Psychiatric Teaching and Research Group of the
Shanghai Railways Medical College324
From June 16 to 20, 1987, the First National Academic Conference on Forensic Psychiatry took place in the city of Hangzhou, and more than 100 scholarly articles were submitted to the conference from all over China. The following is a preliminary summary and analysis of these various articles, presented here for reference and information purposes.325
The papers can be grouped according to theme and content under the following main headings:
2) Theoretical studies on the capacity for legal responsibility of mentally ill persons (15 articles.
3) Comprehensive analyses of specific cases of forensic psychiatric appraisal (12 articles.)
4) Empirical summaries of the forensic psychiatric appraisal of each main type of psychiatric illness (34 articles.)
5) Analyses of the various categories of dangerous behavior displayed (11 articles.)
6) Other headings, including: the psychological testing of mentally ill people who create disastrous incidents (3 articles); the question of suicide (3 articles); an investigation into the use of narcotics as a means of questioning suspects (1 article);326 several articles on other related topics; and three articles concerning the draft legislation on forensic psychiatric appraisals (i.e. the fifth draft of the PRC Law on Mental Health, the discussion draft of the Regulations on the Work of the Forensic Psychiatric Appraisal of Mental Illnesses, and the discussion draft of the Zhejiang Provincial Regulations on the Work of Forensic Psychiatric Appraisals.)
b. 590 cases of rape (7.67 percent.) In one article, the three categories of murder, rape and injury were dealt with under the composite heading of "violations of the person"; [the number of rapes] was given as 308, resulting in a total figure of 3,186 (or 41.38 percent.)
c. 340 cases involving other sex offenses and acts of hooliganism (4.42 percent.)
d. 770 cases of crimes against public or private property, including theft, fraud, looting and corruption (10 percent.)
e. 1,621 cases of reactionary or counterrevolutionary behavior (21.05 percent.)
f. 326 cases of disturbing social order (4.23 percent.)
g. 187 cases of arson and sabotage (2.43 percent.)
h. 371 cases involving various other types of dangerous behavior (4.81 percent.)
i. 898 cases involving the sexual molestation or violation of mentally ill women (11.66 percent.)
a. Schizophrenia was the principal diagnosis, accounting for altogether 3,488 cases (or 44.37 percent of all those appraised);
b. there were 1,570 cases of mental retardation (19.97 percent); and
c. 287 cases of neurosis, mainly hysteria (3.65 percent);
d. 282 cases of epilepsy (3.59 percent);
e. 185 cases of reactive psychosis (2.35 percent);
f. 160 cases of personality disorder (2.04 percent);
g. 125 cases of affective illness (1.59 percent);
h. 89 cases of organic psychotic disorder;
i. 79 cases of paranoid psychosis;
j. 52 cases of sexual perversion;
k. 30 cases of prison psychosis;
l. 27 cases of alcoholic poisoning;
m. 7 cases of grafted psychosis
n. 499 cases of other mental disorders (6.35 percent.)
4) Issues requiring further comment:
b. Altogether 898 of the cases (or 11.66 percent) involved the forensic examination of mentally ill women who had been sexually abused, placing this category of offense in third most frequent position after murder/injury and counterrevolution. This category [of offense] is still rapidly on the increase at present, and given the dramatic fall in the number of forensic appraisals of counterrevolutionary speech and action that has occurred since the 1980s, it has probably now risen to second place in the frequency ranking of forensic psychiatric appraisals in criminal cases. This situation ought to arouse substantial concern and attention on our part.
c. As regards the distribution of mental illnesses by [diagnostic] category, several of the articles reported the incidence of schizophrenia among those forensically appraised as having been, variously, as high as 75.45 percent, 60 percent and 56.7 percent, with the lowest reported incidence of the illness being 17.8 percent; the average rate of schizophrenia derived from the overall statistics found in 11 of the articles came to 44.37 percent. It is noteworthy that in the two articles describing the situation in Beijing and Shanghai, both of which covered relatively large numbers of forensic appraisals (1,259 cases and 708 cases respectively), the incidence of schizophrenia was reported as being 26.45 percent (Beijing) and 20.76 percent (Shanghai.) Very clear discrepancies can be seen, therefore, among the relevant figures provided in the various articles. Aside from the objective differences found in the individual targets of appraisal, the most important reasons for this were probably the divergent levels of rigor and precision applied in diagnosing schizophrenia, together with a tendency toward over-broad diagnosis of the condition and a lack of uniformity in the criteria used. [Case example: omitted in this translation.] Henceforth, therefore, it is vital that any diagnoses of schizophrenia made in the course of forensic psychiatric appraisals should be strictly based upon the diagnostic criteria for this condition as laid down by the Chinese Medical Association in 1984, in order to avoid the bias toward artificially amplifying the scope of schizophrenia diagnosis.
d. There were also fairly large discrepancies between the figures given in the various articles for the proportion of those found to be not suffering from mental illness; in two of the eleven articles [that addressed this issue], the figure was said to be 0 percent, which clearly did not accord with the objective reality. Could it be that these authors simply assumed that the people being appraised must all be suffering from some mental illness or other, causing them to disregard issues and factors of common criminal psychology, so that they became unconsciously enmeshed in the "pan-psychiatrism" perspective? This is a problem that merits our further attention. The lowest figure given for the diagnosis of absence of mental illness was 0 percent, the highest figures were 26.32 percent and 33.33 percent (Inner Mongolia and Shanghai, respectively), and the total average figure derived was 11.85 percent.
e. The discrepancies among the statistical proportions for those found to be feigning mental illness were also quite substantial. Seven of the articles gave a figure of 0 percent on this count, but several of the authors had placed the cases of malingering they observed under the heading of "absence of mental illness" (e.g. Beijing and Shanghai.) In four other articles, the proportions given for malingering were 0.63 percent, 0.71 percent, 1.79 percent and 4.26 percent (17/399); this last figure seems to be artificially high. Altogether 45 cases of malingering were identified in the 11 articles, accounting for 0.57 percent of the total number of criminal cases forensically appraised. It is clear from this that cases of feigning mental illness are in fact very rare, and therefore that special caution must be exercised, and solid evidence adduced, before making this diagnosis.
f. As regards the appraisal of capacity for criminal responsibility, again, substantial discrepancies and variations were found to exist. The highest proportion given for those found to bear full legal responsibility [for their criminal actions] was 51.6 percent, the lowest figure given was 12.22 percent, and the average proportion derived from ten of the articles on this count was 33.32 percent. The statistic for Beijing stood at 32.1 percent, and that for Shanghai at 48.9 percent. (All these figures included persons found to be not suffering from any mental illness.) By contrast, the proportions given for those found to bear no legal responsibility for their actions ranged from a high point of 73.33 percent, to the low levels of 27.5 percent (Beijing) and 29.6 percent (Shanghai), the two latter figures being fairly close together.
Clinical typology: 273 cases of paranoid schizophrenia were diagnosed (55.83 percent of the whole); 41 cases of hebephrenic schizophrenia (8.38 percent); ten cases of catatonic schizophrenia (2.04 percent); five cases of simple schizophrenia (1.02 percent); 81 cases of indeterminate or composite schizophrenia (16.56 percent); 53 cases of chronic schizophrenia (10.84 percent); 23 cases of residual or remittent schizophrenia (4.78 percent); and three cases of other schizophrenic variants (0.16 percent.) The paranoid, indeterminate (or composite) and chronic types were the most common, with - most strikingly - the paranoid variant accounting for over one half of the cases.
Ranked in order of frequency, the various forms of dangerous behavior [carried out by schizophrenics] were as follows:
a. 206 cases of murder (42.13 percent) and 64 cases of injury (13.09 percent); the combined figure for both types of dangerous behavior was 270 cases (or 55.22 percent), making this the most frequent category. Among the data from Shanghai and Nanjing, 177 persons committed acts of murder and injury, killing 122 persons and injuring 83, making a total of 204 victims. Of these, 165 were known by the perpetrators and 39 were strangers. Among the known group, 82 were relatives of the perpetrators, while the remaining 83 were neighbors, friends or colleagues. Hence, it is vital that relatives and friends of mentally ill people, and especially the close relatives, should increase their levels of vigilance and avoid upsetting or provoking them in any way.
b. 38 cases of rape (7.78 percent);
c. 29 cases involving other sex offenses or acts of hooliganism (5.93 percent);
d. 49 cases of disturbing social order or disrupting traffic and production (10.02 percent);
e. 41 cases of reactionary or counterrevolutionary speech and action (8.38 percent);
f. 28 cases of theft, looting and corruption (5.73 percent);
g. 23 cases of arson and sabotage (4.70 percent);
h. seven cases involving other types of dangerous behavior (1.43 percent); and
i. four cases of sexual molestation (0.82 percent.)
The two most frequent types of dangerous behavior, therefore, were murder and disturbing social order.
b. 136 cases of appraisal of criminal defendants were carried out, of whom 129 were male and seven were female, giving a gender ratio of 18.4:1. Intelligence testing was performed in 97 of these cases; moderate mental retardation was identified in 20 cases, and minor mental retardation or lower was identified in 87 cases.328 Among the 136 cases were also found eight persons who underwent psychotic episodes or were suffering from grafted psychoses.
ii. 31 cases involving acts of indecency or hooliganism (22.79 percent);
iii. 24 cases of theft and looting (17.65 percent);
iv. 21 cases of murder (15.44 percent) and five of injury (3.68 percent);
v. nine cases of arson and sabotage (6.62 percent);
vi. five cases of reactionary speech or action (3.68 percent); and
vii. one case of prostitution (0.74 percent.)
b. 20 cases involving epileptic disturbances of consciousness (20.62 percent);
c. 10 cases of schizophreniform epileptic psychosis (10.31 percent);
d. four cases of epileptic psychomotor seizure (4.12 percent);
e. three cases of epileptic paroxysmal dysthymia;
f. two cases of epileptic impairment of intelligence;
g. one case of epileptic sleep-walking;
h. three cases involving other mental impairments; and
i. five cases where crimes were committed during the intermission between grand mal epileptic seizures.
The following varieties of dangerous behavior occurred:
a. 34 cases of murder (35.05 percent) and 23 cases of injury (23.71 percent), giving a combined figure of 57 cases (58.76 percent); the crimes committed were often extremely cruel and vicious in nature, resulting in numerous injuries and very severe consequences;
b. 22 cases of disturbing public order (22.69 percent);
c. six cases of reactionary speech and action;
d. five cases of theft and looting;
e. three cases of rape;
f. two cases of hooligan behavior; and
g, two cases of arson and sabotage.
Another article supplied opinions on the capacity for legal responsibility of 59 of the afflicted persons: six were found to bear full legal responsibility (10.35 percent); nine were found to have partial legal responsibility (13.90 percent); and 44 were found to have no legal responsibility for their actions (75.95 percent.) Of the six persons who bore full legal responsibility, five committed their crimes during intermissions between grand mal seizures and while mentally normal; and the other had a minor epileptic personality disorder and committed his crime while mentally normal, during a fit of intense anger brought on by a practical setback. Among the 44 persons who were found to bear no legal responsibility, 16 had epileptic personality disorders accompanied by outbursts of pathological excitement; 13 had post-grand mal disturbances of consciousness and one had pre-grand mal disturbance of consciousness; nine had schizophreniform epileptic psychosis; three had epileptic psychomotor seizures; two suffered from severe epileptic impairments of intelligence; and another suffered from epileptic sleep-walking.
Tang Xiaofeng, Li Shenlu and Zhao Bencheng,331
Ankang Hospital of the Hangzhou Municipal Public Security Bureau
Findings: At the end of 1993, China had altogether 20 Ankang hospitals (mental hospitals run by the Public Security system), comprised of 5,090 beds, 559 doctors and 991 nurses.
Key Words: Mental hospital, Public Security system.
For a long time now, the Ankang hospital system has been shrouded in mystery for most people, and there has been very little information available about its function and purposes, its size and distribution, and its current situation and inner workings. In order to give our colleagues throughout the country a more complete picture of the Ankang hospital system, in October-December 1993 we drew up a questionnaire titled "Survey of the Current State of China's Ankang Hospital System" and distributed it to all 20 Ankang hospitals in the country.
As of the end of 1993, there were a total of 20 Ankang hospitals nationwide, and apart from the one in Inner Mongolia, which for various reasons had not yet formally opened, all were operating normally. As can be seen from the attached Table,332 the regional distribution and numbers of beds of the various Ankang hospitals was very uneven, with the largest number (four) being located in Zhejiang Province, in the cities of Hangzhou, Ningbo, Jinhua and Shaoxing. The Ankang hospital network had a total capacity of 5,090 beds, the greatest density of which was in Beijing, Tianjin and Hangzhou, accounting for 47.54 percent of the whole. The Beijing and Tianjin facilities each had a capacity of 1,000 beds, but half of the remaining Ankang hospitals had no more than 100 beds. Fifteen of the hospitals, or 75 percent, were built since the start of the 1980s, all of which shows that China's Ankang enterprise is currently still at the fledgling stage of development.
Across the national Ankang network, there were 559 specialized doctors (zhuanke yisheng) and 991 nurses. The ration of beds to doctors was 1: 0.11, while that of beds to nurses was 1: 0.19 (the national statistical average was somewhat lower than that reported by Zhejiang Province.) As regards the composition by professional and cultural ranking, there were altogether 42 senior-level physicians (7.51 percent), 183 medium-level physicians (33.45 percent) and 330 basic-level physicians (59.03 percent.) One hundred and one of the doctors, or 18.7 percent, were university graduates; 139, or 24.87 percent, were college (da-zhuan) graduates; 286 were technical secondary school (zhong-zhuan) graduates; and 44, or 7.87 percent, had received an informal professional training. Of the nursing staff, 69 were senior nurses, 343 were middle-ranking nurses, and 579 were basic nurses. In all but a few of the Ankang hospitals, there were insufficient numbers of doctors and nurses, and the shortfall was especially severe at middle and senior professional levels. The cultural level of the staff was also uniformly low.
2. State of operations:
The total number of mentally ill people being detained for treatment within the Ankang system nationwide was 4,637. According to incomplete data, altogether 1,907 of the patients (or 41.13 percent) had created disastrous incidents of various kinds within society, including 1,045 persons (or 22.54 percent) who committed murder or injury. The length of stay for patients of this kind is usually quite long, and even if they recover and become cured, many patients cannot easily be discharged and have to spend the rest of their lives within the [Ankang] system. For all kinds of reasons, specialized hospitals [of other types] around the country are unwilling either to admit or to treat patients of this category. So again, we can see the urgent need for more Ankang hospitals to be established. The majority of those detained for treatment within the Ankang network have been involved in acts of behavior that pose a definite threat to society, and hospital staff members are thus correspondingly likely to meet with sudden or violent assaults by these patients. Incomplete figures show that during 1993, staff members were assaulted 343 times by patients, resulting in minor injuries or less to 105 of the victims. The degree of hardship experienced by Ankang staff is readily apparent and naturally deserves the support and understanding of people at all levels of society.
The most frequent type of mental illness found among Ankang patients is schizophrenia, accounting for 74.12 percent of the total. The next commonest categories are affective mental disorder, mental retardation and epilepsy. These four categories combined account for 89.51 percent of all those hospitalized.
At present, 13 of the Ankang hospitals conduct forensic [psychiatric] appraisals. Apart from a few institutions, most of these hospitals have only recently begun doing this kind of work. Some of them also invite experts and professors from outside the Ankang system to take part jointly in the forensic appraisals. So far, forensic appraisals of over 10,000 cases of all types have been carried out, and this has greatly reduced the [country's] previous difficulties in getting such appraisals done, while at the same time greatly assisting the ability of our political and law-enforcement personnel (zheng-fa renyuan) to deal with cases rapidly.
In addition, seven Ankang hospitals have in recent years set up detoxification wards for drug addicts and people with other pharmaceutical dependencies; more than 1,000 addicts have so far been cured in these wards. The detoxification process relies on a combination of voluntary and coercive measures, in order to guarantee smooth results. Since drug abuse has been continually increasing and spreading in certain parts of China, it is important that Ankang hospitals in all areas should collaborate with the work of the Public Security departments in banning drugs.
As regards the question of patient expenses, all Ankang hospitals currently levy rather low charges. The monthly cost per patient ranges from 200 to 800 yuan, averaging out at 447.33 yuan, which is far lower than the amount charged by other specialized hospitals. This undoubtedly benefits those patients who come from the economically backward rural areas, as well as those suffering from chronic illnesses who require lengthy hospitalization. From the long-term perspective, however, such low charges leave most Ankang hospitals in danger of being economically unviable; moreover, they exert a negative influence on the hospitals' prospects for institutional expansion, their ability to attract new talent, improve the living conditions of both the staff and the patients, and so forth.
3. Academic and research achievements:
In 1988, the journal Research in Public Security [Psychiatric] Custody and Treatment (Gong'an Guan-Zhi Yanjiu) was founded; for internal circulation only, it appears annually and so far five issues have been published. In the same year, a National Ankang Hospitals Coordinating Group was set up to provide unified coordination of scientific research work, exchange of information and data, and other tasks, throughout the Ankang network. It was also decided that a national academic exchange conference on Public Security custody and treatment work should be convened every two years. According to preliminary figures, a total of 1,024 research articles have been written and produced within the Ankang hospitals network since its founding; of these, 185 have been published in national scholarly journals, 241 in provincial-level journals, and 598 have been circulated on an internal-use-only basis. Progress in this area has still been uneven, however; the general level of the articles has left much to be desired, and a minority of Ankang hospitals is still not using quantitative evaluation tables or psychological testing procedures such as WAIS and MMPI.333 In addition, the Ankang facilities have few academic exchanges and vocational links with other specialized hospitals, and only seven of them periodically invite outside experts to come in and carry out ward inspections, deliver lectures and perform forensic appraisals. Fourteen Ankang hospitals have sporadically taken part in some of the academic activities of the local specialized hospitals, but it is clear that increasing the level of exchanges of this type and promoting further vocational contacts with the specialized hospital network is vital if the Ankang hospitals are to raise their standards of medical treatment.
Luo Jiming, Li Shenlu and Tang Xiaofeng,
Hangzhou Ankang Municipal Hospital335
Instances whereby mental illness sufferers, owing to the severe weakening or outright loss of their powers of recognition and control, become involved in [criminal] 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 committed 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 (P<0.01). Our findings on these cases were as follows:
Analysis of data: Of the 41 cases, 30 were male (73.2 percent) and 11 were female (26.8 percent.) Their ages ranged from 21 to 65 years, averaging 41.3 years (_ 8.6.) Fourteen were married (34.1 percent), 17 were single (41.5 percent) and 10 were divorced (24.4 percent.) Educational status: 18 were educated to lower-middle school level (43.9 percent), 7 to upper-middle school level (17.1 percent), and 4 to university or college level (9.8 percent.) Professional status: 7 were peasants (17.1 percent), 18 were workers (43.9 percent), 9 were cadres (21.9 percent), and 7 were from other working backgrounds (17.1 percent.) Seven persons (17.1 percent) had positive family histories [of mental illness], while 26 persons (63.4 percent) themselves had previous histories of mental illness.
Clinical diagnoses: 30 cases of paranoid schizophrenia (73.2 percent), three cases of paranoid psychosis (7.3 percent), two cases of depression (4.9 percent), two cases of mania (4.9 percent), three cases of psychogenic mental disorder (7.3 percent), and one case of mild mental retardation (2.4 percent.)
Criminal case categories: (see Table 1.) In all cases, the commission of the crimes was directly related to the persons' mental symptoms. Fifteen cases arose from delusions of persecution, three from delusions of reference, two from delusions of grandeur, two from delusions of non-blood [non-parentage] relationship, one from delusions of physical influence, eight from auditory hallucinations, five from impairments of thought and logic, two from emotional depression, two from disturbance of consciousness, and one from pathological lying.
Discussion: 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 (see reference notes 1 and 2); 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, delusions of reference, and delusions of grandeur, as well as their impaired thought processes. Three of the paranoid schizophrenics were dominated by systematic delusions that led them to make ceaseless complaints and accusations against their so-called "persecutors." In the cases of the two people suffering from depression, getting themselves punished was the actual aim of their criminal activities. The two mania sufferers committed their crimes as a result of a severe impairment of their powers of self-control. Of [the three persons] suffering from psychogenic mental disorders, two wrote letters to enemy intelligence organizations after encountering frequent setbacks in life, as a way of trying to extricate themselves from their difficulties, and compared with the other mentally ill [offenders of this type] they showed a higher degree of premeditation and also a greater sense of self-preservation; the other person shouted reactionary slogans while undergoing an acute episode accompanied by disturbance of consciousness.
As regards the modus operandi of the various offenses, in the overwhelming majority of cases - whether it was sending letters or writing reactionary slogans - the methods employed were all relatively simple, stupid, or self-contradictory and inconsistent. For example, one sufferer who sent a signed letter to members of the central [Party] leadership began by writing "Dear Comrade So-and-so," then went on to say "I'm determined to bring about your downfall" and other such things. Another sufferer wrote to a newspaper saying that he planned to hijack an airplane and go to Taiwan; he explained his reasons for doing so and then wrote down his real name and work unit at the end of the letter. A minority of the sufferers wrote long screeds that went on for thousands of words, but these documents were vague, general and repetitive in content, and lacking in any clear or purposeful sense of logic. As for the "reactionary slogan" writers, most used cigarette packets or other pieces of scrap paper to write down their thoughts on, so the pathological nature of their activities was obvious to others, and clearly different from most other cases of counterrevolutionary crime. Among the eight cases of petitioning and litigation, the majority involved people who kept barging into [government] offices and ceaselessly quibbling and arguing, in an indiscriminate and directionless manner that took no account of whether or not they were talking to the appropriate official and if they were having the desired effect; this again was markedly different from petitioning and litigation by normal people. Of the cases of mentally-ill crime under study, all were committed by single persons rather than groups of people; none of the offenders had considered the likely consequences of their actions beforehand, and afterwards they all actively confessed and showed no sense of concealment or fear.
The greatest numbers of sufferers from the group in question were admitted to hospital in 1978 and 1989, and this seemed to be distinctly related to the wider background and climate of those two years.336 In all successive periods of large-scale social change and political campaigns, it can be seen that a number of mentally ill people "respond promptly to the call" by coming out to add further fuel to the flames; for example, the manic illness sufferers who go around making speeches all over the place, inflaming public sentiment, setting up road blocks, shouting slogans, and generally exerting a highly pernicious influence in society. For example, the mildly retarded person in the group under study had expressed a horrifying political rumor to a large group of onlookers, and taken much pleasure in doing so. This prompts us to the need to exercise even greater control and management over mentally ill people during periods of social turmoil and change. 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. An examination of the specific hallmarks of this type of crime thus has considerable practical importance.
(Article received on March 11, 1996.)
2. Shen Muci, "An Analysis of 654 Cases of Forensic Psychiatric Evaluation," Chinese Journal of Nervous and Mental Diseases, 1988, No.2, p.167.
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, even if we discount the mental state of those concerned, and only consider the nature and degree of the threat posed by such actions, it is clear that the majority of acts of this type carried by mentally ill people do not fulfill the relevant criteria of the Criminal Law for the constitution of crimes. The question therefore arises of how to characterize, from an overall perspective, the commission of acts by the mentally ill that endanger the state and the social system. To describe it as "counterrevolutionary behavior" or as "behavior that endangers state security" would obviously 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.
A review of the literature on forensic-psychiatric medical appraisals shows us that while the expression of negative political speech and action by the mentally ill is hardly a common occurrence, it is also by no means rare.
· In a report by Shen Muci et al on 654 cases of forensic appraisal conducted during 1973-86, out of a total of 566 crimes, 103 were cases of a political nature, or 18.2 percent. (Eighty of these cases dated from 1980 or earlier.)
· Xu Shenghan, in a report on 708 cases of forensic appraisal carried out during 1982-86, found that 32 of the 638 offenses committed (or 5.02 percent) were crimes of counterrevolutionary behavior.
· In a report by Liu Guangyu et al on 931 forensic appraisal cases dating from 1979-90, among a total of 667 offenses committed, 27 (or 4.05 percent) were identified as being political cases.
This decline in the incidence of cases of a political nature affords much food for thought. Tracing the matter to the source, and leaving other issues to one side, one major factor at least has been the change in the political climate. After the conclusion of the Cultural Revolution, and particularly since the start of [China's] opening up and reform, there has been a gradual relaxation in the political environment, and some acts that were previously seen as being "counterrevolutionary crimes" are no longer regarded as such, and may even not be viewed as crimes at all; having the Criminal Law available as a yardstick by which to ascertain "crimes of counterrevolution" has allowed us to avoid the [former] problem of the arbitrary amplification of the scope of these crimes. We can also anticipate that, following the redefinition of "counterrevolutionary crimes" as "crimes of endangering state security," the number of political cases will inevitably decline still further as a proportion of all crimes committed. Naturally, however, an incidence rate of 5.6 percent is by no means something that we can afford to ignore, and it fully justifies treating acts of negative speech and action by the mentally ill as being a problem requiring special study and attention.
Especially during the periods when politics was all encompassing and the political atmosphere had descended to an especially vicious level, the role played by political factors [in generating mental illness] was even more pronounced. At those times, some people were unable to withstand the politically-induced mental stresses they experienced after coming under political persecution and attack; others could not adapt to the psychological pressures they had to endure as a result of the cruel and harsh political environment; still others were unable to deal with the psychological blow of being discovered to have "political problems"; and others again were incapable of adapting to or dealing with the sudden dramatic changes that so often occurred in the political climate. As a result, they either suffered from short-term mental-abnormality reaction states or else developed full-blown mental disorders.
The writer Hu Feng was one such example. As Hu's son, Zhang Xiaoshan, has revealed, after the Cultural Revolution, while he was lying in hospital recovering from the long-term political persecution he had endured, and longing for news of his rehabilitation by the Central Committee, Hu became mentally abnormal:
Moreover, mental illness can also influence people's political behavior. In contemporary society, every mentally normal person has his or her own political beliefs and political consciousness, and may engage, at appropriate times, in certain types of political action and behavior on the basis of these beliefs and consciousness. So, can the same be said of those suffering from mental disorders? It is quite hard to give a general answer to this question. Mentally ill people who do not suffer from impairments of thought, consciousness and intellect, or those who, despite having such impairments, still retain relatively good powers of recognition and discrimination343 and also the capacity for political consciousness and political behavior, are able to participate in political activities. The situation of mentally ill people who suffer from severe impairments of thought, consciousness and intellect, however, is quite different. Their capacity to receive and understand political information, and their ability to make judgments about political issues and engage in political behavior, are all relatively severely impaired; since their capacity for political consciousness and political activity has either been weakened or entirely lost, they are incapable of fitting in with [existing] political life. When their illnesses are exceptionally severe, then the political rights that they enjoy as citizens may be restricted according to law. For example, Article 23, paragraph 2 of China's "Law on Elections" stipulates: "If a mentally ill person is incapable of exercising his or her electoral rights, then upon confirmation of this by the Electoral Commission, he or she shall not be listed on the roll of electors."The quiet hospital room in no way served to calm father's nerves. One morning, sitting on the sofa and with eyes staring fixedly ahead, he told me he had received a message through the air saying that Vice Premier Deng [Xiaoping] had delivered a speech calling for several people to be punished, and that five people had been stripped of their Party membership and taken away in handcuffs. News of this event would shortly be appearing in the newspapers: 3,890,000 copies had already been printed and had sold out immediately... That afternoon, he said he had received another message through the air, telling him to take a helicopter and leave right away; he began to put on his overcoat and tried to go out to board the helicopter, and despite all our efforts we were unable to prevent him from going outside.
However, to say that a mentally ill person's capacity for political consciousness and political activity has either been weakened or entirely lost is only true in terms of the substantive meaning of that statement, and it by no means implies that mentally ill people of this kind are fundamentally incapable of forming views of a certain political coloration, of uttering language of a certain political coloration, or of engaging in behavior of a certain political coloration. The reason for this, primarily, is that these mentally ill people have already, prior to becoming ill, doubtless been in receipt of all kinds of political information and influences, and these influences may persist after they become ill and may also make themselves manifest. Secondly, mentally ill people of this type, after they fall ill, may receive all kinds of [new] items of political information and may react to them, even though they may now perhaps fail to correctly understand the nature of the political information and may be incapable of reacting to it in an appropriate manner. This was all the more true during previous eras in China when politics was the main topic on the national agenda.344 For example, during the decades when "politics came first" [zhengzhi diyi], politics formed the single most important aspect of daily life and everyday language was filled with political terminology of all kinds; everyone talked non-stop about politics and even small children became infected with the habit, so how could mentally ill people living in the same social environment manage to completely avoid such influences? In those times, politics even penetrated into the symptomatology of mental illness. For example, some sufferers would walk only on the left-hand side of the road, believing that this would prove they were "leftists"; others developed delusions of guilt that they were agents or spies; and others would have auditory hallucinations in which they heard messages to them from the central Party leadership. [...]345
First, it may be a consequence of the mentally ill person's own history prior to their falling ill. If the mentally ill person was actively concerned about politics and had independent views on the subject before becoming mentally ill, or if he or she was the innocent victim of psychological trauma arising from political attacks, then he or she might engage in negative political speech and action after falling ill. 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 can 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 acts at the unconscious level. Second, they may have been influenced and affected by other people's negative political speech and action. Some mentally ill people suffering from impaired powers of recognition can be unwittingly influenced by other people, and may simply copy them and ape whatever they say. Third, some mentally ill people, under the influence of their external environment, may be interested in politics and yet their mental conditions render them incapable of thinking correctly, and this can sometimes lead them to engage in negative political speech and action.
We should also consider one other point: while the speech and actions per se of some mentally ill people may be devoid of any real political meaning or significance, they may nonetheless, under certain specific kinds of circumstances, be elevated in the minds of others to the high realm of politics. For example, schizophrenics suffering from delusions of grandeur sometimes believe and declare themselves to be the Emperor or the President; in normal times, people would pay little or no attention to statements like that, but during periods when the political atmosphere is tense, such statements may well be seen as constituting "counterrevolutionary speech." Similarly, if an epilepsy sufferer kills someone in the course of an epileptic seizure in which they have lost normal consciousness, their choice of target in the attack will be quite random; during the Cultural Revolution era, however, if the victim happened to be a Party member or a cadre, it would likely have been viewed as a case of "counterrevolutionary murder."
We should now try to analyze further the specific situations and circumstances in which mentally ill people engage in negative political speech and action. This is by no means an easy task, since the case materials in this area are quite fragmentary and there are very few studies by others that one can consult. In comparison with the categories of violent crime and sexual crime, research into the topic of negative political speech and action by the mentally ill has thus far been a much-neglected area of study. The following analysis, therefore, can probably only supply a few clues that may promote more thoroughgoing research into this question in the future.
The kinds of mentally ill people who engage in negative political speech and action for pathological reasons are, primarily, those suffering from schizophrenia, paranoid psychosis, manic-depressive illness, reactive psychosis or mental retardation. The mental states directly leading to negative political speech and action include, in most cases, delusions of persecution, delusions of grandeur, delusions of reference, impairments of thought and logic, auditory hallucinations, and disturbances of the intellect. According to the above-mentioned report by Shen Muci et al, the types of mental illness identified among the 103 cases of a political nature they examined were as follows: 55 cases of schizophrenia; nine cases of reactive psychosis; eight cases of manic depression; five cases of mental retardation; one case each of prison psychosis, organic brain damage sequela, and other psychosis; together with seven cases of personality disorder and 16 cases where no mental illness was found. The various psychiatric symptoms displayed were as follows: in 13 cases, delusions of persecution; in 15 cases, impairments of thought and logic; nine cases of auditory hallucination; in five cases, delusions of reference; and one case of delusions of jealousy and one of disturbance of consciousness; in addition, there were 31 cases of pathological behavior, including eight cases [identified as being due to] personality disorder and 20 that were non-pathological [in origin.]
Furthermore, in the report by Luo Jiming et al regarding 41 cases of a political nature, the types of mental illnesses involved were listed as follows: 30 cases of paranoid schizophrenia; three cases each of paranoid psychosis and of psychogenic mental disorder; two cases of depression and two of mania; and one case of mental retardation. The various psychiatric symptoms in these cases were as follows: in 15 cases, delusions of persecution; eight cases of auditory hallucination; in five cases, impairment of thought and logic; in three cases, delusions of reference; two cases each of delusions of grandeur, delusions of non-bloodline relationship; two each of emotional depression and disturbance of consciousness; and one case each of delusions of physical influence and pathological lying.346 Evidently, the pathological causal factors leading to negative political speech and action by the mentally ill are different in each case, and because this is so, the specific situation and circumstances whereby mentally ill people engage in negative political speech and action will also, of necessity, have their own specific hallmarks.
Foremost among the pathological factors leading mentally ill people to engage in negative political speech and action are delusions, and impairments of thought and logic. The content of the delusions that can lead to negative political speech and action is always related, directly or indirectly, to questions of politics. 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.
For example, some sufferers initially only make accusations against the leader of their work unit and demand that the government department concerned punish him or her, but when they fail in this objective, they become convinced that the government is acting in collusion with the leader of their work unit. Others, suffering from delusions of grandeur, may develop political mania [zhengzhi kuangre] and become excessively interested in political matters - believing, for example, that they themselves have some political mission to fulfill and that they are destined to become (or already are) political leaders. If they proceed to propagate such views publicly, they will come into sharp conflict with the actual environment around them. In some cases, the sufferers not only exaggerate their own importance, but also seek to deny or negate that of others, and they may even try to usurp the latter's role, so leading to even greater complications. Usually, the various types of delusions relating to politics result only in the sufferer making and distributing speeches that attack the ruling political party, the state institutions or individual leaders; but if allowed to continue unchecked, such behavior can lead to extreme consequences, and the sufferer may then resort to dangerous measures, such as attempting to assassinate the perceived persecutor or anyone else he believes is trying to obstruct him from carrying out his political mission.
In addition, persons suffering from paranoid psychosis, paranoid schizophrenia, mania, and also organic psychosis accompanied by symptoms of delusion, are all liable, by virtue of the above-mentioned delusory symptoms, to engage in negative political speech and action. That carried out by paranoid psychotics has one common and persistent characteristic, namely that the behavior in question always seems to be "based on real facts" [shi chu you yin], whereas in reality it is motivated by pathological factors. The negative political-speech-and-action behavior of such people may seem, on the face of it, just like normal behavior, and so long as it does not impinge upon the delusory notions per se, these people can appear to be quite normal. They cleave stubbornly to their opinions, they regard themselves as being in the right, they dare to conduct their activities openly and make no attempt to conceal their identities or give false names, and they are not afraid of being arrested and brought to justice. Unless careful discrimination is exercised with [mental illness] sufferers of this type, miscarriages of justice can easily arise.347
Certain sufferers are highly fluent speakers and proficient at weaving stories, so some mentally normal people can become convinced that what they say is true and may even end up spreading the ideas further. In the case of those suffering from paranoid schizophrenia, the negative political speech and action may be caused not only by their delusions, but also by impairments in their thought and logic, or by a combination of both factors. The impaired thought and logic of some sufferers who are fascinated by politics can lead to their espousing the most strained, anomalous, bizarre and sometimes even ridiculous kinds of political viewpoints. Also, the role of auditory hallucinations should not be underestimated. Manic illness sufferers who engage in negative political speech and action while under the dominance of their delusions are usually in a state of emotional excitement and mania at the time, and their behavior can be especially sudden and unpredictable. Also, the delusions of persecution and grandeur displayed by those suffering from organic psychotic disorders are, in terms simply of their behavior, quite hard to distinguish from those of people suffering from the functional psychoses, although the delusions may be either looser in structure or more systematic and entrenched. For this reason, people with organic psychosis can engage in negative political speech and action in much the same way as those with functional psychosis.
Case No. 225:
Mr. Liu, 47 years old, a university graduate and returned overseas Chinese. After immigrating to China in 1962, he went to one of Beijing's most famous universities, graduating in 1968. That year was the harshest phase of the Cultural Revolution, and because of his class status and family background he was sent down to a state farm to perform manual labor. In 1972, he was sent to work in a research institute. He was generally enthusiastic in his work and achieved outstanding results, but he kept himself to himself most of the time and also was stubborn and self-willed. Throughout his time at college, the state farm and the research institute, Liu applied several dozen times to join the Communist Party of China, but he was always turned down because of his overseas connections. Because of this, he wrote numerous letters to the leading officials concerned, stating that he himself was free from any [political] taint, that there must be dissidents within the Communist Party of China, and asking the Party Central Committee to clean up the membership. The relevant departments criticized and educated Liu many times on this account. He was even subjected to criticism and struggle sessions and sentenced to a period of reform through labor. But Liu continued to uphold his own viewpoints.
After the end of the Cultural Revolution, he again wrote numerous letters to the competent departments expressing these viewpoints. Later, he wrote another letter, saying that in the mid-1980s he had organized and set up a political party called the "China Party for Democratic National Reconstruction" (Zhongguo Minzhu Jianguo Dang.) In addition, he wrote a detailed and tightly argued "Party Charter" that was tens of thousands of words in length, in which he declared his intention "to unite with all advanced intellectuals at home and abroad," in order to assist the Communist Party "to clean up the membership." Liu made many copies of this document and distributed them within society, and he also sent a copy to a leading official of the Communist Party Central Committee. He was subsequently taken into custody for criminal investigation. Suspecting that he was mentally ill, the authorities sent him for forensic psychiatric examination. Appraisal findings: paranoia; no capacity for criminal responsibility.349
Case No. 226:
Mr. L, 32 years old, a worker, educated to lower-middle school level. He became ill immediately after the Cultural Revolution, believing that he was "the son-in-law of a fourteenth-generation descendant of Zheng Chenggong" and that he could lead the whole of China in carrying out reforms. He proposed to replace the Chinese Communist Party with a "Labor Party of China" (Zhongguo Laodong Dang), with himself as "Chairman," and he proceeded to formulate a "Party Charter" and "Party Constitution" and also to recruit members into the party. Three ignorant youths joined this organization. He also drafted a "Law of the People," a "Cadres Law," a "Military Law" and a "Law on Science," the contents of which were a total mishmash and full of nonsense, so that no one could make head or tail of them. Later on, he and his collaborators distributed several thousand leaflets throughout all areas of the city, thereby creating an extremely bad influence. He was then arrested on charges of committing "counterrevolutionary crimes."
During his investigation and questioning, it was discovered that although he confessed unreservedly both about the events in question and about his criminal motives, there were certain absurd and unusual elements in his account. He was then sent for forensic psychiatric appraisal. In the course of the appraisal, it was ascertained that he had a family history of mental illness, with several of his relatives afflicted. Upon psychiatric examination, it was found that while his consciousness was normal and his memory and intellect were both sound, he nonetheless had marked delusions of grandeur and his ideological outlook was fallacious and unrealistic. He requested the government not to destroy the various "laws" he had formulated, saying that although he had to go to prison and so would be unable to complete his "enterprise," these "laws" should still be preserved for the benefit of future generations, to serve as the basis for carrying out a scientific reformation of the country. Appraisal findings: paranoid schizophrenia; crime caused by delusions of grandeur during an active phase of the illness; no capacity for criminal responsibility.350
In some cases of negative political speech and action by the mentally ill, the capacity for discrimination and recognition of those concerned is fairly intact at the time they commit their offenses, but they are subject to the influence of other pathological factors. Cases of negative political speech and action by those suffering from minor manic disorders, for example, arise as a consequence of their reduced capacity for self-control. Minor mania sufferers have an unduly high opinion of themselves and are fond of arguing with others. While they may be dissatisfied with specific [government] policies, the criticisms they raise are not just restricted to the matter in hand but instead tend to go off in all directions at once, becoming high-flown and generalized in nature and striking out at random, so that such people often end up making extremist statements. They also enjoy propagating their viewpoints in public and in front of many onlookers, and they strive hard to convince people that they are correct, thereby giving rise to the impression that they are engaging in "counterrevolutionary propaganda and incitement." In the case of those suffering from depressive illness who engage in negative speech and action, sometimes their aim in doing so is to commit an indirect form of suicide (self-punishment.) Some mentally ill people of this kind write letters to the relevant departments informing them that they're planning to carry out such-and-such an act which endangers state security, adding their real names and work-unit details to the letter, and they then sit back and await their punishment.
People suffering from impairments of the intellect can also engage in negative political speech and action. Such impairments impact, primarily, in two separate ways on the emergence of negative political speech and action. The first is that impairments of the intellect prevent those affected from being able to properly understand or construe the various items of political information they receive, with the result that they may uncritically adopt undesirable political ideas. The second is that these impairments prevent them from making appropriate judgments, on the basis of existing knowledge, in respect of the various political questions at issue, thereby leading them into careless and wild behavior. Whatever other people say or do, they will also say or do, although very few of them have any real insight into the nature and significance of their speech and actions. At certain times, they express "revolutionary" views, and at other times they express "counterrevolutionary" views; the listeners, however, will probably only notice the "counterrevolutionary" content of their statements and hence will regard them as being "counterrevolutionaries." While such people may have real or practical motives for engaging in negative political speech and action, nonetheless, not all of these will be directly related to politics; for the most part, they tend to be motivated by lower-level factors such as obtaining material gratification or getting attention from others. For example, one mildly mentally retarded person created and spread a horrifying political rumor, but he did so just because it amused him and he found it enjoyable.
Other mentally retarded people, despite having an impairment of the intellect as a whole, can still display special abilities and be able to accomplish certain tasks very skillfully, even when their motives for doing so are immature and the tasks themselves involve the wildest of fantasies. For example:
Case No. 228:
Male, mentally retarded. Suspected by his work unit of theft activities. After listening to radio broadcasts from Taiwan, and using a specified liaison point, he compiled an encryption system and wrote five coded letters to enemy espionage organizations in Taiwan and Hong Kong using a false name. He stated in the letters that he had established a counterrevolutionary group, and asked the recipient organizations to recognize his group and provide it with funds, weapons and intercom communications devices; he also asked them to send him a fully competent female assistant who would become his wife and would take instructions from him, and he specified a contact address and a password to be used for this purpose. After he was arrested, he confessed to having the following motives for doing all this: "I wanted to prove that I hadn't actually stolen anything, so I thought up the idea of contacting Taiwan by letter and tricking them into sending over enemy agents and large amounts of money, weapons, ammunition and radio transmitters, so they could all be captured in one big net, as a way of proving that I was innocent and well-intentioned." He had firmly believed he could prove his innocence in this way, and at the same time get himself a wife.353
The incidence and investigation rates for cases of negative political speech and action by mentally ill persons suffering from marked impairments of the intellect vary, to a very great extent, in accordance with the [prevailing] political climate. At times when the influence of politics is all-pervasive, such people tend to engage in negative political speech and action quite frequently; while during more normal periods they do so rather rarely, since they are not inherently interested in politics. When the political atmosphere is harsh and restrictive, their negative political speech and action will be taken very seriously, and moreover will be investigated by the legal authorities; whereas at normal times people will tend not to pay any particular attention to such speech or action, since they know the person concerned is "crazy." Two sets of statistics appear to confirm this point. According to the first, between 1960 and 1976 a certain hospital dealt with a total of 40 mentally retarded persons who had committed crimes, and ten of these were cases of a political nature, making this the most frequent of all the various categories of offense. According to the second set of figures, between 1989 and 1992 another hospital dealt with altogether 116 cases involving mentally retarded persons, of whom 75 had committed crimes; among the latter, only three cases involved public disturbances that were probably linked to politics.354
Negative political speech and action by those with personality disorders is an intentional and deliberate form of behavior, and is prompted by authentic motives. If we analyze the matter on a deeper level, however, we find that the personality disorders exert a distinct influence in causing such people to engage in this kind of speech and action. For example, people with anti-social personality disorders are frequently punished because they often break the law, but more often than not, instead of learning from these punishments and reforming their evil ways, their rebellious character type is such that they become even more hostile, and moreover start directing their feelings of hostility toward the state and the social system. A person suffering from anti-social personality disorder who had committed theft and mugging, for example, was sentenced to forced reeducation through labor, but during his time in reeducation he made the wildly arrogant statement: "It's no big deal for me to spend several years in jail; I'm planning to tussle with the dictatorship of the proletariat and I fully expect to be shot."355 Similarly, people with paranoid personality disorders usually fail to look at problems in a complete and objective way, and if they are dissatisfied with a particular policy this will often develop into a sense of dissatisfaction with the government itself; and once such prejudices have formed in these people's minds it is very difficult to change them.
Perhaps the hardest thing of all to appreciate is that negative political speech and action can, in certain cases, become compulsive in nature. In the compulsive neuroses, this can assume a particular form known as compulsive antithetical thought.356 Whenever people suffering from this condition encounter a particular object or phrase, they feel compelled to react with a diametrically opposite concept or phrase, even if it clashes strongly with their normal understanding of things. With some sufferers, moreover, the compulsive antithetical thoughts extend to politics. In Tsarist Russia, for example, there was a government official who was normally quite timid and nervous, and who always took great pains over his work for fear of offending his superiors; after being criticized on one occasion, however, he developed compulsive antithetical thought syndrome. From then on, whenever his top boss, Ambassador So-and-so, used to enter the hall where important government meetings were being held, he felt impelled to make a speech denouncing the Ambassador for his reprehensible private life and to shout out slogans demanding his overthrow. He knew that if he did this he would bring disaster down upon his head, so he always made an enormous effort to control himself. But these compulsive antagonistic thoughts kept on reemerging time and time again, leaving him in an extreme state of fear and anxiety. After the Tsar was overthrown, the man again became preoccupied with thoughts of attacking and overthrowing a certain leading official of the new government; just as before, these thoughts just kept on recurring and was unable to free himself of their influence.
Provided the content of these compulsive thoughts is not actually expressed or put into action, no real harm can arise. In the course of China's past political campaigns, however, some afflicted people actually gave voice to their compulsive thoughts and intentions, and as a result they were subjected to mass criticism and struggle sessions for displaying "reactionary ideology."357
324 Jia Yicheng, Shanghai Archives of Psychiatry (Shanghai Jingshen Yixue), no.3 (1987) p.118.
325 The author notes elsewhere that the following analysis was based on fifty-seven of the articles presented at the 1987 conference.
326 The Chinese term used is mazui fenxi (drug analysis): this refers to the police practice of drugging criminal suspects before questioning and interrogation, as a means of lowering their level of self-vigilance and inhibition and making them freely "confess." (See also Note 88, above.)
327 This figure appears to be a misprint; it seems to refer to the twelve articles containing comprehensive analyses of actual cases, but since the matter is unclear the original figure has been left unaltered here.
328 Figures as given in the original text; one of the three figures appearing in this sentence seems to be a misprint.
329 In most national jurisdictions, personality disorders are not viewed as sufficient grounds for findings of legal non-imputability in criminal cases; the author's implication here is probably that the detainees in question should have been found fully capable of bearing legal responsibility for their offenses.
330 The final section of this article has been omitted here for reasons of space; it explored in greater detail the questions of murder, injury and sexual offenses by the mentally ill.
331 Shanghai Archives of Psychiatry, vol. (New) 8, no.1 (1996), pp.24-25.
332 For some reason, the article as published did not include the table referred to by the authors.
333 MMPI: the Minnesota Multiphasic Personality Inventory test; WAIS: the Wechsler Adult Intelligence Scale.
334 According to the China Encyclopedia of Public Security (1990), the complete list of official police targets for Ankang psychiatric custody also includes the following category of "mentally ill offenders": "Persons who shout reactionary slogans, or who stick up or distribute reactionary banners and leaflets, thereby exerting an undesirable political influence." (See above Notes 187-188 and accompanying text.)
335 Journal of Clinical Psychological Medicine (Linchuang Jingshen Yixue Zazhi), vol. 6, no. 6 (1996), pp.356-357.
336 The year 1978 saw the emergence of China's first modern dissident groups, focused on the Beijing's "Democracy Wall"; and 1989 was the year of the Tiananmen Square protest movement and the June 4 massacre of peaceful student and worker demonstrators in Beijing.
337 As given in original text; the actual year of publication for this article was 1987, not 1981 as stated. (See Document 8, above.)
338 Liu Baiju, Jingshen Zhang'ai Yu Fanzui (Mental Disorders and Crime), (Beijing: Shehui Kexue Wenxian Chubanshe [Social Sciences Documentary Publishing House], August 2000); the present document is a translation of most of Chapter 7 ("Xiaoji Zhengzhi Yan-Xing") of this recent 857-page, two-volume work. The author, Liu Baiju, is a Researcher at the Chinese Academy of Social Sciences' Bureau of Scientific Research, and a graduate of the law department of Chinese People's University.
339 Zheng Yanping and Yang Desen, "Life Events, Mental Anxiety and Neurosis," Chinese Journal of Nervous and Mental Diseases, no. 2 (1983).
340 Zhang Mingyuan et al., "An Inventory for the Assessment of Life Events: Some Common-Pattern Outcomes," Chinese Journal of Nervous and Mental Diseases, no. 2 (1987).
341 For a detailed account of the political persecution of one of Hu's closest associates, the writer Lu Ling, see above, "Judicial Psychiatry in China and its Political Abuses," Section III.B.
342 Zhang Xiaoshan, "A Fragmentary Reminiscence: In Commemoration of the Fifth Anniversary of the Death of My Father, Hu Feng (Pianduan de Huiyi: Jinian Fuqin Hu Feng Shishi Wu Zhounian)," in Historical Materials on the New Literature (Xin Wenxue Shiliao), no. 4 (1990).
343 "bianren nengli."
344 "Zai neizhong da jiang zhengzhi de shiqi jiu geng shi ruci."
345 Four pages omitted here: Accounts of "mad national leaders" in history, e.g. Liu Xin (a famous homosexual emperor of the Han Dynasty), Hong Xiuquan (leader of the Taiping Rebellion), Caligula, Nero, Emperor Charles VI of France, and Adolf Hitler; also, a discussion of the Western analytical schools of psychohistory (Erich Fromm, Lloyd DeMause) and pathography.
346 Luo Jiming, Li Shenlu and Tang Xiaofeng, "An Analysis of 41 Mental Illness Sufferers Involved in Cases of a Political Nature," Journal of Clinical Psychological Medicine (Linchuang Jingshen Yixue Zazhi), no. 6 (1996). (See Document 10, above, for the full text of this article.)
347 "Dui zhelei huanzhe, ruguo bu jiayi zixi shibie, keneng zaocheng cuo'an."
348 "Fukua feng": The term officially used in China today to denote the tendency by Party officials at all levels during the Great Leap Forward (1958-60) to grossly over-report production statistics (especially grain output) in their localities, as a means of convincing the central government that they were implementing Mao's Great Leap Forward directive to do everything "more, better, faster, and more economically" (duo-kuai-hao-sheng). This wholesale fabrication of production figures is acknowledged to have been the main reason for the disastrous famine that ensued in China in the early 1960s, in which at least 27 million people died of starvation and related causes.
349 Sun Dongdong, Jingshenbingren de Falü Nengli (Legal Capacity of the Mentally Ill), (Xiandai Chubanshe, 1992), p.127.
350 Jia Yicheng, ed., Shiyong Sifa Jingshenbingxue (Applied Forensic Psychiatry), (Anhui Renmin Chubanshe, 1988), pp.192-193.
351 "si bao gongcheng." In 1982, before China's market economy began, citizens were normally not allowed to undertake paid work outside their state-appointed jobs.
352 Lü Xianrong, ed., Sifa Jingshen Yixue Anli Ji (A Compilation of Forensic Psychiatric Medical Cases) (Ankang Hospital of the Wuhan Municipal Public Security Bureau, 1992), p.137.
353 Shen Zheng, Sifa Jingshenbingxue (Legal Psychiatry), (Zhongguo Zheng-Fa Daxue Chubanshe), p.220.
354 Wang Zenghui, "An Analysis of 116 Cases of Forensic Psychiatric Appraisal of the Mentally Retarded," Linchuang Jingshen Yixue Zazhi (Journal of Clinical Psychological Medicine), no. 6 (1996).
355 Li Congpei, ed., Sifa Jingshenbingxue (Forensic Psychiatry), (Renmin Weisheng Chubanshe, 1992), p.322.
356 In Chinese: "qiangpoxing duili siwei," also translatable as "compulsive antagonistic mentality."
357 Li Congpei, ed., Sifa Jingshenbingxue (Forensic Psychiatry), p.270.