Review Essay Ego, Skill, and the Practice of Medicine in Socialist China - Brill
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asian medicine 8 (2013) 485–489
brill.com/asme
Review Essay
∵
Ego, Skill, and the Practice of Medicine in
Socialist China
Stewart, Roderick and Sharon Stewart
2011, Phoenix: The Life of Norman Bethune, Montreal and Kingston: McGill-Queen’s
University Press. Pp. xiii +479. CDN $39.95 Paperback. ISBN 9780773586031
Lynteris, Christos
2013, The Spirit of Selflessness in Maoist China: Socialist Medicine and the New Man,
New York: Palgrave Macmillan. Pp. ix +126. $67.50 Paperback. ISBN 9781137293824
On 21 December 1939, Mao Zedong wrote a short essay commemorating the
‘spirit of selflessness’ of the Canadian communist surgeon, Norman Bethune.
‘What kind of spirit’, Mao asked, ‘is this that makes a foreigner selflessly adopt
the cause of the Chinese people’s liberation [against the Japanese invaders]
as his own’? In the Shanxi-Chahar-Hebei border area, ‘no soldier or civilian
was unmoved who had been treated by Dr Bethune or had seen how he
worked’. To this end, Bethune was a doctor who was constantly perfecting his
skill, Mao said, and all communists ‘must learn the spirit of absolute selfless-
ness from him’. A man who had learned this spirit would be ‘noble-minded
and pure’ and is above ‘vulgar interests’ (‘In Memory of Norman Bethune’,
www.marxists.org).
These words were memorised by hundreds of millions of Chinese school
children throughout the Cultural Revolution and beyond, making Bethune one
of the ten most influential foreigners in modern Chinese history, despite living
in China only 17 months. Two recent books attempt to make sense of Bethune
and his legacy in radically different ways: Stewart and Stewart build on a
lifetime of research about Bethune’s life to write the definitive biography of the
man; Lynteris instead examines two competing interpretations of the spirit of
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selflessness in Maoist China—what he calls the self-cultivation interpretation
and self-abolition interpretation. The key difference is relevant to interpreting
Bethune’s life and legacy, and can be stated simply. The first interpretation said
that doctors must lose their egotistical motives and learn how to humbly serve
the people, while the second argued that this was not revolutionary enough,
since it still contained room for ego and skill-as-private-property.
Who was Norman Bethune? Bethune was once called a missionary, a
description he treated like an epithet. For Bethune, missionaries were lackeys
of the imperialist powers (Stewart 341). Medical missionaries themselves
did not usually identify with worldly interests, but saw their own mission as
inherently selfless. Indeed, mission dispensaries and hospitals in small inland
towns, like those of Canadian Dr Richard Brown in Henan, or New Zealander
Dr Kathleen Hall in Hebei (two medical missionary colleagues of whom
Bethune approved), were the first outposts of Western medicine in rural China
until the Cultural Revolution. These doctors constantly walked a tightrope
between the ideals fostered in pristine conditions at home and the lack of
infrastructure and supplies outside of major Chinese cities. They attempted to
bring medicine, however incompletely, to the countryside. Yet Bethune, born
to an evangelical Presbyterian minister’s family, rejected Christianity and its
cultural accommodation to a capitalist society of inequality (whatever its own
narrative of selflessness). Bethune could be said to have been a missionary of
wartime surgery and recovery, performing ‘near miracles by teaching peas-
ant boys skills that made them effective medical workers in guerilla warfare’
(Stewart 377). But he was also a student, rather than a teacher, of communism
among the people of rural north China for whom ‘communism is a way of life,
not merely a way of talking or a way of conscious thinking’ (Stewart 303).
Was Bethune, as Mao claimed, actually selfless, and without ego? Anyone
who reads Phoenix will laugh at this baldly stated question—Bethune clearly
had a massive ego. The details of Bethune’s personal life explored in Phoenix
demonstrate a charming, talented, and even visionary man dissipated by drink
and self-destructive temper tantrums. Even at his best in China, Bethune was
described by Richard Brown, his surgical partner in 1938, as ‘psychopathic’ and
‘a horrible man’ (Stewart 295). The reader is nonetheless attracted to Bethune’s
ego as it lurches from grandiose plans to private failings. Bethune’s ‘nexus of
narcissism and humanitarianism’ is described by a friend, even as Bethune
‘laid his life on the line time and again, persistently trying to aid people in
extremely adverse circumstances’, he was nonetheless always feeding his own
vanity as if to say, ‘Oh well, gee, I’m quite a guy’ (Stewart 198). The nadir of
Bethune’s life seems to be his time in Spain where his mobile blood service
made a real contribution to the civil war effort against Franco’s fascists, even
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as his m ismanagement of its Madrid headquarters and an inability to play
well with others led to his banishment from Spain by the very Republican
Government that he had come to aid (Stewart 155–211).
Unfortunately, Stewart and Stewart do not help us escape Bethune’s ego.
They consistently privilege Bethune’s thoughts, words, and actions over con-
text. Men, women, institutions, and even nations in turmoil, provide only
background noise to a man of great potential looking for his opportunity to
make a great contribution to mankind. ‘I believe I have found my mission
in life’, he said in July 1938 as he settled in behind Japanese lines in China,
‘[i]n this great area of 13,000,000 people and with 15,000 armed troops, I am the
only qualified doctor!’ (Stewart 296). But there are hints that Bethune himself
somehow recognised a need to escape the self:
You need an altar to immolate yourself upon—a glad, burning sacrifice to
a living God—you ask to be consumed—to rise again like a phoenix from
the ashes of your own glad destruction—clean and pure and free—with
wings (Stewart 368).
In contrast, Lynteris has no interest in Bethune’s life, but only in narrating and
theorising the important legacy of Mao’s eulogy to Bethune, ‘the afterlife of
his spirit of selflessness’ (Lynteris 9, n. 1) that eventually became a full-blown
cult (Lynteris 103–4). In four, tightly-knit chapters with judicious use of critical
theory, Lynteris explores first the sublimation of skill to the revolution and the
Confucian roots of self-cultivation, followed by an account of the increasing
contradictions between being ‘red’ and ‘expert’ in the years leading up to the
Cultural Revolution, and then culminating in the clash of the two interpreta-
tions at the height of the Cultural Revolution between 1966 and 1969 when
Bethune’s legacy was used to abolish the self as private property. The book ben-
efits from engagement with works by David Lampton, Kim Taylor, Roderick
MacFarquhar, and Joel Andreas on the red vs. expert conflicts. And it is well
grounded in a confident interpretation of the writings of Mao and Liu Shaoqi
and a survey of medical publications from the 1950s and 1960s.
For Lynteris, the conflict between two interpretations of Bethune’s legacy
formed the dialectic of socialist medicine in China. For the professional phy-
sicians of the Chinese Medical Association, such as Fu Lianzhang (Fu Lien-
chang), Bethune set an example for physicians to self-cultivate the proper
attitude of service toward the people. In an editorial in the Chinese Medical
Journal in 1952, Fu described Bethune as an extraordinarily gifted surgeon who
had chosen to set aside his own material goals as a bourgeois physician to serve
the people of China.
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Comrade Bethune has no personal interests or private ends. His life is
the highest manifestation of the selfless spirit in that he had merged his
personal interests and aims in the general interests and aims of the prole-
tariat. He has set an inspiring example (Lynteris 24, emphasis mine).
The key to Fu’s interpretation was to choose the most radical passage of Mao’s
memorial and to ‘domesticate this phrase’s political potential’ to remake
socialist physicians, and thus all of Chinese society. Knowing that he and his
colleagues were in a potentially precarious position in the new China that
aimed to eliminate old forms of privilege, Fu argued that there could be a
healthy give and take between the expertise of the medical specialists and the
people’s experience—a balance between being red and expert. It would be a
dialectic relationship, with experts working among the people to hear their
‘concrete health problems’ and the people turning these over to the specialists,
who then deal with them based on their long experience among the people
(Lyneteris 26). This was the line of Liu Shaoqi, and like the fortunes of Liu, this
line of ‘self-cultivation’ was ascendant in China in the early years of the PRC,
and again in the five years between the Great Leap Forward and the Cultural
Revolution (1961–66).
Yet for the radical interpretation of Mao’s words, self-cultivation led only to
liberal do-goodism that would retain enough bourgeois theory and practice to
form a fifth column in socialist China. A true proletarian medicine must nec-
essarily remake medicine itself. The Great Leap Forward and the anti-rightist
movement of the late 1950s, followed by the build-up to the Cultural Revolution
saw a temporary retreat of self-cultivation. Mao attacked the Ministry of
Health in 1965 as a ‘Ministry of Gentlemen’s Health’, signaling the beginning of
CCP support for (and creation of a simplified) Traditional Chinese Medicine as
a counterbalance to the monopoly of medical expertise. Suddenly, there were
accounts of Marxist-Leninist theory being applied to formerly hopeless medi-
cal cases, as in the case of a worker who had almost 90 per cent of his body
surface burnt. Capitalist medicine would give up on such a case, but socialist
medicine would not.
Between 1965 and 1966, medical leadership attempted to deflect the brunt
of this criticism through a variety of methods, including revisiting Bethune’s
legacy. They continued to insist that there should be a role for both red and
expert: ‘Following the teaching of Chairman Mao Zedong, the Chinese people
have learned from Comrade Bethune and are marching along the road of “red
in politics and expert in profession” ’ (Lynteris 84).
In December 1966, the People’s Liberation Daily published an editorial
(reprinted in major medical journals) that essentially attacked the professional
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physicians’ self-cultivation line arguing that Mao’s Bethune eulogy ‘provides us
with a powerful weapon to eradicate self-interest and foster public interest’,
thus enabling all Chinese communists to ‘sweep away the filth in the depth of
our souls’ (Lynteris 91). Such a process of soul-searching was a revolution of
one’s basic class attitude toward life and society—such a change, frequently
reenacted, would allow truly selfless people to emerge. Medical workers who
considered their skill as ‘inalienable private property that may lead to fame
and fortune’ were clinging to private ownership of their skills (Lynteris 93).
Like Liu Shaoqi, these recalcitrant physicians were taking the ‘capitalist road’
and continued to prefer urban over rural, specialist over manual labour. In a
word, they were afraid to get their hands dirty: ‘I struggled with myself over my
fear of dirt’ (Lynteris 105). While Liu Shaoqi’s model of the socialist New Man
could be achieved through specialist skill applied to the problems of the revo-
lution, the Cultural Revolution aimed rather to identify the class enemy within
one’s self and continuously engage in struggle to eradicate it (Lynteris 110).
Stewart and Stewart are interested in Bethune for his concern for ‘social
justice and humanitarianism’ (377–78), a kind of proto-Médicin Sans Frontiers
secular missionary. For them, Bethune’s final sacrifice in China provides an
example of internationalist brotherhood, his phoenix moment to make up for
his character flaws. But perhaps it is rather in Lynteris’ account of the role that
the Bethune-inspired concept of selflessness played in the Maoist era that we
may witness Bethune’s phoenix moment, free at last from the last vestiges of
ego that drove him. There was room, in Mao’s eulogy, for a doctor or a good
communist’s skill, but there was no room for the ‘leather shoe attitudes’ of Liu
Shaoqi and Fu Lianzhang who were afraid of dirt. Bethune himself quickly
gave up on shoes altogether and wore the simple sandals of the peasants.
It is beyond the scope of this review to address the major governmental
problem of modern medicine in China—how medical care might be extended
to those too poor to pay for it. As critical scholars we must not shy away from
the theoretical problems with which the revolution wrestled, despite acknowl-
edging its failures. My main criticism of Lynteris’ thin volume is that it does
not explore the subject enough, and so I hope that his work will inspire more
empirical and theoretical studies of the medicine of the Cultural Revolution.
David Luesink
University of Pittsburgh
david.luesink@gmail.com
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