Published 25 June 2010, doi:10.1136/bmj.

c3371
Cite this as: BMJ 2010;340:c3371

News

China's psychiatric hospitals collude with officials to stifle dissent, say civil rights' groups

Jane Parry, Weiyuan Cui

1 Hong Kong and Geneva

In 2003, Xu Lindong, a farmer from Yancheng county, Henan province, China, decided to file a
petition in Beijing to help his neighbour protest about maltreatment at the hands of local
officials in a land dispute. Xu never filed his petition. On the outskirts of Beijing he was
intercepted by a Daliu township government official and a policeman, taken home, and
subsequently incarcerated in Zhumadian Psychiatric Hospital, Henan, at the request
oftownship and county government officials.

Six and a half years later in April 2010, Xu was released from Luohe Psychiatric Hospital, also
in Henan province, where he had spent the last five months of his ordeal, after being
transferred there from Zhumadian Hospital. When he met the media he described barbaric
treatment while in hospital, including being given electric shocks 54 times and being forced to
take chlorprothixene and chlordiazepoxide, drugs which made him feel faint and dizzy.

Xu's family did not know what had happened to him until July 2007. "Someone from his home
town visited other patients in the same hospital as Xu and he managed to ask the visitor to get
a message to his family," says Xu's lawyer Chang Boyang. The family tried to secure his
release but it was only when journalists brought the case to the attention of the lawyer Chang
that sufficient public pressure mounted in the media to get him out.

"I obtained Xu's medical record, which showed that between February and December 2009,
the Daliu township government paid an average of 1500 yuan (£148;
{euro}<http://www.bmj.com/math/euro.gif> 177; $219) a month for the cost of Xu's
incarceration," says Chang. Four government officials who were involved were subsequently
fired from their posts.
- Nascondi testo citato -

Xu's case is, it seems, just the tip of the iceberg. Lawyers, human rights activists, journalists,
and bloggers have been collating and exposing evidence of widespread abuse of the
psychiatric hospital system with "troublemakers" incarcerated without any formal psychiatric
evaluation or due legal process. The situation has received widespread media and internet
coverage in China.

"Since October 2009 we have collected data from the media, our own volunteers, affected
individuals and human rights organisations overseas on more than 500 cases. The majority of
them are petitioners, as well as rights activists and dissidents," said Liu Feiyue, founder of
Wuhan based non-government organisation Civil Rights and Livelihood Watch.

"When normal citizens are put into psychiatric hospitals the situation is very grave. They are
often forced to take medicine or injections, and when they don't cooperate they report being
bound, beaten up, force fed and electrocuted," Liu says. "As social conflicts in China have
intensified in recent years the number of petitioners has increased and so has the number of
normal citizens being incarcerated in psychiatric hospitals."

It is a phenomenon that suits both local government officials who want a swift solution to
citizens who protest about their activities to higher authorities, and psychiatric hospitals, which
are under pressure to be self financing in a healthcare system that since the 1990s has left
hospitals to largely fend for themselves. In addition to petitioners complaining about local
officials' malfeasance, there are also cases of families and employers using this method to
deal with troublesome employees and relatives, observers say.

"Treatment is only available when there is someone willing to pay. If they have the money and
the motive they can send someone to psychiatric hospital," says Huang Xuetao, a lawyer at
the Shenzhen branch of Beijing Horizon Law Firm, who has taken on numerous cases
involving involuntary psychiatric commitment.

"The whole psychiatric hospital system is commercialised, and as long as payment continues,
the patient cannot leave without the permission of the sender. Even if there is a medical
decision that the person is ready to leave they can't until the sender settles the bill. In the case
of Xu Lindong, even withthe huge pressure from the media, the hospital did not make the
discharge decision, nor did he, his family or his lawyer, but officials from the local government
department that sent him to hospital."

In addition to psychiatric hospitals under the Ministry of Health there are at least 23 known
Ankang (literally "safety and health") maximum security forensic hospitals under the control of
the Public Security Bureau. All staff are police officers, including the psychiatrists and nurses,
and there is no professional separation of custody and treatment.

Use of psychiatric hospitals for political suppression has been a longstanding practice in China
since the 1950s when Soviet experts were invited in to establish China's psychiatric hospital
system based on the Soviet model, says Robin Munro, deputy director of Hong Kong based
non-government organisation China Labour Bulletin, who has extensively researched
politicalabuse of psychiatry in China.

"Ankang hospitals were used to incarcerate real political dissidents, but according to my data
in the early 1990s there was a shift and the target switched to petitioners, persistent
complainers and corruption whistleblowers," he says. "I've documented numerous cases of
incarceration of people who have sought independent medical evaluation to prove that they
are mentally entirely normal, and this is happening more and more often."

Financial pressures are at play in the Ankang hospitals too, says Huang. "Because there are
not enough patients coming from the criminal system, they also recruit patients from the wider
community."

International response to political abuse of psychiatry in China has so far been muted. The
World Psychiatric Association's Committee for the Review of Abuse of Psychiatry has in the
past investigated allegations of abuse of followers of the Falun Gong religious sect, but it has
not acted on more recent and far more widespread reports about abuse of psychiatry to
silencepetitioners and other political dissenters.

Within China, however, as the number of cases increases, so does the publicity about them,
despite the government's best efforts to control the media and the internet. "The contribution of
independent civil society through the Internet is so big now with more and more cases being
publicized by the victims and their legal representatives," says Munro.
Legal recourse is harder to come by, however. Xu says he wants to take his case to a civil
court at a national level to seek 300 000 yuan in compensation, but his lawyer has told him to
keep his expectations realistic, especially as mental anguish is not considered grounds for
financial compensation in China's legal system. "As long as he can get some compensation he
shouldbe happy, because once the media attention is over it's unlikely he will get anything,"
says Chang.

Calls from the BMJ to the Ministry of Health were not answered.

Cite this as: BMJ 2010;340:c3371

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