From China to the APA, ‘medicalisation’ is used to dismiss political opponents

In the Fall of 1913, Lenin wrote a couple of letters to Maxim Gorky in which, deeply disturbed by Gorky’s support of the humanist ideology of the “construction of God,” he implies that Gorky succumbed to this deviation because of his bad nerves, and advises him to go to Switzerland and get there the best medical treatment. In one of the letters, after making it clear how he is shocked at Gorky’s ideas – “Dear Alexei Maximovitch, what are you doing, then? Really, it is terrible, simply terrible! / Why are you doing this? It is terribly painful. Yours, V.I.” – Lenin adds a strange postscript: “P.S. Take care of yourself more seriously, really, so that you will be able to travel in winter without catching cold (in winter, it is dangerous).” Obviously, Lenin is worried that, apart from catching cold, Gorky will catch a much more serious ideological disease, as it is clear from the subsequent letter (posted together with the previous one): “Perhaps I don’t understand you well? Perhaps you were joking when you wrote ‘for the moment’? Concerning the ‘construction of God,’ perhaps you didn’t write that seriously? Good heavens, take care of yourself a little bit better. Yours, Lenin.” 

What should surprise us here is the way the root of Gorky’s ideological deviation is located in a bodily condition (over-excited nerves) that needs medical treatment. One should note that this is not (yet) Stalinism: in Stalinism, the cause of illness is no longer “objective” but is brutally re-subjectivised, i.e., the accused is considered fully responsible for his crimes. Occasionally, however, the objectivising approach returns with a vengeance in late Stalinism. In my comment on toxic masculinity published in Spectator, I’ve already mentioned the notorious Sherbsky institute in Moscow which treated dissidence as a form of mental illness; we find exactly the same stance in a recently obtained official Chinese Communist Party recording which characterises Uyghurs who have been sent for political “re-education” as “infected by an ideological illness” (harbouring “strong religious views” and “politically incorrect” ideas) – here are some passages worth quoting in detail:

Members of the public who have been chosen for re-education have been infected by an ideological illness. They have been infected with religious extremism and violent terrorist ideology, and therefore they must seek treatment from a hospital as an inpatient. The religious extremist ideology is a type of poisonous medicine which confuses the mind of the people. Once they are poisoned by it, some turn into extremists who no longer value even their own lives … If we do not eradicate religious extremism at its roots, the violent terrorist incidents will grow and spread all over like an incurable malignant tumor.

Although a certain number of people who have been indoctrinated with extremist ideology have not committed any crimes, they are already infected by the disease. There is always a risk that the illness will manifest itself at any moment, which would cause serious harm to the public. That is why they must be admitted to a re-education hospital in time to treat and cleanse the virus from their brain and restore their normal mind. We must be clear that going into a re-education hospital for treatment is not a way of forcibly arresting people and locking them up for punishment, it is an act that is part of a comprehensive rescue mission to save them.

In order to provide treatment to people who are infected with ideological illnesses and to ensure the effectiveness of the treatment, the Autonomous Regional Party Committee decided to set up re-education camps in all regions, organizing special staff to teach state and provincial laws, regulations, the party’s ethnic and religious policies, and various other guidelines. They mobilized the public to learn the common language [Mandarin Chinese], complete various technical training courses, and take part in cultural and sport activities, teaching them what is correct and incorrect … so they can clearly distinguish right from wrong … At the end of re-education, the infected members of the public return to a healthy ideological state of mind, which guarantees them the ability to live a beautiful happy life with their families.

Some people worry that once they have been through the re-education process, they will be classified as bad people, and that even after having worked hard to complete the re-education program they will be discriminated against and treated differently. In fact, this is an unnecessary concern. Just like people who have had an operation, and have taken medication before recovering from their illnesses, the public won’t see them as someone who is ill.

However, we must be cautious about one fact: having gone through re-education and recovered from the ideological disease doesn’t mean that one is permanently cured. We can only say that they are physically healthy, and there is no sign that the disease may return. After recovering from an illness, if one doesn’t exercise to strengthen the body and the immune system against disease, it could return worse than before.

Before we shrug these lines off as a typical expression of Chinese Communist totalitarianism, we should remember that exactly the same logic is at work in the recent public statement of The American Psychological Association which proclaimed “traditional masculinity” as toxic – again, medicalising” an ideological conflict by way of reducing the opponent to a product of medical illness. In the terms of Lacanian psychoanalysis, what we get here is a pure case of the “university discourse, a social link whose agent is a bearer of objective knowledge. This agent does not impose himself as a master giving orders and demanding obedience; he acts like a neutral expert establishing facts. Just think about what economy experts are telling us again and again: they present tough austerity measures, lower taxes for the rich, etc., as something required by economic reality, not as decisions that are based on some politico-ideological preferences. (And, incidentally, the same fake “expert” stance is clearly discernible in a weird “Leftist” argument for open borders: “Europe needs immigrant workers for its economy to continue to expand…” – (But which Europe? Capitalist Europe, capitalism needs them for its expanded reproduction.)

The hidden truth of such a discourse is, of course, that the neutral expert knowledge is based on politico-ideological choices: economic measures advocated by experts are a form of brutal domination, in the same way that the “science” which treats dissidence as an illness relies on ruthless political domination, and the same holds for today’s Chinese treatment of Uyghurs who resist the Chinese domination… and for the APA categorisation of “toxic masculinity” as a form of psychic illness.

Here we are, then, today: when the task is to dismiss political or ideological opposition through brutal medicalisation, Chinese totalitarianism and Political Correctness can work hand in hand.


  • James Gatehouse

    Very well put, Mr Žižek. To compund matters, those who recognise and wish to treat illnesses such as toxic maculinity are surely doing good? Who wouldn’t want to be cured of ill health, it will be argued.

    Presumably masculinity described as toxic is recognised through its behaviour. I don’t think there’s a blood test for it, or maybe a brain scan that can be carried out to help diagnosis. Could it be that I’m not up to date, so that I haven’t heard of a gene having been identified for the condition? I don’t think so, which means we are left with behavioural observations and tell-tale signs communicated to a therapist through off colour conversation. This alone is the means of diagnosis.

    Behaviour is usually seen as a sign of ethical impulse. If a person wants to act in a certain way, then surely it’s because he has agency and wishes to act like that? It isn’t always so where something obviously physical is at fault; however, we say under these circumstances that if masculinity is acting toxically then ethically the male in question has a deficiency. Medicalising the problem, or scientifically diagnosing it as a condition then, sets science up in opposition to ethics, because it finds medical a medical reason for behaviour.

    Where behaviour does not arise from ethical decisions in the chooser science used in this way seems to invite us to believe that in the end there are no bases for behaviour arising from agency. We are victims of our disordered bodies. How fortunate a scientist or medic of that persuasion must feel when he recognises that the gods rolled the health dice in such a way that they were not themselves so afflicted. The fault is in the stars.

  • Paul Atreides

    The misuse of the suffix “phobia”, which suggests a disordered state of mind seems to be another facet of this. So, people who reject Islam on entirely reasonable grounds are labelled “Islamophobic”, suggesting that their dislike of Islam is irrational and hysterical. The same goes for “transphobia”. In both cases it is ironic because one could contend that a Muslim who believes that the Koran is the inerrant word of the creator of the universe, or a man who thinks he is a woman, are themselves suffering from mental incapacity of some kind, rather than their critics.