The Ambivalent Tactics of Therapeutic Governing

Li Zhang has captured a fascinating moment in the social and political transformation of psychotherapy in China. There is much to say about this exquisite book. While grounded in the particularities of postsocialist China, Zhang situates her analysis in dialogue with much broader questions relating to globalization, governmentality, and grassroots practices. Her book will undoubtedly stimulate rich dialogue with scholars working on similar questions in diverse regions of the world.

What most caught my attention was one of Zhang’s three core concepts, “therapeutic governing.” Drawing on the works of Nikolas Rose and James Nolan, Zhang explores how the recent rise of “psy fever,” a popular and widely-shared desire for therapeutic fixes, has been co-produced with the emergence of a new cadre of middle-class “grassroots counselors.” In the context of a rapidly changing society, therapists and clients are coming together to produce new tactics and ways of knowing that render subjects “governable.” There are manifold contradictions and ambiguities in how grassroots counselors and clients are engaged in therapeutic governing. Some tactics of governing, Zhang writes, “are flourishing… while others meet subversion” (27). Counselors sometimes work to unsettle core values of the “ideal citizen” of postsocialist China, while they sometimes also subdue the resistances and confrontations of an anxious and skeptical workforce.

On the one hand, there are strong ideological and state-controlled dynamics at play. Therapeutic techniques are being used by government and state-owned enterprises to improve the management of work force, and importantly, the military and police (chapter 7). Counselors are being asked to run screening tests in order to add to the dangan, the personnel file, which can have ramifications for an individual’s livelihood. Clients seek psychotherapy to cope with “hierarchical” and “masculine” environments of the workplace and with the growing demands to increase performance in a context of limited resources. Psy work is revamping postsocialist governing at a time when socialist “thought work,” a form of grassroots campaigning that worked to align the values and ethics of individuals’ with those of the party-state, is no longer effective. Cognitive behavioral therapy (CBT) has undergone bentuhua, the process of making Western technologies fit in Chinese norms and values, and there are striking similarities between a transformed CBT and thought work. Both are simultaneously political and personal, social and intimate. CBT entails not a process of private retreat into the self nor indeed the search for freedom as in “the West.” Rather, CBT reworks the individual’s relationship to the social realm. Clients who feel worn out, overworked, and stuck in a harmful workplace learn that even though they cannot change their reality, “they still have control over how to respond” to their reality (165).

On the other hand, grassroots counselors are escaping from and sometimes pushing up against the control of government. With training from decentralized entities that provide short-term certificates, they have grown to massive numbers in a short period of time. Though contracted by state institutions, they also work in a loosely regulated private economy for fee-paying individuals. This new class of counselors are criticized by established psy-elite (academics and hospital-based psychiatrists) for having poor quality training and lack of credentials, and counselors do not withhold from criticizing this very elite for being “arm-chair therapists with minimal real-life experience” (40).

Counselors are privy to a great deal of social tension and resistance to the institutionalization of life. Zhang quotes a human resources manager in a state-owned enterprise explaining that counselors are being brought in because employees are, in his words, “irritable, grumpy, [and] defiant towards… authority” (165). When Xiao Wang, a mid-level technician in cigarette production company is strongly encouraged to participate in a group counselling session, he becomes resistant and cynical, claiming the “psychological work” is merely one more way for authorities to “brainwash” the population. While he ultimately finds the emotional work helpful and “soothing,” he is not deluded regarding the “powerful structural forces shaping his life” (166-167). Counselors are keenly aware of their multiple and tenuous positions in society. One of Zhang’s interlocutors, who was simultaneously a counselor in a police station, a police officer, and a member of Communist party, explained, “If I am not careful, I can easily become their instrument of control and lose the trust of the officers” (158).

This is not an either/or situation. Zhang masterfully avoids binaries of all sorts: global/local, West/non-West, internal self/public self; these binaries do not frame the analysis. This allows Zhang to distance herself from the traps of a false consciousness analytic and hone in on the productive and generative tensions at play. Psychotherapy is fundamentally outward-looking in China, a means to reflect on society, and yet clients are also repeatedly told they need to adapt to their reality. Might this very tension, the modes of awareness that are brewing, turn into actions that challenge normative structures and ways of life? Where are the cracks in this current postsocialist therapeutic governing? How might discontinuities with the past break through and gain momentum?

In my reading, I was curious about two potential inroads. The first is the repeated claim, made by authorities, therapists, and clients, that grassroots counselors are “unqualified.” This may be true in a technical sense, for instance in terms of time devoted to formal training or breadth of texts used. But it is also the case that the authority to define what counts as qualification is currently being challenged in China. Where multiple and conflicting forms of expertise crystallize on the ground, novel therapeutics and forms of collective care and subjectivities can and often do emerge. User-led movements, citizen science and co-production have gained considerable traction at the grassroots level and in often juxtaposition to more formal modes of governance (Rose and Kalathil 2019). Many of the counselors Zhang met are in unique in-between positions: on the borders of different ways of knowing, navigating the space between institutions and the myriad of places that sit outside of sanctioned authority. Whether they constitute an emerging group of professionals whose practices are marked—precisely because they are able to unsettle the many practices that reproduce the figure of the “ideal citizen”—remains to be seen (Boyer and Lomnitz 2005). There does seem to be something distinctive about the intimate, public, and collectivizing ambiguities they inhabit, and the ways they are creating an ecological and always relational model of self and psychological experience (Kitanaka 2020).

The second inroad relates to Zhang’s reliance on Bakhtin’s notion of the “dialogic,” a process in which seemingly contradictory or opposing forces interact and mutually transform one another (Bakhtin 1981). Zhang explores dialogic processes in relation to global-local frictions, as well as to the fluid and hybrid practices she found taking place in clinical encounters. I wondered if Zhang found similar dialogic processes taking place at a meso-level, for instance between grassroots counselors and the elite psychiatric establishment in China, or between counselors (together with their grumpy and skeptical clients) and other bottom-up semi-organized popular movements? What is the potential here for praxis? Paulo Freire, also well known for theorizing the potential of dialogic openings in the pedagogic process, claimed that praxis—analysis via the attempt to intervene and modify one’s world—was integral to reflexivity and social change (Freire 2005 [1970]). In Brazil, colleagues and I found dialogic praxis taking place iteratively in multiple interconnected spaces: clinics, schools, families and in the less governable spaces of the street. Dialogic praxis allowed people to imagine different approaches to psychological life and to act on these imaginings, upholding a purposefully equivocal way of relating to others while also changing their worlds (Béhague 2009, Béhague 2020). Were grassroots counselors, given their unique placement in the meso-levels of therapeutic governing, engaged in any such enacted imaginings?

Dominique Béhague is Associate Professor at the Department of Medicine, Health and Society at Vanderbilt University and Reader at the Department of Global Health & Social Medicine at King’s College London. An anthropologist by training, Béhague’s long-term research in Southern Brazil explores the intersection of psychiatry, politics, and the rise of adolescence as an object of expertise. She co-designed the longitudinal ethnographic sub-study of the 1982 Pelotas Birth cohort situated in Southern Brazil, one of a handful of interdisciplinary cohort studies to take place in a country in the so-called Global South. Her research has been funded by the US National Science Foundation, the Fulbright Foundation, the World Health Organization, the UK Economic and Social Research Council, The Wellcome Trust, and her publications appear in a range of anthropological, sociological, and public health journals and edited volumes. She has also co-edited three Special Issues in Culture, Medicine and Psychiatry (2008), Social Science and Medicine (2015) and Medical Anthropology Quarterly (2020).

Works Cited:

Bakhtin, M. (1981). The Dialogic Imagination. Austin, University of Texas Press.

Béhague, D. (2009). “Psychiatry and politics in Pelotas, Brazil: The equivocal uses of “conduct disorder” and related diagnoses.” Medical Anthropology Quarterly 23(4): 455- 482.

Béhague, D. P., et al. (2020). “Dialogic Praxis—A 16-Year-Old Boy with Anxiety in Southern Brazil.” New England Journal of Medicine 382(3): 201-204.

Boyer, D. and C. Lomnitz (2005). “Intellectuals and nationalism: Anthropological engagements.” Annual Review of Anthropology 34 105-120.

Freire, P. (2005 [1970]). Pedagogy of the Oppressed. New York, The Continuum Publishing Company.

Kitanaka, J. (2020). “In the Mind of Dementia: Neurobiological Empathy, Incommensurability, and the Dementia Tojisha Movement in Japan.” Medical Anthropology Quarterly 34(1): 119-135.

Rose, D. and J. Kalathil (2019). “Power, Privilege and Knowledge: The Untenable Promise of Co-production in Mental ‘Health’.” Frontiers in Sociology 4(57).