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Document 1283: Give Full Prominence to Politics and Follow China's Own Path Toward the Cure and Prevention of Psychiatric Illness284

Editorial Board of the Chinese Journal of Neurology and Psychiatry

April 1966

After Liberation, under the leadership of the Party and especially since the Great Leap Forward of 1958, all parts of the country have been making great efforts towards the cure and prevention of mental illness, and definite successes have been achieved. However, we are still lagging sharply behind in this area, as compared with the excellent overall situation that has arisen throughout the country as a whole. Many problems still exist in our work, foremost among them being that some psychiatric workers are still quite heavily influenced and affected by bourgeois medical ideology: they emphasize treatment and cure, but not disease prevention; they are concerned only with the situation inside their hospitals and ignore the situation beyond the hospital walls; they use too many drugs and pharmaceuticals to treat patients and fail to mobilize the positive factors within the patients themselves, and so end up treating the illness rather than the person; they rely in their work upon a small number of specialized personnel and not upon the broad masses of the people; they one-sidedly stress objective factors and conditions and are afraid of difficulties; and their ideology is lacking in the self-consciously revolutionary spirit of self-reliance, of hard work and thriftiness, and of wholeheartedly serving the people.

For the past year and more, medical health workers throughout China have been resolutely implementing the directives of the Party Central Committee and Chairman Mao by taking part in the Three Great Revolutionary Movements;285 large numbers of doctors and pharmacists have been going "up to the mountains and down to the villages" in order to relieve the peasant masses of their pains and illnesses; and while healthcare work has been greatly reinforced in the countryside, a revolution has been taking place in the urban healthcare field. Most important of all, an ardent high tide in the universal study of Chairman Mao's works has been unleashed, allowing us to raise our level of ideological awareness, to give full prominence to politics, and to criticize and condemn the bourgeois ideological preference for working in isolation from politics, the masses and reality. [...]

As regards work on the treatment and prevention of schizophrenia, our medical personnel, after profoundly studying and learning from the works of Chairman Mao, have become imbued with the spirit of serving the people wholeheartedly and of conquering the academic viewpoints of subjective idealism and metaphysics that previously filled their minds.286 As a result, a whole new situation has arisen, and they have smashed through the old mindset of treating mental illnesses solely by means of insulin coma therapy, electroconvulsive treatment and psycho-pharmaceuticals. Now, at the same time as using drugs and so forth, they also stress mobilizing the positive factors within the patients themselves. Many work units have organized the patients into groups to study Chairman Mao's teachings on the treatment and cure of disease, and this has fortified the patients in their resolve to do battle with their illnesses and relieved them of all kinds of psychological burdens, thereby benefiting their recovery.... In Beijing's Anding Hospital, for example, the relapse rate among schizophrenics has fallen from a previous level of 60 percent to a mere 20 percent. [...]

In Chengdu in March of this year, at a national symposium to exchange research-work experiences in the fields of psychiatry and neurology, the question of the content and essential nature of "psychotherapy" (xinli zhiliao) was quite extensively discussed. In the view of the conference, China's "psychotherapy" is fundamentally different in nature from the old-style "psychotherapy" found elsewhere. The main difference is that it has a clear and distinctive class nature: it employs a variety of means to help the patients strengthen their resolve to fight their illnesses for the sake of the revolution, and to do so self-confidently; and it firmly opposes the subjective-idealist ideological standpoints adopted by the bourgeois schools of psychoanalysis and psychobiology. The second difference is that it emphasizes the importance of mobilizing the patient's inner subjective dynamism287 during the treatment process... "Psychotherapy" is therefore a kind of ideological re-education, the essence of which is to instill in the patients a revolutionary worldview and outlook on life... Although for the meantime we are using the term "psychotherapy" to denote this treatment method, it may well turn out to be a rather inappropriate term. We will need to reconsider what name to use for it in the light of subsequent practical experience...

Document 2: Give Full Prominence to Politics and Revolutionize the Clinical Management of Mental Illness288

Tianshui Mental Hospital, Gansu Province

April 1966

Whether we do a good or a bad job in managing mental illness is a crucial issue that affects both the quality of the medical treatment provided and also the recovery rate among the mentally ill. Here we would like to describe the efforts made by this hospital over the past few years to revolutionize our clinical management work.

In the early period after the founding of our hospital, we lacked experience in clinical management and so tried to study and emulate the experiences of other local hospitals. But we basically continued to follow the capitalist managerial model, with patients being confined in isolation, spending long periods in a boring and depressing environment and undergoing a gradual mental decline. In the course of the 1957 Anti-Rightist Movement and the struggle to annihilate capitalism and assert the proletarian worldview,289 however, the level of ideological awareness among our medical personnel rose greatly and we made initial progress in critiquing the bourgeois viewpoint that "mental illness is protracted and incurable" and so nothing much can be done about it. [...]

In line with the gradual unfolding and deepening of the Great Socialist Education Movement,290 we have been conducting a major campaign to study the works of Chairman Mao, to learn from the People's Liberation Army and to promote the excellent situation of "Upholding the Four Firsts,"291 and we have been greatly educated and inspired by this. Getting clinical management work right is essentially a complex human relations project. Every human activity has an ideological basis, and the mentally ill are no different in this regard. Where problems of an ideological category are concerned, it is no use just relying on giving medicine and injections. What we really have to focus on is helping mental patients to give full prominence to politics, raise their levels of class-consciousness, and embrace the ideology of becoming well for the sake of the revolution and of waging conscious battle against their illnesses. While following the medical principle of curing both the sickness and the sufferer, and at the same time as unfolding "psychotherapy" work, we have set up an "administrative ward inspection system" whereby every Saturday morning the Party secretary, the hospital director and all the various department heads carry out a comprehensive and thoroughgoing inspection of the sick wards, holding conversations with the patients and discovering and solving any problems.

Among the patients themselves, depending on their individual circumstances, we have set up groups for the living study and living application of Chairman Mao's works, organized newspaper-reading classes, and held education sessions on current political affairs and on the advanced example set by the heroes of the revolution. Moreover, especially among the long-term inmates, we have compiled textbooks that take account of their particular mental conditions and which we use for purposes of re-educating them. The mental patients have found these very interesting, and when used in combination with psychotherapy and appropriate clinical management they have proven to be quite effective. In addition, we have purposefully arranged for the patients to view films such as "Be Eternally Loyal to the Party" and "The Spark of Life," to visit exhibitions on political class education, to take part in "recalling past bitterness and remembering present happiness"292 sessions, and to hold group classes where they enthusiastically sing revolutionary songs, and all of this has helped release the patients' subjective positivity and has imbued them with a spirit of revolutionary optimism. In short, the everyday atmosphere in the sick wards is increasingly brisk, lively and dynamic. One mental patient, for example, wrote to us after being discharged from hospital: "My stay in hospital this time was just like being in a school of politics - you cured both my physical illness and also my ideological sickness. I want to thank the Party for all the warmth and concern it has shown me."293 [...]

Document 3: Analysis of a Survey of 250 Cases of Mental Illness294

Chenzhou District Mental Hospital, Hunan Province;

Medical Group of the Mental Clinic of PLA Hospital No.165

August 1972

(Editor's Note: The history of mankind's understanding of mental illness and of the development of psychiatry is at the same time a history of struggle between idealism and materialism. Since the start of the Great Proletarian Cultural Revolution, China's revolutionary medical workers, guided by Chairman Mao's revolutionary line on medical healthcare and with Chairman Mao's philosophical thoughts as their compass, have carried out new explorations in the field of mental illness and have achieved many gladdening results. The following article provides an object example of this. Mental illness is a very complex phenomenon, especially as regards its fundamental nature and how one should categorize the various types of illness, and diverse views and opinions exist on these matters. The authors of the article have based their views on the practical experiences gained in their own work units, and we hope that our readers, in accordance with Chairman Mao's policy of "letting a hundred flowers bloom and a hundred schools of thought contend," will study and discuss it. We believe that such a discussion will be of great benefit to China's creation and development of a new-style psychiatry.)

Guided by Chairman Mao's revolutionary line, under the correct leadership and concern of our superior Party committee, and in accordance with our great leader Chairman Mao's instructions to "stress investigation and research" and "conscientiously summarize experience," our work units conducted, from the standpoint of "class struggle," "one divides into two"295 and "practice first," a home-visits follow-up survey of 250 mental patients (from altogether five counties, three municipalities, one town and eight factories and mines) who had been discharged from hospital during the period since May 1959. After combining this with a rough analysis of the relevant clinical materials, we reached the following findings:

      General Situation

    1. Gender distribution: 135 males, accounting for 54.0 percent of the cases studied; and 115 females, accounting for 46.0 percent of the cases.

    2. Age at onset of illness: One person of nine years of age (0.4 percent); ten people in the 10-15 years age range (4.0 percent); 127 people in the 16-25 years age range (50.8 percent); 72 people in the 26-35 years age range (28.8 percent); 27 people in the 36-45 years age range (10.8 percent); eleven people in the 46-60 years age range (4.4 percent); and two people aged 61 years or more (0.8 percent.)

    3. Family history of mental illness: among the 250 cases, 45 people (or 18 percent) were found to have a family history of mental illness.

      Survey Of The Causes Of Mental Illness

Concerning the causal factors that led to mental illness in these 250 cases, our survey found:

    1. In 219 of the cases (87.6 percent), mental illness arose as a result of certain objective things that were reflected within the person's mind but which he or she was unable to deal with properly. (See Table 1.) For details of the personality characteristics of these people, see Table 2.

      Table 1 Statistics on the Various Psychological Factors Leading to Mental Illness


Number of Cases


Inability to deal with criticism correctly



Family disharmony



Inability to deal with family upsets correctly



Romantic disappointment



Inability to subordinate personal interests to the interests of the Party



Failure to unite with others



Non-fulfillment of personal desires



Inability to deal correctly with difficulties at work



Being frightened or receiving a shock



Dissatisfaction with the policies of the Party owing to erroneous standpoint



      Table 2 Statistics on Personality Characteristics


Number of Cases


Fragile and delicate



Arrogant and conceited



Lively and energetic



Solitary and withdrawn



Narrow-minded and intolerant



Ordinary type



    As Chairman Mao teaches us: "The fundamental cause of the development of a thing is not external but internal; it lies in the contradictoriness within the thing."296 As can be seen from Tables 1 and 2, because people live in society, objective facts or things are reflected within their minds, and these [mental reflections] in turn engender different ideologies. When certain objective things are reflected within the minds of people whose worldview has not been properly reformed and in whose thinking the word `private' is playing havoc,297 or because their ideological methodology for the handling of contradictions is incorrect, an intensified struggle arises among the various contradictions in their mind, thereby leading to an imbalance in the biological functioning of certain parts of the brain and hence to the emergence of a whole series of psychiatric symptoms - namely, mental illness. Mental illness is therefore not, as the bourgeois scholars would have us believe, a "supra-class, solely biological phenomenon," but rather something that is inextricably linked with the class struggle and with the clash between the two major worldviews.298 Human personality is mainly acquired, not innate, and is a reflection of one's overall worldview. With people who are relatively heavily imbued with bourgeois ideology, we generally find that their personalities are narrow-minded, intolerant, solitary and withdrawn, or else show a mixture of fragility and arrogance. Unless people like this diligently and earnestly study Marxism-Leninism and Mao Zedong Thought and conscientiously reform their own worldviews, they will usually become obsessed with thoughts of personal gain or loss and fail to apply the methodology of "one divides into two" in dealing with problems, and instead end up making nit-picking self-justifications and putting their own personal interests in first place. Under the socialist system, a clash will inevitably develop between the concept "public" and their own preoccupation with the concept "private," engendering a contradiction within their minds between these two things. And unless this contradiction can be correctly resolved, the ideological struggle within their minds will intensify and may produce partial imbalances in the functioning of their cerebral cortexes; so people like this can very easily develop mental illnesses.

    2. Mental illness arose in fifteen of the cases, or 6.0 percent of the total, as a result of external injury, infection or similar causes. These included six cases of external injury (2.4 percent), five of poisoning (2.0 percent), one of infection (0.4 percent) and three of post-natal complications (1.2 percent.)

    The mental impairments resulting from these various factors were successfully cured after appropriate treatment. In eleven of the cases, mental factors led to the reemergence of the impairments later on; and in the remaining four cases (two of external injury, one of poisoning and one of post-natal complications), the reasons for relapse were not identified.

    3. The causes of mental illness could not be ascertained in sixteen of the cases (6.4 percent.)

Clinical Manifestations And Illness Categorization

Controversy still exists over the question of how to categorize mental illnesses. In our own clinical practice in treating the mentally ill, we find that while the precise causal factors may vary in each case, the patients' clinical signs and treatments nonetheless show common features. Using the combined methodology of clinical symptoms and treatment, therefore, we have roughly categorized the 250 mentally ill persons' conditions as follows:

    1. Manic type: 111 cases (or 44.4 percent.) Clinical symptoms: onset of illness was generally acute, and those afflicted showed a prior tendency toward irritability and irascibility; after falling ill, they mostly slept and ate very little or else ate food randomly and suffered from insomnia; and they became argumentative or started singing and dancing around, talking incessantly and in a decadent manner running around all over the place, taking off their clothes and going around naked, beating and injuring people, and sometimes even inflicting self-harm or attempting to commit suicide.

    2. Depressive type: 76 cases (or 30.4 percent.) Clinical symptoms: in general, onset of illness was fairly slow and there was a pre-illness tendency toward low mood and emotional distress; after falling ill, the patients became dull and morose, confused of speech, prone to bouts of abnormal crying and laughing or to periods of prolonged silence, stopped eating or moving, lay on their beds all day long, became stiff of movement and blank of facial expression, or incontinent and unable to control their bowels.

    3. Hallucinatory and delusional type: 55 cases (or 22.0 percent.) Clinical symptoms: slow onset of illness, with a marked prior tendency toward suspiciousness and mistrust; after falling ill, the patients became dysthymic and suffered visual and auditory hallucinations, delusions of grandeur and delusions of persecution, and these notions were deep-seated and unmovable.

    4. Chronic type: eight cases (or 3.2 percent.) Clinical symptoms: lengthy duration of illness (three to five years or more), with little or no response to prolonged treatment and showing progressive mental decline.

Accord Mao Zedong Thought The Commanding Role At Each And Every Stage In The Process Of Treating Mental Illness

In our clinical practice, we emphasized resolving the relationship between "internal factors and external factors," between "commonality and particularity" and between the "principal contradiction and secondary contradictions," and by arming the patients' minds with the weapon of Mao Zedong Thought we were able fully to mobilize their own internal [curative] factors; after then, on this basis, applying a supplementary combination of new-style acupuncture, Chinese herbal medicine and a small therapeutic dosage of wintermin,299 we succeeded in turning around and resolving the patients' inner contradictions. In all, we managed to cure 198 of the patients and substantially improve the condition of a further forty-nine, resulting in a complete recovery rate of 79.2 percent and an effective cure rate of 98.8 percent; the average course of treatment was forty-six days.

      I. Using Mao Zedong Thought to re-educate and reform the mentally ill.

In firmly seizing the fundamental task of using Mao Zedong Thought to re-educate and reform the mentally ill, we persisted in organizing the patients into groups to study the works of Chairman Mao, held frequent and numerous lecture meetings and mass criticism sessions, exchanged experiences among ourselves, unfolded mutual assistance programs and conducted one-on-one discussions with the patients. Throughout this, we comprehensively educated them on the following four main topics:

      a. Political class education. When applying class education, we focused on "recalling past bitterness and remembering present happiness" and on "recalling past bitterness and remembering our present empowerment,"300 and by so doing we were able to raise the patients' level of class consciousness and make them bear firmly and constantly in mind that their personal emancipation has been entirely due to the Communist Party and that they have Chairman Mao to thank for all of their present happiness and good fortune.

      b. Education on political line. We frequently lectured the patients on the history of the two-line struggle [within the Party] and held profound sessions of revolutionary criticism and denunciation, during which we purged the patients' minds of the residual poisonous influence of the traitor Liu Shaoqi and his black "six theories," while at the same time raising their level of awareness of the political-line struggle and of the need to self-consciously defend Chairman Mao's revolutionary line and to take the initiative in doing battle with all kinds of undesirable ideological tendencies.

      c. Education on the current situation. Focusing on major events within China and abroad, we gave the patients frequent and extensive lectures on the excellent nature of the overall current situation, thereby making them pay attention to national affairs and the world situation and arousing their revolutionary spirit and ardor.

      d. Education on worldview. We organized the patients repeatedly to study articles by Chairman Mao such as "Serve the People," and thereby, taking the "three glorious examples" as a model,301 encouraged them to take a correct outlook on matters of life and death, happiness and suffering, love and marriage and so forth, to struggle consciously against capitalism and revisionism, and to implant within themselves the proletarian worldview.

      e. Education on the theory of dialectics. In addition, we organized the patients to study Chairman Mao's glorious philosophical thinking by repeatedly doing a good job of both studying and applying the fundamental principles of "one divides into two," "practice first," "the relationship between internal causal factors and external ones" and "the turning around and resolving of contradictions," and thereby eliminating idealism and metaphysics and upholding the theory of materialist dialectics.

      f. Education on doing battle with one's illness. In accordance with the different ideological realities of the individual patients, we organized them to take part in a variety of study groups in which we explained to them the causes of their mental illnesses and helped them to properly identify the principal contradictions in their thinking; by this means, we fully mobilized their inner subjective dynamism and enabled them to dig out the real roots of their illnesses by eradicating "private" thoughts and implanting the concept "public" in its place, thereby reinforcing their sense of self-confidence in waging battle with their illnesses.

      II. Using Mao Zedong Thought to manage the mental patients.

Here, we made a decisive break with the previous management methods of "confining, tying down, and suppressing" mental patients, and in their place mobilized the "two enthusiasms"302 and set up a new management system covering both work and rest:

      a. We organized the patients into Red Health Squads (hong-jian-lian) and let them manage themselves.

      b. We widely lauded model individuals and events as a way of arousing the patients' positivity.

      c. We implemented open-door treatment and, in accordance with the specific nature of their illnesses, organized the patients to take part in manual labor, cultural and sports activities, physical exercises or to go for walks.

      d. We set up some rough and ready sickbeds in the outpatient section, as a means of fully mobilizing the enthusiasm of the [patients'] partners and allowing them to play an active role in the job of improving the patients' ideology and assisting in the management and treatment work.

      III. Combining Western and Chinese medicine

At the same time as persisting in the use of Mao Zedong Thought to re-educate and reform the mentally ill, thereby removing the causes of illness at the fundamental level, we also had to provide a supplementary combination of Western and Chinese medical treatment in order to help restore the biological functioning of the patients' brains. The details of the treatment courses appear in Table 3.

      Table 3 Statistics on Treatment Outcome by Group


New-style acupuncture

New-style acupuncture + wintermin

Herbal medicine + new-style acupuncture + wintermin

Total number of cases




Complete recovery




Near recovery




Condition improved




No change




[Section omitted]303

      On The Problem Of Illness Recurrence

In our home visitation survey, we found that among the 198 patients who had been cured (either complete or near cure) and discharged from hospital, recurrence of illness had occurred in 40 cases, or 20.2 percent of the total, while there was no recurrence in 158 of the cases, or 79.8 percent of the total. There appeared to be four main reasons for the relapses that occurred. First, after being discharged, the patients did not show a high level of self-awareness in studying Mao Zedong Thought and had insufficiently emphasized the task of self-reform. Second, in certain work units, timely and appropriate arrangements to look after and manage the discharged patients were not made, and also the patients themselves had failed to deal correctly with this situation. Third, a small portion of the populace had continued to treat them like ill people and used colorful or derogatory language toward them. And fourth, some patients were hospitalized for too short a period of time, so the roots of their illnesses had not been properly dug out and there was poor recovery of function.

In socialist society, there are still classes, class contradictions and the class struggle. The reformation of people's ideology will never be fully completed. As soon as one contradiction is resolved, a new contradiction arises in its place. Mentally ill people are no exception to this rule, and so the recurrence [of mental illness] and the struggle to avoid such relapse is absolute. We consider that, in practice, the following steps must be taken in order to consolidate cure and forestall any recurrence of illness:

      1. During hospitalization, persist in using Mao Zedong Thought to re-educate and reform the mentally ill, thereby helping them to dig out the roots of their illnesses and self-consciously replace their selfish "private" ideas with the new "public" ones. Prior to being discharged, patients should be placed in study groups to help them understand the causal pattern of their illnesses and also to teach them the methodology of turning around and resolving contradictions, and treatment should be reinforced.

      2. At the time of discharge, take the opportunity of accompanying the patients home to explain to their work units and families both the reasons why they became mentally ill and also the methodology of turning [contradictions] around; and stress to them the importance of looking after the patients' political welfare, as well as the need to help them resolve the practical problems of daily life.

      3. Go out into society to publicize widely Chairman Mao's great directive, "All people in the revolutionary ranks must care for each other, must love and help each other,"304 in order to change past erroneous attitudes toward the mentally ill, mobilize the masses to show them warm assistance, and jointly implement a mass-based approach to prevent their illnesses recurring

      4. Through correspondence or home visits, keep in frequent contact with the patients, their families and work units, and find out about their situations in a timely manner so that recommendations on preventing any recurrence of illness can be made when needed.

      Typical Cases

Case 1: Wu XX, male, 29 years old, a worker at a factory in Changsha. The patient graduated from a vocational middle school in 1963, had high hopes of becoming a technician and then eventually an engineer, and he also wanted to find himself a "pretty" wife. After meeting with disappointment in these goals (he was assigned a job as a lathe operator), he became extremely unhappy and increasingly despondent; he couldn't sleep at all and started talking all the time about how he wanted to "become an engineer and marry a pretty wife." He was hospitalized three times and given numerous courses of "electroconvulsive therapy," but all to no apparent effect; and November 25, 1969 he was admitted to our hospital.

      Diagnosis: psychosis, hallucinatory-delusional type.

      Hospital treatment: Since the patient's mental illness resulted from his unfulfilled desires, we held numerous sessions with him to study and re-study "Serve the People," "In Memory of Norman Bethune" and "The Foolish Old Man Who Removed the Mountains." In addition, we held revolutionary mass criticism sessions to denounce the "six theories" of Liu Shaoqi, so that he could gradually acquire a more correct understanding of such matters. And we combined this with new-acupuncture therapy (applying needles once a day at the tailing, anmian and baihui pressure points) and, when he had trouble sleeping, a daily dosage of 250 mg wintermin taken orally. The symptoms basically disappeared and he was discharged from hospital on July 19, 1970.

      Follow-up situation: The patient returned to work after leaving hospital and remained in average condition thereafter.

Case 2: Huang XX, male, 66 years old, a worker at a Chenzhou bean curd factory. He was previously always diligent and responsible in his job, but on November 19, 1969, a fellow worker with whom he was preparing a pot of bean curd juice accidentally spoiled the pot, and later the same day he also damaged a sheet of muslin used for straining the bean curd. Huang then became extremely anxious and couldn't sleep all night long; the following day, he started muttering incessantly to himself, saying things like: "It's all over now, someone's going to roast me for sure," and "I have to be vigilant because they're going to start catching bad people again." Eventually a fight broke out and he was admitted to hospital on November 21, 1969.

      Diagnosis: psychosis, hallucinatory-delusional type.

      Hospital treatment: The patient's mental illness was caused by his incorrect ideological methodology in dealing with problems, so during his time in hospital we studied together with him the doctrines of "serve the people" and "one divides into two," and we praised him for eschewing negligence and taking a responsible attitude towards revolutionary work. We then inspired him to correctly use the method of "one divides into two" in dealing with the incident at work, thereby lancing his ideological "boil," and we followed up with some new-acupuncture therapy (applying needles once a day at the tailing, zusanli and anmian pressure points) and a daily dosage of 100 mg wintermin. On December 1, 1969 he regained his health and was discharged from hospital.

      Follow-up situation: The patient displayed an enthusiastic and responsible attitude at work, was able to deal correctly with any incidents that occurred and was praised by everyone.

Case 3: Li XX, female, 18 years old, a member of a county-level commune in Guiyang. In early December 1968, the patient's fiancé was assigned to work as a cook; considering this to be an inglorious occupation, she became moody, depressed and insomniac. Later she became overly loquacious and would often weep and create disturbances and run around all over the place; eventually she started taking off her clothes, breaking things and getting into fights with people, and became unable to look after herself properly. On January 10, 1969 she was admitted to hospital; her father, elder sister and elder brother all had histories of mental illness.

      Diagnosis: psychosis, manic type.

      Hospital treatment: Although the patient's family had a history of mental illness, the direct cause of her mental illness was still her problematic worldview. After being hospitalized, she was given both electroconvulsive therapy and large dosages of wintermin; this relieved her symptoms somewhat, but the improvement was not stable and so the above-mentioned symptoms repeatedly reemerged. In April 1969, we made her participate in the hospital's "First Study Group on Mao Zedong Thought." In the course of the study group, we read together with her "Serve the People" and other articles by Chairman Mao, and also, in line with the realities of her ideological situation, repeatedly propagated to her Chairman Mao's great teaching that "everyone is a functionary of the people, irrespective of the high or low status of their job." At the same time, we carried out careful and patient ideological work to make her realize that there is no social hierarchy within the revolution, only a division of labor, and that no matter what one's job may be, one is always serving the people. Thereupon, her mood gradually returned to normal again. We also supplemented this with some new-style acupuncture: from April 18 to 25, we applied needles once a day to the tailing, zusanli and neiguan pressure points, which basically removed her psychiatric symptoms; and we followed this up with a daily stimulation of the taodao and neiguan pressure points. By May 17, she had completely recovered and was then discharged from hospital.

      Follow-up situation: After leaving hospital, the patient enthusiastically participated in collective production work and took the lead in studying Mao Zedong Thought. When her husband requested a divorce on the grounds that she had been mentally ill, she dealt with this personal difficulty in a correct manner. Moreover, she mobilized the other women to plough the fields and build a reservoir and was then selected as leader of the women's production team. In 1970, she gloriously participated in the Guiyang County Activists' Conference for the Study of Mao Zedong Thought.


Our findings from this survey analysis of 250 cases of mental illness were as follows:

      1. Mao Zedong Thought and Chairman Mao's glorious philosophical thinking is the powerful ideological weapon that guides and directs our understanding, treatment and prevention of mental illnesses. The decisive factor in treating and curing mental illness is to mobilize the "two enthusiasms" and employ Mao Zedong Thought to re-educate and reform the patients.

      2. The reason why most patients become mentally ill is connected to the class struggle, and the fundamental causal factor in the majority of cases is that the patients still retain a bourgeois worldview and methodology.

      3. On the basis of clinical symptoms and treatment, mental illnesses can be divided into four main categories (manic type, depressive type, hallucinatory-delusional type and chronic type.)

      4. The main prerequisites for successfully treating and curing mental illnesses are: to deal correctly with the relationships between "commonality and particularity" and "internal causation and external causation"; to break with the former management practices of "confining, tying down and suppressing" the mental patients; to comprehensively break with the "three great treasures" (electroconvulsive treatment, insulin coma therapy and high-dosage wintermin medication), all of which destroy the patients' health; and to adopt new medical treatment methods based on a combination of Western and Chinese medicine.

      5. Using Chairman Mao's "mass line" standpoint, make contact and liaise with the work units and families of the patients after their discharge from hospital and mobilize everyone to do a good job of consolidating the patients' recoveries.

Our level of study of Mao Zedong Thought and Chairman Mao's philosophical works is far from sufficient, our level of awareness of the political line is not high enough, and our survey data is rather incomplete. As a result, many problems still exist in our practical understanding of mental illness and in our attempts to treat it, and we invite readers to point out and correct any shortcomings or errors in our survey analysis.

      Appendix I: New-style acupuncture pressure points [- omitted]

      Appendix II: Herbal medicines [- omitted]

Document 4: Study and Discussion Notes on "Analysis of a Survey of 250 Cases of Mental Illness"305

Yichun District Mental Hospital, Jiangxi Province

March 1973

We have recently been studying the article that appeared in issue No.8 of New Medicine, titled "Analysis of a Survey of 250 Cases of Mental Illness" (hereafter referred to as Analysis of a Survey.) Guided by Chairman Mao's instruction to "let a hundred flowers bloom and a hundred schools of thought contend," we have discussed this article thoroughly among ourselves and now offer our views on it.

First of all, we all agree that the trail blazed by the comrades of Chenzhou Mental Hospital - their spirit of daring to think and act fearlessly; their conscientious work style of careful investigation and research; the great efforts they have made in deploying Mao Zedong Thought to re-educate, reform and manage the mentally ill; their resolute pursuit of the path of combining Chinese and Western medicine in the treatment of mentally ill people; and their policy of going outside the hospital and into society in order wholeheartedly to serve the workers, peasants and soldiers - is one that has achieved outstanding results and is eminently deserving of our emulation. Indeed, our own efforts are orientated in the same direction.

On the basis of our experience in clinical practice, however, my colleagues and I wish to express several views and opinions that are at variance with those given in Analysis of a Survey.

      1. On The Causal Factors Of Mental Illness

As a wealth of facts demonstrate, whether in the pre-illness period, during the illness or after clinical recovery, certain problems can always be identified in the mental patient's worldview and methodology; that is to say, contradictions exist between objective reality and their ideological awareness. In view of this, we ourselves at all times persist in using Mao Zedong Thought to re-educate, reform and manage the mentally ill, and practice has shown us that doing this task well always has a positive effect on their treatment and management and helps to prevent their illnesses from recurring. In studying and learning from the Chenzhou experience, we have gained an even deeper understanding of these matters.

From the point of view of psychiatry as a branch of science, however, we feel it is inappropriate to regard problems of worldview and methodology as being the fundamental causal factor in the emergence of mental illness as a whole. According to Analysis of a Survey,

Since the worldview [of those afflicted] has not been properly reformed and the word "private" is playing havoc in their minds, or because their ideological methodology for the handling of contradictions is incorrect, an intensified struggle arises among the various contradictions in their mind, thereby leading to an imbalance in the biological functioning of certain parts of the brain and hence to the emergence of a whole series of psychiatric symptoms - namely, mental illness.

If this were indeed the case, then the majority of ordinary people would also be likely to develop mental illness, since at the present stage of social development a very large section of the population still cleaves to the word "private" and has an improperly reformed worldview; but why, then, is the rate of mental illness among China's population still running at the level of only several people per thousand? Pursuing this logic further, if the word "private" [and associated thinking] serves as the "hotbed" of mental illness and if reactionary ideology lies at the root of all such illnesses, then people whose thinking is most heavily larded with the concept "private" - namely, those whose worldview is basically bourgeois or capitalist in nature - should all surely become mentally ill. But in actual practice, we discover no such rule or regularity as this.

In our view, problems relating to worldview and methodology can only partially explain the emergence of mental illnesses and cannot be regarded as the primary causal factors behind mental illness as a whole; nor should they be seen as the principle reason for the emergence of schizophrenia, a very common illness, for to do so would hinder our further investigations into the true reasons for this illness and impede the search for an effective somatic cure. According to the current findings of research into schizophrenia, people with this illness have certain protein and glucose-related metabolic disorders, so continued efforts should be made to investigate and understand these disorders.

      2. On Clinical Manifestations And The Categorization Of Illness

We find the ideas and proposals put forward in Analysis of a Survey to be simple and clear, easy to grasp and suitable for wider dissemination, and we regard them as having a certain practical significance in the field of disease prevention work. From the more specialized scientific point of view, however, attempting to identify illnesses and their subtypes solely on the basis of clinical manifestations is a highly inadequate and incomplete way of proceeding. A much more appropriate methodology is to start by investigating the causes of illness, and then to identify particular categories of illness by finding out which factors are most conducive to their cure and prevention, to the goals of scientific research, to the assessment of prognosis, and to clinical practice. For example, in the case of organic psychosis, one would never be able to prescribe an appropriate cure for the sufferer's symptoms by focusing solely on the clinical manifestations of the illness. And certain other illnesses (for example, neurotic functional disorder) are in no way amenable to categorization under the kind of typology presented in Analysis of a Survey. For these reasons, we continue to favor adhering to the "Draft Classification of Mental Diseases," as formulated in 1958 by the First National Conference on the Cure and Prevention of Mental Illness.

      3. On The Treatment And Cure Of Mental Illness

Studying the Chenzhou experience has further strengthened our determination to employ Mao Zedong Thought as a means of re-educating and reforming the mentally ill, and we have now begun pursuing this task in a variety of different ways. Practice has shown that when we do a good job in this area, the political atmosphere in the wards becomes rich and all-pervasive, the mental patients' thinking and ideology undergo a total transformation, and an orderly and well-structured climate for treatment and cure is created. At the same time, we have achieved heartening results by making extensive use of Chinese herbal medicine and new-style acupuncture therapy. In the case of Ms. Gan, for example, a schizophrenia sufferer who had been hospitalized for over eight months and had received - all to no avail - large doses of chlorpromazine and extensive insulin coma treatment and electroconvulsive therapy, we eventually cured her by using a compound of herbal remedies, and her health continued to be good after two years of follow-up visits. The combined use, in the treatment of mental illness, of Chinese herbal medicine and new-style acupuncture (electric acupuncture) on the one hand, and tranquilizer drugs on the other, has achieved fairly good therapeutic results and has also allowed us to reduce the amount of tranquilizers given. Electric acupuncture has also proven to be fairly efficacious in reducing over-excitement and bodily agitation.

In short, our achievements in practice have made us all the more resolute in perceiving the need to continue along the path of combining Chinese and Western medicine. But in applying the new medical therapeutic methods, we have also encountered many mental patients whose conditions fail to respond to the new treatments that are currently available. In accordance with Chairman Mao's instruction to "Make foreign things serve China," by using, in such cases, an appropriate quantity of the "three major therapies,"306 we have managed to restore the health of certain people whose mental illnesses had hitherto proved intractable. A schizophrenic named Huang and a compulsive neurotic named Li, for example, both failed to improve after more than a year of combined treatment with Chinese and Western medicine, new acupuncture therapy and electric acupuncture, but they were eventually cured by a course of insulin coma treatment. For this reason, we feel that the "three major therapies" should be viewed and understood in the light of historical materialism and dialectical materialism, and that we should preserve what is best in them while discarding what is bad, in order that they may more effectively serve the cause of the people's health; simply rejecting them across the board is not, in our view, an appropriate or advisable course of action.

      4. On The Question Of Preventing Recurrences

We concur with the various proposals put forward in Analysis of a Survey on "the measures required for consolidating the cure and guarding against a relapse." In addition, in the course of our own clinical practice and follow-up observations, we have found that in the case of the commonest form of recurrent mental illness, schizophrenia, the maintenance of tranquilizer therapy over a fairly long period is an effective way of preventing recurrence.

Document 5: Mental Disease Cannot be Regarded as an Ideological Defect - An Opinion on the Essential Nature of Mental Illness307

Yang Desen

No.2 Affiliate Hospital, Hunan Medical College

August 1976

Mental activity is a function of the human brain; it is the inner reflection of objective reality.

Mental illness is a disease of the brain, and it is expressed primarily in abnormalities of mental activity.

Mental abnormalities manifest themselves, in cognitive terms, in the form of distorted reflections of objective reality, and on the practical level these are expressed in the form of disordered speech and behavior.

Distorted reflections of objective reality can be found in normal people's thinking as well as in the minds of the mentally ill. In the latter case, this is caused by the presence of disease in the brain, and one of the ways it expresses itself is through mentally pathological thoughts. In the former case, the brain itself is not defective, and the various manifestations - such as erroneous thoughts and ideology, the presence of [philosophically] idealist theory, religious superstitions, and prejudiced and one-sided notions of various kinds - are all rooted in the question of [political] class and epistemology. When erroneous ideas emerge in the minds of normal people, they can usually be resolved in the course of social practice and through persuasion and re-education. But mentally pathological thoughts and ideas are produced by illness, arising in train with the development of the disease and then duly disappearing once the illness has been cured; so they do not amount to a simple question of epistemological error, and the two situations are essentially different. While in general terms one can say that mentally pathological thoughts also fall under the heading of incorrect cognition and understanding, it is nonetheless quite wrong to lump them together with [the erroneous ideas of mentally normal people.]

What points of commonality and difference exist, then, between the pathological thoughts of the mentally ill (for example, hallucinatory and delusional content) and the erroneous ideology of normal people? This question has not yet been openly discussed in China. Comrade Stalin gave an explication of this issue in his writings on the relationship between Marxism and linguistics, and in China in the 1960s, when our philosophers discussed the question of the unity between thought and [social] existence, the majority viewpoint held that erroneous thoughts and existence also occur in unity. All this provides a source of enlightenment for us in the present discussion. The pathological thoughts of the mentally ill do not simply fall from the skies, any more than do the erroneous thoughts and ideology of normal people, and neither are they something fixed or eternal in the minds of the mentally ill (different people suffering from the same mental illness, for example, often express similar thoughts and ideas.) They too represent a distorted reflection of objective reality. The dialectical-materialist and historical-materialist principle that existence determines consciousness, and that social existence determines social consciousness, is a universal truth and one that is equally applicable when interpreting the pathological thoughts of the mentally ill.

One point should first of all be clarified: the ideological speech and behavior of a mentally ill person can by no means be viewed as being entirely, one hundred percent abnormal. Usually, a certain portion of his or her ideological speech and behavior will remain normal in character, and this represents a direct continuation of the person's pre-illness ideological consciousness and expression; whatever the ideological tendency displayed, such speech and behavior should still be seen as normal, and certainly not as something pathological. This is true not just during the illness but also prior to the onset of illness: no fundamental distinction should be drawn here, and hence there is no need to dwell further on this point.

What needs to be clarified here is that the pathological thoughts of mentally ill people still constitute a distorted reflection of objective reality. This is a fundamental question relating to our continued staunch adherence, in the field of psychiatry, to the materialist theory of reflection.308 The content of the delusions in the minds of the mentally ill has a clear social nature and a clear class nature. With delusions of grandeur, for example, a person's belief that he or she is an emperor, prime minister or general would be a reflection of the feudal social consciousness; while in the case of those believing themselves to be model workers, it would serve to reflect the social consciousness of the socialist system. Similarly, a [mentally ill] person's belief that he or she was a landlord or a capitalist would, under the psychiatric symptomatology of the old [i.e. pre-1949] society, have manifested itself as a delusion of grandeur accompanied by a sense of elation; whereas the same belief in the new society would serve to express something quite different: namely a delusion of guilt or culpability, accompanied by feelings of depression. In the case of delusions of influence, moreover, we typically see a shift in the content of such delusions, away from the idea that the sufferer is being possessed by spirits and ghosts, and toward the idea that he or she is being controlled by some remote electronic device; or in the case of delusions of invention, from believing they have invented airplanes or tanks toward the imagined invention of ballistic missiles, satellites and so forth.

All this shows us that the content of mental delusions changes over time and in accordance with the trends of social change and development, and that such content is entirely a transplanted and distorted reflection of objective reality. And this is true not only of the content of delusions, but also of the particular forms they assume (delusions of grandeur, self-guilt, persecution, jealousy and so forth): these various forms are also distorted expressions of human social relations. Delusions of so-called grandeur or self-guilt are undoubtedly concepts involving an individual's social self-evaluation, and if the person were to be removed from his or social context, for example by being placed on a desert island, then the notions of grandeur or self-guilt would lose all grounds for existence; similarly, delusions of persecution no doubt serve to reflect the "dog-eat-dog" social mentality found in the exploitative social systems; and it is very hard to conceive of delusions of jealousy arising within, for example, the polygamous systems of primitive societies. To sum up: neither the content nor the form of mental delusions should be regarded as something eternally unchanging and divorced from real social existence. The speech and behavior of the mentally ill is a reflection of their diseased mental reality. In class society, the pathological thoughts of the mentally ill are also clearly stamped with the mark of class.

We should now consider the further question: what is the nature of the interrelationship between the pathological thoughts and ideology of the mentally ill and the normal thoughts and ideology they had prior to falling ill?

Some people maintain that pathological thoughts are simply a continuation of the normal thoughts found prior to the onset of illness, and that if any changes occur, these can only be quantitative and not qualitative in nature. Putting the matter bluntly, they maintain that the pathological thoughts provide a naked, wholesale revelation of the true thoughts and ideology that the mental patients had prior to falling ill. And they attribute the fact that the patients concerned did not express such thoughts before they fell ill, and that they hastily try to repudiate such thoughts after recovering their mental health, to mere phony and disingenuous attempts by the patients to conceal their true thoughts. They then conclude that the patients' expression of pathological thoughts provides the clearest possible indication of the essential nature of their underlying ideology. According to this line of analysis, patients who develop delusions of grandeur were from the outset prone to self-aggrandizement and overestimation of self; those who develop delusions of self-guilt have all along been resigned to their own backwardness and given themselves up as hopeless; those with delusions of persecution have always been conspiratorial and manipulative by nature; those suffering from delusions of loss have only become so because of their consistently self-interested and selfish dispositions; those with hypochondriac delusions are that way because they have been deeply influenced by the philosophy of survival preached by the modern revisionists;309 the shallow and frivolous sexual behavior of patients suffering from manic disorder is merely an expression of their corrupt and degenerate ideology; the underlying pessimism and attempted suicides of those suffering from depression is the outcome of their atrophied revolutionary willpowers; the sudden mood swings of those with manic-depressive illness is but a typical expression of the constant shift between [political] fanaticism and dejection characteristic of the petty-bourgeois ideological mindset; and so on and so forth. According to this general perspective, all the symptoms of mental illness are fundamentally rooted in the patient's pre-illness ideological and political-class background, and moreover a positive identification of the patient's ideological awareness and character can be made on the basis of these symptoms.

While this general viewpoint is not entirely unjustified as a means of analyzing the symptomatic manifestations of certain psychogenic mental illness, for example psychogenic delusions, the majority of professional psychiatric workers would regard it as being of little practical use as a way of interpreting the symptoms of organic psychosis (for example, poliomyelitis-induced imbecility, or delusions of grandeur caused by a tumor of the prefrontal cortex) - indeed, a wealth of practical clinical experience flatly contradicts any such simplistic and mechanistic theory of causation as this. In addition, a great many of the pathological thoughts found among those suffering from the most common form of severe mental illness, schizophrenia, cannot be explained at all on the basis of this theory: for example, a schizophrenic from a stable and harmonious family background who starts suspecting that his mother or spouse is trying to poison him or that his infant son is keeping him under surveillance; or the case of a revolutionary cadre who, because of his mentally disordered condition, starts claiming that he has committed major crimes of counterrevolution. In these cases, no causal interconnection whatsoever can be found between the patient's pre-illness thoughts and ideas and those that arise after the onset of illness; the latter are diametrically opposed to the former, and the patients themselves, once recovered, see them as absurd and ridiculous. Another example is that of a schizophrenic who suffered from auditory hallucinations in which he heard his neighbor swearing and cursing at him. In reality, the neighbor was a bad person, but the patient's psychiatric symptoms then assumed the form of a determination on his part to do battle against all bad people and things. Eventually he moved house, but the auditory hallucinations then began to contain the voice of his new neighbor - who happened to be a leading official in his work unit. The patient's mental symptoms took the form of making frequent complaints and bizarre statements [about the leading cadre], and in the end they escalated to the level of an outright and open confrontation between him and the entire organizational leadership. As an indicator of his [political] ideological awareness, therefore, the psychiatric symptoms of the very same patient were transformed, in essence, into their own diametrical opposite. At times, the two sets of antagonistic thoughts may also become mixed up together, giving rise to coercive or compulsive thinking that goes against the patient's own subjective wishes and desires. It is hard to connect or reconcile any of these kinds of phenomena with the pre-illness ideological realities of those concerned.

By indiscriminately and matter-of-factly applying the methodology of analyzing normal people's thinking to the task of analyzing the pathological thoughts of the mentally ill, and in the process equating the latter with the erroneous ideological tendencies of normal people and overestimating the role played by mental factors in the genesis of different types of mental illness, it becomes very easy to start seeing mental illness itself as constituting an "ideological defect." The absurd content of the pathological thoughts generally eludes and evades any kind of strict ideological source analysis, and attempts to extrapolate from these pathological thoughts the nature of the patient's pre-illness ideological consciousness can therefore easily give rise to an extremely superficial conclusion: namely, that all mental illness is caused by the extreme and unchecked development of individualism.310 Public opinion in general, and also people who have done no serious investigation or systematic observation of the essential nature of mental illness, are all too ready to accept and give credence to this kind of conclusion. This in turn easily creates a public mindset whereby mentally ill people are universally looked down upon and discriminated against, to the point even where certain individuals try to prosecute and hold mentally ill people legally responsible in all kinds of ways for their pathological speech and behavior (although they have no capacity to bear such responsibility).

Mental disease cannot be equated with defective ideology. Severe mental illness can result in death or long-term disablement, and what the patients urgently need is medication and treatment. There is a world of difference between this situation and that of normal people who display ideological defects, and the two simply cannot be put on a par. While we cannot say that pathological thoughts have absolutely no connection to the patient's pre-illness thinking, there is certainly no direct or necessary relationship of cause and effect to be found between them. Hence, the viewpoint described above cannot be said to be fully grounded in scientific fact, and it undeniably contains elements of subjective conjecture. Since it is not grounded in the concrete analysis of concrete contradictions,311 it cannot be seen as being in complete conformity with the principles of Marxism.

Precisely because mentally ill people still retain a certain amount of normal brain activity, they are able, just like normal people, to benefit from re-education based on Marxism and Mao Zedong Thought; their inner subjective dynamism can be mobilized and they can engage in battle against their illnesses. Psychotherapy is very important, [but] it neither precludes nor can totally substitute for pharmaceutical medications. The speech and behavior of mentally ill people may well have adverse influence and effects upon society, and all erroneous things should of course be subjected to appropriate criticism and must not be permitted to spread unchecked or to threaten public order and stability. [Such people] should be subjected to compulsory treatment and we should reinforce management over them; this is essential for purposes of safeguarding both the interests of society and also the personal interests of the mentally ill.

The opinions expressed above are not necessarily correct and I would be glad to receive any criticisms or corrections.

Document 6: More on the Essential Nature of Mental Illness312

Jia Rubao

Employees' Hospital of the Huashan Metallurgy and

Vehicle Repair Plant, Huayin, Shaanxi Province

April 1977

The history both of mankind's understanding of mental illness and of the development of psychiatry itself is one of a battle between materialism and idealism. Within the psychiatric domain, many idealist and metaphysical viewpoints continue to persist even today. For example, attempts to use psychology to arbitrarily construe the changes that occur in the minds of the mentally ill - stuff like "sexual urges being repressed since childhood," "inequilibrium of the personality" and "lack of adaptation to the environment" - all fall under the headings of idealism and mind-body dualism. In addition, there is the school of experimental research that studies mental phenomena in isolation from their social context, repudiates the class nature of mental activity, denies the counteractive force of mind upon matter (the brain), ignores the distinction between humans and animals, and carries out certain anatomical, physiological and biochemical work that is independent of human society. This is all a reflection, within the field of psychiatric research, of the one-sided and mechanistic doctrine of mechanical materialism,313 and bears no relation at all to objective reality.

I agree with Yang Desen's basic propositions: "Mental activity is a function of the human brain, a reflection of objective reality," and "Mental illnesses are diseases of the brain that primarily manifest themselves in abnormalities of mental activity." This is because mental activity is a reflection within the human brain of things that exist in objective reality; it is certainly not something permanently fixed in the brain, and neither is it something subjectively generated within the brain from nowhere. The content of mental activity originates from within social practice - that is, from the struggle for production, from the class struggle and from scientific experimentation314 - which is why infants and small children very rarely suffer from non-organic psychosis. It is social existence that determines people's consciousness and the realities of the class struggle that determine people's ideology and emotions. "In class society everyone lives as a member of a particular class, and every kind of thinking, without exception, is stamped with the brand of a class." (Chairman Mao, "On Practice," [1937] Selected Works of Mao Zedong, p.272.) For this reason, the content of the psychiatric symptoms of the mentally ill (their thoughts, emotions, behavior and also the imbalance between these things and the environment) is all closely bound up with the reality of the three great revolutionary struggles315; that is to say, [these symptoms] are a reflection of the different ideologies, cultures, customs and beliefs, emotions and sentiments of different societies (classes.) In its essential nature, mental illness is a disease intimately connected to worldview. The following are the points on which Comrade Yang and I disagree:

Mental illnesses (aside from those caused by organic changes in the brain resulting from external injury, poisoning or infection) are non-organic diseases involving imbalances in the functioning of the brain. Since they are diseases, they cannot simply be defined as defects of ideology; however, this still misses the essential nature of the problem. "People's knowledge and understanding of things, phenomena, processes and so forth consists of a constantly deepening [cognitive] progression, one that goes from phenomenology to essence and from less profound levels of essential nature to more profound levels." (Lenin, "Extracts from Hegel's Logic," Collected Works of Lenin, Vol.38, p.239.) This is a core tenet of dialectics. Similarly, "practice is the sole criterion of truth" is a fundamental principle of Marxist philosophy; and "carrying out concrete analysis of concrete conditions" is the living soul of Marxism.316 Guided by the philosophical thought of Chairman Mao, when we thoroughly investigate and conscientiously analyze the disease-causing factors and the mental activity of mentally ill people, we can readily observe that mental illness is intimately connected to the question of worldview, and that the pathological thoughts and ideas [of the mentally ill] are closely interconnected with the normal thoughts and ideas they had prior to becoming mentally ill. Quantitative increase [in such thoughts and ideas] leads to qualitative change (i.e. cause and outcome), leading to mental illnesses caused by unchecked and uncontrollable imbalances in the functioning of the brain. In seeking to treat and cure mental illnesses, therefore, we must accord Mao Zedong Thought the commanding role at each and every stage of the psychotherapeutic process, and if we do so, outstanding results will be guaranteed.

Using the epistemological method of dialectical materialism, we carried out an extensive survey analysis of several hundred mental patients in order to identify the causal factors that had made them mentally ill. We found that the overwhelming proportion (94 percent) had fallen ill as a result of external psychological blows, such as family disputes, romantic disappointment, inability correctly to deal with criticism, or accidents and natural disasters, or as a result of objective [sic] factors such as getting a fright or shock, not uniting with others (bu tuanjie), being afraid of difficulties, putting self first-ism (geren diyizhuyi) or having unfulfilled selfish desires. That is to say, when certain objective factors (things) are reflected in people's minds, and if those concerned do not apply the dialectical materialist viewpoint in order to deal with them correctly, then these factors or things will turn into adverse psychological pressures or stimuli leading to mental illness.

As we know, however, not everyone who encounters these kinds of disease-causing factors (things) in his or her mental world falls mentally ill. As Chairman Mao taught us: "The fundamental cause of the development of a thing is not external but internal; it lies in the contradictoriness within the thing"; and "Materialist dialectics...holds that external causes are the condition of change and internal causes are the basis of change, and that external causes become operative through internal causes." ("On Contradiction," Selected Works of Chairman Mao, pp.289-291.) In our survey, we found that the overwhelming majority (92 percent) of the mental patients had shy and solitary dispositions, were narrow-minded and intolerant, and also vain and arrogant. Personality and character is acquired, not innate, and it is an expression of one's worldview. When these sorts of people are faced with the persistent presence in their minds of certain objective things, because they have failed to reform their worldviews properly and have used incorrect ideology in dealing with contradictions, the contradictory struggles within them only intensify; and since they are unable to rid themselves of the constant pressure and stimulus arising from these intensified contradictory struggles, the external factors (objective things) then act through the internal factors (worldview and methodology) to produce partial imbalances in the biological functioning of the brain and hence a whole series of psychiatric symptoms.

Mental illness, therefore, is not, as the bourgeoisie would have us believe, a "supra-class, solely biological phenomenon," but rather something that is inextricably linked with the class struggle and with the clash between the two major worldviews. Indeed, the pathological thoughts are simply a continuation of the normal thoughts that existed prior to the onset of illness. As we know from their own post-recovery accounts, the mentally ill are often people who previously were obsessed with considerations of personal gain and loss, were backward and had no desire to make progress in life, had failed to employ the methodology of "one divides into two" in dealing with their problems and resorted instead to mere hair-splitting and self-justification, and who were drowning fast in the sea of individualism. They paid no attention to the advice of others and so the struggle between contradictions became more and more intense in their minds, leaving them in a constant state of agitation and insomnia, with no interest in food, and increasingly withdrawn and isolated. The process goes exactly like this: under the socialist system, it is impossible for these people to satisfy their selfish desires and so the "boil" cannot be lanced; at first, the normal thoughts and the pathological thoughts coexist side by side, but as the pathological thoughts steadily gain the ascendant in their minds, they begin to sing, dance and run around aimlessly, tearing off their clothes and going around naked, and sometimes injuring or killing people - that is, they become mentally ill. We see, therefore, that bourgeois worldview and methodology are the fundamental causal factors in the emergence of mental illness; indeed this is the essential nature of mental illness. Some people will ask the question: in capitalist society, then, is mental illness more commonly found among the bourgeois class? Yes, there are certainly more mentally ill people from this class background than elsewhere. But since the bourgeois scholars absolutely never try to study or analyze the problem in this light, the only set of treatments that the mentally ill ever receive [in capitalist societies] is: "Lock them up, tie them down, suppress them, give them electroshock therapy and drug them up to the gills."317

Our own approach, by contrast, is: "Examine the symptoms, find the causes, and treat the illness at its source." [In practice this means:] combining Chinese and Western medicine; persisting in using Mao Zedong Thought to re-educate and reform the mentally ill and also arming their minds with the weapon of Mao Zedong Thought; fully mobilizing within them the positive role of subjective dynamism;318 emphasizing, in clinical practice, the correct handling of the relationship between internal and external causal factors, while carefully analyzing and actively removing the external ones; making a diligent analysis of both the general and the specific character of the problem (i.e. its universality and particularity) and then focusing upon the primary contradiction, using the method of "opening a lock with the appropriate key"; using class education and political-line education to profoundly re-educate the mentally ill in the proletarian worldview, and thereby implant within them a correct conception of human destiny, romantic love, and personal pleasure and hardship; hooking them up with reality by educating them about both the current [political] situation and the principles of dialectical materialism, and by raising their awareness of the class struggle, the struggle over political line, and the necessity of continuing the revolution under the dictatorship of the proletariat; digging out the roots of mental illness by overthrowing the concept of private ownership and establishing the principle of public ownership, waging a stubborn battle against disease by engendering the lofty and far-sighted ideals of Communism and convincing [the patients] of the inevitability of victory; while at the same time, on this overall basis, applying a supplementary combination of Chinese herbal medication, new acupuncture therapy, an appropriate amount of sedatives and tranquilizers, thereby correcting the imbalances in the functioning of the brain; and finally, under certain specific conditions, organizing the mental patients to take part in recreational visits, manual labor, and sporting and cultural activities. If we do all these things well, then the overwhelming majority (90 percent) of mentally ill people can be completely cured.

In order to consolidate the curative effect and to forestall any recurrence of illness, we must also pay close attention to the need for the patients work units, families and neighbors to persist in sincerely and actively giving them ideological reassurance that they will not be discriminated against or abused and ill-treated, as a means of combating erroneous past attitudes toward the mentally ill. In particular, we must help mentally ill people to acquire both a firm understanding of the patterns of origin of their illness and also the methodology of spontaneously trying to resolve their own inner contradictions. It should be stressed that the process of reforming and raising one's ideological level is a never-ending one; as soon as old contradictions are resolved, new ones will keep on emerging. Therefore the recurrence [of mental illness] and the attempt to avoid such relapses is absolute. But as the socialist revolution deepens over time, and as the new-style medical science of combining Chinese and Western medicine unfolds and develops, not only will a broad new vista emerge on the mental illness preventative front in China, but also the non-organic mental illnesses will become more and more rare and will eventually disappear altogether.

Document 7: Subjective Conjecture is No Substitute for Scientific Research319

(A Summary of Readers' Views)

Yang Desen, August 1978

(Editor's note: Since issue No.3, 1976, this journal has given space to an academic debate on the question of the essential character and nature of mental illness. This debate has attracted the widespread support and attention of our readership and many people have sent us manuscripts expressing their viewpoints. All this became possible only after the smashing of the "Gang of Four" by our brilliant leader, Chairman Hua Guofeng, and the Party Central Committee and as a result of their promotion of the policy of "letting a hundred flowers bloom and a hundred schools of thought contend."

In the course of the development of psychiatry, there have been numerous controversies over the issue of the essential nature of mental illness. This is one of the fundamental questions in psychiatry. Up to the present day, however, owing to the limitations of scientific development and research methodology, a definitive resolution of this issue has still not been reached. In fundamental terms, we have not yet identified the factors causing specific mental illnesses. A thorough exposition of the essential nature of mental illness would affect not only the kinds of attitude we adopt toward mental illness and the mentally ill, and the ways in which we deal with them, but also the orientation of our overall research work in the field of psychiatry, and would thus be beneficial to the development of our preventative work in the mental health field.

The following is a summary digest of eleven articles we have received expressing similar viewpoints on this question. For reasons of space, among other things, we shall now impose a temporary moratorium on further discussion of the topic. This journal intends to reopen the discussion at a suitable future date. In our view, where academic questions are concerned, provided the "hundred schools of thought" policy is respected and people adhere to facts and rational argument, the full and untrammeled expression of different opinions is the only effective way of enlivening the academic atmosphere and advancing the cause of science.)

The article by Comrade Yang Desen in Issue No.3, 1976 of this journal and the article by Comrade Jia Rubao in Issue No.2, 1977 presented fundamentally opposite views on the question of the essential nature of mental illness.320 Both these viewpoints are quite influential both within domestic social opinion as a whole and among medical personnel in the psychiatric field. The debate has attracted strong interest and support from everyone and has been closely followed, understandably enough, by many mentally ill people and their families. We have received eleven separate articles supporting Yang's position, and since for reasons of space we cannot publish these articles in their entirety, we have instead put together a summary digest of the main points and arguments.

1. First of all, we must define more narrowly the real scope of this debate; otherwise the controversy will remain diffuse and unfocused. [Manuscripts 1 & 2.]

Apart from the neuroses and mental retardation, mental illnesses generally fall into one of three main categories, and opinions were basically unanimous on the first two of these categories, with controversy being focused mainly on the last category. First, there are the organic and symptomatic mental illnesses, caused by infection, poisoning, external injury or somatic disease; opinions were unanimous and no conflict of views arose with regard to this category of illness. Second, there are the psychogenic and reactive psychoses, which appear in susceptible individuals as a result of intense psychological pressures and stimuli; cases of this type are few in number, with such reactions being much more commonly found among neurosis sufferers, and again opinions were pretty much united in regard to this category. And third, there is the major category known as the endogenous mental illnesses, foremost among which is schizophrenia, whose causal factors still remain to be discovered; the controversy was centered primarily on this category of mental illness.

On the one hand, while some outstanding research discoveries have been made in the fields of psycho-biochemistry, genetics, neuropathology, psychopharmacology and experimental psychiatry, these have still not produced any affirmative conclusions on the question in hand. On the other hand, only in certain specific cases [of schizophrenia] can we observe, prior to the onset of illness, the presence of any clear and conspicuous elements of psychological pressure or stimulus. Thus far, [schizophrenia] has always been known as a "functional" psychosis; some scholars, however, both at home and abroad, now regard it as being similar in nature to idiopathic epilepsy, that is to say, they see it as being an organic brain disorder caused by certain as yet unknown genetic defects or metabolic disorders. The controversy over the nature of the factors causing schizophrenia has therefore centered upon two main issues: first, the question of how to assess the role played by psychological pressure or stimuli in the genesis of the disease; and second, the question of the connection between the formation of mental illness and the nature of the sufferer's worldview and methodology.

2. Mental illness is a common disease that afflicts the ordinary working populace; it has always existed and can be found both in China and all other countries. Just as in the case of high blood pressure-induced ulcers or other disorders, mental illness knows no class boundaries or divisions. [Manuscripts 3 & 4.]

Comrade Jia maintains that in capitalist societies "there are certainly more" mentally ill people from within the bourgeois classes than from elsewhere in society. Some people questioned whether any actual survey data exists to support this view, while others maintained that the exact opposite is true: that since there is usually a direct link between poverty and illness, it is by no means clear that the working people of capitalist societies - given the oppression and exploitation they are under, the psychological distress and practical difficulties they experience in daily life, and also their lack of access to medical treatment - are at all less likely than others to be afflicted by mental illness. According to surveys by certain foreign scholars, the incidence of mental illness (including mental retardation) among the population has been found to be inversely proportional to family income and standard of living, that is, it occurs more frequently among the impoverished social classes, and it would be wrong for us to discount these findings as having no basis in fact. Seen in this light, mental illness is somewhat like tuberculosis, in that, whether in the old society or the new, it strikes disproportionately against the working population.

We cannot, therefore, in disregard of the plight of large numbers of working people who suffer from mental illness and in the absence of any compelling scientific evidence, simply claim that mental illness is a disease of the bourgeoisie, a disease of capitalist society. In our own view, within the field of health and hygiene, the superiority of the socialist system lies mainly in the fact that socialism seeks, by universally expanding disease prevention work and the social welfare system, to reduce the incidence of diseases of all kinds among the working population and to wipe out the serious infectious illnesses. In the case, however, of certain illnesses whose causes are still unknown - for example cancer, cardiovascular disease and schizophrenia - thus far, and irrespective of national boundaries, the disease incidence rates have shown no sign of declining; to the contrary, as mortality rates fall, they have been steadily rising. The objective existence of schizophrenia, therefore, cannot be explained away as being the product of any particular social system; indeed, there is a much more conspicuous causal connection to be seen between certain organic mental illnesses, such as those induced by syphilis, alcoholism and narcotic addiction, and the particular nature of the social system. Under the superior kind of social system that we live in today, what we ought to be doing is widely to publicize a correct understanding of the essential nature of mental illness and diligently to pursue the tasks of disease prevention and cure. What we should not do is either to commit the error of thinking that by acknowledging the objective existence of mental illness in our society we will somehow be harming China's reputation, or to prematurely set ourselves the goal and task of eliminating all mental illness, in the belief that it is somehow incompatible with our [superior] social system. Neither of these approaches is at all conducive to a fact-based resolution of the problems.

3. We cannot accept that bourgeois worldview and methodology is the main and fundamental factor causing mental illness. [Manuscripts 1-11.]

The contributors were unanimous in rejecting Comrade Jia's contention that "A bourgeois worldview and methodology are the fundamental causal factors in the emergence of mental illness; indeed this is the essential nature of mental illness." They opposed this viewpoint from a range of angles and on various different grounds, which may be summarized broadly as follows:

      a. The character of a mentally ill person, prior to the onset of illness, may display certain weaknesses or defects, such as having a shy and solitary disposition or being narrow-minded and intolerant, but these are not necessarily all attributable to the "vanity and arrogance" and "putting self first-ism" (geren diyizhuyi) found in the bourgeois worldview. A person's character or disposition cannot be equated with his or her worldview, for within a given social class, one comes across many people who share the same worldview but whose characters are quite different. There are only two basic worldviews, the proletarian and the bourgeois, but individual character comes in endless shapes and sizes: for example, the brave or timid types, the frugal or spendthrift types, the profound or superficial types, and the well-adjusted or over-solitary types. Furthermore, given that all of us need to reform our worldviews and that no one is in a position to say they have finally succeeded in this task, the claim that mental illness is the consequence of a failure to properly reform one's worldview could plausibly be applied to everyone who has ever been afflicted by any kind of mental illness, and is therefore devoid of any specific meaning or significance. Trying to understand and explain the particularity of a given contradiction by considering only its universal aspect, as, for example, in the attempts of some people to explain the mental activity of the brain by reference to the contradictory motion of atoms, is at once the most economical of approaches and also the one least likely to produce a solution to specific problems.

      We often say that one important reason why people make mistakes is that they have not done a good enough job of reforming their worldview, so if we now also identify this problem as being the reason why people become mentally ill, it becomes all too easy to start equating becoming mentally ill with making mistakes, and to start seeing mental illness itself as constituting an "ideological defect" (sixiang maobing); at the very least, the distinction between these things becomes blurred and vague. None of this tallies with what we actually observe in the course of clinical psychiatric practice. To stick the accusatory labels of "putting self first-ism" and "improperly reformed worldview" onto large numbers of mentally ill workers, peasants and soldiers is neither fair nor just. People with widely divergent worldviews and all different levels of political consciousness fall victim to schizophrenia. In our clinics and sick wards, we come across numerous workers, peasants and soldiers, and also many cadres and intellectuals, who suffer from this disease, among them Party officials, model workers and other advanced individuals of various kinds, and both during their illnesses and afterwards, they all show warm love and affection for the Party, an enthusiasm for laboring on behalf of socialism, the qualities of loyalty and reliability, and a willingness to help others; while at the same time, we come across some patients whose minds are filled with selfish ideas of all kinds and in whom individualism is running relatively unchecked. Both situations exist side by side, and we must not take a one-sided view of things or seek to characterize the whole on the basis of a part, far less try to draw any blithe theoretical generalizations.

      b. During the initial onset of illness and also prior to any relapses, many schizophrenia sufferers show no conspicuous signs of being under adverse psychological pressure or stimuli, or of having been caught up in any obvious clash or conflict of personal interest; the attribution by others, after the onset of illness, of so-called psychogenic factors in their cases is often quite forced and arbitrary. Even going by Comrade Jia's own statistics, we see that not all of his cases showed psychogenic causal factors; and even if those that didn't amounted to only a few percent of the total, how then can he explain either the reasons for these people becoming mentally ill or the essential nature of their mental illnesses? In children, schizophrenia can emerge before the age of ten, and at this early age, strictly speaking, they cannot yet be said to have formed any particular worldview. Simple schizophrenia can also strike suddenly and without warning in childhood or early youth and then progress slowly thereafter. Countless numbers of chronic schizophrenics are left disabled for many years by the disease, unable to take care of themselves and more or less completely isolated from the outside world, but no pre-existent adverse psychological pressures or stimuli can be found in their cases. And in those cases where psychogenic factors were identified at the onset of illness, such factors have mostly long since disappeared from the scene. In all such cases, the chronic course of the illness is remarkably similar to that of the organic diseases, and it is very hard to explain such an outcome by reference either to psychogenic factors or to the nature of the sufferer's worldview.

      c. In many cases of schizophrenia, prior to the sufferers being hospitalized and with a view to resolving any ideological contradictions or unfulfilled desires that may be present in their minds, the work units, colleagues, families and friends of those afflicted have often made extensive efforts to educate, persuade, comfort and reassure them, and also to improve their living environments, but the effect and outcome of all this work is generally quite minimal; the illness continues to develop as before, and eventually those afflicted have to be sent to mental hospitals for treatment. Once in hospital, they can get relief from their symptoms only if given drug therapy; or if that too fails, they will be discharged as incurable. In all countries around the world, large numbers of schizophrenia sufferers improve as a result of drug therapy alone, and after recovery their individual worldviews remain, as one would only expect, entirely the same as before. Truth knows no boundaries and is equally valid everywhere, so a correct theory of medical treatment must be equally applicable to patients overseas and those living in China. While not denying the importance and significance of ideological re-education and psychotherapy (jingshen zhiliao),321 we do not believe that bourgeois worldview and methodology is the universal and fundamental causal factor leading to onset of the endogenous mental illnesses.

4. The case findings from numerous other medical surveys conducted in China [Manuscripts 1, 2, 3 & 9] do not support the "overwhelming majority" conclusions derived by Comrade Jia from his survey.

In his article, Comrade Jia says that his survey of several hundred cases of mental illness established that there were "three overwhelming majorities," namely, that in an overwhelming majority (94 percent) of the cases he studied, the cause of illness was adverse psychological pressure or stimuli; that in an overwhelming majority of cases (92 percent), the sufferers had "failed to reform their worldviews properly and used incorrect ideology in dealing with contradictions"; and that the overwhelming majority of mentally ill people (90 percent) can be completely cured. And Comrade Jia also states: "The pathological thoughts are simply a continuation of the normal thoughts that existed prior to the onset of illness." Our various contributors put forward the following set of dissenting opinions on these points:

      a. Comrade Jia overestimates the role played by psychological pressures and stimuli prior to the onset of illness, and also the extent to which these factors actually exist. Without contradictions there would be no world, and inasmuch as mental contradictions are a reaction to the contradictory existence of objective matter, we can all be said to have mental contradictions. These naturally exist also before people fall mentally ill, but a large proportion of them do not directly cause the illness, and indeed may have no causal connection with the illness whatsoever. But Comrade Jia's survey stresses the key role played by psychogenic causal factors, so whenever such factors appear, he adamantly and confidently ascribes to them the decisive role in the illness's overall genesis.

      b. Under the special circumstances [of China's recent past], "when evildoers are in power, the good people suffer"; but even when those evildoers' worldviews were of the most extremely reactionary kind, they themselves did not become mentally ill. Many good people, on the other hand, were attacked, persecuted, killed or driven insane by them. By what kind of bizarre logic are we now supposed to ask those who became mentally ill as a result of all this to start "re-examining their worldviews" in an effort to find the "causes" of their illnesses, not to mention the absurdity of attributing their mental problems to "putting self first-ism"? The pathological factors leading to mental illness include, among other things, being so grief-struck at the death of a family member through accident or natural disaster that one falls seriously ill. Are we supposed also to lump this kind of mental illness under the heading of "improperly reformed worldview"? Just what kind of a theory is this?

      c. The results obtained to date in the treatment of schizophrenia, both at home and abroad, are very far from satisfactory. In the case of those with acute or short-term illnesses, the rate of recovery or near-recovery is no more than around 70 percent; and in the case of chronic sufferers whose illnesses have been going on for a long time it is less than 20 percent. Claims that the overwhelming majority of sufferers can be cured of the illness are generally based on loose and inaccurate diagnostic criteria (for example, including hysteria sufferers in the sample group) or on excessively broad criteria for identifying recovery (for example, the inclusion of sufferers who have improved to the extent merely of having their excitement states brought under control), and they simply ignore any residual negative symptoms or impairments of self-awareness that may exist; and usually, no follow-up examinations of the patients have been carried out either.

      d. Among mental patients we find those who, because of delusions of jealousy, kill their own wives and children; those whose delusions of self-guilt drive them either to refuse all food or to eat their own excrement; people who, because of their shallowness of emotion, stand muttering and laughing in front of their dead mother's body; others whose conflictual auditory hallucinations drive them to curse and swear into the empty air; and still others who - in Comrade Jia's own words - "sing, dance and run around aimlessly, tearing off their clothes and going around naked, and sometimes injuring or killing people." In none of these cases, however, would it be plausible to assert, "The pathological thoughts are simply a continuation of the normal thoughts that existed prior to the onset of illness." It is unimaginable that all such abnormal and pathological thoughts, statements and actions as those just mentioned were prefigured by, or existed in, the normal thinking of those concerned prior to the onset of their illnesses, or that there was any kind of systematic connection between their eventual pathological behavior and their initially normal mentality.

5. Marxism-Leninism and Mao Zedong Thought can only be a guide to psychiatric research; it cannot be a substitute for it.

      a. To regard mental illness as being an ideological defect, and hence to substitute ideological reeducation work based on Marxism-Leninism and Mao Zedong Thought in place of pharmaceutical drug therapy; to substitute the philosophical concepts of internal and external causality in place of the medical theory whereby specific internal and external causal factors are sought within the various mechanisms leading to each different disease; to regard psychiatry itself as being a social science rather than a branch of medical science; and to repudiate the biological basis of mental illness, and hence deny the validity of natural-scientific research in this field - none of these approaches accords, in any way at all, with the principles of Marxism-Leninism and Mao Zedong Thought.

      b. Comrade Jia writes,

      In addition, there is the school of experimental research that studies mental phenomena in isolation from their social context, repudiates the class nature of mental activity, denies the counteractive force of mind upon matter (the brain)...and carries out certain anatomical, physiological and biochemical work that is independent of human society. This is all a reflection, within the field of psychiatric research, of the one-sided and mechanistic doctrine of mechanical materialism, and it bears no relation at all to objective reality.322

      Comrade Jia correctly emphasizes here the social nature and class nature of mental phenomena; the latter cannot be "reduced" simply to physiological or biochemical phenomena. But two further points need to be made in this connection. First, the "counteractive force of mind upon matter" means, in philosophical terms, that mental or spiritual factors can become transformed, in the course of practice, into physical or material factors; in other words, it signifies the real counteraction of the spiritual world upon the material world. It does not, however, mean "the counteractive force of mind upon matter (the brain)"; mental activity is a function of the brain itself, and therefore can exist neither in isolation from the brain nor in opposition to it. Second, mental illness is the consequence of pathological changes occurring in the physical matter that makes up the brain, so it is vital that dissections, physiological and biochemical studies and other forms of scientific research be carried out on the brain; there is simply no substitute for this. Provided the research findings are properly construed and understood, there is no grounds for dismissing such work as "mechanical materialism."

      c. In Comrade Jia's view: "The process of reforming and raising one's ideological level is a never-ending one; as soon as old contradictions are resolved, new ones will keep on emerging. Therefore the recurrence [of mental illness] and the attempt to avoid such relapses is absolute." But he then goes on to say, "the non-organic mental illnesses will become more and more rare [as socialism advances] and will eventually disappear altogether." As several contributors to the discussion pointed out, these two statements are self-contradictory: according to the former, the task of reforming and raising one's ideological level (i.e. the struggle between contradictions) is eternal; while in the latter, it is predicted that the non-organic psychoses will eventually become extinct (i.e. the struggle between contradictions will cease, or at least will never again flare up or intensify.)

      d. According to Comrade Jia's understanding, every recurrence (relapse) of a mental illness is due to the emergence of a new contradiction, and each time a recurrence of illness is cured, it is because the contradiction has been resolved. The question of the recurrence and remission of mental illness becomes, therefore, one of a struggle between contradictions in the realm of ideology, or rather a reflection of the ongoing struggle between the two major worldviews. This kind of attempt to use philosophical concepts to explain the natural course of illnesses, such as the remission and recurrence of schizophrenia and mania, is hardly very plausible or convincing. Even in the case of episodic hysteria, there will not necessarily be any psychogenic factors in evidence; somatic illness, pain in the internal organs, or just excessive work can also spark off the condition.

      Compiler's Postscript

The question of the correct understanding of the essential nature of mental illness is something that has direct relevance both for the treatment of millions of mentally ill people and also for the future development of our profession, and the present debate has been an important struggle between truth and fallacy in this arena. Moreover, this is a debate that has been going on since ancient times, and it continues to this day all over the world. In the past, when mental illness was believed to be the result of possession by ghosts or spirits, people used to scorch the flesh of the mentally ill with burning sulfur in an attempt to purge them of evil, or would lash them with peach branches until their bodies were a mass of bleeding wounds. Subsequently, when mental illness was believed to result from unfulfilled erotic urges, the mentally ill would be tricked or forced into sudden arranged marriages, thereby making their lives even more unmanageable, with children left destitute and uncared for, and creating an even greater burden for society. Our ignorance about the essential nature of mental illness has resulted in endless forms of random and harmful treatment being applied, including starvation, bloodletting, anacarthsis [forced vomiting] and the use of drastic abdominal purgatives, with the sufferers often being left on the verge of death. At other times, techniques of fear and intimidation were employed, for example, firing guns in the air, submerging the sufferers in water, or spinning them around in mid-air until they were almost unconscious from shock. And then along came other treatments, such as artificially raising the patient's body temperature, applying electric shocks to their brains and surgically removing parts of the frontal lobe. In short, the impotence of science has exacerbated the sufferings of the mentally ill in manifold ways.

After the founding of New China, the Party and the People's Government made great efforts to improve the health of the population and actively pursued all kinds of disease prevention work, especially in regard to tuberculosis, leprosy and mental illness. Large numbers of hospitals, convalescent homes and reception centers were set up, many new medical staff and specialists were educated and trained, and numerous medical journals and publications were established. In universities and colleges, courses in psychiatric medicine were set up and, guided by Chairman Mao's revolutionary line in healthcare, enormous progress was made in this field, as in other branches of medical science in China.

After Lin Biao and, especially, the Gang of Four started to peddle their reactionary political line - a line that was "left" in form but right in essence - the country was plunged into deep disaster. Every aspect of official life in China suffered the noxious consequences of their doctrines, and the damage wrought in the field of psychiatry was certainly no less serious and profound than elsewhere. They threw people's thinking into complete chaos, and metaphysics and idealism became rampant. As part of their nakedly careerist plan to seize political power within the Party and the government, they even, at one point, instigated mental patients to "rise up in rebellion," and those who did so were then lauded as being "madmen of the new era." They claimed that mental patients were being "persecuted" in our socialist hospitals, and they vilified the broad mass of revolutionary medical workers by accusing them of exercising "bourgeois dictatorship" over mental patients. They characterized all the currently effective, though far from ideal, forms of treatment and therapy used for mental illness in China and the rest of the world as being "instruments of torture designed to destroy patients' health." They even laid down a "class line of demarcation" in respect of the dosages of medication that could be prescribed. Old therapies would be suddenly banned, and new ones imposed, solely by administrative fiat. As a result of all this, in the worst hit mental hospitals, recovery rates and sickbed rotation rates began to decline and medical staff became so demoralized that they left psychiatry altogether.

Eventually, [the ultraleftists] claimed that the real reason people became mentally ill was that their heads were filled with an "excess of selfish ideas and personal concerns" and that mental illness was the product of "an extreme development of individualism." Simplistic techniques of ideological re-education then became the principal form of treatment and cure for mental illness in China. Mentally ill people were made to undergo re-education at the hands of the medical staff and ordered to dig out, from within their own minds, the "ideological roots" of their illnesses. In some mental hospitals, patients who uttered banned thoughts or engaged in banned forms of behavior because of their illnesses were held criminally responsible, and even their families were wrongfully implicated. This conception of mental illness as being an ideological sickness and a disease of the bourgeoisie, the belief that it is a product of the capitalist social system, holds in lofty disdain the sufferings of countless numbers of working-class mentally ill people and has served to consign psychiatry to the distant margins of public health work in our country. Is it not now incumbent upon us, therefore, to expose and criticize to the fullest extent possible all these absurd theories and pernicious policies of the Gang of Four, these perversions of medicine that have inflicted such harm and damage upon the mentally ill and upon the great majority of those working in our profession?

As Chairman Mao taught us,

Idealism and metaphysics are the easiest things in the world, because people can talk as much nonsense as they like without basing it on objective reality or having it tested against reality. Materialism and dialectics, on the other hand, need effort. They must be based on and tested by objective reality. Unless one makes the effort, one is liable to slip into idealism and metaphysics.323

No matter what the circumstances, we must always have the courage to uphold the truth, rectify our mistakes, seek truth from facts and study with humility. Only thus will we be able to contribute to the cause of socialist reconstruction by realizing the Four Modernizations, including the modernization of science and of psychiatric medicine.

Index of manuscripts cited above:

    1. Zhu Xixi, "My Views on the Question of the Essential Nature of Mental Illness."

    2. Yu Zhanfei, "Some Rough Opinions on the Causes and Treatment of Mental Illness."

    3. Liu Hengwen, "A Discussion of the Causal Factors Leading to Mental Illness."

    4. Long Yaxian, "Reflections Upon Reading [Jia Rubao's] `More on the Essential Nature of Mental Illness'."

    5. Sun Ru, "Taking Issue with Comrade Jia Rubao on the Question of the Essential Nature of Mental Illness."

    6. He Xingqing, "Subjective Conjecture is No Substitute for Scientific Research."

    7. Zhang Jiejie, "Mental Illness is Not an `Ideological defect'."

    8. Ding Qinzhang, "Do `Ideological Problems' Play the Leading Role in the Causation of Mental Illness?"

    9. Cao Songyao, "Marxist Philosophy Provides a Compass for Understanding the Essential Nature of Mental Illness."

    10. Yan Shengmei, "The Study of Dialectics is the Guide to Medical Practice."

    11. Lu Lizhao, "Taking Issue with Comrade Jia Rubao."

(Compiled by Yang Desen)

283 All translations of the following documents are by Robin Munro; article titles and subheadings are as they appear in the original documents.

284 "Tuchu Zhengzhi, Zou Woguo Jingshenbing Fangzhi Gongzuo Ziji de Lu," Chinese Journal of Neurology and Psychiatry, vol. 10, no. 2 (1966), pp.95-97.

285 In Maoist parlance, these are: the struggle for production, the class struggle, and scientific experimentation.

286 In Maoist political philosophy, the terms "metaphysics" and "idealism" are generally used as terms of abuse to denote any viewpoints or policies that are officially deemed to be diametrically opposed to, respectively, the Marxist theories of "dialectics" and "materialism."

287 The concept of "subjective dynamism" (zhuguan nengdongxing) was a prominent strand in radical Maoist thought from the early 1960s onward; it reflected Mao's belief that China under socialism could develop at a much faster rate than the backward material and economic conditions of the country would otherwise allow, provided the population fully believed in and utilized the transformative powers of human subjective will. In a colloquial sense, it amounted to a kind of "mind over matter" belief system, the principal target or adversary of which was the orthodox (Soviet) Marxist doctrine of "economic determinism."

288 "Tuchu Zhengzhi, Cujin Jingshenbing Linchuang Guanli Gongzuo Geminghua," Chinese Journal of Neurology and Psychiatry, vol. 10, no. 2 (1966), pp.107-108.

289 "fan youpai, xing-wu mie-zi de douzheng"

290 The Socialist Education Movement began in the early 1960s, first in the countryside and then later in the cities, and was the immediate forerunner of the Cultural Revolution.

291 "jianchi sige diyi," namely, "the priority of men over weapons, of political work over other work, of ideological work over routine political work, and of living ideology over ideas from books"; see Stuart R. Schram, ed., Mao Tse-tung Unrehearsed - Talks and Letters: 1956-71 (Harmondsworth: Pelican Books, 1974), p.246 and p.339 (Note 6).

292 "Yi ku si tian": political consciousness-raising sessions in which people would hear tales from the elderly about how harsh and exploitative life had been before 1949 and then dwell upon all the ways in which life had improved under Communism. These sessions were a regular feature of daily life in China from the early 1950s until the late 1970s.

293 Elsewhere in the same issue of the journal, another patient was reported as saying: "In the past, when the doctor told me that `to cure your sickness you must be guided by correct ideology," I felt quite upset and offended. How could correcting one's ideology ever make one recover from mental illness? Would this not mean that actually I had an ideological sickness? Now that I've gained an understanding of the dialectical relationship between ideology and illness, however, I know why the medicine I used to take had no effect and I've become confident of being able to cure myself" (Chinese Journal of Neuropsychiatry, vol. 10, no. 2 [1966], p.114).

294 Xin Yixue - Shenjing Xitong Jibing Fukan (New Medicine - Supplementary Series on Diseases of the Nervous System), no.8 (1972), pp.12-16. This journal was published on a monthly basis "for internal use only" (neibu faxing) by the Zhongshan Medical College in Guangzhou and was one of only a tiny handful of medical journals produced in China during the Cultural Revolution.

295 The proposition "one divides into two" (yi fen wei er) is a key tenet of Maoist dialectics and epistemology and stresses the primacy of contradiction and struggle in human affairs. It was given great prominence by Mao before and during the Cultural Revolution, as a means of combating both the early 1960s Khrushchevite doctrine of "peaceful coexistence" between the Communist world and the United States and also the increasing elite support within China at that time for the alternative Marxist philosophical proposition "two combine into one" (he er er yi); the latter sought to downplay, among other things, the centrality of class struggle in China's post-capitalist development.

296 Mao Zedong, "On Contradiction," Selected Works of Chairman Mao, pp.289-291. NB: Until the late 1970s, any quotations from the works of Mao in the published writings of others were always highlighted in bold text; we have preserved this convention in the translated documents presented here.

297 "`si' zi zuo guai," i.e., they still retain "selfish" ideas that conflict with the Communist or socialist values of public ownership and communal living.

298 i.e., the proletarian worldview and the capitalist or bourgeois worldview.

299 "Dongmian ling": a herbal preparation used in traditional Chinese medicine; see also (on its uses in "deep sleep therapy" in China) Note 75, above.

300 "yi ku si quan"

301 Namely, the Canadian doctor Norman Bethune, a Red Army soldier named Zhang Side and the "Foolish Old Man of North Mountain," about whom Mao wrote, respectively, in his celebrated three articles titled "In Memory of Norman Bethune" (1939), "Serve the People" (1944) and "The Foolish Old Man Who Removed the Mountains" (1945). These three articles were at the core of all Communist Party educational efforts in China after 1949.

302 The meaning of this term is unclear.

303 The section omitted here contained around half a page of medical details on the dosages of herbal remedies and the combinations of acupuncture points used in the treatments summarized in Table 3.

304 Mao Zedong, "Serve the People," September 8, 1944.

305 Xin Yixue (New Medicine), vol. 4, no. 3 (1973), pp.176-178; cover date March 15, 1973.

306 "San da liao fa," namely, chlorpromazine (or other antipsychotic medications), insulin coma therapy, and electroconvulsive treatment.

307 Yang Desen, Xin Yixue - Jingshen Xitong Jibing Fukan (New Medicine - Supplementary Series on Diseases of the Nervous System), vol. 2, no. 3 (1976), pp.187-189. NB: This article was published only one month before the death of Chairman Mao and at the height of power of the ultraleftist "Gang of Four."

308 "weiwuzhuyi fanyinglun": the Marxist epistemological doctrine whereby all human mental activity is seen as being rooted in, and ultimately reflective of, events and circumstances occurring in the "material" realm.

309 "huoming zhexue": expanded English translation above taken from The Pinyin Chinese-English Dictionary (Beijing, 1990); the author's implicit reference to the "modern revisionists" who allegedly spout this philosophy means, in the context of late Maoist thought, the USSR and the Communist Party of the Soviet Union.

310 "jingshenbing dou shi gerenzhuyi jiduan fazhen de jieguo"

311 See below, Note 316.

312 Xin Yixue - Shenjing Xitong Jibing Fukan (New Medicine - Supplementary Series on Diseases of the Nervous System), vol. 3, no. 2 (1977), pp.142-143. It is clear from this article that the author, Jia Rubao, was also one of the authors of Document 3, above: "Analysis of a Survey of 250 Cases of Mental Illness."

313 "Mechanical materialism" was the pejorative term used by Marx to describe the system of thought of the German philosopher Ludwig Feuerbach (see, for example, Marx's famous 1845 essay, "Ten Theses on Feuerbach," and also his 1886 article "Ludwig Feuerbach and the End of Classical German Philosophy"). Marx claimed to have "redeemed" Feuerbach's materialism by removing the "mechanistic" aspects and replacing them with a (similarly cleansed) version of Hegel's theory of dialectics; Marx called the resultant theory "dialectical materialism."

314 These three things are often referred to, in Maoist political discourse, as the "three great revolutionary movements" (san-da geming yundong).

315 See preceding Note.

316 The last two quotes are taken from Mao Zedong's writings. The locus classicus of the proposition "practice is the sole criterion of truth," which in 1978 became Deng Xiaoping's battle cry in his decisive struggle against the residual ultraleftists in the Chinese Communist Party, is Mao's famous article of July 1937, "On Practice." The main source for the Maoist variant of the phrase "the concrete analysis of concrete conditions" is Mao's equally famous August 1937 article, "On Contradictions." (Mao himself borrowed the phrase from Lenin's article, "Communism," in which Lenin, criticizing the Hungarian Communist Bela Kun, said that he "gives up the most essential thing in Marxism, the living soul of Marxism, the concrete analysis of concrete conditions" [see Collected Works of Lenin, Russian edition, Moscow, vol. 31 (l950), p.143].)

317 It is unclear why this passage appears in quotation marks in the original text; it is probably a quotation from some ultraleftist Chinese "authority" on psychiatry.

318 See Note 287, above.

319 Xin Yixue- Shenjing Xitong Jibing Fukan (New Medicine - Supplementary Series on Diseases of the Nervous System), vol. 4, no. 5-6 (1978) (cover date August 20, 1978), pp.329-332.

320 See Documents 5 and 6, above.

321 Somewhat confusingly, given the generally positive image of psychotherapy in the West, in China "jingshen zhiliao" was introduced by the Maoist ultraleftists in the mid-1960s and was essentially a process whereby the mentally ill were subjected to compulsory political and ideological re-education. To some extent, the term "psychotherapy" retains these negative connotations in China even today. (See also the final paragraph of Document 1, above.)

322 For an explanation of the term "mechanical materialism," see Note 313, above.

323 Introductory note to "Material on the Hu Feng Counterrevolutionary Clique" (May 1955); translation taken from Quotations from Chairman Mao Tse-tung, (Peking: Peking Foreign Languages Press, 1966).

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