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Why do people diagnosed with schizophrenia in China hear “voices” of state leaders? How do these voices relate to the world depicted by “China Dream” discourse?  

Simon Fraser University (SFU) anthropology professor Jie Yang studies mental health and indigenous and non-indigenous psychology in China. She is fascinated by the ways that different strands of ideologies emerge in language and in people’s emotional lives. She also studies how power can affect these highly personal realms. Among people diagnosed with schizophrenia, she analyzes the relationship between ideological “reification” or narrowing, social alienation and mental distress. Her research themes include postsocialism; neoliberalism; unemployment and urban poverty; affect/emotion and happiness; gender and sexuality; and distress among Chinese officials.

In her recent article, Hallucinations of the “China Dream:” Forbidden Voice, Articulation, and Schizophrenia in China, published in Medical Anthropology, Yang discusses the contents of voices heard by people diagnosed with schizophrenia in China. She concludes that patients’ heard voices are linked to “China Dream” discourse—particularly aspects of that discourse that distort reality. [PDF available at SFU Library, computing ID required].

The “China Dream” as defined in the article is the “sustained, collective and individual efforts to create an economically prosperous and culturally revitalized nation.” This Dream underpins an idealized notion of society that prioritizes national interests and social harmony, while repressing dissent and transferring state responsibility to individuals.    

Yang interviewed doctors, caregivers, patients and family members at two psychiatric hospitals in Beijing and in Shandong province to learn about their experiences. Research informants included a young woman who had endured public shaming for poor grades at school, a factory worker whose well-founded fear of being laid off derailed his work, and a successful woman entrepreneur expected to carry huge family responsibilities. All these individuals experienced intense pressure to meet societal and state expectations. All experienced hearing the voices of state leaders, present and past that reinforced their experiences.

Yang argues that in China’s shifting political and economic landscape, heard voices are not random. Rather, they express experiences of pressure, subordination and self-preservation in response to the ideological narrative of a Dream that includes many, yet excludes others.

We spoke with professor Yang about her research. 

Can you say more about what people mean when they describe the “China Dream?”

The “China Dream” is an official campaign launched by President Xi in 2012. It is now a key organizing principle of the Communist Party. We have all heard of the American Dream, which is about individuals striving for personal goals like money, success or fame. In the China Dream, prosperity means something different. Success is more closely linked to the success of the country as a whole. Basic tenets of the China Dream include economic expansion, scientific prominence and greater global influence.

In official discourses, the Dream is always associated with Chinese prosperity, like collective efforts for rejuvenating Chinese civilization, socialism, and national glory. But there is a catch. None of those collective nationalist agendas can succeed unless Chinese people get on board. The Dream depends on harnessing the power of individual dreams. People are encouraged to embrace entrepreneurship and to look inside themselves for new resources they can develop. This streamlines what people are supposed to dream.

The ideological thrust of the Dream highlights certain values, like individuality, that run counter to traditional Chinese ways of being, which are very dynamic. Two terms to describe that dynamism are “holism” and “relational ethics.” Traditionally, people in China are part of a rich social network that determines their roles, responsibilities and sense of self; they are holistically and ethically linked to family and community. In the China Dream, we are seeing a shift away from this, and more emphasis on how you as a person can help build China’s future while achieving your own success.

Why is voice hearing—and hearing the voices of state officials like President Xi or Premier Li—so common in individuals diagnosed with psychological “illness?”

We know from the scholarly literature that the content of delusions experienced by people diagnosed with schizophrenia in China has changed over time. This includes voice hearing. Interestingly, you can track these changes by looking at social changes in the country. I have spent a lot of time examining these parallels and why they occur. I think they are due in part to elements of Chinese cultural tradition. Traditionally, ethics in China are relational and the self is interdependent—the concept of the psyche does not apply. In the Confucian tradition, fulfilling your role, small or large, is not just good for you, but good for society. Social hierarchy is highly valued.

In this context, people tend to look to higher-ups or leaders for guidance. Regarding the current “China Dream,” its ideology has become ubiquitous in public discourses and peoples’ everyday conversations. China’s leaders regularly appear on state media to promote the campaign. Their frequent appearances are part of a process that narrows, or flattens, what people are supposed to dream—what I call ideological reification. A more unified vision of how people should be and what they aim for comes into focus. This minimizes space for dissent. It is unsurprising then that today many of those diagnosed with schizophrenia “hear” directly from these leaders.

Does the diagnosis of psychological “illness” or schizophrenia occur most often in certain groups or individuals? Have you observed any trends in those diagnosed with psychological illness?

Studies of mental health in anthropology have shown that people in society who are marginalized, impoverished, or discriminated against tend to suffer more mental distress than people who belong to privileged groups. We also see more distress in people who live with more social conflict or contradiction, compared to people who live in relative peace. In China, the source of moral or ethical conflict might be tensions between a cultural emphasis on collectivity and family values, including filial piety—or duty to parents—and individual concerns. Personal interests can get lost, leading to distress. Conversely, in the era of the China Dream, tension can arise between the duty to live for country and succeed individually, and the loss of relational community support and care.

In the example of your research informant Kan, the successful entrepreneur who felt compelled to write a guide for a new communist society, can you explain why political activists are called “bigotry petitioners?” What does this mean?

Kan is a special person—very driven, but also highly ethical. But she has also faced many challenges in her life. I have learned, through my research, that when venues in civil society for people to freely express their concerns are limited or blocked, people resort to official channels to petition in order to be heard. Those who repeatedly petition local or central governments in China seeking restitution for injustices, but who are perceived to lack “just cause,” are often pathologized by local governments as “bigotry petitioners.” They are sometimes sent to mental hospitals for treatment. That happened to Kan. She had some delusions related to her plans for a new society, but I think she also has great sympathy for others.

What are you working on next in your research?

I am excited about my next research project. Along with diverse colleagues in Canada, the United States, China and Europe—a truly international and interdisciplinary team—I have been reading classic works of Chinese literature, philosophy and medicine. I want to know what these classics can teach us about Chinese psychology, well-being and healing. The project has already generated many questions—for example, how does Chinese tradition classify types of mental distress? Are there opportunities for mental health treatment that we have overlooked? And can Chinese psychology offer an alternative to Euro-American psychology—if so, what does that look like? Ultimately, we hope to develop fulsome mental health care models based on Chinese indigenous psychology. It is an SFU-led collaboration with six partner universities and 15 scholars of philosophy, cultural history, anthropology and psychology. We have a lot to explore!

To learn more about professor Yang’s research and view her books and articles, visit her faculty web page.


This research has been funded by the Social Sciences and Humanities of Research Council of Canada.

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