JUDICIAL PSYCHIATRY IN CHINA AND ITS POLITICAL ABUSES²³

I. INTRODUCTION

In the Soviet Union today, whoever takes a proletarian standpoint, upholds Marxism-Leninism, and dares to speak out and resist is...arrested and imprisoned, or declared `mentally ill' and thrown into `lunatic asylums.'

- People's Daily, 1964²⁴

The content of Zhu's "theories" was conceptually chaotic... [They were] a form of "political delusion," a pathological mental disorder...

- Chinese forensic-psychiatric case report, March 1987

Without a correct political standpoint, one has no soul.

- Mao Zedong

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.²⁵ 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.²⁶

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,²⁷ but these have rarely addressed the legal or forensic dimension of the topic in significant depth.²⁸ 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.²⁹

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 until June 2000. Xue was reportedly force-fed psychiatric drugs and held in a room with mental patients who kept him awake at night and harassed him by day.³⁰ 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.³¹

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,³² 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.³³ 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.³⁴ 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.

The present article is an attempt to reconstruct the shadowy history of the political misuse of forensic psychiatry in the People's Republic of China - its antecedents and influences, general nature and overall scope and extent - and also to assess the degree to which it remains a problem in China today. The article comprises the following main themes and sections. The first is an overview of the origins and development of Chinese forensic psychiatry through the country's main historical periods since 1949, with a focus on the 1950s, during which Soviet influences predominated; the Cultural Revolution decade (1966-76), when political psychiatry reached its absurd apogee; the 1980s, when the reform era of Deng Xiaoping seems to have meant, for forensic psychiatry, a partial return to the orthodoxies of the pre-Cultural Revolution period; and the 1990s, which appeared to see a significant decrease in politically-directed psychiatry in China, only to be followed, at the end of the decade, by a substantial resurgence of abusive practices, notably in the case of Falun Gong detainees.

The second is a discussion of the judicial and legislative framework governing the practice of forensic psychiatry in China: the criminal and civil law contexts, legislation on mental health and forensic-psychiatric assessment, the levels of determination of criminal "non-imputability" by reason of insanity that can be made, the kinds of offenders falling within the system's purview, and the extent to which the rights and interests of the latter are (if at all) taken into account and afforded legal protection. Also considered is the question of China's expansive definition of the key legal determinant of involuntary psychiatric committal, namely "social dangerousness." Whereas under international standards, the applicable scope of the "dangerousness" criterion is mainly restricted to situations where mentally ill people pose a direct physical danger either to themselves or to others, in China it is applied also to those, such as certain types of dissidents, whom the government regards as posing a political threat to "social order."

The third is a survey of the professional legal-medical literature from China, including numerous quoted passages illustrating the close and longstanding cooperation between forensic psychiatrists and the security authorities in effecting the simultaneous criminalization and medicalization of certain forms of dissenting activity. The focus here is on official statistics showing the relatively high proportion of so-called "political cases" among those brought for forensic psychiatric examination throughout China, and on passages describing the various diagnostic theories and perspectives that are commonly applied in such cases. Also discussed are the several main categories of political and religious nonconformists that are especially liable to fall prey to these police-dominated diagnostic and judicial procedures: so-called "political maniacs," whistleblowers and exposers of official corruption, persistent complainants and petitioners, and also unconventional religious sectarians of various kinds.

Several more detailed case accounts are presented to complement and concretize this general picture. These afford both an illustrative insight into the kinds of individuals most at risk of being branded as criminally insane on account of their peaceful views and activities, and also an opportunity to evaluate whether or not they may indeed, as claimed by the authorities, have been mentally disordered to any significant degree. While this is clearly a relevant issue, it should be noted that the persons in question were in most cases arrested on criminal charges - but for activities not held to be crimes under international legal standards - prior to being committed for forensic psychiatric evaluation. If truly mentally disturbed, they should not have fallen within the scope of the psychiatric-criminal justice system, but should rather have been given appropriate treatment by the regular mental healthcare system.

Also included below is a first introduction to China's little-known network of special custodial centers for the criminally insane. Although several such institutions have existed in China since at least the 1960s, in 1987 the Chinese government for the first time decided to establish a nationwide system of high-security facilities for "dangerously mentally ill offenders." These, the equivalent of the USSR's Special Psychiatric Hospitals run by the Interior Ministry, were to be uniformly designated as "Ankang" (Peace and Health) institutions, and were to be directly 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 committal in such institutions. To date, twenty Ankang facilities have already been built and brought into service around the country. These highly secretive institutions deserve to become more widely known as perhaps the last unexplored aspect, and possibly the most sinister one, of China's extensive laogai system of judicial incarceration.

Perhaps the most striking aspect of all the official documentary sources consulted is the high frequency with which they refer to "cases of a political nature" (zhengzhixing anjian) in describing the day-to-day casework of State-appointed forensic psychiatrists in China. Time and again, even in the most cursory accounts of this type of work, specific mention is made of "political cases" as constituting a distinct category among the various types of criminal defendants routinely referred by various law-enforcement authorities for expert "forensic-psychiatric evaluation" (sifa jingshenbing jianding) - and even percentage rates for cases of this type are often provided. Indeed, it was from passages of this nature found in the official psychiatric literature almost a decade ago that the evidentiary paper trail for this article first began. In the Soviet case, by contrast, no such official mention or statistics were ever found in the relevant literature.

This study does not claim to be a comprehensive analysis of the political aspects and abuses of Chinese forensic psychiatry. Many important questions remain to be considered elsewhere and by other observers, many of whom will doubtless be better qualified than this writer to comment on matters relating to law and psychiatry. What follows is a preliminary attempt to bring together a significant corpus of new, though sometimes fragmentary, documentary evidence about the theory and practice of Chinese forensic psychiatry since 1949. It is one that amounts, however, to a clear and unmistakable prima facie case showing the longstanding and continuing existence of political psychiatric abuse in China.

²² This account of the Soviet-era psychiatric abuses was written by Robert van Voren, secretary general of the Geneva Initiative on Psychiatry.

²⁴ See "On Khrushchev's Phony Communism and its World Historical Lessons (Ninth Letter to the Soviets)," Renmin Ribao (People's Daily), July 14, 1964. This important article, a fifty-page "Open Letter" sent by the Chinese Communist Party leadership to the Central Committee of the Communist Party of the USSR, signaled the final stages of the Sino-Soviet split. The passage quoted above is said to have been written by Wang Li and Wu Lengxi, but Mao Zedong almost certainly edited and approved the article as a whole.

²⁵ Some historical context:

Twelve years ago, during the World Congress of the World Psychiatric Association (WPA) in Honolulu, the Soviet All-Union Society of Psychiatrists and Neuropathologists was condemned by the General Assembly of the WPA for abusing psychiatry for political purposes. Six years later, at the beginning of 1983, it was almost certain that later that year a majority of the WPA General Assembly would vote in favor of either expulsion from the WPA or suspension of membership of the Soviet All-Union Society. Keeping the honor to themselves, the Soviets withdrew from the WPA. (Robert van Voren, ed., Soviet Psychiatric Abuse in the Gorbachev Era [Amsterdam: International Association on the Political Use of Psychiatry (IAPUP), 1989], p.10.)

²⁶ For full and detailed accounts of the political abuse of psychiatry in the former Soviet Union see: Sidney Bloch and Peter Reddaway, Russia's Political Hospitals: The Abuse of Psychiatry in the Soviet Union (Victor Gollancz, 1977), and Soviet Psychiatric Abuse: The Shadow Over World Psychiatry (Victor Gollancz, 1984); Theresa C. Smith and Thomas A. Olesczuk, No Asylum: State Psychiatric Repression in the Former USSR (New York University Press, 1996); and Robert van Voren, ed., Soviet Psychiatric Abuse (1989).

²⁷ See Veronica Pearson, Mental Health Care in China: State Policies, Professional Services and Family Responsibilities, (Gaskell, 1995); Michael R. Phillips, "The Transformation of China's Mental Health Services," The China Journal, no. 39 (January 1998), pp.1-36; Arthur Kleinman, M.D., Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in Modern China (Yale University Press, 1986); and Michael R. Phillips, Veronica Pearson and Ruiwen Wang, eds., Psychiatric Rehabilitation in China: Models for Change in a Changing Society, vol. 165, Supplement 24 (August 1994). For a disturbing photo-journalistic portrayal of conditions in ordinary mental hospitals in China in the early 1990s, see Jurgen Kremb, "Wie ein Tier am Pfahl," Der Spiegel, no. 32 (August 1992), pp.140-146.

²⁸ For an important exception, see Veronica Pearson, "Law, Rights, and Psychiatry in the People's Republic of China," International Journal of Law and Psychiatry, vol.15 (1992), pp.409-423.

²⁹ See Nigel S. Rodley, United Nations, Economic and Social Council, Report of the Special Rapporteur on Torture, Submitted Pursuant to Commission on Human Rights Resolution 1992/32, (New York: United Nations, January 12, 1995), General E/CN.4/1995/34. The report stated: "The Special Rapporteur also transmitted [to the Chinese government] reports he had received of persons detained in a psychiatric hospital for political reasons, where no medical justification was said to exist for their detention. The cases summarized in the following paragraphs concerned persons detained at An Kang Public Security Bureau Hospital[s]..." The report continued, "Wang [W]anxing was arrested on 3 June 1992 while attempting to unfurl a banner commemorating the June 1989 demonstrations at Tiananmen Square. He was transferred to An Kang in July 1992, where he was allegedly administered medicine that kept him drowsy and weak. Although he was said to have no psychiatric problems, his wife signed documents confirming that he did, after being pressured to do so and being reassured that this would lead to her husband's early release." According to the report, the Chinese government replied as follows: "An Kang hospital's psychological appraisals unit 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. He was continuing to undergo treatment at the hospital."

³⁰ "Rights Group Says China Sent Labor Activist to Mental Hospital," Associated Press, April 11, 2000.

³¹ "AFP Reports 2,000 Protest against Failed Investment Firm," FBIS Daily Report, November 16, 1998. According to the report, "Xue Jifeng was taken from his home last Monday and placed in a psychiatric asylum after accusing the Henan authorities of being responsible for the failure of the Three Stars investment group. The provincial government in May announced the closure of the three-year-old group, which collapsed owing about 10,000 investors more than three billion yuan (360 million dollars)..." NB: In the original Columbia Journal of Asian Law version of this article, it was wrongly stated that Xue Jifeng was still being detained at the mental hospital "as of December 2000"; according to subsequent information from the monitoring group Human Rights in China, Xue was discharged from the hospital in late June 2000.

³² This was the figure as of late 2000; by March 2002, the Falun Gong network had reported more than 300 cases involving the psychiatric detention of Falun Gong practitioners.

³³ According to one source, for example, mental illness was the chief cause of crime in 20.7 percent of all cases of murder, injury, arson, poisoning and explosions committed in a certain area of China in 1982 (see Li Tianfu et. al., Fanzui Tongjixue (Criminal Statistics), [Qunzhong Chubanshe, 1988], p.45). More recent reports indicate that mental illness-related crime remains a serious national problem.

³⁴ See, e.g., Li Congpei, ed., Sifa Jingshenbingxue (Forensic Psychiatry), (Renmin Weisheng Chubanshe, February 1992), p.381. According to the author, out of three million mentally ill people in six central Chinese provinces, approximately 400,000 posed a direct danger to society.