THE UNIVERSITY OF CHICAGO INSANITY, INTIMACY, AND INSTITUTION: GOVERNANCE AND CARE UNDER THE MENTAL HEALTH LEGAL REFORM IN CONTEMPORARY CHINA A DISSERTATION SUBMITTED TO THE FACULTY OF THE DIVISION OF THE SOCIAL SCIENCES IN CANDIDACY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF COMPARATIVE HUMAN DEVELOPMENT AND DEPARTMENT OF ANTHROPOLOGY BY ZHIYING MA CHICAGO, ILLINOIS DECEMBER 2016 Copyright @ 2016 by Zhiying Ma All Rights Reserved TABLE OF CONTENTS LIST OF FIGURES ....................................................................................................................... iv ACKNOWLEDGMENTS .............................................................................................................. v ABSTRACT .................................................................................................................................. xii INTRODUCTION .......................................................................................................................... 1 SECTION ONE: INSANITY, INTIMACY, AND INSTITUTION 1. Insanity, Intimacy, and Institution: A History ...................................................................... 36 2. Constructing Rights, Contesting Paternalisms: The Making of the Mental Health Law in China .................................................................. 91 SECTION TWO: LOGICS OF RISK, ETHICS OF PATERNALISM 3. Cruel Hope: Hospitalization, Risks, and Abductive Commitments ................................... 134 4. Biopolitical Paternalism and Ordinary Maternalism: Family Relations amidst the Rise of Community Mental Health ....................................... 181 SECTION THREE: PREDICAMENTS AND POTENTIALS OF GUAN 5. The Ins and Outs of the Mental Health Law ....................................................................... 230 6. Waiting for the Parent State: Suffering, Sociality, and Citizenship among Family Caregivers ........................................ 270 EPILOGUE ................................................................................................................................. 313 REFERENCES ........................................................................................................................... 329 iii LIST OF FIGURES Figure 1.1 Image 1 from Hospital Reports, the Kerr Refuge for the Insane, 1916-1917 .... 58 Figure 1.2 Image 2 from Hospital Reports, the Kerr Refuge for the Insane, 1916-1917 .... 60 Figure 1.3 Image from Charles C. Selden (1909c). “III. Treatment of the Insane,” in The China Medical Journal. .......................................................................... 60 Figure 3.1 Bus Poster Advertisement for Guangzhou Baiyun Mental Hospital ............... 147 Figure 4.1 Chongqing, 2011: a 40-year-old patient restrained with chains by her mother for 23 years ....................................................................................................... 211 Figure 4.2 Baoding, 2009: a patient who has lived in a cage for 10 years is “rescued” by hospital psychiatrists .................................................................................... 212 Figure 5.1 Attorney reading the verdict to Xu Wei at the hospital gate ............................ 262 Figure 6.1 Family caregivers in the circle drawing exercise .............................................. 293 iv ACKNOWLEDGMENTS Eight years ago, I arrived at Hyde Park, not having a clue about anthropology, graduate studies, or the United States. Eight years later, as these words appear on the computer screen, I am setting off for another destination. Although I am again not quite sure what lies ahead, at least this time I have a dissertation in hand, reminding me of what I might achieve with all the guidance, friendship, and love from others. Foremost I wish to express my appreciation to the members of my dissertation committee. Soon after I decided to come to the University of Chicago, Judith Farquhar got in touch with me and gave me a precious opportunity to work on—or rather, learn from—her research. Since then, she has been tirelessly showing me the beauty of anthropology. She allowed me the freedom to do whatever I want, while always nudging me to go a bit further and be a bit more creative. She is a rigorous thinker, but she always engages with students’ works and words in a generous spirit. This gave me warmth and confidence that I, as an international student, desperately needed. Whether in Chicago, Chapel Hill, or Beijing, whether in person, by phone, or via email, she always made herself available for graduate student consultation. Judy has been, and will continue to be, my lighthouse in academia and in life. Even before he formally assumed the faculty position at Chicago, Eugene Raikhel had been advising me on my Trial Research thesis. From then on, he has read and commented on countless drafts of my thesis, grant proposals, and journal article submissions. Eugene was mindful of my professional development. He took me to lectures out of town, introduced me to scholars who might be interested in my work, and invited me to be a teaching assistant and then a guest speaker at his popular course Culture, Mental Health, and Psychiatry, a course highly v relevant to my research. In the 2015 Society for Psychological Anthropology Biennial Meeting, Eugene offered to organize a panel with me on the specter of institutionalization in psychiatric reforms around the world. That panel helped me think through many issues in my dissertation. I am also grateful for his advice, when I was most uncertain about continuing with graduate studies, that one should persevere and not think about Plan B when striving for intellectual achievements. While I appreciate other teachers’ generosity to my work, I am also indebted to Don Kulick’s strictness. In his weekly “lab” with students, he challenged us to write in a clear, succinct, and jargon-free way, questioned our research with “so what,” and asked us to show our work ethics by sticking to deadlines, time limits, and so on. The training might be painful, but it showed me a path out of the disorienting experience of dissertation writing. My research also benefited from Don’s idea of vulnerability as a starting point of ethics. The Narrative seminar that Susan Gal offered in my first year opened a new world called semiotic analysis for me. In our conversations, she urged me to pay attention to discursive constructions of the public/private divide, to routes of translation, and to entanglements of discourse and institution. With her work in Eastern Europe, Sue was always able to give me comparative insights on post-socialist experiences. Teachers outside of my committee, or even outside of the University of Chicago, have helped me in various ways. Richard Taub’s urban ethnography course sharpened my perspective as a fieldworker. Although he was only my first-year advisor, he continued to give me emotional support and practical advice through laid-back conversations. As the outside reader of my dissertation proposal, Kaushik Sunder Rajan asked me incisive questions, warning me against applying Foucault’s historical narratives directly onto China. His course Health, Value, and vi Politics pushed me to think more deeply about political economy. Summerson Carr reminded me to put Chinese mental health in the context of global circulations. I also appreciate her difficult yet important questions for my work, such as institutional processes of community mental health, my own attitude toward drugs, and my definition of paternalism. Angela Zito at New York University pointed out the pivotal role of filiality in imperial Chinese kinship and kingship. She also suggested that I organize an AAA panel on contemporary Chinese families, which turned out to be an inspiring conversation. Hsuan-Ying Huang, now at Chinese University of Hong Kong, impressed me with his encyclopedic knowledge on Chinese psychotherapy and psychiatry. He was munificent in sharing his knowledge and connections. At the University of Chicago, support from department administrators might at times be invisible, but it is always indispensible. Whenever I was faced with bureaucratic troubles, Anne Ch’ien (Anthropology), Janie Lardner (Comparative Human Development), and Spencer Bonadeo (Comparative Human Development) quickly brought me peace of mind by patiently explaining to me the institutional procedures, sharing their experiences, and connecting me to relevant resources. As I juggled between two programs, they often went out of their way to explore the requirements I should meet, to communicate with faculty and staff at their own and/or the other departments about my needs, and to negotiate between different or even contradicting demands on my behalf. In the difficult journey of graduate studies, fellow students at or beyond the University of Chicago have provided invaluable comradeship. As my first friend in the United States, Amir Hampel was always there to help when I needed suggestions on a paper or a presentation. Conversations with him never failed to inspire, be they on Nietzsche, on mental health, or on political culture in China. Michael Chladek is one of the most magnanimous persons I know. vii During my distress, his words could always calm me down. I was fortunate to have both Jenny Miao Hua and Hiroko Kumaki as my interlocutors on East Asian medicines. Jenny read and commented on some of my chapter drafts, and Hiroko kindly shared many relevant course materials with me. I also benefited from the help of more advanced