Over the past decade, there has been a growing anthropological literature on newly emerging psychotherapy programmes in contemporary China, notably represented by Jie Yang’s Unknotting the Heart: Unemployment and Therapeutic Governance in China (Cornell University Press, 2015) and Li Zhang’s Anxious China: Inner Revolution and the Politics of Psychotherapy (University of California Press, 2020). By contrast, psychiatry programmes have remained largely invisible in this literature.
Ma’s monograph offers a compelling ethnography of how families in contemporary China have been made central to the governance of “serious mental illness” and of the political, ethical and affective consequences of that shift. Drawing on fieldwork in hospitals, community mental health programmes and households, Ma traces what she calls a “hospital–family circuit” in which patients are shuttled between home and institution while kin are interpellated as psychiatry’s closest allies and indispensable risk managers. This framework makes a distinctive contribution to discussions of Foucauldian biopolitics in contemporary life by showing that biopower is exercised not only through formal institutions and professional experts such as psychiatrists or human rights lawyers, but also through its enactment by non-experts within intimate relations.
Between Families and Institutions is carefully structured to link shifting state–family relations with transformations in mental health institutions. It begins by tracing the transition from the Maoist “parent state,” which claimed responsibility for the welfare of the people as a whole, to the reform-era naturalization of the family as the primary unit of intimacy and care – a shift that underwrites the retreat of public provision. Subsequent chapters examine how everyday hospital practices translate relational disorder into individual pathology, how national community mental health programmes mobilize family members as frontline risk managers, and how the Mental Health Law’s risk-based criteria for involuntary admission have, in practice, left the number of long-term inpatients largely unchanged while multiplying the risks that caregivers feel compelled to report.
Ma’s main contribution is the notion of “biopolitical paternalism.” Policymakers frame new regimes of patient management as an extension of the state’s paternal care for its people, drawing on historical legacies and cultural ethics of paternalism. Yet the concrete responsibilities for care and control – from arranging hospitalization and overseeing medication to bearing legal liability for patients’ acts – are displaced onto families, especially women and the elderly, who become the de facto custodians of those categorized as chronically risky subjects. A second key thread is the analysis of guan, a linguistically rich term in Chinese that connotes both “management” and a normatively charged practice of parenting. The Mental Health Law, passed in 2013, initially calls upon “all facets of society” to participate in the comprehensive guan of people diagnosed with serious mental illness, but quickly devolves responsibility to the family, who must secure treatment, supervise behaviour and provide for daily needs.
One of the book’s major strengths is its sustained attention to gender. While law and policy imagine the “family” as a unitary bearer of paternalistic authority, the labour of care and risk management is heavily feminized and concentrated among mothers and ageing kin. The author shows that these women are not merely implementing state mandates; their “maternal” practices also supplement – and at times subtly subvert – biopolitical paternalism. Through tinkering with medication, negotiating with community workers, and experimenting with expanded notions of normalcy to keep relationships and households viable, they broaden definitions of family and personhood to include those deemed hereditarily damaging, unproductive or unfit for marriage.
The book will be of interest to scholars of Chinese politics and society not only because it documents the concrete effects of the Mental Health Law and associated programmes, but also because it situates these developments within broader historical trajectories: the shift from the revolutionary “people” to a biologized “population,” the neoliberal devolution of welfare and the consolidation of the security state. Particularly valuable is chapter six, which analyses caregivers’ collective narratives and appeals to the state. Ma reads these as claims to a form of “paternalistic citizenship” that demands recognition of reproductive and caregiving labour while accepting certain forms of state tutelage. By examining caregivers’ narratives in genres such as suku (“speaking bitterness”), the author shows how underclass families frame their suffering in terms of social injustice and unfulfilled socialist promises rather than private misfortune. This perspective complicates more familiar rights-based framings of mental health advocacy and will stimulate debate among readers concerned with citizenship, legitimacy and popular politics in and beyond China.
The book would benefit from a more sustained cross-cultural analysis. For example, while the author briefly references comparable psychiatry programmes in Mexico and Japan, this discussion could be expanded to better situate the Chinese case within a broader comparative framework. Methodologically, the author combines in-depth ethnographic interviews with fieldwork, court cases and archival research. Although the archival component – focused on historical context – strengthens the anthropological argument, the links between historical materials and contemporary analysis are at times insufficiently articulated. In particular, the relevance of sources from imperial China and the Republican period to the book’s central concern – the intertwined relationship between family and state under a contemporary market economy – remains underdeveloped, especially in the discussion of gender dynamics. Furthermore, because the bulk of the fieldwork was conducted between 2013 and 2014, readers may wonder about developments in the 2020s. Although the author uses COVID-19 as a case in which the state intensifies biopolitical paternalism in the everyday governance of the Chinese population, a brief return to the field sites could have helped update and contextualize some of the earlier ethnographic findings.
Despite these minor issues, Between Families and Institutions stands as an empirically rich and theoretically sophisticated study that will reward close reading by anthropologists, sociologists and political scientists specializing in China, as well as by scholars of disability, law and biopolitics beyond the China field. The book could also serve as a text for advanced undergraduate or graduate seminars in medical anthropology or the cross-cultural study of mental health.
