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Abstract

Over the last three decades, most psychiatric inpatients in China have been hospitalized against their will, by their families. Despite intense public discussion on patient rights over the last ten years, the first national Mental Health Law, effective since 2013, has reinforced the family’s rights and responsibilities in psychiatric care. The family’s involvement is inscribed in a technico-administrative discourse of risk management. It is also inscribed in the law’s central motif of 管/guan, a polysemous word that can refer to concerning oneself with and being responsible for another individual, and/or to managing, governing and control. The family, as it is conceived in the Mental Health Law, thus becomes a primary unit to mediate individual liberty, wellbeing, and population security in post-socialist China. Why does the family continue to occupy such a critical role in Chinese psychiatry? Although Confucian family ethics certainly have an enduring legacy, my research examines the family’s involvement in psychiatry as technological, institutional, and ideological configurations. It explores their implications for the ethics, affects, and political economy of care and population governance in post-socialist China. To those ends, I conducted 32 months of fieldwork in psychiatric hospitals, community mental health teams, social work centers, family support groups, and human rights agencies, mostly in Guangdong. I also interviewed lawmakers, attended national conferences, and conducted archival and media analysis to understand historical developments and contemporary debates of Chinese psychiatry. In China’s mental health legislation reform, the notion of paternalism was used to justify involuntary commitment and surveillance by families. My research shows that this notion of paternalism allows the post-socialist state to fashion itself as humanitarian, while relegating to the families responsibilities to care for vulnerable patients and to prevent potential violence. With its critique aimed only at the state and its inability to conceive of intimate politics, the human rights campaign has inadvertently reinforced this family-mediated, biopolitical paternalism. I argue that this biopolitical paternalism bespeaks the general tenor of post-socialist governance, which is shaped by conditions such as the retreat and uneven resurrection of the welfare state, and the rise of security apparatus. My research also reveals that this paternalistic governance requires and transforms the family ethics of care. Existing literature on biopower attends to how biomedical knowledge shapes bodily discipline and population governance. Yet it often ignores how biopower is mediated by modalities of intimate practices, by people’s desire and responsibility to care for the vulnerable other. In Chinese psychiatry, governance and care are entangled in guan, the central mandate of the Mental Health Law. Tracing how guan is invoked, defined, and enacted in everyday practices and medico-legal discourses, I show that mental illness is inscribed in a chronic trajectory of risks, requiring management in the form of medication and institutionalization. Families that guan thus come to shoulder responsibilities of financial provision, tasks of medical surveillance, and affects of ambivalence. Meanwhile patients long for the emotional ties but fear the intimate domination in practices of guan. However, family members may also flip the demand of guan back onto the state, asking the state to become a proper parent. My analysis of guan contributes to the anthropological and philosophical literature on care by revealing the intimate politics, ethical contestations, and political potentials in care. Because biomedicine is redefining individual wellbeing and population security, and because neoliberal policies throughout the world tend to generate moralized discourses of private care to evade public responsibilities, this research provides a lived critique of biopolitical paternalism in and beyond China.

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