Although in recent years a handful of cases in which individuals were incarcerated in psychiatric institutions for their political activism have become known, it was thought that China had not systematically adopted the discredited Soviet misuse of psychiatry. Now pathbreaking research by Robin Munro based on official documents and textbooks on Chinese forensic psychiatry shows that that assumption was wrong.
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. 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.
An extensive study of the officially published legal-psychiatric professional literature in China from the 1950s to the present day has now produced substantial documentary evidence to indicate that the Chinese authorities also have 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. The extent to which Chinas 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.
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. In the Soviet case, by contrast, no such official mention or statistics were ever found in the relevant literature. According to the official Chinese legal-medical literature, during the Cultural Revolution as many as 50 to 70 percent of all criminal suspects subjected to forensic psychiatric examination had initially been detained for political offenses a figure going way beyond the level of similar-style abuses found in the Soviet Union in the 1970s and 1980s. During the 1980s, the officially recorded level of political psychiatric cases had fallen to around 15 percent of the criminal psychiatric caseload in China, and by the early 1990s it was said to have been further reduced to the level of one or several percent of the total. (In the Soviet case, significantly, the scale of political-psychiatric abuse is believed to have consistently remained at no more than the latter approximate level until the fall of the Berlin Wall.)
For the first few decades of the Peoples Republic, these political cases in the field of Chinese forensic psychiatry mainly involved, according to the official legal-medical literature, unknown political poster-writers, speech-makers and the like who had expressed their views peacefully, but in a manner seen by the security authorities as being particularly brazen or flagrant, and hence as displaying a puzzling absence of any instinct for self-preservation. (A common and highly revealing police observation in such cases, for example, has been that the perpetrators in question unlike the more mentally normal dissident offenders, who are simply sentenced as counterrevolutionaries and sent to prison had generally signed their real names to dissenting wall posters or petitions and then failed to run away afterwards. The official implication in such reports, essentially, is that one would have to be mad to behave in such a politically dangerous way in China.)
Since July 1999, however, there has been a conspicuous and disturbing resurgence of political psychiatric abuse in China, with many Falungong practitioners reported to have been forcibly committed to mental asylums by the police (the groups overseas support network has documented over 100 such cases, while unconfirmed estimates go as high as 600). Moreover, as the case of Cao Maobing (see related articles) and other recently detained labor activists has shown, the security authorities currently appear to be extending their longstanding mental pathology model of political-criminal deviance not only to banned religious nonconformists such as the Falungong, but also to increasing numbers of illegal trade unionists and worker-rights activists as well.
Thus far, most of those subjected to this particularly disturbing form of human rights abuse over the past two years have, so far as is known, been sent by the authorities to regular mental hospitals and asylums, rather than to facilities specifically intended for the custody of mentally-disordered criminal offenders (so-called institutes for the criminally insane). Since 1987, however, the Chinese authorities have been engaged in a determined effort to construct an entire new network of custodial institutions of precisely this kind around the country. Known collectively as the Ankang, these highly secretive institutions deserve to become more widely known as perhaps the last unexplored aspect, and possibly the most sinister one, of Chinas extensive laogai network of judicial incarceration. Several well-known political prisoners (including the Beijing dissident Wang Wanxing and the Shanghai labor-rights activist Wang Miaogen) have been languishing in Ankang psychiatric detention since the early 1990s, and the main reason why the recent Falungong victims of Chinese political psychiatry are not also being held in the Ankang appears to be, quite simply, that most parts of the country do not yet possess any such institutions.
In the mid-1980s, Chinas leaders, perceiving the emergence of an ideological vacuum among the populace, caused mainly by the official downplaying of politics in national life since the Cultural Revolution, launched a campaign to build socialist spiritual civilization (shehuizhuyi jingshen wenming) across the country. The purpose was to create a spiritual counterpart to Chinas already fairly well developed material civilization (the national infrastructure and the economy). Since in Chinese the words for spiritual and mental are the same, the new movement was also an attempt to expand mental civilization, and thus had important implications for the field of mental health work.
In October 1986 in Shanghai, the ministries of health, civil affairs and public security convened the countrys Second National Conference on Mental Hygiene Work, the first national-level meeting of this kind in almost 30 years. The main item on the agenda was the sharp increase in the rate of mental illness among Chinas population in recent years: since the 1970s, the rate was said to have risen from seven per thousand members of the population to as many as 10.54 per thousand. (It is currently said to stand at over 13 per thousand.) The level of violent crime in society was also rising rapidly, and Chinas severe lack of healthcare facilities for the mentally ill was identified as a major causal factor.
In April 1987, the three concerned ministries drew up a list of proposals designed to address these problems. According to the resulting policy document, Opinion of the Ministries of Health, Civil Affairs and Public Security on the Strengthening of Mental Health Work, An especially urgent need is for the public security organs immediately to set up institutions for the custody and treatment of mentally ill people who break the law and create disastrous incidents Owing to the lack of management over the mentally ill, many of them are spread over society at large and they create endless disastrous incidents that pose a very serious threat. The ministries main policy recommendations were threefold: first, to speed up the passage of a national mental health law; second, to further develop forensic appraisals work; and third, to establish a national network of police-run centers for the custody and treatment of severely mentally ill offenders.
Shortly thereafter, it was officially decided that the name Ankang, meaning Peace and Health, would be used as a uniform designation for the proposed new network of custodial facilities for mentally ill offenders. A small number of institutions for the criminally insane had already been in existence in China for many years; known locations include Beijing, Shanghai, Tianjin, Dalian and Jilin Province. After the April 1987 conference decision, however, moves to establish institutions of this type elsewhere proceeded apace, and by May of the following year, a total of sixteen Ankang centers had been established and brought into service.
By 1992, the total number of such institutions had risen to 20, with several others under construction. They are located in Tianjin, Beijing, Shanghai, Shenyang, Dalian, Tangshan, Wuhan, Xian, Suzhou, Chengdu, Hangzhou, Hefei, Fuzhou, Ningbo, Jinhua and Shaoxing; and also Heilongjiang Province, Jilin Province, Ningxia Autonomous Region and Inner Mongolia Autonomous Region (city locations for the latter four are unknown). According to one medical textbook, large Ankang centers can accommodate around 1,000 inmates; the Tianjin facility, however, is now believed to have around twice that capacity. According to another official source, the average length of stay for mentally ill offenders in the Ankang system is five and a half years, with some inmates being held for as long as 20 years. The governments eventual goal is to establish one Ankang center for every city in China with a population of one million or above.
The institutional model for the new Ankang forensic-psychiatric regime set up in China after 1987 was the Shanghai Municipal Hospital for Custody and Treatment of the Mentally Ill, which was established in May 1985. In April 1986, the Shanghai government took the national lead by promulgating a detailed set of regulations for the compulsory hospitalization of mentally ill people who create incidents or disasters (zhaoshi zhaohuo). These regulations are still the most specific thus far issued in China on the crucial procedural matter of how mentally ill offenders actually get admitted to Ankang care: expert forensic psychiatric appraisal of the detainee was to be performed, but once a finding that the person should not be held legally responsible had been made, the public security departments were then accorded complete authority to issue the necessary paperwork for compulsory psychiatric admission; the courts had no visible role in the process. Shortly thereafter, municipal and provincial governments elsewhere in China, including Tianjin and Guangdong, issued similar sets of regulations.
It is reasonable to assume that most inmates of the Ankang network of psychiatric detention facilities are, in fact, genuinely mentally-disturbed individuals who, as a result of their illnesses, have committed serious criminal offenses such as murder, rape, or arson. Official documents describing the role and purposes of the Ankang system, however, make it abundantly clear that certain types of peaceful political offenders are also seen as ranking among the most dangerous and politically threatening of Chinas allegedly mentally-ill criminal population, and hence are likewise destined for long-term psychiatric incarceration within the system. Specific criteria outlining the various types and categories of mentally ill offenders who are to be compulsorily admitted to Ankang can be found in several published sources in China. These criteria vary slightly from source to source, but the most complete and exhaustive version appears in an official encyclopedia of police work, China Encyclopedia of Public Security, published in 1990. The encyclopedia begins by explaining the three main types of people who are to be taken into police psychiatric custody:
The first are those commonly known as romantic maniacs [hua fengzi], who roam around the streets, grab food and drink from others, expose themselves naked, or look unkempt and disheveled, and so have an adverse effect on social decorum.
The second are those commonly known as political maniacs [zhengzhi fengzi], who shout reactionary slogans, write reactionary banners and reactionary letters, make anti-government speeches in public, and express opinions on important domestic and international affairs.
The third are those commonly known as aggressive maniacs [wu fengzi], who beat and curse people, pursue women, elderly people and children, smash up public property, commit murder or arson, or who otherwise endanger peoples lives and the safety of property.
The encyclopedia then lists the following more specific and operational criteria for dealing with mentally ill people falling within the three categories:
The public security organs have primary responsibility for the management and treatment of the following five kinds of severely mentally ill persons, all of whom pose a relatively grave threat to social order:
- Persons carrying knives who commit violent or injurious acts; those who are suicidal; and those who commit arson or other acts that seriously disturb social order, with definite consequences.
- Persons who disrupt the normal work of Party and government offices or who disrupt normal work and production in enterprises, scientific and educational institutions, thereby posing a danger.
- Persons who frequently expose themselves naked, or otherwise harm social morals, in busy crowded areas or in public places.
- Persons who shout reactionary slogans, or who stick up or distribute reactionary banners and leaflets, thereby exerting an undesirable political influence [Huhan fandong kouhao, zhangtie sanfa fandong biaoyu, chuandan, zaocheng buliang zhengzhi yingxiangde].
- Mentally ill people who drift in from other areas and disrupt the public order of society.
Upon encountering any of these five types of people, the public security organs are to take them into custody for treatment.
Finally, the police encyclopedia adds, The taking of mentally ill people into custody is especially important during major public festivals and when foreign guests arrive for visits, and it should be appropriately reinforced at such times. For our present purposes, the most important categories of alleged mentally ill people listed above as being targets for Ankang-style custody and treatment are, first, political maniacs, namely those displaying dangerously political dissident-like behavior, including expressing opinions on important domestic and international affairs; and second, those accused of disrupting the normal work of Party and government offices, since in practice this category is often taken to include the kinds of persistent petitioners and complainants whom the police regard as suffering from litigious mania.
Another important category of persons liable to be sent to Ankang facilities is those who develop prison psychoses of various kinds during their confinement in regular prisons. The incidence of this type of mental illness has apparently risen sharply in China in recent years. One significant subgroup of such sufferers is reportedly those sentenced to death and awaiting execution; if the stress and anxiety of impending execution leads them to become mentally ill, they are regarded as incompetent to undergo punishment and are then placed in Ankang custody for treatment until they become sane enough to be executed. Moreover, prisoners who stage hunger strikes in jail are often regarded as suffering from a subtype of this particular illness and are therefore also sent to Ankang centers for secure psychiatric treatment.
Most countries need to maintain institutions for the criminally insane in order to protect the public from genuinely dangerous psychotic offenders. At least in the modern era, however, few countries have ever regarded the kind of political and litigious maniacs described in the police encyclopedia as being legitimate targets for forced psychiatric custody. The former Soviet Union was the most prominent such country, and to the extent that it now follows a similar set of practices, Chinas recently established Ankang system appears to be performing a role much the same as that of the Soviet Interior Ministry-run Special Psychiatric Hospitals, which were used to incarcerate, in a medically unjustifiable way, hundreds and possibly thousands of peaceful Soviet dissidents.
Owing to the highly secretive nature of these institutions, little is known about the conditions of detention and treatment currently found within them. One first-hand account of conditions at the Shanghai facility on the eve of its transformation into an Ankang center, however, painted a disturbing picture of widespread fear among the inmates arising from the frequent resort by warders and nursing staff to various abusive methods of punishment. The account, which was written by a female dissident and former political prisoner who had been placed in the Shanghai facility in early 1987 and which contained case details of several other political maniacs held there at the time, reads as follows:
The only difference between [prison and this hospital] was that the two used different methods of punishment. The instruments of punishment in prison were common handcuffs, whereas the hospital used medical appliances
If patients were disobedient in the hospital, the doctors would increase their medication. Besides eating, they only felt like sleeping, and often suffered from cramps. This is not a civilian hospital that you can leave in three or five months. There, three or five years was considered to be a short time. Moreover, you had to work for seven hours a day. Those who were on more medication dribbled saliva constantly. Their eyes often rolled upwards helplessly in their sockets. They walked slowly and stumbled frequently.
If such and such a person was to be punished, her bed would be taken to the area between the dining hall and the workshop, and she would be tied by her four limbs to the bed by straps looped through the metal bed frame. In this way the nurses could supervise her from morning till night. In the daytime during working hours the dormitory was locked. Sometimes two people could be punished at once. During the daytime when everyone was working, we looked at the womens hands and feet tied to the bed. We all kept silent, lowered our heads and carried on working. In the evening when we returned to the dormitory, we would watch the bed carried away, and see the empty space where it had stood. A cold shiver would go through your heart. You didnt know when it would be your turn. Maybe you would be punished because the doctors discovered you had smuggled a letter out to some visitors, or maybe because you had had an argument with the doctors or nurses. When they wanted to punish someone, the alarm outside the dormitory (in the dining room) would sound and several police would arrive at once, and tie you to the bed.
Another kind [of punishment] was injections. One kind was muscular injection and the other intravenous, which was much more painful. I saw some patients after intravenous injections, whose tongues were so swollen they bulged out of their mouths. After a few days of injections, their facial muscles were all stiff, their eyes fixed and staring. Their faces were like waxwork masksthey couldnt turn their heads and would have to slowly turn their whole body if they wanted to look at something.
Yet another kind of punishment was acupuncture with an electric current. The patients called it the electric ant. It uses electrically controlled acupuncture needles. There are three levels of current. The higher the current, the more painful, and the degree of pain also depends on the particular acupuncture points used.... In civilian hospitals, when a patient is subjected to electric shock treatment it is forbidden to let the other patients watch, but in this [kind of] place, treatment was no longer about curing illness and saving peoples lives. It had become the penal code the doctors used to maintain control. When they wanted to punish someone, they would make all the patients stand around her bed, while the patient twitched in agony and pitifully cried, I wont do it next time I wont do it again, please let me go... After it was over, the nurses admonished all the other patients that whoever violated the rules next would suffer the same treatment as her. Everyone would lower their heads, fearing that their faces had turned pale.
The handwritten account from which this portion is excerpted was circulated to various human rights groups in 1995, but the writer cannot presently be identified for reasons of personal safety. According to the account, the ward in which she was placed held 20 women, three of whom were political dissidents of various kinds. Moreover, [inmates] convicted of murder were allowed to talk freely together, but political prisoners were not permitted to do the same. The reason why one of the three dissidents had been admitted was, according to the same account, as follows: [The woman] had gone onto the streets to make a speech protesting about the high increase in the cost of living. She said that skyrocketing prices had made peoples lives worse, and that political corruption nowadays meant officials made a fortune through their official posts, something that could not have happened in Mao Zedongs day.
The most recent confirmed case of a political dissident being sent to the Shanghai Ankang facility is that of Li Da, a young worker at an electrical appliances firm in the city who had apparently been involved in the May 1989 pro-democracy movement. On three separate occasions, prior to his arrest in July 1998, he stood outside the Shanghai No. 1 Department Store handing out leaflets calling for the rehabilitation of victims of the June 4, 1989, government crackdown, for greater political democracy in China and for the right to commemorate Taiwan National Day. Lis case was briefly reported on by Voice of America in February of the following year, on the basis of a letter he had smuggled out of the Shanghai Ankang facility. There has been no further news about him since.
Another account, this time involving a fatality at the Ankang facility in Beijing, suggests that staff violence against inmates was still commonplace in institutions of this type at least as late as 1993. In March that year, as part of Chinas bid to host the 2000 Olympic Games, a delegation from the International Olympic Committee arrived in Beijing to inspect the city sporting and other facilities. Over the preceding few weeks, among other preparations designed to enhance Chinas chances of winning its bid for the games, the Beijing authorities had removed large numbers of homeless, indigent, or mentally ill people from the streets of the city and shipped them out of town either to their original place of residence or to temporary holding centers, and in the case of mentally ill targets of this cleanup operation, the Beijing Ankang center was apparently also used for this purpose. One such person was a 41-year old mentally retarded man named Wang Chaoru, who lived with his parents in the southern part of the city. According to a detailed account of Wangs case that was subsequently written by the Beijing correspondents of The New York Times during that period, Nicholas Kristof and Sheryl WuDunn, and published in their 1994 book China Wakes: The Struggle for the Soul of a Rising Power, a policeman arrived at the familys door, accompanied by a woman named Zhang from the local Street Committee, two days before the IOC delegations arrival in Beijing:
The policeman wanted to take Wang away, but the retarded man began shrieking his protests. So the policeman and Zhang left. The next morning, Zhang returned, this time with two policemen... They had no arrest warrant, no detention warrant, and they didnt suggest that Wang had broken any law or endangered anybody. They didnt give any reason for wanting to take him away, but they insisted that he had to leave with them. I dont want to go, Wang cried out in fear. Mama, Papa! He raced to the corner of the big bed, shielding his head with his arms. His parents knew that it would be futile to resist, so they watched helplessly as the two policemen dragged away their terrified son. Wang had reason to be frightened. A year earlier, as part of their efforts to beautify Beijing in preparation for the annual session of the National Peoples Congress, the police had taken him to a sanatorium on the outskirts of Beijing and beaten him to a pulp. A few days later, they drove him to the Temple of Heaven, where they deposited him in a wounded clump at the front gate. It took Wang two hours of walking to find his way home.
As the Olympic delegation toured Beijings sports facilities on March 7, Wangs parents waited anxiously for news about their son. Two days later, shortly after dawn,
A police car came to pick them up, but the police officer said that only one of the parents could go. The parents, now desperate with worry, imagining their son beaten bloody, perhaps even in a coma, insisted that they both go. The police backed down and drove them out to Fangshan, a hospital closely associated with the Public Security Bureau When they arrived, the police took the parents into an office that was bare except for several chairs and a table. The person has died, an officer informed them matter-of-factly. We have inspected the body.
Later, the couple described to the foreign journalists what they found on arrival at the hospital morgue:
There was blood all over our sons face, the father recalled slowly and hesitantly, like a man fighting with himself, negotiating between his desire to tell the world and the pain of remembering. His hair was all red with blood. His lips were cut up, and his eyesthey were pierced, as if they had burst open and then swollen shut. In his back, there was a big hole. Someone must have stuck a police baton into his back, boring it into the flesh. And his behind was all bruised The back of my sons legs, he continued, as he rubbed his hands under his kneecaps, had these huge bumps, these swellings. I told them I wanted to sue, and you know what they said? Youll never win. On the day we cremated him, they gave me a bag with 5,000 yuan in it. They didnt say what the money was for.
The Beijing Public Security Bureau has a close organizational affiliation with only two hospitals in the capital: one is the Binhe Penal Hospital, located until recently within the grounds of the Beijing No. 1 Municipal Prison (this facility was torn down and relocated about five years ago); the other is the Beijing PSB Ankang Institute for the Custody and Treatment of the Mentally Ill, which is located in Fangshan District, a suburban area to the southwest of the city. Even today, very few foreigners living in China have ever heard of the name Ankang, so it is unsurprising that the authors of the above account did not specifically identify the place of Wang Chaorus death as being the Beijing Ankang facility. But that is undoubtedly where he died.
Such use of the Ankang facilities highlights the need for the international community to address the abuses occurring in this system, as well as the use of psychiatric detention for dissidents outside it. Just as in the case of the Soviet Union, the international psychiatric community has a key role to play in this.
The challenge for that community now is to find ways of exerting its influence to ensure that Chinas secretive Ankang system and other custodial psychiatric facilities around the country can no longer be used by the security authorities as a long-term dumping ground for political and religious nonconformists who, for one reason or another, they find it awkward or inconvenient to bring to criminal trial. As an indispensable first step towards this goal, both the World Psychiatric Association and its constituent national professional bodies should begin seeking direct access to the Ankang network and other places of psychiatric custody in China, with a view to independently monitoring conditions and practices therein. Advocacy efforts by local and international psychiatric bodies would also greatly assist in encouraging individual Western governments and the European Union to take up the issue, notably by placing the issue of political-psychiatric abuse in China on the formal agenda of the various bilateral human-rights dialogue sessions that have become, in recent years, a central and regular feature of Sino-Western relations.
(This examination of the evolution of Chinas forensic psychiatric institutions is an excerpt of a longer paper describing what is known about the political use of psychiatry in China, Judicial Psychiatry in China & its Political Abuses, Columbia Journal of Asian Law, Spring 2000. The full text is available on-line at: http://www.law.washington.edu/clnet/features/articles/index.
Robin Munro is Senior Research Fellow at the Law Department and Center of Chinese Studies, School of Oriental and African Studies (SOAS), University of London, and a member of HRICs board of directors.