political abuse of psychiatry political abuse of psychiatry political abuse of psychiatry, also commonly referred to as punitive psychiatry, is the misuse of psychiatry, including diagnosis, detention, and treatment, for the purposes of obstructing the human rights of individuals and/or groups in a society.: 491 in other words, abuse of psychiatry (including that for political purposes) is the deliberate action of having citizens psychiatrically diagnosed who need neither psychiatric restraint nor psychiatric treatment. psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.: 6 as scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.: 14 nowadays, in many countries, political prisoners are sometimes confined and abused in psychiatric hospitals.: 3 part of series oninvoluntary treatment restraint physical restraint chemical restraint involuntary commitment involuntary commitment outpatient commitment court order regulated by medical ethics (informed consent) mental health law mental health tribunal capacity human rights alternatives voluntary commitment informal coercion treatment intramuscular injection (antipsychotic, benzodiazepine, ketamine) force-feeding covert medication psychiatry possesses a built-in capacity for abuse that is greater than in other areas of medicine.: 65 the diagnosis of mental disease allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society.: 65 psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.: 65 the use of hospitals instead of jails also prevents the victims from receiving legal aid before the courts in some countries, makes indefinite incarceration possible, and discredits the individuals and their ideas.: 29 in that manner, whenever open trials are undesirable, they are avoided.: 29 the political abuse of the power entrusted to physicians, and particularly psychiatrists, has a long and abundant history, for example during the nazi era and the soviet rule when religious and political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments". in the period from the 1960s up to 1986, abuse of psychiatry for political and ideological purposes was reported to be systematic in the soviet union, and occasional in other eastern european countries such as romania, hungary, czechoslovakia, and yugoslavia.: 66 the practice of incarceration of religious and political dissidents in psychiatric hospitals in the eastern bloc and the former ussr damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community. political abuse of psychiatry also takes place in the people's republic of china. psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the ussr were used for political purposes.: 77 by country canada the duplessis orphans were several thousand orphaned children that were falsely certified as mentally ill by the government of the province of quebec, canada, and confined to psychiatric institutions. donald ewen cameron's operation was running from what is today known as the allen memorial institute (ami), part of the royal victoria hospital, and not to be confused with the non-governmental organization based in montreal, ami-québec agir contre la maladie mentale. china in 2002, human rights watch published the book dangerous minds: political psychiatry in china today and its origins in the mao era written by robin munro and based on the documents obtained by him. the british researcher robin munro, a sinologist who was writing his dissertation in london after a long sojourn in china, had traveled to china several times to survey libraries in provincial towns and while he was there, he had gathered a large amount of literature which bore the stamp 'secret' but at the same time, it was openly available.: 242 this literature even included historical analyses which were published during the cultural revolution and it concerned articles and reports on the number of people who were taken to mental hospitals because they complained about a series of issues.: 242 it was found, according to munro, that the involuntary confinement of religious groups, political dissidents, and whistleblowers had a long history in china. the abuses began in the 1950s and 1960s, and they became extremely widespread throughout the cultural revolution.: 242 during the period of the cultural revolution, from 1966 to 1976, the political abuse of psychiatry reached its apogee in china, which was then under the rule of mao zedong and the gang of four, who established a very repressive and harsh regime. no deviance or opposition was tolerated, either in thought or in practice. the documents described the massive abuses of psychiatry that were committed for political purposes during the rule of mao zedong, when millions of people were declared mentally sick.: 242 in the 1980s, according to official documents, fifteen percent of all forensic psychiatric cases had political connotations.: 242 in the early 1990s, the number of such cases had dropped to five percent, but with the beginning of the campaign against falun gong, the percentage of such cases increased quite rapidly.: 242 official chinese psychiatric literature distinctly testifies that the communist party's notion of 'political dangerousness' was institutionally engrafted as the main concept in the diagnostic armory of china's psychiatry for a long time and its most important tool for suppressing opposition was the concept of psychiatric dangerousness.: 4 despite international criticism, china seems to be continuing its political abuse of psychiatry. political abuse of psychiatry in china is high on the agenda and it has produced recurring disputes in the international psychiatric community. the abuses there appear to be even more widespread than they were in the soviet union in the 1970s and 1980s and they involve the incarceration of 'petitioners', human rights workers, trade union activists, members of the falun gong movement, and people who complain about injustices that have been committed against them by local authorities. it also seems that, china had no known high security forensic institutions until 1989.: 243 however, since then, the chinese authorities have constructed an entire network of special forensic mental hospitals which are called ankang which means 'peace and health' in chinese.: 243 by that time, china had 20 ankang institutions and their staff was employed by the ministry of state security (mss).: 243 the psychiatrists who worked there wore uniforms under their white coats.: 243 the political abuse of psychiatry in china only seems to take place in the institutions which are under the authority of the police and the mss but it does not take place in those institutions which belong to other governmental sectors.: 243 psychiatric care in china falls into four sectors which are hardly connected with each other.: 243 these are the ankang institutions of the mss; those which belong to the police; those which fall under the authority of the ministry of social affairs; those which belong to the ministry of health.: 243 the sectors which belong to the police and the mss are all closed to the public, and, consequently, information about them hardly ever leaks out.: 243 in the hospitals which belong to the ministry of health, psychiatrists do not have any contact with the ankang institutions, and they have no idea of what occurred there, which means they can sincerely state that they were not informed about the political abuse of psychiatry in china.: 243 in china, the structure of forensic psychiatry was to a great extent identical to that which existed in the soviet union.: 243 on its own, it is not so strange, since psychiatrists from the moscow serbsky institute visited beijing in 1957 in order to help their chinese 'brethren', the same psychiatrists who promoted the system of political abuse of psychiatry in the soviet union.: 243 as a consequence, diagnostics in china were not much different than those which were made in the soviet union.: 244 the only difference was that the soviet union preferred "sluggish schizophrenia" as a diagnosis, and that china generally cleaved to the diagnosis of "paranoia" or "paranoid schizophrenia".: 244 however, the results were the same: long hospitalizations in mental hospitals, involuntary treatments with neuroleptics, torture, abuse, all of which were aimed at breaking the victim's will.: 244 in accordance with chinese law which contains the concept of "political harm to society" and the similar phrase dangerous mentally ill behavior, police take "political maniacs into mental hospitals, those who are defined as persons who write reactionary letters, make anti-government speeches, or "express opinions on important domestic and international affairs". psychiatrists are frequently caught involved in such cases, unable and unwilling to challenge the police, according to psychiatry professor at the peking university yu xin. as liu's database suggests, today's most frequent victims of psychiatric abuse are political dissidents, petitioners, and falun gong members. in the beginning of the 2000s, human rights watch accused china of locking up falun gong members and dissidents in a number of chinese mental hospitals managed by the public security bureau. access to the hospitals was requested by the world psychiatric association (wpa), but denied by china, and the controversy subsided. the wpa attempted to confine the problem by presenting it as falung gong issue and, at the same time, make the impression that the members of the movement were likely not mentally sound, that it was a sect which likely brainwashed its members, etc.: 245 there was even a diagnosis of 'qigong syndrome' which was used reflecting on the exercises practiced by falung gong.: 245 it was the unfair game aiming to avoid the political abuse of psychiatry from dominating the wpa agenda.: 245 in august 2002, the general assembly was to take place during the next wpa world congress in yokohama.: 247 the issue of chinese political abuse of psychiatry had been placed as one of the final items on the agenda of the general assembly.: 251 when the issue was broached during the general assembly, the exact nature of compromise came to light.: 252 in order to investigate the political abuse of psychiatry, the wpa would send an investigative mission to china.: 252 the visit was projected for the spring of 2003 in order to assure that one could present a report during the annual meeting of the british royal college of psychiatrists in june/july of that year and the annual meeting of the american psychiatric association in may of the same year.: 252 after the 2002 world congress, the wpa executive committee's half-hearted attitude in yokohama came to light: it was an omen of a longstanding policy of diversion and postponement.: 252 the 2003 investigative mission never took place, and when finally a visit to china did take place, this visit was more of scientific exchange.: 252 in the meantime, the political abuse of psychiatry persisted unabatedly, nevertheless the wpa did not seem to care.: 252 cuba although cuba has been politically connected to the soviet union since the united states broke off relations with cuba shortly after fidel castro came to power in 1959, few considerable allegations regarding the political abuse of psychiatry in this country emerged before the late 1980s.: 74 americas watch and amnesty international published reports alluding to cases of possible unwarranted hospitalization and ill-treatment of political prisoners.: 75 these reports concerned the gustavo machin hospital in santiago de cuba in the southeast of the country and the major mental hospital in havana.: 75 in 1977, a report on alleged abuse of psychiatry in cuba presenting cases of ill-treatment in mental hospitals going back to the 1970s came out in the united states.: 75 it presents grave allegations that prisoners end up in the forensic ward of mental hospitals in santiago de cuba and havana where they undergo ill-treatment including electroconvulsive therapy without muscle relaxants or anaesthesia.: 75 the reported application of ect in the forensic wards seems, at least in many of the cited cases, not to be an adequate clinical treatment for the diagnosed state of the prisoner — in some cases the prisoners seem not to have been diagnosed at all.: 75 conditions in the forensic wards have been described in repulsive terms and apparently are in striking contrast to the other parts of the mental hospitals that are said to be well-kept and modern.: 75 in august 1981, the marxist historian ariel hidalgo was apprehended and accused of 'incitement against