Law and Psychiatry Prior to 1949
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.
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.
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
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:
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.
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
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:
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
- 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:
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:
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
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
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:
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,
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,
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 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.
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,
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.
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:
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.
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:
Gluzman's other proposed methodology was as follows:
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.
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) 3rd 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,
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).
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 , 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 , 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:
100 The Encyclopedia Britannica provides the following summary of this incident:
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 , 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:
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 , 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.
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.