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China’s Psychiatric Terror

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At its triennial congress in Yokohama last September, the World Psychiatric Association (WPA) overwhelmingly voted to send a delegation to China to investigate charges that dissidents were being imprisoned and maltreated as “political maniacs” both in regular mental hospitals and in police-run psychiatric custodial institutions known as the Ankang. (The word literally means “Peace and Health.”)

The WPA’s vote was a direct result of Dangerous Minds, written for Human Rights Watch and the Geneva Initiative on Psychiatry by Robin Munro, and one of the most revealing books about China in many years. Many of the leading figures in the WPA acknowledge that Munro’s ground-breaking research lies behind the association’s negotiations with Chinese psychiatrists over the last year and its decision to send a delegation to China. What Mr. Munro’s eloquent and convincing study reveals is that from the 1950s onward not only Chinese dissidents but people who submitted petitions to the authorities have been detained by the police, examined by psychiatrists, and found to be criminally insane—or, if found mentally “normal,” designated as criminals to be cast into the prison system.

Once in China the members of the WPA delegation intend to visit several of the secret Ankang mental hospitals where dissidents are confined—they are in more than a dozen large cities—and to form their own professional judgments of the conditions of the inmates. It would be useful, although it is unlikely to happen, if the delegation were able to come face to face with some of the inmates described in Munro’s book.

The Chinese Society of Psychiatrists (CSP) is a member of the WPA, which represents psychiatric organizations in 119 countries, with 150,000 psychiatrists. China is bound, in principle, to adhere to the articles of the association’s 1996 Madrid Declaration, which forbids introducing political judgments in psychiatric diagnosis.

But a question immediately arises: Will this Western-dominated medical association, which has been mainly concerned with professional standards and behavior, be any match for an authoritarian government that puts security, order, and secrecy before human rights? Both the WPA’s past president, Juan Lopez-Ibor, in his visit to China last February, and the vote last September in Yokohama made it plain to Beijing that psychiatrists throughout the world want the WPA to conduct a thorough investigation of the allegations of psychiatric abuse. But in its official statements about contacts with Beijing the association is proceeding cautiously, if not timidly. It is essentially limiting the concerns of what the CSP calls its “educational” visit next year to China to treatment of the members of Falun Gong, the religious and meditative group that since 1991 has been proscribed as criminal. Its members, when imprisoned, are often treated as criminally insane.1

The WPA’s self-imposed limitation ignores the hundreds of political dissidents who are confined in the Ankang psychiatric hospitals run by the public security organs and who are the main subject of Munro’s book. The psychiatrists who staff these institutions, Dangerous Minds shows, tend to assume that their patients are mad because of their political beliefs or actions. The diagnoses made in both the political dissident and Falun Gong cases, ranging from “delusions of reform” to “paranoid psychosis,” are highly reminiscent of the long-discredited label of “sluggish schizophrenia” that the Soviets used to apply to their dissidents and religious nonconformists.

At the Yokohama meeting, according to one report, “Lopez-Ibor said the team must have the right to inspect wherever and whenever it wants.” But he also conceded that China has the final say. “We don’t have the possibility to visit all the hospitals one by one,” he said. “We need some green lights from the Chinese health authorities.”

What we want is that the people who go have the freedom to do what they want,” he told Reuters. “It would be a disaster if the [mission] goes there and comes back with more questions than answers.”

It is, however, unlikely that visits will be permitted except under tight control by Beijing, which has officially denied as “sheer nonsense” the allegations of Human Rights Watch and the Geneva Initiative. On October 4 the official New China News Agency, Xinhua, stated that

the State Council Information Office held a press conference at which it rejected as a “vicious slander” claims at “international conferences” that China has used psychiatric treatment to perse-cute “dissidents” and “Falun Gong followers.

This statement will make it still harder for the WPA to insist that it be permitted to interview detainees in the Ankang during any visit it makes. Asked if China had received a request from the WPA to send a mission, the Foreign Ministry spokesman said, “No. I have not heard about this.” The spokesman was either lying or unaware of the facts. According to an internal WPA memorandum circulated at the Yokohama meeting, “The WPA President met in Beijing in early 2002 with the CSP and with the Chinese Deputy Minister of Health.”

Robin Munro, a key figure at the Yokohama congress, is the preeminent researcher in the field of Chinese human rights. He is the coauthor of a thoroughly documented exposé, which Beijing condemned, of the shocking state of Chinese orphanages, and a comprehensive directory of political and religious prisoners, both published by Human Rights Watch. Dangerous Minds is his most impressive work to date. It documents more than fifty years of political repression and what many international medical experts strongly suspect is politically motivated psychiatric malpractice. Dr. Paul Appelbaum, president of the American Psychiatric Association, told me recently: “But for Robin Munro’s work, none of this would be happening. Munro is the only person to have presented persuasive evidence on the basis of which action could be taken.”

Well before the Yokohama congress, in July 2001, Britain’s Royal College of Psychiatrists resolved that

bearing in mind the available evidence that political dissidents in the People’s Republic of China (PRC) are being systematically detained in psychiatric hospitals… the World Psychiatric Association [should] arrange a fact-finding visit to the PRC.

This resolution was presented at Yokohama but not voted on. It was evidently regarded by the WPA’s leaders as too harsh in advance of the visit to China supposed to take place next year.

This is the WPA’s conundrum. Its leadership is keen to avoid the uncertainty and timidity which for years prevented the organization from confronting the Soviet psychiatric persecutions, which continued into the late Eighties. Dr. Lopez-Ibor insists that the WPA action on China “is not comparable at all with the Soviet issue in which the confrontation between the WPA and the All Union Society of Psychiatrists and Narcologists was total.” In a letter to me he wrote:

The Chinese Society of Psychiatry is collaborating with the WPA Review Committee in collecting the information. They have gathered data on the cases of the Munro book plus a list of over 200 other cases submitted by the WPA. This information is now being considered by the WPA Review Committee. The Chinese Society of Psychiatrists has accepted the ethical principle of the WPA as stated in the Declaration of Madrid.

In his letter Dr. Lopez-Ibor stressed that Falun Gong will be the focus of the WPA investigation. “As you see, the process of analyzing the alleged cases of abuse of psychiatry on Falun Gong practitioners is open and…the WPA has [so far] been able to get support from our local Member Society,” i.e., the Chinese Society of Psychiatrists. In other statements, the WPA speaks of five hundred Falun Gong cases. “Up to this point, we have had good cooperation with the Chinese,” according to Dr. Marion Kastrup, outgoing chairman of the Committee for the Review of Abuse of Psychiatry and director of the Institute for Trans-Cultural Psychiatry in Copenhagen. “We have to look at files and talk with persons. We must obtain entry to China and permission to study whatever we need to study.”

Dr. Lopez-Ibor’s and Dr. Kastrup’s assurances do not fill one with confidence. While members of Falun Gong are indeed detained in mental hospitals in large numbers, it seems unjustifiable for the WPA to exclude virtually all the other political detainees about whom Mr. Munro provides so much evidence. For the past twenty years psychiatric malpractice has, according to Munro, concentrated on at least three thousand political dissidents. Munro derived this figure, which he thinks is probably too conservative, from numerous officially published studies and statistics on “political cases” dealt with by Chinese “forensic psychiatrists”—i.e., psychiatrists concerned with applying the law—since the late 1970s.

As for the current negotiations, Munro pointed out to me that the Chinese Society of Psychiatrists is relatively powerless compared to the Chinese government’s Public Security Bureau, which does most of the actual psychiatric committals of dissidents and Falun Gong activists. The Chinese government’s single-minded objective, in Munro’s view, is to deny all the allegations, “disprove” them by means of a controlled WPA mission (if such a mission takes place), and thereby win the public relations battle. Professor Arthur Kleinman of Harvard, a leading expert on Chinese psychiatric practice, told me that Ankang visits will not take place because the authorities will not permit them. Dr. Mike Shooter, the president of the Royal College of Psychiatry, which said last year that the visit must be “an inspectorate and not a collegiate one,” told me:

If the Chinese government refuses any part of the WPA protocol for a truly open visit [i.e., by a team chosen by the WPA, independent of the Chinese government or local organizations, and with free access to inspect any institution or talk to any person they wish] then I personally feel that the WPA should call an extraordinary meeting of its member organizations or their representatives specifically to discuss what action it should take.

Robin Munro, mindful of how long it took the WPA to expel the Soviet Union’s psychiatrists, is aware of the organization’s difficulties in dealing with one of its members. “The important thing,” he told me,

is to remember that the WPA has been mandated by the entire membership at Yokohama to conduct a full investigation; they have their own Madrid Declaration breathing down their necks, and they have to report back on progress at the American Psychiatric Association’s annual meeting in San Francisco next May. If they can’t give the right answers, such as whether or not they actually had access to Ankang facilities, or indeed to any psychiatrically detained dissidents or Falun Gong activists so they could be independently medically examined, but at the same time try to claim that they’ve received full cooperation from the Chinese side in the investigation, they’ll be heavily criticized at San Francisco. The British and American member societies would probably insist that China’s continued membership in the WPA be opened up for reconsideration. It would take some time, but in the end China could well be expelled from the WPA on the grounds of manifest non-cooperation in the investigation.

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    See “Dangerous Meditation: China’s Campaign Against Falungong” (Human Rights Watch, 2002, available at www.hrw.org).

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