February 18, 2001
Psychiatric Abuse Reportedly Used to Repress Sect
By ERIK ECKHOLM
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EIJING, Feb. 17 — China's crackdown on the Falun Gong spiritual movement is focusing new attention on Beijing's practice of imprisoning dissenters in psychiatric hospitals. In the government's campaign to discredit Falun Gong, the official press here has openly suggested that believers are mentally disturbed and need treatment. Hundreds of defiant followers have been forcibly hospitalized and medicated, according to reports from Falun Gong and from human rights monitors.
A new report has further stoked alarm abroad by documenting an unexpectedly rich history of questionable psychiatric practices aimed at stifling political dissenters. "But what's surprising now is the sharp increase in cases," said Robin Munro, a British researcher and author of the report, which appeared in the Columbia Journal of Asian Law. He said the rise was attributable to the government's 18-month-old crackdown on Falun Gong, a widespread spiritual movement that the government has condemned as a dangerous cult.
The new attention on China's abuses comes as the country has been trying to burnish its human rights image, hoping to be chosen as the site for the 2008 Olympics. Bush administration officials nonetheless said on Friday that they would condemn China's record at an annual United Nations forum in Geneva.
Apart from the wrenching decade of Mao's Cultural Revolution, which ended in 1976, China has not been known for the systematic abuses of psychiatry that occurred in the Soviet Union, where hundreds of dissidents were spuriously diagnosed as schizophrenic and locked away. And Chinese and Western experts have praised the broader field of psychiatry here for advancing under difficult conditions and becoming more scientific. But with the Falun Gong crackdown, concern over the political misuse of psychiatry is rising. And outside Falun Gong, political cases like that of Cao Maobing, a worker in a state-owned silk mill in Jiangsu Province, have attracted international attention.
Last year, Mr. Cao was in trouble with authorities after he protested against corruption and tried to organize fellow workers into an independent trade union. In December, one day after he spoke with foreign reporters about his complaints, the police took him to a psychiatric hospital, where he has been medicated and forced to undergo electroshock therapy, said relatives and friends who insist that he is not insane but a determined advocate. The hospital director says a committee of 17 experts has declared that Mr. Cao suffers "paranoid psychosis."
Even given such cases, Mr. Munro said official data indicated that China's political use of psychiatric confinement had declined significantly in the 1990's, before Falun Gong was banned a year and a half ago. Now, he said, "the new repression of Falun Gong has sounded a loud warning bell.
"The mental-pathology model is being extended to religious nonconformists," Mr. Munro charged. He calls this a potentially ominous harbinger as China enters an era of rapid social change. That fear is vehemently countered by leading Chinese psychiatrists, supported by some experts in the West, who say the fervent spiritual practices of Falun Gong present a special case.
Mr. Munro's report casts special attention on a secretive, police-managed system of 20 centers for the criminally insane. Critics say those hospitals may harbor the worst examples of political abuse, although they have not generally been used for Falun Gong believers.
Alarmed by the Falun Gong reports and by the evidence in Mr. Munro's article of a broader history of problems than many had realized, medical and rights groups abroad are starting a global campaign to condemn psychiatric abuses in China and to push for access to suspect hospitals by outside experts.
"We hope that outside pressure can end this form of repression," said Robert van Voren, general secretary of the Geneva Initiative on Psychiatry, a coalition of European and American doctors that drew world attention to Soviet misdeeds. "With China's desire to host the 2008 Olympics, I don't think they'll want another scandal," Mr. van Voren said in an interview. The group has started lobbying national psychiatric associations around the world to consider censuring or suspending China at next year's meeting of the World Psychological Association.
But many Chinese psychiatrists, supported by some Western experts, insist that comparisons with the former Soviet Union are misleading and that political malpractice by their profession is uncommon today. "Our biggest problem is not that normal people are diagnosed as mentally ill, but that ill people are not getting the evaluation and treatment they need," said Dr. Tian Zu'en, chief of forensic psychiatry at Anding Psychiatric Hospital, run by the Bureau of Health in Beijing. Dr. Tian said that while there might be a few examples around the country of people in the criminal system having been committed to hospitals without the required scientific evaluation, the problem "should not be wildly blown out of proportion."
Mr. Munro, the report author, said the problem was ultimately rooted outside psychiatry, in China's repression of independent political speech and organizing. "Sane or insane, these people are not committing criminal offenses by international standards," he said. Those who have mental disorders should be treated in a medical rather than a criminal setting, he said.
Mr. Munro hazards a calculation that since 1980, at least 3,000 people who were arrested for some kind of "political" crime were referred for psychiatric evaluation, with many of them deemed mentally ill and confined for some period. "We don't know how many of these people were mentally disordered," Mr. Munro said. "What we know is that the official threshold for doubting the sanity of these individuals is very low."
His review of official documents, Mr. Munro said, indicated that specific types of "political criminals" are most likely to be referred to psychiatrists. These include persistent petitioners, those who shout or post anti-Communist slogans and those who display what the police see as "a perplexing absence of any normal instinct for self-preservation" in the face of certain arrest.
Citing Chinese textbooks, Mr. Munro shows that diagnostic concepts like "political mania" and "litigious mania" have received mention here within the last decade. As a residue of such ideas, he argues, some people who are especially driven or eccentric in their actions may be improperly labeled as psychotic. In Western societies, he said, many of these same people might be seen as odd or even as neurotic or suffering from personality disorders, but forced confinement would not be an issue.
In an example often cited by human rights groups, a politically independent worker in Beijing named Wang Wanxing was diagnosed as a "paranoid psychotic" after his arrest in 1992 for unfurling a pro-democracy banner in Tiananmen Square. He spent the next seven years in a police hospital for the criminally insane. He was sent home in early 1999 and seemed perfectly lucid to acquaintances. But later that year — after he said he intended to hold a news conference to denounce his treatment — he was taken back to the center, where he remains. In response to inquiries from the United Nations, Chinese authorities said an appraisal by hospital doctors "had determined that he was suffering from paranoia, that some of his actions were governed by wishful thinking, that he had lost his normal capacity for recognition and was irresponsible."
Dr. Yu Qingbo, deputy chief of forensic psychiatry at Anding Hospital, said Chinese psychiatrists — including those at the centers run by the police — use diagnostic criteria consistent with those in the West. Both Dr. Yu and Dr. Tian said it was usually not hard to distinguish between a sane, committed political dissident and a person who is lost in delusions. "If true dissidents are sent to us and we falsely claim they are ill, then we can be accused of trying to protect them," Dr. Yu said.
Likewise, Dr. Tian said, it is usually not hard to distinguish between a religious believer in a hypnotic or "altered state" — who is not considered ill — and a person whose ego is shattered. "Around the world, all psychiatrists could agree on that," he said. More difficult to discern, he said, were cases where a person joins a religious sect while in the early stages of developing psychosis, a common phenomenon that can require longer-term observation.
Another psychiatrist here said that abusive practices were more likely outside the major cities, where trained doctors are scarcer and the police may hold greater influence over doctors. Like many experts here, this doctor asked why the authorities would need to resort to psychiatric commitments at all. "They have labor camps everywhere, and they've shown they aren't afraid to use them," the doctor said. "Why go to the trouble and expense of psychiatric confinement?"
A leading Western expert on Chinese psychiatry, Dr. Arthur Kleinman of Harvard University, said the abuses "are lodged mainly in the mental hospitals run by the police."
"Getting observers into that sector is important," he said. "But what I fear is that the entire profession will be unfairly tarnished in what will amount to a global witch hunt."