To what extent—and in what ways—is psychotherapeutic work on the “self” necessarily a political project? If it is political, is it an inherently neoliberal endeavor? What are the ultimate aims of this focus on the self? Are psy practices functionally conservative, inducing people to adjust to existing circumstances? Or are they potentially liberatory, facilitating radical transformation of self and society? These are some of the provocative questions raised in Li Zhang’s book Anxious China.
Psy practices and politics have long been uneasy and awkward bedfellows. From the impact of anti-Semitism on the development of Freudian psychoanalysis (Frosh 2004), to the “quiet revolution” of Carl Rogers’ person-centered approaches (Rogers 1978), to the “emancipatory” aims of some contemporary intersubjectivist work (Brandchaft et al. 2010), the potential—or not—for transformative self-work to become socially transformative (and whether this should be an explicit goal or merely a collateral effect) has been hotly debated.
These questions have taken on a new urgency in recent years with the globalization of western psy practices, aided by such factors as the World Health Organization’s Mental Health Action Plan (WHO 2013) and the explosion of the global psychopharmaceutical industry. Critical engagements with these developments have focused on two central and related components: (1) What kind of subject is cultivated through these practices? And (2) How does that view of the subject relate to questions of transformative political action?
Much has been written in recent years about how the subject of western psy practices is constituted and the degree to which the globalization of these practices constitutes a neo-colonialist project (see Bemme and Kirmayer 2020 for an excellent overview). The prevailing argument is much of this literature that these interventions enfold a philosophy of the person based in values of individualism, independence, and self-determination, combined with an injunction to self-knowledge, self-discipline, and self-responsibility. As a result, they cultivate a particular kind of “self” that aligns with neoliberal priorities. In this way, the incorporation of western psy practices in non-western contexts is often seen to be both an indicator of and a catalyst for a shift towards more stereotypical “western” modes of being and engaging in the world. While there is by no means consensus about how this shift happens or what (if anything) to do about it, most scholars of cross-cultural psy practices agree on this foundational point.
Where they tend to disagree is on whether this subject formation is a politically conservative or politically liberatory endeavor. Critical perspectives maintain that this kind of intensive self-work diverts clients’ attention away from very real structural and social problems for which experiencing distress may be an entirely appropriate response. The history of psychiatry is riddled with examples: American housewives in the 1960s were medicated out of “female malaise” and into more compliant forms of domesticity (Ussher 2011), African American men in the U.S. have been disproportionately institutionalized for their “uncontrollable” rage (Metzl 2011), and children in foster care are prescribed psychotropic medication at rates nine times higher than other children (Franklin, 2014). Viewed from this perspective, psy practices certainly seem to function as a mechanism of discipline and domestication, keeping individuals docile and compliant and pathologizing disruption and dissent.
Writing from a very different perspective, however, other theorists argue that a focus on the self can, in fact, be liberatory, allowing individuals to build capacities and resources for change. Liberation Psychology for example, specifically aims to understand and address the needs of oppressed individuals in order to promote social change (Martín-Baró 1996). Drawing on liberation philosophy, Marxist, feminist and decolonial thought, and critical theory, this orientation focuses on consciousness-raising, empowerment, and linking individual trauma healing to larger ethical social transformation.
So, we are left with the question: are psy-practices conservative or liberatory? Well-reasoned opinions sustain both sides of the debate, and so it continues.
What Zhang brings to these discussions in Anxious China is a much-needed corrective. Grounding her analysis in a deep engagement with China’s historical, political, and social specificity, she acknowledges the neoliberalizing potential of western psy practices, but stresses that they take on significantly different meanings in China. And not just in the sense of dressing up western ideas in local garb. She discusses, for example, the parallels between cognitive-behavioral therapy (CBT) and communist thought work. Thought work utilized strategies similar to CBT, not to concretize the individual, but to further embed the experience of the self in social and relational worlds. So while CBT in China certainly has political connotations, we cannot simply categorize it as a neoliberal project, or at least not in the sense of an imported philosophy of self that becomes unproblematically inculcated in clients through the enactment of CBT practices.
Instead of simply imposing western views of the person, Zhang argues, western psy practices in China seems to offer people tools for navigating multiple culturally relevant models of the person, the self, and the goals of transformation that coexist in the wake of post-communist developments. While one might observe that this, in and of itself, might be interpreted as a rather neoliberal project, Zhang shows convincingly that it is not, or at least not entirely. Western psy practices may carry with them a great deal of cultural material, but they are not strands of DNA transmitting unadulterated self-philosophies that are simply implanted in new contexts. They are engaged by living people in living contexts with complex histories and presents. How and when and in what ways such practices take root depends on whether they resonate with prevailing social concerns, whether people find them useful, and how they are adapted to local frameworks of meaning. Those concerns, that utility, and those frameworks can be—and often are—very different from the ones that gave birth the intervention.
While Zhang does not come down explicitly on the question of whether psy practices are inherently conservative or potentially liberatory, her book challenges us to step back and reconsider the foundations of that distinction. Indeed, the question itself enfolds a view of self and society that is deeply culturally inflected, presuming that there is a “natural” tension between the individual and the collective, and that benefit to one only comes at a cost to the other. In considering how western psy practices are engaged in China, Zhang recenters the question away from how these practices might be colonizing the emerging Chinese mental health industry, towards how they seem to enable Chinese practitioners and clients alike to work towards culturally meaningful goals that may be very different than those in western contexts. This, she says, has become increasingly important in contemporary China, whose conditions, as she so persuasively demonstrates, is increasingly anxious.
Rebecca J. Lester is Professor of Anthropology at Washington University in St. Louis with research interests in mental health, gender, sexuality, and religion. She is also a practicing psychotherapist specializing in eating disorders, trauma, personality disorders, mood disorders, and gender/sexuality issues. Her most recent book, Famished: Eating Disorders and Failed Care in America (2019) was awarded a Victor Turner Prize for Ethnographic Writing. She is currently Editor-in-Chief of the journal Culture, Medicine, and Psychiatry and president of the Society for Psychological Anthropology.
Bemme, D. & LJ Kirmayer. (2020). Global Mental Health: Interdisciplinary Challenges for a Field in Motion. Transcultural Psychiatry 57 (1): 3-18.
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Franklin, SS. (2014). Over-Medication of Psychotropic Drugs & African-American Girls in Foster Care. Baltimore, MD: Franklin Law Group.
Frosh, S. (2004). Freud, Psychoanalysis, and Anti-Semitism. Psychoanalytic Review 91(3): 309-330.
Martín-Baró, I. (1995). Writings for a liberation psychology(A. Aron & S. Corne, Eds.). Cambridge, MA: Harvard University Press.
Metzl, J. (2011). The protest psychosis: How schizophrenia became a Black disease. New York: Penguin Random House.
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Ussher, JM. (2011). The madness of women: Myth and experience. New York: Routledge.
World Health Organization (2013). Mental Health Action Plan 2013-2020. Geneva, Switzerland: WHO Document Production Service.