Political abuse of psychiatry in the Soviet Union and in China: complexities and controversies.

On first glance, political abuse of psychiatry appears to represent a straightforward and uncomplicated story: the deployment of medicine as an instrument of repression. Psychiatric incarceration of mentally healthy people is uniformly understood to be a particularly pernicious form of repression, because it uses the powerful modalities of medicine as tools of punishment, and it compounds a deep affront to human rights with deception and fraud. Doctors who allow themselves to be used in this way (certainly as collaborators, but even as victims of intimidation) betray the trust of society and breach their most basic ethical obligations as professionals. When the story is so straightforward, political abuse of psychiatry is universally condemned. Even regimes that sponsor psychiatric repression find it morally embarrassing to admit that they engage in such a corrupt practice. When the Soviet Union was defending its suppression of political and religious dissent, it steadfastly denied allegations of psychiatric repression—allegations that have now been well documented and are no longer contested by the psychiatric leadership in Russia and other post-Soviet states. If this were the whole story, political abuse of psychiatry would take its odious place alongside torture and other abuses of state power and perversions of medical ethics, but it would not be deeply interesting, either morally or sociologically. However, corruption is not the whole story, and political abuse of psychiatry is more complicated than it first appears. Most important, whether the dissident individuals subjected to psychiatric confinement are (or are not) mentally ill is often contestable, especially when culturally embedded features of psychopathology are taken into account. The mental health of dissidents could be contested, even if diagnoses were grounded in a single internationally recognized system of classification, but the problem is all the more complicated when psychiatrists in different societies are trained to understand normality and psychopathology in different ways. Taking into account culturally linked ambiguities in psychiatric diagnosis, it seems likely that at least some cases of alleged abuse represent good-faith efforts by psychiatrists to apply prevailing psychiatric knowledge in politically repressive societies. Thus, two explanations compete for attention in cases of political abuse: corruption and culture. There is a second complicating factor. In the “uncomplicated story,” human rights and medical ethics are perfectly aligned. Intentional misdiagnosis and naked psychiatric punishment amount to simultaneous violations of human rights and breaches of medical ethics. But what is the normative significance of the fact that some people apprehended for dissident conduct are mentally ill? From a human rights perspective, criminal intervention in such cases is still a violation of human rights, because the state has no legitimate authority to arrest anyone for political or religious expression. Whether or not the person is mentally ill, the conduct itself is not properly subject to prohibition or punishment. Moreover, under contemporary principles of mental health law, codified in many countries, a person who Mr. Bonnie is John S. Battle Professor of Law and Director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia, Charlottesville, VA. Address correspondence to: Richard J. Bonnie, University of Virginia School of Law, 580 Massie Road, Charlottesville, VA 22903. E-mail: [email protected]