Political abuse of psychiatry

Political abuse of psychiatry is the purported misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society. In other words, abuse of psychiatry including one for political purposes is deliberate action of getting citizens certified, who, because of their mental condition, need neither psychiatric restraint nor psychiatric treatment. Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances. Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions. Psychiatric confinement of sane people is uniformly considered a particularly pernicious form of repression.

Psychiatry possesses a built-in capacity for abuse that is greater than in other areas of medicine. The diagnosis of mental disease allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society. In addition, receiving a psychiatric diagnosis can in itself be regarded as oppressive. In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. The use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, discredits the individuals and their ideas. In that manner, whenever open trials are undesirable, they are avoided.

Examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history and seen during the Nazi era and the Soviet rule when political dissenters were labeled as “mentally ill” and subjected to inhumane “treatments.” In the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia. The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community. Political abuse of psychiatry also takes place in the People's Republic of China. Psychiatric diagnoses such as the diagnosis of ‘sluggish schizophrenia’ in political dissidents in the USSR were used for political purposes.

Nazi Germany
In Nazi Germany in 1940s, the abuse of psychiatry was the abuse of the 'duty to care' in enormous scale: 300,000 individuals were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe. For the first time in history, during the Nazi era, psychiatrists sought to systematically destroy their patients and were instrumental in establishing a system of identifying, notifying, transporting, and killing hundreds of thousands of "racially and cognitively compromised" persons and mentally ill in settings that ranged from centralized mental hospitals to jails and death camps. Psychiatrists played a central and prominent role in sterilization and euthanasia constituting two categories of the crimes against humanity. The taking of thousands of brains from euthanasia victims demonstrated the way medical research was connected to the psychiatric killings. There were six psychiatric extermination centers: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein. They played a crucial role in developments leading to the holocaust.

Romania
In Romania, there have been allegations of some particular cases of psychiatric abuse during over a decade. In addition to particular cases, there is evidence that mental hospitals were utilized as short-term detainment centers. For instance, before the 1982 International University Sports ‘Olympiad’, over 600 dissidents were detained and kept out of public view in mental hospitals. Like in the Soviet Union, on the eve of Communist holidays, potential “troublemakers” were sent to mental hospitals by busloads and discharged when the holidays had passed.

Japan
Japanese mental institutions during the country's imperial era reported an abnormally large number of patient deaths, peaking in 1945 after the surrender of Japan to Allied forces. The patients of these institutions were mistreated mainly because they were a hindrance to society. Under the oppressive Imperial Japanese government, citizens were expected to contribute in one way or another to the war effort, and the mentally ill were unable to do so, and as such were looked down upon and abused. The main cause of death for these patients was starvation, as caretakers did to supply the patients with adequate food, likely as a form of torture and a method of sedation. Because mentally ill patients were kept secluded from the outside world, the large number of deaths went unnoticed by the general public. After the end of Allied occupation, the National Diet of Japan passed the Mental Hygiene Act (精神衛生法,) in 1950, which improved the status of the mentally ill and prohibited the domestic containment of mental patients in medical institutions. However, the Mental Hygiene Act had unforeseen consequences. Along with many other reforms, the law prevented the mentally ill from being charged with any sort of crime in Japanese courts. Anyone who was found to be mentally unstable by a qualified psychiatrist was required to be hospitalized rather than incarcerated, regardless of the severity of any crime that person may have committed. The Ministry of Justice tried several times to amend the law, but was met with opposition from those who believed the legal system should not interfere with medical science. After almost four decades, the Mental Health Act (精神保健法,) was finally passed in 1987. The new law corrected the flaws of the Mental Hygiene Act by allowing the Ministry of Health and Welfare to set regulations on the treatment of mental patients in both medical and legal settings. With the new law, the mentally ill have the right to voluntary hospitalization, the ability to be charged with a crime, and right to use the insanity defense in court, and the right to pursue legal action in the event of abuse or negligence on the part of medical professionals.

Cuba
Although Cuba has been politically connected to the Soviet Union since the United States broke off relations with Cuba shortly after the president Fidel Castro came to power in 1959, few considerable allegations regarding the political abuse of psychiatry in this country emerged before the late 1980s. Americas Watch and Amnesty International published reports alluding to cases of possible unwarranted hospitalization and ill-treatment of political prisoners. These reports concerned the Gustavo Machin hospital in Santiago de Cuba in the southeast of the country and the major mental hospital in Havana. In 1977, a report on alleged abuse of psychiatry in Cuba presenting cases of ill-treatment in mental hospitals going back to the 1970s came out in the United States. It presents grave allegations that prisoners end up in the forensic ward of mental hospitals in Santiago de Cuba and Havana where they undergo ill-treatment including electroconvulsive therapy without muscle relaxants or anaesthesia. The reported application of ECT in the forensic wards seems, at least in many of the cited cases, not to be an adequate clinical treatment for the diagnosed state of the prisoner — in some cases the prisoners seem not to have been diagnosed at all. Conditions in the forensic wards have been described in repulsive terms and apparently are in striking contrast to the other parts of the mental hospitals that are said to be well-kept and modern.

In August 1981, the Marxist historian Ariel Hidalgo was apprehended and accused of ‘incitement against the social order, international solidarity and the Socialist State’ and sentenced to eight years’ imprisonment. In September 1981, he was transported from State Security Headquarters to the Carbó-Serviá (forensic) ward of Havana Psychiatric Hospital where he stayed for several weeks.

China
In 2002, Human Rights Watch published the book Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era written by Robin Munro and based on the documents obtained by him. The British researcher Robin Munro, a sinologist who was writing his dissertation in London after a long sojourn in China, had travelled to China several times to survey libraries in provincial towns and had gathered a large amount of literature which bore the stamp ‘secret’ but at the same time was openly available. This literature included even historical analyses going back to the days of the Cultural Revolution and concerned articles and reports on the number of people who were taken to mental hospitals because they complained of a series of issues. It was found, according to Munro, that the involuntary confinement of religious groups, political dissidents, and whistleblowers had a lengthy history in China. The abuse had begun in the 1950s and 1960s, and had grown extremely throughout the Cultural Revolution. During the period of the Cultural Revolution, from 1966 to 1976, it achieved its apogee, then under the reign of Mao Zedong and the Gang of Four, which established a very repressive and harsh regime. No deviance or opposition in thought or in practice was tolerated.

The documents told of a massive abuse of psychiatry for political purposes during the leadership of Mao Zedong, during which millions of people had been declared mentally sick. In the 1980s, according to the official documents, there was political connotation to fifteen percent of all forensic psychiatric cases. In the early 1990s, the numbers had dropped to five percent, but with beginning of the campaign against Falun Gong, the percentage had again increased quite rapidly.

Chinese official psychiatric literature testifies distinctly that the Communist Party's notion of ‘political dangerousness’ was long since institutionally engrafted in the diagnostic armory of China's psychiatry and included in the main concept of psychiatric dangerousness.

The People’s Republic of China is the only country which appears to abuse psychiatry for political purposes in a systematic way, and despite international criticism, this seems to be continuing. Political abuse of psychiatry in the People’s Republic of China is high on the agenda and has produced recurring disputes in the international psychiatric community. The abuses there appear to be even more widespread than in the Soviet Union in the 1970s and 1980s and involve the incarceration of ‘petitioners’, human rights workers, trade union activists, followers of the Falun Gong movement, and people complaining against injustices by local authorities.

It also seemed that, China had hardly known high security forensic institutions until 1989. However, since then, the Chinese authorities have constructed the entire network of special forensic mental hospitals called Ankang which in Chinese is for ‘Peace and Health.’ By that time, China had had 20 Ankang institutions with the staff employed by the Ministry of State Security. The psychiatrists who worked there were wearing uniforms under their white coats.

The political abuse of psychiatry in China seems to take place only in the institutions under the authority of the police and the Ministry of State Security but not in those belonging to other governmental sectors. Psychiatric care in China falls into four sectors that hardly connect up with each other. These are Ankang institutions of the Ministry of State Security; those belonging to the police; those that fall under the authority of the Ministry of Social Affairs; those belonging to the Ministry of Health. Both the sectors belonging to the police and the Ministry of State Security are the closed sectors, and, consequently, information hardly ever leaks out. In the hospitals belonging to the Ministry of Health, psychiatrists do not contact with the Ankang institutions and, actually, had no idea of what occurred there, and could, thereby, sincerely state that they were not informed of political abuse of psychiatry in China.

In China, the structure of forensic psychiatry was to a great extent identical to that in the USSR. On its own, it is not so strange, since psychiatrists of the Moscow Serbsky Institute visited Beijing in 1957 to help their Chinese ‘brethren’, the same psychiatrists who promoted the system of political abuse of psychiatry in their own USSR. As a consequence, diagnostics were not much different than in the Soviet Union. The only difference was that the Soviets preferred ‘sluggish schizophrenia’ as a diagnosis, and the Chinese generally cleaved to the diagnosis ‘paranoia’ or ‘paranoid schizophrenia’. However, the results were the same: long hospitalization in a mental hospital, involuntary treatment with neuroleptics, torture, abuse, all aimed at breaking the victim’s will.

In accordance with Chinese law that contains the concept of “political harm to society” as legally dangerous mentally ill behavior, police take into mental hospitals “political maniacs,” defined as persons who write reactionary letters, make anti-government speeches, or “express opinions on important domestic and international affairs.” Psychiatrists are frequently caught involved in such cases, unable and unwilling to challenge the police, according to psychiatry professor at the Peking University Yu Xin. As Mr. Liu’s database suggests, today’s most frequent victims of psychiatric abuse are political dissidents, petitioners, and Falun Gong members. Psychiatrists are frequently caught involved in these cases, unable and unwilling to challenge the police, according to psychiatry professor at the Peking University Yu Xin. In the beginning of 2000s, Human Rights Watch accused China of locking up Falun Gong members and dissidents in a number of Chinese mental hospitals managed by the Public Security Bureau. Access to the hospitals was requested by the World Psychiatric Association (WPA), but denied by China, and the controversy subsided.

The WPA attempted to confine the problem by presenting it as Falung Gong issue and, at the same time, make the impression that the members of the movement were likely not mentally sound, that it was a sect which likely brainwashed its members, etc. There was even a diagnosis of ‘qigong syndrome’ which was used reflecting on the exercises practiced by Falung Gong. It was the unfair game aiming to avoid the political abuse of psychiatry from dominating the WPA agenda.

In August 2002, the General Assembly was to take place during the next WPA World Congress in Yokohama. The issue of Chinese political abuse of psychiatry had been placed as one of the final items on the agenda of the General Assembly. When the issue was broached during the General Assembly, the exact nature of compromise came to light. In order to investigate the political abuse of psychiatry, the WPA would send an investigative mission to China. The visit was projected for the spring of 2003 in order to assure that one could present a report during the annual meeting of the British Royal College of Psychiatrists in June/July of that year and the Annual Meeting of the American Psychiatric Association in May of the same year. After the 2002 World Congress, the WPA Executive Committee’s half-hearted attitude in Yokohama came to light: it was an omen of a longstanding policy of diversion and postponement. The 2003 investigative mission never took place, and when finally a visit to China did take place, this visit was more of scientific exchange. In the meantime, the political abuse of psychiatry persisted unabatedly, nevertheless the WPA did not seem to care.

The Soviet Union
From the early 1970s, during Leonid Brezhnev's rule of the Soviet Union, reports started reaching the West that religious and political dissenters were being detained in maximum-security mental hospitals in the USSR without medical justification. In 1977, the World Psychiatric Association condemned the USSR for this practice, and six years later, the All-Union Society of Neuropathologists and Psychiatrists seceded from the WPA rather than face almost definite expulsion. During this period, while reports of continuous repression multiplied, Soviet psychiatric officials refused to allow international bodies to see the hospitals and patients in question and denied the charges of abuse. In 1989, however, the stonewalling of Soviet psychiatry was overcome by perestroika and glasnost. Over the objection of the psychiatric establishment, the Soviet government permitted a delegation of psychiatrists from the USA, representing the U.S. Government, to carry out extensive interviews of suspected victims of abuse.

In February 1989, a delegation of US psychiatrists and other experts visited the Soviet Union on the invitation of the Soviet government. The delegation was able systematically to interview and assess present and past involuntarily admitted mental patients chosen by the visiting team, as well as to talk over procedures and methods of treatment with some of the patients, their friends, relatives and, sometimes, their treating psychiatrists. Whereas the delegation originally sought interviews with 48 persons, it eventually saw 15 hospitalized and 12 discharged patients. About half of the hospitalized patients were released in the two months between the submission of the initial list of names to the Soviets authorities and the departure from the Soviet Union of the US delegation. The delegation came to the conclusion that nine of the 15 hospitalized patients had disorders which would be classified in the United States as serious psychoses, diagnoses corresponding broadly with those used by the Soviet psychiatrists. One of the hospitalized patients had been diagnosed as having schizophrenia although the US team saw no evidence of mental disorder. Among the 12 discharged patients examined, the US delegation found that nine had no evidence of any current or past mental disorder; the remaining three had comparatively slight symptoms which would not usually warrant involuntary commitment in Western countries. According to medical record, all these patients had diagnoses of psychopathology or schizophrenia.

When returned home after a visit of more than two weeks, the delegation wrote its report which was pretty damaging to the Soviet authorities. The delegation established not only that there had taken place systematic political abuse of psychiatry but also that the abuse had not come to an end, that victims of the abuse still remained in mental hospitals, and that the Soviet authorities and particularly the Soviet Society of Psychiatrists and Neuropathologists still denied that psychiatry had been employed as a method of repression.

Russia
Reports on particular cases continue to come from Russia where the worsening political climate appears to make an atmosphere in which local authorities feel able to again use psychiatry as a means of frightening. In modern Russia, the fact that a person is a human rights defender again means that the person risks receiving a psychiatric diagnosis.

The United States
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. In addition to identifying drapetomania, Cartwright prescribed a remedy. His feeling was that with "proper medical advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented." In the case of slaves "sulky and dissatisfied without cause" — a warning sign of imminent flight — Cartwright prescribed "whipping the devil out of them" as a "preventative measure". As a remedy for this disease, doctors also made running a physical impossibility by prescribing the removal of both big toes.

In the United States, political dissenters have been involuntarily committed. For example, in 1927 a demonstrator named Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of Sacco and Vanzetti.

In the 1970s, Martha Beall Mitchell, wife of U.S. Attorney General John Mitchell, was diagnosed with a paranoid mental disorder for claiming that the administration of President Richard M. Nixon was engaged in illegal activities. Many of her claims were later proved correct, and the term "Martha Mitchell effect" was coined to describe mental health misdiagnoses when accurate claims are dismissed as delusional.

In 2006, Canadian psychiatrist Colin A. Ross's book was published, titled The C.I.A. Doctors: Human Rights Violations by American Psychiatrists. The book presents evidence based on 15,000 pages of documents received from the CIA via the Freedom of Information Act that there have been systematic, pervasive violations of human rights by American psychiatrists during the recent 65 years.

In 2010, the book The Protest Psychosis: How Schizophrenia Became a Black Disease by psychiatrist Jonathan Metzl (who also has a Ph.D. in American studies) was published. The book covers the history of the 1960s Ionia State Hospital located in Ionia, Michigan and now converted to a prison and focuses on exposing the trend of this hospital to diagnose African Americans with schizophrenia because of their civil rights ideas. The book suggests that in part the sudden influx of such diagnoses could traced to a change in wording in the DSM-II, which compared to the previous edition added "hostility" and "aggression" as signs of the disorder.

Psychiatric reprisals
Whistle-blowers who part ranks with a government agency or major corporation can expect to be depicted as unhinged; it's in the agency's best interests. For example, Russ Tice was punished with psychiatric evaluations that labeled him as "mentally unbalanced" after persisting in his investigations of potentially illegal spying activity at the NSA. As another example, an NYPD veteran who alleged falsified crime statistics in his department was forcibly committed to a mental institution.