articles/judicialpsychiatry2001.pdf
site of complete but permission protected article
China's Judicial Psychiatry
The use (and abuse) of mental-health treatment.
BY ROBIN MUNRO
Tuesday, June 19, 2001 12:01 a.m. EDT
All countries have valid and necessary reasons for detaining certain criminally active members of their mentally ill populations (notably psychotic murderers, arsonists and rapists) in secure psychiatric hospitals. This also holds true in China where there are officially some 10 million mentally ill people, of whom some 10% to 20% are regarded as posing a "serious danger" to society.
But China also applies its "serious danger" criteria to those whom the government deems a political threat to "social order." As a result, thousands of political and religious dissenters, including urban dissidents, exposers of official corruption, persistent complainants and petitioners, and unconventional religious sectarians, have in recent decades been forcibly and unjustifiably incarcerated in mental asylums. Under internationally agreed standards of legal and medical ethics defined by the United Nations and the World Psychiatric Association, peaceful religious or political dissidents are emphatically not considered as belonging to this highly select category of the criminally insane. While these abusive practices seemed to have declined since the late 1980s, there has been a conspicuous resurgence lately in the case of detained adherents of the Falun Dafa spiritual movement and others.
Moreover, little known to the outside world is China's network of some 20 special Ankang--"Peace and Health"--institutions for the criminally insane, administered and run by the Ministry of Public Security and its subordinate provincial-level departments. Arrested political dissidents and others in similar categories brought for assessment by the State's forensic psychiatrists are often officially treated as ranking among the most "serious and dangerous" of all alleged mentally ill offenders, and are thus prime candidates for compulsory and indefinite committal in these secretive institutions.
The Chinese misuse of psychiatry for purposes of political repression mimics similar practices by the former Soviet Union, where the incarceration of political dissidents during the 1970s and '80s aroused widespread concern in the West. However, officially published legal-psychiatric professional literature in China from the 1950s to the present day, viewed in conjunction with a growing number of independent case accounts, indicate that the Chinese authorities may well have exceeded in scope and intensity the thoroughly documented abuses of psychiatry that occurred in the former Soviet Union prior to 1990. In essence, these practices involve not only the criminalization of dissent, but also an attempt by the State, in a significant minority of cases, to additionally "medicalize" the problem.
Chinese forensic psychiatry has gone through several distinctive stages of development since the founding of the People's Republic in 1949. During the 1950s, Soviet influences (characterized by the now widely deplored range of unorthodox clinical theories whereby particular forms of political and religious dissent were attributed to certain specific varieties of "dangerous" mental illness) dominated. During the Cultural Revolution decade (1966-76), when human psychology was officially repudiated and "correct" political ideology was equated with mental health in general, an estimated 50% to 70% of psychiatric appraisals of criminal detainees in areas including Shanghai were categorized as "political in nature."
In the 1980s, the reform era of Deng Xiaoping seems to have allowed for a return to the more low-level psychiatric abuses typical of the pre-Cultural Revolution period. And at first, the 1990s appeared to see a significant decrease in politically directed psychiatry. But scattered reports soon began to indicate that individual dissidents and other political nonconformists were again being subjected to forensic psychiatric appraisal by the police and then committed to special psychiatric hospitals on an involuntary and indefinite basis. By the end of the decade, there had been a substantial resurgence of abusive practices in the case of Falun Dafa followers, free trade unionists and others.
One of many examples is that of Xue Jifeng, an unofficial labor-rights activist who in December 1999 was detained by police in Zhengzhou, the capital of Henan province, for attempting to hold a meeting with other labor activists and independent trades-unionists. He was then committed involuntarily to the Xinxiang Municipal Mental Hospital, where he remained until July 2000. Mr. Xue was reportedly being force-fed psychiatric drugs and held in a room with mental patients who kept him awake at night and harassed him by day. This was his second forced term in a mental hospital for "illegal" labor activities.
More recently, another labor organizer, Cao Maobing, was committed by police to a mental hospital in Jiangsu province. He was arrested after speaking with foreign reporters about his complaints, and has since been medicated and forced to undergo electric shock therapy. The hospital's director has said that a coterie of experts has found that Mr. Cao suffers from "paranoid psychosis."
Central to the campaign to crush Falun Dafa, aside from its sheer scope and brutality, has been the large numbers of the group's practitioners who have allegedly been forced into mental hospitals by the police. Overseas Falun Dafa support groups have documented well over a hundred such cases, while overall estimates of the total number dealt with by the authorities in this way is around 600. Three of those sent forcibly to mental asylums are reported to have died as a direct consequence of the ill treatment they received.
Why would any repressive regime resort to such elaborate and often costly measures against a certain number of its political and religious opponents when there are other much simpler methods of neutralizing them--for example, execution or lengthy imprisonment? One possible reason is that in post-Mao China, as in the Soviet Union after Stalins's death, the former totalitarian solution of physically liquidating political enemies was ended by the emergence of reformist leaderships dedicated to the curtailment of past policy "excesses."
For dissidents of various kinds, arrest no longer meant execution, but rather long terms of imprisonment from which they had a reasonable chance of emerging alive; a sustained dissident network or movement therefore could, and did, come into being in both the Soviet Union and China after the deaths of their respective "great dictators." For successor authorities such as Nikita Khrushchev and Deng Xiaoping, however, this represented an unwanted complication of their new "liberalizing" dispensations; more elaborate and sophisticated mechanisms of inducing long-term fear in the enemies of the State thus had to be found.
Historically, there are few more potent deterrents to dissident activity of any kind than the threat of permanent or semi-permanent forced removal to an institution for the criminally insane. Furthermore, psychiatric labeling of this kind serves to stigmatize and socially marginalize the dissident in a way that regular criminal imprisonment, in the present era at least, often fails to do.
Another likely reason is the Chinese leadership's growing concern with its international image and prestige. Naked repression as conducted in the old days has become a source of increasing international embarrassment for the government. Hence, the former overtly political crimes of "engaging in counter-revolution" have been relabeled with the more internationally acceptable rubric of "crimes endangering state security," while particularly flagrant or uninhibited political or spiritual protestors, such as members of the Falun Dafa, are officially sometimes seen as ill (rather than necessarily ill-intentioned) and thus sent to mental hospitals to be "treated," rather than simply jailed as before.
A second target of psychiatric abuse in China, historically, has been the legions of petitioners, complainants and "whistleblowers" who regularly appeal to the authorities to redress their grievances. As China continues to develop its legal system and expand the principle of rule by law, and as ordinary Chinese become more conscious of their rights, so-called "dangerous" behaviors of this kind are bound to increase. Similarly, although for somewhat different reasons, religious sectarianism is now rapidly on the rise, and the authorities' recent extension of the "mental pathology" model to significant numbers of Falun Dafa adherents thus further lengthens the shadow over any hopes or optimism that political psychiatry may anytime soon disappear from the Chinese law-enforcement scene.
The challenge for the international psychiatric community now is to find ways to exert its influence to ensure that China's Ankang system and other custodial psychiatric facilities around the country can no longer be used by the security authorities as a long-term dumping ground for political and religious nonconformists who, for various reasons, are not brought to criminal trial.
Similar efforts came to fruition in the case of the Soviet Union. By 1983, a protracted campaign by Western psychiatric professional bodies and international human rights organizations led to a decision by the Soviet All-Union Society of Psychiatrists and Neuropathologists to withdraw from the World Psychiatric Association in order to avoid almost certain expulsion. It was not readmitted to the body until 1989, after several years of perestroika and the preliminary establishment of direct access by Western psychiatric delegations to Soviet forensic-psychiatric institutions and their alleged mentally ill political, religious and ethnic inmates.
As an indispensable first step towards helping the Chinese psychiatric profession divest itself of this unethical legacy, both the World Psychiatric Association and its constituent national professional bodies should begin seeking direct access to the Ankang network and other places of psychiatric custody, with a view to independently monitor conditions and practices therein. Advocacy efforts by local and international psychiatric bodies would also greatly assist in encouraging individual Western governments and the European Union to take up the issue of political-psychiatric abuse in China, notably by placing it on the formal agenda of the various bilateral human-rights dialogue sessions that have become, in recent years, a central and regular feature of Sino-Western relations.
Mr. Munro is a senior research fellow at the Law Department and Center of Chinese Studies, School of Oriental and African Studies (SOAS), University of London. His article "Judicial Psychiatry in China and Its Political Abuses" has just been published in the Columbia Journal of Asian Law.
Judicial psychiatry in China and its political abuses
Robin Munro
During the 1970s and 1980s, reports that the security authorities in the Soviet Union were incarcerating substantial numbers of dissidents in mental asylums aroused widespread concern in the West. As the quantity and reliability of the documentary evidence and victim testimonies steadily increased, the issue of politically directed psychiatry in the Soviet Union quickly became, along with political imprisonment and the refusal of the authorities to allow Soviet Jews to emigrate, a third principal item of human rights contention in Soviet-Western relations. By January 1983, a protracted campaign by Western psychiatric professional bodies and international human rights organizations led to a decision by the Soviet All-Union Society of Psychiatrists and Neuropathologists to withdraw from the World Psychiatric Association in order to avoid almost certain expulsion. It was not readmitted to the body until 1989, after several years of perestroika and the preliminary establishment of direct access by Western psychiatric delegations to Soviet forensic-psychiatric institutions and their alleged mentally ill political inmates.
The subject of forensic psychiatry in China has thus far received little academic attention outside of China. A number of very detailed and informative studies of China's general psychiatric and mental healthcare system have been written, but these have rarely addressed the legal or forensic dimension of the topic in significant depth. In particular, very little documentary or other evidence has hitherto come to light suggesting that abusive practices similar to those that occurred in the former Soviet Union might also have existed, or might even still be found, in China. The general assumption has therefore been that the Chinese authorities, despite their poor record in many other areas of human rights concern, have at least never engaged in the political misuse of psychiatry. This article seeks to challenge and correct that assumption.
From the early 1990s onwards, scattered reports from China began to indicate that individual dissidents and other political nonconformists were being subjected to forensic psychiatric appraisal by the police and then committed to special psychiatric hospitals on an involuntary and indefinite basis. One prominent example was that of Wang Wanxing, a middle-aged worker who had first been arrested in the mid-1970s for supporting the then officially denounced policies of Deng Xiaoping. Partially rehabilitated after the death of Mao, Wang resumed his political-activist career in the 1980s and became personally acquainted with the student leaders of the spring 1989 pro-democracy movement in Beijing. In June 1992, he unfurled a banner in Tiananmen Square calling for greater human rights and democracy in China, was immediately arrested, and then sent to an institution for the criminally insane in the outskirts of the capital, where he remained - diagnosed by police psychiatrists as a "paranoid psychotic" - until early 1999. In November of that year, after he announced his intention to hold a press conference with foreign journalists to discuss his ordeal, he was again detained and sent back to the same psychiatric detention facility for an indeterminate period. Wang's case and others like it have been the subject of several statements of concern to the Chinese authorities by relevant bodies of the United Nations.
Another recent example is that of Xue Jifeng, an unofficial labor-rights activist who in December 1999 was detained by police in Zhengzhou, the capital of Henan Province, for attempting to hold a meeting with other labor activists and independent trades-unionists. He was then committed involuntarily to the Xinxiang Municipal Mental Hospital, where he remained as of December 2000. Xue was reportedly being force-fed psychiatric drugs and held in a room with mental patients who kept him awake at night and harassed him by day. Moreover, this was his second forced term in a mental hospital for "illegal" labor activities. The first came in November 1998, after he tried to pursue legal action against local Party officials who he alleged had swindled, through a bogus commercial fundraising scheme, thousands of his fellow residents of their life savings. On that occasion, more than 2,000 people staged a public demonstration in Zhengzhou demanding their money back and calling for Xue's release.
Finally, in July 1999, the Chinese government launched a major and continuing campaign of repression against the Falun Gong spiritual movement, a neotraditional sectarian group, several months after the group staged a massive peaceful demonstration outside the Zhongnanhai headquarters of the Chinese leadership. Over the past year or so, numerous reports have appeared indicating that practitioners of Falun Gong were also being forcibly sent to mental hospitals by the police authorities. The overseas Falun Gong support network has so far compiled details of around 100 named individuals who have been dealt with in this manner, while overall estimates suggest the total number may be as high as 600. To date, reports indicate that three Falun Gong practitioners have died as a direct result of their detention and mistreatment in Chinese mental asylums.
These disturbing cases highlight the need for a comprehensive reexamination of our previous understanding of the role and purposes of forensic psychiatry in China, both historically and contemporaneously. All countries have valid and necessary reasons for detaining certain criminally active members of the mentally ill population (especially psychotic murderers, arsonists, and rapists) in secure psychiatric hospitals. This also holds true in China where there are officially said to be around 10 million mentally ill people in the country, of whom some ten to twenty percent are regarded as posing a "serious danger" to society. Under internationally agreed standards of legal and medical ethics, however, peaceful, religious, or political dissidents are emphatically not considered as belonging to this highly select category of people.
An extensive study of the officially published legal-psychiatric professional literature in China from the 1950s to the present day, viewed in conjunction with the growing number of independent case accounts of the kinds outlined above, has now produced a substantial amount of documentary evidence to indicate that the Chinese authorities have, in fact, a longstanding record of the misuse of psychiatry for politically repressive purposes, one that resembles in all key respects that of the former Soviet Union, and one, moreover, that may well have exceeded in scope and intensity the by now thoroughly documented abuses that occurred in the latter country prior to 1990. It should be stressed at the outset that the extent to which China's psychiatric profession as a whole is complicit in the legal-psychiatric abuses described in this article remains unclear. It seems likely that these abuses are confined mainly to those working within the sub-specialist domain of forensic psychiatry, a small and still secretive field of which most regular Chinese psychiatrists may have little direct knowledge or experience.