The WPA World Congress in Yokohama and the issue of political abuse of psychiatry in China

On 24-29 August 2002 the Twelfth World Congress of the World Psychiatric Association (WPA) took place in Yokohama, Japan. The congress turned out to be much smaller than previous ones, with only 5000 people attending. However, after the congresses of Mexico (1971), Honolulu (1977), Vienna (1983) and Athens (1989), this was the fifth congress that was dominated by the issue of political abuse of psychiatry. This time it was not the former Soviet Union that was the focus of attention, but the People's Republic of China, where abuses are said to take place in an even more widespread form than in the Soviet Union in the 1970s and 1980s.

In the months prior to the Congress, the WPA Review Committee on Abuse had carried out an investigation of the allegations of political abuse of psychiatry, notably the cases of Falun Gong practitioners who had been sent to psychiatric hospitals forcibly as part of the Government crackdown on the movement. Negotiations had started with Chinese authorities with regard to the possibility of an on-site investigation. Also, members of the WPA Executive Committee had maintained contact with the Geneva Initiative on Psychiatry (GIP), trying to find common ground with regard to the question of how to approach the Chinese issue, but without information as to the actual negotiations.

Although the WPA most often referred to the alleged psychiatric abuse in China as ‘the Falun Gong Issue’, it is important to note that the most recent GIP/Human Rights Watch report (Human Rights Watch & GIP, 2002) has given overwhelming evidence of political abuse of psychiatry far beyond the Falun Gong.

Preparing for the General Assembly

In general, GIP has come to enjoy a very positive reputation among world psychiatric leaders, a situation quite different from some previous conferences. In the past, our human rights work was labelled, by some WPA officials, as being CIA-funded, Scientology-inspired and anti-psychiatric in nature. Due to the involvement of the organisation in supporting reform in mental health in Central and Eastern Europe and the New Independent States, the organisation has obtained a respectable status among world psychiatric leaders and several of the WPA Executive Committee members are Patrons of GIP. In July 2001, the Annual General Meeting of the College adopted a resolution proposed by GIP's present and past Chairman, Dr J. L. T. Birley and Professor R. Jacoby. In this resolution, the College called upon the General Assembly of the WPA to decide to send an investigative mission to China. The text of the resolution read as follows:

Resolution

Bearing in mind the available evidence that political dissidents in The People's Republic of China (PRC) are being systematically detained in psychiatric hospitals, we propose that the Royal College of Psychiatrists takes the following action:

1. (1) to join with the WPA to arrange a fact-finding visit to the PRC;

2. (2) if this visit and other evidence confirm political abuse of psychiatry, to ask the WPA to reconsider the constituent membership of the Chinese Society of Psychiatrists;

3. (3) to work with the WPA to provide support for those Chinese psychiatrists who are committed to ethical and evidence-based practice.

This resolution formed the basis of the discussions at the WPA General Assembly. Although most psychiatric associations had received the text either from the College or GIP, or through other channels, the WPA did not disseminate it until the delegates arrived in Yokohama, when they received other materials for the Assembly. The China resolution was one of four ‘specific action items submitted by member societies’, and only 15 minutes were allotted to these four issues, scheduled at the very end of the meeting, 50 minutes prior to the closing.

The fact that the China issue was put at the end of the agenda as a minor issue resulted in protests from member societies. After receiving concerned messages from a number of member societies, the WPA President, Professor Lopez-Ibor (one of GIP's Patrons), decided to organise a private meeting with a number of key delegates to discuss the ‘Falun Gong issue’ and the position of the WPA. As later became clear, he presented those attending with the WPA proposal with regard to the issue, which was later brought forward as a proposal at the General Assembly.

The General Assembly

The General Assembly meeting was scheduled to start at 9:30 a.m., but started 2 hours later. GIP representatives were present well in advance of the meeting, near the registration desk for delegates of member societies, handing out the report published together with Human Rights Watch.

After an introduction to the China issue by WPA President Lopez-Ibor and a detailed report on the interaction with the Chinese by Review Committee Chair Marianne Kastrup, College President and delegate Dr Mike Shooter spoke, calling on the WPA to send an investigative mission to China, stressing the need for it to be independent, with full access to all persons and institutions it wanted to visit. He was supported in this by the delegate from the American Psychiatric Association. Professor Lopez-Ibor called upon the delegates to be cautious and to go step by step, to develop a protocol for the mission first and then to nominate a working group that would carry out the mission. A request from Dr Shooter that the College be involved in the selection of working group members was turned down, and it was decided that the WPA Executive Committee would decide on who would be on the task force to prepare the mission, who would eventually go on the mission and with what protocol the mission would take place. The mission was said to have to take place before the spring of 2003, so that a report would be ready in time for the Annual Meeting of the American Psychiatric Association in May 2003 and the Annual Meeting of the College in July 2003. The General Assembly eventually agreed unanimously with the WPA Executive Committee's proposal, with only the College abstaining from voting.

The aftermath of the General Assembly

After the General Assembly, Professor Lopez-Ibor gave a press conference, during which he stressed that, in his view, the mission to China would only take place if a good protocol could be agreed upon and the delegation could meet any person they wanted and visit any institution they wanted to see. However, he continued to refer to ‘the Falun Gong issue’. At a later press conference, Professor Lopez-Ibor asserted that there was no actual difference between the text of the College resolution and the WPA proposal that had been adopted by the General Assembly and again stressed that the mission would not take place if its independence could not be guaranteed.

On August 29 a workshop was held within the framework of the congress programme, organised by GIP and chaired by its Chairman Professor Robin Jacoby. Speakers on behalf of GIP were General Secretary Robert van Voren, past Chairman Dr Jim Birley and China specialist Robin Munro. On behalf of the WPA, President Professor Ahmed Okasha, Review Committee Chair Dr Marianne Kastrup and her apparent successor, Dr Harold Eist, spoke at the meeting. In general, all the above-mentioned points were confirmed, and Professor Okasha made a very strong statement as to the need for an independent mission. However, he said, ‘I do not have an army to invade China and investigate, unfortunately. If the authorities refuse to cooperate we cannot carry out our mission’.

Future prospects

The forthcoming 6 months are crucial. The WPA will have to work very hard to negotiate with the Chinese authorities, put a team together, carry out the mission and write a report. It is very doubtful that this can be done within the set time frame. Whether or not this is done by the specified deadline, it will be important for GIP and other organisations to continue to raise this issue at psychiatric conferences and elsewhere. In general, it is clear that our role as watchdog was very successful in Yokohama and that our presence and continuous pressure brought about the good result of the congress. Although issues of concern remain — the unclarity of the working conditions of the mission to China and the reluctance by the WPA to take up cases other than those of the Falun Gong — we can be quite satisfied with the outcome. It is now our task to maintain the pressure, collect as much evidence as possible and submit it to both the delegation and the WPA Review Committee; in addition, we need to look for other venues in which the issue of political abuse of psychiatry in China can be raised. Our first candidates in that respect are the European Parliament and the UN Committee on Human Rights.