Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies

ANALYSIS AND COMMENTARY Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies Richard J. Bonnie, LLB J Am Acad Psychiatry Law 30:136–44, 2002 On first glance, political abuse of psychiatry appears psychiatry is more complicated than it first appears. to represent a straightforward and uncomplicated Most important, whether the dissident individuals story: the deployment of medicine as an instrument subjected to psychiatric confinement are (or are not) of repression. Psychiatric incarceration of mentally mentally ill is often contestable, especially when cul- healthy people is uniformly understood to be a par- turally embedded features of psychopathology are ticularly pernicious form of repression, because it taken into account. The mental health of dissidents uses the powerful modalities of medicine as tools of could be contested, even if diagnoses were grounded punishment, and it compounds a deep affront to in a single internationally recognized system of clas- human rights with deception and fraud. Doctors sification, but the problem is all the more compli- who allow themselves to be used in this way (certain- cated when psychiatrists in different societies are ly as collaborators, but even as victims of intimida- trained to understand normality and psychopathol- tion) betray the trust of society and breach their most ogy in different ways. Taking into account culturally basic ethical obligations as professionals. linked ambiguities in psychiatric diagnosis, it seems When the story is so straightforward, political likely that at least some cases of alleged abuse repre- abuse of psychiatry is universally condemned. Even sent good-faith efforts by psychiatrists to apply pre- regimes that sponsor psychiatric repression find it vailing psychiatric knowledge in politically repressive morally embarrassing to admit that they engage in societies. Thus, two explanations compete for atten- such a corrupt practice. When the Soviet Union was tion in cases of political abuse: corruption and defending its suppression of political and religious culture. dissent, it steadfastly denied allegations of psychiatric There is a second complicating factor. In the “un- repression—allegations that have now been well doc- complicated story,” human rights and medical ethics umented1,2 and are no longer contested by the psy- are perfectly aligned. Intentional misdiagnosis and chiatric leadership in Russia and other post-Soviet naked psychiatric punishment amount to simulta- states.3 neous violations of human rights and breaches of If this were the whole story, political abuse of psy- medical ethics. But what is the normative signifi- chiatry would take its odious place alongside torture cance of the fact that some people apprehended for and other abuses of state power and perversions of dissident conduct are mentally ill? From a human medical ethics, but it would not be deeply interest- rights perspective, criminal intervention in such cases ing, either morally or sociologically. However, cor- is still a violation of human rights, because the state ruption is not the whole story, and political abuse of has no legitimate authority to arrest anyone for political or religious expression. Whether or not the Mr. Bonnie is John S. Battle Professor of Law and Director of the person is mentally ill, the conduct itself is not prop- Institute of Law, Psychiatry and Public Policy at the University of erly subject to prohibition or punishment. More- Virginia, Charlottesville, VA. Address correspondence to: Richard J. Bonnie, University of Virginia School of Law, 580 Massie Road, over, under contemporary principles of mental Charlottesville, VA 22903. E-mail: [email protected] health law, codified in many countries, a person who 136 The Journal of the American Academy of Psychiatry and the Law Bonnie has mental illness is not properly subject to coerced Commission, and the State Department. Three clin- treatment solely for nondangerous political or reli- ical teams administered standardized psychiatric in- gious expression, because such a person does not rep- terview instruments incorporating internationally resent a sufficiently serious threat to himself or others accepted diagnostic criteria and also interviewed each to justify the use of coercion. However, it is by no subject on the forensic and human rights aspects of means clear that a physician is behaving unethically the case. Separate interviews were also conducted if, against a person’s wishes, she treats a person who with family members. Soviet psychiatrists were per- has mental illness to ameliorate a serious condition mitted to observe the interview if the subject con- that happens to be manifested by political or reli- sented. The entire interview protocol usually took gious expression. Coerced treatment may be a justi- one full day. Meanwhile, other delegation members fied exercise of paternalism in such cases, especially if made site visits to hospitals selected by the delegation the patient has no capacity to make a rational treat- and disclosed to the Soviets only a few days before the ment decision. delegation’s arrival. These two issues—cross-cultural ambiguities of The investigation by the U.S. delegation provided psychiatric diagnosis and divergent norms of human unequivocal proof that the tools of coercive psychia- rights and medical ethics—explain why recent alle- try had been used, even in the late 1980s, to hospi- gations of political abuse of psychiatry in China, talize persons who were not mentally ill and whose allegations strongly supported by Robin Munro’s ex- only transgression had been the expression of politi- tensive research,4 have stirred up so much contro- cal or religious dissent.1 Most of the patients inter- versy. In this brief essay, I reflect on the connection viewed by the delegation had been charged with po- between the Soviet and Chinese experiences and the litical crimes such as “anti-Soviet agitation and evolution of mental health law and ethics in the propaganda” or “defaming the Soviet state.” Their United States. offenses involved behavior such as writing and dis- tributing anti-Soviet literature, political organizing, Soviet Psychiatry defending the rights of disabled groups, and further- Beginning in the early 1970s reports began to ing religious ideas. reach the West that political and religious dissidents Under applicable laws of Russia and the other were being incarcerated in maximum-security psy- former Soviet Republics, a person charged with a chiatric hospitals in the Soviet Union without med- crime could be subjected to “custodial measures of a ical justification. In 1977, the World Psychiatric As- medical nature” if the criminal act was proved and sociation (WPA) condemned the Soviet Union for the person was found “nonimputable” due to mental this practice, and six years later, the All-Union Soci- illness.7 Nonimputable offenders could be placed in ety of Neuropathologists and Psychiatrists resigned maximum security hospitals (the notorious “special from the WPA rather than face almost certain expul- hospitals”) or in ordinary hospitals, depending on sion. Throughout this period, while reports of con- their social dangerousness. All the persons inter- tinued repression multiplied, Soviet psychiatric offi- viewed by the delegation had been found nonimput- cials denied the charges of abuse and refused to able and socially dangerous and confined in special permit international bodies to see the patients and hospitals after criminal proceedings that deviated hospitals in question.5,6 In 1989, however, the stone- substantially from the general requirements specified walling of Soviet psychiatry was overtaken by glas- in Soviet law. Typically, the patients reported that nost and perestroika. Over the objection of the psy- they had been arrested, taken to jail, taken to a hos- chiatric leadership, the Soviet government allowed a pital for forensic examination, and then taken to an- delegation of psychiatrists from the United States, other hospital under a compulsory treatment order, representing the U.S. Government, to conduct ex- without ever seeing an attorney or appearing in tensive interviews of suspected victims of abuse. court.8 The 1989 investigation had two major compo- The delegation found that there was no clinical nents. Some members of the delegation conducted basis for the judicial finding of nonimputability in 17 intensive clinical interviews with 27 patients whose of these cases. In fact, the delegation found no evi- names had been provided to the delegation by vari- dence of mental disorder of any kind in 14 cases. It is ous human rights organizations, the U.S. Helsinki likely that these individuals are representative of Volume 30, Number 1, 2002 137 Political Abuse of Psychiatry: Complexities and Controversies many hundreds of others who were found nonim- dissent, including any form of political or religious putable for crimes of political or religious dissent in deviance, and by the corrosive effects of corruption the Soviet Union, mainly between 1970 and 1990. and intimidation in all spheres of social life. Psychi- The delegation also found conditions in the spe- atrists were not immune from these pressures. It cial hospitals to be appallingly primitive and restric- therefore seems likely that a small subset of Soviet tive. Patients were denied basic rights, even to keep a psychiatrists, associated primarily with Moscow’s diary or possess writing materials or books, and they Serbski Institute

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