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APPENDIX I: THE CULTURAL REVOLUTION AND LATE 1970s
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.
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.
Chenzhou District Mental Hospital, Hunan Province;
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
Table 2 Statistics on Personality Characteristics
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
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
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
[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.
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. Conclusion 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.)
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]
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.
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.
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.
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.
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
August 1976 Mental activity is a function of the human brain; it is the inner reflection of objective reality.
Document 6: More on the Essential Nature of Mental Illness312 Jia Rubao Employees' Hospital of the Huashan Metallurgy and
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.
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."
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.]
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.]
3. We cannot accept that bourgeois worldview and methodology is the main and fundamental factor causing mental illness. [Manuscripts 1-11.]
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.
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,
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.
As Chairman Mao taught us,
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."
(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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