case from the Cultural Revolution is described at length in Shen Yucun, ed., Jingshenbingxue, pp.1106-1107. See also Jia Yicheng, Shiyong Sifa Jingshenbingxue, p.513. This particular condition is referred to in Chinese psychiatry as either "delusion-like fantasy syndrome" (lei wangxiangxing huanxiang zheng) or "reactive confabulatory syndrome" (fanyingxing xugou zheng); the latter diagnosis may be clinically related to a condition known elsewhere as "Korsakoff's syndrome."

¹¹⁴ "Joint Directive of the Supreme People's Court, Supreme People's Procuratorate and Ministry of Public Security Concerning the Clearing Out of Aged, Weak, Sick and Disabled or Mentally Ill Prisoners," April 16, 1979. All mentally ill (or otherwise infirm) prisoners serving sentences of death with a two-year suspension of execution (si-huan) were, however, specifically excluded from the scope of this official amnesty order. A sanitized version of the April 16, 1979, directive, omitting the statistical and other details cited above, appears in many PRC legal anthologies; the unexpurgated version referred to here can be found in Jiancha Gongzuo Shouce (A Handbook of Procuratorial Work), vol.1 (Kunming: Yunnan Sheng Renmin Jianchayuan, December 1980), pp.281-283. Grateful acknowledgement is due to Lalagy Pulvertaft for kindly providing the uncensored version of this document.

¹¹⁵ See, e.g., Lin Huai, ed., Jingshen Jibing Huanzhe Xingshi Zeren Nengli He Yiliao Jianhu Cuoshi (Capacity of Mental Illness Sufferers for Criminal Responsibility and Measures for Their Medical Guardianship), (Renmin Fayuan Chubanshe, 1996), p.67.

In December 1994, a new Prisons Law of the PRC (passed on December 29, 1994, at the 11^th Session of the Standing Committee of the 8^th National People's Congress) finally superseded the 1954 PRC Regulations on Reform Through Labor (see Laodong Gaizao Tiaoli, in Gong'an Fagui Huibian (1950-1979) [Beijing: Qunzhong chubanshe, 1980], pp. 397-409). Surprisingly, the current law entirely omits the previous "strict" prohibition on prisons accepting mentally ill offenders into penal custody; this move may perhaps be attributable to the authorities' decision several years earlier to set up the Ankang network of facilities specifically for this purpose, but it still merits further examination. According to Article 17 of the new law, "Prisons shall perform physical examinations on all prisoners turned over to them for punishment. If through physical examination either of the following conditions is found in a prisoner sentenced to life imprisonment or to fixed-term imprisonment, they may temporarily not admit the prisoner into prison custody: 1) A serious illness that requires release on bail for medical treatment; 2) pregnancy, or nursing of an infant." Besides omitting any mention of the previous prohibition on prisons accepting mentally ill offenders, Article 17 uses a much less emphatic phrase than before to describe the action to be taken in respect of the types of offenders who are still mentioned. Whereas now, prison authorities "may temporarily not admit the prisoner into prison custody", previously they had "to refuse to take into custody" not only the two categories of offender cited above but also any prisoner suffering from mental illness.

¹¹⁶ Chen Shouyi, in preface to Shen Zheng, Falü Jingshenbingxue, p. 9.

¹¹⁷ Zhong Xingsheng and Shi Yaqin, "A Preliminary Analysis of 210 Cases of Forensic Psychiatric Medical Assessment," Chinese Journal of Nervous and Mental Diseases, vol. 20, no.3 (1987), pp.139-141. As Veronica Pearson has commented, regarding this report from 1987, "There is no discussion of whether this is an absolute drop in numbers due to a decrease in that kind of crime, or whether the officials of the Public Security Bureau now only take notice of such behavior if it is very extreme" (Pearson, "Law, Rights and Psychiatry in the People's Republic of China," p.413).

¹¹⁸ For a detailed discussion of the statistical size and extent of the political psychiatry problem in China since 1980, see Section VII., "Official Statistics on Political Psychiatry," below.

¹¹⁹ See Semyon Gluzman, On Soviet Totalitarian Psychiatry, p.33-35.

¹²⁰ "First of all, every instance of unjustifiable exculpation indicates only professional incompetence and the responsibility of a particular psychiatrist does not reveal an institutional phenomenon. Secondly, it is difficult to collect such information and therefore the proof cannot be complete. The many difficulties in obtaining all legal psychiatric documentation for an objective study make this approach very difficult" (Ibid., p.34).

¹²¹ That is to say, significant numbers of Soviet dissidents and others still managed, despite the politically repressive environment, to collect substantial numbers of individual case details on people placed in mental asylums on account of their political or religious views, and to transmit these to international human rights groups and the foreign news media. This has only recently begun to happen in China's case.

¹²² Gluzman's misgivings about the effectiveness of the method seemingly relate more to the subsequent, "post-mortem" phase of investigations into the Soviet case.

¹²³ At present, the general signs in this area are far from being good: in recent years, despite the continuing economic reforms, the Chinese security authorities have redoubled their efforts to suppress all forms of perceived political or religious dissonance in society; and notwithstanding China's current participation in bilateral "human rights dialogue" sessions with Western countries and the European Union, Beijing continues to view human rights issues in general as representing a major "battle front" in its relations with the West.

¹²⁴ Zhonghua Jingshenke Zazhi and Zhongguo Shenjing Jingshen Jibing Zazhi (formerly known as Zhongguo Shenjing Jingshenke Zazhi; for purposes of consistency, the latter two titles are both referred to in the present article by the journal's current English name, the Chinese Journal of Nervous and Mental Diseases). Each journal appears four times a year.