Commentary Investigating Psychiatric Abuses

November 1, 2002
Alan A. Stone, MD

Volume 19, Issue 11

Is history repeating itself? Has China taken up the political abuse of psychiatry by adopting the methods that made the Soviet Union infamous? That is the claim now being made by human rights groups who are calling on organized psychiatry to intervene.

Is history repeating itself? Has China taken up the political abuse of psychiatry by adopting the methods that made the Soviet Union infamous? That is the claim now being made by human rights groups who are calling on organized psychiatry to intervene. There is no doubt that China is persecuting members of the Falun Gong sect who are the followers of Master Li Hongzhi.

Police and security forces have broken up peaceful demonstrations by the Falun Gong; members of the sect have been beaten, they have been imprisoned, they have been sent to the Chinese labor camp--equivalents of the Soviet Union's gulags--and, yes, some have been sent to psychiatric hospitals. All of this persecution has been confirmed by reliable journalists, by human rights groups and by the friends and families of Falun Gong members who are laboring to enlist support in the West.

The outgoing president of the World Psychiatric Association (WPA), Prof. Juan J. Lopez-Ibor Jr., M.D., reported that over 500 complaints have been submitted to their Committee for the Review of Abuse of Psychiatry. The WPA met in Yokohama, Japan, this past August and voted to send an investigative team to China. The delegation of Chinese psychiatrists to the WPA supported this proposal. British and American psychiatrists had proposed stronger measures.

The exact parameters of the WPA investigation are unclear; we do not yet know what the Chinese government will allow. The Asia division of Human Rights Watch has already criticized the WPA for not playing hardball and for failing to threaten expulsion if China did not adopt effective remedies.

Based on the evidence currently available, I believe that some members of the Falun Gong indeed have been placed in psychiatric hospitals, not because they have serious mental disorders or because they pose a danger to themselves or others, but because they persist in their deep commitment to Falun Gong and to peaceful demonstrations.

China's severe treatment of the Falun Gong is not about political ideology. The Falun Gong is not a political critic of China's government, and, according to knowledgeable political observers, the Chinese government is now best characterized as a "non-ideological authoritarian" regime. The Chinese authorities are apparently threatened by any group that can mobilize a large demonstration. In 1999, when thousands of Falun Gong members completely surprised the Chinese government by assembling in a peaceful demonstration in front of the leadership compound in Beijing, the police and security forces cracked down ruthlessly. The persecution has only continued.

Human Rights Watch has every reason to be concerned about China's current regime, which has dealt ruthlessly with many of its citizens, as well as the Falun Gong. But there remains a critical consideration for organized psychiatry even if we, as individuals, stand shoulder-to-shoulder with human rights groups in condemning China's violations of human rights. Are China's psychiatrists playing an active role in the political abuses of psychiatry, as Human Rights Watch claims? Or are they fearfully and passively acquiescing to the authorities? I believe the answer to that question should guide organized psychiatry's response to our colleagues in China.

There is a reliable anecdotal account that, in my opinion, gives a partial answer to the question. It comes from a Chinese graduate student of physics now studying in Texas. He reports that his mother, a devoted Falun Gong member, was sent to a psychiatric hospital. Her psychiatrist told family members that his mother was not mentally ill, but that both the psychiatrist and family would get in trouble with the authorities if the mother persisted in going to Beijing to protest. Psychiatrists who know the situation in China believe this is the typical pattern. Psychiatric care in China is limited, and psychiatrists have little professional, political or economic power. They certainly do not have the resources to challenge a regime's oppressive measures.

It is certainly possible that some Chinese psychiatrists are actively and unethically cooperating with the authorities, rather than passively acquiescing or courageously resisting and risking retribution. Robin Munro, the chief spokesperson for Human Rights Watch, asserts that China's psychiatrists have been playing an active role in the persecution of political dissidents in China since the days of Chairman Mao.

It is, of course, well-known that under Mao, China engaged in horrific abuse of its citizens. During the Cultural Revolution, the totalitarian psychological methods of "Thought Reform" were imposed on anyone who opposed Mao or Maoism. Social scientists, psychiatrists, psychologists and other scholars around the world have studied the methods of Thought Reform.

Now Munro claims to have discovered that an influential cadre of forensic psychiatrists were directly involved in those abusive practices beginning in Mao's day and continuing to the present. His reconstruction, in the Human Rights Watch publication Dangerous Minds, of what he calls "the shadowy history of the political misuse of forensic psychiatry in the People's Republic of China" has become the basis of claims that Chinese psychiatrists, and particularly forensic psychiatrists, have adopted the methods of Soviet psychiatry.

Munro has no training in psychiatry and no direct knowledge of psychiatry in China. Nor is his claim based on new documents or recently available archives. He has gleaned his putative evidence from his reading of the published Chinese psychiatric literature. His is a tendentious reading, and he writes about the political abuses of judicial psychiatry in China during decades when there were no judges, no courts, no independent legal system and no forensic psychiatrists. The claim that there is a cadre of Chinese forensic psychiatrists who have adopted Soviet-style political abuses of psychiatry and who wield political power and misuse psychiatry seems without foundation in fact.

It is important to emphasize that even Munro, in condemning China's forensic psychiatrists for decades of political abuse, acknowledged that they were not involved in the recent measures taken against the Falun Gong. This is an important distinction that has been overlooked in the resolutions of organized psychiatry and in the media, where the claims are lumped together under the banner of Soviet-style abuse. There is very good evidence that police and security forces are abusing their plenary powers to relegate some members of the Falun Gong to psychiatric hospitals. There is none to support Munro's claim of Soviet-style abuse.

Based on that distinction, I believe the WPA has taken the right first step in voting to send an investigative team to gather more information. The evidence now available is insufficient to condemn Chinese psychiatrists or to threaten them with expulsion from the WPA.

Human Rights Watch and other groups are reporting significant increases in China's violations of its citizens' rights. Nothing I have written here is meant to diminish those very real concerns.