Punitive Psychiatry

Political abuse of psychiatry, also commonly referred to as punitive psychiatry, is the misuse of psychiatry, including diagnosis, detention, and treatment, for the purposes of obstructing the human rights of individuals and/or groups in a society. In other words, abuse of psychiatry (including that for political purposes) is the deliberate action of having citizens psychiatrically diagnosed who 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 psychiatric hospitals.

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. 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 also prevents the victims from receiving legal aid before the courts in some countries, makes indefinite incarceration possible, and discredits the individuals and their ideas. In that manner, whenever open trials are undesirable, they are avoided.

The political abuse of the power entrusted to physicians, and particularly psychiatrists, has a long and abundant history, for example during the Nazi era and the Soviet rule when religious and 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 and ideological 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 religious and political dissidents in psychiatric hospitals in the Eastern Bloc 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.

By country

Canada

The Duplessis Orphans were several thousand orphaned children that were falsely certified as mentally ill by the government of the province of Quebec, Canada, and confined to psychiatric institutions.

Donald Ewen Cameron's operation was running from what is today known as the Allen Memorial Institute (AMI), part of the Royal Victoria Hospital, and not to be confused with the non-governmental organization based in Montreal, AMI-Québec Agir contre la maladie mentale.

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. (Google Books) (HTML) The British researcher Robin Munro, a sinologist who was writing his dissertation in London after a long sojourn in China, had traveled to China several times to survey libraries in provincial towns and while he was there, he had gathered a large amount of literature which bore the stamp 'secret' but at the same time, it was openly available. This literature even included historical analyses which were published during the Cultural Revolution and it concerned articles and reports on the number of people who were taken to mental hospitals because they complained about a series of issues. It was found, according to Munro, that the involuntary confinement of religious groups, political dissidents, and whistleblowers had a long history in China. The abuses began in the 1950s and 1960s, and they became extremely widespread throughout the Cultural Revolution. During the period of the Cultural Revolution, from 1966 to 1976, the political abuse of psychiatry reached its apogee in China, which was then under the rule of Mao Zedong and the Gang of Four, who established a very repressive and harsh regime. No deviance or opposition was tolerated, either in thought or in practice.

The documents described the massive abuses of psychiatry that were committed for political purposes during the rule of Mao Zedong, when millions of people were declared mentally sick. In the 1980s, according to official documents, fifteen percent of all forensic psychiatric cases had political connotations. In the early 1990s, the number of such cases had dropped to five percent, but with the beginning of the campaign against Falun Gong, the percentage of such cases increased quite rapidly.

Official Chinese psychiatric literature distinctly testifies that the Communist Party's notion of 'political dangerousness' was institutionally engrafted as the main concept in the diagnostic armory of China's psychiatry for a long time and its most important tool for suppressing opposition was the concept of psychiatric dangerousness.

Despite international criticism, China seems to be continuing its political abuse of psychiatry. Political abuse of psychiatry in China is high on the agenda and it has produced recurring disputes in the international psychiatric community. The abuses there appear to be even more widespread than they were in the Soviet Union in the 1970s and 1980s and they involve the incarceration of 'petitioners', human rights workers, trade union activists, members of the Falun Gong movement, and people who complain about injustices that have been committed against them by local authorities.

It also seems that, China had no known high security forensic institutions until 1989. However, since then, the Chinese authorities have constructed an entire network of special forensic mental hospitals which are called ''Ankang'' which means 'Peace and Health' in Chinese. By that time, China had 20 Ankang institutions and their staff was employed by the Ministry of State Security (MSS). The psychiatrists who worked there wore uniforms under their white coats.

The political abuse of psychiatry in China only seems to take place in the institutions which are under the authority of the police and the MSS but it does not take place in those institutions which belong to other governmental sectors. Psychiatric care in China falls into four sectors which are hardly connected with each other. These are the ''Ankang'' institutions of the MSS; those which belong to the police; those which fall under the authority of the Ministry of Social Affairs; those which belong to the Ministry of Health. The sectors which belong to the police and the MSS are all closed to the public, and, consequently, information about them hardly ever leaks out. In the hospitals which belong to the Ministry of Health, psychiatrists do not have any contact with the ''Ankang'' institutions, and they have no idea of what occurred there, which means they can sincerely state that they were not informed about the political abuse of psychiatry in China.

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

In accordance with Chinese law which contains the concept of "political harm to society" and the similar phrase dangerous mentally ill behavior, police take "political maniacs into mental hospitals, those who are 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 Liu's database suggests, today's most frequent victims of psychiatric abuse are political dissidents, petitioners, and Falun Gong members. In the beginning of the 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.

Cuba

Although Cuba has been politically connected to the Soviet Union since the United States broke off relations with Cuba shortly after 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.

Germany

By 1936, killing of the "physically and socially unfit" became accepted practice in Nazi Germany. In the 1940s, the abuse of psychiatry involved the abuse of the "duty to care" on an enormous scale: 300,000 individuals were involuntarily sterilized and 77,000 murdered in Germany alone and many thousands further afield, mainly in eastern Europe. Psychiatrists were instrumental in establishing a system of identifying, notifying, transporting, and killing hundreds of thousands of "racially and cognitively compromised" persons and the 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. Germany operated six psychiatric extermination centers: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein. They played a crucial role in developments leading to the Holocaust.

India

It was reported in June, 2012, that the Indian Government has approached NIMHANS, a well known mental health establishment in South India, to assist in suppressing anti-nuclear protests regards to building of the Kudankulam Nuclear Power Plant. The government was in talks with NIMHANS representatives to chalk up a plan to dispatch psychiatrists to Kudankulam, for counselling protesters opposed to the building of the plant. To fulfill this, NIMHANS developed a team of six members, all of them, from the Department of Social Psychiatry. The psychiatrists were sent to get a "peek into the protesters' minds" and help them learn the importance of the plant according to one news source.

In July, 2013, the same institution, NIMHANS, was involved in a controversy where it was alleged that it provided assistance to the Central Bureau of Investigation relating to some interrogation techniques.

Japan

Japanese psychiatric hospitals 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 considered a hindrance to society. Under the 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 not 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 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 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.

Norway

There have been a few accusations about abuse of psychiatry in Norway. See Arnold Juklerød and Knut Hamsun.

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.

The People's Republic of Romania held to a doctrine of state atheism. Many Christians, including those from the Baptist Church and Lord's Army wing of the Orthodox Church, were forced into psychiatric hospitals where they died.

Russia

Reports on particular cases continue to come from Russia where the worsening political climate appears to create an atmosphere in which local authorities feel able, once again to use psychiatry as a means of intimidation.

Soviet Union

In 1971 detailed reports about the inmates of Soviet psychiatric hospitals who had been detained for political reasons began to reach the West. These showed that the periodic use of incarceration in psychiatric institutions during the 1960s (see the biography of Vladimir Bukovsky) had started to become a systematic way of dealing with dissent, political or religious. In accordance with the doctrine of state atheism, the USSR hospitalized individuals who were devout in their faith, such as many Baptist Christians.

In March 1971 Vladimir Bukovsky sent detailed diagnoses of six individuals (Natalya Gorbanevskaya and Pyotr Grigorenko among them) to psychiatrists in the West. They responded and over the next 13 years activists inside the USSR and support groups in Britain, Europe and North America conducted a sustained campaign to expose psychiatric abuses. In 1977 the World Psychiatric Association (WPA) condemned the USSR for this practice. Six years later, the Soviet All-Union Society of Neuropathologists and Psychiatrists seceded from the WPA rather than face almost certain expulsion.

During this period reports of continuous repression multiplied, but Soviet psychiatric officials refused to allow international bodies to see the hospitals and patients in question. They denied the charges of abuse. In February 1989, however, at the height of perestroika and over the opposition of the psychiatric establishment, the Soviet government permitted a delegation of psychiatrists from the United States, representing the U.S. government, to carry out extensive interviews of suspected victims of abuse.

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. The delegation originally sought interviews with 48 persons, but saw only 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 Soviet authorities and the departure from the Soviet Union of the US delegation. The delegation concluded 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 records, all these patients had diagnoses of psychopathology or schizophrenia. The authorities had justified compulsory psychiatric treatment by slow and weak forms of schizophrenia – a so-called “latent schizophrenia” according to a concept of Eugen Bleuler. Such forms would allegedly make the sufferer prone to criminal acts.

Returning home after a visit of more than two weeks, the delegation members wrote a report which was highly damaging to the Soviet authorities. The delegation established that there had been systematic political abuse of psychiatry in the past and that it had not yet come to an end. Victims continued to be held in mental hospitals, while the Soviet authorities and the Soviet Society of Psychiatrists and Neuropathologists in particular still denied that psychiatry had been employed as a method of repression.

The American report and other pressures, domestic and external, led the Politburo to pass a resolution (15 November 1989) "On improvements in Soviet law concerning procedures for the treatment of psychiatric patients".

Suriname

Louis Doedel (1905–1980) was a trade unionist. He was involuntary committed in psychiatric hospital on 28 May 1937 by Governor Kielstra. Doedel was forgotten and presumed dead. It wasn't until 1980, 43 years later, that he was released.

Thailand

Following the 2014 Thai coup d'état, there were a few cases where the National Council for Peace and Order (NCPO, the Thai military junta) alleged its opponents, including a protesting schoolchild, Nattanan Warintawaret, were mentally disturbed. In addition, the military junta introduced a systematic process of 'attitude adjustment', whereby hundreds of dissidents were subjected to forcible detention and propaganda until they reformed their views of the junta; the majority did not and were subsequently charged with crimes. While psychiatrists were not employed, a team of psychologists was involved, implying psychological warfare rather than political psychiatry.^:453 On July 9, 2020, Tiwagorn Withiton, a Facebook user who went viral after posting a picture of himself wearing a t-shirt printed with the message “I lost faith in the monarchy” was forcibly detained by police officers and admitted to Rajanagarindra Psychiatric Hospital in Khon Kaen. Tiwagorn has stated that he does not wish the Thai monarchy to be abolished but 'loss of faith' may imply lèse-majesté, a serious crime in Thailand. Tiwagorn is quoted as saying, “I well understand that it is political to have to make people think I’m insane. I won’t hold it against the officials if there is a diagnosis that I’m insane, because I take it that they have to follow orders." Subsequent to protests by civil rights groups and media stories, Tiwagorn was released by Rajanagarindra Psychiatric Hospital, on July 22, 2020.

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 inventing 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. Cartwright also proposed "dysaesthesia aethiopica" as a mental illness that caused laziness among slaves.
*In the United States, political dissent

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