Psychiatry in its political and professional contexts: a response to Robin Munro.

Robin Munro’s review of “political psychiatry” in China during the past half-century is a reminder that psychiatry has a political as well as a professional and scientific context. In the authoritarian state governed by the Chinese Communist Party (CCP) no aspect of collective experience can be separated from politics. The party has a structure parallel to that of the government, and each work unit has a party secretary who keeps an eye on political issues affecting its members. The secretary maintains a personal dossier on each individual in the unit. In the past, that document was crucial for the person’s career and living conditions. Since the beginning of the era of economic reforms in 1978, the party-dominated public sector of Chinese society has gradually shrunk, and a robust private sector has emerged that is much less fettered by the party’s political constraint. Nonetheless, Munro reminds us, even today, professional life in China can be suborned to the interests of the state to a degree that is much greater than in democracies; but it is also important to keep in mind that psychiatry in every state, including Western liberal democracies, has a political context. A former Director of the Hong Kong Office of Human Rights Watch, Munro has had a career as a China scholar—and he is an impressive one—that is closely connected with his professional role as a documenter and critic of alleged human rights abuses. Hence, he brings to his perspective on psychiatry in China a particular orientation and, indeed, even a bias. He is clearly committed to proving that the abuse of psychiatry has a long history and is today rampant in China. Much of his argument about the political abuse of psychiatry in China is based on unconfirmed allegations, many from human rights groups with their own axes to grind, and others from the Falun Gong religious cult, which, whatever we think of it, we must remember is engaged in a nasty political struggle with the Chinese state. The struggle doubtless results from political repression by the Chinese authorities, but it has taken on a life of its own, in which escalating allegations of political abuse by the Chinese government are the Falun Gong’s master counterresponse. Hence, Munro’s sources have a political cast of their own. At this time, it is not possible for us to confirm or disconfirm the evidence Munro cites, and it would be futile to enter into a debate about that evidence until it is feasible to determine its validity and reliability objectively. It is worth noting, however, that Professor Zhang Mingyuan (surname, Zhang), President of the Chinese Psychiatric Association (CPA), has recently informed one of the authors (A.K.) that in a preliminary investigation (including detailed review of clinical case notes) conducted by the CPA, which obviously has its own political constraints, four of the cases of alleged abuse of psychiatry cited in Munro’s original review were looked into with the result that the CPA now concludes that these individuals had already had a history of schizophrenia, even before they were hospitalized for the alleged reasons. A full report by the CPA on this issue, which we understand is forthcoming, is clearly necessary Dr. Lee is Associate Professor of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China, and Lecturer, Department of Social Medicine, Harvard Medical School, Boston, MA. Dr. Kleinman is Presley Professor of Medical Anthropology and Psychiatry, Harvard Medical School, and Professor of Social Anthropology, Harvard University, Boston, MA. Address correspondence to: Sing Lee, Department of Psychiatry, 11/F, Prince of Wales Hospital, Shatin, Hong Kong. E-mail: [email protected]