In the former Soviet Union during the Khrushchev-Brezhnev era, the KGB used its forensic psychiatric institutions to brand, arbitrarily and for political reasons, large numbers of political dissidents as suffering from "schizophrenia" and "paranoid psychosis" and then incarcerated them for long periods in "special psychiatric hospitals." In 1976, the Soviet Union was severely censured on this account by psychiatrists from all over the world at a conference in Hawaii of the World Psychiatric Association. Only after Gorbachev's rise to power were these errors rectified. We have now discovered that similar practices have also occurred in certain parts of China."1
In January 2001, the first detailed study of the political misuse of psychiatry in the People's Republic of China as a means of silencing peaceful political dissidents and others appeared in a U.S. law review.2 The subject quickly attracted wide international attention, prompting a strong public denial by the Chinese Ministry of Foreign Affairs.3 It also led to the formation of a growing advocacy campaign in several countries to pressure the Chinese medical and legal authorities to investigate and put a stop to these ethically wrong practices.
This report seeks to advance the current debate within the world psychiatric and human rights communities, bringing the issue of politically abusive psychiatry in China to a much wider audience. It provides important new documentary evidence showing that such abuses were more common in China during the Cultural Revolution (1966-76) and the subsequent decade than in the former Soviet Union or any other country where similar phenomena have occurred in the past, and that, moreover, official psychiatric theory in China continues to condone and encourage such practices in the twenty-first century. To set these recently uncovered documents in their proper historical and analytical context, we also reproduce here the full text of the Columbia Journal of Asian Law article that launched this latest round in the longstanding controversy over China's abusive human rights record in general.
As if to emphasize the continuing seriousness of the political-psychiatric abuse problem, the Chinese authorities since mid-1999 have forcibly sent detained Falun Gong activists to mental asylums throughout the country; as of March 2002, Falun Gong sources reported that more than three hundred of their members had been subjected to this treatment and three had died as a direct consequence; no independent verification of these figures has been possible. The authorities' current attempt to partially "psychiatrize" the Falun Gong question by claiming that the group's spiritual doctrines and practices drive its members insane represents only the most recent phase in a now well-documented history of political psychiatric abuse in China stretching back almost half a century.4
Since the earliest years of the People's Republic, political dissidents, religious nonconformists, "whistle-blowers," and other dissenting citizens have consistently been viewed by the Communist Party of China as posing a major political threat to society. Even in today's economically more open China such people continue to be arrested and imprisoned as enemies of the state. (Until 1997, the criminal charge of choice was "counterrevolution," while nowadays the less political-sounding charge of "endangering state security" is most often applied.)5
The official psychiatric literature in China unequivocally records that in many cases since the late 1950s, however, detained dissidents, non-conformists, "whistle-blowers," and other dissenters have additionally been subjected to forensic psychiatric evaluation by the legal authorities, found to be criminally insane and then forcibly committed to various types of psychiatric institutions.6 In essence, the question placed before psychiatric examiners by the police in all these cases has been: are the detainees "bad," "mad" or (in certain borderline cases) a combination of both? Freedom - pursuant to a finding that the forensic examinee is sane and also innocent - is rarely an option for those concerned, since even today the acquittal rate for people accused of political crimes in China is virtually nil; and if found non-prosecutable or not guilty by reason of insanity, they are in most cases sent for long-term custodial care. In the authorities' view socially dangerous acts have "objectively" been committed, and so society must be protected from any further such threat.
As the documents presented below indicate, China's official psychiatric literature records clearly that the Communist Party's notion of "political dangerousness" was long ago institutionally grafted on to the diagnostic armory of Chinese psychiatry and incorporated into the key concept of psychiatric dangerousness.
It is important to stress that we adopt, in this report, an agnostic position on the question of whether some or perhaps even many of the victims of China's "political-psychiatric dangerousness" policy are in reality suffering from some form of mental illness or impairment. The truth of this matter can be established conclusively only by the Chinese government agreeing to allow qualified outside observers full access to places of psychiatric detention, so that their alleged mentally-ill political, religious and labor activist inmates can be given an independent medical evaluation. It is entirely possible that at least some of those concerned will prove to be suffering, or to have suffered in the past, from conditions ranging from minor personality quirks or abnormalities all the way through to full-blown mental illness.
The bottom line, however, is that most of these people should not have been arrested or brought for forensic psychiatric evaluation (formal or otherwise) in the first place, since in the overwhelming majority of recorded cases their only "offense" was to have expressed views or beliefs which served to offend the political sensitivities of the Chinese Communist Party. Any of them who are indeed mentally ill should be offered suitable medical care and treatment, on an outpatient or in-patient basis as appropriate. Involuntary confinement in mental hospitals (whether civilian or police-run) should be contemplated only in the case of those meeting the internationally agreed minimum criteria for mentally ill persons who pose a direct danger to themselves or others. The Chinese authorities' frequent imposition of this extreme measure on individuals (mentally normal or otherwise) whom they regard as posing only a "political threat" to society stands in clear and direct violation both of the World Psychiatric Association's 1996 Declaration of Madrid and of the U.N.'s 1991 Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care.7
The real cause of politically abusive psychiatry in China today is to be found in the more intractable problem of the Chinese authorities' longstanding insistence upon viewing the peaceful expression of dissident or nonconformist viewpoints as constituting "political crimes" that must be sternly punished by law. Until this fundamental impediment to the observance of internationally recognized human rights in China can be removed, a small but significant proportion of those arrested on such charges will no doubt continue to be diagnosed as having committed their "heinous offenses" as a result of mental illness rather than from any politically "hostile" intent. Any genuinely mentally disturbed dissidents and religious believers - and also any non-dissident individuals who happen to express their mental disturbances in the form of politically-colored thought, speech and action - should be given the benefit of humane and appropriate medical care in a non-forensic, regular psychiatric care setting. Many Chinese psychiatrists now publicly acknowledge that most of those in the latter categories (a quixotic but seemingly quite large group that might best be described as "pseudo-counterrevolutionaries") became mentally disturbed or were driven insane as a direct result of the incessantly persecutory political campaigns of China's recent past. For the legal and medical authorities to treat such people also as being "dangerously mentally ill criminals" is an affront to human dignity.
Analysis of New Documentary Evidence
The previously known evidence of political misuse of psychiatry in China is set forth in extensive detail in the first main item of this report: the article titled "Judicial Psychiatry and its Political Abuses in China." The remainder of the report consists of hitherto unknown material shedding important new light on two key aspects of the psychiatric abuse problem in China: first, its origins and development during the Cultural Revolution decade, and second, how China's law-enforcement and psychiatric establishments have continued to pursue similarly abusive policies (albeit on a substantially reduced scale) against political dissidents and others during the post-Mao reform era and right up to the present day.
The first two documents appearing in the Appendices date from April 1966 - the eve of the Cultural Revolution - and provide a tantalizing glimpse of the tectonic upheaval that was about to hit the Chinese psychiatric profession and whose dire effects were to last for the ensuing decade and more. As Document 1, an editorial from the Chinese Journal of Neurology and Psychiatry, notes, "Many problems still exist in our work, foremost among them being that some psychiatric workers are still quite heavily influenced and affected by bourgeois medical ideology...[However,] an ardent high tide in the universal study of Chairman Mao's works has been unleashed, allowing us to raise our level of ideological awareness, to give full prominence to politics, and to criticize and condemn the bourgeois ideological preference for working in isolation from politics, the masses and reality."
Document 2, an article from the same journal, written by staff at a Gansu Province mental hospital, elaborates on this theme, stating: "In the course of the 1957 Anti-Rightist Movement and the struggle to annihilate capitalism and assert the proletarian worldview,8 the level of ideological awareness among our medical personnel rose greatly and we made initial progress in critiquing the bourgeois viewpoint that `mental illness is protracted and incurable' and so nothing much can be done about it."
Intriguingly, in common with much of the reforming zeal that arose in other walks of life during the opening months of the Cultural Revolution, Chinese psychiatry appears at this time to have addressed certain real and pressing problems in the care of the mentally ill - in particular, the over-reliance on medication and institutional confinement that was also found in most other parts of the world at that time - and moreover, to have done so in a way that might, if political circumstances had been more favorable, have turned out rather differently. For the first time in China, for example, the non-biological approach of "psychotherapy" (xinli zhiliao) began to be used as an alternative therapy within the mental healthcare system. As this document and others show, however, the form of psychotherapy actually used from early 1996 onwards consisted of increasingly intense political indoctrination sessions in which mental patients were exhorted to cure themselves by studying the works of Mao and adopting a "proletarian" political outlook:
[T]he everyday atmosphere in the sick wards is increasingly brisk, lively and dynamic. One mental patient, for example, wrote to us after being discharged from hospital: "My stay in hospital this time was just like being in a political study school - you cured both my physical illness and also my ideological sickness. I want to thank the Party for all the warmth and concern it has shown me.9
Documents 3-7, taken from a "restricted circulation" medical journal published in China between 1972 and 1978, chart in vivid and painful detail the practical outcome of the quickly thwarted moves to reform Chinese psychiatry in the direction of a more patient-centered approach. They take the form of a crucial debate among several leading Chinese psychiatrists on the question of what constituted the "essential nature of mental illness." By the late 1960s, Mao's insistence upon the Promethean role and virtue of human will and subjective political ideology attained its apotheosis in a corollary belief, on his part, that incorrect thinking or mentality was therefore tantamount to a crime against the revolution. This punitive doctrine pervaded all walks of life in China during the Cultural Revolution, but it found especially fertile soil for development within the field of Chinese psychiatry. In the Chinese language, fortuitously or not, the words for "ideology" and "mentality" are one and the same (sixiang.) The outcome of all this was that individual mental problems soon came to be seen, in simplistic and reductionist fashion by the ultra-Maoists, as being not merely reflective of, but actually caused by, incorrect or deviant political thinking on the part of the sufferer. Three short extracts from the 1972-78 debate, the conclusion of which marked a fundamental return by the mainstream of Chinese psychiatry toward more internationally accepted standards of psychiatric diagnosis and ethics, should suffice to illustrate its overall contours.
First, let us see the viewpoint that prevailed throughout most of the 1970s. Document 3 - "Analysis of a Survey of 250 Cases of Mental Illness" - was published in August 1972 and presented the "model findings" of a wide-ranging psychiatric study carried out by a group of ultra-Maoist civilian and military psychiatrists some months earlier.
Under the socialist system, a clash will inevitably develop between the concept "public" and [certain people's] preoccupation with the concept "private," engendering a contradiction within their minds between these two things. And unless this contradiction can be correctly resolved, the ideological struggle within their minds will intensify and may produce partial imbalances in the functioning of their cerebral cortexes; so people like this can very easily develop mental illnesses... The reason why most patients become mentally ill is connected to the class struggle, and the fundamental causal factor in the majority of cases is that they still retain a bourgeois worldview and methodology...
Some five years later, Jia Rubao, a psychiatrist from Shaanxi Province and one of those who had participated in the original "250 cases" survey, further elaborated (in Document 6) on the highly influential psychiatric theory that had emerged from that study:
The process goes exactly like this: under the socialist system, it is impossible for these people to satisfy their selfish desires and so the "boil" cannot be lanced; at first, the normal thoughts and the pathological thoughts coexist side by side, but as the pathological thoughts steadily gain the ascendant in their minds, they begin to sing, dance and run around aimlessly, tearing off their clothes and going around naked, and sometimes injuring or killing people - that is, they become mentally ill. We see, therefore, that bourgeois worldview and methodology are the fundamental causal factors in the emergence of mental illness; indeed this is the essential nature of mental illness.
Some people will ask the question: in capitalist society, then, is mental illness more commonly found among the bourgeois class? Yes, there are certainly more mentally ill people from this class background than elsewhere... [However,] if we use class education and political-line education to profoundly re-educate the mentally ill in the proletarian worldview...and raise their awareness of the class struggle, the struggle over political line and the need to continue the revolution under the dictatorship of the proletariat...and dig out the roots of mental illness by overthrowing the concept of private ownership and implanting the principle of public ownership...then the overwhelming majority (90 percent) of mentally ill people can be completely cured.
The following intervention (Document 7) by a psychiatrist who was himself persecuted during the Cultural Revolution and who is now one of the most respected and influential psychiatrists in China, was made on the eve of Deng Xiaoping's return to national power, at a time when scholars in all fields had begun to receive license from the Communist Party to fundamentally rethink the future policy contours of post-Mao China.
Yang Desen, Hunan Medical College, August 1978:
After the founding of New China, the Party and the People's Government made great efforts to improve the health of the population... [However,] after Lin Biao and, especially, the Gang of Four10 started to peddle their reactionary political line - a line that was "left" in form but right in essence - the country was plunged into deep disaster. Every aspect of official life in China suffered the noxious consequences of their doctrines, and the damage wrought in the field of psychiatry was certainly no less serious and profound than elsewhere... As a result of all this, in the worst-hit mental hospitals, recovery rates and sickbed rotation rates began to decline and medical staff became so demoralized that they left psychiatry altogether.
Eventually, [the ultraleftists] began claiming that the real reason people became mentally ill was that their heads were filled with an "excess of selfish ideas and personal concerns" and that it was the product of "an extreme development of individualism." Simplistic techniques of ideological re-education then became the principal form of treatment and cure for mental illness in China. Mentally ill people were made to undergo re-education at the hands of the medical staff and ordered to dig out, from within their own minds, the "ideological roots" of their illnesses. In some mental hospitals, patients who uttered [politically] banned thoughts or engaged in banned forms of behavior because of their illnesses were held criminally responsible, and even their families were wrongfully implicated. This conception of mental illness as being an ideological sickness and a disease of the bourgeoisie, the belief that it is a product of the capitalist social system, holds in lofty disdain the sufferings of countless numbers of working-class mentally ill people and has served to consign psychiatry to the distant margins of public health work in our country. Is it not now incumbent upon us, therefore, to expose and criticize to the fullest extent possible all these absurd theories and pernicious policies of the Gang of Four, these perversions of medicine that have inflicted such harm and damage upon the mentally ill and upon the great majority of those working in our profession?
Two years earlier, in August 1976, one month before the death of Mao and at the height of the power of the "Gang of Four," Yang had expressed broadly similar views, albeit in a less adamant and forthright manner.11 (See Document 5.) It would be hard to overstate the degree of personal bravery he showed at that time in frontally challenging the Cultural Revolution orthodoxy whereby all mental illness was said to be caused by politically deviant thinking on the part of the sufferer. As the full exchange of views between Professor Yang and his ultra-Maoist colleagues eloquently shows, the depth and extent of the politicization of Chinese psychiatry that occurred during the Cultural Revolution decade went well beyond anything of a similar nature found in the former Soviet Union. According to one of China's leading forensic psychiatrists, for example,
Political cases...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.12
In other words, the numbers of detained political activists sent to institutes for the criminally insane during the Cultural Revolution far exceeded the combined total of psychotic murderers, rapists, arsonists and other violently mentally ill offenders dealt with under China's forensic psychiatric system at that time. And as further official testimony provided below shows, many genuinely mentally ill people were sent to prison or shot as "counterrevolutionaries" in the course of Mao's "revolution to touch men's souls." Any attempt to defend Chinese psychiatry against the current allegations of political abuse on the basis of the acknowledged fact that some psychiatrists were themselves persecuted for upholding ethical standards during the Cultural Revolution must also, unavoidably, take on board the equally significant fact that other psychiatrists were, for whatever reason, active participants in the wholesale ethical abuses of that period.
Over the past two decades, mainly as a result of the courageous stance taken by Yang Desen and other veteran Chinese psychiatrists around the time of Mao's death, the Chinese psychiatric profession has steadily evolved to the point where, nowadays, its theory and practice is in general based on internationally accepted diagnostic and ethical standards. The recent decision of the Chinese Psychiatric Association to remove homosexuality from the country's list of officially recognized mental disorders provides a clear illustration of this trend.13
Where Chinese forensic psychiatry was concerned, however, the deeper conceptual and institutional roots of the late-Maoist psychiatric orthodoxy that equated mental illness with political deviancy survived substantially intact. At best, it underwent what can be termed a "nuanced reversal": Whereas, during the Cultural Revolution decade, more or less all mentally ill people were seen as being that way because of their "bourgeois ideological defects", from the late 1970s onwards the view became that some people who displayed these same ideological defects (namely a subgroup of political and religious dissidents) held the offending views in question because they were mentally ill.
This revised theory, entailing a return to the classic "hyperdiagnosis" (or politically-inspired overdiagnosis of mental illness) model found in Soviet psychiatry, persisted in China during the 1980s and then steadily declined in influence during most of the 1990s, in line with the sharp fall in the numbers of "counterrevolutionary offenders" arrested in China at that time. But the basic doctrine remained intact within the forensic branch of Chinese psychiatry, and since the start of the campaign against Falun Gong in mid-1999, it has been pressed back into widespread service by the Chinese police and their forensic psychiatrist colleagues. (We shall consider the Falun Gong caseload in more detail shortly.)
Document 8 is the most detailed retrospective survey so far published in China on the question of the nature and main targets of forensic psychiatric appraisals work carried out across the country from the 1950s to the late 1980s. According to its author, Jia Yicheng, who is currently China's senior authority on such matters, the average incidence of "political cases" dealt with under the system throughout this four-decade period was more than 20 percent of the total criminal psychiatric caseload. Jia's commentary on this state of affairs also provides a useful summary of the broader historical trend:
As can be seen from the statistical data provided in the twelve articles [under study], altogether 1,621 (or 21.05 percent) of the 7,699 criminal cases under examination involved reactionary or counterrevolutionary speech or action (fandong huo fan'geming yan-xing), placing this category in a high second position [after murder: 23.03 percent] on the overall statistical list of dangerous behaviors. However, when viewed from a periodic perspective, a very clear distinction emerges. Six of the articles contained statistical data on appraisals carried out during the post-Cultural Revolution period of 1981-86, and among the 2,019 criminal defendants who were appraised during this period, only 59 (or 3.12 percent) had engaged in counterrevolutionary speech or action. The other six articles contained statistical data from the period beginning in the 1950s and ending in 1976, and among the 5,680 criminal defendants appraised during this period, the relevant figure was 1,562 persons, or as much as 27.5 percent. This was clearly a product of the Cultural Revolution period and of the ultraleftist ideological trend that preceded it.
As the statement by Jia Yicheng presented at the beginning of this report vividly shows, he was acknowledging by 1998 that these cases were of a "similar" politically abusive nature as those that used to occur in the Soviet Union. It is important to note, however, that Jia's figure of 3.12 percent for "political cases" during the early to mid-1980s was substantially lower than the average incidence of such cases (10-15 percent) found in numerous local forensic psychiatric studies carried out during the 1980s as a whole by other researchers. And crucially, it was only with the sharp percentage reduction in such cases that occurred in the early 1990s, to a level of between 1 and several percent, that China's level of political psychiatric abuse began, finally, to fall to approximately the same level as that found at the height of similar phenomena in the Soviet Union during the 1960s and 1970s. Hitherto, China's incidence rates for "political cases" appear to have been much higher than those found under Soviet psychiatry. Equally important, moreover, with the current psychiatric detention of Falun Gong protestors, the incidence curve in China has again started to move upwards.
In Document 9, an article published in a Shanghai psychiatric journal in 1996, we are given a rare glimpse into the workings of China's police-run network of institutes for the criminally insane, the so-called Ankang hospitals, which were first set up in 1987 and of which there are so far twenty around the country. According to the authors, who worked at the Hangzhou city facility, "Ankang hospitals...are meant to be specialized hospitals that serve the goals of public order by taking in and treating mentally ill people who create disastrous incidents of various kinds. As the Ministry of Public Security calculated in 1993, there are approximately 12 million severely mentally ill people in China, more than 1.3 million of whom pose a serious danger to public order; it is therefore essential that every province in China should establish its own Ankang hospital." As other documents discussed in the Columbia Journal article presented below show, alleged mentally ill political dissidents figure prominently on the authorities' target list of those who "create disastrous incidents" and who must therefore, for the protection of society, be incarcerated in Ankang facilities. The article as a whole paints a depressing picture of conditions within the Ankang hospital system as of early 1996: a very high patient-to-doctor and nurse ratio, severe underfunding by the government, and serious lack of capacity leading to a dense overcrowding of inmates. This scenario would be broadly familiar to those working in high-security institutes for the criminally insane in most countries, but in China's case it serves to dramatize the plight of the peaceful and non-violent dissidents and religious nonconformists who end up being confined in such conditions alongside genuinely dangerous psychotic offenders.
The official psychiatric literature is also quite specific in noting that persons arrested for dissident activities who are then found non-prosecutable or not guilty by reason of insanity are, in most cases, sent for involuntary and indefinite psychiatric committal - either in an Ankang hospital or (in the many areas of China which do not yet have this kind of specialized police-run facility) the closed wards of general mental hospitals. For example, according to Document 10 - "An Analysis of Forty-One Mentally Ill People Involved in Cases of a Political Nature,"
Instances whereby mental illness sufferers, owing to the severe weakening or outright loss of their powers of recognition and control, become involved in cases of a political nature are by no means rare. After committing these crimes, once ascertained in the course of forensic-psychiatric evaluation as being not legally responsible for their actions, the majority of such people are sent to Ankang hospitals. During the period 1978-89, the Hangzhou Ankang hospital admitted 41 patients of this kind, accounting for 7.8 percent of all admissions. The largest numbers were admitted in 1978 and 1989, when they accounted for 17.1 percent and 14.6 percent of total admissions respectively - markedly higher than in other years...
As the authors of this article themselves obliquely indicate, the reason why so many "political case" admissions took place in 1978 and 1989 was that the former was the year of the Democracy Wall movement (the first phase of China's modern dissident/human rights movement) and the latter was the year of the Tiananmen Square pro-democracy movement. The article continued,
According to reports in the Chinese literature, the proportion of mentally ill persons subjected to expert judicial appraisal who have committed political offenses is between 15.7 percent and 20.5 percent; this is second only to cases of murder and injury, although there has been a marked decrease in such cases since the 1980s. The majority of those in the case group had schizophrenia, but unlike the situation in other kinds of criminal cases, they were all suffering from the paranoid variety. This shows that paranoid schizophrenics tend to commit "anti-government" activities much more readily than those suffering from other variants of the disease, probably as a result of their delusions of persecution, relational delusions, and delusions of grandeur, as well as their impaired thought processes.
Literally dozens of similarly specific references to "political case" percentages among forensic psychiatric sample groups in China appear throughout the professional literature. Virtually all of the leading specialist authorities in the field have written about it at length over the past twenty years. As we also learn in Document 10, the most frequent diagnosis made by police psychiatrists in this context is of either "schizophrenia" or "paranoid psychosis" leading to the following kinds of "crimes" by the alleged sufferers: "sending reactionary letters," "writing reactionary slogans," "petitioning and litigating," "shouting reactionary slogans" and "spreading rumors to delude the masses." And as the authors conclude, "Cases of political crime created by the mentally ill usually exert a highly negative influence in society and have extensive ramifications. They take up large amounts of human and material [police] resources and pose a definite disruptive threat to the normal functioning of state offices and to the political stability of the country."
Document 11, a chapter taken from a major two-volume study on mental illness and crime published in August 2000 and written by a law researcher at the Chinese Academy of Social Sciences, represents the current "state of the art" thinking within Chinese forensic psychiatry on the question of "political crimes" committed by alleged mentally ill dissidents. Titled "On Negative Political Speech and Action," the chapter begins by stating,
Acts that endanger the nation and threaten the social system can, when severe in nature, constitute crimes. Offenses of this type are customarily referred to as political crimes... Mentally ill people, owing to the pathological factors that beset them, may also engage in behavior that endangers the state and the social system, and the most commonly seen forms of such behavior are the writing of banners, distributing leaflets and flyers, sending letters, making speeches, and shouting out slogans... [However,] to describe [this] as "counterrevolutionary behavior" or as "behavior that endangers state security" would obviously [since those concerned are mentally ill] be "inappropriate." To call it "reactionary behavior" would also not be good, since the term "reactionary" has excessively vague connotations. In the end, this writer has decided to use the term "negative political speech and action" [to denote such behavior.]
So far so good: the author appears to be making an effort to "downgrade" the seriousness of the political offenses committed by dissidents in cases where they are perceived by the authorities to be suffering from mental illness. However, while he brings to his topic a degree of analytical sophistication going well beyond that found in most other Chinese forensic-psychiatric discussions of this question, he remains severely hampered in this endeavor by the awkward fact that all the dissident activities in question are still held under China's criminal law to constitute the most serious possible forms of crime. Hence, his adoption of the slightly more liberal and user-friendly rubric of "negative political speech and action" in place of the formerly prevalent terms "reactionary" and "counterrevolutionary" to denote such activities turns out to have no practical legal consequences for the detainees concerned: they must still be sent either to institutes for the criminally insane or to locked wards in general psychiatric hospitals.
One of the more interesting aspects of Document 11 is the author's discussion of the seemingly large subgroup of such "offenders" whom we earlier called the "pseudo-counterrevolutionaries": people who were driven insane by China's past campaigns of political persecution and whose psychiatric symptoms have taken the form of "reactionary" or "counterrevolutionary" thoughts, speech and behavior. (Since the late 1950s, according to the official psychiatric literature, these symptoms have consisted primarily of political "ravings" against Mao, the Cultural Revolution and the current Chinese leadership.) There is, nonetheless, a strongly oxymoronic quality to his account of this topic.
For example, if those who become mentally abnormal as a result of suffering political persecution then develop delusions of persecution, the content of these delusions may have a negative political coloration, and such people may therefore develop hostile feelings toward the political environment. However, the fact that such a history existed before the mental illness arose by no means implies that the negative political speech and action expressed by the mentally ill person concerned is necessarily rational in nature. For sufferers of this kind, the influence of the pre-illness history occurs at the unconscious level.
In other words, even though "sufferers" of this type were in fact the targets of severe political persecution in the past, their resultant long-term feelings of persecution are still, in the author's view, to be attributed to mental illness ("unconscious delusions" against the Party) rather than to any rational or accurate subjective construal of their past traumatic experiences. Any hapless bona fide dissident who had encountered previous episodes of official persecution on ideological grounds would be hard-pressed indeed to argue that he or she was not, contrary to the official perception, "pathologically deluded" in the present. Considerable caution is therefore called for when evaluating even this subgroup of what the authorities colloquially term "political lunacy" (zhengzhi fengzi) cases in China today.
As the author of Document 11 further explains,
Among the various categories of delusion, the ones that most readily give rise to negative political speech and action are delusions of persecution and delusions of grandeur. If the identity of the persecutor that is fabricated [in the mind of the detainee] by virtue of the delusions of persecution happens to be either the ruling political party, the state institutions, or individual members of the leadership, then inevitably the sufferer will develop feelings of hostility and over-vigilance toward the ruling political party, the state institutions or individual leaders, and they may then start "exposing," "denouncing" and "condemning" the latter's various "conspiracies" and "crimes." In general, the targets of these delusions of persecution are limited to certain specific individuals, but in some cases the scope of hostility may become constantly amplified in the sufferer's mind, progressing from one individual to a number of different people, and then onward to include a whole organization, the government, or even the whole of society.
Forensic psychiatrists in most developed countries are familiar with a specific subcategory of violent criminal offenders who commit their crimes because they suffer from systematic paranoid delusions broadly related to politics: they may believe, for example, that the Queen of England or the President of the United States is trying to persecute and punish them, or (most commonly in the case of schizophrenics) that they have had electronic bugging devices implanted in their brains by the security services; they then feel compelled to fight back, sometimes in a violent and indiscriminate manner.
The crucial distinction in China's case, however, is that in the great majority of officially reported cases no internationally recognized criminal offense has taken place, and the alleged mentally ill detainees in question are found criminally insane solely on account of their peacefully expressed "anti-government" thoughts and viewpoints. Again, if genuinely mentally ill, such people should in all cases be afforded humane and appropriate medical care in a non-coercive psychiatric setting. They should not be incarcerated in high-security mental institutions simply because their political or religious views happened to upset the Chinese Communist Party. Finally, the author poignantly cites yet another subcategory of this type: "In the case of those suffering from depressive illness who engage in negative political speech and action, sometimes their aim in doing so is to commit an indirect form of suicide (self-punishment.)" This formulation speaks volumes as to the wider state of freedom of political thought and expression in China today.
These two documents shed important light on the situation of detained Falun Gong practitioners who have been forcibly confined to mental institutions since the start of the government's crackdown against this unorthodox traditional spiritual sect in July 1999. The first document discusses the mental condition, first discovered by Chinese psychiatrists in the early 1980s and later (in 1989) incorporated as a "culture bound disorder" into the Chinese Classification of Mental Disorders, known as "qigong-induced or qigong-related mental disorder." Qigong is a traditional Chinese form of mind-body exercises that shares certain features of yoga, meditation and other non-Western self-cultivation practices; according to Chinese psychiatry, if practiced improperly or too intensively, it can produce, alongside its many acknowledged benefits, a series of mental imbalances ranging from minor cognitive disorders to occasionally more serious, psychosis-like conditions. Since all Falun Gong followers practice a variant form of qigong, it was previously believed that this particular diagnosis served as the Chinese authorities' main medical justification for psychiatrically detaining large numbers of Falun Gong activists. A number of Western commentators have even argued that no unethical misuse of psychiatry or other human rights abuse has been involved in these cases because those concerned probably were suffering from qigong-related mental disorders.14
In fact, psychiatric studies published in China over the past year or so have contradicted this assumption by stating that the diagnosis of qigong-related mental illness is not to be used in the case of Falun Gong detainees, since (according to Document 13), "Falun Gong is entirely different from ordinary body cultivation techniques, and no clear definition of the type of mental disorder that it produces can be found within China's currently used body of diagnostic criteria for mental illness." Instead, the entirely new diagnostic label of "evil cult-induced mental disorder" (xiejiao suo zhi jingshen zhang'ai) has now been coined by Chinese psychiatry, for exclusive use against the Falun Gong and any other unorthodox spiritual movements in China that happen to have been banned by the Communist Party and government.
In effect, the legal authorities' post-Mao formulation that "some dissidents commit political crimes because they are mentally ill" has now been supplemented by the issuance of a Chinese government "health warning" to the public: "Spiritual or religious beliefs banned on political grounds can drive people mad." The close similarity between this and the Cultural Revolution doctrine that mental illness is caused by politically deviant thinking should be readily apparent.
Four specific cases are presented in Document 13 - "A First Look at the Forensic Psychiatric Evaluation of Falun Gong Cases" - and each illuminates in different ways the politically persecutory essence of this new forensic diagnosis. Since the Falun Gong caseload represents the most recent and conspicuously serious phase in China's decades-long history of the misuse of psychiatry as a tool of political repression, and since so much controversy currently surrounds this particular group of detainees, it is well worth examining these four cases in some detail.
The first case discussed concerns a 45-year-old woman who (according to the two psychiatrists who wrote the article) "went to Beijing to petition the authorities and was then placed under criminal detention, but still she persisted in practicing Falun Gong." In other words, the reason for her arrest was not that her mental condition had posed any immediate physical or psychological danger to herself or to anyone else, but rather that she had been brave or foolhardy enough to openly express her peaceful opposition to the government's relentless campaign of suppression. The forensic examiners' conclusion was: "Mental disorder caused by practicing an evil cult; no capacity to bear legal responsibility [for her crimes]; recommend medical treatment." The mental symptoms cited by the examiners to justify this conclusion consisted almost entirely of a list of the patient's Falun Gong-inspired spiritual beliefs. (While some of these admittedly would strike a Western observer as being highly unusual, it is surely not the job of psychiatrists to pass judgment on their patients' spiritual or religious convictions.) The remaining "symptoms" cited by the forensic examiners included: "flagrantly telling everyone how much she was benefiting from her practice of Falun Gong" and "refusing to be dissuaded from her beliefs and continuing to gather people to practice Falun Gong...even after the government declared it to be an evil cult."
The second case concerns a 62-year-old man who, after suffering from insomnia for a long time, took up Falun Gong in 1995. According to the forensic case report,
He soon became solitary and untalkative, and he began giving people valuable presents for no reason. He always ate less than other people and would buy the cheapest of foods, to the point even of buying and taking home items that others had turned down. He said that [this was because] he wanted to be a genuinely "truthful, compassionate and forbearing" person.15
There was nothing in the case account that would plausibly indicate that the detainee posed any psychiatrically related danger to himself, others or society. Again, the sole reason for this person's arrest was that, according to the forensic report, "After the government declared Falun Gong to be an evil cult, he not only ignored all efforts to dissuade him from continuing to practice Falun Gong, but also joined with other practitioners in traveling to Beijing to `uphold the dharma' on behalf of Falun Gong." It is clear from the final diagnosis - "mental disorder caused by practicing an evil cult; should bear partial legal responsibility for his crimes" - that the examining psychiatrists partially acknowledged that the "danger" he posed was basically unrelated to his alleged mental condition; however, the immediate consequence of the detainee's being found only "half mad" was that, in their view, he must face criminal trial for his non-violent beliefs.
Here we see the ethical dilemma faced by Chinese psychiatrists in all such cases: had they found, as international standards require, that the patient was basically quite sane, he would certainly have been sent to prison for his "crime" of peacefully demonstrating in Beijing. A finding of complete insanity would have been ethically absurd in this case, so they instead opted for the middle course. While we are not told about the final disposition of this case, being set free was certainly not an option: the detainee would either have received a reduced prison sentence or, perhaps more likely, have been sent for some form of custodial psychiatric care.16
The third case concerns a young male worker and Falun Gong practitioner who appears to have been genuinely mentally ill: said by the forensic examiners to have already been suffering from symptoms of schizophrenia prior to taking up Falun Gong, he claimed that he "could tell what was going on in people's minds without the use of any instruments of detection; and that his soul had been fully realized and he was able to maintain frequent contact with aliens from outer space." The examining psychiatrists' verdict was: "[S]chizophrenia; behavior and actions completely dominated by pathological factors, and hence no capacity to bear legal responsibility." From the case details supplied, this forensic conclusion seems to be an accurate and ethically appropriate one. But we still need to look further. Why was the person arrested? It was because, once again, he had gone to Beijing to petition peacefully against the crackdown on Falun Gong - "thereby exerting an extremely bad influence in society" - and not because his schizophrenic symptoms or behavior had posed any perceptible threat to public safety. Having been accused of this grave "national security" offense, the inevitable outcome of the forensic diagnosis was that he would be sent to a custodial facility for criminal offenders (either the locked ward of a regular mental hospital or an Ankang facility - most parts of China do not yet have the latter, which appears to be why most Falun Gong psychiatric detainees have ended up in the former).
Perhaps the greatest irony here is that, as most expert outside observers acknowledge, China's national psychiatric care system is so severely under-funded that the great majority of mentally ill people, even schizophrenia sufferers, currently receive no medical care, institutional or otherwise. The schizophrenic worker discussed above, in common with countless other Falun Gong practitioners suffering from other medical ailments for which they simply cannot afford to be treated under China's increasingly expensive government-run healthcare system, was recommended to join the Falun Gong because it claims dramatically to improve practitioners' health.17 Is it ethically appropriate that extremely scarce psychiatric resources should be allocated in such a way that a schizophrenic posing no evident threat to society, and who would otherwise probably have gone totally untreated, is sent by the police for custodial medical care of a kind which, according to all accounts so far provided by Falun Gong psychiatric detainees, amounts to an extrajudicial form of physical and psychological punishment?18
The final case illustrates yet another permutation of the whole sorry business. It concerns a 41-year-old female government official who began practicing Falun Gong in 1996 and then went on to become a leader and organizer of the movement in her area of residence. According to the forensic report issued after her arrest, "Consciousness clear and alert; thinking logical and well-ordered...apart from being emotionally over-excited, she showed no signs of hallucination, delusions or other conspicuous mental abnormalities. Forensic finding: not mentally ill; should be held legally responsible for her crimes." On the face of it, no ethical abuse was involved in this case because the examinee was found to be mentally normal and hence no psychiatric treatment was ordered. However, the key issue highlighted here concerns Chinese forensic examiners' attitude toward the question of a detainee's "legal responsibility" for peaceful dissident offenses. Had the psychiatrists involved in the examination of this and other similar cases simply confined their conclusions to the medical side of things, then the issue of psychiatric abuse would not have arisen and it would have been just another case of political persecution under the Chinese criminal justice system. But no, the examining psychiatrists first confirm that the only reason for the female Falun Gong practitioner being placed under police arrest was that, "rejecting all efforts to persuade and educate her away from the cult, she continued to organize groups of practitioners to carry out petitioning activities on its behalf." They then, in the medical diagnostic portion of their report, saw fit to make the wholly political comment and judgment: "she defended with extreme vigor the various advantages of practicing Falun Gong, and in so doing slandered and vilified [China's] present social realities." In other words, the psychiatrists appear to have felt under intense political pressure to endorse - enthusiastically and without reservation - the spurious criminal charge that had been laid against the detainee. Either that, or they did so freely and willingly.
As if to underscore this same point, the authors of this report on the four Falun Gong cases conclude by saying: "If we exercise comprehensive judgment, it is usually not difficult to make a diagnosis of evil cult-induced mental disorder. At the same time, [recently established criteria] will help us to identify and maintain our guard against any die-hard Falun Gong elements who might try to feign mental illness as a way of escaping legal punishment for their crimes." So there we have it: the examining psychiatrists evidently saw it as being one of their most pressing concerns to help weed out, on the government's behalf, any Falun Gong detainee who might deviously wish to pretend to be mad as a means of avoiding stern punishment for what, by international standards, was the entirely non-criminal act of belonging to an unorthodox spiritual group. It is in cases like this that one sees perhaps the most striking evidence of complicity and collaboration by Chinese psychiatrists in the Chinese government's continuing repression of peaceful political and religious belief.
A Call to the World Psychiatric Community
As the foregoing discussion has sought to explain, China's forensic psychiatrists unavoidably still find themselves, wherever political dissident cases or ones involving Falun Gong detainees and the like are concerned, at the ethically invidious intersection of modern medical principles and an unreconstructed criminal justice system whose overriding concern remains the arbitrary suppression of dissent. We do not yet know how many, or even what general proportion of, Chinese psychiatrists are directly involved in these ethically abusive practices, but it seems clear that they form a relatively small minority within the profession as a whole.19 Furthermore, it is possible that many of the Chinese psychiatrists who have written extensively on the topic of "political cases" dealt with in the forensic domain since the early 1980s have been motivated to do so by a desire to bring the existence of this still sizeable ethical problem to a wider domestic, and possibly also international, audience. If so, the absence of overt value judgments in most of their reports would mirror their need to protect themselves against charges of disloyalty to the Party.
From all of this, we can begin to discern the outlines of an appropriate response by the international psychiatric community to the problem of politically abusive psychiatry in China: on the one hand, to stand in firm solidarity with the ethically sound mainstream of the Chinese psychiatric profession, while recognizing that current political conditions in China make it largely impossible for psychiatrists there, individually or collectively, to speak out openly themselves against these abuses; and on the other hand, to work in a targeted manner, through the World Psychiatric Association and its national member associations, to put pressure upon the Chinese authorities to end the political misuse of psychiatry within the forensic evaluations domain, the Ankang police custodial network, and the relatively few corners of the general psychiatric system where it still persists.20
At their annual general meeting in July 2001, the members of the Royal College of Psychiatrists overwhelmingly passed the following resolution on the China question:21
Bearing in mind the available evidence that political dissidents in The People's Republic of China (PRC) are being systematically detained in psychiatric hospitals, we propose that the Royal College of Psychiatrists takes the following action:
1) to join with the World Psychiatric Association (WPA) to arrange a fact-finding visit to the PRC;
2) if this visit and other evidence confirm political abuse of psychiatry, to ask the WPA to reconsider the constituent membership of the Chinese Society of Psychiatrists;
3) to work with the WPA to provide support for those Chinese psychiatrists who are committed to ethical and evidence-based practice.
It should be stressed that, under the terms of the WPA's 1996 Madrid Declaration, the need to reconsider China's constituent membership of the WPA would follow automatically from any finding of systematic political abuse of psychiatry in China, so the inclusion of point 2), above, in no way served to prejudge the issue. Rather, the attention of the world psychiatric community should presently be focused on the other two proposals: that a WPA-led fact-finding mission be undertaken to establish the veracity or otherwise of the allegations, and that meanwhile the hand of professional friendship and support be extended to all Chinese psychiatrists not directly involved in the abuses concerned. This carefully worded resolution from the Royal College expresses, we believe, priorities that should now be weighed and acted upon by psychiatrists everywhere.
1 Jia Yicheng, "A Discussion of Certain Legal Issues Concerning the Hospitalization of the Mentally Ill," Shanghai Archives of Psychiatry, no.1 (1998), pp.6-10. (Two factual corrections should be made here: first, the Hawaii conference of the WPA took place in 1977, not 1976 as stated by Professor Jia; and second, the political misuse of psychiatry in the Soviet Union went well beyond the forensic psychiatric domain. In perhaps a majority of cases, political dissidents and others were committed to regular mental institutions without the involvement of the forensic authorities. For an explanation of the term "forensic psychiatry," see Note 6 below.)
2 Robin Munro, "Judicial Psychiatry in China and its Political Abuses," Columbia Journal of Asian Law, vol. 14, no.1 (2000), pp.1-128. (The journal cover date notwithstanding, the article itself was completed in November 2000, and the journal issue was published in January 2001.) See also Robin Munro, "Political Psychiatry in Post-Mao China and its Origins in the Cultural Revolution," Journal of the American Academy of Psychiatry and the Law, vol. 30, no.1 (2002), pp.97-106. The same issue of the AAPL Journal contains several other articles and commentaries on the China political psychiatry question (by Richard J. Bonnie, Robert van Voren, Jim Birley, Frederick Hickling, Alan Stone, Arthur Kleinman and Sing Lee, and Sunny Y. Lu and Viviana B. Galli).
3 See, for example, Erik Eckholm, "China's Crackdown on Sects Stirs Alarm Over Psychiatric Abuse: Rights Groups Cite Rise in Medical Detentions," New York Times, February 18, 2001; and Isabel Hilton, "The China Scandal," The Guardian, February 22, 2001. The same week, Zhu Bangzao, spokesman of the PRC Ministry of Foreign Affairs, stated: "Such allegations are totally groundless and unacceptable...There is no evidence to support it" ("China Slams Study Alleging Psychiatric Abuse," Reuters, February 20, 2001). See also "Contortions of Psychiatry in China" (editorial), New York Times, March 25, 2001.
4 Human Rights Watch, Dangerous Meditation: China's Campaign Against Falungong, (New York: Human Rights Watch, 2002).
5 For a detailed account of China's legislation in this area, see Human Rights Watch/Asia and Human Rights in China "Whose Security?: `State Security' in China's New Criminal Code," A Human Rights Watch Report, vol. 9, no. 4 (C), April 1997.
6 The term "forensic psychiatry" refers to the field of professional cooperation between psychiatrists and the police or judicial systems. They may cooperate, for example, in cases where police officers suspect that a detainee may be mentally ill and so seek expert psychiatric opinion as to mental capacity to undergo further legal proceedings. Although forensic psychiatry is commonly applied, in China as elsewhere, within both the civil and the criminal sectors of the legal system, the focus of the present report is on its nature and political misuses within the Chinese criminal justice system. The closely related term "judicial psychiatry" refers more narrowly, in most countries, to the involvement of psychiatrists in formal court proceedings. In China, however, the Public Security Bureau (the police) is officially viewed as being a constituent part, together with the courts and the prosecution authorities, of the country's "judicial organs" (sifa bumen). Therefore, the terms "judicial psychiatry" and "forensic psychiatry" are used interchangeably in this report to denote all cases where police and psychiatrists work together, including those in which the courts and judiciary may have no professional involvement, direct or otherwise. In China, significantly, the majority of crime-related psychiatric cases are still handled solely by the police, with only a small proportion proceeding to the stage of formal prosecution and trial. For a brief account of the history of forensic psychiatry in China, see below, "Judicial Psychiatry in China and its Political Abuses," section III., "The Early Years of the People's Republic." For a detailed overview of the role of forensic psychiatry within the Chinese legal system today, see section V., "Legal Norms and Judicial Process." As is discussed in further detail below, the majority of cases involving the political abuse of psychiatry in China appear to occur within the forensic or police-related branch of the country's psychiatric profession. Although there has been a resurgence of such abuse within the general psychiatric domain since 1999, it is important to note that the wider field of general psychiatry in China nowadays conforms, in the main, to internationally accepted standards of mental healthcare diagnosis and treatment.
7 For further information on these important documents, see below, "Judicial Psychiatry in China and its Political Abuses," Section II.
8 "The struggle...worldview" in Chinese: "fan youpai, xing-wu mie-zi de douzheng." The Anti-Rightist Movement was the Communist Party's first post-1949 campaign of mass repression against Chinese intellectuals. In the course of the campaign, hundreds of thousands of intellectuals were imprisoned or sent into internal exile, often for periods of up to twenty years.
9 Elsewhere in the same issue of the psychiatric journal in question, another patient was reported as saying:
In the past, when the doctor told me that "to cure your sickness you must be guided by correct ideology," I felt quite upset and offended. How could correcting one's ideology ever make one recover from mental illness? Would this not mean that in fact I had an ideological sickness? Now that I've gained an understanding of the dialectical relationship between ideology and illness, however, I know why the medicine I used to take had no effect and I've become confident of being able to cure myself. (Chinese Journal of Neuropsychiatry, vol. 10, no.2, (1966), p.114.)
10 Marshall Lin Biao was Mao's close second-in-command and designated successor until September 1971, when he was said to have tried to defect to the Soviet Union. In what the Chinese government subsequently termed the "Lin Biao Self-Explosion Incident," he died when his aircraft crashed in a remote part of the Mongolian People's Republic, presumably en route to Moscow. The "Gang of Four," arrested in October 1976, a month after Mao's death, consisted of Mao's former close political colleagues Zhang Chunqiao, Yao Wenyuan, Jiang Qing and Wang Hongwen.
11 It is worth noting that even Yang, in his August 1976 intervention in this debate, felt it necessary to state that thoughts and ideas expressed by mentally ill people that had "adverse influence and effects upon society...must not be permitted to spread unchecked or to threaten public order and stability." In his view at that time, those concerned "should be subjected to compulsory treatment and we should reinforce management over them..." (See Document 5, below.)
12 Shen Zheng, ed., Falü Jingshenbingxue (Legal Psychiatry), (Beijing: China University of Law and Politics Publishing House, 1989), p. 314.
13 As in earlier versions of the American psychiatric profession's Diagnostic and Statistical Manual (DSM), the residual category of disorders caused by lack of self-acceptance on the part of homosexuals has still been retained in China.
14 See, for example, Arthur Kleinman and Sing Lee, "Psychiatry in its Political and Professional Contexts: A Response to Robin Munro," Journal of the American Academy of Psychiatry and the Law, vol. 30, no.1 (2002), pp.120-125. See also Robin Munro, "On the Psychiatric Abuse of Falun Gong and Other Dissenters in China: A Reply to Stone, Hickling, Kleinman and Lee," Journal of the American Academy of Psychiatry and the Law, vol. 30, no.2 (2002), pp.266-274.
15 "zhen shan ren": the three cardinal teachings of Falun Gong.
16 Purists might argue that the examining psychiatrists' only ethically correct course of action in this case would have been to inform the police: this man is both sane and also innocent of any crime; in reality, though, the psychiatrists would probably have suffered harsh retribution from the political authorities had they dared to suggest any such thing.
17 Incidentally, several wide-ranging medical surveys conducted by numerous top Chinese physicians prior to the July 1999 crackdown on Falun Gong concluded that, in the case of most common illnesses, it actually does so; schizophrenia, of course, is quite another matter, but it should also be noted that this particular detainee apparently had the condition well before taking up Falun Gong. For details of two of the pre-crackdown medical surveys, see below, Note 267.
18 On a related point, several Western commentators offer an alternative "scarce resources" argument against the political abuse allegations. They consider it to be highly improbable that the Chinese authorities would send mentally normal dissident offenders for custodial psychiatric care, when prison is a much cheaper and more obvious option. In fact, it costs the government a substantial amount nowadays to house a convicted prisoner, whereas Falun Gong and other dissenting involuntary inmates of psychiatric institutions are usually billed, directly or through their families, for all hospitalization and treatment charges.
19 There are still relatively few full-time forensic psychiatrists in China; probably a majority of the forensic cases are examined and dealt with by general psychiatrists who work part-time for the police.
20 As indicated earlier, it is likely that only a relatively small minority of Chinese psychiatrists are involved in political abuses of the profession. However, it is vital to remember that this was also the case in the former Soviet Union; in both countries, political and religious dissidents have accounted, naturally enough, for only a small part of the overall psychiatric caseloads.
21 Annual General Meeting of the Royal College of Psychiatrists, London, July 11, 2001; in the final vote on the China resolution, there were two abstentions and no votes against.