In his letter taking issue with our claim that psychiatry is abused by the Chinese authorities for political control purposes, Dr Sing Lee (Reference Lee2001) cites his own experience in examining patients there suffering from ‘qigong-related mental disorder’. He concludes that this culture-bound syndrome both exists and can be a serious condition, and that the psychiatric detention ofFalun Gong practitioners in China today is therefore not a sign of the political abuse of psychiatry. Without challenging the validity of Chinese psychiatrists' diagnoses of qigong-related mental disorder in particular cases, it should be stressed that the Chinese authorities themselves hardly ever mention this diagnosis when justifying the psychiatric detention of Falun Gong practitioners. Indeed, recent articles in the Chinese psychiatric literature have stated that this diagnosis is not generally applicable to Falun Gong practitioners, who are instead alleged to be suffering from a separate and more serious condition (albeit one not recognised in the official Chinese Classification of Mental Disorders) for which the term ‘evil cult-related mental disorder’ has conveniently been coined (Reference Shen and GongShen & Gong, 2000).

More worryingly, Dr Lee makes no reference in his letter to the reality that the Falun Gong practitioners concerned were first arrested by the police, in most cases to prevent them from staging peaceful demonstrations against the Chinese Government's continuing suppression of their spiritual movement nationwide. To our knowledge, the articles from the Chinese psychiatric literature concerning qigong-related mental disorder that Dr Lee refers to in rebuttal of the claims of political psychiatric abuse in China do not address the cases of patients detained by the police — they were all apparently voluntary patients. On both the above key counts, therefore, the Falun Gong cases (all of whom were reportedly arrested and then forcibly committed) evidently fall into a different category from that with which Dr Lee is personally familiar.

The recently compiled evidence of the state abuse of psychiatry against political dissidents over the past decades (Munro, Reference Munro2000, Reference Munro2002), most of which comes from the official Chinese psychiatric literature, is overwhelming in quantity and specificity. Given this past track record, the burden of proof now clearly falls upon the Chinese authorities to convince their own citizens and the outside world that the several hundred reported cases of arrested Falun Gong practitioners sent to involuntary psychiatric treatment (see http://hrreports.faluninfo.net/book4/CategoryIndex.htm) are, as Dr Lee seems to believe, valid and suitable cases for treatment. The simplest way to do this would be for the Chinese authorities to allow suitably qualified outside observers free access to the Falun Gong psychiatric detainees so that their mental conditions can be independently evaluated. Thus far they have shown no such willingness, and several Chinese nationals who tried to document such cases have been jailed.

We acknowledge that Chinese psychiatry as a whole is not generally complicit in these politically motivated distortions of ethical psychiatry and that they are largely (though by no means entirely) confined to the domain of forensic psychiatry. This was also true, however, in the case of the former Soviet Union and certain Eastern European countries, where political dissidents, religious nonconformists and others formed but a small minority of the overall psychiatric inmate population. Then as now, the key issue is that the numbers of those affected is none the less substantial, and that any psychiatric diagnosis based on politics — whatever the scale — poses a potentially wider ethical threat to the profession. This is why the World Psychiatric Association, through its Madrid Declaration on Ethical Standards (see http://www.wpanet.org/home.html), has specifically banned member societies from engaging in politically based diagnosis of any kind.

Finally, the most pressing point to note is that, whereas the incidence of such practices in China had apparently been steadily declining since the late 1980s, the Government's crackdown on Falun Gong since July 1999 has resulted in a sharp renewal of politically abusive psychiatry. Failure by the international psychiatric community to speak out clearly against this disturbing trend now could well give the green light to a further expansion of these measures by the Chinese authorities in their ongoing fight against domestic dissent of all kinds.