In the social sciences, “mental health” is a controversial category. While many accept it as a useful way of conceptualizing the mental, emotional or behavioural condition of certain individuals, others have developed an extensive tradition of critiquing the very notion of mental health. Since the 1960s, scholars in psychology, anthropology and sociology have closely attended to the ways notions of mental health are drawn upon to bolster governmental and other authoritative controls over the population. Drawing especially on Foucault, their critiques point to the ways institutions and individuals perpetuate structural inequalities and social control by reinforcing the need for psychological self-management and – when particular selves fall short at managing themselves – expert supervision. One of the consequences of such control, many note, is that governing organizations and those in power evade responsibility for addressing social troubles that their previous actions have caused. While much of this literature focuses on the West, in her work Jie Yang has consistently brought this critique to bear upon various institutions, activities and popular trends in contemporary China. Mental Health in China constitutes a compilation of her previous work, as well as a deepening and clarification of her arguments regarding the functioning of “therapeutic governance” in China.
Drawing upon ethnographic research conducted in multiple contexts over roughly 15 years, the book includes seven content chapters in addition to a comprehensive introduction and conclusion. It provides a wide-ranging tour through an immense and complex terrain: from mental hospitals to government-supported therapeutic programmes to high-end personal development workshops. Yang's central argument – that psychology in all of its forms exists as a technique of power – ties these diverse chapters together, providing a consistent structure and perspective.
The monograph begins with an introduction to what is publicized as China's mental health “crisis.” Since the 1990s, rapid transformations in Chinese society have led to widespread unemployment and increased disparities in income, access to housing, food and medical care. This has generated an uptick in the experience of symptoms of anxiety, depression and other mental illnesses among the population. Yang explains how this has coincided with the massive popularization of psychotherapeutic frameworks for imagining the self as well as managing it through psychological as opposed to political techniques. Yang highlights how such techniques serve political interests, even if on the surface they differ from the “thought work” of the Maoist era.
Each of the following chapters develops the central theme of governmentality and psychotherapeutic care. The first chapter explores in depth how mental health and illness are conceived in contemporary China. Yang notes the influences of Chinese medicine, Confucianism and remnants of socialist politics, attending to the subtle but important differences that these generate between Western and Chinese definitions and enactments of mental health policy. A section discussing “officials’ heartache” serves as an ethnographic example of how Chinese experiences of distress are situated in this complex sociopolitical terrain. It further shows how the insidious manipulation of psychotherapeutic tools by the Chinese state enacts a cultural variation on therapeutic governance as it has been understood in other settings. This theme continues in the next chapter, which describes new Chinese mental illnesses such as “money hunger disease” (jinqian jikesheng) and “smog depression” (wumai yiyuzheng). Brief ethnographic examples and cases are included within several illness sections. Overall, however, Yang never breaks the frame established with her opening and closing discussion of what – socio-politically speaking – such diagnostic labels mean and what they do for both individuals and the state.
In chapter three, Yang maintains her tight focus on governmentality and psychotherapeutics in a discussion of gender and class. Here, there is a great deal of discussion – including brief ethnographic vignettes – specifically about women's roles. She analyses the emerging category of “depressed mother” and eating disorders in terms of how therapeutic governance functions in the gendered experience of women from different class backgrounds. Yang also includes a section on “sick man phenomenon” (nanren bing), showing how therapeutic governance in contemporary China equally but differently affects men. Though not the explicit focus of the fourth chapter, which discusses “stigma and control,” gender and class remain central to Yang's developing argument. Stigma, Yang demonstrates through a fluid incorporation of historical discussion and ethnographic vignettes, acts as a form of social control that leads to intense self, family and community surveillance of individuals deemed “mentally ill.” This situation not only bolsters therapeutic governance in China, but also interestingly offers certain individuals the opportunity to strategically “play” the system to their advantage.
At this point in the book we get a sense of how Chinese individuals and groups can sometimes – albeit in limited ways – enact a kind of agency in terms of resistance, contestation and negotiation. Such themes are more explicitly discussed in chapter five, which is centred around an ethnographically-based discussion of two psychiatric hospitals in vastly different socioeconomic settings. Here, Yang details how dominant forms of psychopharmacology in contemporary China shape new subjectivities, creating bounded selves that dis-embed individuals from more complex social networks and reduce them to biological beings. This homogenizing process, Yang explains, can sometimes be effectively resisted and challenged by patients’ refusal to control their symptoms through drugs, their insistence on talk therapy, and their incorporation of Chinese medicine into their regimen. One gets the sense, however, that such acts of resistance are relatively ineffective for altering the overall impacts of therapeutic governance in China.
Chapters six and seven discuss indigenous psychology and self-help, respectively. With her explanation of several forms of indigenous psychological counseling techniques – including “dredging therapy,” “imagery communication psychotherapy” and “homecoming therapy” – Yang details how therapeutic governance is enacted in hybrid forms of counseling that masquerade as tradition while perpetuating hegemonic state interests. Yang maintains a similar focus in chapter seven, which examines self-help and happiness literature, workshops and programs. This complex chapter incorporates ethnographic vignettes, textual studies and a discussion of how the meaning of “self-cultivation” has changed throughout history. As in other chapters, the overall tone of Yang's discussion here is critical, as it highlights the ways that happiness and self-help material advance government interests by instilling the sense of needing to self-manage in people who are then motivated to consume the relevant self-management products. Yang hints, however, that when it comes to happiness and self-help, not all Chinese individuals are pawns in a government-controlled scheme. For instance, Yang mentions resistance through organized “happiness groups” with political ambitions, as well as implicit governmental critiques within the work of some of the major self-help players. She also mentions what sounds like an extremely active online community of Chinese individuals who are vocal and explicit in their critiques of self-help literature as “reductive” as well as numbing and ultimately destructive.
Yang's conclusion provides a beautiful summary, going through seven major aspects of therapeutic governance in the vast range of settings where she conducted research. Her overarching point is consistent: that “mental distress” (and its management) in contemporary China “is not only about psychological responses to social, economic, and political transformations, but also about culturally mediated experiences with power and injustice” (p. 212). Indeed, with the ethnographic evidence and nuanced theoretical, historical, and political discussions Yang provides in this text, there is simply no way for readers to come away from this book naïve to power and governmentality. Readers might crave more discussion of agency and resistance, which were mentioned throughout but never fully developed theoretically. I would have welcomed more discussion of what the application of such awareness might look like: Yang alludes throughout the book and mentions once explicitly (on p. 98) that the mental health system in China needs to be reformed to incorporate public health and social justice approaches. Given the complexity of the situation in China, one wonders how this might be manifested. One book cannot ever do it all, however. Those of us interested in hearing more from Yang – her perspectives on agency and resistance among microbloggers or her ideas about how to enact socially conscious reform in China – will, for now, just have to relax and enjoy the massive contribution that she has made to the field with this volume, which with its tight focus and clear prose makes it an excellent text for teaching both graduate and undergraduate level courses on contemporary China.
