Political abuse of psychiatry

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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.[1][2]:491 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.[3] 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.[4]:6 As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.[5]:14 Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions.[6]:3 Psychiatric confinement of sane people is uniformly considered[by whom?] a particularly pernicious form of repression.[7]

Psychiatry possesses a built-in capacity for abuse that is greater than in other areas of medicine.[8]:65 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.[8]:65 In addition, receiving a psychiatric diagnosis can in itself be regarded as oppressive.[9]:94 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.[8]:65 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.[10]:29 In that manner, whenever open trials are undesirable, they are avoided.[10]:29

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.[8]:66 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.[11] Political abuse of psychiatry also takes place in the People's Republic of China.[1] Psychiatric diagnoses such as the diagnosis of ‘sluggish schizophrenia’ in political dissidents in the USSR were used for political purposes.[12]:77

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National Socialist Germany

Main article: Action T4

In National Socialist 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.[13]

Romania

In Romania, there have been allegations of some particular cases of psychiatric abuse during over a decade.[8]:73 In addition to particular cases, there is evidence that mental hospitals were utilized as short-term detainment centers.[8]:73 For instance, before the 1982 International University Sports ‘Olympiad’, over 600 dissidents were detained and kept out of public view in mental hospitals.[8]:73 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.[1]

Japan

In Japanese mental institutions, cases of disgraceful conditions resulting in despair and death have been well documented.[14]

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.[8]:74 Americas Watch and Amnesty International published reports alluding to cases of possible unwarranted hospitalization and ill-treatment of political prisoners.[8]:75 These reports concerned the Gustavo Machin hospital in Santiago de Cuba in the southeast of the country and the major mental hospital in Havana.[8]:75 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.[8]:75 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.[8]:75 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.[8]:75 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.[8]:75

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.[8]:75 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.[8]:76

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.[15][16] 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.[17]:242 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.[17]:242 It was found, according to Munro, that the involuntary confinement of religious groups, political dissidents, and whistleblowers had a lengthy history in China.[18] The abuse had begun in the 1950s and 1960s, and had grown extremely throughout the Cultural Revolution.[17]:242 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.[18] No deviance or opposition in thought or in practice was tolerated.[18]

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.[17]:242 In the 1980s, according to the official documents, there was political connotation to fifteen percent of all forensic psychiatric cases.[17]:242 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.[17]:242

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.[15]:4

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.[1] 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.[1] 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.[1]

It also seemed that, China had hardly known high security forensic institutions until 1989.[17]:243 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.’[17]:243 By that time, China had had 20 Ankang institutions with the staff employed by the Ministry of State Security.[17]:243 The psychiatrists who worked there were wearing uniforms under their white coats.[17]:243

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.[17]:243 Psychiatric care in China falls into four sectors that hardly connect up with each other.[17]:243 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.[17]:243 Both the sectors belonging to the police and the Ministry of State Security are the closed sectors, and, consequently, information hardly ever leaks out.[17]:243 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.[17]:243

In China, the structure of forensic psychiatry was to a great extent identical to that in the USSR.[17]:243 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.[17]:243 As a consequence, diagnostics were not much different than in the Soviet Union.[17]:244 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’.[17]:244 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.[17]:244

The World Psychiatric Association (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.[17]:245 There was even a diagnosis of ‘qigong syndrome’ which was used reflecting on the exercises practiced by Falung Gong.[17]:245 It was the unfair game aiming to avoid the political abuse of psychiatry from dominating the WPA agenda.[17]:245

In August 2002, the General Assembly was to take place during the next WPA World Congress in Yokohama.[17]:247 The issue of Chinese political abuse of psychiatry had been placed as one of the final items on the agenda of the General Assembly.[17]:251 When the issue was broached during the General Assembly, the exact nature of compromise came to light.[17]:252 In order to investigate the political abuse of psychiatry, the WPA would send an investigative mission to China.[17]:252 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.[17]:252 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.[17]:252 The 2003 investigative mission never took place, and when finally a visit to China did take place, this visit was more of scientific exchange.[17]:252 In the meantime, the political abuse of psychiatry persisted unabatedly, nevertheless the WPA did not seem to care.[17]:252

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.[7] 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.[7] 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.[7] In 1989, however, the stonewalling of Soviet psychiatry was overcome by perestroika and glasnost.[7] 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.[7]

In February 1989, a delegation of US psychiatrists and other experts visited the Soviet Union on the invitation of the Soviet government.[8]:69 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.[8]:69 Whereas the delegation originally sought interviews with 48 persons, it eventually saw 15 hospitalized and 12 discharged patients.[8]:69 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.[8]:69 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.[8]:69 One of the hospitalized patients had been diagnosed as having schizophrenia although the US team saw no evidence of mental disorder.[8]:70 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.[8]:70 According to medical record, all these patients had diagnoses of psychopathology or schizophrenia.[8]:70

When returned home after a visit of more than two weeks, the delegation wrote its report which was pretty damaging to the Soviet authorities.[17]:125 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.[17]:125

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.[1] In modern Russia, the fact that a person is a human rights defender again means that the person risks receiving a psychiatric diagnosis.[19]

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.[20]:41 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."[21] 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".[22][23][24] As a remedy for this disease, doctors also made running a physical impossibility by prescribing the removal of both big toes.[20]:42

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.[25]

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.[26] 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.[26]

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.[5] 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.[5] 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.[5]

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.[27] As another example, an NYPD veteran who alleged falsified crime statistics in his department was forcibly committed to a mental institution.[28]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 van Voren, Robert (January 2010). "Political Abuse of Psychiatry—An Historical Overview". Schizophrenia Bulletin 36 (1): 33–35. doi:10.1093/schbul/sbp119. PMID 19892821. Retrieved on 17 April 2011.
  2. (2010) Ethics in Psychiatry: European Contributions. Springer, 491. ISBN 9048187206. 
  3. (Russian) Глузман, Семён (январь 2010). "Этиология злоупотреблений в психиатрии: попытка мультидисциплинарного анализа". Нейроnews: Психоневрология и нейропсихиатрия (№ 1 (20)).
  4. (2005) Oxford handbook of psychiatry. Oxford: Oxford University Press, 6. ISBN 0198527837. 
  5. 5.0 5.1 5.2 5.3 Metzl, Jonathan (2010). The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon Press. ISBN 0807085928. 
  6. Noll, Richard (2007). The encyclopedia of schizophrenia and other psychotic disorders. Infobase Publishing, 3. ISBN 0816064059. 
  7. 7.0 7.1 7.2 7.3 7.4 7.5 Bonnie, Richard (2002). "Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies". Journal of the American Academy of Psychiatry and the Law 30 (1): 136–144. PMID 11931362. Retrieved on 12 December 2010.
  8. 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 (1992) Medicine betrayed: the participation of doctors in human rights abuses. Zed Books, 65. ISBN 1856491048. 
  9. (2002) Chronic myofascial pain: a patient-centered approach. Radcliffe Publishing, 94. ISBN 1857759478. 
  10. 10.0 10.1 (1975) Case studies on human rights and fundamental freedoms: a world survey. Martinus Nijhoff Publishers, 29. ISBN 9024717809. 
  11. (2002) "The labelling of dissent — politics and psychiatry behind the Great Wall". The Psychiatrist: 443–444. doi:10.1192/pb.26.12.443.
  12. (2005) Psychiatry at a glance. Wiley-Blackwell, 77. ISBN 1405124040. 
  13. Birley, JL (2000). "Political abuse of psychiatry". Acta Psychiatrica Scandinavica. Supplementum 399 (399): 13–15. PMID 10794019.
  14. Gostin, Larry (September 1986). "Sovriet Psychiatric Abuse: the Shadow Over World Psychiatry". Journal of Medical Ethics 12 (3): 161–162. Retrieved on 18 January 2011.
  15. 15.0 15.1 Munro, Robin (2002). Dangerous minds: political psychiatry in China today and its origins in the Mao era. Human Rights Watch. ISBN 1564322785.  (Google Books)
  16. Munro, Robin (2002). Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era. Human Rights Watch. ISBN 1564322785.  (HTML)
  17. 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 van Voren, Robert (2009). On Dissidents and Madness: From the Soviet Union of Leonid Brezhnev to the "Soviet Union" of Vladimir Putin. Amsterdam—New York: Rodopi, 242. ISBN 9789042025851. 
  18. 18.0 18.1 18.2 Freedman, M (October 2003). "Dangerous Minds: Political Psychiatry in China Today and Its Origin in the Mao Era". Psychiatric Services 54 (10): 1418–1419. doi:10.1176/appi.ps.54.10.1418-a. Retrieved on 10 December 2010.
  19. (Russian) (2005) "15 лет Независимому психиатрическому журналу". Nezavisimiy Psikhiatricheskiy Zhurnal (№ 4). ISSN 1028-8554. Retrieved on 24 July 2011.
  20. 20.0 20.1 White, Kevin (2002). An introduction to the sociology of health and illness. SAGE, 41, 42. ISBN 0761964002. 
  21. Cartwright, Samuel A. (1851). "Diseases and Peculiarities of the Negro Race". DeBow's Review XI. Retrieved on 16 November 2011.
  22. (2004) Health, disease, and illness: concepts in medicine. Georgetown University Press, 35. ISBN 1589010140. 
  23. Paul Finkelman (1997). Slavery & the Law. Rowman & Littlefield, 305. ISBN 0742521192. 
  24. Rick Halpern, Enrico Dal Lago (2002). Slavery and Emancipation. Blackwell Publishing, 273. ISBN 0631217355. 
  25. Moshik, Temkin (2009). The Sacco-Vanzetti Affair. Yale University Press Publishers, 316. ISBN 9780300124842. 
  26. 26.0 26.1 Ross, Colin (2006). The C.I.A. Doctors: Human Rights Violations by American Psychiatrists. Manitou Communications. ISBN 0976550806. 
  27. The Professional Paranoid: Why NSA whistle-blower Russ Tice may be right
  28. Cop hauled off to psych ward after alleging fake crime stats

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