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Allegations of complicity by Chinese psychiatrists in abuse and persecution of members of the Falun Gong continues to trouble the World Psychiatric Association. Are the steps being taken to learn the truth enough? Dr. Stone provides a look at the events that have unfolded to date.
The plight of the Falun Gong in China is no longer a front-page story in the West, but allegations that Chinese psychiatrists were involved in their persecution continues to trouble the World Psychiatric Association (WPA) (Stone, 2002b). The new China with its political and economic power on the world stage has been able to block investigations by the United Nation's Commission on Human Rights and to brush aside the many vociferous critics of its human rights record. That powerful China was on display for the millions of people who watched the splendid pageantry at the 2004 summer Olympics closing ceremonies in Athens, Greece, as a proud Chinese nation invited the citizens of the world to Beijing for the next summer Olympics in 2008. A triumphal Chinese state with a new younger regime in place and a growing sense of national pride may be more willing to acknowledge past mistakes, but it is unlikely to allow its human rights critics to rake up the many unresolved allegations: Tibetan Buddhism, suppression of the pro-democracy movement and a litany of other serious human rights complaints including the persecution of the Falun Gong (Amnesty International Testimony, 2002).
The WPA, responding to complaints and a resolution of its General Assembly members, had joined the active ranks of China's human rights critics and had been attempting to arrange for an independent investigation of the allegations of systematic political misuse of psychiatry in China. In January, after a meeting in Beijing with representatives of the Chinese Society of Psychiatrists (CSP) and a vice minister of health, the WPA leadership reported that the Chinese had acceded to the Yokohama Resolution and would permit an independent investigation (WPA, 2004). This, if true, was an astonishing achievement; such an agreement was without precedent in China's international dealings.
The WPA executive committee, meeting in Cairo, Egypt, in February 2004, appointed a task force of experts to carry out that investigation. (This writer was included on the task force.) The task force met in London in March 2004 and after reviewing the allegations that had been submitted to the WPA's Review Committee prepared a detailed agenda for its visit that was forwarded to the CSP. The investigation would have included face-to-face interviews with Falun Gong practitioners, their families, the psychiatrists who treated them and an examination of the relevant medical records at various psychiatric facilities. It should be emphasized that the WPA is not an organization with resources, procedures and technical infrastructure to carry out fact-finding investigations nor does it have the authority to subpoena witnesses, collect independent evidence or other similar activities. Nonetheless the task force made a good faith effort to prepare for the independent fact-finding investigation called for in the Yokohama Resolution. It was clear that the success of the task force would depend on the cooperation of not only the CSP but also the Chinese authorities. I must confess that I had many unresolved questions about the enterprise and was particularly concerned that the doctors, patients and families who cooperated with the investigation might suffer reprisals and that the WPA could not assure their protection.
The CSP, late in March 2004 and only days before the task force was scheduled to arrive in Beijing, rejected the proposed agenda. Their response--unlike previous communications with the WPA--took the standard hard-line position that the Chinese state had adopted in responding to all of the previous international criticisms of its persecution of the Falun Gong, namely that this was a domestic criminal matter, not an issue for outsiders. It seemed clear to me that Chinese government officials had intervened and quashed the investigation. The WPA was back to square one, in much the same position that other human rights critics of China had found themselves. The idea of an independent fact-finding investigation as planned by the task force now was out of the question.
Despite their disappointment the WPA leadership did not respond with confrontation or by threatening the CSP with expulsion as some critics might have wished. World Psychiatric Association's President Ahmed Okasha, M.D., remained calm in the eye of the storm. He maintained a cordial relationship with the CSP and was willing to consider alternative approaches. I made certain proposals to him in the hope we could get beyond the impasse. An unprecedented meeting was scheduled between the WPA and the CSP that took place in New York on May 4 (WPA, 2004). With the encouragement of Okasha, I had prepared three resolutions for that meeting in the hope that if there could be no independent investigation, a new approach based on negotiation and conflict resolution might break the stalemate in which China simply denied all allegations. If the CSP could acknowledge that there were, in fact, real clinical problems in the diagnosis and treatment of members of the Falun Gong, then I thought there might be a basis for continuing international collaboration and perhaps constructive change.
The key psychological issue from my perspective was to find a way to allow the CSP to acknowledge that there were serious problems without losing face and without risking reprisals from their own government. This, if it could be done, would provide a basis for continuing collaboration between the WPA and the CSP. Since there could be no independent fact-finding investigation as originally planned, this seemed a small step forward. The CSP--to the surprise of many--agreed in principle to the proposals. Confusing and misleading reports of the WPA and CSP agreement, however, have produced a swirl of controversy and condemnation (Hausman, 2004).
The points of greatest controversy involve the WPA's conciliatory reaction to China's decision not to permit the independent fact-finding investigation, the idea that some secret deal was made, and that language in the reported agreement between the WPA and CSP indicated that the WPA had somehow decided that there was no systematic abuse of psychiatry in China. I shall discuss these matters further but here it should be said that the language about no systematic abuse was not in my proposals. None of the evidence reviewed by the task force would justify such a finding. Okasha, in an editorial "On the China Issue" in October 2004, recently confirmed that understanding. It should be emphasized that some members of the WPA leadership believe that in some sense they are still pursuing the specific objectives of the Yokohama Resolution. My own personal opinion is that the Chinese government has made those objectives impossible and that future collaborations between the WPA and the CSP will require negotiation, not unilateral demands. In what follows, I shall describe the Falun Gong spiritual movement, review the allegations of abuse, and present my own personal views of China's rejection of the task force investigation and the results of the joint meeting with the CSP held in New York.
A chronicle of the Falun Gong's emergence and its relation to other millennial movements throughout the long history of China has now been published (Chang, 2004), and it should provide psychiatrists a more objective understanding of the broader religious cultural issues than was previously available. Chang's explanation, which is similar to that of other experts on China, is that the Falun Gong spiritual/alternative healing movement filled a vacuum that appeared in Chinese life in 1982 with the collapse of Maoism as a coherent ideology, the turn to a market economy that left behind many sectors of the population, and the growing gaps in China's provision of health care to its citizens (Forney, 2001). In less than two decades the Falun Gong movement numbered in the millions. The Internet was the "medium" that allowed the Falun Gong to recruit members across the Provinces of China.
Chang describes the landmark protest of April 25, 1999, when the courageous Falun Gong "defied the state." Jiang Zemin, then president of China, was driven in his personal limousine through the crowd of 10,000 to 16,000 Falun Gong practitioners who gathered unexpectedly for a peaceful demonstration at the high-walled compound in Beijing where the leaders of China work and live. Jiang, peering through the tinted glass windows, was reportedly shocked to see members of the communist party, minor government officials, middle-aged and elderly people; these were not the young political upstarts of the pro-democracy movement who had rallied 10 years before in Tiananmen Square. What Jiang saw for himself was a well-behaved group of older Chinese citizens defying their government, holding in their hands the blue book of their leader, Master Li Hong-Zhi.
Chang has carefully worked her way through Master Li's writings and she characterizes the Falun Gong as a millennial movement, the title of her book is Falun Gong: The End of Days. This is not the prevailing understanding in the West, but it is central to her thesis. The respectability and decorum of the Falun Gong protesters averted an immediate repressive reaction. But in the weeks that followed it became clear to the government that the Falun Gong numbered in the millions, and they were prepared to militantly protest any public derogation of their practices or of their leader. Jiang Zemin, Chang tells us, was well aware that throughout the history of China millennial groups had toppled governments. Chang provides a brief overview extending from the 1st to the 20th century: the Yellow Turbans, the Mahayan Rebellion, the White Lotus, the Eight Trigrams, the Taiping Rebellion, the Boxers. She believes that several of the early communist leaders of the 20th century began in similar groups. Chang's account of this history and the amazingly rapid growth of the Falun Gong in China explain for the first time why Jiang Zemin and the Chinese government embarked on its cruel campaign of persecution against a non-political movement.
If Chang explains what happens, she certainly does not excuse it. With remarkable objectivity she goes through the catalogue of Falun Gong beliefs and practices. Unlike human rights advocates and most of the Western media, she has made it clear that Falun Gong is not just about people practicing a variant of traditional Chinese exercises and abiding by the moral law of Zhen, Shan and Ren (truth, benevolence and forbearance). Those little blue books the Falun Gong protesters were holding contain the revelations of Master Li Hong-Zhi. Li has proclaimed himself divine and only he can teleport the law wheel (the Falun) into the practitioner's body. The Falun with his help will restore youth and health and will get rid of the bad karma.
Li tells his followers, "If I cannot save you nobody else can" (Chang, 2004). He claims to be superior to Jesus and the Buddha Sakyamuni who appeared here on earth, while he is "not of the universe" (Chang, 2004). He has claimed that he can fly, walk through walls and has many other supernatural powers (Chang, 2004). Li's revelations about aliens here on earth and the threat they pose to humanity (e.g., their harmful science with its Western technology and medicine), their goal of obtaining our perfect human bodies and so on are carefully detailed. The dubious reader can confirm or deny Chang's evaluation by consulting the writings of Li that are available on the Web (Hong-Zhi, 1998).
For psychiatrists the crucial lesson in Chang's exposition is that Falun Gong practitioners have accepted Li's teachings as their personal and spiritual reality. For example, they believe--according to those teachings--that Li has implanted the wheel of law into their abdomens and the more advanced practitioners can actually feel it rotating. They feel this even though Li has said the Falun exists in a different dimension. (The Falun is the Buddhist symbol appropriated by the Nazis and known in the Western world as the swastika.) This implanted wheel is the Falun Gong practitioners' indoctrinated and widely shared spiritual belief, not a bizarre somatic delusion. They believe that the wheel is protecting their health and rejuvenating them. Ironically, Chinese psychiatrists unfamiliar with the Falun Gong's teachings have cited the patient's belief that he has a wheel in his abdomen as the obvious proof of their diagnosis that a practitioner was psychotic. Chinese psychiatrists who reviewed these reports failed to recognize these "proofs" as failures to understand the spiritual beliefs of their patients.
Chang identifies Li's revelations as a syncretic blending of Buddhism, Daoism, classical Chinese folk religion, magic and unidentified flying objects. However, she makes it quite clear that the Falun Gong is not the evil cult portrayed by the Chinese authorities. This is a much more balanced and contextual account than was previously available to psychiatrists and it is striking that, in her description of the persecution of the Falun Gong, Chinese psychiatrists are not at the forefront of their government's aggressive measures nor is systematic misuse of psychiatry central to the suppression of the Falun Gong. Furthermore, her account explains why an ethical psychiatrist unaware of Falun Gong beliefs might honestly, if incorrectly, think a practitioner was mentally ill.
As we know from other accounts, Jiang Zemin decided in 1999 to eradicate the Falun Gong (Ping, 2003). To that end the government created a special office, The 610, with plenipotentiary authority to root the Falun Gong out of Chinese society. Laws were passed criminalizing the Falun Gong. A propaganda campaign was initiated at home and abroad that labeled the Falun Gong an "evil cult." The founder of the Falun Gong was declared a criminal and--since he had already fled to the United States--China demanded his extradition. Chinese authorities identified "leaders" of the Falun Gong, arrested them and sent them to prison. Practitioners who nonetheless persisted in gathering and protesting were met with police brutality and sent to temporary holding areas, jails, prisons and labor camps.
China, which had abandoned Maoist ideology, imposed a new more cynical/thought reform: Work and suffer until you repent your Falun Gong practices and belief. Claims of torture by police and by guards in labor camps were widely reported (Carlyle, 2002). Thousands of Falun Gong practitioners were arrested and since the government's conservative estimate was that at least 2 million Chinese had joined the movement there were plenty of potential victims. As the government's oppression increased, Falun Gong resistance became more assertive, practitioners took over a television broadcasting system to get out their own message. The Falun Gong's access to the Internet made possible coordinated efforts with minimal organizational infrastructure. These and similar activities led to additional criminal charges and harsher measures by the government (Carlyle, 2002).
The repression of the Falun Gong in its early stages apparently did not include psychiatric intervention. Psychiatric hospitalization was not the Chinese government's first line of attack on the Falun Gong. Thus the condemnation of China's persecution of the Falun Gong began with allegations that the legislative measures openly taken by the Chinese government constituted persecution of a religion. That indictment was somewhat complicated by Li's insistence that the Falun Gong was not a religion. The Chinese government, in defending its assertion that the Falun Gong was an evil cult not a religion, relied on Li's own repeated statement. Chang's conclusion is that the Falun Gong is not an evil cult but can be considered a millennial religious sect.
But perhaps more important than China's public statements and propaganda was the reality of the new China with its economic and political power. It was that power that made it possible for China to fend off the U.N. Human Rights Commission's investigations, enlisting such unlikely voting allies as South Africa. And China has either threatened economic reprisals or simply shrugged off the repeated condemnations by the United States, many European nations and other supporters of the Falun Gong.
China's persecution of the Falun Gong was obviously not the first occasion for human rights groups to focus on China. The ruthless and bloody suppression of the pro-democracy movement after the student demonstrations in Tiananmen Square in 1989 mobilized China's human rights critics and led to the formation of dedicated organizations like Human Rights in China, who monitored and publicized China's record of human rights abuses. But the members of the pro-democracy movement lacked the solidarity, the commitment and the numbers that the Falun Gong would demonstrate 10 years later (Ping, 2003). Li has claimed 60 million followers in China and 100 million around the world, and they made their cause known around the world. The political and human rights supporters of China's pro-democracy movement, despite some misgivings about Li's belief system and his influence over his followers, rallied behind the campaign to publicize China's persecution of the resolute and highly visible Falun Gong.
One reason the WPA's effort became a focus of so much human rights attention is that more than psychiatry and the Falun Gong was at stake. The WPA was attempting to do what neither the U.N. Human Rights Commission nor any other governmental or nongovernmental human rights group had been allowed to do: conduct an independent fact-finding investigation inside China.
Some proponents of the WPA investigation--relying on an expose by Robin Munro, Dangerous Minds--wanted the task force investigation to go beyond the Falun Gong. They wanted to include China's political dissidents who for decades allegedly have been subjected to Soviet-style psychiatric abuse in special secure institutions known as Ankang facilities that are controlled not by psychiatrists but by China's security officials. Munro claims that psychiatrists, and particularly forensic psychiatrists, have been active since the days of Chairman Mao in the systematic misuse of psychiatry for political purposes (Munro, 2001, 2002). His supporters wanted the WPA to extend its investigative task force in that political direction using the Falun Gong as a Trojan horse for the larger agenda of alleged human rights abuse extending back to the thought reform of Mao now characterized as a form of psychiatric abuse perpetrated by forensic psychiatrists. Many psychiatrists endorse Munro's expose, as do the watchdog groups that are concerned about psychiatric abuse (Mirsky, 2003).
I confess that, in my opinion, it is an account so flawed and misleading that it cannot and should not be relied on as evidence (Stone, 2002a). But putting my personal judgment about the substance of these views aside, it is difficult to imagine how any fact-finding investigation of Munro's allegations involving political dissidents, most of which took place decades ago, could be carried out without the consent and the cooperation of the entire Chinese government, its security forces, military leaders and the major stakeholders in the Chinese Communist Party. Does anyone seriously believe the CSP, at the behest of the WPA, has the power and influence to demand that from its government?
In stark contrast to Munro's allegations about the treatment of political dissidents constructed from his layman's reading and tendentious extrapolations of Chinese psychiatric publications were the hundreds of contemporaneous reports of psychiatric abuse of the Falun Gong. These reports identified specific Falun Gong practitioners, named psychiatric hospitals, the medical personnel involved and what allegedly had been done to these people in the hospital. There were too many of these complaints and too much in them to be ignored by responsible psychiatrists concerned about the ethical standards of their profession. This must be said even if one takes into account the fact that under the law of China in force at the time, Falun Gong practitioners were criminals who insisted on continuing their criminal pursuits, that all Chinese citizens had been called on to condemn the Falun Gong as an evil cult, that the majority of Chinese psychiatrists had little or no understanding of the Falun Gong's beliefs, and that those who did know about it considered Li a madman who was leading his followers into madness.
Working with three Harvard Law student research assistants I reviewed hundreds of accounts of Falun Gong psychiatric abuse reported from all over China. (These reviews were done before I was appointed to the WPA task force.) The pattern of hospitalization differed in different provinces and did not suggest the implementation of a uniform government policy. A significant number of the reported cases were Falun Gong practitioners who had been sent on from labor camps where they had suffered terribly. They may well have been tortured and then dumped in psychiatric hospitals as an expedient disposition. The hospitalizations were initiated not by psychiatrists but by local security forces and the local authorities. There were reports of Falun Gong practitioners who were rounded up and brought in groups to psychiatric hospitals. Some were taken from protests, others from trains as they persisted in their attempts to go to Beijing to protest. Family members who felt threatened by the authorities brought others. The Falun Gong hospitalizations certainly did not follow the pattern of Soviet psychiatry portrayed by Munro in Dangerous Minds, no forensic psychiatrists were involved and the patients were not being sent to the special Ankang facilities. Putting Munro's claims aside, the Falun Gong reports of psychiatric abuse posted on the Web and compiled in pamphlets established a practical basis for a factual investigation. Even that proved problematic.
None of the U.S. government or academic experts on international law with whom I consulted believed that China would permit an independent fact-finding investigation even if narrowly limited to the allegations of psychiatric abuse of the Falun Gong. Letting a delegation of the WPA into their psychiatric facilities with a license to interview anyone we chose would open doors that China's government wanted to keep closed for the foreseeable future. The experts proved right, as China's rejection of the independent investigation in March 2004 demonstrated. My own opinion is that the WPA made the mistake of thinking that a vice minister of health had the authority to finally decide such an unprecedented and important political matter.
There is, however, reason to believe that in 2004 the Chinese government is easing in its repression of the Falun Gong. A leading spokesperson for the Falun Gong in the United States personally reported to me that the new Chinese leadership (Jiang Zemin is no longer in control) recognizes that the Falun Gong is not a political threat and should be distinguished from the pro-democracy movement. It is also clear that China's cruel campaign against the Falun Gong seems to have worked and therefore government concern has lessened and for a variety of reasons public opinion in China has turned against the Falun Gong. Falun Gong protest in China has decreased based on a continuing review of Internet reports and there has been a significant decline in new allegations of punitive measures and forced psychiatric hospitalizations. Furthermore, the CSP, which is controlled by the state, has for the past three years shown itself willing to investigate the alleged Falun Gong abuses. Now they are willing to work with the WPA to remedy the mistakes of the past. It may seem to be too late and too little for those who suffered, but it may now be possible for the CSP, with the help of the WPA, to protect Falun Gong practitioners from further psychiatric abuse.
The history I have recounted above is largely drawn from my own academic research; my efforts took a different direction when I was appointed to the WPA task force to investigate the allegations. The mandate to the task force was based on the resolution of its General Assembly members taken in 2002 at the WPA meeting in Yokohama, Japan. But the mandate was far from detailed or specific and it included both the Falun Gong and the Munro allegations.
The CSP, at the WPA's request, had for several years been diligently and in good faith reviewing the psychiatric evaluations of the reported cases of alleged abuse of Falun Gong practitioners in China's psychiatric facilities. Those reviews were shared with the task force and seemed to me to be a serious good faith effort. In addition, a visiting Chinese scholar at Harvard Law School had provided me with an English translation of the first published Chinese forensic psychiatric study of several Falun Gong patients. It was clear from both these sources that responsible Chinese psychiatrists had mistaken the unusual beliefs of Falun Gong practitioners as evidence of delusions. The most blatant example, which I have already described, involved the wheel of law they could feel in their abdomens; other reports made it clear that some Chinese psychiatrists were convinced that anyone who believed Master Li Hong-Zhi had to be crazy themselves. The evidence that there had been a serious problem in Chinese psychiatrists' diagnosis and treatment of Falun Gong practitioners could be documented in their own studies that included such reports. Based on this information previously unavailable to me about their own documentation of the misdiagnosis and mistreatment of Falun Gong practitioners, I hoped they would be able to acknowledge the problem without losing face.
My first motion therefore asked the CSP to acknowledge publicly, based on their own studies, that Falun Gong practitioners had been misdiagnosed. The second motion asked the CSP to acknowledge that as a result of such misdiagnoses, Falun Gong practitioners had in fact been mistreated with antipsychotic medications. There was no mention of the number of such cases. Frankly, I had no idea how many there were, my goal was not to identify and punish miscreant psychiatrists but to have the CSP acknowledge the Falun Gong abuse problem in principle as a basis for future good faith collaboration. The acceptance of those motions by the CSP was a small but I believe a significant step forward in a controversy that had dragged on for several years and was then at an impasse. Nothing, however, in these motions addressed the allegations of "systematic political misuse of psychiatry." In fact my own judgment based on the review of the allegations was that provincial Chinese authorities had used psychiatric hospitals as one disposition for stubborn Falun Gong practitioners and that some psychiatrists had at least acquiesced in this systematic abuse.
The third proposal I made was an attempt to begin to address that crucial question in the collegial spirit of collaboration/negotiation rather than as a prosecutorial investigation. As I have described, there were reports that on certain days in certain provinces a number of Falun Gong practitioners had been involuntarily hospitalized at about the same time. Those situations seemed to offer the best opportunity for evaluating the allegations of systematic political misuse. How had those Falun Gong practitioners been evaluated by psychiatrists and what medical basis was provided for their involuntary treatment?
In my third motion I proposed that this be a collaborative endeavor with the CSP assembling and providing the necessary psychiatric records and examining them with the WPA task force experts. A friendly amendment was made by one of the WPA officers who suggested that this collaboration take place in the context of a joint educational meeting rather than as an investigative event. In that cooperative spirit the CSP accepted the third proposal. The planned meeting as I understood it would specifically keep the issue of systematic political misuse of psychiatry open and also would strengthen the WPA's working and educational relationship with the CSP and with China's psychiatrists, many of whom lack the training and resources to provide their vast population quality care.
It should be clear from this account that no secret deal was hammered out between the leaders of the WPA and the CSP. The CSP certainly never asked for language about no systematic political abuse and that was not in the proposals that I made. Unfortunately, my proposals were neither included in the minutes of the meeting nor accurately reproduced in the reported agreement. As noted earlier, some of the WPA leadership wanted to believe that the agreement kept them on a course that would fulfill or had only postponed the factual investigation of the Yokohama resolution. This spin added to the confusion in reports about the agreement and what it meant.
China did refuse to permit the open-ended independent investigation anticipated by the Yokohama Resolution, and the WPA did accommodate to that refusal. My opinion, guided by those who know much more about China, is that the CSP had very little political leverage and would have been unable to obtain their government's consent if pressed by the WPA. Thus if the WPA leaders had insisted, the outcome would have been the CSP's resignation or expulsion from the WPA. That is the result some WPA critics are now in fact demanding.
The WPA's effort to maintain a collaborative relationship with the CSP and to work with them on the Falun Gong problems rather than precipitate a confrontation and the expulsion of China will understandably disappoint some psychiatrists and many human rights advocates. The harshest critics believe that some Chinese psychiatrists systematically tortured Falun Gong practitioners and that these malefactors should be identified and punished (China Psychiatric Watch, 2004). Others, who accept Munro's allegations, believe that there is a large network of forensic psychiatrists who have been engaged for decades in the systematic political misuse of psychiatry. Unfortunately, the Chinese government will not permit the kind of investigation necessary to prove or disprove these allegations. As we have seen in so many other parts of the world, independent fact-finding about human rights violations seems to require regime change. The fundamental problem that the WPA now faces is whether it can investigate allegations, conduct fair hearings and enforce the ethical standards of the Declaration of Madrid. The lesson of China is that in some situations the WPA has neither the legal authority nor the resources to do this without the permission and assistance of government officials.
I am not a member of the WPA and my account certainly carries no stamp of official authority; hopefully it has shed some light on the problems and the agreement. As I understand the organizational structure and rules of the WPA, its General Assembly could still insist on voting to expel the CSP from the WPA. It is worth emphasizing, however, that around the world in national and international conflicts the parties are increasingly turning to negotiation, mediation and conflict resolution. This approach seems much more in keeping with the values of the psychiatric profession than persisting in the punitive and adversarial approach of legal prosecutors on which the WPA had embarked and which the government of China would not permit.
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