Speech by a British Psychiatrist at a Press Conference in Geneva

[ClearWisdom Net] [Editor's note: Psychiatrists from the United States and Britain held a press conference on April 10, 2001, in Geneva to condemn China's use of psychiatry for political purposes. Dr. Declan Lyons, the Royal College of Physicians of London and the Royal College of Psychiatrists of England, gave this speech in the press conference.]

Richard Brothers, an eighteenth century religious leader in England, when asked why he had been committed against his will to the Bedlam Hospital, replied: 'I and the world happened to have a slight difference of opinion; the world said I was mad, and I said the world was mad. I was outvoted, and here I am'.

This anecdote illustrates an important point however, that psychiatry at various points in history has been accused of serving one important purpose and that is being an agent of social control. This is a viewpoint that has been articulated by not only recipients of psychiatric treatment but also by mental health professionals themselves. This is because in psychiatric practice we sometimes come into contact with people who are complained about, or people who do not wish to voluntarily receive treatment for behaviours or beliefs, that are deemed by others to be outside the norm for society. In this brief talk I will outline my concerns about how abuse of psychiatric practice can lead to suppression of political or social dissent focussing on the recent persecution of Falun Gong practitioners in China.

Making a diagnosis of mental illness is at times fraught with uncertainty and most psychiatrists do recognise the limitations of this. The process of making a diagnosis from psychological ailments is still essentially a clinical one where the individual judgement of the doctor is paramount unlike other branches of medicine where lab tests and x-rays may provide the answer. Social and cultural factors are also important in the expression of mental distress, and the clinician may or may not be aware of these. Hence diagnosis may be seen as an idiosyncratic exercise, which relies heavily on the psychiatrist's own assumptions about what is normal and acceptable behaviour, and the patient may be seen to be 'mad because I say so'. The potential thus for psychiatry to be exploited by others, to reinforce not only social norms, but also political interests is enormous. Internationally recognised diagnostic classification systems such as DSM have been compiled to try and address some of these difficulties. They set out both inclusion and exclusion criteria and list symptoms of different disorders allowing psychiatrists to standardise diagnoses to a greater extent.

Unfortunately it's still relatively easy to find ready examples of the blatant misuse of psychiatry for social control. It is widely known how Soviet dissidents were diagnosed with sinister syndromes such as 'paranoid delusions of reforming society' and 'hippieism' and were incarcerated and forced to take antipsychotic medication. Such diagnostic distortions fortunately never received any international credibility but did undermine the legitimacy of psychiatric practice in these states for decades.

What standards internationally should we endorse to ensure the ethical practice of psychiatry?

Psychiatrists in the United Kingdom for example are one of the most heavily regulated medical specialists and for good reason. A series of mental health laws there beginning in 1959 and continuing to the present day have attempted to end the subjection of the patient to the doctor and put in place legal safeguards to protect those who are unable to protect themselves from ill-treatment, neglect or exploitation. Other principles underpinning any ethical framework for the practice of psychiatry would be to look on people as individuals, with proper regard to their race, sex, social and cultural background. They should be treated in such a way as to promote and enhance their own self-determination and personal responsibility. Even if they are unable to decide for themselves, or have matters taken out of their hands for their own sake or that of others, people with mental illness should still be consulted and their views given proper weight. Proper recognition of the status and needs of all concerned with mental health issues has been given by the United Nations, the World Psychiatric Association and various psychiatric and professional organisations of different countries who have articulated standards of professional conduct. I would particularly draw your attention to principle 4 of the 1991 UN document 'Principles for the protection of persons with mental illness and for the improvement of mental health care'. This states and I quote that "a determination of mental illness shall never be made on the basis of political, economic or social status, or membership in a cultural, racial or religious group, or for any other reason not directly relevant to mental health status." A further quote states that "family or professional conflict, or non-conformity with moral, social, cultural or political values or religious beliefs prevailing in a person's community, shall never be a determining factor in the diagnosis of mental illness."

How does China measure up to these standards in terms of psychiatric practice?

China, as a full member of the World Psychiatric Association, is expected to adhere to the standards that I have partially outlined. Unfortunately the tendency of some forensic psychiatrists in China to diagnose dissident type individuals as "dangerously mentally ill" has as long a history as the Peoples Republic itself. The medical records of [party name omitted] party member Chen Lining, incarcerated frequently between 1962-1966, speak for themselves. According to an entry made in December 1963 and I quote "The patient's mental illness has recurred; his counterrevolutionary statements are none other than a pathological mental symptom of his longstanding reactionary views. Diagnosis: Schizophrenia." Such misdiagnosis of democrats and political activists as psychiatric patients has continued up to the present time but more recently as you are aware members of the Falun Gong movement have attracted the attention of the Chinese authorities. Concern has been growing since the July 1999 crackdown began about the large numbers of Falun Gong practitioners that have been forcibly incarcerated in psychiatric hospitals and assigned psychiatric treatment in an effort to make them renounce their beliefs. It has been claimed that between 600 to1000 Falun Gong practitioners have been compulsorily detained to date. This could be a gross underestimate as Government reports themselves have readily admitted that increasing numbers of practitioners account for a growing proportion of admissions to institutions like the Beijing University of Medical Science. The treatment that has been administered seems to follow a pattern consisting of the administration of antipsychotic medication in injectable form, the use of physical as well as these chemical restraints and the placing of practitioners in solitary confinement. Electro-convulsive therapy has also been meted out in a singularly cruel fashion and is reminiscent of forced medical experiments conducted in Nazi concentration camps. At least three deaths have been reported as a direct consequence of this treatment.

To attempt to justify this behaviour the Chinese Psychiatric establishment has identified a unique set of mental disorders including Qigong induced psychosis, which rather strangely, appears only to have become massively prevalent since the July 1999 crackdown. The often quoted "diagnosis" of "dysphrenia" also carries no diagnostic credibility whatsoever and has never been described in any internationally validated disease classification system.

What possibly concerns me most however are plans to expand the Government network of Ankangs or special police psychiatric hospitals. This suggests that the current practice by police of taking so called political maniacs into psychiatric custody will escalate rather than diminish despite the international outcry.

What can China, a country which has played an active and highly influential part in the drafting of the Universal Declaration of Human Rights, do to reverse this situation and what are the consequences if this is not done?

Psychiatric disorder is now recognised to be one of the greatest causes of human suffering in the world. Drugging people into submission for simply expressing religious or political views however is a horrifying distortion of this medical specialty. By using a medical label to "rescue" people even where well intentioned, it takes responsibility away from them and encourages people to rely on an external solution which is rarely forthcoming and at the same time blaming them for their continuing problems. If the examples of psychiatric practice that I have described continue all of us practising in the arena of mental health stand diminished. We can be justifiably charged with being the agents, not of the individual but of society, whose main function is not treatment but social control. Such abuses of psychiatric practice occur undoubtedly in societies where mental health has a low scientific status but we have already been through the appalling era of Soviet psychiatry and thus Chinese psychiatrists cannot claim lack of awareness for their loss of anchorage to global ethical standards. I am not claiming to fully understand all the cultural nuances of the expression of symptoms of psychological distress in different countries. Neither am I advocating or prescribing a purely western concept of mental health. I do have to ask though why powerful antipsychotic drugs which originated in and have gained therapeutic currency in the west are being widely employed in China to suppress dissent. At stake is the public confidence in psychiatric practice which is already regarded with suspicion. We must be able to accurately define our diagnoses and defend our patients by cultivating an ethos of caring and sensitivity. I have spoken to you today not as a practitioner of Falun Gong, which I have not sought nor have been asked to join, but as an impartial concerned mental health professional. I am a member of Amnesty International but have spoken to you today in a purely personal and professional capacity. I would thus call on the Chinese government to open the Ankang network of psychiatric hospitals to international scrutiny generally and to protect the rights of Chinese citizens to exercise religious freedoms without fear of psychiatric labelling or incarceration. Thank you for your attention.