Escolar Documentos
Profissional Documentos
Cultura Documentos
anna lora-wainwright
Fighting for Breath
Fighting for Breath
Living Morally and Dying of Cancer
in a Chinese Village
Anna Lora-Wainwright
18 17 16 15 14 13 6 5 4 3 2 1
Acknowledgments ix
Guide to Key Places and People xiii
Introduction 1
Part 1: Foundations
Chapter 1: Cancer and Contending Forms of Morality 17
Chapter 2: The Evolving Moral World of Langzhong 51
Conclusion 258
Appendix 1: Questionnaire (English Translation) 267
Appendix 2: List of Pesticides Used in Langzhong and
Their Health Effects 269
Notes 273
References 285
Index 313
Acknowledgments
I was born and raised in a context where those who annoy us can be
jokingly told to “go to China” (ma va’ in Cina!), much the same way as
in the English language we may be told to get lost. China was a place of
the imagination, a remote place where we symbolically send those we
do not care to see again. My native region, the so-called third Italy, is a
previously poor rural area made relatively wealthy by local textile indus-
tries (most notably Benetton) since the mid-twentieth century. Many of
these industries are now following that local dictum and being relocated
en masse to China—a country that is no longer confined to the imagi-
nation, but a real place where products and money are made. Having
been sarcastically urged to visit China a fair few times in my teenage
years, I eventually followed the advice. My experience in China has
made me look at the small mountain village where I was raised in a dif-
ferent light, more aware of how farming affected the landscape and of
the journeys many took (and still take) in search for work.
When I first settled in rural China for my doctoral research, I felt
that the place I had moved to was real enough but also very remote
from anything I had experienced before. The local Sichuanese accent
sounded nothing like the Mandarin I had learned for three years.
Adapting took a concerted effort. But that I succeeded in doing so is
owed to all those local people who overcame their initial suspicions—
Did I suffer from anything contagious? Was I going to eat their food?
Could I really be trusted to harvest rice? And above all, Why had I come
all this way just to live with them?—and welcomed me into their lives.
The first thanks are for my extended host family, in particular my “sec-
ond sister” Erjie, my Ganma and Gandie, my gan haizi, and all the other
local families who shared their time, food, and life experiences with me.
I do not name them, but I trust they all know who they are. Guo Lin, the
first to welcome me and to show unfailing support, has been a reliable
source of humor, and without him I would not have gained the respect
x Acknowledgments
and friendship I have in the lower reaches of Baoma. His mother and
the rest of his family were the best family I could hope for.
Many local officials made my time in rural Langzhong possible. In
particular, I wish to thank the Baoma village party secretary, the former
township party secretary, and the former vice mayor of Langzhong, Wang
Meng. My city friends were few at first, and remain so, but they were always
ready to help—whether I was trying to print photographs, find a lift into
town, or get the local water tested, or craved steamed pig tails. “The doc-
tors” (despite the fact that only one of them really is a doctor) embraced
me within their ranks and addressed me as Doctor An (An yisheng), before
they upgraded me to “Comrade.” Much of what I have achieved would
have been impossible without the help of Comrade Qing: he provided an
invaluable bridge between villagers and the city hospital, which he carried
on after my departure, often insisting on paying for villagers’ checkups
and treatment out of his own pocket. Comrade Qing, Doctor Zeng, and
Brother Xiao have also been wonderful karaoke companions whose frank
judgment on my singing skills I have dreaded on all of my return visits.
Dr. Zhao and Dr. Tu provided a diversion from village diet and some
invaluable help to villagers. Lizzy’s company was a welcome break from
the daily grind. Guo Song, Teacher Xu, and their families are recently
acquired friends but of the kind one always hopes to find.
Contacts at Chuanda have been foundational to the success of my
research. Zheng Li introduced me to my supervisor Professor Chen
Changwen, initiated me to Sichuan food, and welcomed me warmly
into her family. Professor Chen’s contacts in Langzhong made fieldwork
possible, and Professor Hu’s kindness and medical expertise came to my
aid during some difficult times. Zhang Xuemei, Yu Pengjie, Wang Bo,
Tong Xue, and Fu Jing all offered valuable help at various stages of the
research. I am grateful to them all.
Gratitude is equally deserved by those who helped guowai, out-
side China. Elisabeth Hsu at Oxford has been an unfailing source of
knowledge and support. Pam Leonard made my fieldwork possible, set-
ting me up with the initial contacts, welcoming me at my arrival, and
offering occasional solace in Ya’an from the confusion of fieldwork. Kit
Davis, Ian Harper, Paru Raman, and Stuart Thompson at the School
of Oriental and African Studies are teachers who have inspired me to
pursue my anthropological aspirations and provided tools for thinking
about cultures and society critically early on in my training. Vivienne Lo
Acknowledgments xi
The Places
Langzhong city Nearest city to the field site and county seat
Baoma Main field site and the anthropologist’s village of
residence, six kilometers from Langzhong city
Meishan Junhong and Lili’s natal village, twelve kilometers
from Langzhong city
Xicun Erjie’s natal village and village of residence of
Gandie, Ganma, and Erjie’s three brothers
The People
Gandie’s Family
Gandie The father, sixty-two in 2004, former
brigade accountant from the late 1960s until
decollectivization; diagnosed with esophagus cancer
in October 2004, died in February 2005
Ganma The mother, sixty in 2004, devout Christian
Dage Eldest son of Gandie and Ganma, full-time farmer
Dasao Dage’s wife, full-time farmer, occasionally working
in a cow slaughterhouse in Xicun and in charge of
caring for her granddaughter
Guofu Dasao and Dage’s son (twenty-two in 2004), worked
in Shenzhen, wanted to divorce against his parents’
will; did not return home for his grandfather’s funeral
Yumei Guofu’s daughter (born 2002), Gandie and
Ganma’s great-granddaughter
Erge Second son of Gandie and Ganma, worked in a pig
slaughterhouse in the township, devout Christian
Ersao Erge’s wife, worked as an attendant in a hotel in the
city, devout Christian
xiv Guide to Key Places and People
Erjie’s Family
Taoge Erjie’s husband, worked as a carpenter in
Langzhong city, thirty-seven in 2004
Lida Twelve-year-old daughter of Erjie and Taoge
Uncle Tao Taoge’s father and Erjie’s father-in-law
Aunt Tian Taoge’s mother and Erjie’s mother-in-law
Although the building itself was derelict, the living room/bedroom fea-
tured a DVD player and a karaoke system. Until a couple of years ear-
lier, Aunt Zhang explained, they were not doing badly financially. Since
then, however, her son had undergone surgery and taken medication
for nasal cancer, which had exhausted all of their savings. “This fam-
ily is in great difficulty,” she sighed. Her husband sat in the corner in
silence. I smiled and, guessing he may have been roughly my father’s
age, acknowledged him as “Uncle,” adding the typical greeting, “Have
you eaten?” As it turned out, this was a highly topical question. Aunt
Zhang replied for him: “He is an ill man” (ta shi ge bing ren). Uncle Wang
had recently been diagnosed with stomach cancer, and his appetite had
already begun to decrease. Four months later, in November 2004, thin,
weak, and unable to eat, he ended his life in the most common and
speedy way available to villagers: drinking pesticide.
above, had just been diagnosed in June 2004 with stomach cancer and
died in November. In October 2004, my host Erjie’s father, Gandie,
who would posthumously become my “dry father,” was diagnosed
with esophagus cancer and died the following February.3 Baoma’s for-
mer barefoot doctor turned village doctor could list over thirty people,
including his own parents, who had died of cancer in the past twenty
years. I counted eleven from 2003 to 2007 among Baoma’s five hundred
or so residents. In a neighboring village unit (dui or zu) of eighty resi-
dents I call Meishan, nine died of cancer during the same time span.
Already a decade ago, researchers stated that cancer deaths “have
doubled since the 1970s, and are now the leading causes of mortality in
rural China” (Wu et al. 1999, 252). More recently, a World Bank report
assessing the cost of pollution in China again identified cancer as the
main cause of death in China, showing also that mortality rates for
cancers associated with water pollution, such as liver and stomach can-
cer, are well above the world average (2007, 45). Reports about “cancer
villages” in China have appeared with increasing frequency in Chinese
and Western media. All these accounts outline a strong connection
between economic growth, pollution, and cancer.4 Cancer villages are
the result of economic progress, leading to the proliferation of chemical
factories, causing death in villages such as Xiditou and Liukuaizhuang,
near Tianjin in northern China. In an article for the Telegraph (UK),
Richard Spencer wrote, “As the effects of economic reforms rippled
through the 1980s, local governments eagerly built new factories but
had little experience of environmental controls” (2006).5 In most cases,
the continuing misery is attributed to official corruption, which poses
an obstacle to implementing environmental regulations. For instance,
an article examining three cancer villages (in Shandong, Jiangsu, and
Zhejiang) published in Nanfang Wang (2007) as part of a report on water
pollution documents how villagers’ attempts at seeking redress failed
due to insufficient evidence or through uncooperative officials bribed
by polluting industries.6 But how do people experience and understand
cancer in areas where there is no agreement on its cause? Who or what
do they blame? How do they cope with its onset?
The aim of this book is not to debate the existence of cancer vil-
lages or to identify my research location as one. Insofar as Langzhong
has been recognized since the 1980s as an area with a high rate of can-
cer and that industry then and now has been minimal, local settlements
4 Introduction
and moral economy and morality in China. Chapter 2 presents the eth-
nographic setting and provides a historical contextualization of village
life to outline what is at stake for villagers in the contemporary period
as compared to their past experiences and to those of their neighbors.
Part 2 includes three chapters on how villagers make sense of
cancer. Chapter 3 begins to explore the relationship between cancer
etiology and morality. It examines why water pollution, while it was
regarded as a cause of cancer by some, did not appeal to locals more
broadly. I argue that the emphasis instead on hard work, farm chemi-
cals, and contaminated food made more sense to locals, offering the
grounds for a shared moral subjectivity based on past experiences but
also engaging with and commenting critically on the present. Chapter 4
continues the inquiry into cancer and morality by focusing on how an
alternative etiology—anger and anxiety—accrues efficacy. Such nega-
tive emotions, while providing an explanation of why particular indi-
viduals develop cancer, allow ambiguity over who is ultimately blamed
for it, thereby articulating contrasting values and practices. Chapter 5
examines how various etiologies are adopted in the case of Gandie.
Focusing on one case from its inception to well after the sufferer’s death
allows a better understanding of how cancer may be attributed to differ-
ent causes throughout its development and why it may be so. Past expe-
riences coalesce with the new experiences created by illness to form new
parameters of health. As in the previous chapters, this chapter shows
that resort to any etiology is made when it is morally feasible.
While part 2 already indexes some of the ways in which beliefs on
etiology influence paths of healing, part 3 moves more clearly into the
realm of healing practices. Taking on a fuller discussion of family rela-
tions, chapter 6 remains focused on Gandie and his family and compares
it to Uncle Wang’s case to provide a detailed account of the mutually
productive connection between family relations and practices of care.
It offers a sense of the costs—financial and emotional—precipitated by
cancer. Chapter 7 unpacks Gandie’s rejection of surgery by reflecting
on how perceptions of surgery for cancer as inefficacious are socially,
culturally, and historically produced. I argue that his rejection of sur-
gery embodies a moral response to the commodification of healthcare
and as such constitutes an active engagement not only with the healing
process but also with values of the Maoist past and the reformist present.
Finally, chapter 8 concludes my account of Gandie and Uncle Wang by
8 Introduction
turning to the interplay between the spirit world and perceptions of ill-
ness, healing, and mourning. It shows that different religious allegiances
produce different attitudes to healing and mourning, and these pres-
ent occasions for disagreements. Conflicts ongoing after Gandie’s death
highlight the role of ritual practices in producing family and social rela-
tions and in turn in producing contending modes of morality.
her home. While officials insisted this would be a unique opportunity for
her daughter Lida to learn English and live with an educated foreigner
from a “famous university,” Erjie felt Lida—nicknamed “iron mouth”
for her fierce and nondeferential comments—would be too undisci-
plined to make much of this opportunity. Still, the offer was attractive:
we promised we would set up a phone line and pay 500 yuan10 per
person per month for rent and food. This allowed Erjie to remain home
instead of looking for menial work in Langzhong and was a very good
deal in local terms. Still unsure that my presence really was legal, Erjie
requested a copy of the photograph my assistant took of myself with
a host of village, township, and city officials as a guarantee in what she
predicted as the likely event that my presence would raise suspicion.
Over the course of the coming months, Erjie later explained, she
concluded that I was not ill or contagious after all: I was energetic, had a
good appetite, and did eat what she cooked. My relaxed attitude toward
Erjie’s food, however, attracted much gossip and a great deal of envy
amongst her neighbors. At first, and in some cases throughout, Erjie
was heavily critiqued by locals for being “stingy” (xiaoqi), money-grab-
bing (xiang qian), and feeding me simple ( jianpu) food. Villagers also often
used a Sichuanese expression to describe her attitude: jigu. In standard
Mandarin, jigu means to whisper, but in Sichuanese its meaning is closer
to baoyuan—that is, to grumble or complain; it can also mean stingy, the
correspondent of linse in standard Chinese. They accused Erjie of not
caring for me properly, of charging me too much, and a few suggested
that I should move to their family, who would feed me better and charge
less. Also, as her mother predicted, Erjie’s daughter was routinely rude
to me. Endowed with resilient sarcasm, she often suggested that if I was
unhappy about anything I should just leave. Having been my first gan
haizi, Lida despised me for having accepted more gan haizi and having to
share my attention with other children. It took me longer than perhaps
it should have to analytically metabolize these exchanges not only as
evidence that I was not wanted but as one way in which locals posi-
tioned themselves vis-à-vis their neighbors and articulated parameters
of moral behavior.11 Caught at the very center of the process, I was
confused and hurt.
Criticisms of Erjie also came from more official channels. Township
and city cadres routinely visited me and accused her of not keeping
her kitchen suitably clean, adding degrading comments about how one
Introduction 11
could possibly bear to relieve him/herself in the pigsty. (The pigsty is, of
course, where every local family’s toilet, without exception, is located.)
If criticisms by fellow villagers were sometimes hard to objectify as local
power and status games, those waged by cadres were transparent efforts
to undermine Erjie and present their own lives as cleaner and more
cultured, typical of an urban and official superiority complex. As we
shared jokes about cadres’ inappropriate probing into her family home
and their air of snobbery, Erjie realized I did not share their derogatory
view of her and her home. This slowly reinforced our relationship. The
most definitive step toward consolidating it came as I regularly joined
her in visiting her father after he was diagnosed with esophagus cancer
in October 2004. By fostering the sense that I was loyal to Erjie, this
dissipated villagers’ attempts to persuade me to move out of her family
home and into theirs.
By the time the graduate student who had lived with me for the
first two months left in mid-August 2004, my relationships with my
most immediate neighbors had become fairly solid. Villagers in units
further afield were a different matter entirely, however, still baffled by
my suggestion that I wanted to learn about their daily lives. What, they
mused, could I possibly learn from uneducated villagers? It did not help
that Jinghua, the young laid-off worker assigned by the township Public
Security Bureau to “accompany me” after the student’s departure, made
no mystery of her disdain for villagers. She spent much of her time lec-
turing them and the rest absorbed in her mobile phone, unwilling to
answer their questions and rarely acknowledging them with a greeting
or even a glance. A little over a month later, having ostracized most
villagers she talked to, I explained to Jinghua and to the PSB that my
university required I carry out research alone. As I had spent over three
months in the village by this stage, the PSB accepted that villagers were
familiar enough with me to ensure I was “safe.” Catastrophic as I feared
Jinghua’s presence to have been, it paradoxically strengthened my rela-
tionship with villagers. I earned their respect for refusing the company
of someone who ignored them at best and offended them at worst. In
return, villagers confronted visiting officials investigating my work with
a unanimous “she is a good person.” Eventually, they stopped coming.
This meant that apart from the initial period when I was accompanied
by the graduate student (mid-June to mid-August 2004) and by Jinghua
(mid-August to mid-September 2004), I was able to work on my own.
12 Introduction
three weeks. This, however, mainly elicited standard answers and con-
firmed the efficacy of long-term participant observation or “experienc-
ing life” for gaining insights into local knowledge and practices.
Throughout the volume, I have employed kinship terms—such as
Uncle Xu or Grandma Yang—to refer to villagers. I use first names for
those of the same generation as myself and to whom I was close and
surnames followed by kinship terms according to generation in relation
to me (for instance, “Aunt” for women of my mother’s generation) for
those older than me and to whom my I was less close. Most notably,
I refer to my host as Erjie (second elder sister) and to her parents as
Gandie and Ganma (literally “dry” father and “dry” mother), as I did
during fieldwork. This is not intended to naively present myself as a part
of one local family and of the village community more widely. Rather,
I have done so to make my positionality in the village clear and to high-
light the relational nature not only of the data collected but also of
locals’ identities. More crucially, turning those I have learned to address
as older sister, uncle, or grandmother into “Mr.” and “Mrs.” would feel
rather odd and disrespectful. Learning to address locals appropriately
was a vital part of the long process of being accepted by the local com-
munity. Using these terms of address offered an important means to
express and foster respect and familiarity. Retaining kinship terms in
the monograph may be a cultural mistranslation. Yet the process of
defamiliarization and objectification entailed by referring to informants
as Mr .and Mrs. would, I fear, have the much worse effect of denying
or masking relationships that are central not only to this study but also
to my relationships and sense of commitment since fieldwork. If, as this
book argues, relationships are produced through daily practices, among
which addressing villagers through kinship terms is essential, then con-
tinuing with this practice is not only academically sound because it con-
veys a sense of the relationships fostered during fieldwork but is also
respectful to those who have shared their lives with me.
Part 1
Foundations
Chapter 1
The worst thing about esophagus cancer is you can’t eat, not even
drink, you feel dry, you want to drink but you can’t. I know, my mum
and dad died of it, too. And having an operation has only limited
temporary effects; you’re left without any flesh. It’s the worst; with
other kinds of cancer you can still eat, even with stomach cancer—the
food comes out in half an hour, but at least you can eat. And the people
who die of it, they are not that old, they are healthy people, who never
had to take many medicines. There’s just no way to know it’s coming;
it feels like a sore throat at first, and then when you start wondering, it’s
far too late.
—Doctor Wang, village doctor, July 15, 2005
living costs were lower and with urbanites who have fared much more
favorably during market reforms. Cancer is experienced as an extreme
embodiment of these routinized and recurrent forms of social suffering.
It may variously be attributed to suffering and hardship in the past (star-
vation, food shortage, hard physical labor, and humiliation during the
Cultural Revolution) or in the present (consumerism requiring the use
of farm chemicals or anxiety among women and their relatives caused
by their failure to preserve their marriage or produce a son), as well as
to habits such as smoking, drinking, or bad temper. The subtleties of
their experiences and of what is at stake for sufferers and their fami-
lies may only be conveyed through close ethnographic accounts of how
they make sense of cancer and cope with it. The expression “fighting for
breath” encapsulates these everyday struggles.
Scholarship on social suffering aims to “collapse old dichotomies—
for example, those that separate individual from social levels of analysis,
health from social problems, representations from experience, suffering
from intervention” to understand “how the forms of human suffering
can be at the same time collective and individual” (Kleinman, Das, and
Lock 1997b, x). As an illness, cancer affects individual bodies, but its com-
mon incidence in the locality and its fatality rate also make it a collective
matter of concern for the local community more broadly. “Suffering is
profoundly social in the sense that it helps constitute the social world”
(xxiv). Through experiences of cancer, family relations are negotiated,
reinforced, or undermined. Some family members embody care by
visiting the sufferer, offering transportation to the clinic by motorbike,
or offering culinary treats. Yet others manifest their care by becoming
migrant workers and therefore are able to offer better financial assistance
to the sufferer. In the process, all involved constitute a social world where
parameters of moral and caring practices are open to debate. Similar
contestations take place after death between those who wish to abide by
traditional customs and burn paper money and incense at the grave and
Christians who refuse to engage in such “backward” practices. Both par-
ties, of course, regard their actions as morally upright.
The ways in which cancer is understood also offer a commentary
on the past and the present, constituting a social and moral world where
hard physical labor is regarded with both pride and ambivalence, where
divorce is at once acceptable and pathological, where farm chemicals are
necessary but also harmful. These causalities make cancer meaningful
22 Foundations
have also imbued existing activities and values with new significance.
For instance, home-grown food has gained a new significance because
it endows villagers with more control over the chemical content of their
food. Reforms, in other words, have not caused a sense of complete loss
of context: villagers combine elements of the present and the past to
make sense of their lives; they combine the values of “eating bitterness”
and “energy” with a redefined value of “skills”—the value of farming
and the value of wage labor (see chapters 2 and 3). By attributing cancer
to hard work, they critique its necessity while also recognizing its value
as a caring practice of sufferers. Conversely, when they blame cancer
on the increase in farm chemicals, they also attack the moral economy
of which chemicals are part. But the enduring sense of starvation and
former food shortage as a cause of cancer also implies a critique of the
backward, deprived past.
meanings become prominent, who puts them forward, why, how they
originate, and what their effects are. The multiple meanings of AIDS
have different careers. While some—such as AIDS as rampantly con-
tagious—persist, others, such as seeing AIDS as a sign of the end of
the world, have lost currency (317–318). Triechler argues that people
frame the frightening new phenomenon of AIDS “within familiar nar-
ratives, at once investing it with meaning and suggesting the potential
for its control” (5). I suggest that similar processes are at play for can-
cer in Langzhong. Etiologies such as smoking and drinking, which in
a Western biomedical context may be taken as a way of blaming the
victim for cancer, do not operate in the same way in the Chinese con-
text. Matthew Kohrman (2007) has argued that because of smoking’s
centrality to articulating important interpersonal relations and gen-
dered notions of the good life, Chinese families do not blame sufferers
for smoking, even when they admit it may have played a part in caus-
ing cancer. This study suggests that smoking and drinking, like other
etiologies, are only adopted when they aid sufferers and their families
in “remaking a world” (Das et al. 2001) in the aftermath of cancer.
By being regarded as necessary parts of masculinity and social life and
therefore part of normalized habits, or xiguan, smoking and drinking
at once serve to explain cancer but also partly emancipate individuals
from blame for engaging in these activities.
Sontag endeavored to explain away the idea that cancer affects
those “incapable of expressing anger” (1991, 22) by pointing to its roots
in the value placed on expressing passions. She argued that Christianity
imposes “more moralised notions of disease” and “a closer fit between
disease and ‘victim’” (44). In this context, “psychological theories of ill-
ness [repressed emotions] are a powerful means of placing the blame
on the ill. Patients who are instructed that they have, unwittingly, caused
their disease are also being made to feel that they have deserved it”
(58). Rather than dismiss the link between repressed emotions and
cancer as a cultural artifact, a mythology, or a “fantasy” (23), I exam-
ine why this association has come into being and with what effects.
Repressed emotions are situated in a different social and moral universe
and articulate different webs of values in Langzhong than they do in
Sontag’s argument.
With approximately forty converts in Baoma alone (roughly 7 per-
cent of villagers), Christianity was not a new arrival. The presence of
28 Foundations
Christianity in the Langzhong area has been considerable since the end
of the nineteenth century. William Cassels, one of the “Cambridge
Seven” who set out to work as missionaries in western China in 1885,
settled in Langzhong (at that time called Pao-ning) in 1886. He estab-
lished a school, a hospital, and a number of churches, one of which is
still in working order and underwent some renovation in 2004–2005.2
During that period, mass was held there every week. The hospital is
also still open, though with the Communist victory in 1949 it became
the city’s “People’s Hospital.” Family churches (illegal meetings at vil-
lagers’ homes) were also widespread in rural Langzhong. There is no
evidence, however, that Christianity has reinforced an ethic of blaming
the victim for cancer as Sontag suggests. As chapter 4 shows, this eti-
ology is closely entangled with gendered expectations, which are both
resisted and internalized by those potentially blamed for cancer (see also
Gregg 2003).
Illness etiologies are also deeply connected to the economic reali-
ties within which they are situated. Sontag argued that the association
of tuberculosis with low energy, consumption, and wasting during the
Victorian era “echo[ed] the attitudes of early capitalist accumulation,”
fears of not having enough energy, and the necessity of regulated con-
sumption. By contrast, as “advanced capitalism requires expansion,
speculation, the creation of new needs,” cancer “evokes a different eco-
nomic catastrophe: that of unregulated, abnormal, incoherent growth”
(1991, 64).3
In her work on Bolivia, Libbet Crandon-Malamud explained that
until the 1950s the local population regarded an illness manifested
by the marks it left on the abdomen to be caused by the ghost of a
Franciscan monk who made holy oil by stealing fat from the kidneys of
people asleep while guarding their produce in the fields. Changes in the
identity of the ghost since the 1950s show that “the oppressive nature
of social relations between cultural grounds hasn’t changed on the alti-
plano; only the identity of the oppressors has changed.” Following the
rise of capitalist market relations, many Bolivians saw the “Alliance
for Progress,” an inter-American program of economic assistance cre-
ated in 1961, as “an attempt by US to practice genocide for imperialist
gain.” In this new model, the ghost was thought to be any Mestizo who
participated in the trade of human kidney fat “sold to factories in La
Paz who used it to make colored, perfumed luxury bath soap for export,
Cancer and Contending Forms of Morality 29
for tourists, and for the Bolivian elite.” This change is “a reflection of
Kachitu’s and Bolivian history,” where a new colonial-like power is seen
to be stealing local resources, and Mestizos who lost the power they held
before reforms in the 1950s are seen as taking part in exploitation to
mend their desperate financial situation. It reflects changes in the local
configurations of power and exploitation (1991, 120).
In Crandon-Malamud’s words, “Medical dialogue is an idiom
through which people express values” (31). In this book, attention to
medical ideologies and practices dealing with cancer provides particular
insights into the past and present social and cultural context in a rural
region and to emerging and coexisting moral economies. Stomach and
esophagus cancers—the main focus of this work and the most common
types of cancer in Langzhong—have until recently been understood
respectively as “vomiting illness” (huishi bing) and “choking or spitting ill-
ness” ( gengshi bing). We cannot establish how locals explained the spitting
and vomiting illness before cancer gained currency as an illness cate-
gory. Certainly at present, they state that those illnesses, common in the
past, were due to poor diet and to the physical strain of working long
hours on collective farms and infrastructural projects such as irrigation
pools. These causalities have also become associated with stomach and
esophagus cancer. In this semantic and experiential nexus, the ability to
eat and the ability to work (which depends upon being able to eat) are
taken as a sign of health. Conversely, when villagers’ energy, appetite,
and ability to eat decreased, they were suspected of having developed
cancer. Such suspicions were strongest in the cases of those seen to have
had a particularly strenuous life. When a woman in her sixties (the wife
of a barefoot vet) who was single-handedly farming all of her large fam-
ily’s allotment of land and caring for four grandchildren became weak
and unable to eat in 2008, villagers reasoned that she probably had can-
cer. Even when suspicions may have been disproved by the diagnosis of
heart disease, rumors that her family may simply be keeping the cancer
diagnosis a secret persisted.
These perceptions of cancer reinforce the correlation between can-
cer, inability to eat, and having engaged in strenuous physical work. That
past suffering is blamed for a fatal illness in the present also articulates
an implicit criticism of the past political and moral economy, a deep
ambivalence toward the need for physically demanding labor and poor
diet. During late reforms, villagers reflect on their historical experience
30 Foundations
and present the collective past as riddled by spitting and vomiting ill-
nesses, illnesses of inability to consume. In doing so, they also present
the past as a time characterized by a ban on consumption, demonized
as selfish. They critique its demands on productive bodies by attribut-
ing illness to poverty (lack of consumption) combined with the hard-
ships of production. They see cancer in the present as partly caused by
such suffering in the past. Cancer in the present, however, is not only
blamed on the past but also linked to present pathologies of consump-
tion. As we shall see in chapter 3, villagers perceive a strong causal link
between cancer and farm chemicals, which they associate with pres-
ent developments. In this sense, this cancer etiology also serves as a
critique of present consumerism. Where in Crandon-Malamud’s case
the theft of kidney fat moved from being blamed on a dead Franciscan
to being blamed on the new agents of capitalism and imperialism, no
simple chronology of causes of cancer is applicable in my case. In rural
Lanzhong, the shift in moral and political economy from collectivism to
market reforms may lead one to presume that cancer in the present is
ascribed to past failures and shortage, contrasted with an embracing of
current opportunities, consumerism, and prosperity. But villagers attrib-
uted faults to both periods; they were as ambivalent about demands on
their bodies in the past as they were of the price of development in the
present. The transition to a market economy has not erased alternative
ways to value life. The copresence of etiologies that attribute cancer
to excessive production and deficient consumption in the past but also
to excessive consumption in the present is telling of the coexistence of
moral economies.
Just as faults were attributed to both political and moral economies,
neither was fully denounced. Those who lived through collectivism are
proud of their ability to work hard even with a poor diet. Doing so ful-
filled the demands and ethos of the time, enabled individuals to support
their families, and made them an integral part of the local community.
The ability to engage in hard work remains a sign of health, especially
for the older generation. They compare their tolerance for physically
demanding work with the lack of energy of youth in the present. This
does not contradict the harmful potential of hard work. On the contrary,
the two are inseparable: it is because hard work is potentially harmful
that ability to engage in it without suffering any consequences is taken
as a sign of strength and well-being. Conversely, an excessive amount
Cancer and Contending Forms of Morality 31
of hard work and a particularly poor diet can precipitate cancer. Even
as they maintained the value of hard work in the present, nobody in
the village wished a return to the past, and most praised the improve-
ments in living standards in the present. The experience of cancer is
very much embedded in historical experiences of starvation and hard-
ship and present experiences of consumerism and development, as well
as in the moral universes elicited by other etiologies such as repressed
emotions, smoking, and drinking. At stake in these causalities is not only
physical health but the ability to reclaim a moral life.
to cancer that are small-scale socially speaking, but they are no less
unsettling and challenging and also intimately tied to wider socioeco-
nomic conditions. A closer understanding of these microprocesses and
of health care within the home is inextricable from the macro setting
and is intended to enhance the understanding of wider social processes
at play within local settings.
The importance of a study of sufferers was emphasized almost three
decades ago by Arthur Kleinman, a psychiatrist and anthropologist who
has carried out extensive research in Taiwan and China. Understanding
sufferers’ practices becomes all the more crucial given the current state
of health care provision. Access to health care for villagers presents an
ever-taxing issue—one that both is hotly debated by villagers and to
which the state has recently turned its attention. As I will explain in
more depth in chapters 6 and 7, social and economic reforms since
the early 1980s entailed a radical shift toward the commodification of
health care, which affected health services in a variety of ways. The
available health care options have multiplied, but the cost of medication
and treatment has risen rapidly, and although some insurance coverage
for Langzhong villagers has been restored since 2006 in the form of the
new rural cooperative medical system (RCMS), this mostly covers inpa-
tient care and only reimburses a percentage of expenditure. Jing Shao
(2006) argued that it is these conditions—medical institutions in need of
raising their own revenue and poor villagers who face extreme uncer-
tainty in terms of income and whose agricultural labor has declined in
value—that underlie the “plasma economy,” whereby villagers in Henan
sold blood and contracted HIV. Similarly for Kathleen Erwin (2006), the
socioeconomic relations of “donating” blood are premised on an econ-
omy of poverty, exploitation, and inequality (see Farmer 1999), much
resembling the one examined in work on the trade of human organs
and the commodification of the body (Cohen 1999; Scheper-Hughes
2000; Scheper-Hughes and Wacquant 2002). In this context, it becomes
even more vital to examine how laypeople themselves understand ill-
ness and how they deal with it. In many cases, home-based care is all
that the family may be able and willing to afford. Some studies have
begun to examine medical intervention alongside other daily practices
of illness prevention and health maintenance (N. Chen 2003; Farquhar
2002; Farquhar and Zhang 2005; Frank 2006; Jing 2000; Kohrman
2005; White 1993).
36 Foundations
In the Naxi case, women were seen to suffer the most, befitting gen-
dered parameters of status and achievement: for women, sacrifice for
the family through hard work; for men, fame won through competition.
Accordingly, while women’s afflictions are linked to production, men’s
are linked to the consumption of alcohol and tobacco, so central to
their social lives. In rural Langzhong, as predominantly men (and some
elderly women) smoke and drink alcohol, the gendered division identi-
fied by White applies equally. In the case of hard work however, it does
not: physical strain is seen to characterize both men’s and women’s lives,
and accordingly, cancer is commonly traced to hard work for men and
women alike. By identifying labor as a cancer etiology, villagers articu-
late a moral economy in which physical labor, precisely because of its
potential harm, remains a valued way for individuals to care for their
families. Conversely, this etiology also expresses a deep ambivalence
toward these forms of labor, especially when villagers are aware of the
much less physically demanding ways to earn money available to at least
some urban dwellers.
south China village, Sulamith and Jack Potter rejected the applicabil-
ity of the concept of moral economy to reform China for two reasons:
first because “resentment at the success of others is morally legitimate”
and second because villagers take extraordinary economic risks, contra
Scott’s suggestion that they are unwilling to do so and seek to main-
tain a subsistence ethic (1990, 339). On the first point, I would suggest
that resentment toward those who fared better through market oppor-
tunities and liberalization—in particular urban dwellers and officials—
constitutes a moral economy to the extent that it is premised on a set
of principles of fairness and equality. On the second point, villagers in
Baoma did take economic risks—from breeding animals (and risking
their death) and migrating in search of work (and potentially facing
irregular wages) to setting up small businesses and taking loans to build
houses. But they also endeavored to minimize the risk of having no
funds to feed themselves by continuing to farm the land. This resulted
in an emergent moral economy that values market opportunities to face
high costs of health care and education, but it also encourages subsis-
tence farming as a guarantee of security. In response to both points, I
argue that the reformist present has seen a shift in definitions of moral
economy but not its demise. This is consistent with the current trend to
redefine “moral economy” as not only pertinent to premarket societies
but also as a characteristic of all economic systems (Booth 1994).
If Liu and the Potters saw the present as lacking in moral economy,
Chris Hann (2009) described reforms as a return to it. According to
Hann, political coercion and excesses in the redistributive mode during
the collective years resulted in a socially disembedded economy. In this
model, collectivism played the role that Polanyi attributed to the mar-
ket. Conversely, market reforms posed as a state-led form of Polanyi’s
countermovement to reestablish a moral economy. They produced an
embedded form of socialism that gave a new lease on life to subsistence
and kin relations. While I agree that a moral economy is present during
the reforms, I would not deny its existence (albeit in a different form)
during collectivism. During collectives, as we shall see, local officials at
once heeded to state demands for equality and redistribution but also
tried to protect the local community (Shue 1988). Communism did
not eradicate preexisting social relations but rather was inscribed upon
them (Potter and Potter 1990). Just as importantly, memories of the past
play an ambivalent role in contestations around moral economy. For
Cancer and Contending Forms of Morality 41
1960s and 1970s to provide health care, however basic, were cherished
against a money-oriented present. In this context, rather than resign
themselves to a failed morality and lack of state support, families recre-
ate a moral universe by mobilizing resources to care for ill relatives.
and Sex in Post-Socialist China, Judith Farquhar argues that the transfor-
mation from the ethics of serving the people to the reformist empha-
sis on consumerism occurred gradually. Experiences and memories of
collectivism intersect with the “neoliberal environment of the Chinese
free market” in people’s search for health (2002, 287). In this light, it
would be unrealistic to characterize an individualist immoral present as
opposed to a collectivist moral past. A more complex relationship with
both past and present is at play. The present is partly judged through the
prism of the past, but villagers also constantly strive to recreate a moral
universe to make sense of their present. This study shows how morality
was rebuilt through negotiations about family economy, securing health,
and fighting illness.
Madsen outlined some clear ambiguities in moral discourses
in Chen village. He suggested that “traditional village morality con-
sisted not of a tight system of norms that the peasants followed out
of blind habit but of a tangle of notions that were handed down from
the past . . . but were constantly being woven by . . . villagers to fit the
new situations in the present” (1984, 8). The same process, I argue,
is at play in the late reform present. For Madsen, villagers are moral
philosophers, but they are also practical philosophers: their morality is
articulated not in abstract terms but through their daily practices, “dra-
matic gestures,” “aphorisms,” “invectives,” gossip, and public meetings
(1–2; see also Ku 2003). While Madsen focused on moral discourses sur-
rounding village officials, Ellen Oxfeld in her new book examines how
inhabitants of Hakka village Moonshadow Pond in south China artic-
ulate moral discourses surrounding their family lives, social relations,
and obligations (2010). Momentous changes in China’s social, political,
and economic realities have entailed changes in moral discourse, but
this has not meant that previous models were abandoned. Rather, they
intersected: Cultural Revolution struggles against “class enemies” chan-
neled preexisting loyalties and antipathies between families. Likewise, in
the contemporary setting, villagers in Moonshadow Pond “may draw
upon ideas from the old society, the collective era, and the present in
justifying their own actions or criticizing others” (23). While they may
“not agree on what obligates them”—family loyalties, collective ide-
als, and so forth—“they do seem to agree on the concept of obliga-
tion itself, and on the ultimate responsibility of individuals in fulfilling
their moral debts” (51). For Oxfeld, however, morality is not just about
Cancer and Contending Forms of Morality 49
Conclusion
Bodily attitudes and experiences are always situated within particu-
lar contexts: they shape those contexts while being shaped by them.
Their complexity and materiality present a challenge to anthropological
analysis that scholars should not so much aim to overcome but rather
to discuss without oversimplification or abstraction by ideal models. If
this ethnography can convey at least some of those complexities and
allow some of the contradictions and challenges facing Chinese farm-
ers to become apparent, it will offer a ground for understanding how
macroprocesses are rooted in bodies that strive for well-being as they
also mould its boundaries. Writing on illness is never an easy undertak-
ing. Unveiling and unpacking suffering has to be done responsibly. By
being attentive to aspects of concern for villagers, I hope to provide
an account sensitive not only to the cultural and social specificities of
cancer etiology and strategies of its management but also to the lived
experience of cancer in contemporary rural China.
Chapter 2
Figure 2.2
Langzhong’s “old” and
“new” city.
54 Foundations
Chan, Unger, and Madsen 1992). Most Baoma villagers, however, did
not feel that this campaign had much impact on them. The village
hosted some rusticated youths. Aunt Zhang recalled, for example, that
their courtyard house was shared with some of these young men and
women. But they spent only a few months in the village, which, due to
its relative proximity to the city, was a destination reserved for those
with good connections. Villagers were divided into the “yellow faction”
of former landlords and rightists and the “red faction” of revolutionary
poor peasants. But, they claimed, they did not openly fight each other
as their counterparts in the city, where gunshots and explosions were so
loud they could be heard as far as Baoma.
Perhaps the Cultural Revolution was not vividly remembered
because its effects were not significant compared to those it had in the
city or to those that the Great Leap had on them a few years earlier.
It may also be that the wounds inflicted on village relations were still
too deep to be openly discussed, with perpetrators unwilling to admit
to their actions, victims too traumatized to share their tales, and the
line between them unclear in at least some cases. With sustained scru-
tiny from the town officials, I never felt I was in a safe enough posi-
tion to ask openly about sensitive historical periods, especially when my
research interests did not vitally depend on them. Only one couple in
their fifties—the son of a former landlord and his wife, the daughter of
a missionary executed in 1951—briefly discussed their ordeals. She told
me: “You might be standing here talking, and people could walk by and
accuse you, just because they didn’t like you. So many skilled people ( you
benshi de ren) were beaten and killed in the city” ( July 2006). Her husband
nodded as she explained his family had come under attack for being for-
mer landlords. Twice she volunteered an account of her father’s death
and later trials. Both times she became tearful and quickly resolved to
avoid the topic. I felt it best to respect her wishes.
The other prominent landlord family was that of the laozhongyi, or
“old/respected Chinese doctor,” who learned his trade from his father.
He died of leukemia just as I settled into Baoma, however, and I never
had the opportunity to meet him. One of the former village primary
schoolteachers suggested that the doctor developed leukemia as a result
of distress caused by being attacked during the Cultural Revolution
because his father was a local landlord. Arthur Kleinman’s seminal
work The Social Origins of Distress and Disease (1986) bears testimony to the
The Evolving Moral World of Langzhong 57
remained the same, and villagers still use the Maoist terms. As the price
of grain was allowed to rise and farmers could cultivate cash crops and
sell them in the markets, incomes rose accordingly. In the early 1980s,
many villagers had enough funds for new brick-built houses. A few
families set up small enterprises and were able to afford to build a two-
story house in the village. As the loosening of the household registration
system made migration possible, some started to travel away from the
village and from Langzhong in search of paid work.4
By comparison to their neighbors, some villagers did indeed “get
rich first,” whether through remittances from migrant sons and daugh-
ters or through small local enterprises. Gains were, however, short lived.
While incomes rose rapidly in the early 1980s, by the end of the decade
the rising prices and inflation eroded whatever gains villagers had man-
aged to accumulate and caused many local enterprises to go bankrupt.
As they reflected upon this transition in 2004–2005, villagers did not
nostalgically recall collectives, nor did they wish a return to them. But
finding themselves in a volatile and unequal market economy, they bit-
terly complained about inequalities in the present. Similarly, not all vil-
lages faired equally. Some villages, like Erjie’s natal village of Xicun,
sold their collectively owned machinery and animals to villagers and
used the earnings to invest in infrastructure for the village. As a con-
sequence, Xicun was provided with electricity by the early 1980s. In
Baoma, by contrast, earnings from collective goods were largely pock-
eted by village cadres. Erjie mused that when she married into “back-
ward” Baoma, she felt she had gone back in time by ten years and had
to wait until the early 1990s to have electricity in her home. As inequali-
ties grew under Deng—within villages, between urban and rural areas,
and between regions—and became once more ideologically acceptable,
it was as if the collectivist ideal had been all but forgotten (see Chan,
Unger, and Madsen 1992).
To a large extent, farmers have always been self-reliant. Even dur-
ing Mao, collectives offered a local guarantee, but they did not benefit
from any help from higher levels. During Deng, however, self-reliance
became even more important, as the cost of living grew, and costs of
schooling and health care beyond the basic primary care at the village
level escalated. These circumstances gave rise to a renewed impor-
tance of family networks and nonkin guanxi (relationships) as alternative
sources of support to face these soaring costs.5 At the same time, family
60 Foundations
wealth, which made such corruption all the more conspicuous. They
referred to this as cadres “eating village money.” This describes the lav-
ish banquets cadres threw to boost their political capital, but it could
also be extended to their investment in housing and “doing business”
(zuo shengyi). Villagers reasoned: How can cadres afford such houses and
set up businesses if their official salary is only a few hundred yuan per
month? Likewise, where does so much money collected go, when none
is invested in the village?
Numerous ethnographies have highlighted how corruption has
become endemic to village life (Chan, Unger, and Madsen 1992; Ku
2003; X. Liu 2000; O’Brien and Li 2006; Y. Yan 2003). Hok Bun Ku
(2003) argued that when villagers feel that the state has failed to fulfill its
obligations toward them—such as protecting their welfare—resistance
becomes legitimate. Similarly, Kevin O’Brien and Lianjiang Li (2006)
have described a rising tide of “rightful resistance” in rural China:
villagers use the rhetoric of the central government to condemn mis-
conduct by local cadres. When this is the case, the central government
may not only avoid being held accountable but also be strengthened in
the process (Perry 2007). This, however, was not the case in villagers’
complaints during Jiang and in its immediate aftermath. Villagers may
initially assert the well-known dictum “above there are policies, below
there are countermeasures,” which implies local corruption and mis-
conduct. But they also soon concluded that “all birds under Heaven are
black,” suggesting that officials at all levels are corrupt. Legitimacy, for
both local and central state, reached a seriously low point.
Village Economy
On average, villagers had over 9 fen (600 square meters) of land, divided
between paddy land (tian) and dry land on the hillside (di). Additionally,
each person was entitled to 30 square meters for dwelling, and a fam-
ily of three usually had about 120 square meters (including 30 for a
courtyard). According to the village secretary ( July 29, 2004), the grain
and other produce derived from land allocation was typically enough
to feed family members. Participant observation also showed this to be
the case. Villagers occasionally bought vegetables and meat from the
town or city market but did not need to purchase rice, corn, wheat,
or rapeseed oil, locally used for cooking. Rice and rapeseed rotate on
the paddy fields. In late March, rice is planted either on small watered
allotments or on a restricted area of paddy land. At this time, rapeseed
plants occupy the paddy fields. In late April and early May, rapeseed is
harvested. In early June, rice is transplanted by hand to the paddy fields.
Paddy fields are planted with rice from June to the end of August. Rice
is harvested in late August and early September. After the harvest, fields
are cleared and ploughed (using buffalo collectively owned by a few
families) in preparation for rapeseed, which is first planted on hillside
land in October and transplanted to the paddies in December.
Maize is planted on hillside land in February and harvested in
August. It is mostly used as animal fodder but occasionally cooked with
watery rice and consumed for breakfast or lunch. Wheat, used to pro-
duce noodles for family consumption, is planted on dry land allotments
64 Foundations
Figure 2.4 Erjie, Erge, Dajie, and the anthropologist helping to transplant rice
for Erge’s family (2005).
villages along the main road toward Langzhong city attract city dwellers
for the peach blossom festival, in March–April, and enterprising locals
set up small tents and seats in the orchards, offering tea for a few yuan.
In 2005, nonresidents had to pay 2 yuan to enter the area. By employ-
ing land to grow fruit trees, farmers were partly unable to grow veg-
etables and grains on the hillside land. According to national-level laws,
the local government was required to provide farmers who took part
in the scheme with 150 kilograms of grains per mu and with 20 yuan
worth of farm chemicals per year per person for the first five years (con-
firmed by informal conversation with host family on January 25, 2005).
Compensation was erratic, however, and virtually absent since 2004, as
the village secretary claimed that he had diverted the money that would
be spent on reforestation compensation toward the costs of building the
village road. Villagers had already been billed 400 yuan each for two
years toward road building and complained fiercely about these costs.
As a consequence, many continued to farm wheat and corn underneath
fruit trees.
Alongside the sale of vegetables and fruit, families could derive
some income from animal breeding. Families usually bred two pigs—
one to be sold, the other for their own consumption.8 Some families also
derived variable income from breeding chickens or ducks.9 This created
economic differentiation between families. Family members’ ability to
secure off-farm jobs, however, had a much more substantial impact on
their income. According to official township records, the standard per
capita income in Baoma in 2003 was 2,300 yuan, which scores aver-
age within the township and higher that the average for the county. As
figure 2.5 shows, however, this estimate is made artificially high by three
extremely wealthy families. Villagers maintained that families where
wage labor was absent had an average income of roughly 1,500 yuan
per year per family, mostly based on animal breeding.
In 2004, wage laborers working in the town or in the city (as build-
ers, carpenters, and restaurant or hotel attendants) earned between
15 and 30 yuan per day, depending on skills required. As these labor-
ers worked every day, they might be able to secure between 450 and
900 yuan per month and a yearly total income between 5,000 and over
10,000 yuan. This already illustrates the vast disparity (in local terms) in
income depending on the type of occupation. Migrant laborers work-
ing in south China, mostly in factories, could secure over 1,000 yuan
66 Foundations
Note: These are official statistics according to the village secretary ( July 29, 2004).
per month, and a young couple might be able to earn over 2,000 yuan
per month. Some of these higher incomes would, however, be absorbed
by the much higher living costs in these regions. While at home they
could mostly live on farm produce and needed to pay no rent, the cost
of food and rent required when working “outside” (that is, away from
one’s hometown) could severely impact on their ability to save, as did
the costs of their journey home. In a few cases, older men had a pension
of a few hundred yuan as former employees of state-owned enterprises
in Panzhihua, in southern Sichuan. Some were able to pass their jobs on
to one of their sons, though this had recently become impossible.
This resulted in a wide variety of family economies. In Uncle Wang
and Aunt Zhang’s case, a couple in their sixties farmed four people’s
allotment and cared for their ten-year-old granddaughter, while both
her parents worked in factories in Guangdong Province. Together, they
earned less than roughly 1,500 yuan per month, and they spent much of
this on their accommodation and food, sending all they could to cover
health care costs for Uncle Wang’s cancer. In my host family’s case, the
grandparents did not assist with farming or child care, Erjie farmed
three people’s allotment, and her husband, Taoge, earned 28 yuan per
day as a carpenter. In another case, Chunyan and her husband, both in
their late twenties and with a six-year-old child, employed skills learned
The Evolving Moral World of Langzhong 67
ancestor worship took place in the altar room, which was usually clut-
tered and used as storage for grains, farming tools, and empty coffins
kept in the eventuality of the death of a family member. Every family
kept at least one dog in their courtyard against thieves.
As the ubiquitous and threatening presence of the family dog sug-
gests, petty theft was rather common in the village, especially of chick-
ens, ducks, and fruit and vegetables from the fields. Usually, thieves were
said to be from nearby villages, but occasionally neighbors suspected
each other. In one case, the seventy-two-year-old man living in the
house adjacent to Erjie’s complained loudly in his courtyard about the
theft of some of his maize. This implied, Erjie opined, that he thought
the thief was within earshot, or else he would not have persisted in his
grumble for so long. Months later, two of her ducks died—poisoned, she
assumed. This sometimes happens when ducks eat grass that has been
heavily treated with farm chemicals. Nonetheless, she was convinced
that her neighbor poisoned her ducks in retaliation for their occasional
visits to his nearby stem lettuce allotment. She too stood in her court-
yard complaining loudly, so that he could hear her. These attitudes offer
some indication of a lack of mutual trust between even close neighbors.
They are often interwoven with complaints of the failure of morality
and corruption of the present society that families attempt to coun-
ter, whether by defending themselves with family dogs or by preaching
stridently and publicly about abuses of the fruits of their hard work—
whether they be apricots, chives, ducks, or rice cookers.
Villagers’ Expenses
According to an interview with the village secretary ( July 29, 2004),
semistructured interviews, informal conversations with villagers about
their own financial conditions and those of other villagers, and to my
experience of living in the village, the major family-related expenses per
household in 2004–2005 were as follows:
over how funds were used. They suggested that the village secretary had
pocketed most of the money. They were also convinced that payments
were unevenly distributed, with families closer to the village secretary
and village head able to pay less or not at all. Erjie explained that in
the 1990s, when the village secretary was from their village team, those
from the same team who shared the secretary’s surname were at an
advantage. Likewise, villagers stated that the present village secretary of
the Wang family and the village head of the Xu family benefited those
who shared their lineage, both by charging them less and by informing
them promptly of any benefits available. Complaining, villagers argued,
served no purpose as local cadres were more familiar with the rules and
were well connected to higher cadres. The only option was to refuse to
pay these fees, especially when the village secretary failed to distribute
compensation for reforestation, which locals were keenly aware they
were owed according to central state policy.
As figure 2.6 makes clear, although income may seem reasonably
high for a rural household, net income is still very low, even when wage
labor contributions are included. Given that for families without wage
earners the typical yearly income was estimated at around 1,500 yuan,
many of the costs become unsustainable, especially those of schooling,
health care, and various taxes and fees that used to be minimal (see
Flower and Leonard 2009).
of their children and their families in farming the land. However, with
most of the parents and young-adult generation (born in the 1970s and
1980s) having left the village in search of work in more developed areas
of southern China, grandparents were typically in charge of farming
all the family’s land and of caring for their grandchildren. The emerg-
ing picture, then, is not a simple nuclearization of families but one of
nuclear families continuing to depend on help from their siblings and,
most commonly, their parents.
The case of my host family illustrates how important this mutual
support could be to the emotional and economic life of families. A fam-
ily of average wealth in Baoma, it was composed of a couple in their
mid-thirties and their twelve-year-old daughter, Lida, who became my
“dry” child or gan haizi in July 2004. Lida’s father, Taoge, was the only
surviving son of Uncle Tao and Aunt Tian. Taoge’s grandfather was
in his early nineties when I moved to Baoma and died of old age in
December 2004. Uncle Tao and his wife had had two more sons, one
72 Foundations
of whom died as a child and the other who died of hepatitis in the
early 1990s. They also had a daughter who married a man from Baoma
and lived with him in a room in Langzhong city, where he worked as
a carpenter. Like most young couples, Taoge and his wife, Erjie, had
established an independent household, adjacent to Lida’s paternal
grandparents, when she was two years old, in 1994. Unlike other young
couples, however, both still lived in Baoma. Taoge worked in Langzhong
city as a carpenter for 28 yuan per day. Erjie did not engage in wage
labor; she farmed the family’s allotment and raised thirteen ducks and
two pigs. She was unable to leave Baoma in search for work because
Taoge’s parents demanded help with farming. Erjie also felt that Lida’s
grandparents would not be able to care for her properly. Lida refused
to eat her grandmother’s food, which she described as “not tasty” (bu
haochi), and complained that she could not sleep near them because her
grandfather exuded an overpowering smell of tobacco and alcohol (he
smoked a pipe and drank baijiu or “white liquor,” a strong rice spirit).
Erjie and Taoge could have decided that one of them (usually the
husband) should leave the village while the other cared for the farm
and their daughter. Erjie, however, was unwilling to allow her husband
to leave Langzhong alone, having witnessed many other couples’ rela-
tionships deteriorate or disintegrate altogether as a result of separation.
Indeed, divorce was rather common in Baoma. Often a newly married
couple would leave their young child, sometimes only a few months old,
with the paternal grandparents and set out in search of waged labor.
Sometimes they would go their separate ways and only be able to meet
again years later. In other cases, the husband left and the wife remained
in the village. By the time the couple reunited, one or both may have
found a new partner. While some of the current parents’ generation
argued that divorce was a legitimate response to a “disobedient” (read
adulterous) partner, many agreed with the older generation that divorce
should be avoided because of its detrimental emotional effects on the
child. Parents of divorced children also complained about the financial
repercussions, as the other party demanded financial compensation or
took some of the couple’s shared possessions.
While in more remote Langzhong villages some defied family plan-
ning policies, in Baoma a very strict one-child policy was enforced.
There were only four families with more than one child born after the
reforms: one with a pair of eight-year-old twin girls, one whose firstborn
The Evolving Moral World of Langzhong 73
had drowned, one whose first son had been blinded in an accident, and
the party secretary’s family. His was the only family to have exceeded
the one-child policy in order to secure a son after their first child was
a girl. All other cases were exempted from the one-child rule. Having
an extra child would otherwise incur a fine of 10,000 yuan—a sum vil-
lagers could ill afford. Accordingly, the traditional preference for sons,
which may have put families under pressure to have a second child
should the first be a girl, was less than pervasive. Grandparents may in
their time have made sure that they had a son, but charged with caring
for their grandchildren they argued that girls were preferable because
they are easier to control.11 Some young mothers with an only daughter,
like Erjie, also argued that women, provided they were good-looking
and had some skills, could find a good husband, whereas men needed
to have a decent family home and some wealth to be able to find a wife.
She also added that women care for their parents too, and not only
when they are only daughters. Indeed, Erjie and her husband visited
her parents regularly, at least once a month. Her natal home, a village I
call Xicun, was half an hour’s walk from Baoma, up and down the hill,
following narrow paths through the fields. Erjie’s father, Gandie, was
diagnosed with esophagus cancer in October 2004 and died in February
2005. Much of this book is devoted to relating how his family attempted
to make sense of his illness and cope with it. Families are the primary
site in which moral economies are articulated and challenged, especially
since relationships between their members, as we shall see, are often far
from harmonious.
able to afford such goods locally and how so many new shop units would
be filled. By 2007, they were proved wrong. The new shops, teahouses,
restaurants, and karaoke bars built in concrete along the riverfront but
shaped to resemble traditional-style buildings were in business and
seemed to be still thriving in 2009. Incomes have risen steeply. While
carpenter Taoge earned less than 30 yuan per day in 2005, he earned
50 yuan in 2007, 100 per day by 2009, and 150 in 2012. In 2009, his
sister and her husband earned 1,000 yuan per month to care for a dis-
abled man in Langzhong city, a sum far beyond what they might have
earned a few years previously. Some work continues to be poorly paid,
however. One day of work in the local brick kiln earned Erjie a meager
22 yuan per day in 2011.
In 2006, some of the promises of the new leadership began to be
fulfilled. While in 2004–2005 locals complained about the continuing
arbitrary fees, by 2006 these fees had been lifted. This began to per-
suade locals that the new leaders were committed to making life bet-
ter for farmers. Premier Wen Jiabao’s government work report and the
policy plans drawn up as part of the government’s eleventh Five-Year
Plan (2006–2010) were presented to the fourth session of the Tenth
National People’s Congress on March 14, 2006 (People’s Daily Online
2006a). The plan stressed the importance of building a “new socialist
countryside” by increasing rural investment and agricultural subsidies
and improving social services. Among its aims is the resolution of two
problems villagers were particularly vociferous about: education and
health care. In response to the first, “The nine-year compulsory educa-
tion in rural areas will be secured by the public financial system starting
from this year. The central government will invest 125.8 billion yuan
(US$15.2 billion) and local governments 92.4 billion yuan (US$11.1 bil-
lion) into the programme.” In response to the second, “Starting from
this year, both the central and local governments will spend more to
construct the rural co-operative medical service system, which is sched-
uled to cover the countryside by the end of 2008. And a three-level
rural health care service network will be established by 2010 to satisfy
residents’ needs” (People’s Daily Online 2006b). Given this commitment to
addressing inequalities and building a welfare state, it would seem more
appropriate to term the current leadership not “postsocialist” but rather
“late socialist” (L. Zhang 2002) or “neosocialist” (Pieke 2009), reflect-
ing their own term, “new socialist countryside.” With increased central
The Evolving Moral World of Langzhong 75
Figure 2.7 New houses built along the village road in 2007 as part of the new
socialist countryside.
The Evolving Moral World of Langzhong 77
subsidy. One man from a relatively poor family (one of his two broth-
ers was in his fifties and had been unable to marry due to the family’s
poverty) demolished his mud and grass house and built a three-story
concrete house, putting the family 200,000 yuan in debt. He protested,
“After decollectivization we have not got a single penny from the state:
no reforestation compensation, no reward for only having one child
(20 yuan should be given to families with only one child). We were the
first to sign up to this new countryside construction. But we got nothing”
(August 2008). His neighbors, known to be the poorest family in Baoma,
took out a mortgage for 50,000 yuan to build a slightly more modest
concrete home. They stated that they owed 5,000 yuan in interest costs
per year. Another family known to be in financial dire straits because
of steep mental health care costs for their twenty-six-year-old daughter,
Fumei, spent over 50,000 yuan on their new home. Her father, in his
late fifties, had left the village to work in a construction company near
Beijing. Only families in serious difficulties would see a man of this age
migrate in search of work. Fumei’s husband had also left and worked in
a factory in the south. Fumei’s mother explained that in recent months
she had finally been able to secure a minimum living guarantee (dibao) to
help face the steep costs of health care and house building. She claimed
she was able to do this only because her family had “contacts” in the local
Labor Bureau: “You have to know people—if you don’t, you just cannot
get the money” (August 2008). The importance of family connections
remained as a condition of moral economy throughout the socialist and
neosocialist period: during Mao, family connections secured more food,
during Deng and Jiang they meant paying less in arbitrary levies, and at
present they secure access to forms of social welfare. Family connections
are inseparable from the experience of state power.
Despite (or paradoxically because of ) efforts by the central state to
address wealth inequalities and offer subsidies to villagers, local cadres
continued to be seen as extorting money and distributing compensation
unevenly or not at all—and only to those with whom they had good
relationships. Where previously villagers felt that the central leadership
allowed cadres to become corrupt—the most obvious sign being their
ability to charge arbitrary levies—by 2006 they differentiated clearly
between local cadres and central policies. Langzhong received some
central government subsidies in the wake of the 2008 earthquake.
Villagers alleged that they were told they would all receive 20 yuan per
78 Foundations
person, but in fact only some received it. A vocal woman in her seventies
was enraged by the current village secretary. She asserted that for refor-
estation compensation, all villagers were owed a bag of fertilizer worth
100 yuan and some money. But they received this only in the first year.
She claimed he had been seen in the township receiving large deliveries
of fertilizer intended for the village but that it never got there. Confused,
I commented that surely he could not use so much fertilizer for himself.
She sneered, “He sells it, of course!” ( July 2008). Villagers all agreed
that they were promptly told when they owed money to the village, but
that the village secretary would keep very quiet about subsidies or free
health checkups. Bearing all this in mind, chapter 3 will show that, at
least in certain areas of intervention, some local officials did manage to
maintain their legitimacy among villagers by posing as lacking capacity
or lacking funds to address problems.
The two idioms of “energy” ( you jin) and “skills” ( you benshi ) emerged
as emblematic of contending qualities for the grandparents’ and par-
ents’ generations respectively. Grandparents did not romanticize the
collective period—least of all starvation during the Great Leap—but
they were proud of their hard work. They described their main quality
as you jin, which roughly translates as being energetic or having vitality,
both spiritual and physical. Grandparents’ self-perception as energetic
was partly engendered by having been required to endure hard physical
labor. But their perceptions of the present as requiring skills and lacking
in spiritual and physical energy also served as a moral commentary on
the present in light of the past. They certainly did not think of collectiv-
ism as a time for laziness and reliance on others’ work, as some of the
parents’ generation (who had not experienced it) did.
If grandparents characterized parents as lacking in “energy” and
continued to value its importance, parents typically responded that col-
lectivism did not entail many of the challenges that they face now. A
young high school graduate commented, “They worked in collectives,
they didn’t have to go looking for jobs. They couldn’t try to make money
anyway; if they did they were criticized. And everyone was poor, now
all young people are going out to work; we all need to have skills to
find a job” (November 4, 2004). If during collectives working hard in
the village sufficed to qualify as a caring and responsible person, since
reforms it has become necessary to engage in paid work to sustain the
rising living costs. Accordingly, having skills—which in the current con-
text has become equivalent to being able to earn money—is a more
desirable quality than having energy. Most villagers who can engage in
wage labor—that is, they have the abilities required and the opportunity
to leave children to be cared for by relatives—migrate in search of work
(Pun 2005; H. Yan 2008).
It may be as tempting as it would be analytically simplistic to place
farming, you jin, and collectivism on one side of a dichotomy and wage
earning, you benshi, and market reforms on the other. Without doubt,
farming sits lower than wage labor in the occupational hierarchy char-
acteristic of rapid capital accumulation, and this is mirrored by the cur-
rent importance bestowed upon having skills to earn money. This does
not mean, however, that farming is no longer valued by the local com-
munity. In families without wage earners or where wage-earning contri-
butions are minimal, farming still presents the only source of livelihood.
80 Foundations
children education. In the process, all involved made and remade their
sense of selfhood and in turn changed the parameters on which these
judgments are based.
The time predating the economic reforms was widely perceived to
be one of scarcity and hardship. The recurrent claim among villagers
that “pigs now eat better than we did” might suggest that the present
is held to be an adequate antidote for the past. Yet, the equally fre-
quent complaint that “at least back then we were all poor” indicates
that the transition to market socialism was not welcomed unreservedly.
The challenges it poses are clear for all to see, as the younger generation
engages in often poorly paid wage labor whose gains are mostly invested
to face costs—such as taxes, school fees, and health care expenses—that
used to be minimal. Even after these costs have been reduced with the
rise of the Hu/Wen leadership, living costs remain high, as do health
care expenses not covered by the cooperative scheme. Both past and
present are seen to carry some shortfalls: for the Maoist past, hard phys-
ical labor and food shortage; for the reform period, the pressure of the
market economy to earn money and the growing gap between urban
and rural areas and between rich and poor.
This wealth gap was often experienced as a loss of face, a feeling
of shame due to poverty. Villagers partly internalized the snobbery
by richer urbanites and by richer villagers, even though they deeply
resented it. They also “bought into” the market ethic by engaging in
waged labor, although not unconditionally. Indeed, they retained farm-
ing as a guarantee of security and of good-quality food; good-quality
food was redefined as homegrown food, as we shall see in chapter 3.
They were also proud of their work as a means of caring for their fam-
ily. When I visited Baoma in January 2009, Aunt Zhang rented a small
room in the township so that she could provide her granddaughter
Youhui with nutritious meals and a convenient living space near school.
As I sat with them, Aunt Zhang collected an empty plastic bottle from
the street and put it in a corner of the room, next to a collection of other
bottles and cardboard boxes. Youhui grunted, “What are you doing?”
Aunt Zhang turned to me: “This girl ‘loves face’ [ai mianzi, meaning she
is proud of her public image]; she tells me not to do this, that others will
laugh at her. But I can easily get a few yuan from this waste.” Youhui’s
mother, who was making a fleeting home visit for Chinese New Year,
reproached her daughter: “They should laugh at people who sit at home
82 Foundations
industry influence ( J. Zhang et al. 2010, 1116). Cancer etiology is also
extremely complex and varies between types of cancers. In their over-
view of cancer trends in China, Zhao and colleagues summarized risk
factors as follows: smoking for lung cancer, the bacteria H. pylori for
gastric cancer, hepatitis B for liver cancer, the Epstein-Barr virus for
nasopharyngeal cancer, and rising obesity as a general risk factor (2010,
283). Nasopharyngeal cancer (NPC) presents a particularly interest-
ing case for China. Whereas annual incidence rates are less than one
per hundred thousand in most populations, southern China sees more
than twenty cases per hundred thousand. Studies of nutrition and diet
have correlated it with eating highly salted foods (such as the preserved
foods commonly consumed in rural Langzhong) and with vitamin C
deficiency at a young age. Finally, a genetic study revealed a genetically
distinct subpopulation in southern China, which may account for the
higher disease incidence in the area (World Health Organization 2011).
Other studies are more squarely focused on environmental factors. Qin
and Shi (2007) and Zhang and colleagues (2010, 1115) raised environ-
mental pollutants as risk factors, particularly nitrate and nitrite as corre-
lated with digestive system cancers. For esophagus cancer in particular,
water scarcity seems to be a risk factor, alongside a range of genetic
aspects and alcohol and tobacco consumption (Kuwano et al. 2005). A
later study further stressed that esophagus cancer was more common
in relatively drought-prone and low-altitude areas (Wu, Huo, and Zhu
2008). Zhang and colleagues speculated that water scarcity is a factor
to the extent that it increases reliance on unclean water (2010, 1115).
This implies a strong correlation between unclean water and esophagus
cancer. Whether this is indeed the reason for relatively high esophagus
cancer rates in Langzhong would be much harder to establish.
soon as the sufferer feels partly relieved, cancer demands the full dedi-
cation of sufferers and their families. The sense that cancer is incurable
and that it is the biggest local killer no doubt contributes to its grip on
the local moral imagination.
Stomach and esophagus cancer (the focus of this study) are the most
common types of cancer in Langzhong. While their predecessors—
respectively “vomiting illness” (huishi bing) and “choking or spitting
illness” ( gengshi bing )—are at present with few exceptions understood
Notes:
1. The number of cancer sufferers refers to the total village population for the period from
2003 to 2007.
2. Rheumatism was very common, and many claimed that “everyone has rheumatism.”
The cases included in the table were especially serious, which compromised the
sufferer’s ability to work.
3. Two cases were of brain damage caused by penicillin injections administered during
infancy. In the remaining two cases, symptoms similar to personality disorder appeared
during adolescence, but the cause remains undetermined.
The Evolving Moral World of Langzhong 87
Opposing this tendency, Sylvia Tesh has argued that decisions over
what counts as evidence of environmental health harm are not so much
to do with the inherent scientific value of given data but with political
and policy decisions clearly led, in the majority of cases, by industrial and
profit interests (2000, 29). Similarly, for medical sociologist Phil Brown
(2007), public concern about pollution and health should not be hidden
by a focus on scientized views based on seemingly objective notions of
science. By attributing cancer to water pollution, Baohua’s explanatory
approach was clearly vested in avoiding individualized explanations of
cancer and obtaining redress. He succeeded in having high cancer rates
in his village unit recognized by the county CDC and in having water
pollution acknowledged as a problem, but he failed significantly to mobi-
lize his neighbors or to obtain any corrective action. The remaining part
of this chapter ventures some explanations of why this may be so.
(shallow well), with a simple solution (dig deeper) and an equally simple
obstacle (lack of funds). In turn, identifying pollution as a cause of ill-
ness and provision of better water as a solution also functioned to delo-
calize the issue and make it part of a nationwide problem—one that the
central state is responsible for, not localities alone. Devoting attention
to water pollution was central to the local state’s attempts to maintain
legitimacy as a caring provider. Its inability to attend to the issue had to
be carefully managed as a lack of capacity for such legitimacy to remain
unchallenged. This strategy successfully subverts the central state’s invi-
tations to denounce local causes of failed implementation and diverts
what “rightful resistance” may have been waged against local officials
toward deeper problems of capacity.
Baohua felt a frequent discomfort in his stomach and throat and
worried that, as for other locals, this signaled the initial stages of cancer.
Blaming water pollution enabled him to explain why cancer rates were
high rather than why they affected particular individuals. It allowed
him to engage the issue on a broader community level and, he hoped,
implicated and demanded action from local officials in the form of the
provision of better water. Baohua’s attempts to reach a resolution were
frustrated because the issue he selected—water—made it into a problem
far too common to demand immediate intervention and one that, at any
rate, local bureaus did not have the resources to address. Experiences
with the journalist and with local officials went some way toward con-
firming to villagers that water was not a productive factor to complain
about—it had failed to lead to any corrective action. Instead, villagers
embraced alternative explanations for the high incidence of cancer that
both made sense of their historical and current experiences and pointed
to more feasible remedies. The remaining part of this chapter and the
following two will examine these competing etiologies and the kinds of
alternative practices people engaged in to protect themselves from the
threat of cancer.
water pollutants); (2) hardship, anger, and anxiety; and (3) diet, smoking,
and drinking. In this chapter, I focus on the specific elements that were
emphasized with reference to Meishan’s case in particular—namely,
work-related hardship and farm chemicals in food. A number of case
studies in the United States have highlighted that communities suspect-
ing they are affected by environmental health hazards have typically
refused to attribute cancer to lifestyle choices. Martha Balshem (1993)
showed that members of a Philadelphia community with high cancer
rates rejected the suggestion that individual behavior was to blame for
cancer and protested that doctors themselves seem to be unsure as to
what causes cancer. The wife of a forty-two-year-old man lost to pancre
atic cancer insisted that his employment in a metalworking plant, not
his behavior, was to blame for his illness. Phil Brown (2007) provided
many examples of how those subject to environmental health harm
question the dominant epidemiological paradigm that places emphasis
on genetics and lifestyle. As an alternative, they put forward a public
paradigm, often building on citizen-science alliances (see also Brown
and Mikkelsen 1997; Checker 2005). From the point of view of these
scholars working in the United States, citizens’ attribution of cancer to
individualized causes (whether they be genes or lifestyle choices) results
in a failure to recognize environmental threats and to demand better
places to live. But in the different political and economic circumstances
of rural Langzhong, Baohua discovered, constructing cancer as the out-
come of environmental threats did not function to obtain redress from
the local (or central) state. Rather, etiologies that situated cancer within
local experiences and values served as more persuasive ways to make
sense of it.
In the hope of substantiating his proposal that water causes
high local cancer rates, Baohua accompanied me and a friend from
Langzhong county People’s Hospital to visit the families of those who
had recently lost a relative to cancer (March 31, 2007). And yet, two
widows we interviewed at length dismissed his suggestion that water
was to blame. “Why are we all drinking the same water but they are the
ones who died?” asked one woman rhetorically. They argued, almost
verbatim, that their husbands had undertaken physically strenuous
work (xinku), such as digging the communal irrigation pool out of rock;
carrying heavy loads of grains, vegetables, and manure; and applying
chemicals. In this case, quite contrary to Balshem’s informants, villagers
Water, Hard Work, and Farm Chemicals 103
made sense of cancer with reference to causes rooted in the local socio-
economic context—not water pollution, but certain types of hard work
characteristic of local life in the past and in the present.
The etiology of hard work is rooted in and convergent with Chinese
medical assumptions embedded in popular culture. Sydney White has
shown that in rural Lijiang, many common illnesses are traced to hard
work and exhaustion (laolei), making bodies more vulnerable to afflic-
tion. Stomach problems, for instance, are linked to exposure to damp in
the fields and consequently catching a cold, as well as to eating too fast
and eating cold food because of rushing to and from the fields (1993,
257–259). Rheumatism is traced to constant hard work and exposure of
the body to wetness, dampness, or humidity (261–263). Chronic bron-
chitis is seen to be due to farmers rising early to work and routinely
catching a cold (266–267). In rural Lijiang, hard work and the illnesses
it precipitates are seen to predominantly afflict women (White 1997).
This expresses a gender division whereby women show commitment to
their families by sacrificing their bodily health for them. Their sacrifice
Figure 3.1 Uncle Chen carries manure to his hillside allotment (2007).
104 Making Sense of Cancer
younger villagers did not praise such work but resented its continued
necessity for those with no other means of livelihood. Indeed, current
strenuous work routines that remain characteristic of rural ways of life
are also blamed for cancer. For instance, a twenty-year-old female uni-
versity student (the second young woman in Baoma to attend university)
argued that a local man in his forties had developed liver cancer because
in the past decade he had single-handedly dug a well for his family’s use,
growing exhausted and sick from such effort. For the post-Mao genera-
tion, blaming hard work for cancer serves to condemn not only collec-
tivism but also the enduring physical hardship borne by those (typically
but not exclusively older) without access to other forms of livelihood. By
linking cancer, locally experienced as the most deadly illness, to forms
of hard work that are so central to farming life—securing an irrigation
system, tilling fields, and carrying heavy loads—this etiology highlights
the hardship of farmers’ lives compared to those who do not need to toil
in wet and windy conditions. In a political economy in which farming is
often of little financial value and yet living costs soar, older generations
continue to value physically demanding work as their contribution to
the family’s welfare, while those younger no longer regard these types
of work as the sole parameter of care for the family and lament their
inability to make a living without physical strain.
Market reforms following Mao’s death in 1976 increased opportu-
nities for mobility, and migrating in search of unskilled labor in factories
in more prosperous regions of China has become a crucial way of fac-
ing rising living costs. While many between the ages of roughly sixteen
and fifty had left Baoma in pursuit of work, villages like Meishan, where
residents cannot commute daily for work in the county town, are even
“cleaner” (to use a local expression), with mostly those in their sixties
and older left behind. This type of hardship stretches villagers’ defini-
tion of hard work beyond farming and into urban, market exploitation
(see Pun 2005; H. Yan 2008). As hard work expands to include migrant
work, this also comes to count as a vital way of caring for the family.
Young and old villagers are equally ambivalent toward this new form of
hard work, which is praised for its potential to raise family income but
also critiqued for its relatively low pay compared to more skilled jobs
and for the strain it puts upon family relations, separating husbands and
wives and parents and children. As it takes a young labor force out of
Water, Hard Work, and Farm Chemicals 107
rural areas, migration leaves those same people who toiled during col-
lectivism to farm all the family’s land.
The rise in access to and use of farm chemicals has also presented
a new parameter of hard work for those left in the villages: no longer
only strenuous physical activities (such as digging the irrigation pool or
carrying manure) but also work that entails danger of contamination by
chemicals. Indeed, cancer sufferers’ widows listed the use of chemicals
among the kinds of hard work that they held responsible for their hus-
bands’ deaths. Without exception, all villagers agreed that farm chemi-
cals are harmful and regretted their dependence on chemicals. Yet these
substances were not condemned outright. Farm chemicals were regarded
as part and parcel of the transition away from a past when diet was “not
even as good as a pig’s diet now” and when “you could barely grow
anything” (both frequent claims). Farmers noted a stark improvement in
farming since their introduction in the early to mid-1980s.6 They com-
pared the tiny grains of maize of the 1960s and 1970s with those farmed
more recently. Benefits to farming were clear: chemicals killed pests and
fertilized the soil; they reduced the heavy loads of manure farmers had to
carry on shoulder poles walking along narrow paths to their hillside allot-
ments; and they improved the appearance of foods, making them easier
to sell.7 Such perceptions of farm chemicals as an increasingly necessary
part of life served to demobilize locals and undermine attempts, such as
Baohua’s, to fully condemn them and seek redress from the state.
Farmers explained that they resorted to chemicals in order to
respond to market pressures to produce literally spotless food and to
make the workload lighter for the elderly left in charge of farming, as
most of the young generation migrate in search of work. As it begins
to emerge, perceptions of hard work with chemicals as a cause of can-
cer articulate etiologies not only vis-à-vis the family but also vis-à-vis
the current market economy and morality. Complaints that work with
chemicals causes cancer are therefore a commentary on the necessity
of supplementing family income with migrant labor, which takes the
labor force away from farming and makes carrying heavy loads of
manure (organic fertilizer) unfeasible and chemical fertilizers necessary.
It is also a critique of a market economy that demands that they use
chemicals to compete for consumers and increase their revenue. Shao
Jing (2006) reported that villagers in Henan regarded wheat produced
108 Making Sense of Cancer
with fertilizers as “fake wheat” that did not endow them with the same
strength as wheat they farmed in the past. Similar comments on food
farmed with chemicals as less nutritious and less tasty were common
in rural Langzhong. Both metaphorically and in real terms, this shows
that consumerism and the profit model are seen as depleting villagers
of energy. By weakening the strong bodies required by agriculture and
upheld as a core value by the older generation, chemicals also under-
mined the moral economy of farming. Conversely, perceptions of farm
chemicals as a cause of cancer articulate a continuation of a moral
economy of family-based subsistence, but they are also a reaction to a
new setting—rising living costs and market insecurity. The current con-
text, requiring stronger reliance on the market, has ushered in new ways
of perceiving the value of farming and new parameters of well-being,
while providing older ones with new settings and new implications.
These two etiologies of cancer—hard work as physical strain and
as work with farm chemicals—highlight an underlying discontent with
aspects of both the past and the present moral and political economy,
both of which require particular forms of hard work. Hard work, for
both older and younger generations, serves to explain why particular
individuals fall sick, but it does not entail that the individual himself is
blamed for the onset of cancer. On the contrary, by being embedded
in a shared social and economic history that required hard work, this
etiology provides an intersubjective way of explaining cancer. It situates
cancer causality between the individual and the social level of analysis,
making it the result of an individual sacrifice, but one that is socially
recognized and valued. Located as it is within a local moral world that
both commends and condemns hard work, cancer is experienced not
as an individual pathology but as a form of social suffering (Kleinman
1995; Kleinman, Das, and Lock 1997a). Different etiologies entail dif-
ferent aims and outcomes. For Baohua, explaining cancer with refer-
ence to work was unproductive, since there was nothing immediate that
local officials (or anyone) could do. For the widows, however, an etiology
such as water pollution would have failed to relate cancer to suffering
during the life of affected individuals. Rather than molding a biological
citizenship based on shared harm, cancer-causing hard work played a
key role in reproducing family and community relations. As such, attrib-
uting cancer to hard work also articulates its shifting significance and
definition as a parameter of morality.
Water, Hard Work, and Farm Chemicals 109
The causal link between farm chemicals and cancer was not only
understood through work but also through contaminated food. This,
of course, has implications for who is blamed for the development of
cancer and for the strategies seen as suitable to minimize risk. In some
cases, highlighting consumption of chemically contaminated food
serves to blame individual farmers, especially when the person afflicted
by cancer is seen to have fallen victim of his or her own excessive use of
chemicals on products intended for their own consumption. It is much
more common, however, to perceive chemical contamination of food as
a necessity, a harm of which farmers are keenly aware and that they try
to limit. Farmers frequently highlighted this double-edged sword: can-
cer on the one hand and better yields on the other. Baohua’s elder sister
dismissed his suggestion that water was to blame by referring instead to
the high chemical content in food:
intended for the market. Indeed, some villagers defended their eating
preserved vegetables, commonly condemned by city doctors and offi-
cials as a cause of stomach and esophagus cancer, as a healthy choice
because they are sprayed with less chemicals (see chapter 5). These
practices contradict the stereotype of “ignorant peasants” by show-
ing that farmers are keenly aware of food safety issues and that they
reject biomedical tenets such as “preserved vegetables cause cancer”
not through lack of awareness but rather on the basis of their experi-
ence and knowledge of farm chemicals’ harmfulness. Paradoxically, the
need to produce vegetables (and pork) for the market encouraged the
use of chemicals, but in turn it also reinforced their reluctance to con-
sume food from the market. Homegrown products were defended as a
healthier and sounder approach. Regarding cancer as caused by chemi-
cals in food and placing value on homegrown food comprise a means
to defend long-standing local habits, to wage an implicit critique of the
market economy that has made the widespread use of farm chemicals
necessary, and to contest the hegemonic market morality according to
which the ability to afford market food is also an avenue of distinc-
tion. This skepticism toward market food was equally prominent across
generations, with the only exception being young children who might
spend what little pocket money they had on sweets and snacks (see Lora-
Wainwright 2007, 2009).
Karl Polanyi (2001, 44) described the development of the self-regu-
lating market as “the great transformation” supplanting reciprocal and
household-based economies. This transformation, he argued, resulted
in disembedding economic activities from social relations, causing mas-
sive social dislocation and a spontaneous countermovement by society
to protect itself. Building on Polanyi’s work, James Scott proposed that
“Living close to the margin” and “the fear of food shortages has, in
most pre-capitalist peasant societies, given rise to what might appropri-
ately be termed a ‘subsistence ethic’” (1976, 2). In my fieldwork setting,
such a subsistence ethic embodied by preference for homegrown food
is reinforced by the current encounter with the market rather than by
experiences of food shortage. While it may be considered a manifesta-
tion of Polanyi’s countermovement, a closer analysis betrays a more
complex relationship between subsistence or householding and the
market. As Marc Edelman writes of Scott’s study The Moral Economy of
the Peasant, “The term subsistence . . . tends to obscure the relation with
112 Making Sense of Cancer
the market that small producers may have, especially in years of high
yields and surpluses” (2005, 335). To be sure, Scott himself does not
posit a dichotomy between “swashbuckling capitalist risk-taking” and
“immovable peasant conservatism” (1976, 25). My findings also sug-
gest that a dichotomy between subsistence and the market economy
is inaccurate to say the least.8 The expansion of market opportunities
has not caused villagers to abandon household production in favor of
market exchange and consumption of market goods. A kind of subsis-
tence ethic and household consumption remains as a moral alternative
to the market, but production for the market is not rejected. Rather,
farmers strive to take advantage of the market by producing marketable
food. To the extent that farmers produce food for the market with profit
rather than the well-being of the consumers in mind, their engagement
with the market economy is disembedded from social relations. At the
same time, the strategic use of chemicals reembeds social relations by
creating divisions between those who eat their own food, those to whom
relatively green food is offered, and those who consume food from
the market.9 The moral economies of subsistence and of the market-
exchange are intertwined.
Insofar as Langzhong farmers feel ambivalent about the use of
chemicals, they are also engaging in a form of reflexive modernity
(Beck 1992). Yet their example also problematizes any simplistic view
of modernity as constituted by a coherent set of values. Chaia Heller
(2006) has examined postindustrial “quality agricultural discourse” as it
has been taken up by French small-scale farmers and activists as a means
of resistance against GM crops and globalization. The Confederation
Paysanne (CP), Heller explains, reclaimed the term paysan to protect
traditional rural ways of life as “just and dignified” (320) and declared
GM foods to be la malbouffe, or bad-quality food, thereby defining qual-
ity food not simply as “natural” but rather as food that is rooted in
place and culture. Similarly, Langzhong farmers are not skeptical of
farm chemicals on the grounds of their unnaturalness—indeed, nature
rarely enters the popular discourse on chemicals, which is instead domi-
nated by the terms “convenience” and “development” on the one hand
and “cancer” on the other. And yet a romantic idealization of rural
ways of life would be out of place in a setting where nonmechanized
agriculture is perceived not as a privileged harmony with nature but
as incessant hardship and an obstacle to development. Equally, the
Water, Hard Work, and Farm Chemicals 113
Conclusion
This chapter has examined how contending forms of morality are con-
stantly produced through debates about cancer etiology. It has shown
that etiologies such as water pollution, which rely on demanding state
intervention on the basis of its obligations to citizens, fail when state
114 Making Sense of Cancer
possibilities they offer but condemned for causing cancer. This entails
a revaluation of homegrown food, over which farmers themselves have
more control. The transition to neosocialism (Pieke 2009) has enabled
as well as required new forms of moral economy. The value of life itself
is tied to farming and to hard work—but not through a romanticized
rejection of the market morality and economy. Through their ambiva-
lence toward farm chemicals, villagers articulate an alternative way to
value life. Market socialism has created some new parameters and new
desires (for spotless food), but it has also provided older ones with new
contexts—the renewed value of food with limited chemical content.
Villagers’ attempts to understand what causes cancer and to decrease
their chances of developing it tell us as much about their bodies as
about the social conditions in which they live and have lived, about how
selves are formed and relationships reproduced or contested in the face
of emerging and reemerging moralities.
Chapter 4
carefully scrutinized the vehicle, and asked the usual question in these
circumstances: “Who is that (Na shi na ge ma)?”
Aunt Guo (whispering): It’s that one, you know, the teacher’s wife, that
Liu Minjie—she died yesterday. It was stomach cancer. You know
her, right?
Anna: Yes, I know she had thyroid, but she was in good health when I
last met her in April [2007].
Aunt Guo: Yes, but she was a worrier, that one—she was always upset.
She had a hard time, you know; her husband died over ten years
ago, and she cared for those two young children. She found out
she had cancer in the summer. She died really fast—she was ter-
rified when she heard that word, cancer, and if you are terrified
of it, it gets you very fast.
Uncle Xi: Your emotional condition (xinli zhuangkuang) is very impor-
tant. Someone else—a man only in his forties, who lived in the
next village—he died of cancer in just a couple of months, too;
he was scared to death (xiasi) when they told him he had cancer.
I heard of a villager who was told he had only a few months, but
he did not worry, and he got better—he’s well now. But Minjie,
she was scared.
Aunt Liu (Minjie) was fifty-six when she died. It had required par-
ticular persistence to dispel her suspicion toward me when we first met
(August 24, 2004). She believed I was a journalist and that she was too
uneducated to have anything worthwhile to tell me, and feared I would
disgrace her by publishing pictures of her mud and bamboo house,
which she felt was a focus of ridicule in the village. As she had occa-
sion to observe me harvesting rice with a number of local families, she
gained confidence and became one of the most outspoken and welcom-
ing of villagers. During all our meetings, Aunt Liu stressed that her life
had been characterized by a series of hardships. In 1975, she married
one of the village schoolteachers, and as a consequence she had to carry
out all of the farmwork alone. Due to gynecological problems that are
now curable, Aunt Liu had been unable to bear children and had to
adopt a daughter. This, she explained, had attracted her father-in-law’s
anger and frustration. In turn, she felt these negative emotions, as well
as his predisposition to become irritated and resentful (ouqi), had caused
Gendered Hardship, Emotions, and the Ambiguity of Blame 119
role in social life) are inseparable. As the cases below will show, it is in
fact because they are perceived to affect people’s internal states and their
health that emotions play a crucial role in maintaining or challenging
social values and family and social relations. Yet emotions do not pro-
duce a unified sense of who or what is to blame. Anger and anxiety may
be attributed to an individual’s character, allowing those who might oth-
erwise be blamed for causing anger to deny such responsibility.
On the other hand, attributing cancer to negative emotions may
serve to complain against the conditions that are thought to make indi-
viduals angry and anxious and therefore bring about cancer. In this way,
it serves as a powerful tool for social reproduction. The perception of a
given circumstance (divorce or inability to bear children) as a cause of
cancer allows insights not only into the experience of cancer but also
into the clashing values and practices between different generations. I
argue that negative emotions such as anger and anxiety have social effi-
cacy as etiologies of cancer because they are flexible in terms of who
can be blamed, and therefore they adapt to different claims surround-
ing what constitutes moral behavior. Such flexibility is encapsulated by
the ambiguity over whether anger and anxiety are due to a person’s
temperament or whether they are interpersonal, in the sense that they
are caused by others and, therefore, others are to blame. Attention to
the role of gendered experiences of hard work and to emotions in lay
cancer etiologies produces a better understanding of the concerns of
local people and helps to contextualize their practices more adequately.
In turn, it sheds light on how the boundaries of acceptable behavior are
negotiated and on how family conflicts and social change are experi-
enced through contending ideas of what is carcinogenic.
Gendering Hardship
Changes under Mao and following reforms have affected gender rela-
tions in a number of ways. While women’s position improved during
Mao, the promised gender equality somewhat failed to fully materialize
(Croll 1981; K. Johnson 1983; Stacey 1983; Wolf 1985). Rather, tradi-
tional patriarchy was substituted with a “socialist patriarchy” (Stacey
1983). Women’s burden increased, as they were required to take part
in collective work, but their work was rewarded with fewer work points
than that of men (see, for instance, Potter and Potter 1990, 119–123).
Gendered Hardship, Emotions, and the Ambiguity of Blame 121
Sydney White has argued that in rural Lijiang, women have tradition-
ally done most of the field labor. She explained these work patterns
with reference to the Naxi minority’s particular gender identities and
cultural expectations that women would do a large share of the physical
work (1997). While such cultural expectations did not apply to women
in rural Langzhong, villagers also perceived women to have carried out
a substantial share of physical work. But if for men hard work was a
hegemonic part of masculinity, for women it challenged the “normative
construction of deficient female bodies reflected in Confucian-informed
Chinese medical practices” (318; see Furth 1986, 1987, also cited in
White 1997). For instance, the custom of resting for a month following
childbirth (“sitting the month”) and avoiding excessive physical strain
during menstruation is part of such a conception of the female body
as weaker than that of men. However, women who lived through col-
lectivism in rural Langzhong recalled that they worked through their
periods and barely rested a few days after childbirth. Not doing so, they
reasoned, would mean not earning work points and therefore failing to
secure food for themselves and their families. Aunt Li, born in 1949,
traced her rheumatism to having had to carry fifty kilos of grain on
her back during periods, which caused her sweating, exhaustion, and
strained joints and lower back. Her rheumatism later developed into
the rheumatoid heart disease that killed her in 2006. Where for Jacka
(1997), reforms stretched the traditional boundaries of nei and therefore
legitimated women’s activities beyond the household, working patterns
among women in rural Langzhong testify that demands of collectiv-
ism stretched the definition of weak women’s bodies, requiring them to
work during particularly vulnerable times despite the cultural assump-
tion that they should not do so. Conversely, when women who worked
hard even during periods and “the month” died of cancer later in life,
the perception they ought not to do so is reinforced.
While all women were required to work during collectivism, those
whose husbands were absent (because of joining the army or being
enlisted in construction work) or employed in the village (for instance,
as teachers or vets) were thought to have had a particularly hard time.
Grandma Chen (born 1931), who committed suicide after being diag-
nosed with stomach cancer in 2006, was one such case (see the opening
of chapter 7). Her husband left Baoma to fight in Korea from 1953 to
1957. After his return, he neglected his family and had an affair with a
Gendered Hardship, Emotions, and the Ambiguity of Blame 123
contact with them. When I met these two young women in the summer
of 2004, they both complained that their husbands were abusive and
their father-in-law (the vet) followed “traditional customs” and assumed
he could bully them. One day in September 2004, the younger daugh-
ter-in-law “ran away,” as villagers put it, and wasn’t finally tracked down
until the summer of 2008, when she returned, fearing her mother-in-
law was about to die. The elder daughter-in-law, Junhong, left in early
2005, taking her daughter with her, and she has not been seen since.
These emancipation efforts by the younger women left Aunt Cao to
bear the agricultural burden alone (the emotional effects of these rebel-
lions on the older generation are explored fully below).
Aunt Cao’s sustained burden in the present was regarded by her
neighbors as a further reason to suspect that her weakness and inability
to eat in 2008 were indeed symptoms of cancer. Hers, however, was not
an isolated case. Some of her neighbors in their fifties and older com-
plained that their daughters-in-law abandoned the family, leaving them
to farm and care for grandchildren. These women presented divorce
among the younger generation very much as a cause of physical (and
emotional) hardship for them and their grandchildren. While divorce
has become an increasingly widespread way for younger women to
resist enduring the same misery as their mothers’ generation, this older
generation found divorce as unacceptable as it was common. To see it as
a sign of progress in undermining gendered oppression and as liberat-
ing for all women would fail to acknowledge the hardship it brings upon
older women.
Older women were not alone in seeing their lives as hard. In rec-
ognizing the plight of their mothers’ generation and condemning
abuse such as that endured by Grandma Chen, younger women also
expressed an unwillingness to be subjected to the same type of suffering.
Junhong and her sister-in-law are indeed examples of younger women
who resisted abuse by their husbands and in-laws. My host Erjie often
reflected on the bitterness endured by the older generation. She referred
to Grandma Chen as an example, as well as to her neighbor, also in her
early seventies, whose husband and in-laws frequently beat her during
her youth. Erjie argued that women now complain about mistreatment
and rebel against it. She explained that her mother-in-law shouted at
her, refused to help with farmwork or child care, and shared her best
food only with her son and not with her. Erjie liked to point out that she
Gendered Hardship, Emotions, and the Ambiguity of Blame 125
My temper ( piqi ) is good, not like our neighbor’s [the loud mother-
in-law mentioned above]. Yes, she has a hard life (shenghuo ku); I can
understand why she screams so much, but it’s much better if you have
a good temper. And look at my husband and my daughter: you can
only tell them they’re good—you say they are bad and they get angry.
Both of them get upset over trivial matters. Look at my father [whose
esophagus cancer was initially attributed to anger and anxiety]: get-
ting angry is not good for people, life is so short and hard as it is,
we should just take it easy, not be anxious ( gai manman guo, bu zhaoji ).
(March 16, 2005)
getting angry and irritated. But she also acknowledged that her inability
to bear children played a major role in her father-in-law’s anxiety and
anger. By doing so, she recognized the social expectation that she would
bear children, especially a son. Her husband was an only son, and there-
fore the pressure and responsibility were on him (and her) to ensure the
continuation of the family line. Regarding the failure to produce a son
as a cause of such distress that may lead to cancer, Aunt Liu also rein-
forced the importance of this value.
Where Aunt Liu partly blamed her own inadequacies as a daugh-
ter-in-law, wife, and mother for her father-in-law’s illness, in other cases
one family member may denounce another’s misbehavior as a cause
of cancer. Margery Wolf has described how conflicts between broth-
ers and their wives that had been tamed by the father’s presence come
to the surface after the death of the family head, causing the family to
divide (1968, 28). Attribution of blame for cancer may channel such
tensions between siblings and their wives and reproduce unequal power
relations. Strictly speaking, each of Gandie’s sons established his own
household: Gandie and Ganma lived in the same house as their youngest
son’s family (though with separate kitchens), and the other two brothers
lived in adjacent houses. Yet such proximity meant the family members
were engaged in daily interactions, and they were all, in theory, jointly
responsible for caring for their parents. The eldest daughter-in-law
(Dasao), however, felt that she and her husband carried a larger portion
of this burden. Following Gandie’s death from esophagus cancer, Dasao
repeatedly commented (May 2005, April 2006, July 2008) that Gandie’s
youngest daughter-in-law (Sansao) had behaved disrespectfully toward
him and his wife. Dasao claimed that Sansao “looked down on them
[her in-laws]” (kanbuqi tamen), refused to help them with farming, or even
to share her special meals (i.e., those including meat) with them.11 As
a consequence, Dasao argued, Gandie was angry and anxious. Sansao
“made him repress his anger to death” (ba ta ouqi si le).
By attributing Gandie’s cancer to Sansao, Dasao presented herself
as a caring but unreciprocated daughter-in-law. She recalled that after
she married Gandie’s eldest son, Gandie did not help them, and yet
he continued to assist his youngest son and his wife, Sansao, after their
marriage, even though Sansao failed to care for them in return. Dasao
claimed, “If it hadn’t been for me, your Gandie and Ganma would
not have had a happy life.” She felt just as hurt that the youngest son
Gendered Hardship, Emotions, and the Ambiguity of Blame 133
and Sansao might drop by their house only once a month despite liv-
ing next door. She believed that her upset stomach and inability to eat
were at least partly due to their poor relationship. By ascribing Gandie’s
death as well as her own discomfort to Sansao’s disrespectful behavior,
Dasao also laid out a model for a good daughter-in-law and for a badly
behaved one and defined Sansao’s behavior as so unacceptable that it
could cause illness and death. With reference to southern Africa, Jean
Comaroff has shown that processes of blaming for a relative’s death
are central to family relations. While the male agnates (brothers) of a
man killed in a car accident blamed his death on a female affine (his
stepmother), his widow placed responsibility onto his agnates (1980,
650). Such differences in patterns of blaming are informative of existing
family tensions and contribute in recreating them. Similarly for Dasao,
attributing blame to Sansao for Gandie’s illness served to channel her
disapproval of Sansao’s behavior toward Gandie.
If siblings and their wives blame each other for cancer in their par-
ents and in-laws, in other instances blame crosses generational divides.
After Erjie’s father Gandie developed cancer, warnings against the dan-
gers of anger increased among other family members. Erjie’s husband,
for instance, cautioned his mother against being overly critical of her
husband (Uncle Tao) or he would be afflicted by anger (shengqi) and
repressed anger (ouqi), and this would lead to illness. One autumn day in
2004, one of Uncle Tao’s chickens wandered into the nearby allotment,
pecked at some grass covered in pesticides, and died of poisoning a few
hours later. As his wife began to reprimand him for failing to ensure the
fowl did not overstep the boundaries of their yard, their son warned her
not to violate the confines of desirable and productive behavior and to be
lenient toward Uncle Tao or he would become irritated (ouqi) and conse-
quently sick. His criticism of his mother was based on the premise that
Uncle Tao was prone to becoming angry and tense. But it also implied
that if Uncle Tao did become anxious, his wife would be to blame.
The role of cancer etiology in reproducing gender roles and family
values is most clearly articulated in another example. Reflecting on the
incidence of esophagus cancer in the area, forty-year-old Uncle Tian
told me,
I’m not sure, but I think Uncle Liang has cancer, because he came
back from being a migrant laborer and he has not eaten properly since
134 Making Sense of Cancer
New Year. I think it’s because of his daughter. You know, she wants
to divorce [Uncle Liang’s daughter was his only child and had had an
uxorilocal marriage]. Her husband’s fine, he works and doesn’t play
around. But she complains that he’s boring and too honest! She says
she’s found a richer man and wants to marry him. You tell me! Who
wouldn’t get cancer with a daughter like that?” ( July 23, 2005)
It’s linked to anger (shengqi) and anxiety (zhaoji). It is not that people who
get angry easily will develop it. People get angry and tense when there
is a major problem in the family, and this causes cancer. For instance,
Uncle Huang died of esophagus cancer because his daughter was bad
Gendered Hardship, Emotions, and the Ambiguity of Blame 135
to him—she even bit his hand. He was in good health before, but then
he just couldn’t take it. Uncle Liu also got esophagus cancer linked to
the sorrow of his daughter drowning and his wife being bad to him.
When he was diagnosed, it was already too late, he couldn’t eat. . . .
He found out late because it was mistaken for flu. Uncle Fu also died
of esophagus cancer because his wife was bad to him. Uncle Yang also
developed esophagus cancer because he argued with his family. And
Uncle Wu—he was only forty. He didn’t get on with his wife: she was
always at the teahouse; meanwhile he was working hard, even when
he started to feel ill. Then he started to lose weight, and died of liver
cancer. . . . All these men were healthy before; nobody expected them
to die like that. Uncle Zheng’s illness (leukemia) also developed from
repressed anger, but not from his family, they were good to him; it was
being attacked during the Cultural Revolution [he was the son of a
local landlord]. ( July 15, 2005)
cancer in her father, and the former village teacher faulted three wives
and a daughter of making their respective husbands and father ill. In
these negotiations, failure to comply with established values such as the
importance of marriage and of women giving birth to sons and caring
for their husbands and parents-in-law is constituted as pathological. As
both sufferer and accuser are men, cancer becomes constructed as suf-
fering inflicted by women upon men, putting them in a position of moral
inferiority. By attributing blame to the female accused, the male accuser
in each exchange reinforces the importance of such values and consti-
tutes himself as a moral subject in opposition to an immoral counterpart.
In turn, this plays a vital role in the social reproduction of these values.
Yet women did not always consent to these accusations unquestion-
ingly. With reference to past hardship as a cause of cancer, we have
seen that younger women are unwilling to undergo the same suffering
endured by their mothers. Likewise, women accused of causing cancer
did not simply accept such condemnations. Writing on cervical cancer
in Brazil, Jessica Gregg argues that this type of cancer is blamed on
the victims’ sexual activity, and the biomedical discourse “reinforces the
cultural perspective that female sexuality is dangerous and must be con-
trolled” (2003, 41). Although they recognized their own role in causing
cancer, Brazilian women, suggests Gregg, resisted and reinterpreted this
perspective, understanding their sexuality not only in terms of gendered
expectations but also of their socioeconomic settings (54). Sexuality was
seen as a technique for survival, thereby expanding the definition of
acceptable behavior (97). In Langzhong, women expanded the defini-
tion of acceptable behavior by using that very same etiology—repressed
anger—to blame cancer on an individual’s propensity to anger. Like
Gregg’s informants, women such as Aunt Liu also reinterpreted the
connection between emotions and cancer and understood anger and
anxiety as part of the sufferer’s temper, thereby avoiding blame. In
doing so, they partially challenged and subverted the underlying ide-
ology that defined appropriate behavior for wives, daughters, and
daughters-in-law.
Further explaining why Brazilian women held their sexual conduct
responsible for cancer, Gregg proposes that, faced with the uncertainty
and dread of not knowing why they have cancer, women preferred
to fall back on traditional gender ideology to explain otherwise ran-
dom suffering (130). For Langzhong farmers, this uncertainty is also
138 Making Sense of Cancer
rarely opt for surgery. Nondisclosure does not delay alternative forms of
treatment, such as chemotherapy and Chinese medicine, as the sufferer
can make use of these medications without knowing they are aimed at
cancer. This was indeed the case for Gandie. In a context where the
paradigm of autonomous individual is by no means hegemonic, nondis-
closure is in fact morally desirable. Family members who fail to inform
their relative that he or she has cancer are acting morally, and they do
so with the conviction that they are protecting the sufferer’s physical,
psychological, and social well-being.
Conclusion
This chapter has outlined the ways in which the attribution of cancer
causality works to articulate gender relations and with what outcomes.
Demands made of women’s bodies and the opportunities opened to
them have shifted to some extent with the onset of reform. Young
women have gained more independence as they typically leave the vil-
lage in search of work and resist mistreatment from their husbands and
in-laws. When younger women regard the conditions endured by older
women like Grandma Chen as a cause of cancer, they also refuse to be
subjected to the same fate. However, such relative assertions of freedom
are experienced as an increased burden by older women left to do the
farmwork and care for their grandchildren. When cancer among these
older women is explained with reference to their hardship, this implies
not only a critique of their hard work under collectivism but also of the
ongoing physical and emotional strain they experience in the present.
Visions of morality and moral economies may be shifting, as younger
women challenge the need to be submissive to their husbands and in-
laws and gain opportunities denied to their mothers. Yet, present trials
and possibilities also perpetuate older forms of suffering for those of
their mothers’ generation. As the younger generation faces new difficul-
ties, definitions of hard work also change to encapsulate such difficulties.
Where previously farming may have been the predominant parameter
of hardship, migrant work is set to pose as a more recent contender. It
forms the basis of a coexisting moral economy that supplements farm-
ing and depends on it as a guarantee of basic subsistence. Recent work
by Ngai Pun (2005) and Hairong Yan (2008) certainly highlights the
fact that conditions young migrant women bear are often so strenuous
142 Making Sense of Cancer
and the present. Family caregiving practices do not consist only of visits
by close relatives and the offering of food treats. They also include the
many ways in which Gandie’s family learned to attune their relationship
to him throughout illness and to make sense of his decreasing ability to
eat. Finally, the experience of cancer affects not only how relatives care
for the sufferer but also how they care for themselves and each other.
Gandie’s Illness
Xicun, the village where Gandie lived, was half an hour’s walk from
Baoma, where I lived with his daughter Erjie. Xicun had a population
of approximately a thousand people, though migration flows into the
nearby city and to coastal cities make any actual estimates of local pop-
ulation difficult to establish. Some areas of the village could be reached
only on foot, but there was a mud road running through most of it that
made the village accessible by car except on rainy days. The sight of
cars was, however, extremely rare and limited to the occasional taxi.
Langzhong city was less than an hour’s walk from Gandie’s house, and
the journey cost 2 to 3 yuan by motorbike or roughly 10 yuan by taxi
(2005). Most of the locals opted to walk into the city, unless they had
their own motorbike or were unwell.
Gandie and his wife, Ganma, had four sons and two daughters,
but one of their sons had died as a child due to malnutrition (chi de
pie).1 Their three surviving sons shared responsibility for caring for
their parents in their old age. Gandie and Ganma’s house was part of
their youngest son’s family house: they shared the storage room but
had separate kitchens and bedroom/living rooms. Their two older sons
lived in two adjacent houses. Each of Gandie’s surviving sons had one
son. The eldest had a twenty-two-year-old son, Guofu, who worked in
Guangdong. Guofu had a daughter, Yumei (born in 2003), who was
cared for by her grandparents and great-grandparents. Gandie’s sec-
ond son also had a son, Guoyun, who was seventeen years old and had
migrated to Fujian to find work. His youngest son had a nine-year old
son, who lived with his parents. Gandie’s two daughters, Dajie and Erjie
(Erjie was the younger of the two), had a sixteen-year-old son and a
twelve-year-old daughter respectively. While Erjie lived within walking
distance of her natal village, her older sister, Dajie, had to take a ten-
minute bus ride, followed by half an hour’s walk to reach her parents’
Xiguan, Consumption, and Shifting Cancer Etiologies 147
home. Her son lived at home and was attending the second year of high
school in 2004–2005.
My account of Gandie’s illness is based on participant observa-
tion of Gandie’s family during illness and after death. Since Erjie was
the only member of Gandie’s family with whom I had daily contact
throughout, my observations mainly concern the ways in which Erjie’s
attitudes, practices, and perceptions were affected by her father’s ill-
ness. I regularly followed Erjie on her visits to her father’s house in her
natal village.
By the end of October 2004, Gandie had become aware of his
cancer. As Erjie put it, “Of course he knows; when you can’t eat like
that, you know it’s cancer—what else would it be?” Family members all
urged him to have an operation. Considering that he had two migrant
grandsons and a son working in a local factory, surgery would have been
Note: Names used to refer to members of the family are in fact kinship terms in relation to
myself. The couple, Gandie and Ganma, are literally “dry father” and “dry mother.” I refer to
their offspring as a sister would to their elder siblings. The first syllable defines their hierarchical
position vis-à-vis myself: da means “big” or eldest, er is “two,” and san is “three.” The second
syllable denotes their gender and relation to me: ge is “elder brother,” sao is “brother’s wife,”
and jie is “elder sister.” Dage is therefore “eldest brother”; dasao is “eldest brother’s wife”; erge is
“second brother”; ersao is “second brother’s wife” and so on. I refer to Gandie and Ganma’s
grandchildren by name, as they belong to a younger generation than myself.
Erjie (to her father): Have some water and honey. . . . I’ll go and make
doufu tomorrow, and then I’ll bring you some.
Gandie: It’s useless, I will die very soon.
Erjie (whispering to Anna): Did you hear that?
150 Making Sense of Cancer
Erjie lowered her head in silence. Her sister and her mother sat in
the room, but nobody dared speak. Eventually, as Gandie seemed to
have fallen asleep, Erjie’s mother, Ganma, whispered to her.
Ganma: He’s having a really bad time; he cries in the morning and feels
anxious and restless (huang) at night.
Erjie (to her husband): But he must be really quite alert ( jingshen hao),
because he noticed the clock was slow.
body. He had just undergone hospital checkups to make sure his chronic
discomfort in the stomach was not the early stages of cancer. Erjie com-
mented, “He is meant to have stomach problems, but look how much he
eats and drinks spirits!” (February 7, 2005). Erjie felt Uncle Tao’s ability
to eat and drink was in itself a sign of good health. Locals more widely
regarded those who could eat particularly large amounts of food (for
instance, two large bowls of staple food per meal) as unlikely to develop
an illness, especially of the kind manifested as inability to eat, such as
esophagus or stomach cancer. Even when the sufferer’s ability to eat
started to decline and thereby raised the doctor’s suspicion, the sufferer
and their families were still inclined to disprove this with reference to
the person’s track record as someone who is “good at eating” (neng chi).
The historical genesis of the equation of eating and health—
illustrated by the examples of Gandie, Uncle Tao, and Uncle Wang—
may be usefully understood through the notion of habitus. Pierre
Bourdieu elaborated the concept of habitus (1977, 1990) to understand
action as neither a simple and mechanistic reenactment of rules nor
the fulfillment of free will but as a practical logic, a “feel for the game”
based on the player’s sense of its history (2001, 80; 1990, 82).9 As an
“acquired system of generative dispositions” (1977, 95), habitus is an
organizing principle of action. Habitus is engendered by history and
by the economic bases of social formation (1977, 83); it is “embodied
history” (1990, 56). Those who shared a particular historical baggage
therefore also share the same habitus. Such habitus is consonant with
their conditions of existence; indeed, it is produced by those conditions
and predisposed to generate and structure practices in accordance with
itself (1977, 72). As a consequence, characteristics of habitus, as the
equation between eating and health for those of Gandie’s generation,
come to be naturalized and taken for granted.
Innovating upon classical Marxism, Bourdieu argued that habi-
tus consists of durable dispositions that “can outlive the economic
and social conditions in which they were produced” (1990, 62). In the
case of Gandie and his peers, experiences of the Great Leap Forward
Famine between 1959 and 1961 and recurrent food shortages in the
1960s and 1970s have created a perception of health defined as “eating
one’s fill” (chi bao) and, conversely, fostered a sense that having enough
food to eat would produce health. Although famine and food short-
age are no longer part of their daily experiences, perceptions formed
Xiguan, Consumption, and Shifting Cancer Etiologies 153
slowly becoming xiguan to eating less and less—and his family’s xiguan that
“eating” for Gandie designated decreasing amounts of food—served to
adjust expectations and helped them learn to cope with his decline and
to make the experience intelligible, if not acceptable. Conversely, his ill-
ness and his changing ability to eat spurred a culinary reaction among his
close family, as they invested in special treats usually beyond their xiguan.
Erjie, who was otherwise rather frugal about food,12 prepared soup from
two of her ducks and bought doufu and fresh meat for her father. Sons
and daughters made more frequent visits and brought him some of his
favorite foods, such as duck or grapes. Finally, although diet for other
family members did not change considerably and Erjie remained unwill-
ing to spend money on food, comments on which foods one should and
should not eat during a cold or a stomachache increased considerably.
An increased alertness to the effects of food on health was also clear
among Uncle Wang’s family. Upon my first visit to Aunt Zhang’s (Uncle
Wang’s wife) after his death, her account of his final days seamlessly
flowed into reflections on food and advice on keeping healthy: “I tell
you, you have to take care of yourself; if you can’t eat something, you
just have to say. And even if you’re hot, don’t take any clothes off, you’ll
catch a cold. Remember, at home rely on your parents, away rely on
your friends. Don’t eat chilies—it’s not good for women anyway. And
don’t eat sweet potatoes, because you’re not used to it. . . . See [showing
me an infection on her lip], this is because I didn’t eat enough meat.”
Her daughter intervened: “You have to eat, Mom—what are you doing
not eating meat? You must buy some and eat well” (November 4, 2004).
Much of Aunt Zhang’s knowledge that had remained dormant until
then surfaced after her husband’s death. Her understanding of his illness
is primarily linked with eating habits and with wider self-care practices.
In turn, her husband’s illness made Aunt Zhang more attentive to her
own and her family’s eating practices. This was made easier until after
New Year because her daughter-in-law, Pengjie, was home to help her
with work and made trips to the township (one hour’s walk) to buy some
meat and vegetables. Temporarily eating better food (i.e., more fresh
meat and doufu and a wider variety of vegetables) materialized Pengjie’s
care for her mother-in-law and her daughter. It also served to comfort
them as they coped with their loss. Eventually, however, after Pengjie
returned to Guangdong to work in a shoe factory, the daily work routine
made it unfeasible for Aunt Zhang to make frequent trips to the local
Xiguan, Consumption, and Shifting Cancer Etiologies 157
market, and therefore she and her granddaughter relied mainly on their
own produce. At that time of the year (post–New Year), few vegetables
grow at all, and Aunt Zhang had stopped farming most of her hillside
land since her husband’s illness, leaving them with very few vegetables.
Without a journey to the market, they ate salt-preserved cabbage leaves,
turnips, cowpeas, and salt-preserved pig fat, as they had done routinely
before Uncle Wang’s death.
Experiences of cancer in the family affected not only perceptions
of eating but also patterns of care within the family and the propen-
sity to make trips to the doctor. Scared that her discomfort might be
the start of cancer, Erjie had an endoscopy to reassure her that her
stomach was healthy. Her husband was very supportive during the final
three months of his father-in-law’s illness. He missed a few days of work
when Erjie’s flu was serious, staying home in order to cook and wash
for the family. Her husband’s father was also taken to the hospital for
a checkup because he too had a tendency to get angry. Overall, Erjie
and her husband’s attitude to illness changed rather radically, and they
became more prone to hospital checks. As a deeply affecting experi-
ence, Gandie’s illness and death had the power to change his family’s
attitudes about their own health and practices of health maintenance.
Whether this has been sustained in practice in the years following his
death is hard to determine without the benefit of long-term follow-up
fieldwork. Certainly during my monthlong return visits, the legacy of
Gandie’s death remained clear in Erjie’s attitude toward her own health
and in her concerns about her mother’s health.
The practical logic of the family’s encounter with cancer (cf.
Farquhar 1994, passim) at once draws on existing knowledge (eating
constitutes health) but also generates new conditions (a change in eating
patterns) and thus produces perceptions (new definitions of eating) and
practices (preparing special treats and visiting doctors) that are adjusted
to those conditions. By affecting such changes, cancer poses a challenge
to previous parameters of eating, but at the same time new attitudes
rely on a repertoire of what is considered desirable and feasible. This
delineates xiguan as produced in the past but also actively engaging with
the present. Xiguan, rather than being preexistent, is more productively
understood as made through practice, always in the process of being
constituted through people’s engagements with new contexts. This was
indeed the case with Gandie’s and Uncle Wang’s cancer. Their families
158 Making Sense of Cancer
Note: Value: Where there are two values, these refer to the two townships in Cangxi county
that were involved in the CTSU study. Values in the more recent study are categorized
differently and could not be compared to those of the previous study. Ranking: The ranking 1
to 4 refers to the four categories within which the study’s findings fall, with 1 meaning lowest
and 4 meaning highest consumption of a given food or incidence of a type of disease.
160 Making Sense of Cancer
were sometimes random but always started by the host. On more formal
occasions, such as banquets with village officials, the host would start by
toasting the most honored guest and then proceed through guests in a
clockwise order, starting from the guest to his or her right. When he or
she had toasted all guests, the guest to his or her right would follow suit
and so forth until every diner had toasted and been offered a toast by all
others. Toasts would typically require one to ganbei—empty one’s glass.
Not emptying one’s glass would be considered a sign of lack of polite-
ness and manners (meiyou limao), nearly as bad as not reciprocating one’s
toast by in turn toasting others. In some cases, the most respected guests
or best friends toasted each other to drink three or six glasses, in which
case reciprocity required returning the toast in equal numbers.
As many Baoma men took on daytime jobs in the nearby city as
builders and carpenters, they had occasion to observe urban drink-
ing routines and occasionally to take part in them. According to their
accounts of drinking in the city, accounts by city dwellers, and my own
experience of both, pressure to drink among urbanites was incom-
parably higher than that characteristic of their rural counterparts.
For the former, toasting rituals were typically more elaborate and the
gender gap less prominent, especially among the younger generation.
My acquaintances and friends in Langzhong city declared their city’s
drinking culture to be particularly fierce. Whether or not this is objec-
tively true, their self-perception as heavy drinkers is in itself significant.
Drinking culture in Langzhong was so notorious that a few friends from
the nearby city of Nanchong refused to ever visit Langzhong for fear of
being toasted beyond repair.
I sometimes joined banquets and singing parties held by employees
of the People’s Hospital, including both doctors and high-level admin-
istrators. The drink of preference for them as for city dwellers more
widely was beer rather than baijiu, and the pressure to drink was much
stronger, both on me and among them. They explained that it was nec-
essary to drink with work colleagues, especially managers, in order to
secure promotion. The deputy head of the hospital claimed he had to
drink with colleagues to secure good relationships that would place him
in a better position to serve as the future hospital head (which he was
as of 2008). A man who was divorcing his wife stated he had to drink
with his managers to ensure he would be allocated a good flat in the
hospital block once he separated from his wife. Health grounds were
Xiguan, Consumption, and Shifting Cancer Etiologies 161
attitudes toward these activities. Where men see smoking and drinking
as part of their customs or habits (xiguan) and therefore as unavoidable
activities, women who by and large do not engage in these activities
combine this well-established perception with a biomedically derived
awareness of the harm of tobacco and alcohol. When and whether they
attribute cancer to these (and other) competing causalities depends on
whether it helps them to reconstitute a moral world in the face of illness
and death. Doing so is a vital part of their practices of care for cancer
patients and for each other.
deal, you can still eat it (Mei shazi, you fa chi)”18 (a frequent claim). Erjie
also referred to the common saying “bu gan bu jing bu sheng bing” (literally,
“[living in] dirty [conditions, one] does not fall ill”), to argue that eating
dirty food might be a healthy practice (a frequent claim). In some cases,
villagers might feel they are too poor to afford to waste food, even if it
is moldy. For the majority, however, the lack of experience of adverse
physical symptoms after consuming moldy food predisposes them to
avoid wasting it.
Among city doctors and young villagers, it was widely held that
preserved foods might be a cause of cancer, as they were not fresh and
their consumption was inversely proportional to dietary variation. An
official at the Public Health Bureau explained cancer incidence as fol-
lows: “Research in the 1980s suggested that cancer was due to preserved
vegetables. Originally we like eating those here, you know? But the
method for making them has changed. Before they used to be soaked
and kept in a pot, then taken out and washed, so their nitrite content
Figure 5.3 Greens hanging to dry before they are preserved in salt; in the
background, an “old-style” mud and bamboo house (2004).
166 Making Sense of Cancer
was relatively high, but this harmful way of making preserved vegeta-
bles changed; now these vegetables cannot be found in the countryside”
(April 2007).19
Despite his claims, this is precisely how Baoma villagers prepare the
vegetables they eat every day. But villagers were typically skeptical as to
the harmfulness of preserved vegetables. This attitude was sometimes
tied to local perceptions of the influence of fertilizers and pesticides on
the development of cancer (see chapter 3). Following these principles,
many villagers explained, “I eat preserved (suancai) and pickled vegeta-
bles ( paocai), because they contain less chemicals (nongyao)” (a frequent
statement). As was the case for moldy vegetables, the harmful effects of
preserved vegetables would sometimes be dismissed by referring to vil-
lagers in perfect health who consumed them regularly.
I have explained that villagers undermine the certainty of harm-
fulness of particular practices by referring to “Uncle Norman,” a fig-
ure I borrowed from Pat Caplan’s study of diet in the UK. While this
approach accounts for individual behavior, it fails to examine its social
context and conditions of production. Indeed, it is a particular type
of habitus that fosters a predisposition to notice certain characteristics
of “Uncle Norman” in the first place and to consider a particular life-
style as healthy. As we have seen, the naturalization of living conditions
characterized by food shortage (locals becoming accustomed to it) pro-
duced an attitude whereby access to food in itself constitutes health and
a concomitant equivalence between eating and health. In the specific
case of preserved vegetables, a similar dynamic is at play. In Bourdieu’s
terminology, Gandie and those who endured famines and food short-
ages acquire a “taste of necessity” (1984, 177). This, argues Bourdieu,
is the outcome of endeavors to reproduce labor power at the lowest
cost, as was incumbent upon China’s older generation, especially dur-
ing the famine but also since then. In turn, it produces a taste for the
most filling and most economical foods. In the case of rural Langzhong
and much of rural southwest China, this consists of rice or noodles and
salt-preserved vegetables.
While taste for these foods may initially be shaped by economic
conditions, it remains even when such conditions would allow access to
a more varied diet. As Bourdieu puts it, taste is not the simple product
of economic necessity; rather, “Necessity is fulfilled, most of the time,
because the agents are inclined to fulfill it.” Taste is “amor fati, the choice
Xiguan, Consumption, and Shifting Cancer Etiologies 167
Conclusion
This chapter is intended as a backdrop to more detailed analyses of
Gandie’s case in the chapters that follow. Through a close account of
the case of one cancer sufferer and his family, I have outlined how fam-
ily relations were constantly worked on through everyday practices such
as visiting Gandie and offering him food and by his relatives’ changing
eating routines. Experiences of cancer change in the course of illness.
As Gandie’s case shows, practices of care and attitudes about illness and
healing are never given: his family’s views on the effects of his eating,
drinking, and smoking and his temper were constantly redefined in light
of new contexts. Past experiences—for instance, of Gandie as a mighty
drinker and a hearty eater—formed the background through which cur-
rent experiences were understood. At the same time, new experiences
(of Gandie’s decreasing ability to eat) created new parameters. Xiguan,
according to which eating and health are equivalent, is revised in light
of new experiences and takes on a different connotation in a period of
relative prosperity. Epidemiological etiologies such as consumption of
tobacco, alcohol, and preserved vegetables are embraced when they are
morally feasible and productive and rejected when they result in blam-
ing the victim. Their adoption also articulates a commentary on past
and present moral economies.
It is widely accepted in medical anthropology that a serious illness
is a moral event (see, for example, Good 1994; Kleinman 1980, 1986,
170 Making Sense of Cancer
resumed after Gandie’s death. After her father’s death, Erjie reflected
upon the undesirability of her husband’s and daughter’s rash temper
because it could lead to illness as it had done for her father (see chap-
ter 4). Smoking and drinking also shifted from being signs of health
to being potential causes of cancer. After Gandie’s death, Erjie some-
times followed me while I carried out semistructured interviews. This
included questions on drinking, smoking, and cancer (see appendix 1).
When I questioned a neighbor locally famous for smoking and drink-
ing heavily, Erjie cautioned him: “You better watch out—my dad was a
big drinker and smoker, and he died of cancer!” ( July 20, 2005). While
Erjie never made such claims when her father was alive, months later
she stated that drinking and smoking were factors in the development of
cancer and possibly for her own father too.
The reasons for this shift are inseparable from the reproduction of
a moral order in the face of illness. Like Balshem’s informants, since
Gandie realized he was ill, he and his family shunned any attempts at
explaining why cancer had affected him. During illness, relating the
development of cancer in a family member to specific events in his or
her life would be immoral; it would, as Balshem explains, imply that he
had brought cancer upon himself. Evading such connections served to
avoid any possible blame being attributed to him. And yet cancer suffer-
ers and their families do not reject biomedical ideologies outright, nor
do they do so for the strategic purpose of opposing hegemonic ideology,
as Balshem would have it. Indeed, after the sufferer’s death, searching
for an explanation becomes acceptable and desirable. These explana-
tions may rely on epidemiological knowledge, such as in the case of
smoking or drinking, or survivors may search for morality by tracing
cancer to traumatic events and the propensity to get angry. Indeed,
after Gandie’s death, his family began to link his cancer to specific ele-
ments of his biography such as smoking, drinking, and anger. As Linda
Hunt puts it, his relatives strived to compose a “unifying interpretation
capable of giving the disease coherent meaning by relating it to other
problematic events” within his biography (1998, 310). Factors associ-
ated with the development of cancer therefore change in the course of
its development, and identifying any of them as the culprit is revealing
of locals’ perceptions of and active engagement with their past, present,
and future. Etiologies are strategic and situational. Whether they avoid
explanations or search for them, sufferers and their families produce a
Xiguan, Consumption, and Shifting Cancer Etiologies 173
moral commentary not only on the sufferer’s life but on the past and
present contexts more widely.
Arthur Kleinman (1995) argued that social suffering is situated
between collective and individual experience. Cancer in rural Langzhong
may be understood as a form of social suffering to the extent that the
ways in which it is explained draw on both individualized and social
causes: drinking and smoking are individual habits as much as they are
a prerequisite for fostering relationships. Eating preserved vegetables
is a family’s choice of diet as much as it is rooted in historically molded
taste and current attitudes toward market food. Situated as they are
at the intersection between individual and social experience, these causal-
ities play a crucial role in attempts by both sufferers and their families to
rebuild morality. These causes of cancer are rooted in xiguan, but they are
not simply unchanging habits. They embody new connotations as their
contexts change. In the present, smoking and drinking are seen to be all
the more necessary as means of securing relationships. These xiguan are
not legitimated only because they are long-standing but because of their
role in the present. Cancer is experienced as a disease of production
in its link with hard work but also as a disease of consumption—both
excessive and deficient. Cancer etiologies are temporal formations, both
in a micro- and in a macrohistorical sense. Macrohistorical forces were
hinted at briefly with reference to the different roles of preserved vege-
tables in past and present cancers, and I will refer to them more in chap-
ter 7. This chapter has focused mostly on microhistorical changes—that
is, changes I observed during the course of illness. At stake in these
etiologies is the negotiation of local moral worlds where cancer may be
understood as an illness with both individual and social facets.
Part 3
Strategies of Care
and Mourning
Chapter 6
Performing Closeness,
Negotiating Family Relations,
and the Cost of Cancer
On November 24, 2004, Erjie and I set out after lunch to visit her father.
As we walked up the hill, we discussed her feelings of tightness in the
chest, which she experienced frequently since her father was diagnosed
with cancer and she regarded as a consequence of the tension exacer-
bated by his illness. To ease her anxiety, she brewed lotus seed hearts in
hot water, as advised by a trusted city practitioner recommended by her
neighbor. They were expensive and rather bitter, but they made her feel
calmer, so she bought some for her mother, who had been experienc-
ing a similar discomfort. As we approached Gandie’s house, dogs from
nearby yards barked loudly, alerting the neighborhood to our presence.
Gandie’s wife, Ganma, walked toward us and welcomed us. On this
occasion we were not the only visitors, as was usually the case. Gandie’s
seventeen-year-old grandson, Guoyun (his second son’s son), had just
returned from Fujian (in southeastern China), where he worked in a tex-
tile factory. He had been away from home for over a year. Erjie’s elder
sister had also taken the afternoon off from her job as a cleaner in a city
hotel to visit her father. The small room where Gandie rested had bare
concrete walls, adorned with only five family photographs arranged
within a single metal frame and a poster-size calendar courtesy of the
phone company, China Mobile. Few pieces of furniture filled the room:
the four-poster bed where he laid most of the time and where he and
his wife slept, a wooden bench that could be flattened out to become
a bed, and a large wooden storage unit on which rested a black and
white television. Scattered near it were some penicillin pills and pro-
cessed Chinese medicine sachets, which Ganma took to cure her flu,
178 Strategies of Care and Mourning
Medical Costs
The initial hospital checkup, when Gandie was diagnosed with cancer,
cost roughly 200 yuan. In November, Erjie and her brothers claimed
that their father was taking medications (pills and intravenous drips)
that cost 100 yuan per day. I could not establish clearly what medicines
Gandie was taking. When I inquired with staff at the People’s Hospital
in July 2005, I was told that the drugs most commonly used in hospital
treatment of esophagus cancer were as follows:
• Chemotherapy:
– Carboplatin injection: This cost 43.2 yuan per shot, and six shots
are administered per time. A course lasts two to four times. The
cost of treatment per day is 259.2 yuan, and total cost is between
518.4 and 1,036.8 yuan.
Family Relations and the Cost of Cancer 181
– Cisplatin injection: This costs 20.6 yuan per shot, and five shots
are administered per time, once a day for at least three days. The
treatment is repeated every three weeks for three or four times.
Cost of treatment per day is 103 yuan, 309 yuan for a course,
and total cost is 927–1,236 yuan. In all likelihood, Erjie referred
to this drug when she claimed her father was taking medication
for over 100 yuan per day in December 2004.
– Fluorouracil injection: This costs 1.6 yuan per shot, and three
shots are administered per time, once a day, for at least three to
five days. The treatment is repeated every three weeks for three or
four times. Cost of treatment per day is 4.8 yuan, 14.4–24 yuan
per course, and total cost is 43.2–96 yuan.
– Paclitaxel injection: This costs 316 yuan per shot (6 mg), 180 mg
administered (i.e., thirty shots) each time, and it is taken for three
to four weeks. Cost per day is 9,480 yuan. This is among the
most expensive of esophagus cancer drugs, used only by those
covered by insurance or extremely wealthy.
– Tegafur injection: This costs 18.5 yuan per shot (40 mg), and
dosage (15–20 mg/kg) depends on body weight. It is adminis-
tered once a day, and 20 to 40 g constitutes a course. For a body
weight of 60 kg, for example, the cost is 1,110 yuan per daily
shot. The cost of full treatment is 9,250–18,500 yuan.
• Patent Chinese medicine against cancer (kang’aiping) costs 68 yuan
per bottle. One bottle lasts a week, and there is no limit to the length
of treatment. The most important ingredients are Scutellaria barbata
(banzhilian), Rabdosia eriocalyx (xiangchacai), and herba Duchesneae indi-
cae (shemei).
In 2005, the hospital bought these drugs for the above prices, less 12
percent, according to a party directive. Prices for these treatments were
fixed, unlike for other medicines such as penicillin, which could cost
between 2 and 12 yuan depending on where it was bought and on the
brand name (interview with head of financial department, Langzhong
People’s Hospital, July 2005).
Considering the costs of the above medications and the types of
claims made regarding the pattern of Gandie’s treatment (having drips
irregularly), it is likely that he took carboplatin, cisplatin, fluoroura-
cil, and Chinese medicine. Based on the figures cited, this would have
182 Strategies of Care and Mourning
son 100 yuan—a total of 300 yuan. The family was outraged but had
to accept. Erjie explained: “It costs 800 yuan to be cremated. . . . In the
past, we didn’t have to cremate in the countryside. It’s all because of
money—they [the officials] only want money. Whether you cremate or
not, you have to pay: if you do, you pay the cremation company for the
service; if you don’t, you bribe officials to keep it quiet. What kind of
country is this? You tell me!” (March 20, 2005). Erjie’s narrative extends
the link between illness, state policies, and corruption to burials. It is
hardly surprising, then, that local people often went to great lengths to
keep illness (and death) secret. By doing so, they hoped to bury the body
without fines or cremation.
Among the financial flows entailed by illness and death are the
incoming amounts presented as gifts to Gandie. Since realizing he had
cancer, Gandie kept a note of all gifts offered to him, most of which
were financial donations. The highest came from his grandson, Guofu,
a migrant worker who did not attend the funeral but offered 200 yuan
to his grandmother through his parents. Standard donations were of 20
to 50 yuan from relatives and some friends and neighbors. When the
gift was an object, Gandie entered the item (for instance, a clock), the
person who presented it to him, and its value (20 yuan). Many dona-
tions were offered to his wife on the day of his funeral. In total, Gandie
(and his wife) collected over 1,000 yuan in monetary donations over
four months from roughly thirty families, including close relatives (about
500 yuan), distant relatives, and acquaintances (also 500 yuan). Since
my estimate of costs covers the extended family, I will subtract contribu-
tions from outside the extended family (approximately 500 yuan) from
the total expenditure on cancer (fig. 6.2). Although not relevant to the
estimate of the costs by the extended family as a whole, transfers of
capital, gifts, special food treats, and help (for example, taking Gandie
to the hospital by motorbike) offered to Gandie by his children and their
families are of vital interest for understanding family relationships. I will
examine these next.
does not, however, imply that all those involved invested equal amounts
nor that these transfers took place harmoniously and without routine
disagreement and resentment. When asked directly and in the presence
of other family members who was paying for Gandie’s treatment, his
sons replied that they were all contributing toward it.2 Privately, how-
ever, they voiced growing discontent about what they perceived as inad-
equate care by other members of the family. The extent and kind of
engagement with Gandie’s illness varied for different family members.
Day-to-day care was mostly shouldered by Ganma, though Gandie’s
three sons all lived nearby and could easily visit every day. Except for
the eldest son, Dage and his wife, Dasao, who were full-time farmers, his
two other sons and their partners held menial occupations in Langzhong
city. Gandie’s second son, Erge, worked in a pig-slaughtering business,
and his wife was an attendant in a hotel. His youngest son worked with
his wife in a small food shop. As a consequence, they had time to visit
their father only in the evenings. His eldest daughter lived relatively far
(ten minutes by bus followed by a thirty-minute walk) and also worked
as a cleaner in Langzhong city, but she still visited at least once a week.
His younger daughter, Erjie, lived only a half-hour walk from her father
and had no paid occupation; thus she could visit more freely. When
they visited, his children brought Gandie and his wife some food treats,
especially sugar or honey as his condition worsened. Erjie’s daughter
visited Gandie on weekends, but she spent little time in the room and
welcomed the opportunity to watch TV with her cousin undisturbed by
her mother.
It is probable that Gandie’s eldest daughter, sons, and daughters-
in-law occasionally took days off work, and they all did in the final
few days before his death. The total cost of lost working hours is likely
to have amounted to 1,000 yuan at the very least. Erjie’s husband
missed a total of ten days of work to visit his father-in-law and care for
Erjie when she was sick. Since he earned 30 yuan per day working in
Langzhong city as a carpenter, this totaled 300 yuan. Further costs were
entailed by Erge’s son, Guoyun, returning home from Fujian to visit his
grandfather. The journey cost 500 yuan, and he lost roughly 300 yuan
in earnings. Guoyun also returned home for the funeral, which cost
600 yuan, and his lost working hours added up to roughly the same
amount. His behavior was in stark contrast to that of Gandie’s eldest
grandson, Guofu, who had been home in July 2004, around the time
Family Relations and the Cost of Cancer 189
when Gandie was diagnosed with cancer, but failed to return until July
the following year.
Both of Gandie’s grandsons who were of working age manifested
care toward him, albeit in opposite ways: one by returning home twice,
the other by continuing to work and sending a large financial contribu-
tion (200 yuan) toward the funeral. This divergence may only be under-
stood with reference to the particular personal situation of the two
grandsons. Guoyun was unhappy about his work in Fujian and wanted
to look for a new job. He had trained as a tailor but had been unable to
put his training to good use. Indeed, after working in Shanghai for three
months (November 2004 to January 2005), Guoyun returned for the
funeral and found work in Chongqing through family friends. Guofu,
by contrast, seemed to have a stable occupation in Shenzhen since July
2004. More crucially, his troubled relationship with his parents dis-
couraged him from returning home. Under pressure from his parents,
Guofu had married a local woman in 2002. Guofu and his wife did not
establish a separate household as is common in rural Langzhong. In
2003 they had a daughter. Whenever together, the couple argued con-
tinuously and Guofu complained that his wife was not good-looking (bu
piaoliang) and that he wanted to divorce. His parents did not agree and
demanded that he return home to mend his relationship with his wife.
Guofu threatened that if they did not allow him to divorce, he would
simply never come back. During Gandie’s illness and at the time of his
death, the disagreements remained unresolved.
Guofu and Guoyun’s different relationships to their families may
account for differences in their chosen paths of caring for their grand-
father. This divergence also became a channel for disputes among
Gandie’s offspring concerning how best to care for him. The eldest
brother Dage noted that Guoyun’s wish to migrate in search of work
and yet not finding something suitable meant that instead of supple-
menting his family’s income, his parents had to subsidize his two vis-
its home. This in turn weakened their capacity to assist with Gandie’s
expenses. Dage defended his son Guofu’s decision not to return home as
financially sound and morally upright toward his grandfather, because
it provided financial resources to pay for Gandie’s treatment. Guoyun’s
parents, predictably, condemned Guofu’s decision and commended
their son’s willingness to spend his savings on returning home to visit
his grandfather. New challenges to parental authority (see Y. Yan 2003)
190 Strategies of Care and Mourning
and I visited Gandie’s village only during the daytime and walked home
before dark, which meant we rarely met her brothers and sisters-in-law,
who worked in the nearby city. Though Ganma reported instances of
discussions and arguments between them, I had little occasion to wit-
ness them firsthand. I became more familiar with the complaints voiced
by Dage and his wife, Dasao, who were at home during the day. They
were critical of the limited support they felt the youngest brother, Sange,
and his wife offered. They felt that they were by far the most generous in
providing the occasional food treats of doufu and pork rib soup and that
they offered the most help for the day-to-day care and expenses. When
Gandie needed to visit a clinic in the city, for instance, Dage would take
him on his motorbike. Dasao often remarked to me that were it not
for them, Gandie and Ganma would be on their own, both financially
and emotionally. By claiming to endure the most hardship in caring for
Gandie and Ganma, Dage and Dasao iterated a complaint typical of
the oldest son’s family. But by declaring their hardship, they also laid
claim to a moral high ground. Conflicts between daughters-in-law and
allegations that some share less with their in-laws than others are well-
known features of Chinese family life (see, for example, M. Wolf 1968).
Here, they inform the ways in which care during illness is understood
and contested. As noted in chapter 4, Dasao partly blamed Gandie’s
cancer on Sansao for making him angry. In doing so, Dasao portrayed
herself as a dutiful and caring daughter-in-law. Similarly, by emphasiz-
ing the disparity between her care toward Gandie and Sansao’s alleged
disregard, Dasao defined what constitutes care (daily visits, offering
food, and help with travel), reinforced her relationship with Gandie and
Ganma, and presented herself as morally upright. As the eldest son and
daughter-in-law, Dage and Dasao claimed authority in both defining
care and defining who is caring.
Dage and Dasao’s assertions that they were the most caring—and
their implicit claims to authority as the eldest in the family—did not go
unchallenged. Erjie often disputed Dasao’s complaints that she endured
hardship to care for Gandie and Ganma by pointing out that she also
received much help from Ganma. Ganma regularly cared for Dasao’s
granddaughter (her great-granddaughter Yumei), so that Dasao could
fully engage in farmwork. Indeed, on a few occasions Erjie invited her
mother to visit her, but Ganma replied that Dasao did not allow her
to leave because she needed help with child care and farming. At the
192 Strategies of Care and Mourning
other end of the spectrum, Erjie shared Dasao’s contempt for Sansao,
who, despite sharing her house with her in-laws, rarely spent time with
Gandie and Ganma. The reasons for and consequences of their scorn,
however, differed. While Dasao derived authority from disparaging
Sansao, for Erjie criticisms of Sansao were an occasion to compare her
own situation with Sansao’s and Dasao’s. Erjie was ambivalent toward
Dasao because, though she cared for her in-laws, she received much
help in return, and she was contemptuous toward Sansao because she
offered no help. By contrast, Erjie felt that she mustered no help at all
from her own in-laws, while she offered them much assistance with
farming. As Gandie and Ganma’s daughter, Erjie was critical of both
Sansao and Dasao (she seldom spoke of Ersao) but also envious of the
help they received from their in-laws. This envy highlighted her plight
with her own in-laws.
As Gandie became weaker and Ganma refused to arbitrate dis-
putes between siblings, the eldest brother and his family tried to impose
their authority on the younger siblings. However, as all sons shared the
responsibility to care for Gandie, there was ambiguity over who did
so more adequately and who had authority to determine how to do
so. Based on research in Hakka Taiwan, Myron Cohen (1976) argued
that Chinese families divide when there are suspicions of unfair ben-
efits between brothers. At such moments, conjugal solidarity overrides
solidarity between brothers. In this case, the families of Gandie’s three
sons had already divided, but as they were required to share equally in
caring for Gandie, they resembled the workings of a joint family. As
each of Gandie’s sons’ families offered different kinds of help, they all
disputed the appropriateness of others’ contributions. Margery Wolf
illustrated how ambiguity about who had authority in the Lim family
between the wife of the deceased first son and the second son caused
family conflicts. She wrote, “If, like his father, he [the second son] had
complete control and responsibility for all decisions in the family, the
content of his decisions might be questioned, but not his right to make
them” (1968, 143). As Gandie’s sons had to share care for their father
but were not in agreement on how to do so, they also encountered the
same ambiguity. In families with two sons, these ambiguities were less
prominent, as they each took care of one parent by ensuring that they
had staple food (rice and wheat) and that their health care costs were
covered. This still caused disagreements, but there was less ambiguity.
Family Relations and the Cost of Cancer 193
These arguments between Gandie’s sons over how to care for their
father were an important way in which they reproduced their relation-
ships with each other, their sisters, and their parents.
Care for Gandie, finally, was manifested through distress among his
relatives. Just as displaying grief at funerals reproduces family relations,
displaying physical discomfort and linking it to the illness and imminent
death of a relative embodies closeness. Distress linked to Gandie’s illness
may be perceived as a moral response to his suffering, an expression of
affection toward him that reinforced family relations among those who
shared similar discomfort. For instance, my experience of anxiety and
difficulty in breathing during the later stages of Gandie’s illness consid-
erably strengthened my relationship with his daughter Erjie, who was
experiencing similar symptoms. She and her mother understood this
to be a manifestation of empathy and care toward Gandie, and they
offered some of the remedies they took to ease their own discomfort
(penicillin and lotus seed hearts). As Erjie felt lotus seed hearts helped
with her anxiety, I reciprocated by buying more and offering them to her
and her mother. Veena and Ranendra Das have argued that in debating
illness, people also told of kinship relations—who helped and who did
not (2007, 69). Whether by visiting Gandie, offering special treats, or
falling ill through sympathetic distress, relatives embodied their attach-
ment to and care for Gandie and reinforced their relationship with him.
Parameters for what constituted adequate care differed, but all involved
endeavored to reproduce their closeness with Gandie and their iden-
tity as moral subjects. Examining the specific condition in which each
of them found themselves brings to light “local moral worlds” that are
“particular, intersubjective and constitutive of the lived flow of experience”
(Kleinman 1995, 123).
by contrast, had three sons, each of whom lived in recently built two-
story concrete houses, and each family had at least one wage earner (the
son in the eldest brother’s case). It is also likely that kinship solidarity
played a part. The village secretary, who would have reported the failed
cremation to the township authorities, was part of the same kin group;
provided the family did not host a major celebration, he could turn his
head the other way and pretend he did not know. The favor that others
had to buy from him financially could be secured by Uncle Wang’s fam-
ily through reliance on shared kinship.
Uncle Wang and his wife, Aunt Zhang, spent the previously esti-
mated sum of 2,000 yuan on his medications and 100 yuan on consult-
ing a local medium. Uncle Wang’s daughter lived only two hours away
by bus (50 yuan) and returned home for the funeral. As noted, his son
did not return home during his illness or for the funeral. His daughter-
in-law made the trip instead, which cost 600 yuan. Lost working hours
linked to Uncle Wang’s death might amount to 600 yuan, since the
rest of her stay can be seen as a New Year family reunion. Aunt Zhang
is likely to have spent 100 yuan on her own health, 50 on her grand-
daughter’s, and 100 on her daughter-in-law’s, including 50 yuan for
consulting a local feng shui master for her discomfort. Food treats might
have totaled only around 500 yuan at the most, considering they would
have mostly relied on the nuclear family of the sufferer (his son did not
return, his daughter-in-law returned only as he died, and his daughter
visited rarely). Costs for his funeral and subsequent rituals and banquets
might have amounted to 3,000 yuan. The total expenditure linked to
Uncle Wang’s death was thus roughly 7,100 yuan (see fig. 6.2).
As figure 6.2 shows, costs are extremely variable for each case. But
even the lowest levels of expenditure are a harsh blow to the family econ-
omy when compared to a normal expenditure of roughly 1,200 yuan
over the same period of time (six months) for a couple without a young
child (see fig. 2.6). Although the poverty faced by Langzhong farmers
was not as severe as it may have been in the past, the high financial cost
of cancer put families under strain. As with other illnesses that call for
expensive treatment, cancer-stricken families were often reduced to fur-
ther poverty and ultimately required to decide whether to invest in their
healthy members or in assisting the sick (see chapter 7).
Aunt Zhang and her husband had often pointed to the extortionate
expense of treating cancer, but after his death references to it became
196 Strategies of Care and Mourning
Usually we pay for it ourselves, but last year my son gave us money;
we spent thousands of yuan on my husband’s cancer. . . . At first we
bought medicine in the hospital, but it’s terribly expensive; you don’t
even dare go in, you cannot afford it. It’s cheaper elsewhere, like in
the township—it’s the same medicine anyway. . . . Doctor Wang [the
village doctor] doesn’t have those, though—they’re too specialized, so
they cost a lot. . . . I spent hundreds the first time; I didn’t even bring
enough money. . . . If it hadn’t been for my husband’s illness, we may
have bought a house in the city sometime. ( July 8, 2005).
the state. The top officials are still good, but the local ones only want our
money. They make us sign these documents saying that we have a cow
or a pig, so we pay tax for them when we don’t have any. . . . It all goes
in their pockets” (October 26, 2004).3
The relationship between people and officials or the state as it is
articulated by Uncle Wang and other cancer sufferers may be regarded
as a broader version of the relationship between the sufferer and family
members who care for him or her. In the latter case, as we have seen,
closeness is reproduced through practices of care that are diverse, but
all perceived to have Gandie’s health as their aim. People’s relationship
with the state also requires a display of care, in the form of welfare pro-
vision, in order to be maintained. Based on research in rural Guangdong
Province, Hok Bun Ku (2003) proposes that villagers regard reciprocity
between themselves and the state, which is at the basis of their rela-
tionship, to be largely unfulfilled. Villagers feel that social security and
welfare are owed to them by the state: they are the state’s responsibility
in order to maintain its guanxi with the people. Ku’s observations on
the unfulfilled responsibility of the state echo Uncle Wang’s sentiments
that “the state doesn’t care for me.” In criticizing the high costs of care,
Uncle Wang presented them as a symptom that the state does not care
for its citizens (see following chapter). Veena and Ranendra Das (2007,
87) state that the care in the family they describe in India is not intended
to be opposed to a neglectful state. In rural Langzhong, this opposition
was vivid in villagers’ minds and experiences. Certainly, before health
care reforms were implemented in 2006, the state was invariably seen
as neglectful. However, not all in the family were seen as equally caring,
nor were parameters for assessing care unified.
Conclusion
This chapter has outlined the span and diversity of costs precipitated
when families are struck by illness. From special birthday banquets, med-
ical treatment, special food treats, and mourning practices to lost work-
ing hours, journeys home, and treatment for close relatives distressed by
cancer in their midst, families are produced and reproduced through
diverse caring practices. Yunxiang Yan’s cogent ethnographic critique
of kinship’s role as a “gatekeeping concept” in Chinese studies warns
against an unquestioning attitude toward the family, its importance, and
198 Strategies of Care and Mourning
Perceived Efficacy,
Social Identities, and the
Rejection of Cancer Surgery
When I met her, Grandma Chen was a lively seventy-two years old,
although her life had been anything but easy. Born in 1931 in the vil-
lage neighboring Baoma, in 1949 she married Grandfather Li and—as
was customary—did not meet him until their wedding day. Grandma
Chen gave birth to five sons and one daughter, but two sons were still-
born and the daughter died in 1959 at the age of one, at the start of the
Great Leap Forward Famine. She recalled that from 1959 until 1961
there was practically no food, she stopped menstruating, her pregnan-
cies were troubled, and she had no breast milk. Her father-in-law beat
her often: “He beat me on the head with a stick when I was five months
pregnant,” she told me. Her mother-in-law was also abusive to her:
“Once, in the 1950s, I offered sweet potato to our guests, so she beat
me. At that time life was hard, we had no food.” A month after her first
son was born, in 1953, her husband joined the army to fight in Korea
and returned in 1957. Once back, he was violent toward her and had
an affair with a married woman who lived in the same production team.
Her mother-in-law (not her husband’s mother but his father’s second
wife) supported her at that time, and Grandma Chen remembered her
fondly: “Nobody hung her picture after she died—only I have. She died
in 1993 of ‘vomiting illness’—that is, stomach cancer. She couldn’t eat;
she would eat and vomit straight away—she died of starvation.” In 2005
her three sons and their wives were all migrant workers, except for the
eldest daughter-in-law, who was at home caring for her granddaugh-
ter and helping Grandma Chen with farming. She especially liked and
missed her youngest daughter-in-law, who had been away since 1999
Perceived Efficacy, Social Identities, and the Rejection of Surgery 201
and whose parents “both died of the ‘spitting illness’ [esophagus can-
cer]” ( July 10, 2005).
Reflecting on her health, Grandma Chen claimed, “My health is
good now, so I help others with farming. Once, a fortune-teller came
to see my daughter-in-law. I asked him how long I would live, and he
said I would die at sixty-two with ouqi bing [literally, “repressed anger ill-
ness”]. It’s nonsense” ( July 10, 2005). The following spring (April 2006),
at seventy-four, Grandma Chen was diagnosed with stomach cancer.
Having nursed her mother-in-law through the same illness and watched
her neighbor’s husband die of it three years previously, Grandma Chen
killed herself by drinking pesticide. When I visited in July 2006, her
neighbors surmised that she committed suicide to spare her sons the
expense of hospital treatment that cancer would have incurred and to
spare herself the pain she would have had to endure in the following
months. Under what circumstances did Grandma Chen become con-
vinced not only that treatment was unaffordable, but also that it was
unreliable, inefficacious, and therefore not worth investing in? This
chapter examines these two aspects in turn—financial barriers to access
Figure 7.1 Grandma Chen treats her neighbor’s backache with a folk version
of moxibustion to “expel damp” (2005).
202 Strategies of Care and Mourning
Gandie’s case, I show that the recent context of commodified care inter-
sects with locals’ past living conditions and social positions—including
the sufferer’s social standing, their gender, their position within the
family and the community, and their sense of duty and filial piety—to
configure cancer surgery as socially, culturally, and economically inef-
ficacious.2 Critically adopting Bourdieu’s concept of habitus, I propose
that Gandie’s rejection of surgery is both rooted in the past and actively
engaging with the present. These attitudes about cancer and coping
strategies produce a commentary on the overlapping models of moral
economy to which villagers resort in order to make sense of their lives.
With this backdrop, this chapter looks at some early reactions to
the implementation of RCMS, pondering the extent to which RCMS
has made a difference to perceptions of medical care and patterns of
accessing it. I argue that despite recent reforms to make health care
more accessible to rural dwellers, health care providers are still per-
ceived as putting profit before their patients’ well-being. In response,
villagers continue to avoid seeking hospital care, especially from prac-
titioners who have not been recommended by family or friends. A suf-
ferer’s social identity and relationship with his or her family, as we shall
see in Gandie and Grandma Qing’s examples, further reinforce this
reluctance to seek care. For as long as doctors are regarded as akin to
businessmen, state efforts to improve access to hospitals will continue to
be frustrated.
Phase three of Dong and Phillips’ chronology (2008) covers the time
span of early reforms (1977–1989) and is characterized by a general
commodification of health care.3 As a consequence of the transition
to a market economy, the available health care options have multiplied;
yet prices have risen rapidly, insurance coverage (including RCMS)
has declined, and user fees have been introduced or increased without
an adequate exemption system for the poor. Urban dwellers, likewise,
increasingly found they have to pay for their own care (Duckett 2007;
S. Wang 2008). The radical decentralization of financial responsibil-
ity to the provinces has exacerbated disparities between regions and
between urban and rural areas. With less funding devoted to the lower
levels of health care, village and township clinics have seen a shortage
of staff and decline in quality of care (Tang and Bloom 2000). As these
levels of care are the most accessible to rural Chinese because they are
cheaper and closer geographically, rural populations have suffered the
most from these changes. Access to secondary and tertiary sectors with
better quality of care is particularly problematic, as these were hit by a
sharp increase in cost.
As financing was gradually privatized, hospitals have increasingly
relied on sophisticated medical technologies and expensive drugs for
revenue (Fang 2008). This has entailed a huge barrier to accessing hos-
pital care for all those who cannot afford its direct costs (notably medical
care, tests, food, and loss of earnings) and informal costs (such as under-
the-table payments to hospital staff ).4 As a result, patterns of income
inequality have become key determinants of health inequalities, and ill-
nesses can precipitate a family into economic disaster, especially for rural
dwellers. An “interpersonal pattern of inequality in financial access to
health care” has also become more pronounced (Duckett 2007, 54).
The booming informal sector provides an alternative to formal care,
especially in the case of over-the-counter medicines, but it has not been
adequately regulated, posing problems of inappropriate drug consump-
tion as well as the sale of fake drugs (Segall 2000). Although the Chinese
government in the late 1980s made efforts to improve access to care
in rural areas ( Yu 1992), attempts to maintain or reestablish RCMS
were limited.
Phase four, the late reform period (1990–2002), was character-
ized by some attempts to provide more community-based health ser-
vices, though they were mostly unsuccessful. In 1994 the government
Perceived Efficacy, Social Identities, and the Rejection of Surgery 207
period, each county developed its own approach, and areas where only
inpatient coverage was offered had significantly lower coverage rates
than those where outpatient care was also offered. Cook argues that at
current levels of funding, based on pilots until 2006, RCMS had limited
impact and only against catastrophic illness. She concludes by arguing
that the central state needs to play a stronger role in funding this scheme
(2007). Whatever its actual shape and use, a report on November 27,
2008, on the official site of the Center for China Cooperative Medical
Scheme (CCMS) stated that the whole countryside was covered by
RCMS (CCMS 2008).
until 1957, and that it was available only in Langzhong city’s hospi-
tal, formerly established by Christian missionaries from Britain. Baoma
villagers were fortunate enough to have a renowned “senior Chinese
medicine doctor” (laozhongyi) based in the village, who provided Chinese
medicine treatment. Doctor Wang started training in 1966 by attending
short courses (over three months) in the county hospital and by serv-
ing as an apprentice for three years to the village’s laozhongyi, who was
also incorporated into the village health clinic. Between 1969 and 1975,
Doctor Wang explained, each villager would contribute one yuan per
year toward a village cooperative health care scheme. He added, how-
ever, that resources were scant: “We had only twenty to thirty shots of
penicillin, around a hundred pills, and some Chinese medical herbs.
Western medicine was too expensive, so we were told to rely mainly on
Chinese medicine. I tried to grow some medicinal plants, but the climate
is no good for that here. We were also told to use acupuncture, but people
didn’t want to” ( July 4, 2005). Prescriptions cost 5 fen (5 cents of a yuan)
for villagers and 2 jiao (20 cents) for outsiders, and payments would go
to the collective. The village health clinic was maintained until decol-
lectivization (which started in 1980 and was complete in 1981), when
the clinic was privatized and transferred to the barefoot doctor’s own
house and his title was changed from “barefoot doctor” to “village doc-
tor.” The village’s laozhongyi opted instead to open a clinic in Langzhong
city and earned so much money that he bought his son a house and
renovated one for his daughter. This, according to Doctor Wang, was
a reflection of how steeply the cost of health care escalated since the
onset of economic reforms. When I first settled in the Langzhong area
in 2004, it became clear that—as in the rest of China—the gap in quan-
tity and quality of health care between rural and urban areas was wide.
Langzhong city offered a great proliferation of medical services, ranging
from hospitals, clinics, and chemists to masseurs and street stalls selling
a wide variety of local herbal and animal remedies (such as silkworms
to cure rheumatism). In contrast, at the village level, there were only two
clinics: one along the public road at the hilltop, established by a young
local trained in Chinese medicine (and basic biomedicine), and one run
by the former barefoot doctor. For minor illnesses, villagers consulted
village-level doctors. In some cases, they consulted doctors from nearby
villages when they had connections to them or when these doctors were
recommended by neighbors or relatives.
210 Strategies of Care and Mourning
separate issue entirely) exacerbated villagers’ sense that they were not
entitled to the same quantity nor quality of care as their urban coun-
terparts.9 This provides a very concrete sense of the obstacles villagers
faced when accessing care, and it is an important element in discourag-
ing villagers from resorting to hospital care—and to surgery for cancer
as a particular case in point.
While no form of medical insurance was available to local villag-
ers during my initial period of fieldwork, the first post-reform RCMS
was introduced in Langzhong in December 2005 (two months after I
left the area), as it was designated to be one of the trial sites in Sichuan
(Langzhong Rural Health Care Cooperative Management Center
2005). The government contributed 30 yuan per person in 2006 and
40 yuan per person in 2007 (Langzhong county Health Bureau official,
April 4, 2007), a figure consonant with Cook’s findings (2007). Rates of
reimbursement also increased: while in 2006 one could receive 30 per-
cent for county hospital care, 40 percent for township, and 50 per-
cent for village care, in 2007 these rates rose to 40, 50, and 60 percent
respectively.10 According to official figures, in 2006 the RCMS joining
rate in Langzhong was 81 percent, and in 2007 it went up to 90 per-
cent (Langzhong Administrative Service Center 2008). In early 2008,
Langzhong’s mayor, Jiang Jianping, wrote in the Langzhong online
news ( January 4, 2008) that coverage was 98 percent and exhorted
an expansion of the scheme. A report published by Langzhong’s
Administrative Service Center on the same date stated that in 2007
(until November), RCMS had reimbursed 190,000 people for outpa-
tient treatment, amounting to over 3 million yuan, for an average of
16 yuan per person. Some 28,000 people receiving inpatient treatment
were reimbursed over 17 million yuan, for an average of 613 yuan per
person. Sufferers seeking treatment in the city’s hospitals had increased
to such an extent that in 2007 the corridors of the People’s Hospital
were lined with provisional beds, and by the end of 2008 a new hospital
building was completed to cope with growing numbers of patients.
To illustrate RCMS’s benefits, the report cites the case of a fifty-
three-year-old man diagnosed with a bladder tumor in 2006 who
was advised by the hospital to get prompt chemotherapy treatment
in the provincial capital, Chengdu. The total cost of treatment was
70,000 yuan. The patient is said to have received 10,100 yuan initially
in 2006 and a further 11,360 yuan in April 2008. While this is no doubt
212 Strategies of Care and Mourning
even for the most necessary and routine operation” (2000, 195). A simi-
lar avoidance of hospitals in Langzhong is due to perceived extortion
and cheating. It has been well known and debated both within and out-
side the People’s Hospital that doctors prescribe expensive treatments
to gain profit. Villagers and doctors alike maintained that some practi-
tioners prescribe expensive medications because they are bribed by the
company producing them, and this creates a widespread sense of skepti-
cism toward hospital care. As a friend working in the financial admin-
istration of the People’s Hospital remarked, “Before, doctors served
the people (wei renmin fuwu); now they serve the (people’s) money (wei
renminbi fuwu)” ( July 1, 2005). While this may be an overstatement and
a romanticization of the past, it is rather telling of how hospital treat-
ment and staff are perceived and has crucial implications for patterns of
resort and perceptions of efficacy. Villagers’ routine complaints about
the cost of previously more affordable and widespread treatments—
for instance, penicillin pills or cold remedies—indicate that objections
about the cost of health care are not simply due to an inability to afford
it; they are also attacks on the political economy that sustains it and on
the ideology that legitimates it.
These perceptions have major consequences for sufferers’ attitudes
to efficacy and, in turn, for their practices. Sufferers adopt various strate-
gies to identify adequate treatment and avoid being cheated into paying
more than is necessary. As an example, for flu doctors usually suggest a
number of different pills and capsules to be taken together. Villagers are,
in my experience, well informed about the cost of each of these pills and
often design their prescription with the doctor, when possible demanding
that the most expensive pills be replaced with less costly options. Another
widespread strategy is to obtain a prescription from the hospital and then
consult a more trusted doctor or chemist to establish whether there are
any cheaper alternatives without compromising too much on quality. At
any rate, villagers commented to me that they would never buy medicine
at the hospital, because the same or similar treatment is available at local
pharmacies or from the village doctor for less money. Treatment at the
city’s hospital lacked economic efficacy since it was assumed to cost more
without much (or any) improvement on the result.
These examples point to a clear correlation between trust in a prac-
titioner and beliefs about efficacy of the treatment prescribed. Local
knowledge and neighbors’ advice on which doctors had successfully
214 Strategies of Care and Mourning
resources or even by borrowing money. But they chose not to. Gandie’s
example will illustrate why this might be so.
Gandie was about to turn sixty-two when he was diagnosed with
esophagus cancer in October 2004. With three sons and three daugh-
ters-in-law, four of whom had paid occupations in Langzhong city, as
well as two migrant worker grandsons, Gandie’s extended family had
enough income to be able to afford surgery. As opposed to most other
villagers who were diagnosed late with cancer and did not have an oper-
ation, his family was advised that surgery did present some hope for
recovery. However, Gandie still refused to undergo surgical treatment.
A number of factors affected Gandie and his family’s perceptions of
cancer and of what constituted an efficacious treatment: his identity as
a “strong” man, his and his children’s filial piety, his experiences as a
former village cadre, experiences of past shortage, limited access to hos-
pital treatment in the past and in the present, and the current context of
commodified health care. I will examine each of these aspects to shed
light on how Gandie’s rejection of surgery both relies on and articulates
family relations and attitudes about the past and the present. These fac-
tors, I argue, were central to shaping the course of action Gandie and
his family took in response to cancer. They emphasize that access to
health care remains a thorny issue.
Gandie’s family and neighbors regarded him as a very healthy man,
and his cancer came to all as an unexpected shock. Still a very able
worker, his family felt that at sixty-two Gandie was neither “old” nor
weak. His confidence in his own strength probably delayed his admis-
sion that he was suffering and in turn delayed his visit to the county hos-
pital for a checkup. Initially, at least, his family thought he was healthy
enough to overcome cancer—he simply needed to stop getting angry
and anxious. This contributed to persuading them not to reveal the
diagnosis to Gandie (see chapter 4). The expectation that a strong man
would be in a good position to fight off cancer paradoxically worked to
his disadvantage. By the time Gandie realized he had cancer, he had
been in pain at least two months and had a clear sense of the deterio-
rating state of his body. This experience may have contributed to his
perception of his cancer as already too advanced to be curable and to
the conviction that surgery would not have long-term effects.
Once Gandie became aware of his cancer, his family promptly sug-
gested surgery. He alone was opposed to it. Gandie’s children’s insistence
Perceived Efficacy, Social Identities, and the Rejection of Surgery 217
surgery produced and embodied his responsibility (zeren) for the care for
the “wider self ” of his family ( jia), including all three sons, two daugh-
ters, and their families, who would have contributed money toward the
operation. It highlighted the contestability of what constitutes “filial
responsibility,” moral behavior, and family boundaries. This lack of
both cultural and social efficacy reinforced Gandie’s determination to
avoid surgery.
Gandie’s past role as a village-level cadre in the late 1960s and 1970s
further reinforced his sense of responsibility for the wider good. Having
managed the financial affairs of his village unit until 1981, Gandie had
long-term experience of administering public resources. He was praised
by his neighbors as a good cadre who looked out for the needs of the
local community and invested wisely in farming equipment for his “pro-
duction team.” Erjie liked to remark that because of her father’s careful
management of village resources, her natal village had electricity in the
early 1980s, whereas Baoma, only across the hill, had to wait another
decade. During the Cultural Revolution, he volunteered to host a rus-
ticated worker for over a year and treated him like “one of the fam-
ily,” ensuring that he was given the best food on their table (Gandie,
November 1, 2004). He was repeatedly invited to become village party
secretary, but he refused to do so. He explained to me this would have
been too troublesome and would have involved giving and taking bribes,
something he stated he had never done and was not prepared to do.
Deema Kaneff has shown that in postsocialist Bulgaria, personal
biographies influenced the ways in which people related to market activ-
ities. She described how one informant who used to be openly engaged
with Communist Party activities (as a member of the party) found
it shameful to be seen in the market. For the former party member,
“having espoused beliefs all her life which negated market activity and
supported a work ethic based on engagement in the sphere of state pro-
duction, her relatively recent participation in the market came at a cost,
namely feelings of shame and guilt” (2002, 40). Also a party member
and a village official during collectivism, Gandie regarded marketized
and extremely costly hospital treatment with suspicion. His commit-
ment to his community earned him the respect of his neighbors and a
certain social standing, qualities he was keen to maintain. Transposing
his past experience of managing limited funds for the public good to
the present, Gandie was unwilling to require a large investment toward
Perceived Efficacy, Social Identities, and the Rejection of Surgery 219
for the likes of us’)” (Bourdieu 1977, 77). Through habitus, aspirations
are adjusted to expectations based on the perceived probabilities for
success. Because of their habitus, therefore, people become predisposed
to select life trajectories that do not contradict (or exceed) their expecta-
tions. Having lived in a setting where hospital treatment has been histor-
ically and is largely still unthinkable, Gandie was predisposed to make
what is probable (absence of hospital treatment) into reality (Bourdieu
1990, 54). Even though his socioeconomic conditions had changed, his
disposition to avoid hospital treatment had outlived the conditions that
produced it.
In her famous ethnography of Brazil, Death without Weeping, Nancy
Scheper-Hughes portrays mothers who have to allocate scarce resources
to children most likely to survive and avoid mourning those who are
“de-selected” to die (1993, 2008). Although the poverty that villag-
ers in Langzhong faced may not have been of the same extent, when
affected by cancer they adopted a similar attitude. This outlook was
particularly pronounced for rural families. The father of a close friend
in Langzhong city, only a few years younger than Gandie, has been
fighting with cancer for some years, having had a number of opera-
tions and ongoing chemotherapy. His daughter reasoned that he had
survived it only because of his spiritual strength ( jianqiang ). Except for
the very early days of Gandie’s illness, however, neither he nor his fam-
ily thought that any amount of spiritual strength could save him from
inevitable death. This divergence is no doubt at least partly rooted in the
unequal access the two men and their families had to health care. These
structural differences in experiences with health care fostered differing
views of illness and its future: while in the urban case some measure
of hope was present, in the rural case of Gandie such hopes were pre-
cluded from developing.
A further example may illustrate this. A twenty-nine-year-old
woman who lived in Langzhong city and ran a small bar with her hus-
band was diagnosed with cancer in late 2007. According to her hus-
band’s friends, it was already so advanced that not only were doctors
unable to operate, they were also unable to determine where cancer had
originated. In the coming months, her husband routinely took her to a
large hospital in Chongqing, roughly five hours’ drive from Langzhong,
for chemotherapy. Very early one morning the following summer, a few
hours before I had arranged to meet her, she threw herself out of the
Perceived Efficacy, Social Identities, and the Rejection of Surgery 221
to only a few villagers (having been a cadre during the collective period),
most of them are broadly relevant to those his age and older, particu-
larly “traditional customs” toward surgery, past structural conditions,
the experience of shortages, and having to carefully manage resources.
The processes that led to his rejection of surgery are therefore likely to
be similar to those that affect middle-aged and elderly villagers at large.
While in some respects rural and urban dwellers may share attitudes
toward illness, care, and death—for example, a cultural preference for
dying at home—villagers regarded commodified health care as affect-
ing them in particularly adverse ways. As a consequence, the reluctance
to seek formal and expensive care is widespread among villagers, espe-
cially the elderly.
among residents of village units closer to the houses of the village secre-
tary, village head, and village doctor, two of whom also share the same
surname. This physical and kinship proximity to the village cadres and
the village doctor ensures better access to villagers and fosters higher
levels of trust, which might explain the discrepancy in joining rates.
During my initial research on RCMS in July 2006, Baoma villagers
felt that the scheme was a swindle ( pian ren de) and fake ( jia de), no dif-
ferent from all the other fees officials imposed on the local population
to extort money without offering any real benefit. Since the RCMS was
initially perceived to be administered by the village secretary, experi-
ences with other fees, which fomented mistrust and resentment toward
him, extended such mistrust to the RCMS. A few examples illustrate
this. The central government introduced a law to lift the agricultural
tax and all arbitrary levies on villagers as of 2003. Yet some villagers
in Langzhong continued to be charged until 2005. Although part of
the amounts required allegedly comprised levies overdue from previ-
ous years, it fuelled perceptions that local officials were pocketing the
money. In 2006, locals were still not convinced that levies had actu-
ally been lifted. By my following visit in April 2007, with most people
not having paid any levies in the past year, locals seemed increasingly
convinced that central government policies were being implemented.
Yet discontent was still fierce since compensation for the reforestation
project (tuigen huanlin) had not been offered to villagers.14 The village
secretary claimed he used these funds to cover the water tax and costs
of building the local road. But villagers complained they were given no
transparent account of how much money is invested in these activities.
These experiences added to skepticism toward the RCMS, especially
when it is seen to be the village secretary’s responsibility.
The skepticism of RCMS that I encountered in July 2006 had
largely abated by the following field trip in March 2007, giving way to
increased trust in the scheme. One reason for this growth of faith may
be that locals have had positive experiences of using RCMS. The abil-
ity to use payments to the new RCMS as credit to purchase medicine
from the village doctor has contributed to convincing locals that these
schemes are beneficial (“You do not have to suffer losses,” Bu de chi kui).
The fact that those who had treatment as inpatients appear to have
received the amount promised as reimbursement has also been instru-
mental in establishing trust in the health care schemes among locals.
224 Strategies of Care and Mourning
wife of cancer sufferer Uncle Wang explained: “In the past, if you went
to the hospital but had no money to pay, they would still treat you, but
now they only let you in if you have money” (September 2004). That by
2007 some locals began to compare the current RCMS favorably to the
past version and say that the past version was only funded by the village
shows that their memories of past RCMS were not accurate portrayals
of Maoist RCMS. Rather, these accounts served to critique the lack of
insurance coverage and the market orientation of medical treatment
in the present. Though there is evidence that villagers have begun to
reenvision their memories of Maoist RCMS in favor of the new version,
these schemes have not done much to undermine a sense of inequal-
ity compared to their urban counterparts. Despite the recent structural
changes in welfare provision, mistrust of hospitals remains rife.
Conclusion
Discussing medicine and morality in Haiti, Paul Brodwin wrote, “In
negotiating among multiple therapies, therefore, people seek both to
cure the illness and to present themselves as upstanding ethical actors
who have made the right choice among competing moral worlds”
(1996, 14). This chapter has described how, when they choose treat-
ments for cancer, villagers also position themselves vis-à-vis compet-
ing moral economies of Confucianism, socialism, and the market. By
highlighting the importance of social relations and identities involved
in decision making, it has shown economic reductionism to be inad-
equate for understanding the complex negotiations surrounding illness
and care. The effects of the commodification of health care go beyond
the structural barriers to access it has posed for the poorest to a wide-
spread skepticism toward the medical profession and its for-profit prac-
tice, which in turn results in a general unwillingness to resort to formal
medical care and to hospitals in particular. Ruiping Fan has argued for
the need to shed collectivist and egalitarian commitments and recog-
nize (and accept) the profit motive in providing health care as ethical
and in tune with “the new economic realities of China.” For Fan, this
would consist of a “Confucian medical professionalism . . . [which]
places the profit motive within its account of virtue ethics” (2006, 541).
Allowing physicians to work with profit in mind (or at least hoping for
a higher salary), Fan suggests, will encourage the excellence of their
Perceived Efficacy, Social Identities, and the Rejection of Surgery 227
the success rate is so poor). Since 2006, the cost incurred is reduced by
RCMS reimbursements, but it remains steep. Local incidence of can-
cer makes findings in Langzhong difficult to generalize for the whole
of Sichuan, let alone China. The processes by which villagers assess the
efficacy of hospital treatment and views of commodified health care are
likely, however, to be similar to those experienced by other rural dwellers
weighing the pros and cons of expensive health care. Paying attention
to the intricacies of individual cases, as I have done for Gandie, also
highlights the pitfalls of sweeping analyses of the impacts of policy on
people as if these effects were homogenous. In each case, rather, decision
making has complex contexts. In the rural context, while pure cost is by
all means a consideration, attributing lack of treatment simply to poverty
would be an oversight. Rather, perceptions of cost, its social and cultural
connotations, and the social relations and identities it enables or denies
are just as important to constituting cancer surgery as socially, culturally,
and economically inefficacious and thereby motivating a rejection of it.
New perceptions do not form overnight. Changes in health care
policy aimed at offering more affordable treatment, such as the intro-
duction of the new RCMS, are frustrated by lasting perceptions that
health care remains a commodity and that doctors act with financial
interests in mind. Locals will require a new set of experiences of local
policies and their executors to be convinced that what they invest in
health care cooperatives will indeed benefit them. In a similar fashion,
less suspicion toward medical practitioners and the medical establish-
ment as a whole is fundamental to ensuring that when illness strikes, suf-
ferers do not deny themselves treatment, as Grandma Qing and Gandie
did. This can be fostered only by creating a perception of medical insti-
tutions and their practitioners as not only market driven but also avail-
able to those with less means. The new RCMS are beginning to go some
way toward meeting this challenge, but there is so far little evidence
that attitudes about hospitals and medical practitioners, as well as prac-
tices of health seeking, have changed significantly. The scheme would
produce better results if it could be further extended beyond inpatient
treatment (the service that is least likely to be employed by villagers) to
other expensive medications for chronic (and acute) problems treated at
home. This is the type of treatment to which those such as Grandma
Qing and Gandie would be more inclined to resort. The road to more
accessible and equitable health care is long and winding.
Chapter 8
relative’s death. I compare the cases of Uncle Wang and Gandie. The
former and his wife were not Christians and thus more prone to consult
spirit mediums and burn paper money and incense to the deceased. In
the case of the latter, some family members were fervent Christians (his
wife and his second son, Erge, and daughter-in-law Ersao) and thus were
opposed to consulting spirit mediums and to “superstitious” customs
such as offering paper money, incense, and firecrackers. Others were
in favor of these practices, which they saw as “traditional” rather than
superstitious, causing a rift that sometimes became very pronounced.
The role of religious allegiances in channeling family conflicts is elu-
cidated most clearly in the controversy triggered by Gandie’s youngest
son’s failure to hang his father’s ancestral image. Through this case, I
show that ritual practices are not simply a mirror of society; they are
also central to producing family and social relations and to making con-
trasting claims to moral behavior. I conclude that cancer treatment is a
crucial time at which family relations are negotiated and allegiance to
the spirit world plays a vital role in how these relationships are produced.
the social structure (1990, 337). Transformations are thus only a surface
phenomenon, while the underlying values have changed little. This is
the case, for the Potters, because Chinese socialism itself is rooted in
Chinese history and “thoroughly integrated into pre-existing cultural
patterns as it is implemented” (60).1
In fact, both of these perspectives are valid, but rather one-sided.
The resurgence of “tradition” does not constitute a complete break with
the past (as the Potters argue), yet past practices also adapt to substan-
tially new environments (as Siu would have it). In the field of anthropol-
ogy of religion at large, it is by now dogmatic that religious and spiritual
practices are “thoroughly modern manifestations of uncertainties,
moral disquiet and unequal rewards and aspirations in the contempo-
rary moment” (Moore and Sanders 2001, 3; see also Comaroff and
Comaroff 1993). The growing literature on religion in China has like-
wise moved beyond the dichotomies between change and continuity or
tradition and modernity. Drawing on a survey of communal religion in
six hundred Chinese villages, Kenneth Dean has argued that “the ritual
events of Chinese popular religion are not remnants of a rapidly van-
ishing traditional past but are instead arenas for the active negotiation
of the forces of modernity” (2003, 342). Religious practices in China
are now variously understood as reactions to a more relaxed policy envi-
ronment (see Potter 2003), as a comment on the perceived decline of
morality since the start of economic reforms, and as articulations of ter-
ritoriality and community identity. While some characterize religion in
this latter guise as thoroughly interlinked with the workings of the local
state, others see it as a potential site of resistance.2
When modernity coexists with a thriving religious environment,
the secularization theory according to which modernity will lead to
religious decline is proved inadequate (Szonyi 2009; M. Yang 2008a,
2008b). As Henrietta Moore and Todd Sanders propose for witchcraft
in Africa, “Once we admit to ‘multiple modernities’, to the idea that
‘progress’, ‘development’ and ‘modernity’ are multiplex, undecidable
and contextually specific, there is no reason to suppose that the occult
should vanish” (2001, 19). In China, the historical process of differen-
tiation between superstition, tradition, and religion is deeply political,
inseparable from state attitudes toward ritual activities. Mayfair Yang
explains that Confucian rites (such as ancestor worship) were normal
Family Relations and Contested Religious Moralities 233
The shaman wore a red guard armband affixed on her shoulder bag,
incorporated political slogans from the Chinese national anthem
and anti-Japanese war hymns into the ritual, and told the sufferer to
learn from the legendary revolutionary hero Lei Feng. In doing so,
she “grafted national discourse onto local ritual structure in a context
where there had formerly been a clear division between the state and
the shamanic” (1999, 505).
The divide between religion and feudal superstition is the prod-
uct of state policy rather than emic categories (Chao 1999, 517). Since
the start of reforms, this divide and that between official and unofficial
practices are softening (White 2001). Although the state ultimately has
the power to decide what is feudal superstition and what is official reli-
gion, the distinction is not easily made, nor does it translate into gov-
ernment action (Chau 2005, 243; 2006). Among Langzhong villagers,
conceptions of religion, tradition, and superstition were often fluid and
intersected with “science” in a variety of ways. Attitudes about spirit
mediums serve as an example. Shiniangzi, literally “female master,” is the
term people in Langzhong commonly employ to describe spirit medi-
ums, which despite their name could be either a man or a woman.3
In some cases, a feng shui master (literally, “wind and water” master,
more commonly translated as “geomancer”) also functioned similarly
to spirit mediums, to cure problems that eluded other forms of treat-
ment.4 While according to state policy spirit mediums would be firmly
positioned within the realm of superstition, villagers who claimed that
they were reliable did not necessarily perceive themselves as inherently
superstitious or backward. For instance, Liu Min, the twenty-seven-
year-old man who made the fiercest claims to being modern and science
oriented, also believed that shiniangzi and feng shui masters who trained
“properly” (i.e., according to him, as apprentices to a skilled practitio-
ner and with reference to written texts) could cure illness, and that their
expertise was “scientific” (kexue) as opposed to the many “fake” “money
cheaters” recently fostered by both the increased financial resources
available to sufferers and government openness toward “traditional cus-
toms” (Liu Min, November 17, 2004; see Anagnost 1987). The appar-
ent disconnect between belief in and resort to spirit mediums on the
one hand and science and modernity on the other was reconciled by
redefining spirit mediums as part of a legitimate tradition and by grant-
ing healing efficacy to those who practice “scientifically.”
Family Relations and Contested Religious Moralities 235
Clearly, the concept of “scientific” does not carry the same asso-
ciations for Langzhong villagers as it might do for a Western reader.
Literally, kexue, commonly translated “science,” implies specialist study
(see Farquhar 1994; E. Hsu 1999; Scheid 2002). Villagers sometimes
described as scientific actions (such as a way of carrying a heavy bag
that minimized effort, or geomantic practices, or spiritual healing) that
could not be characterized as “scientific” in English. For them, “scien-
tific” described the result of careful thought and long-term experience.
Science was, no doubt, also associated with technology, but this did not
necessarily undermine its other connotations. The most blatant exam-
ple is the popular fortune-telling establishments, where for 1 yuan one
can have his or her palm scanned (printout included) and future told
through computerized analysis of the significance of the palm’s lines.
These advertise themselves as “scientific fortune-telling” (kexue suanming),
thereby deriving their efficacy from both the tradition of fortune-telling
and the advancement of science. Science is put at the service of tradi-
tion in other ways, too. Liu Min proudly used the latest technology he
had acquired for cutting cloth (he worked from home making working
gloves) to cut paper money offered to the kitchen god, which produced
quicker and better (more neatly cut) results.
These examples show that the rise in religious engagement should
not be interpreted simplistically as a return to “tradition” in the face
of the challenges of modernization nor as a sign of backward think-
ing or lack of progress. Even the apparently opposite categories of sci-
ence and superstition are not clear cut, nor are they positioned along a
single evolutionary metanarrative leading from superstition to modern
development. Accordingly, allegiances to spirit mediums or traditional/
superstitious practices cannot easily be mapped onto generational
lines, as if to suggest a progression away from them. Indeed, unlike his
son, Liu Min’s father was starkly opposed to spirit mediums, which he
regarded as superstition. He did nonetheless burn incense and paper
money for his ancestors and the kitchen god, because this, he argued,
was part of traditional customs. Whether villagers identify a particular
practice as a “traditional custom” or as “superstition” therefore serves
respectively as a legitimizing or delegitimizing device in explaining the
resort to such practice or rejection of it. The position of most religious
and ritual practices along the spectrum of religion, traditional custom,
and superstition is very much open to contestation.
236 Strategies of Care and Mourning
who “move on before the anger of the people catches up with them”
(45) places them outside of the village moral economy and presupposes
that they would act with economic self-interested in mind. This weakens
the perceived efficacy of their healing powers.
A further and crucial determining factor concerning the efficacy
of shamanic treatment is the type of illness at hand. Shiniangzi and feng
shui masters were seen to have xiaoguo in treating persistent illnesses that
failed (or were perceived to fail) to respond to Chinese and Western
medicine.7 Erjie, for instance, consulted a shiniangzi when her daughter
Lida was three years old and suffered with insomnia. As doctors failed
to explain or cure Lida’s sleeping problem, Erjie turned to the shini-
angzi, who she felt was ideal for treating a problem over which medicine
had no xiaoguo (see Cline 2010, 527; Fan 2003). Similarly, Aunt Zhang
consulted a local feng shui master to cure her daughter-in-law’s upset
stomach in the wake of Uncle Wang’s death. Her ailment was thought
to be caused by the lingering presence of Uncle Wang’s spirit, consid-
ered particularly threatening because he had committed suicide. These
healers’ efficacy, however, was seen not to extend to treating cancer. A
protracted discomfort in his stomach brought Uncle Wang to the village
doctor in early 2004. When Uncle Wang returned to the village doctor
(Doctor Wang) complaining that the Chinese herbal remedy he had
prescribed had no effect, Doctor Wang suggested a hospital checkup,
hinting that his illness may be a form of cancer. Uncle Wang and his
wife, however, thought cancer was impossible: Uncle Wang was eating
and working normally, and he had always been healthy. In May 2004, as
Uncle Wang’s illness remained undiagnosed and elusive of treatment,
Aunt Zhang called upon a shiniangzi.
Aunt Zhang told me about her experience over a year since the event
( July 2005). Her neighbor and very good friend, who was also unaware
that Aunt Zhang had resorted to one of these healers, cried, “Why didn’t
you call me?” Aunt Zhang began her recollection of the event:
the sky, and the medium went down to the underworld ( yinjian) to see
what illness my husband had. He told me to burn papers an hour
after he had started, to call him back to the world of the living. Then
he prescribed some living world medicines ( yangjian yao), including
250 grams of coptis root (huanglian). In the past, the shiniangzi would
have got out and danced with a knife, but now they are scared other
people might see them.” ( July 8, 2005)
As the shiniangzi predicted that Uncle Wang would die soon, Uncle
Wang went to the county hospital. There, he was diagnosed with
stomach cancer.
Among Baoma villagers, Aunt Zhang was perhaps the keenest on
popular religion, and she enjoyed explaining local customs to me. She
found this failed attempt very upsetting and felt cheated. Having had to
invest over 100 yuan on the shiniangzi’s service (50 yuan for the ritual,
extra cash for paper money and incense he provided, and for food to
offer to him) added insult to injury. Yet this negative experience did not
undermine her faith in the efficacy of spirit healers or “traditional cus-
toms” as a whole (see Anagnost 1987, 51–522). Rather, it made Aunt
Zhang more inclined to resort to spirit healers within the village (as she
did for her daughter-in-law’s illness), who are less likely to act in the
pursuit of profit alone. It also convinced her that “shiniangzi are good for
illnesses that doctors cannot explain, that medicines cannot cure, but
for things like cancer, there’s no point” (Aunt Zhang, July 8, 2005). Erjie
reached a similar conclusion on the presumed inefficacy of shiniangzi
in curing her father. Gandie and his family never consulted a shiniangzi to
inquire about his illness. Erjie was not in principle against shiniangzi.
She had consulted one to treat her daughter Lida’s sleeping problem.
Although convinced that the medium had cured her daughter, Erjie
believed this would not work for her father: “With illnesses that doc-
tors cannot diagnose, shiniangzi are effective, but with things like can-
cer, that’s a bodily problem (shenti de wenti); shiniangzi can do nothing”
(November 10, 2004).
A conspicuous discrepancy emerges in local attitudes toward shini-
angzi’s efficacy. Aunt Zhang, like Erjie, clearly differentiated between
illnesses rooted in the body that might be cured by medical practitio-
ners but not by spiritual healers alone and illnesses that doctors fail
to diagnose, let alone treat, that shiniangzi might cure—such as her
Family Relations and Contested Religious Moralities 239
Christianity’s Challenge
If “modernity” as such does not undermine the appeal and efficacy
of mediums, one alternative model of the spirit world does so very
powerfully: Christianity. Conversion to Christianity demands a renun-
ciation of all superstitious practices. Indeed, Gandie’s family did not
resort to shiniangzi to cure his illness (even before they were told it was
cancer) because Christian members of the family—his wife; second
son, Erge; and daughter-in-law Ersao—were starkly against it and
contested it as a pointless and ineffective practice, a “wasteful super-
stition.” While shiniangzi are potentially part of superstition even for
non-Christians, the category also subsumed many practices otherwise
classed as legitimate “traditional” or “popular” customs, such as burn-
ing paper money, incense, or firecrackers in honor of ancestors and
ghosts.8 Lack of engagement in these practices aimed at appeasing
ghosts implies that Christians do not believe in ghosts, and therefore
they perceive these practices as having no effect and amounting merely
to a misguided waste of resources. Aunt Shen’s claim is very represen-
tative of local perceptions of Christianity: “Christianity is good—you
don’t spend any money on paper; why would you burn that? That’s a
lot of smoke, it’s not money. . . . And firecrackers, and spirit mediums,
and geomancers—why believe those? They just take your money. Why
would you do research on those? You’re a Christian [author: I never said
so myself]—just research Jesus, and research cancer—that’s a serious
problem!” ( July 3, 2005).9
The argument that Christianity is cheap ( pianyi) and advanced was
also used by proselytizers (see Bays 2003). Aunt Liu, in her mid-fifties,
was invited to join a local family church (and take me along) by her long-
term friend, Aunt Xu (February 25, 2005).10 Once we reached Aunt
Xu’s house, I realized that she had insisted that I come to their meeting
as a way of making her argument to Aunt Liu more convincing.
Aunt Xu: You see, foreigners do not burn paper money and all that;
they are developed, and they are all Christians.
Family Relations and Contested Religious Moralities 241
They started about three years ago. They meet every weekend to sing
and read the Bible. It’s so loud, you can hear it from here! If one
of the followers is ill, they will go to his or her house and sing for
them. There are many Christians here, but not all of them join these
meetings. It’s fake anyway, it’s not real. They are not nice people. For
instance, your house has a well and your neighbors want to use it,
they won’t let you, they’ll tell you to build your own. Isn’t Christianity
about doing good and being nice to others? (February 10, 2005)
Both Liu Min and his wife derided them, as if they were unable to
understand Christian principles, and stressed that their form of
Christianity was fake and evil. Others extended their skepticism to the
viability of Christian values as a whole. Erjie, for instance, commented
on two Christian friends of her brother Erge (himself a Christian):
“They say Christians cannot cheat people, but how can they do busi-
ness then? It’s impossible; making money is about cheating people—if
you don’t cheat people you won’t make any” (February 13, 2005). While
for Liu Min only the village-based version of Christianity was fake, for
Erjie its claims to a moral high ground were themselves untenable. In
some cases, such skepticism extended to any forms of belief in the spirit
world, again with reference to the word “fake.” A thirty-two-year-old
woman, Wang Jie, stated, “You should only rely on yourself to make
your fortune. . . . Fortune-telling is fake—I even met a fortune-teller who
said it himself. My husband believes it even less, he walks home in the
dark and all. . . . And Christianity isn’t much good either; people who
believe still behave badly. They say you’ll be cured if you believe, but so
Family Relations and Contested Religious Moralities 243
many who believed here died early. They say you’ll go to Heaven when
you die! Well, if so many people go to Heaven, there can’t be enough
space for everyone!” ( July 2, 2005).
Suspicion and wariness of fakes pervades contemporary China—
medicines, farm chemicals, and nutritional supplements are all frequent
candidates for accusations of being fake, as locals have little knowledge
and no control over the provenance of these substances. Such skepti-
cism is extended to the spirit world itself, as each religious and ritual
paradigm is subjected to suspicion over its ultimate “truthfulness” and
efficacy. Diverse religious allegiances (or the absence of any) pose as
models for morality and care of oneself and one’s family: burning paper
money and consulting a shiniangzi to appease ancestors, attending mass
or family churches, or a skeptical rejection of religious practices in favor
of self-reliance. Branding competing religious beliefs and practices as
“fake,” money oriented, and superstitious serves to dismiss their claims to
function as bastions of morality and protectors and providers of health.
Through their adoption or rejection of spirit mediums, burning of paper
money, and attending family churches or mass, villagers also redefine
the boundaries between tradition and superstition. Disagreements over
what is “fake” or “real” are also ways in which different models of moral
behavior are contested. The legitimacy, truthfulness, and efficacy of a
religious or ritual practice may rely on its belonging to religious habitus,
or it may draw on claims to science and development. But what all these
parameters share is a role in forming views of social and family relations
and in turn in producing or challenging such relations.12 Villagers may
not agree on what moral behavior consists of, but they actively reshape
its definition through their engagements with the spirit world.
the day of the person’s death and subsequently one hundred days from
death and on the first three anniversaries. I did not attend these rites for
Uncle Wang, but I attended most of them for Gandie.
A number of family disagreements were played out through the
burial and mourning rituals. The first and most blatant regarded finan-
cial contributions toward the funeral. Erjie, her sister, her oldest and
youngest brothers, and their respective families were in favor of offering
paper money, firecrackers, and incense to their father (see fig. 5.1 on
Gandie’s family). Gandie’s wife, Ganma, a committed Christian, agreed
Figure 8.1 Junhong and Lili burn paper money at their father’s grave
in Meishan with their daughters (2005).
Family Relations and Contested Religious Moralities 245
to contribute money but never took part in the rituals. Her second son,
Erge, and his wife, Ersao, however, refused to contribute money toward
it because they argued, as Christians, that these practices were wasteful
and pointless. Like his mother, Erge and his wife would go to the grave
site at the time of the offerings but stand on the side, not taking part.
None of her offspring reproached Ganma for refusing to give offerings
to her deceased husband. At first, this seems to confirm Ellen Oxfeld’s
suggestion that funerary rituals are important in fulfilling moral obliga-
tions, although the precise manner with which they are performed is not
entirely prescriptive (2004, 973). Yet the amount of leeway Ganma is
given is more a testimony to her status within the family than proof of a
general flexibility over how such rituals are carried out. Her practice of
abstention from rituals confirmed and reproduced her status within the
family. On the one hand, her established position of authority enabled
her to abstain from the rituals without criticism. On the other, allowing
her not to participate further reinforced her authority and her children’s
respect for her.
If Gandie’s sons and daughters were accepting of their mother’s
practices, they were angered at Erge for refusing to contribute. On the
fifth shaoqi (March 12, 2005), Erge commented sarcastically on those
offering paper money, “I don’t know what you’re doing.” Ready for a
confrontation, Dage replied, “Burning paper money—that’s what we
do. . . . I’m like your God, too.” As he did every week of the shaoqi, he
then proceeded to light two cigarettes, poured some white liquor on the
grave, and addressed his father: “Don’t have too much, you like drinking,
I know . . . and look at all this money! You never had this much all your
life—you have more than you could ever spend.” As with Ganma, the
attitude of brothers and sisters toward Erge both confirmed his status
among them and in turn reproduced it. His self-exclusion from mourn-
ing rituals produced him as a Christian and denied him participation
in a practice through which the rest of Gandie’s offspring materialized
their attachment to their father and in turn their connectedness as a
family. The spirit world had a significant impact on mourning practices,
creating a rift between Christians and non-Christians. I will further
unpack the role of funerary rituals in constituting family relations later
in this chapter. At this point, I would like to examine the divergence in
attitudes about funerary rituals as a way of understanding the relation-
ship between belief and practice.
246 Strategies of Care and Mourning
worship, for instance, suggests that villagers found ways to resist the
state’s manipulation of memory and to articulate their subversive sense
of local community (see also Feuchtwang 2000; Feuchtwang and Wang
2001; Mueggler 2001). Similarly, in Langzhong local customs cannot
have been wholly eradicated as a consequence of Maoist campaigns.
Yet villagers’ perception of the existential absence of spirits at a time
when rituals to establish relationships with them were forbidden sug-
gests that spirits are produced through ritual practices. Their presence is
contingent on the performance of rituals. By extension, this would sug-
gest belief in them can only continue as long as rituals are carried out.14
A parallel can be drawn between Maoism and Christianity not only
in their effects on belief-in-practice but also in terms of the ideology
that underscores both. Both associated themselves with modernity and
progress and therefore required a cessation of superstitious practices.
This is not to imply that all locals perceived burning paper money as
superstition, or that they regarded it as opposed to modernity. As we
have seen, the relationship between tradition and modernity is far more
complex. Yet the ideology of both Maoism and Christianity proposed a
type of modernity that set itself apart from these superstitious practices.
This at once presupposed that there were no ghosts or ancestor spirits to
worship, but also impeded the production of these entities through ritual
practice. In other words, if belief is produced by ritual practices and
thus inseparable from them, it follows that whether or not participants
actually believe is in fact central to their practices. If this were not the
case, Christians would not necessarily cease presenting paper money
and incense offerings. By rejecting these practices, locals also constitute
their identities as nonbelievers in ghosts. Locals’ beliefs are thus more
adequately understood as belief-in-practice, constituted in practice and
indissoluble from it. The following section will supply some examples of
the porous interaction between religious allegiances as belief-in-practice
and family relations with reference to mourning.
Ganma’s brother and his family; and some of his close neighbors. The
seventh shaoqi (March 25, 2005), being the final of the weekly rites, also
included a banquet lunch with around forty guests.15 The first and last
shaoqi, attended by roughly the same people, were the largest. Turnout
in weeks two to six varied. Dage and Dasao attended every week. All the
other family members except Erjie missed two or three occasions due to
work or illness. Erjie’s husband was present on three occasions, includ-
ing the most important (the first and the last), but he was paid by the day
to work as a carpenter and thus did not want to miss work. Erjie’s sister
lived relatively far away and failed to attend three times. When she took
part in the ritual, she was always accompanied by her husband, who on
one occasion attended without her because she had a cold.
Only Ganma, Erjie, her daughter, her sister’s husband, and I
attended the sixth shaoqi, on March 19, 2005. Erjie and Dage reflected on
how inappropriate it was that, over a month after their father’s death, his
ancestral picture was still left facing down on top of a grain storage unit,
where it had been put after the funeral. Since the storage room (which
Figure 8.2 Ganma and Sange’s altar and storage room in 2009, with part of
the Mao poster still hanging but without Gandie’s ancestral image.
250 Strategies of Care and Mourning
Erjie (to her nephew): Were you scared? Is it you who wanted to take
the picture down?
Nephew: Yes, I felt uncomfortable and I was scared to walk past it.
Erjie (unconvinced): Did your mom tell you to be scared?
(The child could only mumble, which Erjie took as an affirmative
answer.)
Erjie: You have nothing to be scared of—he’ll protect you. You were
always good to him; he just wants to see that you’re safe coming
back from school, watch over you while you do your homework.
(March 25, 2005)
Family Relations and Contested Religious Moralities 251
This series of events shows that all involved regarded the ancestral
image as an embodiment of the deceased, who is enabled to guard over
their family through the image.16 For most of the family, Gandie’s pres-
ence enabled by the portrait was regarded as benevolent and protective.
For Sansao, however, he was potentially harmful. This disparity func-
tioned to distinguish those who had been caring toward Gandie and
those who had not. Fear or lack of fear of Gandie’s efficacy through
his picture served to articulate family relationships, to position family
members vis-à-vis one another. All brothers and sisters, except Sange,
agreed that Sansao was scared of Gandie because she had not been car-
ing toward him when he was alive. In turn, her refusal to have his pic-
ture hung in the storeroom presented a further instance of her unfilial
attitude, a refusal to recognize and respect Gandie as her ancestor. As is
common for the youngest son, Sansao and her family lived in the same
house as Gandie and Ganma. This presented daily occasions for small
disagreements and confrontations, which in time escalated to intoler-
able levels. As a consequence, Gandie built a very small separate kitchen
made of bamboo and mud, annexed to the concrete-built house the two
families shared. This marked the separation of the two households ( fen
jia). Both Dasao and Erjie often commented on the poor conditions in
which Ganma cooked: a very small space, not properly aired, and with-
out a chimney to channel out the smoke. Sansao by contrast enjoyed a
large, airy kitchen, equipped with a chimney. Dasao and Erjie saw this
as one example of Sansao’s lack of respect and care for her in-laws.
Dasao said that as a consequence she often cooked for Ganma (and
Gandie) in her kitchen and brought them food.
Erjie’s criticisms of Sansao were filled with a sense of unfair dis-
tribution: she felt she had been caring toward her own in-laws and
received no help in return, whereas Sansao received help but failed
to reciprocate. Dasao’s positionality in the family was different from
Erjie’s, and her criticisms of Sansao therefore have different implica-
tions. Dasao argued, as I have hinted in chapters 4 and 6, that Sansao
did not help Gandie and Ganma with farming and did not share spe-
cial culinary treats with them. Her criticisms, however, cannot be taken
as an objective account of Sansao’s behavior. It is no coincidence that
Dasao would be the family member with the most complaints against
Sansao. As is typical of the oldest daughter-in-law (M. Wolf 1968), she
felt she had to sacrifice the most in helping Gandie and Ganma. When
252 Strategies of Care and Mourning
she first married into the family, her husband’s younger siblings (two
brothers and two sisters) were all still unmarried and, she argued, this
meant that Gandie and Ganma had no time to help her with farming
or child care. For this reason she resented the youngest son and his wife
for having secured the most assistance from Gandie and Ganma and yet
not having given much in return. In criticizing Sansao, Dasao gained
moral standing and authority by presenting herself as a filial daughter-
in-law and demanded that Sansao play a more active role in supporting
Ganma after her husband’s death. At the same time, her resentment
toward Sansao was also telling of her anger at how much help she felt
she had to offer to her in-laws.
The youngest brother, Sange, was also considered to have behaved
inadequately. It was his responsibility, not his wife’s, to hang the ancestral
image. Indeed, Dage had apparently been violent during his confronta-
tion with him, pushing and slapping him, while he did not physically
attack Sansao. Yet he and the rest of the family blamed Sansao rather
than Sange for their failure to hang Gandie’s photo. They felt that their
youngest brother had no fault previous to the picture incident. They
did not think that Gandie would be angered at him or wish to harm
him. This is telling of the position of the young wife (and daughter-in-
law) in the family. Any unfilial behavior on the part of Sange was not
seen to be his fault but was blamed on her negative influence, since
they assumed that she—not originally a member of the family but only
acquired through marriage—would have been less predisposed to be
filial toward her husband’s parents. Thus the picture incident served as
a focal point around which relationships were negotiated. Disputes sur-
rounding Gandie’s picture functioned to articulate family relationships,
both with Gandie and among family members.
I am reminded here of Margery Wolf ’s study of a young woman
who failed to become a shaman. Wolf traced Mrs. Tan’s failure to her
identity as an outsider—as a woman, as a member of a family new to
the village, and as therefore not sufficiently integrated in the village to
have earned credibility. Because of her outsider status, she lacked the
social ties that would have produced her efficacy, convinced other villag-
ers to believe in her, and in turn persuade her to pursue the shamanic
path (1992, 107–113). Mrs. Tan was “too low in all of the hierarchies
to achieve legitimacy as a full member of her community” (113) and
thus could not enlist the support and status that is the prerequisite for
Family Relations and Contested Religious Moralities 253
Conclusion
Much has been written on whether religion is a mirror of society since the
seminal volume edited by Arthur Wolf (1974), which debated this question
in depth. Opinions vary, but they generally problematize a conception of
the spirit world as a simple reflection of society. Stephan Feuchtwang’s
contribution to this debate is central (1992). For Feuchtwang, local reli-
gion provided a sense of place supplementary to that of the ruling ortho-
doxy, thus presenting some potential for change. The significance of the
metaphoric relationship between the world of the living and the world
of the dead thus goes well beyond the reinforcement of secular politics.
For Meir Shahar and Robert Weller (1996), gods are neither a passive
metaphor for China’s political order nor a simple reification of its social
hierarchy. Chinese gods, in other words, also shape the social order, com-
pensate for it, upset it, and change it (see also Mueggler 2001). My find-
ings show that rather than being a mirror of social relations, the spirit
world and the ways in which it is perceived by the living offer an occasion
in which social relations and family relations are negotiated, reproduced,
or challenged (see also Stafford 2000, 79–83).
Based on his research in rural Shaanxi, Adam Chau claims that
“popular religion is thoroughly social: not only socially embedded, but
also socially produced” (2006, 125). My case studies also show that reli-
gious practices are socially produced, as is their perceived efficacy. The
efficacy of shiniangzi is inextricably tied to their association with tradi-
tion (rather than superstition), their record of adequate training, their
accountability within the moral economy of the village (as opposed
to self-interested tricksters and transients positioned outside the local
community), and the type of illness treated. Resorting to these heal-
ers, as well as traditional funerary rituals involving offerings of paper
Family Relations and Contested Religious Moralities 257
When I first settled in Baoma in 2004, I was baffled and perhaps even
slightly upset to be told that I was “very fat.” With a height of 167 cen-
timeters (5 feet 6 inches) and a weight of 60 kilograms (132 pounds), I
had until then happily accepted the biomedical ideology that defines
me as “normal.” As the months went by, I had occasion to realize that
local parameters to assess fatness were somewhat different from my
own. Being fat did not mean being massively overweight, it meant being
strong enough to carry loads and engage in farming activities. Anyone
who was not very skinny was simply considered fat. I also realized that to
be told, “You’ve put on weight,” was a compliment, used interchange-
ably with the expression “You look well.” Eating and fatness, in other
words, were synonymous with well-being, and lack of appetite synony-
mous with illness. This apparently innocuous equivalence is historically
rooted in the lived experience of food shortage and reliance on agricul-
ture during the collective period. Second, villagers regarded fatness as
healthy because the ability to work hard is a crucial parameter in defin-
ing health, and fatness enabled them to do so. Far from being relegated
to the past, strong bodies (of those able to eat) remain important in
the present. While many young adults leave rural areas in search of a
paid occupation, subsistence agriculture still remains a crucial guaran-
tee of security in the setting created by the often unpredictable effects
of the market (see chapter 3). For those who stay in the countryside,
“fatness”—defined as the strength and vitality required to carry heavy
loads—remains the bodily sine qua non of farming life and continues to
be a desirable bodily quality.1
This brief sketch of the coordinates of fatness and health outlines a
micropolitics of how attitudes about the body are produced and inform
experiences of cancer. How is bodily experience configured and made
sense of ? How do past experience (such as starvation) and macrohis-
torical changes constitute present-day experience and perceptions of
Conclusion 259
the body and health? This book has endeavored to answer these ques-
tions in the case of cancer. It has followed the spirit of current medi-
cal anthropology in showing how experiences of cancer, much as the
body described by Margaret Lock and Judith Farquhar, are “contingent
formations” (2007, 1), “social, political, subjective, objective, discursive,
narrative, and material all at once. They are also culturally and histori-
cally specific, while at the same time mutable” (9). As I began to collect
narratives and observe experiences of cancer, I asked: How do locals
experience and understand cancer? How is it positioned within a nexus
of social, cultural, political, economic, historical, and moral settings?
By undermining the ability to eat, cancer challenges the very
foundation of health and the ability to work, themselves central to the
making of a moral person. In a context of relative prosperity, cancer-
induced starvation is experienced and understood as the embodiment
of persistent forms of social suffering. As such, its experience is insepa-
rable from embodied histories of inequality—between rural and urban
areas and throughout living memory. In making sense of cancer, villag-
ers also articulate their views of these histories and contending moral
economies. Far from being attributed only to past or present suffering,
cancer is linked to both: excessive production and deficient consump-
tion in the past but also excessive consumption in the present. Through
its fluid interconnection with the earlier illness categories of “vomiting
illness” and “spitting illness,” cancer is not pervasively regarded as a
malaise of modern times. It is as much an illness of development (farm
chemicals and anxiety precipitated by family conflicts, in turn due to
the speed of social change and migration) as it is an illness of poverty
and past hardship (limited diet, hard work in the fields and in collective
efforts, family conflicts due to failure to fulfill family obligations). The
concurrent blaming and praising of aspects of both past and present
define a community that constantly struggles to reimagine the boundar-
ies of morality.
Social suffering, a sense of injustice, and the search for moral sub-
jectivity also pervade practices of care. As villagers continue to feel
excluded from formal health care provision and disadvantaged when
compared to their urban neighbors, the unaffordability of care is yet
another form of suffering that punctuates their everyday lives. Economic
and structural obstacles to accessing care intersect with experiences of
health care institutions and their practitioners as bent on profit rather
260 Conclusion
illness and death and to be deeply affected by it. Chapter 4 has exam-
ined how social relations are entangled in attributing blame for cancer,
while chapter 7 has stressed their importance to accessing particular
types of treatment. The in-depth focus on one case has unpacked how
experiences of cancer articulate family and social relations. In his bril-
liant study of Catarina’s life in an asylum in Brazil, Joao Biehl writes
that subjectivity is “the material and means of a continuous process
of experimentation—inner, familial, medical, and political. . . . [It] is
the very fabric of moral economies and personal trajectories that are
doomed not to be analysed” (2005, 137). This study, as did Biehl’s, has
explored these moral economies and personal trajectories as they trans-
verse Gandie and his family’s experience of cancer. In doing so, I have
traced emergent moralities surrounding perceptions of what is deemed
carcinogenic and what may be done when cancer strikes.
At stake in the fight for breath against cancer is not only survival but
the struggle for a moral existence. In his recent book, What Really Matters,
Arthur Kleinman explains that “in its broader meaning the word moral
refers to values,” while in “its more focused meaning, moral refers to
our sense of right and wrong, . . . [embodying] our own moral com-
mitments” (2006, 1–2). He argues that “those who seek to live a moral
life may develop an awareness that their moral environment, in the first
sense, is wrong” (3). This insight could certainly be applied to contem-
porary China. In his article “The Good Samaritan’s New Trouble,”
Yunxiang Yan asserts that “it is widely recognised that in a rapidly trans-
forming society like China behavioural norms, ethics, values, and moral
reasoning are also undergoing radical changes” (2009, 11). Yan explains
that while some scholars have identified a lack of morality in the present
(such as Liu 2000 and Y. Yan 2003), others have stressed continuity with
traditional morality (Oxfeld 2004) and yet others the rise of a new kind
of moral reasoning ( Jankowiak 2004, in Yan Y. 2009, 11). My obser-
vations on cancer sufferers highlight that all of these processes are at
play simultaneously. “The rise of utilitarianism, materialism and other
individual-oriented values” has not, in my case studies, been equivalent
to “an ethical shift from communist asceticism to consumerist hedo-
nism” ( Y. Yan 2009, 11). Whether through strategic use of chemicals
or through rejection of surgical treatment for cancer, Langzhong villag-
ers have responded to the surrounding moral economy of the market
with a degree of skepticism. Their reaction to what they may sometimes
264 Conclusion
Questionnaire
(English Translation)
1. Illness
a. What illnesses have there been among family members and what have
your expenses on treatment been?
b. When you are ill, who covers the cost? Can you or your family afford
treatment?
c. Where do you seek treatment? Which doctors do you consult? Is
treatment effective?
d. Have you consulted a spirit medium or a geomancer? Have you ever
done so?
e. If you were given the chance, would you join health care cooperatives?
Why yes? Why not?
2. Perceptions of Health
a. What do you think about fatness? Why do you hold these views? Which
sources have influenced your opinion (experience, media, etc.)? Do you
think that fat people are strong?
b. Apart from regular food, what other nutritional and healthy foods
do you give children? For instance, milk powder? What kind (of milk
powder) is the best? What particular foods do you give children when
they fall ill?
c. What makes a person healthy?
3. Perceptions of Illness
a. How do you know when you have a cold? How do you feel when you
have a cold? What remedies are effective to treat colds? What food
should you eat and avoid during a cold?
b. How/why did you develop rheumatism? How long have you had it?
How does it feel/where does it hurt? How do you treat it? How did you
decide on those types of treatment?
c. Before being diagnosed with (stomach or esophagus) cancer, how do
people feel (for instance, neighbors, relatives, etc.)? Are there any visible
symptoms? How does the body change as a consequence of cancer?
268 Appendix 1
Did you know that the incidence of esophagus and stomach cancer in
Langzhong is extremely high? Why do you think this may be the case?
d. How much do you smoke per day? Do you think that smoking affects
your health? If it is harmful, why do you not quit?
e. Alcohol (see above).
f. What contraception do you use? IUD? Vasectomy? Pill? What effects
has this had on your health?
g. What do you know about AIDS?
List of Pesticides
Used in Langzhong and
Their Health Effects
Potential harm (based on the Hazardous Substances
Chemical Data Bank, US National Library of Medicine,
Name formula Use Description http://toxnet.nlm.nih.gov)
Triazophos C12H16N3O3PS Insecticide Organophosphate Classified as a “bad actor chemical” by the Pesticide Action
for rice Network North America (PANNA, 2010) for being acutely toxic
and as highly hazardous by WHO.
Health effects include:
- Excessive salivation, sweating, rhinorrhea, and tearing.
- Muscle twitching, weakness, tremor, incoordination.
- Headache, dizziness, nausea, vomiting, abdominal cramps,
diarrhea.
- Respiratory depression, tightness in chest, wheezing,
productive cough, fluid in lungs.
- Severe cases: seizures, incontinence, respiratory depression,
loss of consciousness.
- Cholinesterase inhibitor.1
Lambda- C23H19Cl F3NO3 Insecticide Pyrenthroids May cause irritation to the skin, throat, nose, and other body
cyhalotrin parts if exposed. Other symptoms may include dizziness,
headache, nausea, lack of appetite, and fatigue. In severe
poisonings, seizures and coma may occur.
Not classified as a carcinogen.2
Didiwei, C4 H7Cl2O4P Insecticide to Organophosphate Not classified as a carcinogen, but some studies showed an
DDVP or protect stored increased incidence of forestomach cancers in rats.
dichlorvos crops Increased incidence of attention deficit and hyperactivity
disorder in children.
Cholinesterase inhibitor.
Fenaminosulf C8H10N3 NaO3S Bactericide, Not classified as a carcinogen.
(or Dexon) fungicide Moderately toxic if swallowed or in contact with skin.
Glyphosate C3H8NO5P Herbicide Organophosphate Classified as least dangerous compared to other herbicides
and pesticides such as organochlorines, low in toxicity, no
carcinogenic effects.
Thiram C6H12N2S4 Sulfur fungicide Moderately toxic by ingestion, but highly toxic if inhaled.
Ectoparasiticide Acute exposure in humans may cause headaches, dizziness,
fatigue, nausea, diarrhea, and other gastrointestinal complaints.
Marketed for
peaches Chronic exposure in humans includes drowsiness, confusion,
loss of sex drive, incoordination, slurred speech, and weakness.
Repeated or prolonged exposure to thiram can also cause
allergic reactions such as dermatitis, watery eyes, sensitivity to
light, and conjunctivitis. Not registered as a carcinogen.
Ziram C6H12N2S4Zn As above. Not classifiable as a human carcinogen due to
insufficient study but considered likely to be a carcinogen.
Possible cholinesterase inhibitor.
Notes:
1. Cholinesterase is an enzyme produced in the liver and needed for the proper functioning of the nervous systems of humans, other vertebrates, and
insects. Cholinesterase-inhibiting chemicals, most notably organophosphate and carbamate pesticides, do not allow cholinesterase to end the stimulating
signal that causes a build-up of stimulating signals in the nervous system. Because they cannot be removed, the stimulating signals continue firing in the
body, which results in the uncontrollable movements that are the sign of cholinesterase inhibition, including rapid muscle twitching and convulsions
(see http://www.toxipedia.org).
2. “Not classified as carcinogen” means not conclusively proven to be a carcinogen. This classification needs to be read with caution, because it does not rule
out the possibility of the substance being carcinogenic. Of all the chemicals listed, only glyphosate has been proven not to be a carcinogen.
Notes
Introduction
1 Examples include Kleinman (1986); Kleinman, Das, and Lock (1997); and
Kleinman and Lee (2003, 2006).
2 For a book-length account of Cassels’ work, see Broomhall (1926). For Cassels’
own account of Christianity in southwest China, see Cassels (1895). See also
accounts in the China Inland Mission’s yearly publication, China’s Million. For
other missionary accounts of Sichuan, see Graham (1927); see Flower and
Leonard (2005) for an account of Graham’s work in western Sichuan.
3 Emily Martin’s study on the immune system (1994) also provides a valuable
example of the embeddedness of perceptions of health and illness within the
political economy of the time. She shows that the value placed on flexibility
in market accumulation and as an asset for workers has seeped into current
understandings of the immune system as requiring flexibility.
4 For ethnographies of patients’ agency, see the special issue of Anthropology and
Medicine edited by E. Hsu and E. Hog (2002).
5 For studies on the extent to which state legitimacy is challenged through urban
protests by workers, laid-off workers, and pensioners, see Blecher (2002),
Hurst (2004), C. K. Lee (2007), and Thireau and Hua (2003).
6 Much of the literature concerned with ethnic minorities in rural China shows
that they are bracketed as inferior, backward, and marginal both politically
and economically (Harrell 2001; Hyde 2007; Litzinger 2000; Mueggler 2001;
Schein 2000; White 1993). Although ethnic minorities may be seen as a sepa-
rate group due to particular policies reserved to them, much of the representa-
tion of minorities elides with that of rural dwellers at large.
7 A similar trope is at work in urban China, where laid-off workers and pen-
sioners use comparisons to the Maoist past to protest about unfair treatment
(C. K. Lee 2007; Hurst and O’Brien 2002).
8 The volume edited by D. Davis (2000) offers some telling examples of how the
“consumer revolution” has affected urban China.
9 This has been noted in many village studies. See, for instance, Chan et al.
(1992, 281), Croll (1994, 218–222), Endicott (1988, 7), Flower and Leonard
(1998, 274), Gao (1999, 181), Huang (1989, 225), Ku (2003), Leonard (1994,
153), Liu (2000, 12–13), Madsen (1984, 241–243), and Yan (2003, 225–226).
10 See for instance Chan, Unger, and Madsen (1992, 326); Croll (1994, 222);
Davis and Harrell (1993, 20); Gao (1999, 228–245); Ku (2003, 225); Flower
and Leonard (1998); Potter and Potter (1990, 224); Siu (1989, 291–300); and
Y. Yan (1996, 233–234).
11 In his later work, Y. Yan (2009) also examines the “changing moral landscape
in the reform era” through the example of good Samaritans and the circum-
stances in which they operate vis-à-vis the pervasive risk of being conned.
Notes to Pages 50–65 275
1 This disease is known in biomedicine as edema. Its Chinese name made sense
to locals according to their own experience. They explained that shuizhong bing
was the result of eating food that was far too liquid. The swelling (zhong), they
continued, was caused by water (shui) and was a consequence of food shortage.
2 For powerful accounts of this period, see Chan, Unger, and Madsen (1992);
Friedman, Pickowicz, and Selden (2006); Gao (1999); C. K. Lee and Yang
(2007); Mueggler (2001); Potter and Potter (1990); and Siu (1989).
3 For a sample of excellent scholarship on the Cultural Revolution, see C. K.
Lee and Yang (2007), MacFarquhar and Schoenhals (2006), and Schoenhals
(1996).
4 For full-length studies on rural migration, see Rachel Murphy (2002) on rural
China; Jacka (2006), Pun (2005), Solinger (1999), H. Yan (2008), and L. Zhang
(2001) on urban China; and Gaetano and Jacka (2004) on both.
5 This is not to suggest that family relations of guanxi had become irrelevant
during the collective period. To the contrary, as I argued earlier in this chapter,
guanxi were foundational for securing access to food in the harshest times (see
Yan 1996).
6 This is a locally produced preserved dried beef, sometimes flavored with chil-
ies and often served sliced with spring onion and soy sauce. It is first seasoned
with spices, then preserved in salt and subsequently smoked, resulting in a
blackened surface. It is named after Zhang Fei (168–221 CE), an officer of the
kingdom of Shu, who is buried in Langzhong. He was killed by two of his own
men while leading troops to attack the rival kingdom of Wu. Locals explained
that the beef is named after Zhang Fei because, like him, it is black on the
outside (Zhang Fei apparently had dark skin) and red on the inside, the redness
representing Zhang Fei’s fierce loyalty.
7 On this policy and its reception, see, for instance, Flower and Leonard (2009).
8 Starting in late November until the coming of the New Year, each family
would slaughter a pig and prepare the meat for preservation. This meat was
slowly consumed until May the following year. As long as the preserved meat
lasted, little fresh meat was bought at all.
9 In 2004–2005, small pigs cost 300 yuan, and if well bred they could be sold
for 1,000 yuan. It cost 1 yuan to purchase a small chicken, and it could be sold
for 6 yuan per 500 grams if male, 5 yuan if female. Average weight at the time
276 Notes to Pages 69–112
of sale was 2.5–3 kilograms. A small duck cost 2 yuan and was sold for 8 yuan
per 500 grams.
10 Starting in 2006, tuition fees for primary and middle school were abolished.
11 Chapter 4, however, also shows that gender stereotypes and son preference are
still powerful.
12 The centrality of eating patterns to perceptions of health and to understand-
ing the development of cancer will be further explored in chapter 5.
1 In 2005, the typical pay for an unskilled worker in the county town was roughly
20 to 25 yuan.
2 The report was broadcast by Channel 4 on June 15, 2006.
3 In an article published on China Dialogue (a Chinese-English language Web site
devoted to environmental issues, especially in China), Pan Yue, a vice minister at
the Ministry of Environmental Protection, states: “First of all, we must understand
clearly that public participation is the right and interest of the people endowed
by law. . . . Involving public participation in environmental protection should be
an aspect by which to evaluate political performance” (December 5, 2006).
4 Recent edited volumes providing good overviews of environmental gover-
nance in China are Day (2005) and Carter and Mol (2007). For an account of
the development of environmental legislation and governance, see Economy
(2004) and Johnson (2008). For a summary of environmental health problems
and responses in China, see Holdaway (2010).
5 For a further analysis of how experiences of cancer are tied to discourses of
blame and morality, see chapters 4 and 5 in this volume.
6 Although farm chemicals were also used before the 1980s, they are widely
regarded as characteristic of the reform period and linked with the need to
compete in the market to secure a livelihood.
7 Jakob Klein (2009) makes the same point in his discussion on the introduction
of organic foods in Kunming.
8 Scholars working on Eastern Europe and Asia have recently been cautious to
unpack the transition to postsocialism not as a complete denial of past values
and to suggest that the market was already in existence, albeit in different
forms, during the socialist period (see Mandel and Humphrey 2002). Chris
Hann (2009) has innovatively adapted Polanyi’s concept of socially embedded
economics to post-Mao socialism, to argue that excesses in the redistributive
mode during Mao were undone during reform, producing an embedded form
of socialism that gave a new lease on life to subsistence and kin relations.
9 In an interesting reversal, Jakob Klein (2009) argues that PEAC (an NGO
promoting alternatives to pesticides) staff viewed urban consumers of organic
Notes to Pages 113–129 277
food in Kunming as interested only in their own well-being and not in the
welfare of farmers.
10 In this sense, the strategic use of chemicals is a form of what Rabinow would
understand as artificiality, to the extent that it involves an active engagement
with the environment, a remaking of Nature “through technique” (1996,
104–108; see also Latour 1993). This attitude delineates blurring categories of
natural and artificial food, whereby “natural foods” are always the product of
human practices and imbricated in complex moral claims.
11 Along similar lines, Aihwa Ong (2006, 23) critiques Giorgio Agamben’s (1998)
conception of humanity and the good life as exclusively based on juridical-
legalist parameters.
1 For a wide selection of social science accounts of emotions, see Greco and
Stenner (2008).
2 On emotions and illness in China, see S. Davis (1996), Kleinman (1980, 1986),
Ots (1990), Sivin (1995), and F. Wu (2005). For a recent full-length monograph
on emotion-related illnesses in China, see Y. Zhang (2007).
3 Although the term is not widespread in the rest of China, the link between
fiery qi and illness is common. Y. Zhang (2007, 95), for instance, presents a
patient who describes her condition as huoqi da, “a big fire,” which made her
easily angry and therefore sick.
4 For full-length studies on contemporary Chinese medicine, see Farquhar
(1994), E. Hsu (1999), Kleinman (1980), Porkert (1974), Scheid (2002), Sivin
(1987), and White (1993).
5 For a definition of qi, see also E. Hsu (1999, 67–87), Porkert (1974, 167),
Scheid (2002, 48–49), and Unschuld (1985, 72).
6 Sydney White (1999) illustrated that popular cultural understandings and
practices of Chinese medicine were instrumental in shaping the rural practice
of “integrated Chinese and Western medicine” invented during the Cultural
Revolution and forming the epistemological handmaiden of rural cooperative
medicine introduced at that time.
7 “Culture-bound syndromes” is an expression meant to connote illnesses that
are found only in certain cultures. Cheng’s discussion of koro (1996) may
serve as an example. Koro is a condition mostly found in southern China and
Southeast Asia, characterized by complaints of shrinking sex organs and
believed to be fatal. For Cheng, koro is not an individual psychopathology but
rather a social malady, maintained by cultural beliefs that affect the whole
community and not just those diagnosed with it. While valuable for highlight-
ing the importance of culture to illness categories, reference to culture-bound
278 Notes to Pages 129–149
had migrated to cities to work were more open to later marriages. Nonetheless,
for a young male villager to be twenty-five and still unmarried (there were
two I knew of ) was a matter of major distress for both the parents and the
young men themselves. Women who reached the same age unmarried were an
even greater cause for worry. The average marriage age seemed to be between
twenty and twenty-two. For an excellent ethnographic analysis of marriage
patterns, see Y. Yan (2003).
6 Among villagers, it was common for medicines to come with their price
attached as a sort of epithet, rather than any medical information about it: “I
had 12 yuan of medicine” and so forth. This is significant in how medicines
were perceived more widely in the area where I worked. I return to these issues
in chapters 6 and 7.
7 See chapter 8 for an analysis of the spirit world and family relations.
8 Uncle Wang’s case is discussed in the introduction and in chapters 6 and 8.
9 Bourdieu was not the first to use the concept of habitus. In his seminal essay
on body techniques, M. Mauss (1979) defined habitus as the sum of cultur-
ally patterned uses of the body in a society. Bourdieu, however, elaborated
the concept much further, introduced a discussion of power to habitus for-
mation, applied it systematically to his research, and elevated it to a central
methodological status that far outstrips earlier uses of the term (see Kauppi
2000, 101).
10 See Lora-Wainwright (2007, 2009) for a detailed examination of how attitudes
about food are historically produced and their social effects in the present.
11 Numerous critical volumes have tackled Bourdieu’s work on more or less
sympathetic grounds (see Calhoun et al. 1993; Fowler 1997; Harker, Mahal,
and Wilkes 1990; Jenkins 1992; Kauppi 2000; Reed-Danahay 2005; Robbins
1991; Robbins 2005; Shilling 1993; Shusterman 2000; and Swartz 1997).
12 See Lora-Wainwright (2007) on why this was the case.
13 Neither, however, is the highest within category 4 in the CTSU study. The high-
est incidence in China for these two types of cancer is in both cases roughly
twice the value for Cangxi.
14 See chapter 3 on the extent to which water was seen as a cause of cancer.
15 This pressure to drink despite sickness was also noted by Charles Stafford at
New Year (2000, 50) and on other banqueting occasions (104).
16 Research in these fields also has the added complication of the variations in
locals’ behavior as a consequence of the researcher’s presence. Depending on
the identity of the interlocutor, locals may boast that they drink and smoke
more than they actually do. On the other hand, they may reduce the estimate
of how much they engage in these practices, aware that they are considered
harmful in the biomedical dogma. Participant observation may provide a
firmer sense of these practices, but the very presence of the researcher may
280 Notes to Pages 162–197
make drinking more prevalent during the encounter, as locals extend their
hospitality to the researcher/guest.
17 Similarly, based on research in a working-class community in Philadelphia
with high cancer incidence, Martha Balshem (1991, 1993) suggests that locals
resisted the biomedical ideology promulgated by cancer education projects by
referring to “defiant ancestors” who “smoked two packs of cigarettes a day, ate
nothing but lard and bread, never went to the doctor, and lived to the age of
93” (1991, 162).
18 The literal translation is “There are ways in which (you can) eat it,” but the
expression was commonly used to mean “It is possible to eat” rather than to
indicate “ways” to eat something apparently inedible.
19 Although his reference to research in the north of their municipality complied
with ongoing CTSU research in Cangxi county, his later reference to two fur-
ther localities convinced me the research projects must have been separate.
CTSU’s two other sites in Sichuan were Wenjiang county and Qu county.
20 For details of these differences, see Lora-Wainwright (2009). On generational
differences in attitudes to eating and food, see also Jun Jing (2000).
21 For book-length accounts, see Balshem (1993), Gregg (2003), and Sontag
(1990). Insightful articles include Chavez et al. (2001), M. Good et al. (1994),
Gordon (1990), Hunt (1998), Mathews (2000), and Weiss (1997).
22 For a similar account of AIDS in Haiti, see Paul Farmer (1992). See also
Sandra Hyde (2007) on the politics of AIDS and blame in southwest China.
1 This estimate is based on the average total yearly expenses for a family of three
(5,300 yuan), less 1,800 yuan estimated for school fees, divided by two-thirds
(for two people), and halved (for six months).
2 Families with more than two sons often faced disagreements as to how to divide
care for their parents. The parents typically lived with their youngest son’s
family, even when the two family units were economically separate ( fenjia), but
care for parents was shared with older siblings. Daughters and their families
also offered assistance, as I noted for Erjie, but this was rarely formalized.
3 The opposition between high officials as righteous and low officials as corrupt
was a recurrent one throughout my fieldwork (see also O’Brien 2001, 428).
Locals did, however, also find higher levels of party bureaucracy unfair (see
Flower and Leonard 2009). Some of the complexities surrounding which lev-
els of officials may be held accountable and for what reasons were examined
in the ethnographic introduction and chapter 3 of this volume.
Notes to Pages 198–215 281
1 Mobo Gao makes a similar argument with regard to the revival of tradition in
Gao village. Like the Potters, he argues that religious practices were never com-
pletely uprooted (1999, 228–231). He concludes, “The Communist onslaught
on tradition has brought about changes only when there was a socio-economic
back-up. Otherwise traditions continue and revivals of traditional practices
take place once the ideological grip is loosened” (245).
2 See the special issue of China Quarterly (Overmyer 2003) for overviews of reli-
gion since 1949, and Mayfair Yang’s edited volume (2008b) on the historical
transformations of various religious traditions and religious life in twentieth-
century China. Full-length monographs on religion and ritual include Ole
Brunn (2003) on feng shui, Adam Chau (2006) on popular religion and the
local state, Jun Jing (1996) on lineage revival, Richard Madsen (1998) on
Catholicism, and Erik Mueggler (2001) on spirit possession. On religion as a
reshaping of local identity and networks, see John Flower (2004), John Flower
and Pamela Leonard (1998), Ben Hillman (2005), and Jun Jing (1996). On
religion as central to the local state, see Celina Chan and Graeme Lang (2007),
Adam Chau (2005, 2006), Kenneth Dean (2003), Ben Hillman (2004), Xiaofei
Kang (2009), Lily Tsai (2002), and Mayfair Yang (2004, 2008a). On religion
Notes to Pages 234–243 283
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culture: social inequalities and, 217–218; 140, 151–152, 277n3; repressed, 27, 33,
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anger; anxiety
Daoism, 233 environmental controls, 3, 84, 98, 99.
Das, Ranendra K., 32, 170, 193, 197 See also pollution; water pollution
316 Index
health insurance, 205, 207, 210–211. 207; perceived, 260; persistence, 260;
See also rural cooperative medical system regional, 59; socioeconomic, 153–154,
Heller, Chaia, 112, 113 207; urban-rural, 39, 44, 54, 59, 62, 80,
hospitals: cancer treatments, 180–181; 202, 205. See also poverty; wealth
distrust of, 203, 210, 212–213, 225, inflation, 59, 63
261; distrust of workers, 140–141, interview questionnaire, 12–13, 267–268
204, 264; fees, 210; missionary-built,
28; records, 4; revenue sources, 206. Jacka, Tamara, 121, 122
See also health care; Langzhong People’s Janes, Craig, 18
Hospital; surgery Janzen, John, 31
householding, 39, 41, 111, 179, 198. See Jing, Jun, 45, 47, 114, 247–248
also families Judd, Ellen, 121
housing, 1–2, 59, 67–68, 76–78, 76, 165
Hsu, Elisabeth, 36, 130–131 Kaneff, Deema, 218
Humphrey, Caroline, 39, 49 Kapferer, Bruce, 239
Hunt, Linda, 170, 172 kinship, 13. See also families
Hyde, Sandra, 34, 37 Kipnis, Andrew, 161, 180, 199
Kleinman, Arthur, 20, 35, 56–57, 128–129,
illnesses: AIDS, 18, 24, 26–27, 31, 34, 130, 173, 262, 263
37; in Baoma, 85–86, 86; chronic, Kohrman, Matthew, 27, 34, 100, 162
212, 281n12; culture-bound, 129, koro, 277n7
277n7; as deviation from norm, 136; Ku, Hok Bun, 41, 43, 44–45, 47, 61, 197
emotional links, 126–130, 135–137,
140, 151–152, 277n3; food consumption labor. See migrant workers; wage labor; work
links, 30, 259; inequality and, 18; Lakoff, Andrew, 262
management of, 32–33, 34, 36; as moral land allocation, 63
events, 169–170; neurasthenia, 129, Langzhong city: Cultural Revolution, 56;
130; political and economic contexts, drinking culture, 160–161; economic
36–37; of poor, 30, 167; resilience and, growth, 73–74; health care services, 209;
24–25; rheumatism, 122; secrecy, 185; hospitals, 28, 160–161, 180–181, 187,
Severe Acute Respiratory Syndrome, 209, 210, 211; incomes, 74; investment
207; shuizhong bing (edema), 55, 275n1; in, 62–63; location, 51; old city, 8, 51,
subjectivity, 23–24; tuberculosis, 28, 53, 58, 63; schools, 69, 80; tourism,
241, 283n11. See also cancer; health 51–52, 58, 63
care; suffering Langzhong county: administrative units,
incomes: in Baoma, 51, 65, 66–67, 70, 58–59; cancer in, 2–4, 228–229; Center
71, 74, 210; of doctors, 209; family, for Disease Control, 95–96, 98, 99,
68–70, 71, 74, 81, 182; from farming, 100; Christianity, 27–28; climate, 51; in
59, 65, 79; inequality, 153–154, 207; collective era, 52–58; economic reforms,
in Langzhong city, 74; in Langzhong 58–61; everyday suffering, 20–21;
county, 51, 59; of migrant workers, farming conditions, 52; as fieldwork site,
65–66; pensions, 66, 75; from wage 8–9; health care system, 57, 208–212;
labor, 65–66, 81, 276n1. See also poverty incomes, 51, 59; map, 53; migration
inequality: in collective era, 54; from, 52, 59, 143; peach blossom
embodiment, 259; environmental festival, 64–65; population, 51; Public
exposures, 97; government policies, Health Bureau, 4, 95–96, 165–166;
260; growth, 81; health, 18–19; in rural cooperative medical system, 35,
health care, 202, 205, 206, 207, 75, 211–212, 222–223; Water and
209–211; market economy and, 39, Electricity Bureau, 96–97, 99, 100–101;
Index 319
water pollution, 84. See also Baoma; separations, 123–124, 143; women’s
Meishan; rural areas roles, 125, 261. See also divorces
Langzhong People’s Hospital: Martin, Emily, 26, 274n3
chemotherapy drugs, 180–181; fees, 187, masculinity, 27, 122, 162. See also men
210; history, 28; RCMS patients, 211; meat, 4, 63, 110–111, 151, 156, 275n6,
staff members, 160–161, 180, 213, 214 275n8. See also food
Larsen, Janet, 83 medical anthropology: bodily experiences,
Leonard, Pamela, 8 259; of cancer, 262; critical, 18, 19;
leukemia, 56–57, 135 culture, 26; factors in treatment efficacy,
Li, Lianjiang, 43, 61, 98 203; morality and, 169–170; of rural
Liu, Lee, 84 China, 34–35; subjectivity, 23–24; of
Liu, Xin, 39, 40, 44, 46 urban China, 34
liver cancer, 3, 83, 84, 85, 135 medical care. See Chinese medicine; health
local moral worlds, 20, 47, 108, 114, 173, care; Western medicine
193, 198, 240 mediums. See spirit mediums
local state: corrupt officials, 60–61, 69–70, Meishan: cancer deaths, 3, 102; cancer
77–78, 183–185, 197, 218, 223; distrust etiologies, 101–103; cancer incidence,
of, 223; environmental issues, 93, 99–100; 91–92, 98; farm chemicals used, 109;
financial resources, 99, 100; legitimacy, migration from, 106; water pollution,
101; officials, 10–11; priorities, 99–100; 94, 100–101
relations with villagers, 197. See also men: masculinity, 27, 122, 162; migrant
Langzhong county; state workers, 121; smoking and drinking, 27,
Lock, Margaret, 19, 20, 259, 260 38, 145, 159–160, 161–162, 163–164;
lung cancer, 83, 85 spermatorrhea, 36–37; unmarried,
Lutz, Catherine, 119 278n5. See also gender; marriages
Mencius, 227
Madsen, Richard, 39, 42, 45, 46, 47, 48, mental illness, 129
162–163 migrant workers: cost of living, 66; costs of
Mandel, Ruth, 39 travel, 188, 195; divorces, 72; families,
Maoist period, 42. See also collectivism; 106–107, 123, 149; food consumption,
Cultural Revolution 110; hard work, 106–107; incomes,
market economy: disembedded from social 65–66, 106–107; men, 77, 121;
relations, 39, 111; environmental issues, remittances, 21, 59, 189–190, 194; stress,
3; ethnographies, 38; farm chemicals 141–142; women, 141–142, 143
in, 23, 24, 107–108, 111, 113, 115–116, Ministry of Health, Third National Survey
260; gender roles, 121, 141; Hu and on Causes of Death, 83
Wen policies, 61–63, 73–75; illnesses modernity: reflexive, 112; religion and,
associated with, 28–29, 30; individual 233, 234–235, 248, 256–257; ritual
responsibility, 42–43; inequality, 44, 207; practices and, 232; tradition and, 8
morality, 44, 80, 263–264; skills needed, Moerman, Daniel, 214
79; social relations, 39, 111, 142–143; Moore, Henrietta, 232
suspicion of, 218–219; transition to, moral economies: of cancer, 49; of cancer
39, 42–43, 58–61, 114, 116, 276n8; etiologies, 22–23, 24, 114–116, 145,
villagers’ reactions, 30, 31, 40, 41, 172–173, 264–265; changes, 38–39, 40,
44–45, 46–47, 59–60, 263–264. See also 41, 42, 46, 47–48, 141, 168, 260–261,
economic reforms 263; competing, 30, 226, 259, 261–262;
marriages: abusive in-laws, 124–125, definition, 39; ethnographies, 38;
126, 200; ages, 278n5; expenses, generational differences, 78–82; market
68–69; extramarital affairs, 125, 200; reforms and, 38–41, 80, 263–264;
320 Index
of past, 48, 105, 168; in rural China, patients. See cancer patients; health care;
38–42; study of, 39–40; subjectivity and, illnesses
263; of work, 114 peasants, 39, 44, 56, 82–83, 111, 205. See
morality: Christian, 242, 257; Confucian, also farming
42; contexts, 47; definition, 49; Maoist, pesticides, 2, 95, 113, 117, 201, 270–271.
42, 45; meaning, 263; overlapping See also farm chemicals
models, 49; perceived decline, 38, Petryna, Adriana, 97, 115
46–47, 68, 232; practical considerations, PHB. See Public Health Bureau
48; shared, 257; social change and, 44, Phillips, Michael, 204, 207
48–49; in social relations, 43 physicians. See doctors
Moran-Thomas, Amy, 23–24 Polanyi, Karl, 39, 40, 111
mourning practices: in collective era, 247; pollution, 3, 83–84, 97–99. See also
costs, 183–185, 184; disagreements environmental controls; water pollution
in families, 21, 50, 244–245, 254, Popkin, Samuel, 39
257, 261–262, 264; family relations popular religion: in collective era, 231–232,
and, 249–252, 253–256; functions for 247–248, 282n1; in post-Mao China,
families, 245; motives for performances, 231–232, 233–235, 256–257; shamans,
283n12; paper money burning, 240–241, 233–234, 236–237, 252–253; social
243–246, 244, 254; secrecy, 185, relations and, 256. See also ancestor
194; shaoqi rituals, 243–246, 248–249; worship; religion; spirit mediums
standardization, 247. See also funerals Potter, Jack, 40, 44, 57–58, 142, 231–232
Mueggler, Erik, 34, 45, 55 Potter, Sulamith H., 40, 44, 57–58, 142,
Murphy, Rachel, 43 231–232
Murphy, Robert, 24 poverty, 30, 35, 167, 170, 220. See also
incomes; inequality
nasopharyngeal cancer (NPC), 85 preserved foods: cancer linked to, 4, 85,
National Bureau of Statistics, 83 111, 145, 165–166, 167, 168–169,
Nelson, Richard L., 96 265; meat, 4, 63, 110, 275n6, 275n8;
neosocialism, 116. See also market economy vegetables, 165–166, 165, 167, 168–169
neurasthenia (shenjing shuairuo), 129, 130 production, excessive, 30, 259. See also work
Nichter, Mark, 32, 202, 212, 217 Public Health Bureau (PHB), Langzhong
Nichter, Mimi, 202 county, 4, 95–96, 165–166
nitrates and nitrite, 84, 85, 95, 96, 165–166 Pun, Ngai, 141
Novas, Carlos, 24, 115
qi, 127–128, 130, 136, 277n3
O’Brien, Kevin, 43, 61, 98
one-child policy, 59–60, 72–73, 77, 138 Rapp, Rayna, 25
Ong, Aihwa, 43 Rawski, Evelyn S., 247
Ots, Thomas, 129–130 RCMS. See rural cooperative medical
Oxfeld, Ellen, 48–49, 245 system
reciprocity, 39, 41, 43, 160, 179, 197, 198,
paper money, 230, 240–241, 243–246, 214
244, 254 reforestation program, 64–65, 69, 78, 223,
past and present: ambivalence toward, 45, 282n14
78, 259; attitudes formed in past, 153, reforms. See economic reforms; market
154; cancer etiologies and, 45, 168–169; economy
moral economies, 48, 168. See also religion: anthropology of, 232; behavioral
collectivism; market economy influences, 230–231; Buddhism, 233;
Index 321
differences within families, 231; fatalism, SARS. See Severe Acute Respiratory
171; legitimacy, 233, 243; modernity Syndrome
and, 233, 234–235, 248, 256–257; in savings, 66
post-Mao China, 47, 231–232, 233–235, Scheid, Volker, 36
243; relationship of belief and practice, Scheper-Hughes, Nancy, 19, 24, 212–213,
245–247; skepticism, 242–243; social 220
relations and, 256. See also ancestor schools. See education
worship; Christians; mourning practices; science, 234–235, 236, 239
popular religion Scott, James, 39, 40, 43, 111–112, 170
religious efficacy, 236, 253, 255 secularization, 232
religious habitus, 236 SEPA. See State Environmental Protection
resilience, 24–25 Administration
resistance, 43, 44, 98–99, 101 Severe Acute Respiratory Syndrome
responsibility: health care decisions, 6; (SARS), 207
individual, 42–43, 80–81; moral, 43, 48; sexuality, 36–37, 137
of state, 43, 44, 45–46, 87, 197. See also shamans, 233–234, 236–237, 252–253. See
blame; cancer etiologies; filial piety also spirit mediums
ritual practices: belief and, 247–248; Shao Jing, 34, 37, 107–108
Confucian, 232–233; legitimacy and shiniangzi. See spirit mediums
efficacy, 230, 235; modernity and, 232; of Shue, Vivienne, 57
shamans, 233–234; social relations and, Sichuan Province: health care system, 208;
255–256; traditional customs, 235. See also map, 53
funerals; mourning practices; religion Singer, Merrill, 18, 19
Rofel, Lisa, 78 Siu, Helen, 54, 57, 231
Rose, Nikolas, 24, 115, 199 smoking: cancer linked to, 24, 27, 38,
rural areas: alcohol consumption, 161; 85, 102, 145, 162, 172; gender
cancer deaths, 3, 83; education, 74; differences, 27, 161–162, 163–164;
ethnographies, 39, 41, 46, 61; health illnesses caused by, 100; prevalence,
care, 5–6, 35, 57, 204–212, 219, 259; 279n16; promotion by state, 100; social
health insurance, 207; investment in, pressures, 145, 162, 163
207; medical anthropology, 34–35; social identities, 218–219, 221–222, 228
social suffering, 20–21; subsidies, 75; socialism. See collectivism
taxes, 223; welfare system, 62, 74, social relations: cancer etiologies and,
163, 196–197, 207. See also inequality; 22, 131–138; in collective era, 40, 58;
Langzhong county distrust of outsiders, 261, 264; health
rural cooperative medical system (RCMS): care access and, 203–204, 217–219;
in Baoma, 222–226; coverage rates, 204, in market economy, 39, 111, 142–143;
207–208, 211, 224; financing, 57, 74, morality and, 49; rituals and, 255–256;
75, 207–208, 211, 224; in Langzhong role of emotions, 119–120; of village
county, 35, 75, 211–212, 222–223; doctors, 214. See also families; guanxi
obstacles to effectiveness, 222–225; pre- social suffering, 20–22, 108, 173, 259. See
reform, 205, 224, 225–226; reactions to, also suffering
75, 204, 223–224, 229; reimbursement somatization, 128–130
rates, 224; services, 212; in Sichuan, Sontag, Susan, 25, 26, 27, 28, 119, 136, 171
208; strengthening, 207, 222 spirit mediums (shiniangzi), 32, 234, 235,
236–240, 256, 261
Sanders, Todd, 232 state: accountability, 100; cancer etiologies
Sangren, Steven, 254 and, 92–93, 94–101; investment projects,
322 Index
62; legitimacy, 42, 61, 100, 101; local values, 263. See also morality
agents, 57–58; resistance to, 43, 44, 98; villages. See Baoma; Meishan; rural areas
responsibilities to individuals, 42–44,
45–46, 87, 197. See also collectivism; wage labor, 65–66, 79, 80, 81, 91, 276n1.
economic reforms; local state; See also migrant workers; work
welfare system Water and Electricity Bureau, 96–97, 99,
State Environmental Protection 100–101
Administration (SEPA), 98 water pollution: agricultural runoff,
state of exception, 100–101 94; cancer linked to, 3, 84, 85, 92,
stomach cancer: in Baoma, 86–87; in 94–101, 114, 265, 273n5; Drinking
China, 83; incidence in Langzhong, 228; Water Guidelines, 96; industrial, 3, 84;
in Langzhong county, 2; mortality rates, investigations, 84–85, 94, 95–96; state
83; in past, 29; perceived uncurability, responsibility, 101, 265. See also farm
25; risk factors, 84, 145; as vomiting chemicals; wells
illness, 29, 86–87, 144–145 Watson, James, 247
students. See education wealth, 60–61, 65, 66, 67, 81, 207. See also
subjectivity, 22, 23–24, 263 incomes; inequality
subsistence, 39, 40, 41, 93, 111–112, 179, welfare system: in 1960s and 1970s, 45–46;
258 criticism of, 43; improvements, 74; in
suffering: everyday, 20–21; inequality rural areas, 62, 74, 163, 196–197, 207; in
and, 18; intersubjectivity, 34, 262; lack urban areas, 54; urban-rural disparities,
of health care access, 259; of patients, 44, 205, 206, 225. See also health care
33–34; of poor, 170; social, 20–22, 108, Weller, Robert, 256
173, 259; study of, 23–24, 35 wells, 94, 95–96, 99, 100–101, 106. See also
suicides of cancer patients, 2, 31, 117, 194, water pollution
201, 220–221 Western medicine, 36, 128, 130, 170,
superstition, 233–235, 240, 242, 257 277n6
surgery: costs, 210, 215–216, 225; refusal White, Sydney D., 34, 36, 37–38, 103, 122,
of, 147–148, 204, 214–220, 221, 128, 205, 233
227–228, 261 Whyte, Susan Reynolds, 23, 31
Wolf, Arthur P., 256
Tesh, Sylvia Noble, 98 Wolf, Margery, 132, 142, 192, 252–253, 254
therapy management groups, 32 women: bodies, 26, 122; farming activities,
Thompson, Edward P., 39 121, 122, 123; hardship experienced by,
tobacco. See smoking 118–119, 120–126, 141–142; hard work,
traditional culture, 8, 233, 235, 239. See also 37–38, 103–104, 122–123, 124, 126;
popular religion maternal mortality, 18; migrant workers,
Treichler, Paula, 26–27, 262 141–142, 143; sexuality, 137; smoking,
tuberculosis, 28, 241, 283n11 162; stress caused by behavior of, 33,
261, 265; unmarried, 278n5. See also
Unger, Jonathan, 41, 45, 46, 47, 162–163 daughters-in-law; gender; marriages
urban areas: alcohol consumption, 160–161; work: agricultural, 103, 106, 260–261;
cancer deaths, 83; cost of living, 66, 81; cancer linked to, 23, 29–31, 37, 38, 94,
food consumption, 276n9; food quality, 102–108, 114, 124; changing definition,
110; gender relations, 125; health care, 114; in collective era, 54–55, 79,
205, 206, 225; medical anthropology, 34; 104–105, 114, 121–123, 126; energy,
welfare system, 54. See also inequality; 79; fatness and, 258; gendered division,
Langzhong city 120–121; health and, 29, 30, 104, 258;
Index 323
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