Can Science and Technology Save China?

Susan Greenhalgh, Li Zhang, Susan Greenhalgh, Li Zhang

• Publisher: Cornell University Press
• Year: 2020
• Print ISBN: 9781501747021
• eBook ISBN: 9781501747052
• Topic: History
• Subtopic: Chinese History
• Index: History

Can Science and Technology Save China? assesses the intimate connections between science and society in China, offering an in-depth look at how an array of sciences and technologies are being made, how they are interfacing with society, and with what effects.

Focusing on critical domains of daily life, the chapters explore how scientists, technicians, surgeons, therapists, and other experts create practical knowledges and innovations, as well as how ordinary people take them up as they pursue the good life. Editors Greenhalgh and Zhang offer a rare, up-close view of the politics of Chinese science-making, showing how everyday logics, practices, and ethics of science, medicine, and technology are profoundly reshaping contemporary China. By foregrounding the notion of "governing through science," and the contested role of science and technology as instruments of change, this timely book addresses important questions regarding what counts as science in China, what science and technology can do to transform China, as well as their limits and unintended consequences.

1

NUMBERS AND THE ASSEMBLING OF A COMMUNITY MENTAL HEALTH INFRASTRUCTURE IN POSTSOCIALIST CHINA

Zhiying Ma

On October 9, 2013, a day before that year’s World Mental Health Day, a news article brought the Chinese psychiatric profession to the center of public attention. Published in Southern Metropolis Daily, the article was entitled “ ‘Apportioning’ [tanpai] Quotas [zhibiao] of Mental Illnesses.” It reported that in Zhengzhou, the capital of Henan Province, community mental health practitioners (CMHPs)¹ had received a curious task: finding two persons with serious mental illnesses—schizophrenia, schizoaffective disorder, bipolar disorder, paranoid disorder, mental retardation with psychosis, or epilepsy with psychosis—per thousand residents. Because these CMHPs belonged to administrative communities, or shequ, of different population sizes, the quotas they were assigned were proportionately different. For example, in a community with 35,398 residents, seventy-one patients with serious mental illnesses had to be discovered (Wang and Jin 2013).

According to the article, the CMHPs were required to solicit clues to suspected patients from local bureaucrats and other community residents. They were then asked to visit the suspected patients’ homes in order to confirm their conditions and to register their information in a database. Several CMHPs complained that their home visits were often unwelcome because of families’ concern with privacy, and that on occasion doors were even slammed in their faces. Moreover, despite their best efforts, it just seemed impossible to find so many patients and meet the quotas. In contrast to the quota of seventy-one patients, the CMHP in the aforementioned community could only find twelve patients. “I can’t possibly register those who are not mentally ill as patients, right?” asked another CMHP rhetorically. However, in order to avoid potential institutional punishment, some CMHPs did choose to make up the numbers by counting as seriously mentally ill people who were just a bit “off.”

The article then pointed out that this “quota apportioning” was a nation-wide phenomenon produced by the 686 Program (Wang and Jin 2013). The program was established by China’s Ministry of Health in 2004, and it is officially called the “Program for Managing and Treating Serious Mental Illnesses, Run by Local [Governments] and Subsidized by the Central [Government].” The short form came from the funding, RMB 6.86 million (approximately USD 1 million), which the program received from the central government in its first year (PKU6 2012). The program’s main goals, as stated by its leaders, are “to establish an effective mechanism to comprehensively prevent and control the violent behavior of patients with serious mental illnesses; to enhance the treatment rate and reduce the violence rate; to disseminate knowledge of mental illness prevention and treatment; and to spread the knowledge of systematic treatment of serious mental illnesses” (Ma et al. 2011). After patients are discovered, the plan is for CMHPs to visit them regularly, provide them with free or low-cost medications, and check on them lest they harm themselves or others. Simply put, the 686 Program seeks to build a mental health infrastructure that extends beyond the psychiatric hospital and reaches the public.

Regardless of the program’s goals, the public was scandalized by its “quota apportioning” practice, especially the potential consequence of “making up patients” and subjecting them to unpleasant treatment. In response, Dr. Yu Xin, a leading expert involved in designing and overseeing the 686 Program, explained to journalists that the target detection rate (jianchu lü) was calculated based on the prevalence rate of serious mental illness discovered in epidemiological surveys.² A spokesperson from the Ministry of Health claimed that the rate was merely a guideline for provinces and cities; it was not—and should not be—imposed on health workers at the community level. Echoing these statements, administrators from the Zhengzhou Bureau of Health emphasized the necessity of the 686 Program for patients and the general public (Han and Ren 2013). These explanations did not satisfy critics like Huang Xuetao, a famous human rights advocate for psychiatric patients. She told reporters that practices of community mental health rendered medicine an administrative matter, deviating from medical ethics and scientific methods of epidemiology. By discovering patients and putting them under surveillance, she argued, these practices made mental health services measures of social control (Huang 2013).

Numbers, Communities, and Dreams of Governance in Postsocialist China

As we can see in the Zhengzhou incident, numbers such as the patient detection rate have played an important and controversial role in the design, implementation, and public perceptions of the 686 Program. While the program’s designers and leaders insisted on the scientific nature of the target detection rate, as well as its legitimacy and “soft” quality in practice, grassroots practitioners saw the target as removed from local reality and imposing much bureaucratic pressure on them. Shored up by numbers, the program was seen by its designers and leaders as a good for mentally ill patients and the general public, but it was deemed by critics to be a tool of state control. Why, then, does the construction of a community mental health infrastructure hinge on the assignment, collection, and monitoring of numbers? How does the same set of numbers elicit different feelings and assume different modes of operations? Why is community mental health as a form of numerical governance a dream for some and a nightmare for others? These are the questions that this chapter seeks to answer.

Numbers have become increasingly important for governance throughout the contemporary world. For example, scholars have noticed a rising “audit culture” in neoliberal societies (Strathern 2000), a dominant “indicator culture” in international human rights monitoring (Merry 2016), and an overflow of “metrics work” in global health (Adams 2016). In these forms of numerical governance, numbers project an “aura of objective truth and scientific authority” (Merry 2016, 1), free from personal, political, and moral biases; they provide seemingly universal standards, rendering different social worlds comparable; and their apparent transparency summons bureaucratic accountability even in the absence of direct state interventions or hard international laws. In postsocialist China, the scientific quality of numbers has given them a special appeal. After all, science appears to government leaders, experts, and the populace alike as an antidote to the tendency of over-politicization during the Maoist era. It provides a global standard to diagnose what is wrong with China, as well as to discern how the nation should catch up with the world and achieve modernity (Wang 2008). A key object of governance that numbers have helped to constitute in postsocialist China is the population, a biological entity that needs to be managed by science (Greenhalgh and Winckler 2005), a “collective form of grouping that renders focused research, measurement, and intervention possible” (Cho 2013, 70). Through categorizing, counting, estimating, and projecting, numbers have produced entities ranging from general population overgrowth (Greenhalgh 2008) to specific groups such as the disabled (Kohrman 2003), the poor (Cho 2010), and the infectious (Mason 2016). Taking cues from these studies, this chapter will show how globally validated epidemiological estimates have constituted a population of seriously mentally ill patients in China, the target population of the 686 Program.

Note, however, that numerical governance in China is not necessarily new or simply global. With a long genealogy in Chinese statecraft, the same set of numbers can often operate in different modalities, commensurate various desires, and produce diverse effects or affects (Kipnis 2008).³ For instance, Matthew Kohrman has shown that the codification and quantification of disability allowed Chinese officials to frame the country as simultaneously “backward” and “developing” (Kohrman 2003). Susan Greenhalgh has discovered that the one-child policy combined Western science of population growth modeling with socialist target setting and party-led mobilization to produce a “target obsession and numbers mania,” which treated population as numbers and nothing else (Greenhalgh 2005a). Similar dynamics can be found in the 686 Program. As I will show, the categorization and enumeration of seriously mentally ill patients has allowed psychiatrists and policymakers to commensurate their desires to serve and surveil this population. The dream-like quality of globally circulating numbers has thus helped fashion a dream for a state that is simultaneously caring, secure, and stable. However, as seen in the Zhengzhou incident, when epidemiological estimates operate as target detection rates and program evaluation standards, grassroots practitioners, clients, and critics are reminded of the nightmare of the socialist planned economy. I will suggest that this unintended consequence comes from people’s historical memory of numerical governance, as well as the existing bureaucratic pathways that guide numbers’ traveling.

In adding to the literature on numerical governance, I will show that numbers may help constitute not only populations but also communities as objects of governance. Since the demise of the socialist work units in the 1990s, the Chinese state has sought to reorganize the social along a new axis called “community” (Bray 2006; Tomba 2014). While some scholars have focused on “community” as governing through individuals, families, and private property management agencies (Zhang 2012), others have emphasized the extension of state institutions in community construction (Heberer and Göbel 2011; Read 2012). Here, community mental health seeks to extend institutional psychiatry and integrate mental health work into state-sponsored public health endeavors. Following Nikolas Rose’s idea that community is both “the territory of government” and “a means of government” (Rose 1996, 335), I will analyze the ways in which community is brought to bear on mental health and numbers help construct community. First, numbers can distribute the seriously mentally ill population in bounded territories. The specific geographical imagination of patient distribution is shaped by both the universal, abstract vision of epidemiological estimates and the particular considerations in target setting. Second, by counting out patients estimated to exist and recording their quantitative information, numbers enable professionals to serve and surveil them in situ. Third, through target setting, patient enumeration, and quantitative program evaluation, a team of CMHPs with common protocols and different areas of operations is built. Although targets are envisioned by their designers as no more than soft guidelines, once promoted, they obtain an inertia to travel along existing bureaucratic pathways, press on grassroots practitioners, and roll out the community mental health infrastructure down to the lowest administrative level.⁴

By exploring how numbers help construct the community mental health infrastructure, this chapter also speaks to discussions about emerging health and therapeutic governance in China, especially evaluations of the Chinese state’s renewed promise to care. In her study on state-sponsored psychotherapeutic services for unemployed workers, Jie Yang (2015) uses the term “kindly power” (xiv) to debunk the “trick of kindness that is intended to disguise the unkindness of the state” (25), including past destructions caused by the state-led market reform and current social control. Similarly, Katherine Mason has revealed a “bifurcation of service and governance” in public health programs—that is, a separation “between the group being served and the group being governed” (Mason 2016, 20). On the other hand, Li Zhang (2017) has discovered that therapeutic governing can “simultaneously produce disciplining and nurturing, repressive and unfettering effects in everyday life” (6). She thus suggests that instead of assuming a cynical view, we pay attention to the visions driving local authorities to pursue therapeutic governance, as well as its diverse effects (9–10). In the case of community mental health, I will argue that numbers provide a medium through which different dreams of governance—service and surveillance, humanitarian care and security management—are framed, justified, commensurated, and operationalized.⁵ Therefore, at least for program designers, psychiatric power exerted through community mental health is genuinely kind. Yet by tracing numbers’ circulation, I will also show how service may be unhinged from surveillance, and why community mental health governance may be perceived as unkind. Not only can program targets, transformed from epidemiological estimates, elicit fear, impose bureaucratic pressure, and incite tactical responses of data fabrication, but they may also outrun and limit services that CMHPs provide. Communities that n...

Table of contents

• Acknowledgments
• Introduction
• 1. Numbers and the Assembling of a Community Mental Health Infrastructure in Postsocialist China
• 2. Embracing Psychological Science for the “Good Life”?
• 3. Negotiating Evidence and Efficacy in Experimental Medicine
• 4. Divergent Trust and Dissonant Truths in Public Health Science
• 5. China’s Eco-Dream and the Making of Invisibilities in Rural-Environmental Research
• 6. The Good Scientist and the Good Multinational
• 7. The Black Soldier Fly
• 8. Unmasking a Gendered Materialism
• Afterword
• List of Contributors
• Index