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Who is politicising psychiatry in China?

Department of Psychiatry, II/F, Prince of Wales Hospital, Shatin, Hong Kong

EDITED BY MATTHEW HOTOPF

Having researched on qigong-related mental health problems in China, I am upset to read the statement of Lyons (2001), based indirectly on estimates from Amnesty International and a letter to the Lancet, that "Soviet-style psychiatry is alive and well in the People's Republic".

In China, resurgence of interest in qigong (‘exercise of vital energy’) started as early as 1980, when Chinese people were recovering from the social chaos brought about by the Cultural Revolution (1966-1976). It is worth noting that qigong-induced mental disorder was reported by Chinese psychiatrists long before recent accusations that psychiatry in China is used to imprison people who practise a specific kind of qigong known as falungong. There have been a sizeable number of controlled phenomenological, treatment and outcome studies published in the past two decades that testify that qigong-related mental disorders do not fall into a specific disease category recognised in the modern classifications (see Lee, 1996, for a brief review). In my own field studies, I interviewed people who suffered from acute psychosis induced by the inappropriate practice of qigong in several regions of China as well as in Hong Kong. The condition is intriguing but real, and is deserving of more research from both medical and social science perspectives (Lee & Yu, 1995).

It has been estimated that not less than 5% of people in China practise qigong. The proportion of such people who develop psychiatric complications remains unknown but is likely to be very small. None the less, China has a population of 1.3 billion. The estimate that 600 people received psychiatric treatment for qigong-induced mental disorder cannot automatically be assumed to represent an abuse of psychiatry. China is a huge, heterogeneous and rapidly transforming country in which the standard of psychiatry varies widely from region to region. So the possibility of unethical psychiatric practice certainly exists. Additionally, in the current period of market reforms, the Chinese Government has withdrawn central funding for health care, and hospitals are forced to generate an increasingly large part of their own incomes. As a result, China is in the paradoxical position of having an inadequate number of psychiatric beds, yet at the same time a large number of beds that are unoccupied because families cannot afford to send patients to hospitals on a fee-for-service basis (Lee & Kleinman, 2000).

As a China researcher who can be critical of recent social and moral changes in the country, I feel obliged to point out that even if unethical psychiatric practice existed in China (as it does in the USA, UK, or elsewhere), it would simply not be on the scale seen in the former Soviet Union. I must conclude that the views of Lyons and others who reach similar conclusions (e.g. "Contortions of Psychiatry in China", New York Times, 25 March 2001) are premature and even dangerous, and beg the question of who really is politicising psychiatry in China. As an international leader in psychiatry, the World Psychiatric Association must undertake its review of the accusations against Chinese psychiatrists prudently.

REFERENCES

Lee, S. (1996) Cultures in psychiatric nosology: the CCMD-2-R and international classification of mental disorders. Culture, Medicine, and Psychiatry, 20, 421-472.

Lee, S. & Yu, H. (1995) The evaluation of qigong induced mental disorder as a Chinese culture-bound syndrome (in Chinese). Archives of Psychiatry, 4, 222-225.

Lee, S. & Kleinman, A. (2000) Grave new world: is reform disease or cure for China's mentally ill? Harvard China Review, 2, 72-75.

Lyons, D. (2001) Soviet-style psychiatry is alive and well in the People's Republic (letter). British Journal of Psychiatry, 178, 380-381.[Free Full Text]

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