LORA-WAINWRIGHT, Anna. Fighting For Breath - Living Morally and Dying of Cancer in A Chinese Village

FIGHTING FOR
LIVING MORALLY AND DYING OF

CANCER IN A CHINESE VILLAGE
anna lora-wainwright
Fighting for Breath
Fighting for Breath
Living Morally and Dying of Cancer
in a Chinese Village
Anna Lora-Wainwright
University of Hawai‘i Press

Honolulu
© 2013 University of Hawai‘i Press
All rights reserved
Printed in the United States of America
18 17 16 15 14 13 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data

Lora-Wainwright, Anna, author.
Fighting for breath : living morally and dying of cancer
in a Chinese village / Anna Lora-Wainwright.
pages cm
Includes bibliographical references and index.
ISBN 978-0-8248-3682-5 (cloth : alk. paper)
1. Cancer—Social aspects—China—Langzhong Shi.
2. Cancer—Patients—Care—Moral and ethical
aspects—China—Langzhong Shi. I. Title.
RC279.C6L67 2013
362.19699’43200951—dc23
2012033973
University of Hawai‘i Press books are printed on acid-free

paper and meet the guidelines for permanence and durability
of the Council on Library Resources.
Designed by Janette Thompson ( Jansom )

Printed by Sheridan Books, Inc.
For Gandie
and all those fighting with cancer
Contents
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
Part 2: Making Sense of Cancer

Chapter 3: Water, Hard Work, and Farm Chemicals:
The Moral Economy of Cancer     91
Chapter 4: Gendered Hardship, Emotions, and the
Ambiguity of Blame     117
Chapter 5: Xiguan, Consumption, and Shifting Cancer
Etiologies     144
Part 3: Strategies of Care and Mourning

Chapter 6: Performing Closeness, Negotiating Family
Relations, and the Cost of Cancer     177
Chapter 7: Perceived Efficacy, Social Identities, and
the Rejection of Cancer Surgery     200
Chapter 8: Family Relations and Contested Religious
Moralities     230
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
and Volker Scheid offered a good basis on medicine in China, as well as

unflinching support in developing my research. My colleagues in Oxford
have provided a stimulating environment in which to complete this
book. For very helpful comments on various versions of the manuscript,
in full or in part, I am grateful to Francesca Bray, Adam Chau, Nancy
Chen, Sian Crisp, Kay Dickinson, Glen Dudbridge, Stefan Feuchtwang,
John Flower, Adam Frank, David Gellner, Jennifer Holdaway, Elisabeth
Hsu, James Keeley, Lili Lai, Pam Leonard, Beckie Marsland, Rana
Mitter, Rachel Murphy, David Parkin, Frank Pieke, Laura Rival, Volker
Scheid, Priscilla Song, Charles Stafford, Katie Swancutt, Bryan Tilt,
Benjamin Van Rooij, and Xiang Biao. Two anonymous reviewers for
the University of Hawai‘i Press and editor Pam Kelley have provided
helpful comments. Lee Motteler meticulously edited the manuscript.
Rana Mitter and Adam Frank deserve special thanks for helping to
pitch the project. Friends who made the journey less strenuous are Elena
Barabantseva, Patrizia Bassini, Tineke D’Hasselaer, Bo Hu, Yingru Liu,
Doreen Montag, Chris Ryder, and Eileen Walsh.
This research was supported by the Arts and Humanities Research
Council, the Leverhulme Trust Study Abroad Studentship, the
Universities’ China Committee in London, Green College fund, the
Davis Fund (Oxford), and the Contemporary China Study Programme
(Oxford University). I am deeply indebted to these funders for making
my research possible.
Immense gratitude goes to my families in Italy, especially my mother,
who also offered some avenues for fundraising to help Langzhong
friends, and my sister, who comforted me when I felt lonely and hopeless
and read the manuscript in full. I thank my grandmother (and grandfa-
ther) for overcoming her initial horror at my plans to live in conditions
she felt her generation had only just managed to shake off and for her
interest in all of my following trips. Rosa, Gaspare, Carlo, Sergio, Flora,
Teresa, Tony, Lucio, and other members of “la spedizione punitiva”
are also friends who have offered a shoulder to lean on during hard
times—so much help can never be fully reciprocated. More than any-
one, I thank my husband, Leon, with whom I weathered stormy periods
of separation required by long-term fieldwork, the even stormier peri-
ods of reunion, and the emotional and intellectual turmoil that writing
on illness has caused. I look forward to many more productive, happy,
loving decades together.
Guide to Key Places and People
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
Guoyun Erge and Ersao’s son (seventeen in 2004), trained

briefly as a tailor, in 2004 worked in Fujian and
later in Chongqing; returned home during his
grandfather’s illness and for his funeral
Sange Third son of Gandie and Ganma, worked in a
small food shop in Langzhong city
Sansao Sange’s wife, worked with him in a small food shop
in Langzhong city; she and her husband had a son
who was nine in 2004
Dajie Eldest daughter of Gandie and Ganma, worked
as a cleaner in a hotel near Langzhong city’s long-
distance coach station; her husband worked as a
motorcycle taxi driver; they had a son attending
high school in 2004
Erjie Second daughter of Gandie and Ganma, the
anthropologist’s host and closest informant, thirty-
six in 2004
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
Uncle Wang’s Family

Uncle Wang One of five brothers (one of whom is a fengshui
master), full-time farmer, lived in a portion of
the only surviving courtyard house in Baoma;
was diagnosed with stomach cancer in June
2004 and killed himself by drinking pesticide in
November 2004
Aunt Zhang Farmer, caring for her granddaughter; firm believer
in the spirit world and in “traditional” customs
Wangge Uncle Wang and Aunt Zhang’s son, worked in a
factory in Guangdong
Guide to Key Places and People     xv
Pengjie Wangge’s wife, migrated with her husband and

worked in the same factory in Guangdong
Youhui Daughter of Wangge and Pengjie, ten in 2004
Other Key Informants

Aunt Cao Wife of one of Baoma’s barefoot vets, in her sixties,
had two daughters and two sons, the youngest also
a vet, the other migrated in search of work; both
her daughters-in-law had very poor relationships
with their husbands
Junhong Daughter-in-law of Aunt Cao and the village
barefoot vet, originally from Meishan
Lili Junhong’s younger sister; left her husband and
worked in Xi’an
Baohua Junhong and Lili’s older brother, lives in Meishan
Grandma Chen In her early seventies, had three sons, married to
a Korean War veteran; her suicide by pesticide
poisoning followed a diagnosis of stomach cancer
in 2006
Aunt Liu (Minjie) Born 1951, died in 2007 of stomach cancer;
married to one of Baoma village’s schoolteachers,
who died at forty-eight of pulmonary heart disease;
she could not bear children and had to adopt
a daughter
Introduction
In August 2004, I first visited the only surviving courtyard house in

Baoma, a village in southwestern China where I had settled three
months previously.1 Locals told me the house was three hundred
years old. Over a dozen families had lived there during the Cultural
Revolution, but in 2004 it accommodated only three families, and most
of the former residents had since moved, either to a nearby house, to
the township, or to the small county capital of Langzhong. Most of
the building had fallen into a condition of irreversible disrepair. Some
parts still retained wooden walls with reliefs defaced during the Cultural
Revolution and others were made of bamboo strips covered with mud
or supported by brick-built walls, with bamboo walls dividing the inte-
rior space into rooms.
As I made my way into the courtyard, Aunt Zhang, a woman in
her early sixties, emerged from one of the brick-built units. It had taken
me half an hour to walk to her house from my home on the other side
of the village, and Aunt Zhang invited me to have some hot water
and fruit. It was the first time I had met her, but Aunt Zhang was
very friendly and had predictably heard much about me already. She
laughed at my dressing style—thick blue trousers and a dark blue top—
which she joked was as modest as the local villagers, and she admired
my cheap boots, which came in so useful when the rain poured down
as it had done for several days. Sipping some hot water, Aunt Zhang
volunteered some information on her family. She had a daughter who
lived over two hours’ bus ride from Langzhong city; a son working with
his wife in Guangdong Province (one of southern China’s prosperous
regions) and sending money home whenever needed; and a doting ten-
year-old granddaughter, Youhui, who would become one of my gan
haizi in December 2004.2
Aunt Zhang was very embarrassed and apologetic about the state
of their house, which other villagers considered a clear sign of poverty.
2     Introduction
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.
Making Sense of Cancer

Researching cancer was not my original intention. In May 2004, I for-
mally enrolled as a visiting researcher at Sichuan University, hoping to
carry out fifteen months of ethnographic fieldwork in a rural part of
the province. My Chinese supervisor selected the area of Langzhong
(northeast Sichuan) as a location where, with the help of his connec-
tions, I would be allowed to reside in a village as I had requested. The
following month I settled with a rural family and registered as a resi-
dent of Baoma, a village of five hundred residents six kilometers from
Langzhong city, where I lived until September 2005. I returned for fol-
low-up visits each year since, for a total of eighteen months of research
and residence in the area. Unless otherwise stated, the period 2004–2005
should be taken as the ethnographic “present” of this volume.
I planned to conduct an anthropological study of how villagers
understand health and illness, how they make decisions about treat-
ment within the family, and what home-based knowledge and practices
are widespread for common illnesses. As my research unfolded, how-
ever, cancer occupied an increasing amount of my time and attention.
Doctors and local residents alike highlighted cancer—of the stomach
and esophagus in particular—as a major local killer in the Langzhong
area. In 2004, two of my neighbors had recently lost their husbands to
cancer—one prostate and the other esophagus. Uncle Wang, as noted
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
are extremely unlikely to be classified as “cancer villages” according to

the conventional industrial pollution paradigm. Collecting any quanti-
tative data on cancer in the area proved extremely difficult. Although
the Baoma village doctor, doctors in the city hospital, and Public Health
Bureau staff were aware of research on cancer in Langzhong in the
1980s, they claimed to have no records of such research. They further
explained that even if they located such records, they would probably
be classified as “internal” (neibu) and would therefore be inaccessible
to me. All they could tell me was that such research had attributed the
high cancer rates to consumption of salt-preserved meat and vegetables,
but that this finding was later dismissed. I was confronted with a similar
response when I requested access to hospital records on cancer patients.
I was told that they were not comprehensive and that providing me with
this information would be very troublesome (hen mafan). At any rate,
given that most cancer sufferers do not opt for hospitalization and avoid
surgery, hospital records would have been severe underestimates.
Readers eager to be told in no uncertain terms what causes high
cancer rates in Langzhong will not find an answer here. This is not
only because hard data is inaccessible or unreliable, but also because of
a choice of focus. None of the etiologies explored—from the relatively
more scientific water pollution or consumption of preserved vegetables
to the relatively less scientific emphasis on hard physical work—could be
isolated as typical of this geographic area alone. What I offer, rather, is an
account of how the different etiologies employed locally clash and what
implications they have for inaction. Villagers are shown not as backward
and ignorant of sanitation and nutritional principles but as engaging
with new circumstances of market expansion in complex ways.
Fighting for Breath

This book offers a bottom-up account of how villagers in Langzhong
understand the development of cancer, how they cope with it, and how
it affects and is affected by family relations. Faced with the tragedy of
what is often a fatal ailment, families articulate disparate views to tackle
the question, “Why him/her?” and assemble various and conflicting
strategies to deal with illness. The elements villagers typically identify
as causes of cancer are farm chemicals, smoking, drinking, preserved
vegetables, and repressed anger or enduring hardship in general (most
significantly, strenuous physical work, food shortage, and humiliation

during the Cultural Revolution). A biomedically based account of can-
cer would start with testing villagers’ knowledge that smoking and drink-
ing are potential causes of cancer. By contrast, this monograph gives
primacy to locals’ own explanations of why cancer was common. For
some, cancer is mostly to be blamed on the sufferer—either because of
their bad temper or their predilection for strong alcohol and cigarettes.
For others it is caused by factors beyond the sufferer’s control—rapid
social change leading to tensions amongst family members or consum-
erism requiring the use of farm chemicals. Adherence to one or another
of these etiologies embodies a particular engagement with the sociopo-
litical past and present and provides diverse answers to the question of
who is accountable for illness and who is responsible for healing.
Having become very close to the families of two cancer sufferers,
Uncle Wang and Gandie, and paid them frequent visits, I gained a sense
of the ways in which families perceive these types of cancer and their
etiologies and of strategies they employ to tackle them. Much of this
volume focuses on these two families as in-depth case studies of the
moral economy of cancer. Given my familiarity with some of the medi-
cal staff in the county hospital, villagers often resorted to me as a bridge
between themselves and that most feared of places, the city hospital.
Acting as ganma7 to six children in Baoma also allowed me to develop a
close relationship with some local families and become involved in their
caring practices. This type of involvement with the local community has
enabled an anthropological description of the idiosyncrasies of health
and illness as part of villagers’ everyday practices. Their quests for heal-
ing include trips to the city hospital, Chinese herbs and biomedical pills
from township clinics, and resort to spirit mediums. They often require
selling all of the family’s livestock, asking students to abandon school
to earn money for their parents’ care, and mobilizing connections and
neighborly advice to identify reliable treatment.
I was struck by the stoic attitude with which locals faced illness.
None of those who fell ill and died with stomach or esophagus can-
cer during my stay resorted to surgery, and this came as no surprise
to me. One of the reasons why I had chosen to do research in rural
China was that, as in many other developing countries, especially in
the countryside, people face major problems of access to health care. I
wanted to know more about how sufferers and their families attempted
to overcome these barriers. What I found is that in at least some cases,

financial barriers alone were not what prevented sufferers from resort-
ing to expensive forms of treatment such as surgery. Family relations
and sufferers’ sense of responsibility and entitlement proved just as
important. Villagers’ attitudes and strategies of care offer a prism for
understanding the wider dimensions of social and cultural life in con-
temporary rural China—what I refer to as “fighting for breath.”
“Fighting for breath” is not the translation of a local idiom. The
phrase is intended as a semiotic framework to encompass everyday
efforts to make sense of cancer and treat it. Since esophagus cancer was
also referred to as the “choking illness,” the expression is particularly
pertinent. It is intended to encapsulate the physical, emotional, and eco-
nomic hardship presented by this most often fatal disease. This book illus-
trates villagers’ fight for breath as both a physical and a social struggle
to maintain integrity and to ensure family and neighborly support. It is
not only about fighting for survival but also about the search for a moral
existence. Thus this book engages with the question of how morality is
contested in contemporary China. Is it moral for a son not to visit his
father throughout his illness to ensure that he can send money home for
treatment? What kinds of moral claims are implied by attributing cancer
to water, diet, or anger? How does a woman’s fear of her father-in-law’s
ancestral image configure her relationship with the rest of the family?
This ethnography approaches critically various characterizations of the
post-Mao period as a fall “from heaven to earth” (Croll 1994), as uncivic,
individualistic, and immoral (Liu 2000; Yan 2003). By contrast, it exam-
ines how contending forms of morality are constantly produced through
negotiations about cancer etiology, cancer treatment, and mourning
practices. The fight against cancer, then, is deeply bound to efforts not
only to maintain health but also to debate one’s position within the fam-
ily and the local community (see Crandon-Malamud 1991) and to make
claims to entitlement to care and to a cleaner environment.
Structure of the Volume

The volume is divided into three parts.8 In part 1, chapter 1 situates
the study vis-à-vis relevant areas in the anthropology of suffering and
the anthropology of rural China, with particular reference to social suf-
fering, subjectivity, family management of illness, etiologies of cancer,
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
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.
Entering the Field

Serendipity brought me to Langzhong, and the process of settling
in and becoming accepted by the local community was by no means
straightforward or painless. Dr. Pam Leonard, a friend and colleague
of my doctoral supervisor, was in Sichuan for a year in 2004 and put
me in touch with one of her contacts at Sichuan University, where I
was able to be affiliated as a visiting researcher under the supervision
of sociologist professor Chen. Professor Chen had reliable contacts in
Langzhong and was planning a research visit with some students in June
2004. This would serve as my entry point into the field. When Professor
Chen first made his case for Langzhong, I was suspicious to say the
least. He urged me to carry out research in the area because “it has not
become modern yet” and “tradition is disappearing in China” (May
2004). This baffled me and went against much of what I had learned to
critique in my anthropological training, to do with ready-made opposi-
tions between tradition and modernity, ignorance of social change in so-
called traditional societies, and the salvage paradigm, by which the use
of anthropology is to study cultures on the verge of oblivion. My list of
reservations went on. I was nonetheless intrigued to see what he meant,
and I requested to visit Langzhong before making a final decision.
Upon my first visit to Langzhong in June 2004, I understood
what Professor Chen meant by declaring the area “not yet modern.”
Langzhong is one of a few cities in China to have preserved an “old
city”—an area of low-rise commercial and domestic buildings built
largely of wood and based on a plan dating from the Song dynasty
(960–1279) (Song 2003, 19), earning it the qualifier “traditional” in
Professor Chen’s mind. Most crucially, Professor Chen’s solid connec-
tions in the area meant that I could obtain all necessary official permis-
sions to settle with a village family. Fearing that local officials might (as
indeed they tried to) change their minds about these arrangements or
choose a family on my behalf, I set out on my first morning in Langzhong

to identify a suitable research location.
With a graduate student from Sichuan University assigned to assist
me for the initial period in the field, I was driven as far as was deemed
suitable by a prefecture-level Public Security Bureau (PSB) official and
one of her contacts in Langzhong. We were then asked which side of
the hill we would like to choose. The area on the left seemed to have less
concrete-built new houses and, we were told, despite its relative prox-
imity to Langzhong city and the township center, this village was still
rather poor. We slowly descended to the irrigation pool. The rhythmic
sound of three women gathered at the pool vigorously beating clothes
with a wooden stick reverberated through the valley. As we approached,
the official’s local contact explained that I was a research student look-
ing for a family who could accommodate me for fifteen months as I
carried out a social investigation (shehui diaocha) into rural life. Villagers
were incredulous. None of them had ever seen a foreigner before. They
also doubted that local officials would really agree to this. As the vil-
lage party secretary was summoned by the prefectural PSB official, they
were gradually persuaded that perhaps this was not a con after all.
My assistant and I requested to live in a “common” ( putong) house
of the brick-built type dating to the early 1980s and, if possible, hav-
ing a family with three generations, which I hoped would allow me to
observe any generational divergences in practices of care. This latter
demand considerably narrowed the available pool: most young adults
had left the village in search of waged labor. We were led down nar-
row paths amongst large bamboo groves to a house farther away from
the pool. The family proposed was one of the few in which the young
wife had remained in the village to farm and her husband worked in
Langzhong city (as a carpenter), returning home every night. They had
a twelve-year-old daughter and lived next to the husband’s parents and
his grandfather. It seemed ideal to both me and my assistant.
The proposed host, whom I would learn to call Erjie, was less than
enthusiastic, however. She found the idea that I would eat their food or
understand their local dialect simply laughable. She suspected I was sick
with something contagious—not of the likes of head lice, which I did
catch some months later, but of a more serious variety such as AIDS,
which, she argued, is widespread amongst “foreigners.”9 She also,
understandably, did not relish the official attention this would attract to
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
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.
Becoming accepted did not, of course, mean becoming one of

them. Occasionally, rumors would circulate that the township officials
had visited to hand over large amounts of money to me as welcoming
gifts (and possibly to ensure I would not report negatively on them).
Conversely, stories (in this case, sometimes true) would have me donat-
ing large sums to villagers in difficulty. This made me wonder, at times,
whether some families overemphasized their financial difficulties to get
help. Largely, however, these gossips were quite beneficial. In one case
I was compared to Norman Bethune, the famous Canadian physician
praised by Mao as a martyr and selfless friend of the revolution, for my
willingness to visit and help all families with farm work, regardless of
how poor they might be. In another I was credited with having cured a
young woman’s debilitating rheumatism, which had for years made her
thin and unable to walk, by buying medications for her. It was never
specified where these were from, and any attempts I made to deny it
were simply taken as displays of modesty.
Learning how to present myself to the local community was instru-
mental in slowly undoing suspicion and allowing me to talk about locals’
lives and their challenges in more open and informal ways. I made a
concerted effort to dress modestly, eat whatever I was offered, and
help locals in their activities such as selling noodles, harvesting rape-
seed, transplanting and harvesting rice, and cooking. This earned me
the qualifier jianku pusu, an expression popular during the Mao period
(1949–1976), literally translated as “hard working and plain living.” To
dispel locals’ sense that they knew or did little of interest to my scholarly
pursuits, I took the advice of one of my key informants and learned
to describe my presence not in terms of “research” ( yanjiu) or “inves-
tigation” (diaocha) but rather as an attempt to “experience life” (tiyan
shenghuo). This proved a turning point in establishing productive rela-
tionships with locals and enlisting their trust and support. To be even-
tually described as lively (huopo), easygoing (suibian), and accustomed to
everything (sha dou xiguan) was a great achievement, even though some
remained suspicious of my ultimate goals and continued to think they
had nothing of any substance to talk to me about. Toward the end of
my long-term fieldwork, I carried out over thirty semistructured inter-
views based on a questionnaire that I showed to interviewees during our
discussion (see appendix 1). I conducted this work with the assistance of
a research student from Sichuan University, who visited the village for
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
Cancer and Contending

Forms of Morality
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
This book offers an account of how families strive to make sense of

cancer and care for sufferers in one locality in contemporary rural
China. Here I situate the study vis-à-vis the two broad fields of the
anthropology of health and suffering and the ethnography of rural
China. Villagers’ multifaceted and situationally contingent narratives
about cancer causality and practices of care serve as a prism to explore
what is at stake in the contemporary reform era. I argue that we might
best understand these narratives and practices as embedded in a larger
moral economy discourse on the part of Chinese villagers, regarding
both their social relations with their families and fellow villagers and
their shifting relationship with the Chinese state. In contrast to many
ethnographies of China that see the present as lacking in morality, I
show that villagers make an incessant effort to inhabit moral worlds and
claim to act in a moral fashion. Through these engagements they also
redefine morality’s parameters.
18     Foundations
Suffering and Inequality

Critical medical anthropology is largely defined by its interest in health
inequalities. Leading exponents of this trend Merrill Singer and Hans
Baer see its focus to be on “the importance of political and economic
forces, including the exercise of power, in shaping health, disease, ill-
ness experience, and healthcare” (1995, 5). Paul Farmer, a prominent
voice in this field, has strived to highlight the effects of global political
and economic forces on the distribution of suffering. Through the con-
cept of “structural violence” (1997, 2003), he argued that illness is often
precipitated and worsened for those situated at the bottom of the social
ladder. He cautioned against confusing “structural violence with cul-
tural difference” (1997, 277) and resorting to culture to justify suffering
(torture, for instance) as otherness. Similarly, he opposed the tendency
to account for failures in public health projects with reference to cultural
barriers to their implementation (1999). This literature undermines the
epidemiological inclination to blame AIDS and other infectious diseases
on individual behavior and suggests instead that the burden of disease
is increased by the marginality and poverty of populations particularly
affected by it (see also Whyte 2009). The concept of “syndemics”—that
is, “the synergistic interaction of two or more coexistent diseases and
resultant excess burden of disease” (Singer and Clair 2003, 423; Singer
2009)—was put forward to highlight the connection between disease
and “noxious social conditions and social relationships” (Singer and
Clair 2003, 434).
A study of maternal mortality in Mongolia by Craig Janes and
Oyuntsetseg Chuluundorj (2004) offers an example of how changes in
the socioeconomic and political setting affected health in general and
maternal health in particular. In the wake of the demise of the Soviet
Union, Mongolia was affected by economic reforms similar to those
that took place in China following Mao’s death. Such reforms precipi-
tated economic insecurity among households rendered more vulnerable
to market and climate fluctuations, widespread unemployment and
outmigration in search of work, food insecurity and malnutrition, and
a collapse of public health and health care. As women became eco-
nomically and socially marginal and yet subject to heavy labor demands
and the health care system suffered a lack of investment, maternal
health declined sharply (251–252). As we shall see, health care for rural
Cancer and Contending Forms of Morality     19
Chinese experienced a similar decline in the aftermath of reforms, as

secondary and tertiary care became more reliant on fee-for-service
and grew unaffordable for many rural households. The cost of tests to
diagnose cancer can amount to months of income for a rural family,
and health care costs can soar to a year’s income and often more. Such
financial barriers to accessing diagnostic services as well as care conspire
to delay diagnosis and to decrease the chances of successful treatment.
In this respect, the emphasis on the political economic framework of
illness and health care put forward by critical medical anthropologists
is important for this study. But, as chapter 7 makes clear, delay in visit-
ing the hospital and seeking care is not attributable to cost alone. It is
equally important to understand how sufferers and their families make
sense of cancer and cope with it by turning to factors beyond the solely
economic. This requires combining a political economy lens with keen
attention to illness as a lived experience.
Nancy Scheper-Hughes and Margaret Lock noted over two decades
ago that medical anthropology was split into two camps, one concerned
with political economy and the other with Foucauldian post-structural-
ist analysis. They charged the former with a tendency to “depersonalize
the subject matter and the content of medical anthropology by focusing
on the analysis of social systems and things, and by neglecting the partic-
ular, the existential, the subjective content of illness, suffering and heal-
ing as lived events and experiences” (Scheper-Hughes and Lock 1986,
quoted in Singer and Baer 1995, 44; see also Scheper-Hughes and Lock
1987). While Singer and Baer argued that critical medical anthropology
itself already combined meaning-centered and Marxist analyses (1995,
45), efforts to devote attention to lived experience alongside the connec-
tions between poverty, trauma, and illness have continued to animate
the field. Scheper-Hughes’ ethnography of Brazil (1992), for instance,
is concerned with how economic deprivation affects health inequalities,
but it is equally devoted to understanding experiences of illness and
death within their local context. She argued that the commonality of
child death amongst the poor in Brazil has encouraged mothers to delay
their attachment to young children, explaining the presence of “death
without weeping” not as a lack of humanity on the part of mothers but
as a necessary strategy of survival. This book similarly suggests that
attitudes about cancer as incurable are the result of recurrent experi-
ences of cancer inevitably leading to death. These experiences in turn
produce perceptions of treatment as a waste of resources and make

refusal of expensive treatment socially and culturally legitimate.
Social Suffering and What Is at Stake

Efforts to study both the structural and social origins of suffering but
also lived experience were developed through the concept of social
suffering. Anthropologist and psychiatrist Arthur Kleinman is a long-
standing advocate of studying suffering as a human and “social experi-
ence” (1995, part 2). This entails focusing not on cultural categories but
on “interpersonal or intersubjective experience: social suffering” (15).
He contends that “by alienating the illness from what is at stake for
particular individuals in particular situations, cultural analysis creates
an inhuman reality every bit as artifactual as the pathologist’s disease
entity” (101). A focus on social suffering also avoids the trivialization
of social problems as individual pathology.1 Suffering, rather, is situ-
ated in the intersubjective realm that lies at the intersection of collective
and individual experience. It is characterized by efforts to make sense
of threats to “what is at stake” in everyday life and to rebuild “local
moral worlds.”
Social suffering has been further developed as an area of inquiry in
a series of three books: Social Suffering (Kleinman, Das, and Lock 1997a),
Violence and Subjectivity (Das et al. 2000), and Remaking a World (Das et al.
2001). These volumes explored the ways in which subjects, both collec-
tive and individuals, make sense of traumatic experiences, rebuild their
lives, and “regain their worlds” (Das and Kleinman 2001, vii). In their
introduction to the first volume, the editors propose that “a language
of dismay, disappointment, bereavement, and alarm . . . may offer a
more valid means for describing what is at stake in human experiences
of political catastrophe and social and structural violence” (Kleinman,
Das, and Lock 1997b, xi). The present and recent past in rural China
may not be affected by political catastrophes, deprivation, and vio-
lence on a scale these authors have in mind, but by more common-
place “insidious forms of suffering” (Das and Kleinman 2001, 3), akin
to “petite misère” or the ordinary suffering produced by everyday forms
of exclusion and segregation (Bourdieu et al. 1999). Langzhong villag-
ers certainly experience daily life as an incessant struggle to make ends
meet, made all the more poignant by comparisons with a past when
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
in the local context and, conversely, experiences of cancer strengthen or

challenge established values. By undermining the ability to eat, so central
to local definitions of health, cancer also delivers a blow at the very core
of the local social identities based on ability to endure hardship relying
on a simple diet. Many local explanations draw on shared experiences—
starvation, hard work, use of farm chemicals—but not all are deemed
to have suffered to the same extent. Some, friends and relatives argue,
worked harder than others, endured more severe shortages, and rely
more heavily on farm chemicals. These etiologies then work in two ways:
as unifying principles based on a common history and a common pres-
ent but also as dividing principles, whereby suffering is unequally distrib-
uted. They construct cancer as both a health and a social problem: its
origins are inseparable from local history, and decisions about treatment
precipitate social and moral dilemmas for all involved regarding who
should pay for care and what care is worth investing in.
Understanding how moral worlds are remade in the face of can-
cer requires “close attention not only to the content of narratives, but
also to the processes of their formation within local communities” (Das
and Kleinman 2001, 5). This will be considered on two levels. First, on
a microtemporal scale, cancer narratives shift during illness and after
death, and the experience of cancer changes perceptions of activi-
ties associated with it. Gandie’s relatives, for instance, redefined their
parameters of what counts as “eating” through witnessing his decreas-
ing ability to ingest and digest food. Conversely, regarding his declining
health as a consequence of inability to eat reinforced their sense of the
centrality of eating to health. Likewise, in attempting to make sense of
her father’s death from cancer, Erjie became more vociferous about the
harm of repressed anger and of smoking and drinking. Rather than
assuming a pregiven subject of experience, this study shows how subjec-
tivities are formed through illness and how positions within the family
are affected by individuals’ engagement with it.
Second, on a longer historical scale, the book as a whole describes
how cancer causalities compete and change in significance, combining
past and present values. In doing so, it traces ways of remaking morality
that draw on established parameters alongside more recent innovations.
I argue that changes in political economy and values promoted by the
Chinese state under reform have demanded that people find alterna-
tive ways to make a living and give meaning to their lives. But they
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.
Suffering, Subjectivity, and Resilience

Moving personal accounts of illness (Murphy 1987) and foundational
works on illness narratives (Good 1994; Kleinman 1988; Mattingly and
Garro 2001) and social suffering (Das et al. 2000, 2001; Kleinman, Das,
and Lock 1997a) all endeavored to humanize suffering by providing
subtle narratives of those in pain. The recent focus on subjectivity in
medical anthropology (Biehl 2005, 2007; Biehl, Good, and Kleinman
2007b; DelVecchio-Good et al. 2008; Kleinman 2006) combines this
attention to lived experience with close accounts of micro- and mac-
ropolitics and inequalities as they impact on individual lives. Susan
Whyte (2009) has highlighted the value of detailed ethnographies that
provide discussions of personal experiences contextualized within their
respective lifeworlds. Joao Biehl and Amy Moran-Thomas (2009) stress
the importance of avoiding prescriptive and instrumentalized accounts
that flatten the complexities of people’s lives. They praise the work of
John and Jean Comaroff for “linking historical flows of capitalism and
colonialism with the shaping of contemporary consciousness.” Yet Biehl
and Moran-Thomas argue that the Comaroffs’ recent study (2006)
“often implicitly interprets symptoms, at once physical and social, as
directly springing from new political economies and the uneven terms
of European encroachment and neoliberal trade.” This prevents readers
from conceiving of how individuals’ subjectivity may “remain distinct
from the forces of collective history within which it is embedded” and

of how “individuals might understand themselves beyond their mem-
bership in an exploited population.” They propose instead to “under-
stand the present and people not so much as claimed by history but as
makers of new systems of perception and action that come with specific
sets of possibilities and limits” (276–277).
My account of cancer in Langzhong describes villagers typically
unsure as to how to make sense of cancer, resorting to competing etiolo-
gies with ambiguous undertones. Even when the past political economy
of food shortage and strenuous physical work in the collectives is blamed
for cancer, the pride derived from having managed to provide for oneself
and one’s family also imbues such sacrifices with a moral connotation.
Equally, even as villagers note that life has improved during reforms and
that development is desirable, they do not always embrace prevailing
market attitudes toward farm chemicals as a means of ensuring produc-
tion. On the contrary, they are often critical of chemicals by linking
their use to the development of cancer. Equally, biomedical etiologies
such as smoking and drinking provide an alternative to relating cancer
to a shared collective past and offer a more future-oriented view of can-
cer, a space for reclaiming some agency in diminishing its likelihood.
The commitment to retain a sense of individuals’ vulnerability
and of the uncertainty of life as it is lived (Biehl, Good, and Kleinman
2007a, 12) does not necessarily entail portraying sufferers as victims. In
a largely optimistic assessment of contemporary developments in health
care technologies, Nikolas Rose and Carlos Novas identified a “political
economy of hope” whereby “biology is no longer blind destiny, or even
a foreseen but implacable fate. It is knowable, mutable, improvable,
eminently manipulable” (2005, 442). Anthropologists are decidedly
more skeptical of people’s uneven capacities to take advantage of such
opportunities to manipulate fate and of the potential of commodifica-
tion and pharmaceuticalization of health care to enable agency (Biehl
2007; Petryna, Lakoff, and Kleinman 2006; Petryna 2009). But they
nevertheless highlight sufferers’ efforts to prevail in the face of adversity.
Where Robert Murphy traced a “rage to live” (1987, 3) through his
experience with disability, Joao Biehl similarly outlined a “will to live”
(2007) amongst AIDS patients in Brazil, and Nancy Scheper-Hughes
(2008) described a “talent for life” among Brazilians and South Africans
that combines vulnerability and resilience. In rural Langzhong, villagers
displayed a clear resilience in their ongoing efforts to make ends meet,

care for sufferers, and forge a good life based on parameters drawn from
past experiences but also adapted to the present demand for wage labor.
The distinct resignation sufferers and their families display in the face
of stomach and esophagus cancer is due to perceptions of their incur-
ability based on local experiences of cancer, or what Rayna Rapp called
“popular statistics” (1999). Resilience is again evident in the aftermath
of death, as families search for meaning, make adjustments in their daily
lives to decrease perceived risks, and offer advice on activities to avoid or
undertake to secure health. The focus on vulnerabilities and resilience is
also intended to produce intimate accounts of suffering.
Making Sense of Cancer and the Multiple

Careers of Cancer Etiologies
In Illness as Metaphor, Susan Sontag argues that “illness is not a meta-
phor,” but prejudices and metaphors are an inescapable part of the
cancer experience (1991, 3). For Sontag, the powerful stigma that can-
cer produces is not due to its objective threat to life. Heart disease,
she reasons, is just as deadly, but it does not share cancer’s moralistic
connotations. Rather, the mystery surrounding cancer and its strong
association with death and incurability reinforce the stigma. Herself a
cancer patient, Sontag sets out to show that causes to which cancer is
popularly attributed—such as inability to express anger, diets rich in fat,
tobacco smoke, exposure to industrial pollution and pesticides—are all
scientifically unsound and historically, socially, politically, and culturally
constructed. She opposes these attributions of causality and meaning
because they ascribe responsibility for cancer to the sufferer. For Sontag,
“nothing is more punitive than to give a disease a meaning—that mean-
ing being invariably a moralistic one” (59). Her self-proclaimed purpose
then is to deprive cancer of meaning (99) and by doing so to debunk the
stigma attached to it. In Langzhong, sufferers and their families largely
avoided providing an explanation of why cancer had developed during
its course to evade any attributions of blame. The search for mean-
ing, however, resumed after the sufferer’s death. In contrast to Sontag, I
argue that for those left behind, finding an explanation for cancer helps
them to cope with their loss and to remember their deceased relative
as a moral subject. When and whether the victim’s family attributes
cancer to any of the contending causalities available to them depends

on whether it helps them to reconstitute their moral world in the face
of illness and death.
In accordance with Sontag’s argument, there is evidence that,
because of its perceived incurability, revealing a cancer diagnosis
would amount to social death (Gordon 1990; Gregg 2003; Hunt 1992).
Conversely, secrecy and stigma decrease as treatment becomes more
readily available (DelVecchio-Good et al. 1992). There is also evidence
that causes of cancer such as repressed emotions previously upheld in
the West have lost currency as some of the other causes dismissed by
Sontag—unhealthy diet, tobacco, pollution—have been recognized as
being at least epidemiologically correlated to cancer. This could imply
that biomedical and epidemiological science may, as Sontag hoped,
undo the mystery surrounding cancer and as a consequence dissolve
stigmas associated with it. However, at least in the field site examined in
this book, epidemiologically recognized factors correlated with cancer
such as tobacco, alcohol, and chemical contaminants have not erad-
icated alternative ways of making sense of cancer, such as repressed
emotions, hard work, and past starvation. Secondly, even the suppos-
edly more scientific explanations for cancer are deeply laden with
social and cultural connotations and situated within historical memory
and a contested present. Indeed, a vast body of literature in medical
anthropology has cautioned against the assumption that public health
discourses provide objective and “scientific” discourses, as opposed to
the subjective ones articulated through culture (see Parker and Harper
2005; Browner 1999). Biomedical ideology and practice are culturally
and socially situated (see, for example, Lindenbaum and Lock 1993;
Lock 1992; Martin 1987, 1994; Rapp 1999). Emily Martin’s early work
(1987), for instance, shows that biomedical categories and descriptions
of bodily processes such as birth, menstruation, and menopause are
premised upon a conceptualization of the female body as a machine for
reproduction, which consequently constitutes not having children as a
failure. With these insights in mind, rather than debate the validity of
given factors as causes of cancer because of their constructedness and
relative scientific authority, this study examines how they have become
associated with cancer and with what effects.
For Paula Treichler (1999), understanding the “epidemic of sig-
nification” surrounding AIDS demands an analysis of why certain
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
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,
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
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
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.
Families, Social Relations, and Managing Illness

Diagnoses and therapeutic processes are inextricable from wider social
relations. John Janzen’s award-winning study, The Quest for Therapy in
Lower Zaire (1978), introduced the concept of therapy management and
the therapy management group as “the constellation of individuals who
emerge to take charge of the sufferer during incapacitation” (1987, 68).
For him, therapeutic acts “mediate differing classifications and values
(culture), social structures or roles (society), and protagonists’ assess-
ments of the effectiveness of the therapy” (76). While the therapeutic
management group is not necessarily restricted to kin, the family is an
unquestionably crucial level of analysis in many respects. On a very
basic level, family relations are important to the extent that they are the
most immediate network of resort to mobilize resources for treatment.
Susan Whyte and her colleagues (2006) have unpacked some of the
strategies through which families cope with AIDS treatment in Uganda
under conditions of poverty. In some cases, illness requires family mem-
bers to sell a goat, a cow, or a piece of land; it demands help from wage-
earning relatives; and it may entail withdrawing support from children
in school or from other sicknesses to pay for AIDS treatment. Some
AIDS sufferers claim that they would rather die than impose such a
financial burden. Similarly with cancer sufferers in this book, in some
cases families withdrew children from school and young adults took on
paid work to meet the costs of treatment. On their part, sufferers often
argued that cancer was incurable to persuade their families that not
investing in expensive surgery was morally justified. Some committed
suicide to put an end to their suffering and to spare the family further
expense. These practices do not embody a denial of family relations
but rather, as efforts to minimize the financial impact of cancer, they

express the sufferers’ care for their families.
Negotiations about treatment, then, are never solely financial. For
Mark Nichter, the management of illness entails “marshalling of mate-
rial resources, the management of emotions, the performative aspects
of ‘being sick’ and relating to the afflicted, participation in the co-con-
struction of illness narratives, and provision of a space where healing or
the management of sickness takes place” (2002, 82). Household debates
about treatment are characterized as much by disagreement and con-
flict as by cooperation and attempts to build consensus. Gandie’s close
relatives had diverse views on the best way to care for him, and their
decisions were economic as much as emotional and rooted in particular
historical, social, and cultural contexts. His case illustrates the ways in
which the extent and manner of each family member’s engagement
with illness reconfigures their position within the family. Different family
members cared for the sufferer differently, and such differences were the
center of crucial debates through which family relations were redrawn.
Conversion to Christianity by some of Gandie’s family members—
most significantly, his wife and their second son’s family—precipitated
disagreements over diagnostic and curative choices. While in the early
stages of Gandie’s illness and before he was diagnosed with cancer,
some were keen to consult a spirit medium, Christians opposed this as
a backward, superstitious practice. This reinforced relationships with
Gandie by manifesting care, even as it deepened disagreements between
family members on the best course of action.
At the root of decisions on consulting spirit mediums are diverg-
ing perceptions of what the cause of illness actually is. Families are
important not only in their role as therapy managers but also in the very
way in which discomfort is understood as an illness at all, as well as in
debates about its causes, which are in turn central to decisions about
illness management. Lawrence Cohen (1998), for instance, argued
that whether conditions affecting the elderly in India are understood
as the “normal” result of aging, dementia or Alzheimer’s powerfully
shape family relations and attitudes to care for the elderly. Veena and
Ranendra Das (2007) looked at the emergence of “local ecologies of
care”—that is, how illness categories are formed through family dynam-
ics and interactions with medical providers. For example, a mother’s
claim that her discomfort was “heart trouble” or “mild TB” served to
demand more attention from her son and daughter-in-law. By contrast,

her daughter-in-law’s insistence that her complaints were a normal part
of the aging process and not a sign of illness served to justify their atti-
tude toward the mother (75). This study will show that deliberations
about what causes cancer similarly articulate family relations. One eti-
ology in particular is deeply embedded in family relations: repressed
emotions. When repressed anger is attributed to significant others who
enraged the sufferer, this etiology also serves to condemn and ostracize
relatives (typically women) accused of behaving inappropriately. The
moral order created by blaming cancer on repressed anger caused by
family members reinforces gendered expectations that women fulfill
their duties as mothers, daughters, and daughters-in-law, and it patholo-
gizes their neglect.
Families, then, may be sites of care but also sites of abandonment.
This becomes painfully clear in Joao Biehl’s (2005) moving and insight-
ful study of Vita, an asylum in Brazil where people cut off from their
families are left, waiting to die. Brazil’s privatization of health care and
pharmaceutical focus have deepened exclusion, leaving families alone
to negotiate care and to make painful decisions about which lives are
worth living. In this context, the life chances of some are foreclosed.
By focusing in depth on one such case, Catarina’s, Biehl provides
a powerful account of her suffering as both lived experience and as
entrenched in domestic economies and the national and international
political economy of health care. My study also predominantly focuses
on Gandie and his family, alongside the case of Uncle Wang and a
number of other cases treated in much less detail. In doing so, I flesh
out moments of tension and suffering as well as efforts to make sense
of illness and search for hope and morality. Gandie’s experience is very
much presented through reflections by his family members rather than
by Gandie himself. Debating cancer with him would have been deeply
insensitive, and even his close family members refrained from doing so.
What I offer is rather an account of how practices of care unfolded dur-
ing the months of his illness, based on witnessing these exchanges and
on conversations with his close relatives, most predominantly his daugh-
ter Erjie. Gandie’s illness and his death, as that of Uncle Wang, emerge
as “critical events” (Das 1995) that are both products and producers of
family relations, historical experience, competing moral economies, and
practices of care.
Such a focus on sufferers has a number of advantages. First of all,

it points to the intersubjective character of health and healing and the
ways in which identities are negotiated in encounters with illness and
healing. It highlights that practices of health maintenance and health
care constitute relations between family members and between mem-
bers of a social group, as well as setting social groups apart from each
other. Secondly, such a study shows the importance of acknowledging
sufferers as active subjects engaged in their health maintenance and
healing, both at the individual and communal level.4 Thirdly, it allows
understanding of healing not in terms of medical systems but rather as
a complex set of practices assembled contingently and performatively
and embodied by sufferers and their families, resorting to a number of
potentially contradictory approaches.
Medical Anthropology of China

and the Practices of Rural Sufferers
A number of full-length ethnographies have appeared on medicine
and illness in contemporary urban China. While some of these stud-
ies are principally concerned with medical practitioners (Farquhar
1994; Hsu 1999; Scheid 2002), others have also focused on sufferers’
agency and experiences (N. Chen 2003; Farquhar 2002; Frank 2006;
Kleinman 1980, 1986; Kohrman 2005). To date, the only full-length
volumes tackling illness and healing in rural areas from a grassroots per-
spective are those by Sydney White (1993) and Erik Mueggler (2001);
shorter accounts are found in Sandra Hyde’s study of AIDS (2007),
Matthew Kohrman’s (2005) work on disability, Jing Shao’s piece on
AIDS (2006), and articles and chapters by White (1998, 1999, 2001).
A much greater amount of literature on illness and health care in rural
China has been produced in public health and policy and development
studies (for instance, Anson and Sun 2005; Lancet 2008). Albeit infor-
mative, these works are by their very nature concerned with structural
constraints and institutional settings and thus fail to address how people
experience health and treatment and how such experience is config-
ured socially, culturally, and historically. This volume complements pre-
vious anthropological research on illness and medicine in China with
accounts of sufferers’ agency and of negotiations within the home and
the immediate social surroundings of sufferers. I focus on crises related
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).
As this study centers on how healing is experienced and molded by

laypeople’s practices in rural China, it can draw theoretical inspiration
from the substantial work on how medical knowledge and practice are
constantly fashioned in more institutionalized settings. Judith Farquhar’s
first monograph (1994) examines the practice of kanbing (looking at ill-
ness) as a moment when patients and medical practitioners are both
equally engaged in perceiving and managing illness characteristics and
courses. Elisabeth Hsu’s (1999) ethnographic account of the ways in
which different modes of transmission of medical knowledge foster dif-
ferent “styles of knowing” contextualizes medical knowledge in social
practice and critiques the ideal of a homogeneous doctrine of Chinese
medicine. Volker Scheid (2002) shows that Chinese medicine’s preten-
sions to being static and unitary are in fact a discursive device through
which Chinese medicine asserts its authority within the global setting,
while it constantly changes to adapt to local milieus. The only substan-
tial anthropological study of the development of institutionalized, state-
promoted medicine in rural China is by Sydney White (1993, 1998,
1999, 2001). On the basis of fieldwork in the rural Lijiang basin, she has
shown that the “integrated Chinese and Western medicine” promoted
by the state during the Mao period was as much introduced from above
as it was the result of syncretism from below, shaped by rural health
care seekers and village “barefoot doctors” who continued to combine
Chinese and Western medicine after reforms (1999). In these studies,
medicine in China (which includes both biomedicine and so-called
Traditional Chinese Medicine) emerges in concrete local contexts, being
continuously reconstituted by a plurality of agencies, processes, and
social interactions. Building on such work, this volume focuses on how
medical knowledge is constituted within sufferers’ homes and immedi-
ate social surroundings, the gradual changes it undergoes through the
course of illness, and its role in sufferers’ moral worlds in a rural setting.
Everett Zhang (2007) has shown in the Chinese context what
Crandon-Malamud (1991) showed for Bolivia: that different political
economic contexts give rise to different perceptions of sickness. He
argues that the transition in moral codes from collectivism to economic
reforms was embodied by the increase in diagnoses of impotence in
the present and decline of spermatorrhea ( yijing), which is involuntary
discharge of semen without orgasm and was commonly diagnosed dur-
ing Mao. For Zhang, this difference is due to different moral contexts:
during Mao individual desire was unacceptable, and as a consequence

people felt yijing to be a problem. By contrast, in the time of reform,
individual desire is accepted. Consequently men are no longer preoccu-
pied by yijing but by impotence, as they want to fulfill desires they finally
have an opportunity to satisfy (they have more money), but they are
physically unable to do so. Sandra Hyde views attitudes to sexuality in
a somewhat different light. She identifies competing “moral economies
of sexuality”—including a liberal market morality, a parochial Maoist
morality, a Han nationalist morality, and an ethnic revivalist morality—
that inform how AIDS is represented (2007, chap. 6). She argues that
“the market socialist moral economies in China do not lend themselves
to a story that moves in linear progression from the ancient Confucian
notion of the proper conjugal bed, through a Maoist code of contain-
ment, to emerge into sexual freedom and modernity. It is a story of
ongoing and persistent conflicts among alternative regimes of power”
(191; see also Farquhar 2002; Farquhar and Zhang 2005). Equally
with cancer etiology, we see not a chronology of causes embraced in a
sequence, following changes in political economy, but an overlapping of
moral economies derived from experiences during collectivism and dur-
ing reform. It is not a case of a new moral code eclipsing an outdated
and irrelevant version but of a former moral economy coexisting with
emergent ones.
As we have seen, two values central to rural life—the ability to
eat and the ability to endure strenuous physical work—are under-
mined by cancer. Jing Shao (2006, 555–556) has documented a suspi-
cion toward antiretrovirals (AVRs) in Henan Province’s AIDS villages
similarly founded on their threat to these core values. Added to fatigue
caused by the virus, AVRs caused vomiting, lack of appetite, inabil-
ity to keep food down, dizziness, sore muscles, and overall weak bod-
ies. “These common side effects were experienced as life-threatening
by these agricultural producers, exactly because they seemed to assault
the most essential dimensions of their lives: food and labour” (556). In
rural Langzhong, cancer is experienced just as such an attack on the
most vital requirements of village life. Conversely, hard physical labor is
itself thought to be a cause of cancer. Sydney White (1997) showed that
a number of illnesses common among the Naxi of rural Lijiang such
as rheumatism, bronchitis, stomach problems, and some types of heart
disease are commonly traced to tough and incessant working routines.
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.
Situating an Ethnography of Contemporary China:

Market Reforms and Moral Economy
Many ethnographies have been written on the major social and eco-
nomic changes precipitated by post-Mao reforms in rural China, and I
do not attempt a comprehensive review of the field here. More details
on this transition are outlined in the following chapter. I focus, rather, on
studies that have explicitly engaged with the concepts of moral economy
and morality in rural China. The existence of a moral economy in the
present will be debated to highlight the complex relationship between
past and present. The perceived decline of morality in rural China has
been discussed in the existing scholarship with regard to two main inter-
secting areas: the relationship between villagers and the state (based on
comparisons between rural and urban areas and between pre- and post-
reform), and intravillage clashes regarding parameters of moral behav-
ior (often along generational lines and premised on memories of the
Maoist past) and reactions to a perceived lack of morality. I will look
at both of these in turn and illustrate how contending forms of moral
economy and morality are embraced to make sense of the difficulties
and suffering posed by cancer.
Much scholarship on the relationship between the economy, moral-

ity, and social relations is inspired by Karl Polanyi’s work. Polanyi (2001)
argued that the shift from subsistence, reciprocity, and householding to
the self-regulating market is accompanied by a shift toward the moral
disembedding of the economy from social relations. In China, however,
the social and economic reforms that followed Mao’s death in 1976
promoted the market economy against a background of state-planned
economy rather than in a traditional peasant society setting. Broadly
speaking, the reform period may be characterized as a decline in state
welfare and an increase in inequality. To this extent, it reflected a rela-
tive disembedding of the economy from social relations. Yet the transi-
tion heralded by reforms was much more complex. Growing inequalities
between urban and rural China were based upon an already existing
disparity in the extent of welfare provision for urban and rural dwellers
rooted in the Maoist years. To be sure, Chinese farmers and urbanites
alike were no strangers to the market. Indeed, as Ruth Mandel and
Caroline Humphrey have argued for former socialist countries, market
transition does not precipitate a clash of “mutually alien economic sys-
tems, ‘the market’ and ‘the socialist planned economy,’” but a “much
more complex encounter of a number of specific, culturally embedded
and practical organisational forms” (2002, 1). Likewise, reforms have
seen the intersection of market economy principles with those of sub-
sistence, householding, and reciprocity, rather than their obliteration at
the hands of the market.
Whether these shifts amount to a decline in moral economy is very
much open to debate. James Scott defined “moral economy” in peasant
societies as “their notion of economic justice and their working defini-
tion of exploitation” (1976, 3). Similarly, Edward P. Thompson’s work
(1971) on food riots in eighteenth-century urban England characterized
moral economy as the perceived right to subsistence whose violation—
rather than food shortage per se—pushed people to protest. In his study
of morality in a south China village, Richard Madsen (1984) endorsed
Samuel Popkin’s well-known critique of the concept of moral economy
on the basis that it romanticizes village life and presents moderniza-
tion too harshly. Xin Liu, in his ethnography of a north China village,
claims that the reforms brought about an “immoral economy” (2000,
181), in the sense that villagers did not share a common set of rules or
a hierarchy of meanings. A decade earlier and based on research in a
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
instance, workers in a state-owned distillery studied by Jonathan Unger

and Anita Chan (2007) combined visions that both praise and critique
the Maoist project. They employed Maoist rhetoric to present them-
selves as masters of the country and recall their hard work. But they did
not feel the past was fairer to the working classes than the present. On
the contrary, they demanded generous treatment precisely because of
the deprivation they endured during Mao (133). On this basis, Unger
and Chan claim that reforms have not ushered in the demise of moral
economy in the wake of “the rise of capitalism and of the commer-
cialisation of relationships” (132). However, they conclude that the type
of redistributive moral economy articulated by state-owned enterprise
workers who still regard the factory as paternalistic toward them will not
last in the face of corporate sell-offs.
I outline a rather different picture for the rural community in which
I worked. The common notion of what is just that lies at the core of
moral economy may be subject to contestation. But villagers do struggle
over the creation of such a shared sense of justice—or a shared “moral
universe” (Thireau and Hua 2003)—drawing on a comparison with
their urban peers or on their memories of the past, as well as on their
experiences of the present. Instead of documenting the inevitable down-
fall of moral economy as it encounters the market, I trace efforts to form
a new moral economy that adapts to the reality of market reforms and
combines farming with wage labor and reliance on family and guanxi
(connections) with demands of state-provided welfare. In his ethnogra-
phy of Ku village (south China), Hok Bun Ku argues that the concept
of moral economy is not adequate for understanding Ku villagers’ resis-
tance because unlike Scott’s peasants, their “rationales of resistance are
not totally restorative, antimarket or defensive of past ways of life and
patron-clientele authority” (2003, 15–16). Likewise, Baoma villagers, as
I show in the following two chapters, partly embrace the market and
may not only be understood through the prism of subsistence ethic. A
revised, broader concept of moral economy that allows for moral econo-
mies based on market interactions alongside subsistence, householding,
and reciprocity (Hann 2009; Mandel and Humphrey 2002) is more apt
for conveying the complex negotiations taking place in contemporary
China. In this study, the concept of moral economy applies not only to
negotiations about economic justice vis-à-vis the state (chapter 7) but
also vis-à-vis the village (chapter 3) and family units (chapters 6 and 7).
I outline an emergent moral economy that combines past and present.

This interplay of models of moral economy is visible in the combina-
tion of farming and wage labor outlined in the following chapter, but
it is also illustrated in the ways in which people explain and cope with
cancer outlined throughout the book.
Failure of Morality and Villager-State Relations

Villagers’ perceptions of the state and of what makes it morally legiti-
mate have changed in some important ways since the founding of the
People’s Republic in 1949. Richard Madsen looked at the formation
of morality during Mao and in the early reform period through the
ways in which local leaders’ behavior was justified to their superiors and
by villagers. His study illustrates a variety of relationships between the
state and villagers and “the ambiguities of Chinese moral discourse”
(1984, xiv). Initially, a Maoist paradigm of morality based on the ideal
of serving the people and reading of Mao’s works competed with a
Confucian moral discourse based on “the importance of good ‘human
feeling’” (12). These two paradigms attribute different responsibilities
to state officials and to villagers and assess moral behavior according to
different parameters. Where in the Confucian model partiality to family
and close friends is seen as morally acceptable (13), in the Maoist model
all are required to serve the people equally (except for “class enemies”).
As Maoism turned self-destructive in its attacks on ever-new enemies
and produced a crisis of morality (241), a third paradigm of pragmatic
technocratism, from Liu Shaoqi and Deng Xiaoping, came into play.
According to this model, people are assumed to cooperate with each
other only if it benefits them personally.
In tune with this ethos of state legitimacy, the social and eco-
nomic reforms that followed Mao’s death may be loosely character-
ized as a gradual acceptance of capital accumulation and a change
in the conditions of citizenship—or, in Merle Goldman’s expression,
a transition “from comrade to citizen” (2005). Individuals have been
increasingly urged to be self-responsible, and private entrepreneurship
has been encouraged under the ethos of allowing some to “get rich
first.” Although rural dwellers were already largely self-reliant for their
own welfare during Mao (White 1998), reforms required this to a much
deeper extent. As the costs of education and health care escalated, they
have become mainly the responsibility of individual families. Li Zhang

and Aihwa Ong (2008) have shown that the late-reform Chinese state
requires self-responsible individuals and that such commitment is cen-
tral to consolidating state power. With reference to the discourse of
quality or suzhi, whereby the rural population is described as backward
and uncultured, Rachel Murphy argues that state institutions are pre-
sented as working to improve well-being even as they retreat and make
individuals responsible for raising their own suzhi and well-being (2004).
Xiajia villagers, Yunxiang Yan argues, see the rise of individualism as a
result of the new government emphasis on making money rather than
a selfish rebellion against the state (2003, 217). Overall, individuals are
accorded much more responsibility for their welfare.
As a result of this increased need for self-reliance, scholars have
documented a spreading discontent with the government provision for
its citizens. Hok Bun Ku (2003) looked at how villagers engage with the
state critically and claim that as citizens they are owed certain benefits.
The concept of reciprocity, he explains, is central to maintaining guanxi,
so that when two parties are engaged in guanxi, it is their moral respon-
sibility (zeren) to fulfill their obligations to each other. Villagers feel that
social security and welfare are owed to them by the state; they are the
state’s zeren in order to maintain its guanxi with the people. Thus, when
the state is seen not to comply with its requirements, guanxi is no longer
binding and resistance to state policies is seen as legitimate (see also Ku
and Croll 2002). Studies of popular contention in rural China follow
a similar vein, although they perceive resistance to be mostly aimed at
the local state and therefore less oppositional than Ku proposed.5 Kevin
O’Brien and Lianjiang Li (2006) show how citizenship is made from
below through “rightful resistance” movements that go beyond James
Scott’s “everyday forms of resistance” (1985) but fall short of revolution
(O’Brien and Li 2006, xii). Elizabeth Perry (2007) has similarly argued
that protests are not necessarily a threat to the state, but rather they are
one of the ways in which people have historically informed higher levels
of government about local injustice. Whether they are critical of the
state as a whole or only its local agents, villagers are shown to engage
actively in defining their own responsibilities, sense of entitlement,
and the state’s moral standing. The weakness of the welfare system in
improving access to expensive care is one ground upon which the rela-
tionship between villagers and the state is played out.
One important parameter villagers use in their evaluations of the

state is a comparison between rural and urban China. Sulamith and Jack
Potter (1990) argued that Chinese society since Mao and the creation
of the residence registration system (hukou) was a “two caste society” of
urban and rural residents, where the former were economically privi-
leged and hierarchically superior to the latter (see also Cohen 1993).6
Xin Liu (2000) and Mobo Gao (1999) both identify a sense of inferiority
experienced by villagers when compared to their urban counterparts.
The wide gap in welfare provision between rural and urban areas exac-
erbates this sense of having been left behind by development. Ku’s work
highlights that the state’s derogatory definition of villagers as peasants
(nongmin) and bad citizens (liemin) does not imply that villagers see them-
selves as uncivilized and immoral. On the contrary, villagers are quite
capable of turning the moral equation against the state and its local
representatives (2003, 10; see also Leonard 1994) and propose alterna-
tive ways to evaluate their behavior. They see their refusal to abide by
policies (such as family planning) and pay levies as fair and reasonable
because they perceive the state as having failed to fulfill its responsibil-
ity to the people. Nevertheless, a feeling of having fared less well in
the reforms remains and undermines the state’s claim to morality. As
large portions of the rural population migrate in search of work and
leave their families for years, only to make ends meet rather than to
achieve the promised wealth, the fairness of the current system is put
into question.
Such ambivalence is articulated most prominently through memo-
ries of the past. Xin Liu’s study in rural northern China describes vil-
lagers “who are nostalgic about the Maoist past and suspicious of the
present, . . . who see themselves as being marginalized by the regime of
modernization, those who claim to be hopeless victims of social change,
those who are fearful about their future” (2000, 16). Many have noted
that reference to the Maoist government as caring for the people was
used to critique the present government.7 Elisabeth Croll (1994) argued
that villagers are ambivalent toward the present because the descent
from the “Heaven” of the “collective dream” to “earth” has meant an
increase in uncertainty and a lack of clarity about the new ideology. Ku
maintained that it does not matter much whether these nostalgic mem-
ories of the past as egalitarian and moral reflect reality; rather their
memories “represented a vision of an alternative relationship with the
government” (2003, 231). Proclaimed nostalgia for Mao’s China, then,

serves to express a discontent with the current reforms. The Maoist past
has become a sort of cultural code villagers use to negate the present
government, a reimagining of the past to condemn the present. The
frequent complaint I heard during fieldwork—“At least in the past
we were all poor”—combines the parameters of comparison with the
urban areas and with the past to express dissatisfaction with the present.
And yet, the past was also riddled with uncertainty and is not fondly
remembered by all. In Baoma, no one wished for a return to collectiv-
ism: villagers deplored their lack of control on the products of their
labor at that time and regarded decollectivization as a great improve-
ment, allowing people to make money and manage their own resources.
The morality of the Maoist state was questioned just as much as that of
the current regime. Anita Chan, Jonathan Unger, and Richard Madsen
argued that inhabitants of Chen village (Guangdong) who lived through
Maoism saw their faith in it eroded by the 1970s (1992, 249). Jun Jing
related the experiences of villagers in Gansu who were forced to resettle
in 1960 due to the construction of a dam (1996). Far from recalling
the past in a positive light, villagers protested about the state’s indebt-
edness to the masses and its moral responsibilities for those displaced.
Erik Mueggler’s study among the Yi minority in rural Yunnan outlines
ambivalence to the past and the present state alike—earlier experienced
as a “personified external other” and later as an “abstract internal
Other” (2001, 288).
Whether remembered positively or negatively, the past certainly
serves as a parameter to judge the present. Ambivalence is felt, for dif-
ferent reasons and in different contexts, toward both past and present.
In this study, such ambivalence is articulated through cancer etiologies.
As they attribute cancer to hard work, villagers at once lament their sac-
rifice for collective well-being but also highlight its value. As they blame
it on poverty and food shortage, they also judge the state’s failures to
provide for their welfare. Finally, as they remember the past by relating
cancer to suffering during the Cultural Revolution, they display disdain
toward state-promoted violence and the strain it caused on village rela-
tions. But, in its deprivation, the Mao period is recalled positively to
critique present corruption and the lack of a welfare state to help with
rising health care and schooling costs. When there was little sign of a
welfare state in rural China still until 2005, comparisons to efforts in the
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.
Declining Morality among Villagers?

Remaking Moral Worlds
New values gained currency among villagers in the reform period.
In her study of peasants’ images and experiences of development in
rural China, Elisabeth Croll contends that a plurality of aspiration
and dreams of petty well-being (xiaokang) have emerged after the fad-
ing of the monolithic, homogeneous, and imposed collective dream.
Heaven is no longer the collective good but rather a variety of dreams:
for some a new house, quality furniture, electrical goods, sufficient food
or cigarettes; for others, moving to the city or abroad (1994, 222).8
However, enthusiasm for consumerism and wider changes in attitudes
precipitated by reforms is by no means pervasive. Many ethnographies
of China under reform have argued that the period has been expe-
rienced as a decline in morality.9 Reforms are said to have brought
about a rapid increase in theft, crime, corruption, arbitrary local levies,
and degeneration in public spirit. For Liu, under reforms money rules
supreme, crime is on the rise, corruption goes unpunished, cheating is
the order of the day, and villagers feel they are the worst victims (2000,
12–13). Dissatisfaction toward the present is most acute among the
older generations. In his study of Chen village, Madsen explains that,
already in the mid-seventies, older villagers complained of a “spirit of
lethargy” among the younger generation, who on their part, had had
better schooling and more information about the world beyond their
village and therefore had become demoralized because their urban
counterparts had a better life (1984, 240). According to Chan, Unger,
and Madsen, those who could recall an economic boom in the mid-
sixties and labored hard for the collective felt let down by reforms and
by the younger generations who seemed to put less value on hard work
and be liberal with money (1992, 252–254). Similarly, Yunxiang Yan
argues that reforms left in their wake a “social vacuum of moral values
and behavioral norms” soon filled by a peculiar brand of individual-
ism which “tends to emphasize individual rights and personal interests
while downplaying a person’s obligations to the community and other

individuals” (2003, 16). In this context, older villagers recalled that in
the 1960s, “young people had endless energy and good thoughts” (35).
They looked back on their youth with nostalgia, lamented the waning
of emotional and moral aspects of filial piety (223), and criticized young
farmers for staying in bed late, which they take as a symptom of their
selfishness (224).
The apparent resurgence of “traditional” practices has been widely
regarded as a reaction to the perceived decline of morality in the pres-
ent.10 The renewed importance of the family and kinship (Davis and
Harrell 1993; Ku 2003; Jing 1996), of guanxi ( Yan 1996; M. Yang
1994; Kipnis 1997), and of religion and ritual (see chapter 8) may all
be understood within this context. Both Jing (1996) and Ku (2003), for
instance, show that the revivals of a local temple and lineage group in
their respective field sites were attempts to rebuild the local community
as a base of power and authority alternative to the local state. Equally,
families have been given many responsibilities as support structures in
the absence of a strong welfare state. In a similar way, guanxi or connec-
tions are cultivated on a wider scale. As Chan, Unger, and Madsen have
put it, at a time of great social change such as the present in China, “it
becomes an advantage to be able to turn to more than one sub-com-
munity structure as an anchorage for support” (1992, 326). Reliance on
networks based on family, kinship, and guanxi and on alternative models
of morality is a response to a new setting that exacerbates their need.
Implicit in these accounts is a sense of how local people struggle to
constantly refashion their local moral worlds in new contexts—a strug-
gle that I want to make more explicit. Older villagers’ moral judgment
of the younger generation as egotistic and uncivil is part of their efforts
to establish a moral order rooted in their own experience and memories
of commitment to the collective good during Mao. In much the same
way, I would argue, the younger generation’s behavior is not immoral
or uncivil (as it is construed by the older generation) but rather embod-
ies their own attempts at refashioning the boundaries and parameters
of morality in radically different contexts. Although I do not dispute
that the reform period has triggered profound social changes, I pro-
pose that to continue to characterize the present as lacking in morality
is at least partly out of touch with people’s sustained efforts to recre-
ate morality in their everyday lives.11 In her monograph Appetites: Food
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
obligation. To portray this in a broader context, she employs Caroline

Humphrey’s definition of morality as “the evaluation of conduct in
relation to esteemed or despised human qualities” (Humphrey 1997, in
Oxfeld 2010, 26). On this basis, Oxfeld describes moral discourse as “a
running commentary on the choices people make” (27).
Through the prism of perceptions of cancer and strategies to cope
with it, I also show that villagers may disagree on its parameters, but
they share a concern for what is moral behavior. While I agree with
Oxfeld that morality is always contested, even in societies without radi-
cal change as seen in recent decades in China, I would argue that such
changes make contention even sharper. Facing cancer, as with any major
illness, presents many moral dilemmas. Illness demands care, and care
is a particularly poignant realm in which the boundaries of morality are
tested. In the context of making sense of cancer and caring for a cancer
sufferer, morality is defined not only as the fulfillment of obligations (for
instance of children to parents) but also in terms of evaluating conduct
more broadly. Jarrett Zigon (2008) has warned that morality tends to be
loosely defined, conflated with social, religious, gender, and kinship sys-
tems, but that it should be distinguished from family and social relations.
In the setting examined here, however, these are inseparable. Oxfeld
writes, “For most rural Chinese, the family is still one’s most immedi-
ate set of relations. So issues of moral debt are constantly posed within
the family” (2010, 5). If this is the case, a study of morality is also by
definition a study of family relations. Zigon himself points out that rela-
tionships between children and parents are central to morality in non-
Western moral philosophies such as Confucianism (2008, 11). Studying
morality emically—as it is debated by locals and as it suffuses their daily
practices—must rely on studying those very practices that according to
locals are the seat of contestations about what is fair and just; family
relations and practices of care are two such sites. Not to design moral-
ity in these terms would amount to imposing an outside definition of
morality (be it from Western philosophy or the anthropologist’s own
moral worldview), dangers which Zigon cautions against. This book as a
whole demonstrates how ways of understanding and dealing with can-
cer articulate overlapping models of morality. In part 2 the production
of local moral worlds is examined vis-à-vis perceptions of cancer etiol-
ogy. In part 3 it is unpacked with reference to how family relations are
maintained or challenged through patterns of care.
Experiences of cancer are instances in which social and moral fault

lines may become visible; people reflect on their past through experi-
ences of cancer, and conversely their attitudes to it can tell us much
about how they understand the recent social changes and make sense of
the present. Ambiguities surrounding what constitutes moral behavior
are articulated through decisions surrounding care. Some manifest care
by farming; others by taking up paid work, by returning home to visit
a relative with cancer, or by avoiding such costly journeys and opting
instead for sending remittances to cover health care costs. Whichever
the chosen path, relatives lay claims to behaving morally and adequately
caring for the sufferer. Contending parameters of morality also under-
score mourning practices (chapter 8). The traditional customs of burn-
ing incense, paper money, and firecrackers at the grave competed with
an alternative moral code—Christianity—which shunned such tradi-
tional customs as “superstition” in favor of attending Mass and believ-
ing in God.12 Practitioners of both Christianity and traditional customs
laid claims to morality, and their encounter caused conflicts within the
family and challenged family relations. What emerges is not an immoral
present, but one where the quest for morality is rife.
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
The Evolving Moral World

of Langzhong
Langzhong city is located in a hilly area in the northeast of the

Sichuan basin, on a meander in the middle reaches of the Jialing
river. Langzhong county covers an area of 1,878 square kilometers
(725 square miles), including nineteen ethnic groups, but 99 percent
of the population is Han. At the start of the new millennium, the total
population of the county was 860,000, of whom 200,000 were urban
residents (Song 2003, 1). The county includes twenty-two towns (zhen)
and forty-eight townships (xiang). Average yearly rainfall is 1,034 mil-
limeters (40 inches), and the average temperature is 17 degrees Celsius
(62.6 degrees Fahrenheit), but seasonal variation is great, with tempera-
tures almost reaching freezing in the winter and well over 30 degrees
Celsius (86 degrees Fahrenheit) in the summer.
Langzhong county is poor by Sichuan’s standards: the official aver-
age yearly per capita income in 2003, according to the Baoma village
secretary, was 2,037 yuan (roughly $246 in 2004–2005), although the
actual figure is likely to be much lower. Until recently, Langzhong had
been rather cut off. In 2004 it took approximately five hours to reach the
area from the provincial capital Chengdu ( just over three hundred kilo-
meters away), a journey that until 2002 required a day’s travel. Limited
investment in Langzhong, due to its poor transport links to the rest of
the province, had preserved part of the “old city”—an area of low-rise
commercial and domestic buildings based on a plan dating from the
Song dynasty (960–1279) (Song 2003, 19). By 2004 this had paradoxi-
cally become a selling point for promoting tourism. The stunning loca-
tion of the city and the original meaning of the name as “surrounded
by hills and water” (3) also served to craft the city as the homeland of
feng shui (commonly translated as geomancy), in the hope of attracting

external investment and tourism.
Government efforts to promote Langzhong as a desirable place are
in stark contrast with the perceptions of those dwelling there, especially
in the countryside. Farmers complained that rural Langzhong had no
hope of developing because it was hilly and thus inimical to the use of
farming machinery. Reacting to their perception of the area as under-
developed and to low local wages, many young people migrated to
richer coastal areas in search for work. Much of the data on which this
study is based was collected in Baoma, the village where I lived between
2004 and 2005 and have visited every year since, but this was also sub-
stantiated with data from a number of other villages in Langzhong
county—most notably, my host Erjie’s natal village of Xicun. Baoma is
six kilometers from Langzhong city, along a road built in 2002, and in
2004 it had approximately five hundred residents. This chapter offers
a brief social and economic history of the locality since the advent of
socialism. It points to some of the extraordinarily complex ways in
which Mao and post-Mao policies—from the early reforms of Deng
Xiaoping to Jiang Zemin’s contribution and the current leadership of
Hu Jintao and Wen Jiabao—impacted on villagers. In doing so, it traces
contending forms of morality in the present and their historical refer-
ents, which will be further analyzed through the book.
Langzhong under Mao

The establishment of the People’s Republic of China in 1949 caused
massive changes. Shortly following land reform in the early 1950s,
efforts were made to nationalize industries; unify grain procurement;
set planned production targets, prices, and rationing; and collectivize
agriculture. Initially, farmers were organized into mutual aid teams.
Collectives were formed building on these teams in 1956, and following
this “high tide of socialism,” the Great Leap Forward was launched in
1958. This campaign was intended to establish agricultural and indus-
trial infrastructure in record time. To this purpose, private ownership
was entirely abolished. Higher cooperatives or communes were formed
to preside over brigades (now villages), themselves organized into
production teams. While the boundaries of teams in Baoma broadly
reflected those of kinship groups, each team having predominantly one
Figure 2.1 Map of China, Sichuan, and Langzhong’s location.
Figure 2.2
Langzhong’s “old” and
“new” city.
surname (cf. R. Watson 1985), collectivization entailed a pooling of

resources beyond individual families and reconfigured the texture of
social and economic life. In agriculture, farmers were told to practice
closecropping to increase yields. Likewise in industry, the establishment
of small backyard furnaces was aimed at increasing steel production
(see Shapiro 2001; Tilt 2010). Baoma villagers recall that there was not
a single tree on the surrounding hills, as they were used for burning in
the furnaces, and all available land was farmed.
Overall, priority was given to the urban proletariat, who were pro-
tected by a welfare state that villagers would never have. A residence
registration system (hukou) introduced in 1958 throughout China effec-
tively forbade unauthorized travel. The few to leave Baoma under
Mao were men recruited into the military and those employed to build
bridges in Panzhihua, an area in the south of Sichuan earmarked for
intensive industrial development (Tilt 2010). Some women escaped by
marrying men from Henan, a province where, the rumor went, land
was flat and mechanized agriculture had been introduced. Until this
system was relaxed following Mao’s death, it worked to solidify inequali-
ties between urban and rural China, as well as between regions. While
urban residents were organized into work units that provided them with
work, housing, and other social services (Whyte and Parish 1984), villag-
ers had to produce grain to feed their collective and to hand over to the
state, which redistributed it to feed the cities and for export. But many
recalled, “We just did not know where all of that grain went.” Their
produce, villagers reasoned, was taken away because cadres, swept by
the high tide of socialism, overinflated their reports to their superiors.
On their part, cadres were under pressure to meet unrealistic state
quotas. As Helen Siu explains, cadres were caught within a structural
framework that put pressure on them to perform as expected (1989,
187–188). For the first year of the Great Leap, claims of higher yields
seemed to be reflected in reality. With the introduction of collective
canteens, villagers recall they could eat in one canteen and then move
on to the nearby village’s, eating as much as they wished. This is conso-
nant with research in other localities. Chen villagers in south China, for
instance, recalled a time of abundance at the start of collective canteens
(Chan, Unger, and Madsen 1992).
This prosperity did not last long, however, and the enduring mem-
ory of this period is one of hard work, deprivation at best, and starvation
The Evolving Moral World of Langzhong     55
at worst. While Malthusian cycles of famine surely affected villagers

before the Great Leap, this is the most recent and vividly remembered.
Villagers who lived through the Great Leap can still easily point to the
wild grass they ate in the absence of anything else. Erjie’s mother-in-law
explained: “We ate food we now give to the pigs: sweet potato leaves and
rice husks. . . . They [village officials] checked you before you went to
the toilet to see you didn’t hide food. Our neighbor was beaten for biting
a raw sweet potato in the field. . . . Many died. . . . Another neighbor
tried to live on half her allotted portion of rice and feed her children
with the rest. She starved to death” (February 27, 2005). All talked of
the widespread “water swelling illness” (shuizhong bing) due to starva-
tion.1 Those old enough to work in the fields remembered working hard
but not being given enough food. Those who were children remember
with a great sense of loss the local school closing due to famine and
being required to work. Women recall widespread amenorrhea (abnor-
mal absence or suppression of menses). All remember being severely
constipated. One woman in her mid-sixties explained, “You just could
not push it out, it was too hard” ( July 2005). The death toll of the
famine between 1959 and 1961, when public canteens were dissolved,
is usually estimated at thirty million. The full social and moral implica-
tions of these events are highlighted in Erik Mueggler’s (2001) evoca-
tive study of suffering in this period. Effects on the local community
in Baoma were equally disastrous. Local cadres were held responsible
for handing over too much food to higher cadres and leaving villagers
to starve. Conflicts were also common among villagers competing for
scarce resources. Those closer to the village cadres were suspected of
taking more than their share.2 Relationships were strained.
Baoma villagers did not discuss the next landmark event in the his-
tory of Maoist China, the Great Proletarian Cultural Revolution, with
the same amount of fervor. Starting in 1966, the Cultural Revolution
was at its most virulent until 1969 and ended officially with Mao’s
death in 1976.3 Aimed at destroying the “Four Olds”—Old Customs,
Old Culture, Old Habits, and Old Ideas—it caused massive upheaval
at a national level. Anyone labeled a “rightist” or “bad class element”
(belonging, for instance, to the former landlord class) could be strug-
gled against. The education system was brought to a halt and many
intellectuals were sent to labor camps, while young students also “vol-
unteered” to be rusticated, following widespread encouragement (see
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
effects of humiliation during the Cultural Revolution on people’s men-

tal and emotional health, as well as to the socially and culturally accept-
able medical categories identified to define such distress. In this case,
the effects of past abuse are extended beyond mental health and soma-
tization to encapsulate the biomedical disease category of leukemia.
Attributing the doctor’s illness to such abuse clearly presents a moral
judgment on those turbulent political times and the suffering inflicted.
Beyond these stories of trauma, the period was most clearly associ-
ated with an improvement in health care provision. A “barefoot doc-
tor” was trained at this time and started practicing under the tutelage
of one of the Cultural Revolution’s main victims, Baoma’s laozhongyi.
This initiative was intended to strengthen primary care at the village
level, while more elaborate care could be sought at higher levels (see
Lampton 1977; Sidel and Sidel 1974). Finance for rural health services
came from a combination of government funding, cash payments from
patients, and funds from the rural cooperative medical systems (RCMS),
with higher levels (county level and above) receiving state funding and
village health centers mostly relying on local contributions. In 2004–
2005, when no health care insurance was in place for Langzhong’s rural
population, villagers nostalgically recalled health care provision in the
collective period. They stated that at that time, treatment was either
free or very affordable, and that hospitals would not turn people away
even if they had no funds for treatment. This was the only time that any
attempt at providing better public health in rural areas was made before
the establishment of new health care cooperatives in 2006. It was, how-
ever, not as comprehensive as the urban insurance schemes and relied
mostly on collective funds, which ultimately meant villagers were fund-
ing their own health care schemes (Duckett 2007; White 1998).
Scholars disagree on the extent to which local cadres during Mao
were state agents or political brokers. For Vivienne Shue (1988), local
cadres used traditional bases of support and through them frustrated
the state’s attempt at total control. For Helen Siu (1989), by contrast,
the power of the state was pervasive. This is due both to local cadres’
acting predominantly as agents of the state, who asserted its presence
in the everyday lives of villagers, and also to villagers’ complicity. Only
this can explain the speed and determination with which campaigns
were carried out. Sulamith and Jack Potter put it differently, argu-
ing that “Chinese socialism is not a culturally rootless system without
a history, but it is integrated into pre-existing cultural patterns as it is

implemented” (1990, 60), therefore drawing its strength from existing
structures. The experiences of Baoma villagers suggest that cadres may
have enforced central state policies, but they also protected traditional
familial interests by privileging those closer to them. Beyond doubt, these
events and experiences had a profound effect on villagers’ relations to
the local and central state in times to come. They serve as a parameter
through which villagers assess the present situation. In particular, when
the costs of living soared, villagers began to judge the market orienta-
tion of the present vis-à-vis a tumultuous but less unequal past.
Langzhong during the Early Post-Mao Reforms

After Mao’s death in 1976, the new leadership advocated a series of
social and economic reforms in an attempt to revitalize economic stag-
nation. Deng Xiaoping is often dubbed “the chief architect of China’s
economic reforms and socialist modernization.” Although he never
held office as premier or general secretary of the CCP, he nonetheless
served as China’s paramount leader from 1978 to the early 1990s. The
changes he ushered in are usually known as the “opening and reform”
( gaige kaifang), aimed to transform China into a modern, industrial
“socialist market economy.” At the county level, this meant a gradual
recognition of Langzhong as a famous cultural and historical city, first
by the provincial government in 1984 and at the national level two years
later (Song 2003, 7). This culminated in its opening to external invest-
ment in 1992, when the local government decided that the “old city” of
Langzhong should be preserved and promoted as a tourist destination.
Unlike the Cultural Revolution, Deng’s reforms were often discussed
as a milestone after which the quality of life improved considerably.
Baoma residents admire Deng as a fellow Sichuanese and remember
him in a very positive light for putting families in control of produc-
tion. By going against the grain of much of Maoist ideology, reforms
aimed at dismantling collectives and proposed that for economy to pros-
per, some should be allowed to “get rich first.” Agrarian socialism was
substituted with the “responsibility system,” dividing production among
households. In rural Langzhong, this process was complete in 1981.
Administrative units were renamed—small teams became small organi-
zations (xiao zu) and brigades became villages—though the boundaries
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
planning policies undermined the very attempts of families to rely on

their offspring to increase the family’s income and care for elderly par-
ents. Villagers observed that the steep cost of schooling served as an
even more efficient deterrent to having more than one child than the
family planning policy and dangers of fines. Families, they reasoned,
simply could not afford to raise two children. With these growing bur-
dens on families and lack of state subsidies, a sense of insecurity and
discontent began to spread.
Such discontent was radically exacerbated by the growing corrup-
tion among local officials and steep arbitrary fees they levied on vil-
lagers. These fees reached a peak following the rise of Jiang Zemin as
president and general secretary in 1993. Jiang Zemin was despised by
all Baoma villagers, without exception. They complained that his gov-
ernment did not care about the countryside and allowed corruption
to escalate. By the mid-1990s, Baoma villagers were charged roughly
300 yuan per person per year in arbitrary fees, with a peak of 400 yuan
in one year. These sums were far beyond what the average family of
farmers or even a family with one waged laborer could afford. In dis-
may, some invested 5,000 yuan in buying a city residence permit or
slightly less for a town permit, which would exempt them from these
fees. The village secretary and village head who served at this time grew
wealthy and bought homes in the city, leaving village finances in the red
even when they had charged villagers extortionately. Some complained
to the town government, but to no avail. If you could not pay, villagers
explained, an array of village cadres would sit in your house all day,
demanding to be fed, until you agreed to hand over something. If you
did not, they returned the following day. And if you still claimed not to
have money, they would take the family’s pigs and any other animals
or—when some villagers started to have one in the late 1990s—the tele-
vision (see also Gao 1999).
Corruption, villagers agreed, was not a new phenomenon. But, they
explained, during Mao a corrupt official would be punished; during
Jiang they seemed to be able to grab whatever money they wished and
to be regarded “capable” if they did so. Also, while in the past one
would not gain much wealth (tanbudao ge sha) through corruption because
there simply was little wealth around, the opportunities were now sub-
stantially increased. Villagers were enraged by the seeming tolerance
of corruption coupled with increased opportunities to accumulate
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.
The Ethnographic Present: 2004–2005

The next generation of leaders following Jiang came into power fully
in 2003. Hu Jintao took over as president and general secretary and
Wen Jiabao as premier. The China that they inherited was haunted by
inequalities and growing discontent exacerbated by Jiang’s focus on eco-
nomic growth at all costs. As a remedy, Hu and Wen proposed instead a
model of progress based on “scientific development” aimed at building
a “harmonious society.” This would involve a focus on social stability
and harmony and a view of development centered on people ( yi ren wei
ben), taking into account health and environment rather than economic
growth alone. Most significantly for scholars of rural China, Hu and
Wen turned their attention toward the countryside, pledging to tackle

the “three farm problems”: agriculture, countryside, and farmers. They
abolished the age-old agricultural tax and banned all arbitrary levies.
They planned also to gradually put in place a social security system for
rural dwellers and the poor more widely.
None of the changes outlined above, however, affected Baoma or
Langzhong during my initial period of fieldwork in 2004–2005; they
only began to have some effects in 2006. This period has the quality—
typical of recent transitions—of being nominally Hu and Wen but still
characterized by Jiang policies and, therefore, by vociferous complaints
toward local and central government alike. Unequal levels of develop-
ment and welfare in urban versus rural areas also angered villagers.
Starting in 2004, some investment was put into the area as part of
the “Develop the West” project (the west and interior of China being
notoriously poorer than the coastal areas). Between 2004 and 2005,
a new bridge was built across the Jialing river, and a large shopping
mall was completed next to the People’s Square. The waterfront area
along the old city was also renovated drastically. By September 2005,
Figure 2.3 Baoma village in 2005.

buildings were up for rent or sale as restaurants and shops, couched

within a neotraditional architectural style—concrete buildings imitat-
ing the structure and appearance of traditional houses. The motorway
linking Chengdu to Nanchong, which forms the first half of the jour-
ney between Chengdu and Langzhong, was covered with promotional
signs, advertising Langzhong’s old city as a “rarity on earth” (tian xia
xi) and promoting its local products—in particular, silk, Baoning vin-
egar (Baoning being the name of the town now forming the center
of Langzhong), and Zhang Fei beef.6 Villagers, however, claimed that
their lives had remained largely unaffected by such development, the
only tangible change being a rise in living costs that could only be met
through waged labor.
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
Figure 2.4 Erjie, Erge, Dajie, and the anthropologist helping to transplant rice
for Erge’s family (2005).
in November and harvested in May–June. There were three establish-

ments where locals could grind wheat and produce noodles for 1 yuan
per 50 kilograms. November is a busy season: soybeans, sweet potatoes,
and icicle radishes are harvested and wheat is planted on the dry land.
Together with cabbage, harvested in the same period, these constitute
the typical diet until April the following year. Various vegetables are
planted and harvested in the spring and summer, including cowpeas,
cabbage, asparagus lettuce, peppers, eggplant, cucumbers, and toma-
toes. Locally grown fruit included loquat, peaches, apricots, pomelo,
oranges, pears, and watermelon. These were often for family consump-
tion, though roughly half of local families also regularly sold fruit and
vegetables, earning on average 700 yuan per year for a family of three.
Following a statewide reforestation policy, local farmers were
instructed to plant fruit trees, and according to the village secretary a
total of 400 mu (1 mu = 667 square meters) was planted with peach and
apricots trees in 1999.7 The hills surrounding Baoma and the nearby
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
Figure 2.5 Family savings and debt (2003).

No. of
families Savings/Debt
(%) (Yuan) Comments
1 Over 300,000 savings This consists of three families, one of which
has 1 million yuan in savings. The family
head is the manager of a construction
company. This family is registered in the
village but, predictably, no longer lives there.
7 50,000–60,000 savings This consists of 20 families.
42 2,000–3,000 savings This consists of roughly 120 families.
10 No savings These are families without wage laborers
and without surplus produce to sell.
40 Debt of 10,000 Debt is typically incurred through illness or
or over house building.
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
as tailors in Shenzhen before marriage to set up a small family enter-

prise producing working gloves. When business was good, they had a
net earning of over 1,000 yuan per month. They also bred fish in a vil-
lage pool, and the grandfather worked in a pharmacy in the city, earn-
ing 600 yuan per month.
Such diverse economic outcomes were manifested clearly in three
different types of houses. Bamboo-and-mud houses were regarded to
be the poorest type of dwelling and seen to make the poverty of their
inhabitants visible. This was the type of house that Uncle Wang and
Aunt Zhang lived in with their granddaughter and her parents when
they were at home. Taoge’s parents also lived in a bamboo-and-mud
house, as they relied only on their own income from farming, animal
breeding, and occasionally the sale of laboriously handmade noodles.
The first step up was living in a brick-built house. These houses were
usually built in the early 1980s, but by 2004 they were also regarded
with a degree of shame, although still considered acceptable. This is the
type of house that Erjie and Taoge lived in with their daughter. Many
villagers with modest incomes, perhaps from only one waged laborer,
would live in these houses. The true sign of distinction and wealth was
being able to afford a concrete-built, externally tiled, two-story building.
Only a few families in 2004 could boast such housing, and Chunyan
and her family comprised one such case.
All houses included a kitchen, a pigsty/toilet, two bedrooms (one for
the couple and one for their child), and an altar/storage room. Wealthier
families might have a living room or additional bedrooms. Kitchens
were equipped with two fixed cooking pots fuelled with seasonal farm-
ing refuse (such as rice grass, dried maize plants and cobs, dried soy
plants, and so forth) and occasionally wood. In addition, each household
also had a metal conical burner fuelled with industrially produced coal
briquettes. Some families also had one small gas cooker, but they used
it rarely. Water was provided by shallow wells, from which it was taken
with buckets and carried home on shoulder poles, or less frequently from
deeper wells, where water would be drawn through an electric pump.
Toilets were adjacent to the pigsty, and human and animal refuse was
collected in a pit below to be used as fertilizer. Traditionally, the central
room of each house was intended as an altar room (tangwu), devoted
to ancestor worship. To my knowledge, however, ancestor tablets were
very rare (only one family in Baoma had preserved theirs). Little if any
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:
• House building: a small, ground-floor concrete house cost at least

10,000 yuan; more lavish houses could cost ten times more.
• Marriage costs: at least 15,000 yuan (including a new residence
for the couple). The husband usually paid a bride-price of 2,000–
3,000 yuan to the bride’s family, but each case was different, and
differences were made more significant by the increase of migrant

labor (see Y. Yan 2003).
• Funerals: 3,000–9,000 yuan, depending on family composition and
resources. This includes the cost of cremation (800–1,000 yuan),
compulsory in 2004–2005, or the fine paid to avoid it, which
according to the village secretary amounted to between 1,000 and
3000 yuan but could be as low as 300 yuan (see chapter 6).
• Children’s education: 600–3,000 yuan per year, depending on level
of schooling: 600 yuan per year for primary school, 1,500 for mid-
dle school, and roughly 3,000 for high school. If the student opted
to live at the school residence, this amounted to an extra 1,500 yuan
per year, including food. Few students from Baoma lived in the stu-
dent residence during primary and middle school because they
could walk to the town in roughly forty minutes. The nearest high
school was in Langzhong city, and it took a half hour bike ride to
reach; thus most students from Baoma (I was aware of eight) con-
tinued to live at home, though some (only two to my knowledge)
opted to live in the residence.10
• Regular medical expenditures started at 200 yuan per family per
year for common colds, vaccinations, and minor illnesses, rising
to 20,000 yuan in the case of a serious illness such as cancer (see
chapter 6).
Costs Imposed by the Local State: Arbitrary Levies

Changes between 2003 and 2005 meant that a number of taxes were
lifted. Figures for 2004 are unclear, since it was a transitional period in
the eradication of tax. The comparison between 2003 and 2005 thus is
less ambiguous. According to the village secretary ( July 29, 2004), tax for
farmers amounted to 192.5 yuan in 2003 and decreased to 104.5 yuan
in 2005. The village secretary neglected to mention the fiercely hated
charge for building a road through the village, which totaled 200 yuan
per person per year in 2002 and 2003. In 2004, reforestation compensa-
tion due villagers was also withheld to cover the costs of road building.
When I settled in Baoma in June 2004, the road was still only a mud
truck, impossible to walk on, let alone cycle or drive on after heavy
rain. By the following summer (2005) it had been filled with gravel and
become more practicable. Even after the road was completed, villagers
complained vociferously about these costs and the lack of transparency
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).
Families in Baoma and the Host Family

The influential volume edited by Deborah Davis and Stevan Harrell
(1993) on families in post-Mao China illustrates how families adapted
to the new economic, political, and cultural circumstances in a variety
of ways. Families could be joint or nuclear, depending on the pace of
development in the area, proximity to urban areas, and family mem-
bers’ occupations. Yunxiang Yan’s (2003) ethnography of individuals
and family relations in the Mao and post-Mao period outlines a ten-
dency for the conjugal relationship to replace the parent-child relation
as the primary focus on kin relations. In accordance with Yan’s work,
the vast majority of families in Baoma were nuclear. However, it was
common for relatives to help during busy agricultural periods: broth-
ers’ and sisters’ families might offer (and request) mutual assistance.
Grandparents (born in the 1960s or earlier) might also request the help
Figure 2.6 Income and expenses for a family of three (2004–2005).

Yuan
AVERAGE INCOME (according to township records and including 6,900.0
at least one waged laborer)
EXPENSES (according to statistics and fieldwork):
Living costs (clothes and food excluding special occasions) 850.0
Agricultural costs (including fertilizers and pesticides) and animal 1,000.0
husbandry
Electricity, coal, fuel bricks for stove 300.0
Landline telephone and mobile phones 150.0
Banquets and birthdays 500.0
School fees 1,800.0
Health care (excluding the cost of major illnesses) 400.0
Tax (in 2005) 313.5
TOTAL EXPENSES 5,313.5

NET INCOME 1,586.5
Note: This table is based on official records as reported by the Baoma village secretary in
an interview on July 29, 2004, and substantiated by participant observation and semistruc-
tured interviews conducted in July 2005 (see appendix 1).
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
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
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.
Looking to the Future: Hu and Wen—Not Quite

Postsocialist?
In the years since 2005, much has changed in Langzhong and Baoma.
For this reason I have chosen to limit the ethnographic present of this
study to 2004–2005 (when the most substantial amount of data was
collected), with the notable exception of some parts of chapters 3 and
7. It is worth outlining briefly what some of those changes consist of to
better contextualize the material presented here. In 2004–2005, Taoge
often joked that he would have to work for a month to be able to afford
a single T-shirt on sale in the newly built shops he helped to decorate in
the city. Villagers (myself included) were all baffled as to who would be
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
government transfers to localities and populist policies and rhetoric, the

current leadership seems to be reinventing socialism yet again, rather
than abandoning it.
As part of this effort, starting in 2006 all school fees for primary
and middle school in rural China were lifted and a new rural coopera-
tive medical system was introduced to reimburse part of the costs of
inpatient treatment (see chapter 7). One villager was full of praise for
the new policies: “In all my sixty-seven years it has never been so good
for farmers; the government doesn’t want money from us, and what is
more they give us subsidies, for instance to buy electrical goods. We also
have a health care insurance scheme, and we can even join a pension
scheme” ( January 2009). Another villager, also in his sixties, similarly
commended the new leadership, particularly focusing on the initiative
“electrical goods go to the countryside” (dianji xiaxiang): “We now have
solar-powered hot water. Many families have installed this in the past
couple of years. We got ours two months ago. Now farmers are bet-
ter off, the government is giving a lot of money, a lot of subsidies: for
instance, for buying a TV, or an engine-powered harvester, or even a
fridge” ( January 2009).
Villagers were less convinced, however, that local cadres and insti-
tutions had abandoned their revenue-seeking pursuits. Skepticism
pervaded initial attitudes to the new RCMS. While this reduced some
health care costs, villagers pointed out that it did little to change the
profit-oriented rationale of health care providers and that many treat-
ments were not covered by the schemes, nor were the costs of diagnosis
(see chapter 7). They felt equally skeptical about the cost of schooling.
Although fees had been lifted, children attending middle school were
required to reside in school accommodations and to eat at the school’s
canteen (April 2007). These costs were roughly 500 yuan per term,
which was a little more than families used to pay for school fees. But,
Erjie commented, “The food is disgusting and not nutritious; I have to
go to the school gates with some food every now and then, so Lida has
a better diet, because she has already lost weight since she moved into
the school residence, and she always complains the food does not taste
good.” Children’s pervasive answer to my question “How’s the food
in school?” was inevitably, “Really bad (tai bu hao chi le)” (April 2007).
Villagers explained that “schools are like businesses—they want to make
money but not to spend any” (fifty-two-year-old villager, April 2007). In
ways that resemble Susan Brownell’s findings among Chinese athletes

(1995, 256), villagers felt that schools’ failure to adequately provide for
children’s nutrition may be seen as an inadequacy of the state provisions
more widely. But while during Jiang and in the early Hu/Wen period
they blamed the whole state machinery, they now reverted to blaming
problems only on local implementation.
The most visible change in Baoma due to the new socialist coun-
tryside initiative is the frenetic house building. Where in 2004 concrete-
built, externally tiled houses were rare, in 2007 government subsidies
for new houses triggered a building spree by the new village road. One
sixty-two-year-old villager, who enjoyed watching the news and political
debate on television and seemed among the best informed about cur-
rent policies, explained that compensation was granted on the basis of
the type and size of house demolished, not on the newly built home.
For a brick-built home, compensation was at 80 yuan per square meter,
but for a mud and grass house it was 60 yuan per meter (August 2008).
This principle, however, did not seem to be clear to all those who had
rushed into building very large and expensive homes hoping for a larger
Figure 2.7 New houses built along the village road in 2007 as part of the new
socialist countryside.
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
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.
Remembering the Past to Reflect on the Present

During Mao, the masses were encouraged to “remember past bitterness
and think of present happiness” ( yi ku si tian). During the late reform
period of my fieldwork, villagers engaged in remembering with more
ambivalence about both past and present. The way in which different
generations reflected on their experiences can tell us a great deal about
what villagers felt was at stake within diverse moral economies. For ana-
lytical purposes, the local population may be divided into three genera-
tions: grandparents (born in the early 1960s and earlier and coming of
age under Mao), parents (born between the late 1960s and the early
1980s and coming of age during the reforms), and children and young
adults born after decollectivization. In her work on different genera-
tions of women factory workers in Hangzhou, Lisa Rofel (1999) showed
how they developed different gendered identities linked to the diverse
modernization projects in which they had been enlisted. Similarly, these
social groups in Baoma were equipped with different experiences and
therefore had divergent opinions on the present and on what constitutes
moral behavior. Hard work and the ability to “eat bitterness” are at the
center of claims to moral authority and caring and responsible behavior
for all, though the parameters to define them have shifted in accor-
dance with the different moral and political economies of collectivism
and reforms.
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.
Most crucially, it is farming that enables parents to leave the country-

side in the first place, because it provides grandparents with sufficient
resources to care for themselves and their grandchildren. Agriculture
also provides a level of security in case of loss of earnings, which
remains a real threat in a fluctuating market economy. If farming and
wage labor are interdependent, the transition toward a wage economy
clearly has not spelled the end of previous moral economies. Efforts
made to build socialism have been partly but not fully substituted with
a capitalist future. These two moral economies—and the ideals of hard
work that they produce and require—exist side by side. The current
need for paid labor is still judged vis-à-vis the value of “energy,” and it
still rests on farming skills, while also requiring and fostering new skills.
Children and young adults also make contending claims to moral
behavior. They did not endure physical hardship as their grandparents
did, but they shared their parents’ concern for the need to acquire skills
that would enable them to earn a good living and may spare them hard
physical labor. All generations agreed that a solid education was vital
to ensure this. Students felt that school was demanding in ways that
their parents and grandparents had not experienced. In the final year
of middle school and high school in particular, students spent fourteen
hours a day in school, with only one day of rest per month. For this
reason, often one parent at least returned to Langzhong to support chil-
dren in the final years of school by renting a small room where they
could live with their children, cook for them, and watch over them as
they completed their homework. Demanding school routines entitled
children to claim to also be “eating bitterness” and, on this basis, to
having behaved morally. But children also based their claims of “eat-
ing bitterness” on a comparison with their urban peers: their food may
not be literally bitter, but it was less “tasty” and varied, and they had
fewer toys, gadgets, and clothes. They were confronted daily with con-
spicuous consumption promoted on television and embraced by those
whose families could afford it. Although their parameters differed, no
generation accepted others’ claims to moral superiority unproblemati-
cally. Rather, they engaged in dialogues and clashes that were fraught
with claims of enduring hardship and adequate fulfillment of individ-
ual responsibilities and familial duties. Each generation strived to better
themselves based on the parameters in currency and the means avail-
able to them: for grandparents farming, for parents migrant work, for
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
and do nothing!” This brief but deeply telling ethnographic vignette

shows two contending forms of morality: that shared by Aunt Zhang
and her daughter-in-law, whereby collecting waste counts as a way of
making ends meet, and that of Youhui, possibly subjected to derision by
her peers for being the granddaughter of an occasional scavenger.
Aunt Zhang shows how practices that may be categorized as dirty
and backward may be subversively reclaimed as morally justifiable. An
alternative reaction is to keep embarrassing or incriminating details out-
side the public realm. I learned this when I got head lice. In the late
summer of 2004, I pointed out a number of times to Erjie that my
head was itchy and asked her to check whether she could see anything
irregular. My hair—light brown and very curly—was indeed irregular,
but she could not see any head lice. I was aware that my insistence
might be taken as an accusation that the house or the bed were dirty, so
I scratched in silence for months, until one of my gan haizi finally spot-
ted some lice. Upon a closer look, Erjie saw them, too. The fine-toothed
comb villagers use to tease lice off hair could never work on my curls.
I consulted the neighbor, a young woman to whom I had grown close.
She suggested I should join her for a trip to the city the following day,
where the problem could be solved. We spent hours wandering (aim-
lessly, it seemed) around the city and the vegetable market, and before I
knew it we were back in the township center. I assumed perhaps treat-
ment would be at hand there. But again, we headed back to the village,
with no mention of my lice.
Erjie awaited my return and asked how it had gone. Confused and
somewhat defeated, I told her we had done nothing about my lice. She
smiled and explained that my friend was probably too shy and ashamed
to ask. But a remedy was at hand. Erjie called upon the barefoot vet,
who lived a few meters behind us. He gave her some pills used for pigs’
lice, told her to grind them and mix them with rice liquor, pour this on
my head, and then wrap it for a few hours with a scarf. Retrospectively,
I wonder what high level of anthropological commitment pushed me to
do something that seems potentially so dangerous. Or perhaps I was des-
perate to rid myself of the parasite. I followed their instructions. Barely
an hour later, Erjie declared that some township and city officials had
arrived, unannounced, to treat me to lunch. We stared at each other for
what seemed like an eternity, laughed, and decided I had no choice but
take my improvised turban off and accept the invitation. “Surely—Erjie
mused—you cannot tell them what you were planning to do today?” I

felt slightly drunk and self-conscious from the overpowering smell of
rice liquor my head exuded, but no one commented on it. This epi-
sode taught me not only grassroots strategies for coping with lice (which
were successfully eradicated) but also, more importantly, much about
the boundaries of what can be publicly revealed and discussed and what
needs instead to be shared only with those closest to home. Head lice are
one of the signifiers of a dirty and backward peasant, and they should
therefore be dealt with in secrecy. This need to maintain one’s dignity
impinges clearly on the avenue of action available for treatment. It is
in this atmosphere of ambivalence—about the gap between rich and
poor, stereotypes of peasants as dirty, the shame derived from them,
and strategies to counter them and to make lives better—that this eth-
nography is set.
Cancer and Pollution in China

The Ministry of Health’s Third National Survey on Causes of Death
found cancer rates rising rapidly and implicated cancer in close to a
quarter of all deaths countrywide (Z. Chen 2008). Whereas in urban
China cancer has been the top cause of death since 1987, in rural areas
it increased gradually in the new millennium and became the primary
cause of death in 2006 (Qin and Shi 2007, 2317). Rural areas have
experienced higher mortality rates than urban areas from liver, stom-
ach, esophagus, and cervical cancers (Chen 2008). Janet Larsen, direc-
tor of research for the Earth Policy Institute, writes, “In rural areas,
liver, lung and stomach cancers each account for close to 20 percent of
cancer mortality. Liver cancer is more than three times as likely to kill
a Chinese farmer as the average global citizen; for stomach cancer, rural
Chinese have double the world death rate.” She also notes that, based
on data from the National Bureau of Statistics in 2009, cancer deaths
reached 167.6 and 159.1 per one hundred thousand in urban and rural
areas respectively (2011).
Rising cancer rates are often associated with pollution. The 2007
World Bank Report on the cost of pollution in China estimated three
hundred thousand premature deaths annually as the result of indoor
air pollution and four hundred thousand from outdoor air pollu-
tion—mostly due to lung diseases, cancer, and respiratory problems.
An additional sixty thousand premature deaths were attributed to can-

cers of the digestive system and to diarrhea, all of which are strongly
linked to environmental factors. Environmental risk factors include tra-
ditional risks such as biomass fuel and coal burned for cooking and heat-
ing and lack of access to safe drinking water and sanitation, as well as
modern risks borne by industrialization such as industrial waste, urban
air pollution, occupational exposures, and release of chemical toxins
( J. Zhang et al. 2010). Cancer may be correlated to both these sets of
risks. Epidemiological studies suggest that contaminants such as nitrate,
nitrite (from fertilizers), and chromium (from industry) are major risk
factors for digestive system cancers (stomach, liver, esophagus, and
colorectal). Estimates attribute about 11 percent of digestive cancer
cases to chemical contaminants in drinking water (1115). Conversely,
cancers associated with water pollution, such as liver and stomach can-
cer, are well above the global average.
The phenomenon of cancer villages has often been attributed to
contaminated soil and water, and cancer counties are located mainly
along China’s major rivers. Geographer Lee Liu counted 459 cancer
villages across China, according to official and unofficial reports (2010).
They are clustered in heavily industrialized areas, particularly in the
richer eastern provinces, but they are in relatively poor areas within
those provinces—that is, areas that need investment and are therefore
less strict in enforcing environmental protection. Yet industrial pollution
is not the sole culprit of high cancer incidence. Long-term exposure to
organic pollutants and highly toxic farm chemicals may also be to blame.
According to the World Bank, “The main pollutants are changing from
heavy metals and toxic organic chemicals, which are typically related to
discharge of industrial wastewater, to pollutants from nonpoint sources.
Runoff from agriculture, including pesticides and fertilizers, is the single
greatest contributor to nonpoint-source pollutants” (2007, 34). In some
of rural Langzhong, the Italian NGO ASIA–ONLUS found that the
nitrite content introduced in the water cycle by the proximity of nitro-
gen-fertilized paddy fields to the well was ten times higher than accept-
able values, according to WHO standards as well as Chinese Drinking
Water Guidelines (personal communication, NGO staff ).
Investigations on the health risks of water pollution are ham-
pered by the typical challenges of environmental epidemiology, such
as long latency periods, poor exposure data, chemical mixtures, and
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.
Cancer in Local Context

As figure 2.8 highlights, the incidence of cancers and tumors is nota-
bly high. Baoma villagers are affected by a number of illnesses other
than cancer, and it is possible that the number affected by other illnesses
(such as high blood pressure, heart problems, and diabetes) is an under-
estimate due to the local emphasis on cancer. This is of anthropological
significance in itself. Whereas other health problems such as high blood
pressure tend to be handled erratically, discontinuing medication as
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
Figure 2.8 List of illnesses in fifty families (2003–2007).

ILLNESS M F TOTAL
Cancer1 6 5 11
Rheumatism2 0 6 6
Tumor (not developed into cancer) 1 5 6
Chronic stomachache and poor digestion 1 5 6
Glaucoma 1 4 5
High blood pressure 0 4 4
Mental problems3 2 2 4
Tuberculosis 1 2 3
Chronic headaches 0 3 3
Diabetes 2 1 3
Suicide 2 1 3
Thyroid 0 2 2
Leukemia 1 0 1
Hepatitis 1 0 1
Fatal heart attack 0 1 1
Bone marrow disease 1 0 1
Parkinson’s disease 1 0 1
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.
as equivalent, it is impossible to establish whether the former histori-

cally referred only to cancer or to other illnesses manifested via simi-
lar pathologies of eating. At the same time, the readiness with which
locals attribute inability to eat to cancer—even in cases that have not
been diagnosed as such—shows that the focus on any illness that affects
eating has been extended to cancer. Understanding cancer as affect-
ing eating patterns—one of the most basic human functions but also
a local founding parameter for health—reinforces perceptions of it as a
threat.12 The terms “vomiting” and “spitting illness,” however, have
now been largely supplanted by the category of cancer and are used
descriptively to explain the effects of cancer on the body. The increased
currency of the term “cancer” may well be due to encounters with
medical practitioners who employ this category as much as to its cur-
rency in media reports that attribute it to recent developments and feed
already existing local perceptions of cancer as increasing in the present.
Likewise, all other medical categories employed in figure 2.8 were those
used by villagers themselves.
This book unravels how cancer is experienced locally and analyzes
why it is at the center of attention: because of its effects on eating and
working, the two prominent parameters for assessing health; because
of its perceived links with farm chemicals and current developments by
extension; because it is seen to be caused by negative emotions, which
in turn are precipitated by family conflicts and social change more
broadly; and because of its perceived incurability and devastating finan-
cial impact. Cancer raises questions over individual culpability (e.g., the
sufferer was predisposed to easily lose his temper, or farm chemicals
were used carelessly), but it also presents a context through which family
responsibilities have to be negotiated and the state’s shortfalls in fulfill-
ing its responsibilities toward its citizens are felt most poignantly.
Part 2
Making Sense of Cancer

Chapter 3
Water, Hard Work,

and Farm Chemicals
The Moral Economy of Cancer
Junhong was a striking and independent thirty-year-old woman who

married into Baoma in 1990. She was the seventh of eight children,
and her father died when she was a few years old, leaving the family
in abject poverty. As a consequence, at sixteen Junhong married a man
from Baoma introduced by her eldest sister who had married there ten
years previously. Junhong was very unhappy with her in-laws and her
husband, who was violent toward her and their twelve-year-old daugh-
ter. She delayed divorce only out of fear that her daughter would lose
the support of her father and grandparents, with whom she was living
in Junhong’s absence. By the time Junhong and her youngest sister, Lili,
returned to Baoma in January 2005 to celebrate Chinese New Year, I
had become close to both of their daughters. On January 29, 2005,
I joined Junhong and Lili to visit their mother and brothers in their natal
village of Meishan, roughly fifteen kilometers from Baoma and twelve
kilometers from the county town of Langzhong.
After a steaming hot bowl of noodle soup, we took a walk around
Meishan. We were stopped by a group of locals working to build a bet-
ter village road. Among them was Junhong and Lili’s eldest brother,
Baohua. These farmers/workers explained that one day of work earned
them 10 yuan, but they would never see this money.1 Rather, the credit
earned would gradually offset their debt to local officials for overdue
agricultural and other taxes. While they initially focused their animated
discussion on the low pay for such physically demanding labor, these
workers soon turned to a rather more disturbing issue. As they briefed
the sisters on the latest news in Meishan, a narrative of widespread
92     Making Sense of Cancer
illness began to unfold. Quickly joined by others and spurred by his

younger sisters, Baohua told me that Meishan residents were plagued
by stomach problems and numerous cases of stomach and esophagus
cancer in particular: “It’s only our hamlet; so many people have cancer,
especially of the esophagus, or stomach problems. The village officials
know, but what can they do (tamen guandedao ge sha)? It has been at most
four years. We are not sure why this is happening. But it’s not the air,
because that’s not specific to here. It has to be the water. We need a
reporter to investigate it and to tell our situation. Very many people are
sick.” “Maybe three or four in our hamlet [of 80–90 residents],” inter-
rupted one villager. Another corrected him: “No, more like over ten.
They are all men, all over forty, but it’s hard to say exactly how many;
people don’t want to say, because others get scared and won’t go to see
them—they are scared that they may catch it” ( January 29, 2005).
Where do Langzhong villagers lay the blame for cancer? This and
the following two chapters examine the main factors to which cancer
is attributed and what implications they carry. This chapter in particu-
lar focuses on how Langzhong villagers attempted to make sense of
why cancer seems widespread and why it affects particular individuals.
While it focuses on the specific case of farm chemicals and cancer, it
also raises broader questions surrounding rising forms of “biosociality”
(Rabinow 1996)—the ways in which citizens engage with the local state,
with the market-oriented economy, and with the type of development it
entails. Overall, this chapter illustrates that disputes about cancer cau-
sality and attitudes toward farm chemicals articulate diverse sociologies
and “geographies of blame” (Farmer 1992). Competing cancer etiolo-
gies offer insights into how villagers view collectivism, modernization,
consumerism, and development at large, whether they think the local
and central state are making sufficient efforts to provide for their wel-
fare, or whether they believe the government is able to do so at all.
The chapter is divided into three parts, each of which traces cancer
etiology within the intersecting contexts of the state, the family and local
community, and the moral economy of the market. The first part out-
lines cancer etiology vis-à-vis the state. It provides a brief overview of
farm chemicals in use in China and locally and their effects as potential
contaminants in the local well. It examines Baohua’s attempts to craft
a “biological citizenship” (Petryna 2002) around which villagers would
Water, Hard Work, and Farm Chemicals     93
mobilize. Relating the discussion to relevant literature in the social sci-

ences of environmental health, it provides some of the structural and
political reasons why Baohua’s stress on water pollution and his conse-
quent resort to the media and to the local state failed to gain redress.
Questioning the paradigm according to which the central state has little
control over localities, I argue that conflicting targets issued by the cen-
tral state and shortage of funds are manipulated by local governments
to justify their lack of intervention. I show that although regulations
stipulated the need for a better well, local officials managed to avoid
providing one and still maintained legitimacy by justifying this failure
in financial terms. The local state’s reconfiguration of water pollution
as too common a problem for them to tackle ensured that the issue was
delocalized and undermined its grip as a productive etiology.
The second part of the chapter turns to etiology vis-à-vis the family
and local community to trace further reasons why water pollution did
not serve as a productive or cohesive cancer etiology. It shows that com-
peting etiologies of cancer—based on diverse forms of hard work—
made more sense to locals because they situated sufferers within the
local moral world. This allowed relatives to remember the sufferer as
a moral subject who worked hard and sacrificed their own well-being
for their family. The third part focuses more closely on locals’ ambiva-
lent attitudes about farm chemicals and how these are telling of their
engagement with the market. I argue that blaming cancer on chemically
contaminated food endows locals with a degree of agency in avoiding
cancer by using fewer chemicals on produce intended for home con-
sumption. At the same time, farmers continue to use chemicals for con-
venience and necessity on produce intended for the market.
Through this analysis, I define the contours of a different type of
biological citizenship that does not operate only vis-à-vis the state (as in
Petryna) or on the basis of “scientific” or biomedical evidence but also
on the basis of competing parameters of well-being and welfare based
on personal and social experiences of work and eating. The strategic use
of chemicals embodies and articulates villagers’ attitudes on subsistence
economy and market economy as coexisting moral contexts. Reliance
on the market creates new parameters of well-being based on use of
chemicals, but it also gives new moral significance to those based on a
subsistence ethic and hard work.
Polluted Water and Its Mobilizing Potential

Meishan villagers had at first assumed I was a journalist and, to some
extent, so had Junhong and Lili. Baohua and his younger sisters were
aware that some Chinese villages affected by water pollution (traced
in those cases to local industries) had been described as “cancer vil-
lages” and had received national and global media attention. By blam-
ing a factor as controversial as water pollution, they hoped to attract
similar attention and consequently solve the problem. The opportunity
to involve a reporter, as Baohua had requested, came just over a year
later. In the spring of 2006, a freelance journalist preparing a report
on China’s water pollution for the UK’s Channel 4 television visited
Meishan following my suggestion.2 The local Public Health Bureau,
however, was uncooperative and refused to carry out water tests. One of
the officials interviewed could be heard on the report aired in June 2006
explaining, “We don’t have any illness here, no SARS and no AIDS.”
Despite (or perhaps because of ) the journalist’s failure to identify the
cause of local cancer rates, Baohua remained convinced that the shal-
low well—less than five meters deep, often dry, and in close proximity to
the paddy fields (and therefore chemicals)—was a definite cause of the
high cancer rates.
Baohua’s views resonate with epidemiological theories. Shallow
wells indeed increase the potential for water to be contaminated
from both nearby pigsties and toilets and from farm chemicals. Due
to China’s limited availability of arable land, the government in the
1980s promoted chemical fertilizers and pesticides to increase yields.
Official statistics reported in 2004 indicated that 7 percent of China’s
cropland had been polluted through improper use of farm chemicals.
Agricultural runoff is also a major pollutant of rivers and coastal areas
( Y. Yang 2007). Heavy reliance on farm chemicals (nongyao) and their
effects on health comprise a prevalent topic of debate among villagers
(see also Economy 2004, 85; Sanders 2000; Smil 2004, 2). Opinions
on when exactly the use of farm chemicals became widespread vary,
but most agree that it was approximately in the early to mid-1980s. It
is likely, therefore, that the impact of fertilizers and pesticides on health
would have become fully felt only in the present.
Many different fertilizers and pesticides are available in China.
Those most widely used fertilizers in Langzhong are nitrogen-based
compounds such as ammonium bicarbonate (NH4HCO3), ammonium

sulfate (NH4SO4), urea [CO(NH2)2], and compounds with nitrogen,
phosphorus, and potassium such as N+P2O5+K2O. These are known
as BBfei, or “bulk blending fertilizers.” They are typically administered
in powder form, mixed with ash and compressed rapeseed powder left
over after the production of rapeseed oil, and then spread without any
protective equipment. They can irritate eyes, skin, and the respiratory
system, and they introduce nitrate and nitrites in the water cycle, espe-
cially if wells are not sufficiently deep and far from the fields. When
nitrite enters the bloodstream, it reacts with the hemoglobin and forms a
compound called methemoglobin. This compound reduces the blood’s
capacity to carry oxygen. The oxygen level decreases, and babies show
signs of a disease called methemoglobinemia, also known as “blue baby
disease.” Recent research in China suggests that nitrite nourishes cancer
cells and a reduction of it slows cancer growth (K. Hsu et al. 2007). As
we have seen, nitrites and nitrates are correlated with cancers of the
digestive system ( J. Zhang et al. 2010, 1115). Given that wells in rural
Langzhong are typically shallow, the potential for contamination from
fertilizers is high.
China is the world’s biggest user, producer, and exporter of pesti-
cides. Up to 123,000 people are poisoned by pesticides each year, and
three to five hundred farmers die annually through improper use of
pesticides. “Farmers suffer liver, kidney, nerve and blood problems from
pesticide poisoning, as well as eye problems, headaches, skin effects and
respiratory irritations” ( Y. Yang 2007). Commonly used pesticides in
Langzhong include organophosphate compounds and a great variety
of herbicides, fungicides, and treatments for specific vegetables and spe-
cific diseases. These are usually mixed with water, carried on farmers’
backs in a small plastic tank equipped with a thin rigid hose roughly
one meter in length, and sprayed without wearing masks or protec-
tive gloves. As appendix 2 highlights, pesticides commonly deployed in
Langzhong have a range of adverse health effects, and while none are
categorized as known carcinogens, some are highly toxic and suspected
of being carcinogenic.
Following Baohua’s request, in April 2007 I contacted the county
Center for Disease Control (CDC) and the Public Health Bureau (PHB)
in Langzhong, who agreed to carry out water tests. According to two
epidemiologists I consulted independently in the UK and in China, the
list of contaminants tested was comprehensive and typical of a stan-

dard water test, and there were no obvious omissions of pollutants one
might expect from farm chemicals. As he handed me the test results, my
contact at the CDC commented, “This water is no good” (Zhe ge shui
yaobude). The only irregular values in the test were iron and manganese
content (possibly linked to pesticide use), which at 2.43 and 0.47 mg/L
were respectively eight and five times higher than acceptable values,
according to Chinese Drinking Water Guidelines. While neither of
these substances has been conclusively categorized as a carcinogen,
some studies suggest a potential correlation. As noted by the Agency for
Toxic Substances and Disease Registry, “There are no human cancer
data available for manganese. Exposure to high levels of manganese in
food resulted in a slightly increased incidence of pancreatic tumors in
male rats and thyroid tumors in male and female mice” (2001). Through
a review of existing studies, Richard Nelson (2001) found an associa-
tion between iron and cancer risk in approximately three-quarters of
the studies (see also Stevens et al. 1994). The results did not show high
levels of cadmium or arsenic (known carcinogens) nor any significant
contamination by ammonia or nitrate (which at 4.12 mg/L was well
below the maximum acceptable value of 20 mg/L, according to the
CDC and PHB). I found the absence of high levels of nitrates puzzling,
given that the well is situated immediately adjacent to paddy fields and
that fertilizers are applied intensively in March–April, when the tests
were carried out. While at the time I had no reason to suspect that test
results might have been tampered, I have since wondered whether they
are reliable after all.
The water tests could not indisputably link water to cancer (they
rarely if ever do), but they did confirm that the water was “not safe
for drinking” and that the well did not comply with CDC regulations,
according to which wells ought to be “at least fifty meters from the near-
est toilet” (interviews with CDC staff, April 5, 2007). Nevertheless, this
did not automatically ensure the provision of a more adequate well.
Well digging is the responsibility of the Water and Electricity Bureau,
which according to 2007 budgets had only enough funds to dig one well
per township per year, had already spent its resources, and was more
concerned with more mountainous villages where water is even scarcer.
My contacts at the Public Health Bureau suggested I use my connec-
tions with the city’s former deputy mayor to urge the Water Bureau to
cooperate. Unfortunately, his contact in that bureau had since moved on

and was unable to intervene.
Baohua’s engagement with the anthropologist, the media, and
with county officials embodied attempts to lay claims to a communal
“biological citizenship” based on tracing locally high rates of cancer
to water. Adriana Petryna, in her study of Chernobyl victims in post-
Soviet Ukraine, defines “biological citizenship” as “a massive demand
for but selective access to a form of social welfare based on medical,
scientific and legal criteria that both acknowledge biological injury and
compensate for it” (2002, 6; see also Rose and Novas 2005). She argues
that claiming to be a victim of radiation has become a very important
way to make money in the new market economy; illness has become a
type of work (see also Kirsch 2006). Similarly, Baohua drew a parallel
between water and cancer in the hope of constituting the problem as
a biopolitical one, central to state legitimacy, and one around which
the local community could mobilize. Focusing on water provision high-
lighted that “the biology of citizens [is] a contested part of political
processes” (Petryna 2002, 21).
Social studies of environmental health have highlighted the social
and political implications of attributing cancer to lifestyle choices and
genetic predisposition rather than environmental factors. While a med-
ical student textbook claims as much as 90 percent of all forms of
cancer are attributable to specific environmental factors, a brochure
produced by the U.S. Department of Health and Human Services states
that “about 80 percent of cancer cases are tied to the way people live
their lives” (Steingraber 1999, 24–25). Such different ideas of blame
imply diverse strategies for action. While the brochure urges people
to protect themselves from cancer by changing their lifestyle, the text-
book concludes that the incidence of cancer could be reduced dramati-
cally by limiting or eliminating exposure to environmental carcinogens.
When behavior is held as chiefly responsible, collective agency around
harm caused by pollution is silenced and corporate responsibility for
controlling environmental factors remains beyond discussion (Brown
2007). This masks environmental injustices such as unequal expo-
sure to pollution for the poorer and racially discriminated segments
of the population (Bullard 2005; Wright 2005), leaving unquestioned
the unequal social order on which industry and financial gain depend
(Hofrichter 2000).
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.
Structural Challenges to Politicizing Water

Reference to the wider context of environmental health governance
may elucidate some of the obstacles to providing a better environment
and health and why water failed to work as a trigger to action, even after
it was recognized as polluted. Although China since the late 1970s has
developed an impressive body of environmental protection policies and
legislation, these policies and laws are often not enforced locally (Beyer
2006; Economy 2005; Rooij 2006). In response, starting in the mid-
1990s, the central government has gradually been reforming the admin-
istrative system and raising the bureaucratic rank and clout of the State
Environmental Protection Administration (SEPA) to that of a ministry.
NGOs, the media, and the wider public alike have been encouraged to
promote awareness of environmental issues, report incidents of pollu-
tion, and challenge polluting industries in the courts.3
These efforts may be understood as a legitimization of what Kevin
O’Brien and Lianjiang Li have called “rightful resistance” (2006)—that
is, people’s appropriation of the central state’s regulations and rhetoric
that give them the right to complain and protest against breaches of
the law and failure to implement policy. This strategy assumes a clear
antagonism between a benevolent center producing enforceable policies
and local officials working purely in their own personal interests, caring
little about local people’s welfare. In addition, it still assumes (and hopes
to exploit) a residual revolutionary righteousness and fervor among the

masses. This strategy ultimately ensures that central policies themselves
remain beyond scrutiny, thus reinforcing the state’s legitimacy (see Edin
2003; Pieke 2009). Whether central policies are feasible or even desir-
able at the local level is often left out of the discussion.
First of all, as has been pointed out in the literature, structural rea-
sons exist why local officials fail to prioritize environmental protection.
Economic performance is given primacy in the formal performance
evaluation of cadres (Ho 1994; Whiting 2000, quoted in Edin 2003, 36).
Scholars of the Chinese state have shown that the capacity to monitor
local officials has not declined during the period of reform (Edin 2003;
Pieke 2004). Rather, the clashing targets put forward by the central
state itself pose a challenge to local cadres’ ability to implement central
directives. The tension between environmental protection and eco-
nomic targets is one example of this, although since 1996 officials are
barred from promotion for five years if they fail to meet environmental
protection targets for three consecutive years (Lo and Tang 2006). An
equally problematic tension lies between the political target of social
order—which, according to Edin (2003, 36), is even more important to
cadre evaluation than economic targets—and the emphasis on public
participation as part of environmental protection. If public participa-
tion sometimes amounts to local protests that in turn undermine the
target of social order, it is predictable that local cadres would be less
than keen to encourage such participation.4
The financial conditions in which localities often find themselves
also continue to pose obstacles. The recent abolition of the agricultural
tax has succeeded in appeasing villagers and increasing trust in the cen-
tral government, but, county and lower officials argued, it has also put
even further strain on their capacity to respond to local needs, which
in turn undermines stability. Shortages both in staff numbers and in
financial resources in the county, township, and village governments
have produced some clear structural challenges to environmental and
health protection. Officials at the county Center for Disease Control
defended their colleagues at the Water Bureau, stating that there were
only enough resources to dig one well per township per year. Each town-
ship of an average size might have at least three hundred wells, many of
them in violation of the noted CDC regulation about being at least fifty
meters from the nearest toilet (interviews with CDC staff, April 2007).
The provision of a healthy environment for citizens is a vital source

of state legitimacy. Yet legitimacy may be secured by local officials at
the expense of higher levels of the state (or vice versa) by playing one
target (provision of a safe environment) off against another (preserv-
ing financial resources) and by retaining ambiguity over who ultimately
is held accountable. Officials at the Center for Disease Control read-
ily agreed with Baohua that the village water was “not good.” Had it
been their responsibility to act directly on this knowledge, they may not
have been so keen to identify water pollution as a problem. But lack
of funds served to place them beyond blame. This condition may be
defined through the concept of “state of exception.” In his work Homo
Sacer: Sovereign Power and Bare Life, philosopher Giorgio Agamben (1998)
explains that during a state of exception, the sovereign gains power
by suspending existing laws without abrogating them. Paradoxically,
Agamben argues, it is this suspension that provides the law with its legit-
imacy and the political authority who declares the state of exception
with its power, derived from being outside of the law but also belonging
to it. While Agamben applies his concept to states of war, scholars have
recently used it in a broader variety of contexts. Matthew Kohrman, for
instance, employs Agamben’s state of exception to make sense of why
Chinese people do not hold the state accountable for illnesses induced
by smoking, when they are aware of the ways in which the state pro-
motes tobacco production as a form of development and revenue. He
argues that such a state of exception is sustained by “highly gendered
notions of the good life [which] have been interacting with embodied
memories to defang, defuse and demobilize the anger that might other-
wise arise from tobacco-related death” (2007, 90). Where in Kohrman’s
case competing discourses of life depoliticize the state of exception, in
my case contending perceptions of health and cancer etiology hindered
Baohua’s attempts to mobilize his neighbors around water pollution
and sustained a state of exception that made it acceptable for the state
not to provide cleaner water.
In Meishan, the rule mandating that wells need to be fifty meters
from the nearest toilet was suspended, but by attributing this suspension
to lack of funds, local officials were able to maintain legitimacy. The
absence of funds at the Water Bureau created a state of exception in
which recognizing that the water was polluted suited the CDC officials:
it served to placate villagers by presenting the problem as very simple
(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.
Competing Cancer Etiologies: Hard Work

and Farm Chemicals
A clear obstacle to Baohua’s efforts was that other villagers did not
always agree with him. Water had to compete with other widely rec-
ognized potential causes of cancer, such as (1) farm chemicals (not as
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
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).
is not privatized or individualized, but it is valorized by their family and

community. When Langzhong villagers trace cancer to hard work, they
similarly draw on a popular version of well-established Chinese medical
theories. Like their Lijiang counterparts, sufferers in rural Langzhong
are also seen to have sacrificed their health for the benefit of their fam-
ily and (during collectivism) the local community. But the etiology of
hard work in this setting was applied equally to men (this chapter) and
to women (see chapter 4).
If having endured hard work was seen as a possible cause of can-
cer, the ability to undertake it was typically upheld as the standard for
health. The Baoma village doctor commented, “Now people relax too
much—that is why they get so much more rheumatism,” implying work
and health are equivalent ( July 5, 2005). Conversely, the doctor con-
tinued, “People only come to me if they can’t work anymore. If they
can eat and walk, they won’t come.” When her sixty-year-old husband
died of cancer, Aunt Zhang observed, “He could have worked for ten
more years.” It was widely held by villagers (including the village doctor)
that only strong and healthy people who could work hard get cancer.
Conversely, in recalling those who succumbed to cancer, it was com-
mon to refer to their hardship (xinku), having “eaten bitterness” (chiku,
an idiom to express hardship), or having had a “bitter life” (ku ming).
A woman in her later thirties, for instance, described how her father
“worked hard, had a bitter life, and then he developed esophagus can-
cer and died in his fifties” (August 16, 2005).
This particular intersection between ability to work hard as a sign
of health and enduring hard work as a cause of cancer takes on differ-
ent connotations when it is presented as part of a wider ethics of col-
lective work and when it is part of the reform ethic of working hard to
earn money. While both young and old see physical strain as a possible
cause of cancer, their motivations for doing so differ, as do their respec-
tive implications. Those who lived through collectivism are proud of
their hard physical labor in the collectives, through which they secured
their family’s livelihood. I propose that, for the older generation, the
perception of hard work as harmful reinforces its value by bolstering
the moral standing of individuals who are prepared to forego their own
well-being for the wider good. Remembering physical hardship during
the collectives as so extreme that it may have precipitated cancer later
in life articulates an elision of health and harm for the family’s and
community’s welfare. Hard work was necessary—and for this reason

praised and seen as a sign of health—but also harmful. For the genera-
tion who lived through Maoism, then, blaming cancer on hard work
in the collectives at once highlights the sufferers’ selfless contribution
but also denounces the necessity of such a sacrifice. In attributing their
husbands’ cancers to past efforts for the collective good, these widows
also critiqued the past moral economy that required such individual
sacrifices. This allowed them to make sense of their husbands’ deaths
in ways that water pollution could not. Water pollution was simply
not specific enough to explain why their husbands and not others had
developed cancer.
The willingness to work hard is commonly praised as a defining
feature of caring, morally upright individuals. Working hard conveys
love for the family, for a partner, and possibly for the collective good
(Potter and Potter 1990). Accordingly, attributing cancer to particularly
wearing and harmful activities necessary for family and village subsis-
tence implies that the deceased had adequately cared for their relatives,
ultimately sacrificing their physical well-being for the welfare of their
families. Libbet Crandon-Malamud (1991) argued, in the Bolivian con-
text, that negotiations surrounding social status, class, and ethnic iden-
tity overrode actual beliefs informing therapeutic choice. Attributing
illness to the neglect of ancestral spirits, to biomedically based causes,
or to insufficient faith in the Christian Methodist God enabled differ-
ent sets of social relations and produced diverse social identities. In the
Langzhong case, tracing cancer to hard work served to constitute suffer-
ers as moral subjects. Recently bereaved, widows searched for explana-
tions that would help them to attribute their husbands’ illness and death
to acts of care during their lifetime.5 Reference to hard work also served
as a moral commentary on neighbors who were seen to have partici-
pated less in communal efforts such as building the local irrigation pool
and potentially on relatives who had contributed less to the welfare of
the family. It situated cancer firmly within a broader understanding of
what was at stake in working for the collective.
The younger generations who have not experienced collectivism did
not feel the same sense of pride in physically hard work, but they shared
their older neighbors’ view of it as harmful. Aware that less strenuous
alternatives for making a living are available to those with better social
networks and education (who, more often than not, are city residents),
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
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
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.
Farm Chemicals in Food: Reclaiming Agency

and Avoiding Cancer
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:
Their water should be fine—it’s mountain water; the water here in

Baoma [where hills are less steep] is much worse, it is ground water;
theirs in Meishan should be the best kind. We can’t blame the water.
It is the farm chemicals; they use too much, but if you don’t there is
nothing left. I farm rice and maize; I know, if you don’t use chemicals
they won’t even sprout out of the ground, you won’t get a harvest. . . .
It’s not the water. We need to look at every aspect. It’s the food; it has
all these chemicals, and slowly people who eat it get sick. And once
they do they cannot cure it. (March 24, 2007)
Her statement also implies a rejection of her brother’s resort to officials.

As she explained, “Local officials do not have that knowledge, they do
not understand. They can see you get sick; they don’t know how to
research this” (March 24, 2007).
By lifting the burden of responsibility from the local state, Baohua’s
elder sister shifted such burden onto individual farmers and the market
economy of which they are part. But endowing them with responsibility
also highlighted their potential for intervention. Indeed, farmers may
not single-handedly be in a position to request and afford water tests
or dig deeper wells, but they can, and they do, minimize the amount
of chemicals used on food intended for home consumption. They

claimed they had to use these substances in the paddy fields or rice
would not grow, but on their hillside allotments they limited the use of
farm chemicals to cash crops. Some of these strategies for minimizing
chemical contamination were not fully successful or feasible. Sometimes
overproduction or inability to sell entails home consumption of crops
originally intended for the market—and therefore sprayed with chemi-
cals. Also, given that plots are close to each other, if chemicals are used
on cash crops in the neighboring plot, one’s own vegetables are clearly
less than organic. Yet, regardless of whether these attempts succeeded,
they embody an active engagement with what is perceived as harmful
and express negative views on chemicals and the market economy that
required them.
This perception of farm chemicals and their discriminate use inter-
sects with many common local practices. When I joined local families
for a meal, they often would reassure me that there were no farm chemi-
cals on the food, as it was all farmed for home consumption. Villagers
and city dwellers alike stated that dietary variety was greater in the city,
but that the food consumed in the countryside was fresher and tastier.
Migrant workers usually start out their journeys with oil, peanuts, rice,
and preserved meat from home. This is not simply justified in financial
terms but also in terms of quality: food from one’s own farm “tastes
better.” Returned migrants reinforced this perception with stories of
discolored pork and tasteless food purchased while away. When I left
China in September 2005, local families presented me with thirty kilo-
grams of their peanuts (which they noticed I enjoyed), twenty liters of
village-processed rapeseed oil, and fifteen liters of local vinegar, both
basic cooking ingredients. As they explained, they were concerned that
I might not adjust to what they assumed beyond doubt to be the less-
than-tasty food of urban Britain.
Villagers’ perception of their own food as tastier and healthier may
not be simplistically bracketed as a rejection of market foods, such as
milk powder, on financial grounds. These attitudes intersect with a
more general rejection of food that is not home grown (see Ohnuki-
Tierney 1993). For instance, such recurrent skepticism also applied to
pork purchased on the market (as opposed to pork from the family-bred
pigs), because villagers were acutely aware that pigs may be fed geneti-
cally modified (GM) foods, as in fact they often did themselves with pigs
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
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
benefits of increased production and decreased physically demand-

ing work—characterized as part of development—are too recent to be
rejected with the same force as in postindustrial France. Where France
has reached the moment of post-scarcity with its embedded problems
of loss of food quality and romantic idealization of the agricultural past,
in rural China scarcity is still too fresh in villagers’ memories, fomenting
heightened perceptions of the benefits of chemicals.
For French farmers and activists, Heller argues, ultimately the oppo-
sition is not between GM and organic food but rather between local
and global/noncultural food. These oppositions intersect in Langzhong
villagers’ attitudes on food and health, themselves mapped onto expe-
riences of home and migrant labor in the richer coastal regions.
Chemicals are central to defining the shifting boundary between home-
grown food and market food—shifting insofar as some homegrown food
is intended for the market. And yet, in themselves they are not regarded
as an outside element invading and spoiling traditional ways of life but
rather central to developing production at home. Langzhong farmers
do not propose a return to an idealized natural or organic past but a
strategic appropriation of chemicals when needed for produce to be
sold and a limited use of them on produce for home consumption, aim-
ing to take advantage of the market logic without compromising their
health.10 As their main means of livelihood, farming produce needs to
be competitive in a market that demands “good-looking” food. For this
reason, farmers feel they have no choice but to resort to heavy use of
pesticides for their urban-market destined produce. This seemingly ethi-
cally questionable practice can be understood as part of a moral econ-
omy in which farmers’ own sense of second-class citizenship and lack
of connectedness to at least some of their urban compatriots intersects
with inefficient regulation of food safety and the lack of state welfare
and other opportunities for making ends meet for those unable to join
the flow of young migrants.
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
legitimacy is maintained by referring to lack of capacity. Of equal

importance, other definitions of well-being, beyond the legal param-
eters, need to be considered to understand why villagers did not more
widely mobilize around water. In his work on environmental protests in
rural China, Jun Jing argues that the realization that pollution causes
illness and the decision to take action can take place only when they
resonate “with a society’s value system and its symbolic manifestation”
(2003, 212). This explains why Baohua failed to mobilize the local com-
munity through water: alternative frameworks for understanding can-
cer causality undermined water as a potential etiology. The competing
etiologies of hard work and contaminated food form part of moral dis-
courses that are more in tune with villagers’ experiences and therefore
have more mileage for making sense of cancer.
These etiologies mold an emerging “biosociality” (Rabinow 1996,
99), a form of identification that in this case is clustered around an
unevenly shared, embodied history of hard work, as well as recent
attempts to avoid chemical damage to health while reaping the ben-
efits of development. The social and economic transition from collec-
tivism to a market economy has triggered changes in the definition of
hard work. The older generation remains proud of their physical hard-
ship but at the same time considers it harmful. By attributing cancer
to excessive physical strain during the collectives, villagers lament the
inadequacies of the past. But as hard work has expanded to include new
forms of hardship such as migrant work and working with chemicals,
young and old express their ambivalence toward the demands of the
present as much as those of the past. In doing so, villagers are not con-
trasting an immoral present with a more just past but rather highlight-
ing their efforts to meet the requirements of both collectivism and the
market economy. By explaining their husbands’ deaths as a result of a
hard work that encapsulated both the past parameter of physical strain
and the more recent one of chemical exposure, widows in Meishan
stressed their husbands’ contributions to a shifting moral economy of
work. By being conceived as a result of hard work, cancer is experi-
enced as a biosocial realm of embodiment based on shared suffering
in the past and in the present. Cancer etiology is both a product and
a producer of the local moral world: it is premised upon the need for
certain types of potentially harmful hard work, while also reinforcing
the value of that work.
The complex moral universe of cancer etiology may be unpacked

through a revised concept of biological citizenship that encompasses
competing definitions of well-being and morality based on hard work
and on diet.11 Nikolas Rose and Carlos Novas adapt Petryna’s concept
of biological citizenship as mainly based on demands for state compen-
sation, broadening it to a “biological sense of identification and affili-
ation [that] made certain kinds of ethical demands possible: demands
on oneself, on one’s kin, community, and society; on those who exer-
cised authority” (2005, 441). They highlight that citizenship is not
only made up from above, and that unlike in postcommunist countries
where demands are made on the state, in their cases, “novel practices
of biological choice are taking place within a ‘regime of the self ’ as a
prudent and yet enterprising individual, actively shaping his or her life
course through acts of choice” (458). In the case of Langzhong villag-
ers’ experiences of and engagements with cancer, these two dimensions
converge. Some, like Baohua, made demands on the state to provide
a healthier environment, while all made active attempts to maintain
health, through everyday practices such as limiting the use of chemi-
cals. Indeed, regimes of the self are by no means the prerogative of
advanced liberal democracies. Langzhong villagers took an active role
in shaping risk and saw their role as active, whether by avoiding chemi-
cals or by asserting that polluted water causes cancer. They did not treat
their biological life as ruled by destiny but rather acted to shape it.
More crucially, the distinction between individualized and com-
munal or top-down and bottom-up definitions of biological citizenship
becomes blurred when we consider that the etiology of hard work high-
lights individual efforts but also embodies its value within a moral and
political economy that requires such efforts. Similarly, practices such as
limiting chemical use are aimed at individual and family welfare, but
they also articulate a critique of the current market economy. Indeed,
the perception of farm chemicals as necessary to compete in the mar-
ket traces culpability beyond individual farmers to the market economy
that requires their use. This final etiology—contaminated food— shows
with particular clarity how villagers experience the current moral econ-
omy and their strategic relation to it. The sharp rise in the cost of living
increases the need for migrant labor to supplement agricultural income
and in turn strengthens reliance on chemicals to lighten the workload
for those left behind. In this context, chemicals are celebrated for the
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
Gendered Hardship, Emotions,

and the Ambiguity of Blame
In the afternoon of November 1, 2007, I returned to Baoma. I had

arrived in Langzhong the previous evening on a fleeting visit after a
conference in Beijing. I had not been there since April and was keen
to meet my friends and gan haizi (or “dry” children), and to see what
effects the efforts to build a “new socialist countryside” had had on
the village. When I visited in 2006, two of my former neighbors had
died—Aunt Li of a stroke, Grandma Chen by drinking pesticides after
she was diagnosed with stomach cancer—and I was hoping to avoid
a repeat performance. The sun was shining and a fresh breeze blew
across the fields as villagers patiently administered farm chemicals and
planted wheat. Aunt Guo called me over to the irrigation ditch, which
had barely a few inches of water. As she squatted by the water, washing
the tank she had just used to spray pesticides, we pondered over the
brand new though unfinished houses built along the road in an effort to
ease transport and communications. Her neighbor joined our gather-
ing, while she emptied a basketful of radishes into the same spot in the
ditch and began to wash them. A taxi drove to the end of the village
road, and two passengers got out and walked across the paddies to a
cluster of houses a little farther down. In 2007, taxis remained a rare
sight in Baoma. Few taxi drivers ever agree to descend from the hilltop,
afraid that the bumpy road might damage their means of livelihood,
unless they are trying to extract a few more yuan from their customers.
I perceived this as a bad omen. The only occasions when taxis ventured
to the lower reaches of Baoma were for weddings, serious illnesses, and
funerals. I knew there were no young villagers of marriageable age
in those houses. I looked across to the two women, who like me had
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
him to develop esophagus cancer, of which he died in the early 1990s.

She had commented, “Of course, he was irritated and resentful—peo-
ple like that get cancer” ( June 30, 2005).
Since the mid-1980s, Aunt Liu’s husband had developed heart and
lung problems, rendering him unfit for work and requiring him to be
hospitalized every year. He died of pulmonary heart disease in 1997 at
the age of forty-eight. Her husband’s and father-in-law’s illnesses had
impoverished the family, as well as taken their toll on Aunt Liu’s health,
and she was forced to bear the agricultural burden alone. Since 2000,
she had also cared for her granddaughter (whose parents lived and
worked in Chongqing) and for her nephew, after her brother’s divorce.
She felt the poor state of her house and her swollen eyes (due to thyroid)
attracted the contempt of other villagers.
How is the connection between cancer and negative emotions such
as anxiety, anger, and repressed anger experienced and perceived?
What role do these emotions play in the discourse on blame and respon-
sibility? How do they intersect with gender and family relations? This
chapter continues to examine the interface between morality and can-
cer causality by focusing on women’s particular experience of hardship,
unfulfilled gendered expectations, and emotions as interrelated causes
of cancer. It examines the implications of these etiologies for gender,
family, and social relations and their effects. First, the chapter furthers
the investigation of hard work as a cause of cancer, turning specifically
to women’s perceptions of their hard work in the past and in the pres-
ent. This is situated vis-à-vis a discussion in the existing literature on the
effects of policy and political economic change during Mao and since
reforms on gender relations, gender equality, and women’s lives at large.
The chapter then turns to the perceived role of emotions in can-
cer etiology. Susan Sontag has argued that psychological explanations
for disease, such as linking cancer to emotions, present an attempt to
provide control over uncontrollable experiences: “Psychological under-
standing undermines the ‘reality’ of a disease” (1991, 56). Yet attributing
cancer to emotions has no such connotations in China, where emotions
are seen as very real, physical states. In their study of emotions, Lutz
and Abu-Lughod propose to view emotions “as about social life rather
than internal states” and to focus on their links with “issues of sociabil-
ity and power—in short with the politics of everyday life” (1990, 12).1
I stress that these two aspects (emotions’ effects on the body and their
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).
Transformed circumstances during reforms have had a mixed impact

on gender relations and on the gendered division of labor. As the rural
labor surplus pushed men to migrate to urban areas and work in fac-
tories, they were prevented from exercising day-to-day dominance,
and women were left to work in agriculture or to establish specialized
households. Women made major contributions to the productive work
of their community—in public workplaces, in household sidelines and
enterprises, and caring for the ill and the aged. Ellen Judd’s research in
three villages in north China has shown that household enterprises pro-
vided favorable conditions for mature women, as they could effectively
manage local commerce and run small shops within their home villages
(1994, 248).
According to Confucian ideals, women are confined to the domes-
tic domain of nei (inside) while men may work and interact beyond the
home and the village in the broader domain of wai (outside). This had
already begun to be challenged during Mao, as women were drawn
beyond reproduction for the family into production for the collective.
For Tamara Jacka, reforms stretched the boundaries of nei to include
work in the fields, yet they left the hierarchy between nei and wai unques-
tioned, and women’s work is still assigned a lower value than that of men
(1997). Indeed, the common feminization of agriculture left women in
an undercapitalized sector with low returns on labor (Croll 1983; Davin
1988; Jacka 1997; Judd 1994). Rural industry was equally asymmetrical,
as women had access only to relatively unskilled, dead-end work and
rarely held positions of responsibility. Gender asymmetry and “andro-
centry,” claims Judd, have not been openly perpetuated, but neither
have they been erased by the collective period or by decollectivization
(1994, 244–245). Rather, they have been “reinforced by the congru-
ence between state and familiar asymmetries” (248). Overall, “women
have not benefited from the reforms to the same extent as men, and
the reforms have not led to an improvement in rural women’s position,
either within the family or in the wider community” ( Jacka 1997, 190).
The previous chapter has shown why hard work was seen to be a
cause of cancer for two men in Meishan and with what effects. Here I
turn to examine the ways in which hard work and hardship more broadly
are considered to cause cancer in women, although their boundaries
and undertones are somewhat different. Collectivism is remembered
as having required hard physical labor from both men and women.
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
neighbor. Already in 2004, villagers young and old spoke of Grandma

Chen as a woman who had a particularly tough life. After her death,
they related her cancer to the hardship she endured because of her
husband’s disregard toward his family and her having to shoulder the
work burden alone. Aunt Cao, the wife of one of Baoma’s two barefoot
vets, may serve as a further example. She had single-handedly farmed
to sustain her four children since the 1960s. When she became weak
and unable to eat in 2008, villagers reasoned that someone who had
had such a strenuous life would probably develop cancer. (She was diag-
nosed instead with heart disease and later recovered.) Aunt Liu’s case,
described in this chapter’s opening, is also testimony to the perceived
connection between women’s physical strain and cancer. She connected
her husband’s employment as a teacher since the mid-1970s and his
subsequent illness with her own poor health. Likewise, after Aunt Liu’s
death, her neighbors described her having to carry out all the farmwork
alone as a main cause of hardship that led to the development of cancer.
These women were regarded as subjected to particular hardship
because during collectivism it was less common for men to be exempted
from farming. In their case, however, as their husbands held other occu-
pations, they shouldered most of the farm work. Abundant literature
has shown that reforms have exacerbated such agricultural burdens on
women (Bossen 2002; Croll 1983; Davin 1988; Jacka 1997; Judd 1994).
In rural Langzhong, the effects were evidently harshest on women in
their fifties and older. Often, the same women whose husbands were
absent from agriculture during collectivism found that pattern worsened
by reforms, as not only their husbands but their sons and daughters-in-
law migrated in search of wage labor to face the rising living costs. In
some cases, these middle-aged women shoulder the farmwork alone,
because daughters-in-law who may otherwise have been at home have
left their husbands and moved elsewhere, unwilling to tolerate constant
arguments and (in some cases) physical violence from their husbands,
as well as mistreatment by their in-laws. This was the case for the bare-
foot vet’s wife, Aunt Cao. Her elder son had left Baoma in search of
work, her husband continued to practice as a vet as did her younger son,
and she farmed seven people’s allocation of land while caring for four
grandchildren (the children of her two sons and her two daughters). By
early 2005, both her daughters-in-law ( Junhong, discussed in chapter 3,
was one of them), however, had left their husbands and suspended all
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
had minimized her mother-in-law’s ability to control and affect her by

separating her household from that of her in-laws ( fen jia). She saw this
as “very simple reasoning: you are not good to me, I am not good to
you” (a frequent statement). By challenging the authority of their hus-
bands and in-laws, these younger women also produced a competing
moral order whereby it was acceptable to do so.
Resisting abuse by in-laws is one way in which young women like
Erjie differentiated themselves from the older generation. Control over
their husbands was another. Yunxiang Yan (2003) has argued that the
conjugal relation (between husband and wife) has now become more
important than that between the young couple and the older genera-
tion. Yet the local trope to describe husbands in Langzhong was not
so much about solidarity between partners but about women’s power
over their husbands. Young women recurrently joked that all young
men now have “soft ears” ( pa erduo), a common expression that refers
to the relationship between husband and wife and identifies husbands
as scared of their wives and effectively managed by them. This was as
much a comment on men’s relative submissiveness as on the fierceness
and resilience of young wives, who now have more freedom and more
opportunities for financial independence, and demand more authori-
tatively that their husbands should not waste money and have affairs.
The same trope was also common in the nearby city, though villagers
argued that urbanites were more likely to have extramarital affairs. A
city friend by the surname Li, well known for his strong singing voice,
was nicknamed “pa erduo Li ” (a phonetic rendering of the famous tenor
Pavarotti) because his wife had a tight hold on his spare time and for-
bade him from visiting karaoke bars—notorious venues for men to meet
girlfriends. Having spent several evenings at karaoke bars, I can confirm
that many men (including him) indeed had girlfriends. The converse,
however, was also true: wives also had extramarital affairs. Villagers rea-
soned that urbanites, both men and women, simply had more oppor-
tunities and more resources to sustain such relationships, and that in a
village they would be hard to conceal. By contrast, young rural women
presented themselves as strict toward their husbands and argued that
their husbands had “softer ears” than their urban counterparts. Such
contentions, I would argue, are part of these women’s efforts to ensure
a stable family life, unencumbered by extramarital affairs and expendi-
tures beyond the family.
In tracing women’s cancer to hardship during the collective period,

villagers critiqued its heavy demands on women’s bodies, especially on
those whose husbands were not at hand to offer help. By including vio-
lence and mistreatment by husbands and in-laws in such potentially car-
cinogenic hardship, older women reflected on their plight and younger
women refused to endure the same oppression. Changes under reforms,
however, were not regarded as an improvement by all. While opportuni-
ties to earn money increased younger women’s independence, they left
older women in charge of the physical work. If physical labor for some
was unfairly shared during collectivism, it became even more so during
reforms. When these older women who bore the physical burden of
labor during collectives and in their aftermaths developed cancer, their
suffering was linked just as much to their present as to their past. The
moral economy of the two periods differed in the opportunities open to
the younger generation, but reforms left those older in charge of farm-
ing, just they had been when they were younger. Ideas of what counts as
acceptable moral behavior have begun to shift, as the younger genera-
tion resorts to divorce when relationships with partners and with in-laws
become unbearable. But villagers by and large have all but accepted this
behavior. The physical strain it causes, to older women in particular, is
one reason. As we shall see, however, divorce is also seen as the latest
form of abomination toward gender and family relations (with not pro-
ducing a son as a predecessor, as Aunt Liu’s case shows), causing such
negative emotions for family members who do not accept it that they
develop cancer. It is to this connection between negative emotions and
cancer that I now turn.
Emotions and Illness in the Chinese Context

Villagers very often discussed hardship and family conflicts in par-
ticular as causes of worry, which in turn precipitated various kinds of
common illnesses, ranging from headaches to poor digestion and chest
pains (White 1993, 1997).2 For instance, Aunt Liu perceived a strong
link between her generally poor health and the anxiety and repressed
anger caused by having endured scorn by her father-in-law, the death of
her husband, and more recently caring for two young children. Three
middle-aged women claimed to have suffered from tension and distress
(zhaoji, xinfan) since their respective daughters-in-law had run away and
never returned, leaving husband and child behind. A thirty-three-year-

old woman attributed her chronic headaches to her loud and distressed
mother-in-law, who was prone to shouting—at her but also at other
members of the family—on a daily basis. Her mother-in-law also com-
plained of poor digestion and general tension, as she had to care for her
elderly parents-in-law (in their nineties) and her granddaughter, and she
worried that her son from a previous marriage was still single and had
nowhere to live. (Her first husband, like Aunt Liu’s, was also a teacher
and died of cancer at the age of forty.)
The very way in which emotions are seen in relation to the body
partly explains why they are thought to be potential causes of illness. Qi
(literally, “air” or “breath”) is central to understanding this connection
between emotions, the body, and illness. Indeed, the English expression
“to get angry” may be translated as shengqi (literally, “generate breath”)
or fa piqi (“release spleen air or breath”). Repressed anger and sulkiness
may be rendered as ouqi (irritated and repressed qi). Villagers described
qi dysfunctions and emotions such as repressed anger as having physical
effects. They spoke of discomfort in the chest or stomach as qi huo bing
(literally, “illness [due to] fiery vapor”) and explained that it was due to
a propensity to get angry.3 My host Erjie, for instance, illustrated the
effects of anger and tension on the body as follows:
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)
Not unlike lay perceptions of well-being, Chinese medical theories

hold qi to be of central importance to health.4 Qi may be understood
loosely as “air, breath, vapor and other pneumatic stuff, which perme-
ates and constitutes the universe.”5 At the same time, it also refers to
“the balanced and ordered vitalities or energies” (Sivin 1987, 47). Qi is
generally thought to follow regular cycles of activity, and its transforma-

tions may be understood in terms of yin and yang and of wu xing, which
are not chemical substances but rather “five labels” (52). Imbalance in
the cycles of qi is seen to cause illness. To remain healthy, therefore,
individuals need to be responsive to cyclic changes in the environment
(e.g., seasonal changes) and behave accordingly. Similarly, the idea that
excessive emotions affect qi functions, upset the balance that ensures
health, and thereby cause illness is well recognized by Chinese medical
theories (Sivin 1995). The seminal medical text Huangdi Neijing Suwen
(The Yellow Emperor’s Inner Canon, Simple Questions) explains:
“Anger makes the qi rise, joy relaxes it, sorrow dissipates it, fear makes
it go down, cold contracts it, heat makes it leak out, fright makes its
motion chaotic, exhaustion consumes it, worry congeals it” (quoted in
Sivin 1995, 2).
In his study of Patients and Healers in the Context of Culture, based on
research in Taiwan, Arthur Kleinman noted that his lay informants had
little understanding of what qi meant in medical terms (1980, 265).
Accordingly, Langzhong villagers displayed little interest in the abstract
concept of qi per se. Yet, they invariably used idioms that included qi—
such as shengqi and ouqi—to characterize emotional experiences and
acknowledge their effects on the body. Sydney White has shown that in
rural Lijiang, common lay categories for understanding affliction, such
as hot and cold or exposure to wind, damp, or dryness, were remarkably
consistent with the explanatory models of the medicine of systematic
correspondence, also incorporating influences from Western medical
discourses such as genetic heredity, germ theory, and infectiousness
(1993, chap. 7; 1999, 1340–1341; 2001). While assuming that villagers
subconsciously internalized the Chinese medical understanding of qi
would be epistemologically flawed, lay understandings of illness based
on Chinese medicine do play a powerful role in popular culture and in
China’s plural medical landscape.6
For Kleinman, the recognition among laypeople that emotions are
seen as physical states that have physical results may explain the com-
mon use of somatic expressions in Chinese to talk about emotions (1980,
135–138). He argues that the use of terms such as ganhuo (liver fire) to
connote anger and xinqing buhao (xin meaning heart) to connote unhappi-
ness shows that Chinese people are more prone to express distress physi-
cally, with reference to bodily organs, rather than psychologically (135).
He proposes that this tendency explains the currency of neurasthenia

(shenjing shuairuo) as a culturally fashioned response to stress in Chinese
culture—a sort of “culture-bound syndrome” (119–178).7 Since psy-
chologization is highly stigmatized, he argues, somatization becomes
the culturally legitimated reaction to stress.8 Thus, rather than under-
standing their condition as depression, Chinese sufferers understand it
as neurasthenia, a category long abandoned in Western medicine. In
his seminal study entitled Social Origins of Distress and Disease, based on
research in China, Kleinman states that neurasthenia is used as “a more
respectable somatic mantle to cover mental illness and psychological
and social problems that otherwise raise embarrassing issues of moral
culpability and social stigma” (1986, 15).9 For instance, Mrs. Wu and her
husband reacted very positively to her being diagnosed as neurasthenic
and asked for stronger drugs than those she was originally prescribed
(Kleinman 1991, 95–97). Indeed, claiming that it was the neurasthe-
nia that made her so irritable and unable to cope with the constant
criticisms waged by her live-in mother-in-law prevented her from being
blamed for the ongoing family conflicts. This, however, did not account
for the possibility that her distress may have been caused by her difficult
relationship with her mother-in-law, and thus it made her mother-in-
law and her husband irreproachable. For Kleinman, ultimately, medi-
calizing suffering through a somatic label such as neurasthenia encloses
it within the boundaries of “personal physical complaints” and thereby
masks its social origins and its nature as “social suffering” (Kleinman,
Das, and Lock 1997).
My perspective differs from that of Kleinman’s early work (1980,
1986) in some important respects. First, his outlook presupposes a
Cartesian division between mind and body. Baoma villagers, however,
displayed no dichotomy between mind and body with regard to emo-
tions (although they did, as we shall see in chapter 8, with regard to
cancer and treatment by spirit mediums). Neither was there a causal
relationship between preexisting mental states and physical experiences
supposedly triggered by them. Rather, when emotions were blamed,
both physical and psychological distress became intertwined in villag-
ers’ experience. Here my argument resembles that proposed by Thomas
Ots (1990). For Ots, the strict distinction between somatic changes and
emotions is based on the dichotomized view of mind and body, subject
and object, and it must be collapsed in order to understand the role of
the body in generating culture. Second, given that “personal revelation

outside the family is [considered] a shameful impropriety” (Kleinman
1986, 154), patients who have traditionally handled disorders in somatic
terms might do better experiencing distress somatically, since they would
receive appropriate family and social support for somatization but per-
haps not for “psychologization” or for tracing their problems to given
“social origins.”
In contrast, I argue that the efficacy of emotions as illness etiolo-
gies derives from the ambiguity it allows over whether illness is caused
by physical, psychological, or socially caused distress. Where Kleinman
claims that neurasthenia’s somatic focus precludes attention to its social
origins, I propose that ascribing illnesses to emotions—because of the
ambiguity over attribution of blame (whether it be an individual’s tem-
perament or the conditions in which they live)—allows recognition of
their social origins and articulates comments about social norms and val-
ues. Chronic headaches experienced by my thirty-three-year-old neigh-
bor were taken seriously as an illness, and at the same time their link
to anxiety allowed them to be attributed to the condition in which she
lived. Consequently, she was excused from work and allowed to join her
migrant husband to be away from a home situation that clearly distressed
her. As an illness that is nearly always fatal, cancer presents a particularly
powerful case in which the ambiguity allowed by anger and tensions is
central to making the etiology socially efficacious. I will turn to this next.
“Anger and Anxiety Cause Cancer”: Temper or

Family Conflicts?
As with emotion-related illnesses in general, the emotional causes of
cancer were recognized by Chinese medical practitioners. A young vil-
lage doctor who had studied both Western and Chinese medicine stated
that the effect of smoking, drinking, and consuming preserved vegeta-
bles on the development of cancer was proposed by Western medicine
but not by Chinese medicine. According to the latter, he argued, cancer
was due to pathogenic emotions. He combined Chinese and Western
medical knowledge to explain that repressed anger and trapped qi (ouqi)
cause infections ( fa yan) that in turn lead to the development of cancer.
Along similar lines, a qigong healer with whom Elisabeth Hsu trained
during her fieldwork claimed that an accumulation of qi leads to the
development of tangible lumps, some of them tumors (1999, 83–85).

Villagers’ understanding of the role of emotions in cancer causation
is situated within an epistemological continuum with Chinese medical
theories of cancer, shaped as they are not only by official discourse and
practitioners but also by sufferers.10 One informant, a man in his late
forties, explained the role of emotions in the development of cancer
as follows: “It develops over time; anger hurts the body just like a sore
throat hurts the throat, and then it can develop from there” (August 8,
2005). Locals’ belief that anger and tension could cause cancer was so
firmly rooted that if I openly asked whether these emotions had a link
with cancer, locals laughed and replied, “Of course it’s linked” (Dangran
you guanxi) or “How could it not be [linked]?” (Na ge mei you [guanxi]).
Villagers fluctuated between two possible explanations of why some
people were angry and anxious and therefore developed cancer. In some
cases, emotional reactions were seen as a matter of one’s character or
temperament (xingge). Cancer, it followed, affected those who had a pro-
pensity to get angry (xihuan shengqi), those who had a foul temper, and
those who were often anxious (xingge ji). When cancer is attributed to a
tendency to become angry and anxious, this can amount to a version of
the ethic of “blaming the victim,” holding “those who bottle up anger
or who unbottle high fat, low-fiber diets . . . as personally accountable
for their disorder. Illness is said to be the outcome of their free choice
of high risk behaviors” ( Farmer and Kleinman 1989, 146–147, quoted
in Farmer 1992, 248). But anger and anxiety were not always conceived
as part of a person’s temper. In other instances, villagers suggested that
anger and tension were not inherent in one’s character but rather a
consequence of wider conditions, of difficult situations making people
anxious and angered. They typically attributed blame for precipitating
cancer to significant family members, very often women and younger
generations who may have challenged existing mores. In turn, this etiol-
ogy serves to perpetuate social values and put pressure on those with
traditionally less power to conform.
Often, the same person shifted between these two explanations of
the origins of anger and anxiety, depending on who would be blamed
in the process and whether this served to maintain or challenge par-
ticular definitions of moral behavior. Aunt Liu—mentioned in this
chapter’s opening sequence—strived to partially reject responsibility for
her father-in-law’s illness and death by proposing that he was prone to
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
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
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)
The perceived inevitability of cancer in conditions such as those

described highlights how direct the relationship between cancer and
negative emotions is seen to be. It also reveals how family conflicts may
be perceived and regarded as causes of illness. Emotions are shown to
be the etiological link between cancer and enduring especially difficult
situations and family disagreements. This diverts blame from the indi-
vidual sufferer toward those wider settings and the people perceived to
precipitate them. In other words, regarding divorce as so unacceptable
it causes cancer also serves to produce and reproduce divorce (and fam-
ily conflicts more widely) as incompatible with local values.
Many villagers presented examples of the causal link between fam-
ily conflicts, enduring difficulties, anger, and cancer. One in particu-
lar, former teacher Zhao, was rather comprehensive in his account. He
was sixty-five, used to teach in the village school, and retired in 2002
when the school closed down because villagers gradually transferred
their children to the township school, where they felt they had access
to better-quality education. As all other locals, Zhao usually commu-
nicated with me employing the local dialect. When I interviewed him
more formally, however (see appendix 1), he spoke in standard Chinese
(something rather unique among villagers), adopting a very authorita-
tive tone, often preempting the responses I may have collected from
other villagers and aiming to set himself apart from them. Discussing
cancer with me, Zhao listed a series of local examples to prove that it
was due to pathogenic emotions generated by poor family relations and
by enduring hardship; four were cases of esophagus cancer, one of liver
cancer, and one of leukemia:
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
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)
By outlining these cases in standard Mandarin, Zhao added an offi-

cial aura of authority to his statement, posing as the unquestionable
voice of knowledge, and by extension defending the equally unques-
tionable values of family cohesion and harmony. And in this guise, he
described women as the perpetrators and men as the victims. With the
exception of Uncle Zheng (whose illness was attributed to abuses suf-
fered during the Cultural Revolution) and Uncle Yang (for whom bad
relationships with his family in general were to blame), the other four
cases of cancer were ascribed to women: a daughter in one case and a
wife in the remaining three. Aunt Liu’s father-in-law, Gandie’s youngest
daughter-in-law, Taoge’s father, and the suspected case of Uncle Liang
may be added to these four (although the latter two did not develop
cancer). As these examples make apparent, cancer is often regarded as
caused by worries and tensions that are due to hardship and family con-
flicts in particular. In turn, this etiology functions to articulate relation-
ships and attribute blame in deeply gendered ways.
In its connection to emotions, cancer may be understood as “a ‘pub-
lic health problem’ in an unaccustomed sense: an illness with a public
meaning” (Farmer 1988, 74). Paul Farmer employs this expression to
refer to “bad blood” in Haiti, which is attributed to “‘malignant’ emo-
tions,” typically the result of physical abuse (75). The risk of causing
“bad blood,” argues Farmer, serves as a “warning against the abuse of
women. . . . Transgressions are discouraged by their publicly visible,

and potentially dire, results” (80). In similar ways, cancer’s link to emo-
tions has a particularly poignant public meaning in rural Langzhong.
But where in Haiti bad blood warned against the abuse of women, in
rural Langzhong cancer predominantly cautioned against abuse toward
men or behavior that might aggravate them. Through emotions, cancer
can be attributed to intergenerational and family conflicts (especially
divorce and failure to conform to gendered expectations), financial chal-
lenges to a peasant economy, and to social change more widely. In turn,
devoting due attention to emotions reveals the position of cancer within
the wider social and political framework and the challenges villagers
face in the contemporary world. Cancer is not just a metaphor of cur-
rent social relations and conflicts, as Susan Sontag (1991) has put it; it
also materializes them and serves to produce and reproduce social and
cultural values.
In his seminal work The Normal and the Pathological, Georges Canguilhem
(1991) defined illness as a deviation from the norm. His student Michel
Foucault (2006) expanded on this theme to examine social exclusion
and the institutionalization of the sick, especially the mad, but also of
social outsiders in general. Thus, for Canguilhem and Foucault, stray-
ing from social norms makes one sick, whereas in rural Langzhong
such deviation causes others to become sick and to develop cancer.
Cancer, in other words, may be regarded as caused by significant oth-
ers who have aggravated the sufferer. Chinese medical discourse and
lay understandings of qi and anger’s effect on the body underpin its
connection with cancer. Attributions of blame articulate relations not
only between the sufferer and the reputed person causing the suffering
(whom I refer to as “the accused”) but also between the accused and
the person attributing such blame (the accuser). By blaming herself for
causing her father-in-law’s cancer, Aunt Liu posed as both the accuser
and the accused. More often than not, however, the same person was
not both accuser and accused. In Sansao’s case, the eldest daughter-in-
law denounced the youngest daughter-in-law for failing to care for her
parents-in-law. Here, one woman asserted her moral superiority over
another and reinforced expectations that women care for their in-laws.
In all other cases, men accused women of causing cancer (or risking
to cause cancer) in other men: Taoge accused his mother of threaten-
ing his father’s health, Uncle Liang alleged that his neighbor caused
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
disconcerting, and yet it may also be desirable since it means neither

the sufferer nor their family are blamed for the development of cancer.
An etiology such as anger and anxiety is ambiguous enough to attribute
blame either to the sufferer alone and their propensity to be angry or
to the circumstances and people that made him or her angry. Whether
the focus is on one or the other aspect depends on what is at stake for
the sufferer, the accused, and the accuser. Not being involved in the
day-to-day arguments between his sons and their wives that followed
Gandie’s death, and having little stake in blaming them for precipitat-
ing her father’s illness, Erjie considered his cancer to be (at least partly)
a result of his own propensity to anger. As she explained, “Look at my
father: getting angry is not good for people” (March 16, 2005). This
served to couch his death within a sense of inevitability of which tem-
per was a part. It reassured her that cancer etiology is intelligible, and
that she—given her good temper—was unlikely to develop it. Dasao’s
position within the family was rather different, and for her attributing
Gandie’s cancer to Sansao also served to assert her own moral stand-
ing and to demand that Sansao play a more active role in supporting
Ganma after her husband’s death.
I have argued that an emergent generational gap is visible with
regard to hardship and hard work as causes of cancer. Younger women
claim that they are not prepared to suffer the same fate as their mothers.
They demand more forcefully that their husband be faithful and par-
simonious with the family’s finances, they circumvent abuse by moth-
ers-in-law, and some resort to divorce when their marriage is less than
harmonious. In the case of attribution of cancer to anger and anxiety
(and to unfulfilled gendered expectations), however, the generational
gap is less clear. Just as crucially, some gendered expectations are more
resilient than others. Certainly, some values previously thought to be
untouchable, such as the expectation to produce a son, have started to
erode. As the family planning policy is implemented as a strict one-child
policy in the area, it has become unrealistic to demand a son. As a con-
sequence, young women who find themselves in Aunt Liu’s position are
less likely to be blamed to the same extent. This attitude was also partly
embraced by older women like Aunt Liu. Her claim that her father-in-
law’s cancer might be due to his own bad temper is also a sign that she
did not unconditionally accept that her behavior might have caused
resentment that precipitated cancer.
Divorce, on the other hand, is rather a different matter. Having only

started to make a full-blown appearance in Baoma in the past decade,
divorce was almost universally condemned by young and old alike. This
suggests that it may continue to be seen as a potential cause of anger
and anxiety (and therefore cancer) for some time to come. Ultimately,
however, it is too early to know whether the current generation of young
men and women will maintain this view as they get older. Whether and
by whom a woman’s lack of care for, obedience, and subservience to
her husband and in-laws are still held as unacceptable and a cause of
cancer very much depends on how these are defined, on who is accus-
ing whom, and on what is at stake in such accusations. Indeed, Dasao
(who was in her early forties) maintained that Sansao’s lack of care for
Gandie caused him to develop cancer. But her argument is at least as
much a function of her own situatedness vis-à-vis Sansao and Gandie
as it is a reflection of her commitment to the duties of a daughter-in-
law. Moreover, as chapter 6 illustrates, the definition of what constitutes
care toward a parent, grandparent, or parent-in-law is very much open
to contestation. While different family members may not agree on what
counts as caring and moral behavior, all involved make claims to having
acted as moral individuals.
Understanding Nondisclosure in Context

Having examined emotions as causes of cancer, I would like to end
with some considerations on how anger and anxiety are seen to affect
the development of cancer after its inception and the implications this
carries. In the opening story of this chapter, villagers agreed that Aunt
Liu’s health deteriorated more quickly because she was anxious and
scared of cancer. They noted, by contrast, that another cancer suf-
ferer had recovered because he had a good emotional condition (xinli
zhuangkuang).12 In this context, nondisclosure is a common strategy to
avoid further suffering to the person affected and to avoid quickening
its development. The recognition in Western medicine that anxiety and
stress might make cancer develop faster and the consequent practice of
nondisclosure, which is only recently beginning to decrease in the UK
and the United States, suggest that this etiology is not as alien as it may
at first seem (see Good et al. 1990; Gordon 1990). While Mary-Jo del
Vecchio Good et al. (1990) show that in the United States, given the
better availability of treatment, disclosure has recently become central

to physicians’ attempts to engage sufferers more actively in the therapy,
in Langzhong the reverse seems to be the case.
When my host Erjie’s father, sixty-two-year-old Gandie, was diag-
nosed with esophagus cancer, the family decided, as is often the case,
not to tell him. On October 19, 2004, as we made our way to Erjie’s
natal village to celebrate Gandie’s birthday, she cautioned me: “Don’t
you tell him—he doesn’t know he has cancer. We asked the doctor to
write that part in English. So if dad asks you for a translation, just tell
him he’s ill because he gets angry too often—it’s repressed anger (ouqi).
If he just relaxes and controls his temper, it will go away. That’s what
the doctor said.” Erjie argued so convincingly that her father would
recover that I started to doubt he had been diagnosed with cancer at all.
Nondisclosure itself expressed an active engagement by the sufferer’s
family with the illness in an attempt to secure his health. As in Deborah
Gordon’s Italian case study (1990), it served to keep the sufferer in his
social world, to keep hope alive. Nondisclosure and attributing illness to
a propensity to get angry, as Gandie’s relatives had done, served to make
cancer intelligible as part of a much broader set of emotion-related ill-
nesses and to momentarily maintain hope that if he was able to control
his temper, cancer might not develop further.
When assessed from the standpoint of the paradigm of disclosure,
nondisclosure is construed as immoral, an obstacle to the ability of indi-
viduals to make choices on their own lives based on ideals of individ-
ual free will and on what Gordon and Paci termed “autonomy-control
narrative” (1997, 1434). Taken to an extreme, failure to recover and
death itself could be blamed on the lay etiology that connects cancer to
negative emotions and encourages nondisclosure. This analysis could
be applied to Gandie’s case, where his family’s belief (supported by the
hospital practitioner who diagnosed him) that he had developed cancer
because of his frequent bouts of anger motivated them not to tell him,
convinced that knowing would only make him worse. Yet, to simplis-
tically blame cancer death on the perceived link between cancer and
negative emotions would be to ignore the social relations and moral
positions that are enabled by such linkage and the wider socioeconomic
contexts that support nondisclosure. As I will explain in chapter 7, vil-
lagers have very limited access to hospital care and equally little trust
in hospital practitioners. Even when the diagnosis is disclosed, they
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
they could, in time, be understood as a cause of illness. It is still too

early, however, to predict whether the hardship endured by the current
generation of young migrants will be conceived as a potential cause of
cancer when they reach old age.
Hardship that precipitates cancer is not only caused by hard work
and physical abuse but also by repressed anger and anxiety. These are
commonly seen to originate from family and intergenerational conflicts.
While divorce, for instance, may be experienced by those who resort to
it as a refusal to withstand forms of misery that the older generation
typically accepted, parents and in-laws claim that it causes them such
negative emotions that it could lead to cancer. When cancer-causing
negative emotions are associated with women’s failure to comply with
expectations about marriage (by demanding divorce) and the con-
tinuation of the family line (by not producing a son), these values are
strengthened and reaffirmed. And yet the very same etiology also opens
them to questioning. When Aunt Liu argued that her father-in-law’s
cancer was caused not by her inability to produce a son but by his own
bad temper, she also destabilized this value. By regarding negative emo-
tions as a result of bad temper intrinsic to the individual affected rather
than the product of shortcomings in one’s family obligations, women
are able to avoid blame and to unsettle the hegemony of these expecta-
tions. Ambiguity about who is to blame opens a space for negotiating
new values and moral universes.
Of course, family and intergenerational conflicts are not a recent
innovation. Margery Wolf ’s (1968) portrayal of family life in a farm-
ing family in Taiwan has outlined clearly the many tensions between
siblings and their wives, endemic to the very structure of the family.
Yet historical variations in the structural conditions within which fam-
ily relations unfold affect the types of disagreements and tensions that
may develop, as well as the responses to them. Sulamith and Jack Potter
(1990) have shown that the Marriage Law of 1950, the work-point sys-
tem, and the retreat of the state as a provider of basic security since social
and economic reforms have had some effects on the familiar structures
of marriage, the household, and family organization, although these
have not changed significantly. More recently, Yunxiang Yan (2003)
has highlighted an increase in conjugal solidarity and conflicts between
the young couple and their parents. This is no doubt enabled by the
increased opportunities for independence, as young adults can migrate

in search of work, earn money, and establish a separate household.
In rural Langzhong, the widespread tendency to migrate for work
since reforms has meant that some young men and women may also
develop new relationships and divorce their original partner. Conversely,
when their relationships with their partners are less than harmonious,
some young women, like Aunt Cao’s two daughters-in-law, leave their
husbands and look for wage labor. These circumstances may at least
partly explain the rise of divorce in recent years, as they undermine
the older generation’s ability to impose family cohesion. To consider
divorce as carcinogenic, then, is also a means to condemn recent
changes, such as the prevalence of migration and wage labor, which
have exacerbated existing family divisions and conflicts and presented
those younger with new opportunities for independence. While at pres-
ent divorce remains highly stigmatized, its carcinogenic potential per se
may be disputed if divorce continues to be common. Likewise, as the
strict implementation of the one child per family policy has rendered
it unrealistic to require a son, the perceived carcinogenic potential of
lacking a male heir is decreasing accordingly. Since attributing cancer
to negative emotions could implicate either the sufferer’s character or
misbehavior by close family members, this etiology lends itself well to
a time when the value of family cohesion, the acceptability of abuse
by husbands and in-laws, and the desirability of producing a son are
open to contestation. Anxiety that causes cancer may be regarded as
triggered by a daughter’s or a son’s divorce, but it may also be ascribed
to the sufferer’s character. Women do not submit to traditional gender
norms unquestioningly, and attributing negative emotions to character
is one such avenue of resistance. As they argue over whether such emo-
tions are due to the sufferer’s temper or to those who aggravated him,
villagers also rethink gender and family relations and debate the bound-
aries of moral behavior.
Chapter 5
Xiguan, Consumption, and

Shifting Cancer Etiologies
At sixty-two, Gandie was an active, healthy, and warm-hearted man. He

was the father of Erjie, the thirty-six-year-old woman with whose family
I lived. He liked drinking and smoking; in fact, he was “fierce” at it (xiong
de hen), as his son-in-law remarked in January 2005, the month leading
to his death, when his condition had dramatically deteriorated. When
I was first introduced to Gandie on his birthday (October 19, 2004) by
Erjie, he had been diagnosed with esophagus cancer at the beginning
of the month but was himself still unaware of his illness. Around fifty
people attended his birthday party, but Gandie was clearly not in the
mood for celebration. He ate nothing and paced the courtyard dressed
in his best traditional silk shirt, a dark blue jacket reminiscent of revo-
lutionary times, and a hat. He looked unsettlingly tense and restless,
and seemed to be in pain. An amount of over 500 yuan was spent on
fireworks alone, because, as Erjie put it, “Next year he will not be able
to celebrate his birthday” (Mingnian guo bu cheng shengri).
This chapter will unpack the relationship between cancer, consump-
tion practices (including eating in general, smoking, drinking, and con-
suming preserved vegetables), and health more broadly. As many locals
argued openly, ability to eat constitutes good health. I explain that this
equivalence between eating and health may be understood as a form
of habitus (Bourdieu 1977, 1990) fostered by historical experiences of
food shortage. As they affect the sufferer’s ability to eat, esophagus and
stomach cancer therefore also challenge this historically rooted founda-
tion of health. Indeed, the terms locals employed (and in some cases
still employ) to designate these illnesses—“choking illness” ( gengshi bing )
and “vomiting illness” (huishi bing) respectively—describe degrees of
Xiguan, Consumption, and Shifting Cancer Etiologies     145
inability to eat. Forming a backdrop to later chapters, I begin by narrat-

ing how esophagus cancer was experienced by and affected the family
of Gandie. Gandie’s decreasing ability to eat made him aware of his
illness, and it presented a parameter through which he and his family
measured his physical decline. But through the development of cancer,
the definition of what constitutes eating was revised to make sense of his
condition and come to terms with it. The concept of habitus is inade-
quate to encapsulate the subtle changes in their attitudes. I propose that
the locally prevalent concept of xiguan (habit) is more adept for making
sense of bodily habits that are at once stable and flexible and produced
through everyday practices.
Epidemiological studies regard consumption of preserved vegeta-
bles, tobacco, and alcohol as a possible cause of stomach and esophagus
cancer ( J. Chen et al. 1990). While villagers are aware of this, they often
dismiss it. I explain that this is due to the clashing ideals of moral (or
immoral) subject that are produced by such etiologies. While epidemio-
logically, smoking and drinking are presented as individual practices for
which individuals alone may be blamed, villagers highlight the social
pressure and expectations, for men in particular, to engage in such prac-
tices, as well as the social capital derived from them. In this sense, when
attributing cancer to smoking and drinking, villagers do not blame indi-
viduals alone. Likewise, consumption of preserved vegetables is under-
stood within the historical and economic context that gave it rise rather
than attributed to individual preference. The respective moral econo-
mies current at times of food shortage and at times of relative prosperity
may account for why preserved vegetables are associated with cancer in
the past but not in the present. With reference to Gandie’s and Uncle
Wang’s cases, I show that particular etiologies are adopted when it is
morally feasible and productive. For this reason, attribution of cancer to
particular causes varies in the course of illness and after death. As can-
cer unfolded, Gandie’s family members’ perceptions of his illness and
what caused it changed. Tracing these changes stage by stage highlights
not only how illness itself develops but also how Gandie and his family
attempted to rebuild their moral universe in the face of illness—to avoid
blaming Gandie or other members of the family. Such shifts are also
forms of family caregiving. In turn, this delineates both family relations
and morality as emergent and processual rather than firm and undis-
puted and articulates comments on the moral economies of the past
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’
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.
Figure 5.1 Gandie’s family.

financially feasible, but Gandie refused, arguing that an operation would

only have bought them time, at most a year or two, and that he might as
well die and save the money (see chapter 7). At this time, Erjie made the
half-hour walk to her natal village once a week. The frequency of our
visits increased in the course of her father’s illness. By mid-November
we visited twice a week, and in January we visited three times a week
or more, depending on Erjie’s workload. Whenever we saw her father,
Erjie would offer him some gifts: some medicinal herbs to drink,2 sugar,
some of her homegrown tomatoes, noodles handmade by her husband,
or doufu she had purchased. Her parents reciprocated with similar food
gifts, especially oranges and pears.
In November, Erjie told inquiring neighbors that her father had not
eaten for a month but could still have some broth. As a special treat for
her father, she killed two of her ducks to prepare soup.3 At this point,
he was still having chemotherapy drips in the city. November is a busy
time for agriculture: digging sweet potatoes, harvesting and dehusking
soybeans, sowing wheat, plowing the fields, and transplanting rapeseed
from hillside land into the paddies. Since Gandie could still walk, he
joined his wife working in the fields (carrying loads, digging, and sow-
ing). Erjie explained, “That’s normal; if he manages to eat he’s fine, he
has energy to work, and he doesn’t want my mother to do it all alone”
(November 3, 2004). Until late November, he could indeed still eat, even
if only very little, every two to three days and only after having had an
intravenous drip. Back from the fields, he ate a bowl of noodles and
spat repeatedly afterwards, but he did not vomit. Erjie and her mother
mutually reassured each other that at least he could keep some food
down. It seemed that his family at this stage, however worried, was still
hopeful. Gandie was eating less, but he was after all still eating and still
engaging in regular farming activities.
In late November, family members gradually realized that Gandie
was inevitably going to die. As Erjie observed, the decision by Gandie
and his wife to make a trip to the city to have his photograph taken
signaled the family’s awareness that his health would soon decline and
marked the beginning of their preparations for his death. The photo
was intended as an ancestor image, and as was typical in Langzhong, it
was to be hung after his death in the storage room on the wall opposite
the entrance. On this occasion I was also asked to take some family pic-
tures for posterity, which were hung in Gandie and his wife’s room and
distributed among the relatives. When we returned home, Erjie care-

fully supervised the printing process in my bedroom: “Print them prop-
erly, they’re the only ones I have” (November 24, 2004).4 The return
home from Fujian of one of his grandsons, seventeen-year-old Guoyun,
was also identified by Gandie and his wife as recognition of his immi-
nent decline. Considering that migrant workers sometimes do not even
return home for New Year, this was a very special occasion. Although
already very slim, Gandie was still rather lively and in good enough
shape to scold his grandson for finding a girlfriend so far from home and
at such a young age.5 Photograph taking and Guoyun’s visit emerged as
focal points in Gandie’s and his family’s understanding and experience
of cancer and marked a turning point in their attitudes.
In December 2004, Gandie was unable to keep food down for any
longer than a minute, and he would then spit it out. At this stage, he was
still on various medications, including chemotherapy through intrave-
nous drips. The family members could not explain what these medicines
were, nor did they recognize the term “chemotherapy” (hualiao). They
were, however, keen to emphasize that they cost them over 100 yuan per
day.6 As Gandie became bedbound, he was also unable to continue with
chemotherapy, which required him to go to the city’s hospital. Some
newspapers were cut and placed next to the bed to wipe his mouth and
a bowl was put next to the bed for him to spit in. By January 2005 his
skin had turned much darker and hairier as a result of weight loss, his
cheekbones and eyebrows were ever more pronounced, he spat blood,
and he could hardly speak. He could no longer raise his head, so his wife
put some paper next to his head for him to spit on.
By this stage, his wife would watch over Gandie, without sleeping,
for days at a time, and as a consequence she was often suffering from
colds. She rested on a wooden couch next to the grass-filled four-poster
bed she had shared with her husband throughout their marriage and
where he now slept alone. When Erjie, her husband, her daughter, and
I visited him on January 21, the situation was palpably tense, but Erjie
still tried to put on a brave face.
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?
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.
Erjie’s attempts at self-assurance, however, waned by the end of

January 2005, as it became clear Gandie had only a few days left. On
the evening of January 26, she told her husband the latest about her
father’s condition: “He hasn’t eaten a thing in nine days—he can’t even
drink anything. . . . He said he’d like some grapes, so my brother bought
him some. He put three in his mouth, chewed them and then spat them
out again. He has no energy; he can’t even peel off the grape skin. It’s
so painful this illness, it ‘eats’ all your flesh and only then it lets you die
(ba nide rou chiwanle cai youfa si).”
On the evening of February 2, Erjie’s brother called, as he fre-
quently did in the final month, to announce “Dad cannot speak now,
he’s just talking nonsense (shuo luan hua), making noises; we don’t know
what he’s saying—it’s like he’s gone mad with starvation.” Only Erjie
and I were home that night, and it was already midnight. I asked if she
wanted to go to her father’s. She said, “Yes, but I can’t in the dark—
women shouldn’t go out in the dark and climb mountains, because there
are ghosts ( you gui ).” I told her I was not scared and offered to walk
with her. She was very grateful but could not bring herself to do it.7 We
visited him the following day, and Gandie did indeed make incompre-
hensible moans, which his wife could partly decode as calls to scratch
his throat. “In the past few days, he said ‘It’s itchy here’ [pointing to her
throat] and asked me to scratch it” (February 3, 2005).
Two nights later, February 5, her brother telephoned shortly before
midnight: “Come now, it’s the end.” Erjie and her husband left the
house instantly, but they did not make it in time. Her father died while
the two of them were still climbing the hill. She was the only one of
his children not to be present at his death, and this upset her greatly.
Funerary rituals unfolded the following day, including a major meal at
9 a.m., as the close family had spent the night awake. The body was
interred at around 11 a.m. without cremating it, which was common

but illegal at the time.
Eating, Health, and Family Relations

Gandie’s illness had a powerful impact on how his family cared for him
and for themselves and how they perceived health. Eating emerges as
a prominent idiom for experiencing and understanding esophagus and
stomach cancer. In July 2005, Doctor Wang (the former barefoot doctor
turned village doctor) recalled the reaction of his neighbor Aunt Zhang
upon being told her husband, Uncle Wang (see preface), had been diag-
nosed with stomach cancer: “His wife refused to believe it; she replied,
‘He can eat fat meat and drink spirit, he works in the fields; it can’t be
cancer, it’s impossible.’”8 For her, as for villagers more widely, eating
meat (fat in particular), drinking spirits, and working in the fields were
indisputable signs of good health for men. Doctor Wang was frustrated
by locals’ perceptions of these types of cancer. He claimed, “They just
don’t get it. . . . I told them you can go for a while without medicines
and still be able to eat, and later you can’t eat a thing. . . . People feel that
they’re fine because they can eat; they don’t go for a checkup because
they don’t feel bad—they don’t believe it because they feel healthy”
(Doctor Wang, July 10, 2005).
This passage describes the period immediately after which the suf-
ferer realizes he or she has cancer, because their ability to eat is limited
but they are still able to ingest some food and thus have enough energy
to work and lead a life similar to that predating the development of ill-
ness. For Gandie, this period spanned from the end of October, when he
became aware of his cancer but still helped his wife with farm work, until
the end of November, when he became unable to digest or even swallow
any food. During the initial stages, when Gandie could still eat, even a
little, he and his family maintained a hopeful attitude, taking his ability
to eat as a sign that his health had not (yet) deteriorated irreversibly.
Remarks highlighted above by Uncle Wang’s wife are one exam-
ple of how the equivalence between eating and health is articulated. A
similar approach is betrayed in Erjie’s reflections on her father-in-law
Uncle Tao’s condition a day after her father’s death. Uncle Tao had
been known for years to suffer with ouqi—that is, repressed anger and
the propensity to get angry but not externalize it, thereby harming the
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
through these past experiences persist even when their socioeconomic

conditions have changed. Cancer is experienced as particularly menac-
ing because it unsettles this very habitus by making the sufferer unable
to eat. Strong bodies nourished with filling food were the prerequisites
for carrying out the type of work that was demanded of Gandie and
those of his generation. As the previous chapters have shown, ability
and willingness to engage in hard work are central to defining caring,
moral individuals. Indeed, both Gandie and Uncle Wang insisted they
would work in the fields for as long as their bodies allowed them. But
inability to eat also eventually deprived them of the strength required to
work. Therefore, as it undermines one’s ability to eat, cancer threatens
not only health but also sufferers’ social identity as hardworking farmers
and the moral worth derived from it.
At the level of embodiment, for sufferers like Gandie and Uncle
Wang the starvation that results from stomach and esophagus cancer is
reminiscent of their experiences of the Great Leap Famine as teenagers
and young adults. But the radically different economic context in which
cancer-induced starvation takes place also endows it with different con-
notations. In a time of relative prosperity, this form of deprivation is
also a powerful metaphor for the deep socioeconomic disparities of the
present. While with cancer, food is available but the body is unable to
process it, so with reforms, wealth unimaginable only two decades pre-
viously is displayed on television and in cities, but villagers remain rel-
egated to the status of onlookers unable to fully participate in the feast.
While the concept of habitus is well suited to understanding the repro-
duction and persistence of attitudes and values, it is partly inadequate
for making sense of the ways in which attitudes formed in the past take
on new implications when they are maintained in the present. We have
seen in chapter 3 that a strategic use of farm chemicals and a revalu-
ing of family produce in the current context may serve as a conscious
and politically charged denunciation of consumerism.10 Upholding the
equivalence between eating and health at a time when much more than
simple, filling food is available (though not necessarily accessible) also
designates a critical engagement with the conspicuous consumption
so often lavishly displayed on the ubiquitous TV screens. Conversely,
inability to eat at a time when food shortage is no longer as prevalent as
it used to be makes such inability all the more poignant. The inability to
fulfill even parameters of well-being premised on scarcity when relative
wealth is the norm presents a painful symbol of how unequal access to

well-being is. As a reminder of the socioeconomic disparities in distri-
bution of resources between the relatively wealthy and relatively poor,
cancer undermines a shared moral economy.
Where Bourdieu stressed social reproduction over social change
and his critics charged habitus with overdeterminism, the locally preva-
lent reference to xiguan may place an equal emphasis on the enduring
influence of internalized attitudes formed in the past and the flexibility,
adaptability, and processuality required and fostered by contemporary
life.11 Xiguan is both a noun, which can be translated as “habit” or “cus-
tom,” and a verb, meaning “to be/get used to” or “accustomed to.”
It is frequently used in debating a broad range of everyday activities,
from ways of carrying heavy loads to ways of living, eating, cooking,
walking, and speaking. Xiguan implies a habit that has been fostered by
long-term experience, but it also suggests the ability and willingness to
engage in a particular activity, such as shouldering a yoke with buckets
full of manure or ensuring that the adequate amount of wood is added
to the fire to fry a dish or boil noodles. The frequency and keenness with
which locals discussed xiguan are a powerful testimony of the momen-
tous changes that have characterized China in living memory. Like
Pierre Bourdieu’s concept of habitus, xiguan is socially and historically
produced. It is by its very definition produced through time, through a
process of “getting used to” given conditions. The life span of xiguan,
however, is not always as long, nor are its characteristics as persistent,
as those of habitus. As a process of learning by doing, it may subside
when a person is no longer exposed to given living conditions. When
migrant workers returned to the village, for instance, they claimed to be
no longer xiguan to living conditions at home. Villagers also noted that
after spending over a year in rural China, I would certainly not be xiguan
when returning to Europe. Conversely, xiguan formed in the past may
be activated in new contexts and take on new significance through its
interactions with the present, as the equation between eating and health
does in the context of relative prosperity.
A closer look at how eating itself is defined reveals that microtem-
poral changes in the sufferer’s eating routines changed the definition
of eating in ways that habitus cannot encapsulate. Rather, operating
upon the xiguan that associates eating and health, the experience of
Gandie’s decreasing ability to eat also in turn changed the parameters
of xiguan. Practices during the course of illness reinforced the associa-

tion between health and eating by highlighting how a gradual decrease
in eating corresponded with the sufferer’s march toward death. But
through this process, the meaning of “eating” was continuously recon-
stituted with reference to changing eating practices. Discrepancies in
the claims I collected regarding Gandie’s eating illustrate this clearly.
In early November, Erjie told neighbors that her father had “not eaten
for a month.” Yet I observed that at that stage he could still eat a lit-
tle, provided he took some medicine. He spat after the meal but did
not vomit. In December, Gandie was unable to keep almost any food
down, yet Erjie would sometimes comment that he had eaten a little.
On January 26, 2005, she claimed her father had not eaten for nine
days. When he died ten days later, it followed that he had not eaten for
nineteen days. Yet after his death, her mother told a relative that when
he died “he hadn’t eaten for twenty-eight days, he had no stomach left,
his bottom bones were sticking right out” (March 11, 2005).
Inconsistencies in their claims about the length of time he endured
without eating adequately are shaped by changes in his eating practices,
which in turn produced new and divergent parameters of what eating
amounts to for Erjie and her mother Ganma. At the onset of Gandie’s
illness, Erjie would say that her father was not eating (chi bu xia). Her
claim was made with reference to her father’s habitual practices until
then, characterized by a very good appetite. Toward the end of his life,
however, she began to reply, “He’s eating a little.” This change in her
attitude is emblematic of her coming to terms with the effects of cancer.
These statements, then, were never absolute truths but rather reflections
on his change. The role of practice as a generative basis of knowledge,
much emphasized by Bourdieu (1990), becomes clear in these instances.
But xiguan, unlike habitus, is as much a reliable pool of habitual attitudes
as it is flexible, adapting to new conditions and responding to new prac-
tices, as is the case for the shifting definition of eating.
Changes in eating patterns not only present the most glaring evi-
dence of declining health; they also produce a highly embodied sense
of physical decline. These changes can be observed clearly in Gandie’s
illness. His own realization that he had cancer was not the result of con-
sulting doctors or family members who already knew from his hospital
checkup results. His own body “told” him he had esophagus cancer—he
knew because of his decreased ability to eat. Gandie’s own process of
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
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
relied on their past experience to initially make sense of illness. These

men’s track record as healthy made them incredulous toward the pos-
sibility of their developing cancer. Coming to terms with illness involved
practices that gradually changed their xiguan and forced them to rethink
what constitutes “healthy” and “eating” and how to best care for their
sick relatives. In this process, they also reproduced family relations. The
following section will examine some epidemiological approaches to can-
cer causality and begin to contrast them with the ways in which suffer-
ers’ families identify causes of cancer.
Cancer Epidemiology in Anthropological Perspective:

Diet, Lifestyle, and Mortality
A study initiated by Oxford University’s Clinical Trial Service Unit
(CTSU) on diet, lifestyle, and mortality in China explores cancer cau-
sality and its link to diet. Contributors argue that diet is shown to have
strong links to cancer but cautiously add that simple correlations of spe-
cific foods with cancer are deceptive. Cancer, they propose, is especially
common “among particularly susceptible people (e.g. smokers . . . ) who
are persistently ‘malnourished,’ not with classical nutrient deficiencies
but rather with deviations of the intakes of nutrients and other food con-
stituents from those typically found in a diet with a variety of plant foods,
especially if those variations are large and persistent” ( J. Chen et al. 1990,
57–58). The CTSU study is especially useful, as one of the areas consid-
ered, Cangxi county, borders Langzhong, offering some important quan-
titative data for comparison with my own findings. Using this study as my
reference, I compiled a table (fig. 5.2) that gives an overview of significant
findings for the area of Cangxi. Families with cancer patients in Cangxi
county amount to 19.7 percent (768), and the incidence of all types of
cancer scores within the highest category in the study. Esophagus and
stomach cancer also rank within the highest category in China, both with
much higher prevalence among men than women (114–117).13
Smoking and Drinking

It is epidemiologically tempting to observe some correlations between
the incidence of cancer and consumption of alcohol, tobacco, pre-
served food, and shallow well water.14 Total daily consumption of
alcohol ranked comparatively low in Cangxi, within the second cate-

gory. However, consumption of liquor for men was among the highest,
whereas they consumed little beer and wine. The same applies to Baoma.
When alcohol was consumed, it was nearly always locally distilled rice
liquor (baijiu). Drinking is inextricably linked to a culture of banquet-
ing, welcoming guests, and creating social networks. At banquets, when
guests were present, tables were usually organized along gender lines, so
that men could toast each other (see Kipnis 1997; M. Yang 1994). Toasts
Figure 5.2 Findings on diet and cancer in Cangxi.

Category Value Ranking
Salt-preserved vegetables and dried 313.8 g/day 4
vegetables as-consumed basis
Times per year eat moldy salt-preserved Male: 191.6; 195.6 4
vegetables Female: 199.8; 228.9
Average: 204.1
Times per year eat moldy sweet potatoes 12.5 4
Times per year eat salt-preserved vegetables 308 4
Consumption of liquor 24.1; 34.2 g/day 3
Overall total daily consumption of alcohol 12.1; 17.1 g/day 2
Total current daily consumption of tobacco Male: 14.46; 22.13 4 (m)
(g per person) Female: 1.50; 1.78 1 (f )
Drinking shallow well water 100% 4
Families with cancer patients 19.7% 4
All cancers (cumulative rate, 0–64 years)/ Male: 154.62 4
1,000 Female: 123.43
Average: 139.03
Esophageal cancer (cumulative rate, Male: 79.26 4
0–64 years)/1,000 Female: 48.91
Average: 64.09
Stomach cancer (cumulative rate, Male: 37.16 4
0–64 years)/1,000 Female: 20.94
Average: 29.05
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.
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
not sufficient to excuse one from drinking. Two of the doctors in my

circle of acquaintances fell ill with stomach and liver problems. They
avoided joining any dinner party or visits to the karaoke bar for over
a month because they knew that they would be obliged to drink.15 My
drinking companions would reply that they drank even when they were
sick, and one of them claimed that “toasting friends is more important
than health” (March 30, 2005).
Though the pressure to drink was higher in the city, villagers and
city dwellers alike agreed that drinking was an important way to build
good relationships ( gao hao guanxi ) and therefore very important to
their social life. Toasting others, as Andrew Kipnis noted, “material-
ized respect, while drinking deconstructed the boundaries that distin-
guished guests from hosts, allowing ganqing [feelings] to flow” (1997,
53). Accordingly, whether one was or was not in a position to refuse
a toast or to only drink a little was a key indication of the relationship
between the parties involved. It was also central to the future of that
relationship. Refusing a toast was ever possible (that is, not too great an
offense) only if one was very visibly inebriated and only among the best
of friends or those with negligible relationships. The closest and fur-
thest could refuse a toast: closest because the relationship would not be
undermined and furthest because no real relationship existed. But those
with whom guanxi was at a liminal stage (close enough to be offended
but not enough to accept a refusal) and needed to be consolidated could
not be turned down. Drinking encounters required displays of closeness
that paradoxically showed the precariousness of the relationship. On
this basis, I deduce that pressure to drink was higher in the city because
drinking partners were often work colleagues and people with whom
relationships were in the process of being secured. In Baoma, by con-
trast, the large majority of drinking took place among people who were
already close enough not to need to perform closeness through drinking
to extremes. Secondly, as villagers liked to point out, city dwellers had
much more disposable income and would therefore be in a position to
devote more to drinking. Nevertheless, alcohol consumption was also
common in rural Langzhong.
Smoking was similarly invested in the performance, creation, and
maintenance of relationships. If gender difference was significant with
regard to alcohol consumption, it was even more prominent for tobacco
consumption, which in Cangxi ranked among the highest for men but
very low for women. Again, this is reflected by my findings. Baoma

villagers argued that it is uncommon and undesirable for women to
smoke, and those women who did were seen as promiscuous. It is, how-
ever, acceptable and relatively common for elderly women to smoke.
Matthew Kohrman (2007, 2008) has illustrated how perceptions of
masculinity and the role of smoking in facilitating social relations hin-
der any attempts to quit, despite people’s awareness of the harmfulness
of smoking. He contends that even when a man is dying of cancer,
he and his family acknowledged smoking may have caused it, but they
argued that there is such great social pressure on men to smoke that it
becomes unavoidable. Smoking is seen to be a necessary part of a man’s
existence and is central to gendered notions of the good life. I propose
that when sufferers and their families attribute cancer to smoking, they
also resort to a way of making sense of illness that does not blame the
individual alone. As a socially accepted and respected activity that is
central to social life, smoking cannot be pathologized, nor can individu-
als who engaged in it be blamed for doing so.
In rural Langzhong, the relationship between health, smoking,
and drinking was perceived with ambivalence. Although locals admit-
ted that excessive drinking (500 grams of white liquor per day in one
case; 250 grams per day in some others) and smoking (two packs per
day) were harmful, they also claimed that ability to drink and smoke
was typical of healthy people.16 They often questioned the possibility
of smoking and drinking inevitably causing cancer by referring to the
proverbial “Uncle Norman”—an old man who ate fatty food, smoked,
and drank aplenty all his life and is in perfect health (Caplan 1992, 27;
1997; Balshem 1991, 1993).17 Paradoxically, then, as I explained for
hard work in chapter 3, while drinking and smoking excessively were
perceived as possible causes of illness, ability to do so was perceived as
a sign of health. As the reasoning went, if one can engage in a harmful
practice and still maintain health, it must mean that his body is “fierce”
(xiong), as was noted of Gandie. Given that these activities are associ-
ated with strong males (by contrast, they are regarded as undesirable
for women), they are part of how masculinity is defined, and as a con-
sequence they are a habitual parameter of normality for men. On this
basis, they can hardly be abandoned because of their potential harm.
Anita Chan and her colleagues argued in their well-known study
of Chen village that at a time of great social change, such as the 1980s
in China, “It becomes an advantage to be able to turn to more than

one sub-community structure as an anchorage for support” (Chan,
Unger, and Madsen 1992, 326). Yunxiang Yan (1996, 234) has similarly
maintained that decollectivization forced villagers to cultivate guanxi on
a larger scale than during the collective period, when resources were
scarce, and therefore they fostered instrumentalized relationships with
cadres through gift giving. In a moral economy where personal relation-
ships are crucial to securing help at times of need, activities through
which such relationships are formed—such as smoking and drinking—
may be deemed to be more important than health itself, as one friend
claimed for drinking. In turn, as more cash is available, particularly for
urban dwellers, the ability to resort to these avenues of guanxi forma-
tion has increased along with the need to do so. In this context, the
centrality of smoking and drinking to the definition of strong men and
to local xiguan is not simply rooted in a traditional past; it takes on a new
significance in the new socioeconomic setting. While in recent years the
government has made efforts to build a stronger welfare state in rural
areas, it is unlikely to ever provide for every aspect of citizens’ well-
being, and consequently activities that secure guanxi will remain impor-
tant. Certainly in the ethnographic present, smoking and drinking may
be blamed for cancer, but locals are not willing (or capable) to abandon
or limit these activities because they offer both enjoyment and invalu-
able social capital.
In the two previous chapters, I have shown that hard work is consid-
ered to be possibly carcinogenic, but it is also valued for this very reason.
Consequently, individuals who engaged in it are not blamed person-
ally for bringing cancer upon themselves, but rather their practices are
endowed with a moral connotation. Here, drinking and smoking may be
understood through a comparable framework. These activities are part
of xiguan and therefore cannot entail blaming individuals who engage in
them. They are socially recognized and respected ways of establishing
and maintaining relationships. By linking cancer to smoking and drink-
ing, the sufferer’s practices are culturally intelligible, socially necessary,
and therefore morally justified. In this process, the sufferer himself is
emancipated from blame for taking part in these activities. Attributing
cancer to smoking and drinking is therefore a way to relate it to a shared
reality and to remember the sufferer as a moral subject. The gender
gap in practices of smoking and drinking also intersected with a gap in
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.
Preserved and Moldy Vegetables

Like smoking and drinking, consumption of preserved and moldy
vegetables is also epidemiologically correlated to the development of
esophagus and stomach cancer. If lack of dietary variation and compar-
ative lack of fresh food may be blamed for the development of cancer,
there was certainly some evidence of it in rural Cangxi. Consumption
of moldy, salt-preserved vegetables in the area was remarkably high,
indeed the highest for all the areas examined in the CTSU study, at
204.1 times per year. Most other areas included in the study consumed
none at all. Consumption of moldy sweet potatoes and of salt-preserved
vegetables also scored very highly—second and third highest among
their findings, respectively—as did consumption of salt-preserved veg-
etables and dried vegetables in general. My findings in rural Langzhong
were very similar. Lack of dietary variation was more prominent until
the late 1980s, when according to locals diet consisted of maize, pre-
served vegetables (especially cabbage), turnips, and sweet potatoes.
During fieldwork I observed more variety, but such variety subsided for
nine months between October and June, when locals would typically eat
preserved vegetables, cabbage, peanuts, radishes, and sweet potatoes. At
any rate, fresh vegetables were consumed only once a day at most, while
preserved and pickled vegetables were consumed daily to accompany
watery rice. I also occasionally observed (and participated in) consump-
tion of moldy preserved cabbage, cowpeas, and radishes with my host
family and other local families. Verbally, locals generally accepted that
eating moldy food was possibly harmful: “It’s moldy—that’s no good
(Zhang mei le, yao bu de)” (a frequent claim). In fact, however, they were
reluctant to waste it and would still eat it. They explained, “It’s not a big
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).
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
of destiny, but a forced choice, produced by conditions of existence

which rule out all alternatives as mere daydreams and leave no choice
but the taste for the necessary” (1984, 178). In other words, taste is pro-
duced by one’s living conditions and tends to reproduce itself because
it becomes regarded as natural. In this light, consumption of preserved
vegetables in Langzhong could be seen as a form of Bourdieu’s habitus:
as a habit that outlives the economic and social conditions that had
produced it (see Bourdieu 1990, 62). The consumption of preserved
and moldy food, however, cannot simply be regarded as a form of pov-
erty-related self-oppression. Indeed, hierarchies of value with regard to
food are not given nor perceived as such but rather subject to incessant
negotiations (Lora-Wainwright 2007). Perceptions of what constitutes
an adequate diet depend very much on whose standards such assess-
ments are based. Parameters on which these conflicts are premised
are produced by past and present conditions and by life trajectories.
Differences in taste noted by Bourdieu are visibly mapped across the
generational divide in the contemporary Chinese setting, making some
young villagers keener to consume lesser amounts of preserved vegeta-
bles and to purchase fresh market food.20 Yet for most villagers (except,
in some cases, the youngest), preserved vegetables remain a core part of
local diet even as relatively increased incomes may now permit access
to more diverse foods.
The centrality of preserved vegetables to villagers’ habitus as a
widespread and long-standing practice partly explains why now they
are usually not considered carcinogenic. Yet their perceived role in caus-
ing cancer has changed following their shifting position in the local diet
and economy between times of shortage and times of relative prosper-
ity. Villagers attributed past widespread spitting and choking illnesses
to poverty, starvation, and food shortages. As they pointed to preserved
vegetables as one of the few components of diet during such times, and
given that these illness categories are commonly regarded to correspond
to esophagus and stomach cancer, preserved vegetables are now asso-
ciated with (if not necessarily seen as a cause of ) cancer during those
periods. In this context, retrospectively linking these past illnesses with
preserved vegetables also phrases a denunciation of past poverty. The
significance of these foods has, however, changed in the present. While
villagers now attribute cancer in the past to deficient consumption, can-
cer in the present is more often attributed to excessive consumption of
harmful substances, such as farm chemicals (chapter 3), tobacco, and

alcohol (this chapter), as well as to the excessive demands of production
during the collective past.
The different positions of preserved vegetables in cancer etiology
betray perceptions of the moral economies of the past and present.
Writing on Bolivia, Libbet Crandon-Malamud (1991) argues that the
changing identity of thieves of kidney fat (from the ghosts of Franciscan
monks to Mestizos trading in La Paz) reflects changes in Bolivian his-
tory and power relations. In Langzhong, the difference between linking
cancer to preserved vegetables in the past but not in the present is also
a comment on shifting moral economies. That preserved vegetables are
associated with cancer during times of shortage also implies a judg-
ment of such times as characterized by an immoral economy. During
a time of relative prosperity such as the present, however, they have
taken on different implications. In the context of a market economy
that demands competition and consequently encourages the use of
farm chemicals, eating preserved vegetables presents an effort to recon-
stitute a moral economy based on homegrown food free from chemicals.
Indeed, farmers justify their consumption of preserved vegetables (on
which few chemicals are used) as an attempt to limit harm. As I have
argued in chapter 3, consumption of food with limited farm chemicals
is one way in which villagers reclaim agency in decreasing the likeli-
hood of cancer. Accordingly, preserved vegetables (old habits fostered
by shortage) are seen as the healthy (and green) alternative to buying
vegetables in the market without knowledge of what is used to farm
them. Given their role in current diet and their moral connotations vis-
à-vis the market economy, preserved vegetables are not considered car-
cinogenic. By denying their carcinogenic potential, villagers wage an
implicit critique of the market economy that has made the widespread
use of farm chemicals necessary.
The processes and contexts by which cancer is or is not attributed
to preserved vegetables are too complex to be elucidated with reference
to habitus alone. Like habitus, the consumption of these foods continues
beyond the economic circumstances that made it necessary. The current
refusal to blame cancer on preserved vegetables may partly be ascribed
to their status as a long-standing, internalized habit (or habitus), which
would place them beyond blame. This, however, does not explain why
they are associated with past cancer but excused from blame in the
present. Where habitus describes widespread and common practices

that become naturalized and taken for granted—and therefore, I would
add, practices that cannot be considered causes of illness—past cancer
is in fact linked to a food that is and was very common. While habitus
cannot illuminate why past cancer is associated with a common practice,
neither can it fully clarify the connotations of preserved vegetables in the
present. Although consumption of these foods has remained a common
practice, the new context of the market economy has endowed them
with a different significance. In other words, they are part of xiguan, but
xiguan is flexible; it adapts to new conditions and takes on different con-
notations when it is embraced in the present. The value of preserved
vegetables, expressed in the denial of their carcinogenic potential in the
present, is also a critique of the current market economy.
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,
1995). Equally, experiences of cancer have been shown to be closely

tied to discourses of blame and morality.21 The question of how blame
is attributed and to whom is highly disputed, and it is at the very core of
negotiations about moral behavior. Cancer is often considered “the fault
of someone who has taken part in ‘unsafe’ behavior: alcoholism, smok-
ing, or working with chemicals” (Weiss 1997, 457). Based on research on
cervical cancer in Brazil, Jessica Gregg (2003) has shown that blame for
cancer is situated in cultural and social contexts powerfully transmitted
in stereotypes of the poor as dirty and promiscuous.22 Since these meta-
phors serve to blame poorer social groups for their own suffering, cancer
is also blamed on individual sufferers. In response, cancer patients con-
struct their own accounts of disease, often in contrast with biomedical
discourse. Similarly, Martha Balshem’s research on cancer among work-
ing-class Philadelphians (1991, 1993) shows that the residents of the
“cancer hot spot” refused to adopt changes in lifestyle advised by edu-
cation programs. Where health educators would blame the high rates
of cancer on people’s fatalism and unwillingness to change their life-
style, Balshem understands their actions as a form of resistance, equal
to James Scott’s “weapons of the weak” (1985). By attributing cancer
to fate, people declined responsibility and avoided blame. In doing so,
they also countered the hegemony of biomedicine and unequal power
relations played out in clinical medical practice. In her study of cancer
among Mexicans, Linda Hunt (1998) also suggested that cancer patients
did not resort to biomedical notions to make sense of cancer. But where
Balshem’s and Gregg’s informants did not accept individualized expla-
nations for cancer, Hunt argues that people deny arbitrariness and seek
to understand why individual sufferers developed cancer by relating it
to particular events in their lives.
Neither of these approaches fully applies to the fieldwork find-
ings outlined above. Rather, different etiologies are adopted at dif-
ferent times during illness and after death, depending on who they
implicate and on their role in creating a moral universe. Building on
Byron Good’s understanding of illness narratives as unfinished (1994),
Veena and Ranendra Das stated, “People did not move through illness
experiences with ready-made ‘beliefs’ about the causes of their illness”
(2006, 90). The same may be said of the ways in which Gandie’s fam-
ily made sense of his illness. When Gandie was first diagnosed with
cancer in October 2004 but not informed of this diagnosis, his relatives
confidently attributed his discomfort to repressed anger. This enabled

them to hope that his illness could be cured, if only he learned to con-
trol his temper. At this time, they regarded Gandie’s ability and fond-
ness for smoking and drinking spirits as a sign of health rather than a
cause of cancer. Gandie’s own realization that he had cancer through
his decreased ability to eat—what Deborah Gordon called “embodied
or unconscious knowing” (1990, 276)—triggered a shift in the ways in
which the family explained his illness. In particular, as death came to
seem inevitable, they avoided tracing his illness to any etiology at all,
commenting that “this is what this illness is like—you don’t know why
you get it, and you can’t cure it” (a frequent statement).
I have already highlighted that ambiguity as to whether cancer is the
fault of an individual or of wider circumstances potentially works to rein-
force the efficacy of a given etiology. Repressed emotions, for instance,
are situated between individual propensity and the result of family con-
flicts. Smoking and drinking, similarly, are seen as an individual prefer-
ence but also the result of strong social pressure and of their importance
as a social activity. Ultimately, ambiguity was fully embraced in the later
stages of illness. A study titled “Influence of Traditional Chinese Beliefs
on Cancer Screening Behaviour among Chinese-Australian Women”
suggests that fatalism encountered among Chinese-Australian women
may be traced to the influence of Confucian, Buddhist, and Taoist tra-
ditions and a sense that cancer etiology is mysterious and it is therefore
futile to seek explanation (Kwok and Sullivan 2006, 696). This argu-
ment relies upon a static and unified view of culture and of experi-
ences of illness. I would rather suggest that resort to fate is made as it
allows sufferers and their families to avoid blame. Veena Das (1994)
similarly noted that blaming gods and the contingency of events for
suffering and disorder in one’s life emancipates sufferers from taking
responsibility for their fate.
In this sense, attitudes about cancer during its course broadly
reflect Sontag’s sentiment that finding a meaning for cancer is “puni-
tive” (1991, 59). Indeed, having ascribed cancer to smoking or drink-
ing would have implied that Gandie might be partly responsible for his
illness. Likewise, attributing cancer to anger and anxiety would have
unavoidably resulted in attributing blame—either to Gandie for his bad
temper or to those who made him angry—and this would have reaped
no benefit for Gandie or for his family. Yet, the search for an explanation
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
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
as well as some honey, royal jelly, and a packet of glucose presented as

gifts to Gandie.
All visitors brought something for Gandie. Guoyun offered 50 yuan
to help toward the cost of medicine. Erjie gave her mother one of her
ducks and told her to prepare duck soup for her father, one of his favor-
ite dishes. Uncle Wang (a cancer sufferer in Baoma) had told me that
milk was one of the few nutritious foods he could still consume and that
it made him feel better, so I offered Gandie some fresh milk. His eldest
daughter apologized profusely for not visiting more often and brought
some doufu. She commented that it was soft and nutritious and that given
Gandie’s difficulty in swallowing food, it was ideal to bolster his energy.
Both Erjie and her eldest sister urged him to “eat better food.” Gandie
thanked his daughters and me for the gifts, and he produced a small
notebook on which he recorded all the donations he had received since
falling ill, emphasizing how kind friends and relatives had been. Erjie
remarked that his grandson’s return home from Fujian was also very
expensive and time consuming and expressed Guoyun’s care toward his
grandfather. The conversation then revolved around Guoyun’s life in
Fujian, the unsuitability of his current girlfriend (whom none of the rel-
atives had met), the near impossibility that a girl from a prosperous area
such as Fujian would ever want to marry a man from a poor Sichuanese
village, and the large amounts of time and money youngsters spent surf-
ing the Internet. On our way back, Erjie reflected that the first to die in
a couple is comparatively lucky, because their partner will care for them
until they die. But the one who is left behind, if children are not filial
and caring, will die alone.
What kinds of costs are entailed when a relative develops cancer,
and who shoulders them? Beyond the narrow definition of treatment,
cancer entails great emotional and financial costs for the sufferers and
their families. Returning to the case of Gandie and his family (see chap-
ter 5), this chapter delineates the costs incurred in dealing with cancer
for the sufferer’s nuclear family and extended family. I show that a com-
prehensive account of the cost of illness should include not only expen-
diture on treatment and mourning rituals and banquets but also costs of
travel for visiting relatives, lost working days, and medical expenses for
distressed members of the family. Indeed, when a relative is diagnosed
with cancer, the reaction is often an exodus in search for money, travel-
ing for days on coaches to more prosperous distant cities in the hope
Family Relations and the Cost of Cancer     179
of raising enough to cover at least some intravenous drips. Conversely,

relatives who have lived and worked far from home may abandon their
jobs and return home. Loss of earnings caused by diverting energies to
caring for a sick relative also needs to be factored into the estimation of
the cost of illness. As Erjie’s case illustrates, cancer developed by one
family member causes deep distress to others and often results in their
physical discomfort, which in turn requires more financial investment.
Accounts presented here should provide a more comprehensive sense
of the ways in which illness affects the sufferer’s family and serve as an
example of the costs of cancer in the family and of the diversity of fam-
ily caregiving practices.
A comparison of Gandie’s case with that of Uncle Wang highlights
the fact that expenditure varies greatly depending on family composi-
tion, income, and family members’ attitudes and attachment to the suf-
ferer. At first, costs that concern those outside the nuclear family of the
sufferer may seem tangential, since income and expenses for Gandie’s
family and for Erjie’s, her sister’s, and her brothers’ are typically kept
separate. But illness provides exceptional circumstances in which the full
impact of illness can only be understood by looking beyond the narrow
confines of the nuclear family of the sufferer. Indeed, all of the sons and
daughters were involved in decision making and expenditure for Gandie
and their own personal health, although their decision power, influence,
and investments may have been uneven. The extent to which family
members contribute to the financial and other costs of illness is central to
defining who is encapsulated by the label “family” and to challenging or
reproducing family relations. Divergence in parameters of care caused
conflicts between siblings (for instance, between Guofu and Guoyun’s
parents). It also channeled ongoing tensions (between Guofu and his
parents, between Dasao and Sansao, and between Erjie, Dasao, and
Sansao). Examples illustrate family relations that are always in the mak-
ing, through engagements with caring practices. What constitutes care,
however, is very much open to dispute. The sufferer’s need for care mobi-
lizes diverse moral economies—subsistence, householding, reciprocity,
and market economy. Each is attributed a different value by different
family members and may be employed to varying degrees, but all are
central to the family’s moral economy and its ability to respond to illness.
The examples of Gandie and Uncle Wang allow a closer grasp
of the intricate processes through which closeness is formed through
practices of care. As Andrew Kipnis (1997) and Yunxiang Yan (1996)

have argued for guanxi production, these caring practices are never
solely financial, but they are imbued with emotional engagement and
significance. Through a focus on costs, both emotional and financial,
this chapter unravels the specific local moral worlds in which cancer
was experienced (see Kleinman 1995). It describes some of the ways
in which morality is performed and constituted through family caring
practices, which at once presuppose a loving relationship and rein-
force it. By examining these caring practices and the dynamics of fam-
ily relations, this chapter forms a background to the following one, in
which the attention is focused specifically on attitudes and decisions
surrounding treatment. The financial challenges incurred by a major
illness force families to make difficult decisions and result in many dis-
agreements as each member of the family negotiates the parameters of
moral behavior. As they engage with illness, the agency of sufferers and
their families becomes clear, but it ought to be measured against the
many structural and financial obstacles that make any talk of biology
as “manipulable” (Rose and Novas 2005, 442) overly optimistic at best
and potentially undesirable from the point of view of sufferers’ families
(see previous chapter).
The Costs of Cancer for Gandie and His Family
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.
– 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
amounted to roughly 2,000 yuan over the course of illness. Alongside

these injections, he was also taking pills to “replenish vital energy, nour-
ish yin, accompany radiotherapy, chemotherapy or surgical operation
and restore body functions” (description printed on the container in
English) and other nutritional ( yingyang ) supplements such as honey and
royal jelly. The cost of his treatment (including nutritional supplements
and food treats such as meat, duck soup, doufu, milk, and honey) is likely
to have been around 3,000 yuan. Ganma and her sons and daughters
often remarked that “thousands of yuan” were spent on his illness. Only
he and his wife would have known the exact figure, and it seemed insen-
sitive to ask, but a total figure of 3,500 yuan over six months for diag-
nosis, medication, and food treats is a fair estimate. Compared to the
average expenditure over six months for a couple of farmers without
school-age children (roughly 1,200 yuan; see fig. 2.6),1 expenditure on
Gandie’s health was extremely high by local standards.
When Erjie and I visited her father, her routine question to him was
whether he had had a drip that day or recently. Regardless of whether
the answer was in the affirmative, Gandie continued to argue, “It’s a
waste of money—I’ll die anyway.” Chapter 7 unfolds the complex rea-
sons why Gandie argued in favor of limiting investment in his treatment,
stressing the inevitability of his own death. At this point it will suffice
to say that a level of noncompliance was typical in villagers’ approach
to any illness. The attitude was that if no progress was evident after a
few days, there was no point taking more medicine. This would have
been more difficult to establish with treatments such as chemotherapy,
which lasted a few days and then required a wait of three weeks before
the next treatment. Gandie’s outlook on drips and medication may be
understood in a similar fashion to his approach to surgery (see chap-
ter 7), motivated by a sense of duty to his family and by a perception
that, considering the high cost of treatment, it did not in fact have the
desired effects (if any at all).
Banquets and Mourning Costs

Other costs were entailed in Gandie’s illness beyond the strictly medical
ones. His birthday banquet required an investment of over 500 yuan on
fireworks alone, because, as Erjie put it, “Next year he will not be able
to celebrate his birthday” (October 19, 2004). These were purchased by
Erjie and her husband. Other banquet costs (including food, drinks, and
extra firecrackers) amounted to around 1,200 yuan, catering for roughly

sixty people divided over two days. I attended ten birthday parties for
those in their sixties or older and only half of these included fireworks.
In some cases, the host or hostess was against expenditure on fireworks
and asked instead to be given food or money. Only in one case did the
amount of fireworks equal that of Gandie’s, and this party was also in
honor of a man diagnosed with esophagus cancer, whose family (rightly)
thought he would not have any more birthday parties. He died three
months later, in September 2005.
The costs associated with the funeral and mourning customs are
the most significant after medical costs. I have compiled a table (fig. 6.1)
that outlines the cost of mourning rituals in the cases of Gandie and
Uncle Wang, and the average costs according to two key informants:
Xiaohong, a local twenty-two-year-old man, and Tianhui, a local nine-
teen-year-old woman. During fieldwork in 2005, Xiaohong and Tianhui
helped me to gain a sense of these costs based on locals’ accounts of
direct experience and on their sense of average expenditure. As this
table shows, expenditure for mourning rituals varies greatly depending
on family composition and resources. For Gandie, these costs amounted
to 5,800 yuan, excluding the banquet and rituals on the first anniver-
sary of his death (February 2006). In stark contrast to medical costs,
which families complained were extortionately high, families rarely
complained about the costs of mourning rituals—as when they felt that
they had not been distributed evenly among family members (see chap-
ter 8). These costs would be entailed by any death, and this may also
explain why family members did not feel as outraged by mourning costs
as they did by those precipitated by cancer specifically. But since they
were substantial and an unavoidable part of the costs precipitated by
cancer more widely, they nevertheless demand consideration.
Usually, families who did not cremate their relatives’ bodies paid
local officials between 300 and 1,000 yuan to keep the matter quiet.
Gandie’s family, however, refused to do either. Perhaps because he had
served as a village official in the past and was well liked and because they
felt it was unfair to bribe officials, his family refused to do so. A couple
of weeks later, however, township officials confronted Gandie’s family
and asked for 600 yuan as a fine. Ganma argued that her husband had
served in the local government and that the family had already spent a
large amount of money on his illness. The official agreed to charge each
Figure 6.1 Cost of mourning rituals (yuan)
Average expenditure Uncle Wang’s
(Xiaohong’s Average expenditure Gandie’s case case (my
Items estimate) (Tianhui’s estimate) (my estimate) estimate)
Cremation or fine for avoiding cremation 300–1,000 depending 300–1,000 300 N/A
on connections
Four major banquets (funeral day, last 150–200 per table, 300–400 per table, 3 tables 300 per table, three 1,000 for
shaoqi ritual, one hundred days after death, 3 tables on on 4 occasions: total: tables: 900, three 3 occasions
and first anniversary) with minimum of 4 occasions: total 3,600–4,800 occasions during during
three tables (10 people each) 1,800–2,400 fieldwork, total 2,700 fieldwork
Chef 20–30 per table, minimum 100 in total (only
of three: total 60–90 employed on funeral day)
Smaller weekly banquets during shaoqi 250 300–500, depending on 400 200
period total family size and attendance
Funeral band 150 (usually courtesy of
the guests)
Geomancer 100 50–100 100 100
Eight assistants to the rites, given a pair of 40–50 times 40–50 times 8 = 320–400 400 300
shoes, a towel, four packets of cigarettes, 8 = 320–400
and 20 yuan
Incense, paper, and firecrackers (in total 200–500 700–900 800 (excludes cost of 300
for all shaoqi, usually courtesy of family yearly anniversaries for
and friends) three years)
Coffin 800–1,000 800–1,000 1,000 1,000
TOTAL 3,770–5,650 6,280–8,940 5,800 (excludes banquet 2,900 (excludes
and rituals for first banquet and
anniversary, probably rituals for first
over 1,000 yuan) anniversary)
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.
Health Costs for Gandie’s Extended Family

As we have seen, Gandie’s suffering brought great distress upon his
close relatives, which in turn required further investment in diagnosis
and treatment. Gandie’s wife, Ganma, predictably suffered the most. In
the final two months leading to his death, Ganma had a persistent cold
and took Chinese medicine and sometimes amoxicillin pills bought over
FIGURE 6.2 Total costs precipitated by cancer

Gandie’s case Yuan Uncle Wang’s case Yuan
Costs for Gandie and his wife: Costs for Uncle Wang
Birthday banquet (including 1,700 and his wife:
fireworks) Medical expenses for 2,600
Medical expenses (including 3,500 Uncle Wang
diagnosis, food treats, and Mourning rituals 3,000
treatment) for Gandie Uncle Wang’s wife’s 100
Mourning rituals and fine 5,800 health
Ganma’s health 200
Extra costs for other family Costs for other family

members: members:
Erjie’s family’s estimated lost 300 Daughter-in-law’s trip 1,200
working hours home and estimated lost
Three sons, one daughter, 1,000 working hours
and their spouses estimated Daughter’s trip home 50
lost working hours Family healthcare costs 150
One grandson’s two trips home 2,000
Erjie’s health care costs 400
Monetary gifts from outside –500 Not

extended family known
Total costs for Gandie and 11,200 Total costs for the couple 5,700
his wife
Total cost for extended family 14,400 Total cost for extended 7,100
family
the counter. It is difficult to know exactly how much of these medicines

she took. She told me, “I take some when I’m particularly bad” (a fre-
quent statement). When I visited her in December and January (roughly
twice a week), she always had some amoxicillin and penicillin pills and
some patent Chinese medicine sachets for colds to dissolve in boiling
water ( ganmao chongji). When I praised her strength and courage, she said,
“What else can I do? I can’t sleep with him like this.” Then she turned
to her daughter, “How could I sleep? Just look at him!” ( January 21,
2005) It is likely that Ganma spent at least 200 yuan on trying to ease the
discomfort caused by the traumatic experience of watching her husband
starve, the emotionally and physically demanding task of caring for him,
the sleepless nights spent assisting him, and her ensuing colds and flu.
The extent of the physical impact of Gandie’s illness on his sons

was less easily observed, because when I visited they were usually at
work. I saw his eldest daughter only when she visited and therefore
have little sense of how her father’s illness affected her physically and
emotionally. I had occasion to observe closely the effect of Gandie’s ill-
ness on his daughter Erjie, as we shared all of our meals and had long
informal conversations. Like her mother, Erjie was ill with a persistent
cold from November 2004 until February 2005, which she attributed to
anxiety about her father’s condition. Since her father became sick, Erjie
experienced difficulty in breathing and eating due to a feeling of anxiety
(zhaoji) and heat in her chest (xinli fa re). As she put it, “As soon as I think
of him, I become very anxious and cannot eat” (a frequent statement).
She often avoided sitting at the table with her husband, daughter, and
me, instead remaining behind the cooking stove, holding a small bowl
of rice and eating with some reluctance. Such retreat from commen-
sality is a powerful statement given its cultural and social significance
as a producer of social relations (see Lora-Wainwright 2007; M. Yang
1994). To some extent, mealtimes made Erjie reflect most painfully on
the condition endured by her father and on the impossibility of sharing
a meal with him. Commensality with her husband, daughter, and me
made the imminent and inescapable loss of her father more conspicu-
ous and thus made her unwilling to eat (bu xiang chi). By not eating, Erjie
merged her experiential horizon with that of her father and positioned
herself closer to him. In January, whenever we visited him, Erjie sat in
the room watching the floor and rubbing her forehead, complaining
of headaches. She remarked on this more or less daily because, as she
frequently pointed out, she “never really got ill in the past, not even with
colds.” This observation highlights the extreme suffering her father’s ill-
ness caused her, unmatched by any discomfort she had ever experienced
until then. Worried that her distress closely resembled her father’s initial
symptoms, Erjie also spent 200 yuan on an endoscopy at the Langzhong
People’s Hospital and about 200 yuan on remedies for flu and chest dis-
comfort from a city clinic recommended by her neighbors.
Contesting Care within the Extended Family

Considering the extended family’s expenditure surrounding Gandie’s
illness provides a more realistic sense of the financial flows involved. It
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
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)
are articulated through Guofu’s choice of caring for Gandie by sending

a financial contribution rather than coming home. In this way Guofu
laid claim to caring for his grandfather, while he also evaded his parents’
control over him. On their part, Dage and Dasao strived to maintain at
least a semblance of control over their son by presenting his refusal to
return as a decision that they approved of. Indeed, the more other sib-
lings faulted Dage and his wife for failing to control their son, the more
Dage and Dasao insisted that their son’s choice was sanctioned by them.
Diverse means of livelihood embraced by Gandie’s offspring
enabled alternative ways of caring. Some offered money, some produce
from their own farm, others day-to-day care, food treats, and help with
travel to the clinic. All, however, made claims to caring for Gandie. In
doing so, they endeavored to maintain a moral position within the fam-
ily. Equally, family relations have a powerful influence upon the ways in
which family members care for a sick relative. Guofu’s decision not to
return for Gandie’s illness and death may be seen as the result of a dis-
pute between Guofu (who wanted to divorce), his parents (who wanted
to stop him from doing so and retain control over him), and Dage’s sib-
lings (who criticized him and his wife for failing to control their son). His
parents, however, strived to frame his choice not as an act of disobedi-
ence toward them but as a caring act toward Gandie. Guoyun’s return,
likewise, was presented not as a result of his practical circumstances
(lack of a suitable job, younger age, and relative geographical proximity)
but as a desirable way to care for his grandfather. Through discussions
over their respective sons, the families of Dage and Erge competed to be
recognized as caring toward their father and as able parents who could
advise their sons and secure their compliance. At stake in their argu-
ments over family caring practices was not only their respective son’s
moral standing but also their own standing as able parents.
While Dage and Erge’s families both made claims to caring for
Gandie, all of Gandie’s children criticized their youngest brother, Sange,
and his wife, Sansao, for failing to care for Gandie. Both Dage and
Erge’s homes were adjacent to Gandie’s, but Sange’s home was shared
with his parents, as is common for the youngest son. Soon after they
married, however, Sansao had recurrent arguments with her in-laws,
the two households divided ( fen jia), and Gandie built a separate kitchen
for himself and Ganma—a narrow bamboo and mud room without
a smoke chimney—leaning on the outer wall of their bedroom. Erjie
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
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.
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).
Uncle Wang’s Illness

In all likelihood, medical expenditure for those who did not undergo
surgical procedures amounts to a minimum of 2,000 yuan for basic
health care of the cancer patient, excluding diagnosis, nutritional sup-
plements, and food treats. Differences between cases are, however, strik-
ing. I will briefly consider the case of Uncle Wang as a comparison to
highlight how diverse family composition and family relations entail dis-
parate patterns of expenditure. This will further unravel the divergent
strategies families adopt and competing parameters of what constitutes

caring practices.
Uncle Wang, like Gandie, was in his early sixties. He was diag-
nosed with stomach cancer in June 2004 and committed suicide in the
late stages of cancer in November the same year. His family was much
smaller than Gandie’s. He had only one son and one daughter, and
his grandchildren were not of working age. Uncle Wang’s son and his
wife were therefore solely responsible for providing for his treatment.
Uncle Wang’s wife, Aunt Zhang, explained that they did not want any
help from their daughter because she had no income other than farm-
ing and was responsible for caring for her in-laws. As was the case for
Guofu, Uncle Wang’s son had been home briefly in May 2004, at the
outset of his father’s illness. He did not attend his father’s funeral but
returned three months later, in February 2005, for Chinese New Year.
Aunt Zhang told me she did not consider her son’s behavior immoral
or unfilial—quite the contrary. Indeed, his decision to continue work-
ing in a factory in Guangdong was the result of his father’s illness and
enabled him to send some money home to cover his father’s medica-
tions. By November 2004, his wife had not returned home for over a
year, and their daughter, Youhui, missed her very much. Aunt Zhang
felt that Youhui needed her mother’s support and that she could do
with some help at home. As they were not in a position for both to quit
work, and Youhui’s father earned more than her mother, they decided
that her mother should return home. The fact that his wife returned in
time for the funeral and stayed home for over two months helping her
mother-in-law contributed to making Uncle Wang’s son’s behavior not
only acceptable but also commendable.
As with most villagers, Aunt Zhang refused to cremate her hus-
band’s body. In order to evade the fine she would incur for avoiding
cremation, Aunt Zhang kept her husband’s death as secret as possible.
This entailed limiting the funerary rituals to make his death less con-
spicuous. The family, for instance, did not host a large banquet for his
funeral. Unlike Gandie’s family, Aunt Zhang succeeded in avoiding the
fine. Partly this might be due to the care she took in keeping a low pro-
file. Partly it might be linked to the fact that Uncle Wang and his family
lived in one of the poorest houses in the village, and they were known
to be facing dire financial straits, relying on the income of only two
migrant laborers (one after the daughter-in-law’s return home). Gandie,
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
more direct. In the course of semistructured interviews in July 2005 (see

appendix 1), I asked Aunt Zhang about medical expenses:
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).
In this narrative, a clear and lasting effect of cancer on the family

emerges: financial loss. Having worked as migrants in Guangdong for
over ten years, Uncle Wang’s son and his wife hoped to be able to buy
a small house in Langzhong city. Uncle Wang’s illness, however, meant
that savings accumulated through years of migrant labor were spent on
health care, binding them to a mud house in the countryside.
Reflecting with me on his condition in October 2004, Uncle Wang
claimed, “When we [farmers] get ill we can’t even afford treatment—
we’re just left to die.” As he explained, the lack of a welfare system
providing free or more affordable health care is a crucial problem for
cancer sufferers, and it is exacerbated as the illness aggravates. Indeed,
all the cancer sufferers and families with whom I discussed these issues
complained about the cost of treatment. This attitude is not specific to
cancer, but the fact that cancer requires large sums of money throws
into sharp relief the lack of state intervention to alleviate these costs
for those without funds. This claim elucidates the ways in which can-
cer and illness more widely are often perceived to embody large-scale
social forces. As I explain in the following chapter, perceptions of the
inefficacy of surgery for cancer and people’s inclination not to resort to
hospital care in general are also shaped by these contexts. Uncle Wang’s
own narrative about expenditure linked to cancer articulated more
than simply a complaint about its high cost; it was also a critique of the
social policies that allowed it to be the case: “I can’t work; this illness is
serious—I can’t do anything, I just sleep and sit. . . . And nobody can
help, the state doesn’t care for me; I haven’t received even a penny from
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
its corporate nature to the detriment of individuals and emotions (1996,

115; see also Y. Yan 2003).4 Gandie’s and Uncle Wang’s examples show
that attention either to individuals, to conjugal units, or to the family
as a corporate unit may not account for the complex engagements of
family members with cancer, the reasons behind their disparate modes
of engagement, nor their effects on family relations. By not returning
home, Guofu exerted his independence from his parents, but his deci-
sion was reappropriated by his parents as a way of caring for Gandie.
Guofu’s position can therefore be understood both in individual terms
and as an engagement with his own nuclear family (his wife), his par-
ents, and the extended family at large. The diverse reactions of Gandie’s
close relatives outline a family that is both united in its aim (care for
Gandie) and divided by disagreements over how to reach it.
Care and affection toward Gandie were embodied in a variety of
practices: Guoyun’s return home; Guofu’s refusal to return and his
financial contribution; visits by his offspring, relatives, and acquain-
tances; Erjie’s gift of ducks; her sister’s offer of doufu; pork rib soup from
his eldest son’s family; milk from the anthropologist; and Erjie and her
mother’s physical discomfort. Care toward Uncle Wang similarly took
different forms: his wife offered day-to-day care, his son sent remittances
to cover health care costs, his daughter visited, and his daughter-in-law
returned home at the late stages of his illness. The diverse ways in which
family members respond to illness can only be understood by consider-
ing the local moral worlds of the subjects involved. To some extent,
differences in caring practices followed age lines: those older, such as
Ganma, Dage, and Dasao, offering day-to-day care, and those younger,
such as Erge and Sange, taking on waged labor. But age was not the
only determinant. Differences also depended on the abilities of each
family member—that is, whether or not they could secure waged labor
and whether their occupation was lucrative (Guofu) or less so (Guoyun).
One’s existing relationships with other family members and their posi-
tion within the family also influence how each cares for the sufferer and
the moral worth he or she claims to derive from doing so. How families
are mobilized to cope with illness involves the intersection of house-
holding (pooling from the family), reciprocity (resorting to connections
to identify reliable practitioners and treatment), subsistence (farming
to guarantee food and food gifts), and market economy (seeking wage
labor to face the costs of treatment). Different models of livelihood are
valued and embraced differently by different generations and family

members, but all are central to the moral economy of the family. The
picture that emerges is one of people striving to build morality just as
much as they complain about its lack.
Examining the diversity and disagreements in relatives’ engage-
ment with Gandie’s illness helps to unpack family relations as always in
process, renewed or challenged through social practices. Ethnographers
of China have explored how family and social relations are produced
through everyday practices such as visiting, gift giving, and participation
in rituals that are not merely utilitarian but also affective (see Kipnis
1997; Y. Yan 1996). Examining the complex relationship between emo-
tions ( ganqing) and relations ( guanxi), Andrew Kipnis has argued that the
display of emotions and gift giving are never purely instrumental or cal-
culated. Subjects are aware of the social effects of engaging (or failing
to engage) in particular practices, but this does not make their intentions
dishonest (1997, 104–115). Similarly with caring practices, they are not
simply functional practices that fit neatly in a model of social exchanges,
but rather they channel the flow of care and emotions, playing a cen-
tral role in the constitution of moral subjects. Relatives’ endeavors to
provide for the sufferer are all the more central to the production of
moral subjects given the limitations of state provision (particularly until
2006). In this context, families take on the role as “medical agents of
the state” (Biehl 2005, 22). Nikolas Rose may recognize some of the
practices in which Langzhong villagers engage as efforts to reconfigure
“the politics of life itself ” (2007), taking an active part in understanding
their illness and in their own recovery. The extent of individual choice
and the “new space of hope and fear” (Rose and Novas 2005, 458) in
which people deconstruct biological determinism and make decisions
on their health are, however, a far cry from the sense of limited options
Langzhong villagers have at their disposal. As the following chapter
demonstrates, denial of hope in some cases serves to reinforce family
relations. A clearer sense of the constraints, of the variety of strategies
to tackle them, and of how the specific texture of family life influences
paths of healing provides some insight on the production of moral sub-
jects and on what happens to families in rural Langzhong when they are
faced with cancer.
Chapter 7
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).
and perceptions of efficacy—to trace the various factors influencing

health care–seeking patterns. It illustrates how hospital treatment (and
cancer surgery in particular) is understood by villagers, why, and with
what effects.
The first part of this chapter provides an account of the devel-
opments of health care provision since the founding of the People’s
Republic (1949) at the national, provincial, county, and village level.
This elucidates the ongoing health care disparities between rural and
urban and wealthy and poor regions both in terms of quality and quan-
tity of care available and the clear structural obstacles villagers face
in accessing extortionately expensive care. It highlights villagers’ self-
perception as second-class citizens, left behind by improvements that
have benefited their urban counterparts. As cancer sufferer Uncle Wang
stated, “When we [farmers] get ill, we can’t even afford treatment—
we’re just left to die” (October 2004). This sentence was perhaps the one
that recurred with the most frequency during my fieldwork. In this light,
before the introduction of the new rural cooperative medical system
(RCMS, a collective health insurance program) in the area in 2006, the
answer to the question “Why do villagers not seek hospital treatment for
cancer?” might seem to have been straightforwardly financial.
The second part of the chapter argues that, however important cost
may be, the widespread failure to resort to surgery is not only a conse-
quence of lack of funds per se. Writing on the folk dietetics of pregnancy
in southern India, Mark and Mimi Nichter argue that “economic expla-
nations for the food habits of rural poor pregnant women are insuf-
ficient. Within the ‘continuum of poverty,’ resources are maximised to
varying extent by those with similar economic capacities” (2003, 36).
In other words, cost considerations alone cannot account for health-
seeking behavior. It would be just as flawed, however, to assume that
cultural factors are sufficient to explain medical choices. Work by Leo
Chavez and colleagues (2001) on Latinas’ attitudes to cervical cancer-
screening tests in the United States highlights this point. Their research
shows that when Latinas’ beliefs were close to those of Anglo women,
they were more likely to have had a pap test, while those whose beliefs
were closer to physicians were less likely to have had the test recently.
This finding disproves the assumption that compliance with medical
advice is at its best when the patient’s beliefs converge with those of
the physician. In turn, it questions the assumption that culture (read
non-White and non-Western culture) undermines compliance. On this

basis, Chavez and colleagues advocate balancing attention to both cul-
tural beliefs and structural factors such as medical insurance, age, mari-
tal status, education, and language acculturation. In making sense of the
widespread rejection of cancer surgery among villagers in Langzhong, I
embrace their call to take seriously both structural and cultural factors.
As Gandie’s example will illustrate, decisions about treatment lie at the
intersection between structural conditions in the past and the present,
cultural beliefs, and social identity.
Perceptions of a treatment’s efficacy have a crucial impact on
whether sufferers and their families opt to resort to it. Medical anthro-
pologists have long maintained that a treatment’s efficacy is not only due
to its inherent properties but also dependent on its social, cultural, and
economic contexts.1 When I use the term “efficacy,” this refers neither
to actual clinical efficacy as measured in clinical trials nor to the effec-
tiveness of treatments in real-life situations (Kamat 2009) but rather to
perceived efficacy—that is, whether villagers consider a particular treat-
ment efficacious and why. The second part of this chapter examines how
perceived efficacy and inefficacy are formed. I suggest that the high cost
of surgery, understood within the wider context of commodified health
care, contributes to producing its perceived inefficacy. Perceptions of
hospital care as premised on raising revenue for health care providers
feed skepticism toward such care and, consequently, unwillingness to
resort to it.
This understanding of hospital care as money oriented intersects
with social, cultural, and historical dimensions in ways that reinforce
perceptions of it as inefficacious. Anita Hardon’s work on self-care for
common health problems in Manila highlights that mothers choose par-
ticular cold remedies for children because they are part of a shared
symbolic system through which mothers are constituted as caring indi-
viduals. Treatments have economic efficacy when the balance between
cost and quality of care is adequate and the financial effort is seen to lead
to a long-term and worthwhile outcome. They have social and cultural
efficacy to the extent that they mark people’s identities, they produce or
contest family and social relations, and they intimately affect their per-
ceptions of themselves and enable particular kinds of social and sym-
bolic processes (van der Geest, Whyte, and Hardon 1996, 156–157; see
also Crandon-Malamud 1991). Conversely, through close analysis of
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.
Healthcare Provision in Context

The National Context
In a short piece written as part of the Lancet Series on Health System
Reform in China, Zhe Dong and Michael Phillips (2008) divide “the evo-
lution of China’s health-care system” into five phases, which are useful
for making sense of the changes in health care since the Communist take-
over in 1949. During the early “post-liberation” phase (1949–1965), the
government gradually took over the management of health care, started
a number of public health campaigns, and tackled health care provision
through a hierarchical structure of resort with village (brigade) clinics at
its base, township (commune) hospitals as the second step, and county
hospitals for more complex health problems. This structure was further
reinforced during the second phase, the Cultural Revolution (1966–1976),
when village clinics were strengthened through barefoot doctors—villag-

ers trained with city doctors (sometimes for as little as three months, oth-
ers over a year)—to offer primary health care at the village level. County
hospitals also provided mobile medical teams that took turns to serve in
the countryside (see Lampton 1977; Sidel and Sidel 1974).
Finance for rural health services during these two phases came from
a combination of government funding, cash payments from patients,
and funds from the rural cooperative medical systems, with higher levels
(county level and above) receiving state funding and village health cen-
ters mostly relying on local contributions. Pre-reform RCMS have often
been credited as providing coverage for all rural dwellers and producing
amazing results for a developing country, but their extent and even-
ness of provision are probably less comprehensive than is often thought
(White 1998; Duckett 2010). A rural-urban divide in health care insur-
ance emerged, as both areas relied on their respective structures of gov-
ernance: rural communes and urban work units. This structural gap in
welfare provision between urban and rural China was produced and
institutionalized by the household registration system (hukou) put in
place in 1958, which entitled urban residents to a number of benefits
while creating the category of peasants (nongmin) as second-class citizens
(M. Cohen 1993; Potter and Potter 1990). On the one hand, greater
government investment was devoted to cities, resulting in more and bet-
ter facilities, and urban dwellers received treatment free at the point of
delivery (Duckett 2007, 50). On the other hand, rural areas depended
on a cooperative scheme that was “self-funded and much less gener-
ous” (51), and their access to secondary and tertiary sectors remained
limited. Sydney White has shown that regional and intervillage varia-
tion in insurance cover was wide, as was the life of such schemes. In
one Yunnan village, the scheme lasted only three years and was discon-
tinued in favor of higher pay-per-visit fee. Ultimately, self-reliance was
“the mantra for ‘peasants’ . . . during the Maoist period, just as it has
continued to be during the post-Mao period” (White 1998, 483). This
meant urban dwellers faced fewer financial and physical obstacles to
accessing care than their rural counterparts. Accordingly, accounts that
indicate very high coverage by the late 1970s (90 percent in some cases)
are likely to be inflated (Duckett 2010). Whatever the coverage rate for
RCMS in the late 1970s, it was less than 5 percent by 1984 (Carrin
et al. 1997).
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
launched an initial trial of different health insurance schemes in poor

counties (Carrin et al. 1997). The year 1997 saw a renewed effort to
promote RCMS on a voluntary basis and mainly based on individual
investment, with little government input and flexibility to adapt to local
conditions (Duckett 2010). These efforts, however, did not lead to imple-
mentation on a large scale. In 2000, China’s health care system ranked
188 out of 191 World Health Organization member nations in terms of
its fairness of financing, outperforming only Brazil, Burma, and Sierra
Leone. Health inequalities and the gap between health care available
to China’s new wealthy and the deprivation characteristic of the poor
remained unchallenged (Reddy 2007). Dong and Phillips see the Severe
Acute Respiratory Syndrome (SARS) epidemic in 2003 as the cause for
the start of a fifth and most recent phase in the evolution of China’s
health system. SARS, they argue, highlighted the poor state of health
care, its infrastructure, and problems of access and spurred the neces-
sary political will to reform the system, with central funding supporting
the reestablishment of RCMS and a parallel program for urban areas,
aiming to achieve total coverage by 2020.5
Documents and official speeches throughout 2004 bear testimony
to a further strengthening of RCMS (Duckett 2010). This support of
RCMS was also evident in the Chinese government’s latest five-year
plan (2006–2010), which stressed the importance of building a “new
socialist countryside” by increasing rural investment and improving
social services. Among its aims is the resolution of the problem of
health care provision through the implementation of RCMS, which was
scheduled to cover all of China’s vast countryside by the end of 2008.6
The success of RCMS both locally and nationwide, however, has been
mixed. Several studies have already identified some of the problems of
implementing RCMS.7 In poorer areas, there are few local resources
to finance these schemes, and in sparsely populated or remote areas,
the time invested and costs incurred by travel, accommodation, and
food while accessing health care may discourage people from seeking it.
Sarah Cook’s research on RCMS shows that while individual contribu-
tions stayed at 10 yuan, contributions from local and central govern-
ment increased from 10 to 20 yuan each per person, raising the total
funds per person from the original 30 yuan to 50 yuan. RCMS, however,
cover costs only for certain conditions, and reimbursement mechanisms
are often complex and cover only a proportion of these costs. In its pilot
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).
The Local Context: Sichuan Province

Developments in health care provision in Sichuan since the founding
of the People’s Republic closely resemble those outlined for China as a
whole. While RCMS was established in the late 1960s, it was dismantled
by the early 1980s (Langzhong Public Health Bureau staff, April 2007).
A 2006 report in the online government forum China National Social
Security on RCMS in Sichuan stated that it was reestablished in June
2003 and that in trial areas the joining rate is 78 percent, up by 19.5 per-
cent from 2005 (CNSS 2006). As in the trend described by Cook (2007),
contributions per person also rose from 30 yuan originally to 45 yuan in
2006, including 10 yuan per person from villagers, 20 yuan per person
from the central Finance Bureau, and 15 yuan from province, prefec-
ture, and county, including a contribution from the provincial Finance
Bureau of 9 yuan per person. In 2005 the provincial government gave
36 million yuan to twenty-one counties included in the trial, and in
2006 the figure rose to 236 million. With an increase in participating
areas, in 2007 the province was expected to contribute 600 million
yuan, which according to the CNSS report strains the financial capacity
of an agricultural province such as Sichuan. In an attempt to ease these
pressures, in 2008 the central government’s Finance Bureau contrib-
uted over 2.4 billion yuan to Sichuan’s RCMS.8 The same report stated
that all of Sichuan Province’s 176 counties were covered, including the
rural population (central government web portal, September 16, 2008).
The Local Context: Langzhong County

Baoma’s first barefoot doctor, Doctor Wang, recalled that there was
very little if any biomedical treatment to be had in the Langzhong area
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.
For persistent and more serious ailments, villagers resorted to hospi-

tal care. Hospitals, however—and in particular the more sophisticated
People’s Hospital in Langzhong city—were seen as places that villagers
“don’t dare go in” (bu gan jinqu) or “can’t afford to go in” ( jinbuqi ). In
2004–2005, the cost of a minor surgical operation amounted to around
3,000 yuan, and a more serious one, of the kind required for esophagus
cancer, started at 6,000. Informal costs were also extortionate: financial
“gifts” (hongbao) of 500 yuan for minor and 1,000 for major operations
were offered to doctors. To these costs should be added those of hos-
pitalization preceding and following surgery and of other medications.
Considering that, according to township statistics, annual income per
capita in 2004 was 2,300 yuan (but likely much lower in reality), these
costs usually entailed spending all the family’s savings and very often
borrowing money. Because of these costs, villagers continued to under-
stand hospital treatment as very much part and parcel of the structural
gap in welfare provision between urban and rural China. A perception
that city dwellers typically had a salary and a pension, and were more
likely to have health insurance (whether or not this is still the case is a
Figure 7.2 The barefoot doctor’s clinic in Baoma (2005).

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
an improvement on the absence of insurance, it still left the family to

cover almost 50,000 yuan in costs, a sum that few rural families can
afford. On the other hand, when the scheme covers only large medical
costs, those who joined but failed to benefit from it may be skeptical of
its advantages. Attempting to cope with this potential skepticism toward
RCMS in 2007, those who joined but had not made use of the scheme
were entitled to receive a free health checkup; 155,945 people did so, for
a cost of almost 1.9 million yuan. From October 2007, a special method
for reimbursing the medical costs of outpatient treatment for chronic
illness was formulated, ruling that malignant tumors, chronic kidney
failure, and twelve other illnesses could resort to outpatient treatment
in 1,382 designated clinics. The total budget available for reimbursing
these treatments was 1.5 million yuan.
Commodified Health and Its Consequences

Perceptions of Care at the County Hospital and
Their Effects on Action
Increase in the cost of care following reforms doubtlessly poses obsta-
cles to accessing hospital treatment. But it has also had an important
effect on the ways in which health care is perceived and therefore on
the extent to which villagers resort to it. According to Mark Nichter
(2003b), in South Asia the commodification of health care has decon-
textualized health care issues from wider social issues and engendered
a false sense of security based on the assumption that health can be
achieved provided one pays for it. Similar processes of commodification
have had very different effects in rural Langzhong. In Nichter’s account,
people mostly follow the dominant rhetoric of a pill for every ill, and
this reduces their impetus to mobilize in favor of a better environment
and hygiene. In rural Langzhong, by contrast, villagers are highly criti-
cal of the consumerist approach to health care, which made hospitals
and their practitioners more profit oriented. This in turn informs per-
ceptions of doctors outside one’s social network—and hospital practi-
tioners in particular—as moneygrubbing and untrustworthy (see also
Nichter 2003a, 247; Whyte 1997).
Discussing work on organ trafficking in India by her collaborator
Lawrence Cohen, Nancy Scheper-Hughes states that allegations of
organ theft at public hospitals push people to “avoid public hospitals
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
treated particular problems and were reasonably priced, or—even bet-

ter—neighbors who counted a doctor among their relatives served as
key resources for securing adequate treatment and producing percep-
tions of it as efficacious and good value for the money. In other words,
practitioners one knows, or those associated with the positive experi-
ences of others, accrue social efficacy. Trust in the practitioner then acts
as a sort of placebo effect or “meaning response,” as Daniel Moerman
(2002) termed it, thereby contributing to the efficacy of treatment.
Social efficacy does not, of course, imply that trusted practitioners are
seen as infallible. But it increases the likelihood that sufferers will be
content with the result of treatment and with the balance between cost
and quality, and that they will return to the same practitioner in the
future. Village doctors, for instance, draw much of their efficacy from
their position within the local community (Lora-Wainwright 2005).
Whereas doctors in general are seen to no longer “serve the people,”
village-based practitioners still do so because their fees are regulated
by the state, they are part of the village community, and they have a
network of guanxi there and therefore respond to its moral economy.11
Conversely, hospital treatment such as cancer surgery typically lies
outside the moral economy of village relations and reciprocity. Villagers
attempt to integrate it within such moral economy by resorting to a
practitioner (for both diagnosis and treatment) known personally by the
sufferer, their family, or one of their acquaintances and with whom they
have a good relationship. For instance, when I became close to some
members of the staff at the People’s Hospital, some villagers sought me
out to serve as a reference point to have checkups or find medicine with
a positive balance between cost and quality. When such connections or
advice are unavailable, cancer surgery is more likely to be seen as inef-
ficacious. Indeed, sufferers and their families often suspect that doctors
advise in favor of surgery simply because it is the most expensive course
of treatment. By delaying diagnosis, lack of social and economic effi-
cacy in turn increases the likelihood that surgery for cancer will be clini-
cally inefficacious. Combined with experiences among other villagers
that cancer surgery is often ineffective in the long (and often short) term,
their suspicion typically results in a rejection of surgical treatment. The
high cost of care (including informal payments) and perception of the
revenue-seeking incentives of hospital practitioners therefore create not
only a structural obstacle to accessing treatment (as I outlined in the
previous section), but these factors also stigmatize treatment as undesir-

able and practitioners as untrustworthy. By denying hospital treatment
social and economic efficacy, high cost further persuades villagers to rule
out the possibility of resorting to such care. The next section will look at
some additional factors that motivate a rejection of hospital treatment.
Cancer Surgery in Rural Langzhong before the New RCMS

When a family member is diagnosed with cancer, the most important
decision they feel they face is whether to invest in surgery.12 Ultimately,
very few villagers decide to undergo surgery, and even fewer make a full
recovery in its aftermath. The barefoot-turned-village doctor (Doctor
Wang) could easily list over thirty villagers who died of cancer in the
past twenty years. Of all these cases, only one, a fifty-two-year-old
woman, had surgery for esophagus cancer and made a full recovery.
Doctor Wang could think of only four more villagers affected by other
types of cancer who opted for surgery. Two of them died within two
years of the operation, while the remaining two were less fortunate.
Forty-year-old Uncle Song was diagnosed with bladder cancer in 2002
and died in the operating theater. His family was poor by local stan-
dards, and his only son—fourteen years old and a good student when
his father had been diagnosed—discontinued his studies and migrated
to Chengdu to work in a factory to finance his father’s operation. His
neighbor, Uncle Zhao, was diagnosed with esophagus cancer in May
2006 at the age of forty-six. His family sold all their pigs and chickens
and borrowed money from relatives so he could undergo surgery. He
died the day following surgery. His case was seen as yet another example
that surgery is not clinically efficacious and configured it as socially, cul-
turally, and economically inefficacious.
In most cases I encountered in Baoma, the reasons given for avoid-
ing surgery were that “We found out too late (Faxian le tai wan le)” or “It’s
too expensive (Tai gui le).” Given the cost of surgery and its poor success
rate, cancer-stricken villagers usually “waited to die (deng si)” or killed
themselves drinking pesticides. But while locals’ emphasis on the cost
of treatment is central to their perceptions of efficacy and entitlement
to care, I argue that the refusal of surgery cannot be explained only as
a function of limited funds or of what Paul Farmer calls “structural
violence” (2003, 40). In fact, in some cases sufferers and their families
were able to afford hospital treatment by investing all of the family’s
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
that he undergo surgery and take medications was an embodiment of

their filial piety (xiao)—their affection and respect for him.13 The ability
to care adequately for their father would have legitimated their social
position and materialized their care and concern. In this sense, sur-
gery had social and cultural efficacy: it enabled particular family rela-
tions and was in tune with the widespread cultural value of filial piety.
Conversely, being unable to relieve his pain exacerbated their sense of
unfulfilled care toward Gandie, which became stronger as the cancer
aggravated. Toward the final stages, his youngest son complained, “This
illness has no filial sons (zhe ge bing meiyou xiao zi)” (February 2, 2005).
This resonates with the widespread proverb, “Long illnesses do not have
filial sons ( Jiu bing wu xiao zi )” (X. Dong 2001, 166). “Long illnesses”
such as cancer confronted Gandie’s offspring with the insurmountable
challenge of caring adequately for their father and sparing him suffer-
ing. The inability to succeed on these accounts constituted for them a
lack of filial responsibility.
If feelings of affection and responsibility for their father motivated
Gandie’s children to insist he undergo surgery, Gandie’s own filial piety
committed him against it. According to Confucian doctrine and tradi-
tional customs (chuantong xiguan), explained Ganma and Dajie, surgery
would violate the entirety of the body given to him by his parents and in
turn express lack of respect toward them (see Xiaojing 1975, 2–3). This
constitutes surgery as unfilial and therefore inappropriate. This ideology
at the same time provided a culturally legitimate rationale for not seek-
ing expensive treatment and thereby alleviated Gandie’s family’s moral
obligation to pay for surgery by putting forward an alternative morality.
As such, surgery lacked cultural efficacy. Examining a case of someone
who refused treatment for tuberculosis on the basis that it was not com-
patible with her body, Mark Nichter suggested that “cultural concepts
are used by the poor to cope with hard choices” (2002, 92). According
to Nichter’s model, it would follow that Gandie resorted to Confucian
doctrine in an almost utilitarian way, with the explicit aim of justify-
ing lack of treatment. Insofar as Nichter explains the resort to cultural
concepts as produced by socioeconomic settings, his approach is valid.
I would, however, stress the more dialectical relationship between cul-
ture and socioeconomic conditions and the role of culture in producing
social inequalities. Culture not only is a product of these conditions
but also serves to articulate them. Indeed, Gandie’s decision to avoid
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
his individual well-being. He argued that it would be pointless to waste

funds on an intervention with only short-term effects such as surgery
but instead more desirable to invest in the long-term future of his family
members. Libbet Crandon-Malamud (1991) has brilliantly illustrated
the ways in which social identities are shaped through choices about
healing. For instance, a poor man who sought the aid of a Methodist
priest to cure his illness also constituted himself as part of a group
socially superior to his own. In Gandie’s case, his rejection of cancer
surgery articulated and reinforced his rejection of commodified health
care and, by extension, his commitment to socialist values he upheld in
his youth.
Gandie’s socioeconomic condition in the past further disposed him
against surgery. Combined with his role in economizing communal
resources during the collectives, his experiences of food shortage, aus-
terity, and hard work taught Gandie to put the good of the family before
the good of the self and made him unwilling to invest a large amount of
money on himself. Even though the poverty Gandie endured in the past
was no longer characteristic of his life, his experience shaped his sense
of nonentitlement, which was retained even when economic conditions
changed. This sense of nonentitlement was reinforced by experiences
with county-level health care. As we have seen, during the Mao period
(1949–1976) rural health care was organized as a three-tier system, and
therefore county hospitals would be resorted to only in cases that could
not be tackled by lower levels. Although cancer surgery would indeed
be such a case, a more general sense of limited experience of health
care as a whole and county hospital care in particular placed it beyond
Gandie’s expectations.
Pierre Bourdieu has shown that taste (e.g., for food) 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 of destiny, but a forced choice, produced by conditions of
existence which rule out all alternatives as mere daydreams and leave
no choice but the taste for the necessary” (1984, 178). This conception
of taste is part of a broader argument on social reproduction premised
upon habitus. Habitus is not formed through obedience to rules but
rather through the “practical evaluation of the likelihood of the success
of a given action in a given situation [which] brings into play a whole
body of wisdom, sayings, commonplaces, ethical precepts (‘that’s not
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
window of their fourth-floor apartment. Later that day, her husband

told me she had declared she wanted to kill herself for months but
complained she lacked the courage. The sense that cancer inevitably
results in death is by no means limited to rural areas, nor are desperate
measures confined to the countryside. Yet her husband insisted that she
should continue treatment until the end. In the rural setting, this perse-
verance with clinical treatment was less strong.
As a form of Bourdieu’s habitus, Gandie’s attitude toward treat-
ment became a naturalized basis for his actions. Understanding his
rejection of surgery through the prism of habitus serves to situate it
within the wider historical and sociopolitical context. Yet, attitudes
about treatment are not simply formed in the past to later remain
unchanged. When they are situated within the current political econ-
omy of reform and marketization, predispositions molded in the past
take on new implications. Gandie’s rejection of surgery was rooted in
his past experiences and social identities—as a healthy man, a filial son,
the head of the family, a former official, and a farmer who experienced
chronic shortage—which convinced him that investing a large amount
on a single individual at the expense of the wider family would unsettle
the family’s moral economy. But in making this decision, Gandie also
actively engaged with the commodification of care and articulated his
sense of responsibility for the wider good of his family. Rejecting sur-
gery was not only a result of economic deprivation but also a comment
on the present state of health care.
Literature on the organ trade (Scheper-Hughes and Wacquant
2002) and on the globalization of pharmaceuticals (Petryna, Lakoff,
and Kleinman 2006) highlights processes whereby a new moral econ-
omy has increasingly reconfigured human beings and health as com-
modities. Gandie’s rejection of surgery shows that acceptance of this
moral economy is not pervasive. On the contrary, Gandie earned moral
standing in his readiness to sacrifice his own well-being for the wider
good of the family. His rejection of surgery may only be understood
as a combination of actual structural constraints (high cost of care and
a health care system biased against villagers), cultural beliefs (surgery
seen as a violation of filial piety), and internalized structural constraints
(surgery is not for the likes of us) based on past experiences and social
positions that place the sufferer at odds with the imperative to pay a
high price for health. While some of Gandie’s identity markers apply
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.
The New Rural Cooperative Medical Scheme:

Potential for Change?
Aware of the rising rural discontent caused by the absence of a func-
tioning welfare system and of the potential threats this poses to national
stability, the Chinese government has taken steps to provide more equi-
table access to health care for the rural population through a new Rural
Cooperative Medical Scheme (RCMS). Its implementation in Baoma,
however, shows that the success of such structural changes is far from
secured. There, staff shortages in the township and village govern-
ment produced some clear structural challenges to implementing the
new RCMS. Together with the village head and the village doctor, the
village secretary was responsible for informing locals about how the
RCMS worked and was accountable for local joining rates. Yet the vil-
lage school, from which new policies were broadcast through the village
tannoy system (a public address system using loudspeakers) until 2005,
was closed and sold to a local family in 2006. Though the village secre-
tary retained use of a small upstairs room where the tannoy system was
operated, the system was broken until 2007, leaving the village secretary
with little means to introduce RCMS and urge locals to join them. His
only option was visiting villagers at home, but most were out during
the day (either in the fields or commuting to the city for construction
and other menial work), which according to him hindered his chances
of implementing policies, including the RCMS. Indeed, in their first
year of running in the Langzhong area (2006), joining rates were higher
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.
Roughly one-third (nine out of thirty) of villagers interviewed in depth

in March 2007 stressed that one of the most positive aspects of the
new RCMS is that whereas the Maoist rural cooperative medical system
was a “village matter” (i.e., administered in the village, based on vil-
lage funds, and mostly offering only village-level care), the new system
offers assistance for hospital treatment. Moreover, they argued, the new
RCMS is mostly funded by the central government and is not controlled
by village or township officials, which means that these officials have
little opportunity to squeeze money out of the schemes for themselves.
The partial disassociation of RCMS from local officials therefore con-
tributes to their efficacy. The same interviewees also added that unwill-
ingness of some villagers to join the schemes is most likely attributed to
a lack of understanding of precisely this aspect.
Joining rates by themselves, however, do not prove that RCMS helps
villagers in any significant way or that it is changing their perception of
hospital practitioners. Even though by 2007 most villagers had joined
RCMS, they were not satisfied that the scheme offers enough reimburse-
ment, and they complained that it is limited to inpatient services and
does not include crucial outpatient or preventive health care treatments.
The introduction of coverage for outpatient treatment starting in 2008
(Langzhong Administrative Service Center 2008) has not yet changed
these attitudes significantly. In March–April 2007, the predominant
feeling in rural Langzhong was, as Cook (2007) has pointed out, that
RCMS has so far done little to raise villagers’ sense of entitlement to
hospital care and to dispel perceptions that medical treatment is unaf-
fordable and expenses are liable to rise uncontrollably. Villagers felt that
RCMS could diminish the cost of treatment, but it did not completely
eliminate the problem: medical care remains extremely expensive. As
a twenty-three-year-old villager put it, “Even 60 percent [the rate of
reimbursement for village clinic treatment at the time of interview] is
not enough. Surgery for cancer costs 6,000 yuan; it still leaves thousands
for the family to pay—villagers still cannot afford it. And it excludes the
cost of medication at home. Doctors are corrupt; they prescribe the
most expensive medicine and inflate prices. If the government could
control this and keep the prices low, they would not need to invest in
RCMS” (March 23, 2007).
This quote begins to highlight that the fierce skepticism toward hos-
pital treatment is a major obstacle to RCMS functioning and benefiting
villagers. A sixty-year-old woman, for instance, claimed that one could

be reimbursed through RCMS only if he or she had contacts (shuren)
in the hospital. Grandma Qing, in her early seventies, refused to have
surgery for glaucoma, even when it was offered at half its price, because
she felt that the cost would escalate uncontrollably. When I told her
that county hospital staff had assured me the operation would cost only
200 yuan, she replied sarcastically, “And you believe them, do you?” She
then added, “One eye is enough; I’m old and there is no point spending
so much money on me” (March 16, 2007). She explained that her son
is renting a room in Langzhong city to support her grandson through
his final year of high school. Work in Langzhong is poorly paid, and her
daughter-in-law’s earnings (from work in a Shenzhen factory) are barely
enough to cover their living costs and her grandson’s school fees. As
with Gandie, Grandma Qing denied herself treatment to save funds for
the family as a whole and by doing so showed her care to the rest of the
family. As far as she was concerned, treatment for glaucoma lacked effi-
cacy economically (costs might escalate), socially, and culturally (caring
for her family was more important than caring for her health). Although
both Grandma Qing and her neighbor had joined RCMS, their per-
ception of hospital practitioners remained that they “cheat/extort your
money” ( pian ni de qian). Many interviewees stated that one goes to the
hospital only when he or she absolutely has to: “If you can walk and
eat, you don’t go to hospital.” This enduring attitude toward health
care is rooted in a widespread spirit of self-abnegation, self-reliance,
and distrust over whether formal institutions are really set up to care for
villagers’ welfare.
Locals’ skepticism toward hospital care and marketized medicine
at large is not founded on a timeless and abstract ideal of a health
care system fully funded and able to cure all ills; rather it is measured
against two idealized parameters: urban insurance schemes and the
Maoist RCMS. Villagers contrasted their situation with that of their
urban counterparts who, they thought, were covered by more com-
prehensive insurance schemes. Although this is no longer necessarily
true, their perception is embedded in a long-standing gap in welfare
provision between rural and urban dwellers and in widespread feelings
of dissatisfaction about the rural-urban gap in incomes and lifestyles.
Before the introduction of the new RCMS, villagers often compared
their current predicament with insurance coverage under Mao. The
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
practice (544). “Currently most additional payments to physicians (e.g.,

under-the-table supplementary payments from patients and their fami-
lies called “red packets” and over-prescription) are part of a practice
that is considered corrupt. Yet such practices reflect a natural desire to
be paid better for better services, as well as a natural desire of patients to
purchase better care” (545, my emphasis).
Fan’s proposal contrasts starkly not only with the literature promot-
ing health equality (e.g., see Anand, Peter, and Sen 2004; Farmer 2003,
2010), which Fan may deem culturally and socially unfitting for con-
temporary China, but also with how villagers themselves understand
health care. To explain his argument, Fan refers to the Mencius, in which
Mencius instructs an egalitarian populist that division of labor and trad-
ing benefit all involved: the farmer who exchanges grain and the black-
smith who makes pots. But is this analogy transferable to the farming
family that sells all of their livestock and becomes heavily indebted to
afford hospital treatment? Do villagers believe that it is morally justifi-
able or “natural,” as Fan puts it, to expect to pay more for better treat-
ment? Is it then acceptable, according to Confucian virtue bioethics,
that those who cannot pay or are unwilling to pay extortionate costs
for care should “wait to die”? And when sufferers and families do make
the painful decision of rejecting care for the benefit of the wider fam-
ily, is this immoral according to the Confucian ethics outlined by Fan?
The fact that Gandie’s family understood and accepted his unwilling-
ness to cut his body as Confucian while describing their commitment to
care for him through the Confucian term “filial piety” should highlight
that “Confucianism” is clearly made of a complex set of potentially
contradictory moral precepts that orient practice. While villagers’ pride
in their hard work and the (financial) benefits it produces may be in
tune with the Confucian ethics described by Fan, villagers were without
exception opposed to a system by which access to care is established on
a financial basis. This opposition to the marketized system motivates
people to reject care even when they may be able to afford it. Rather
than an unethical or unnatural refusal to pay for a service received, their
rejection articulates an alterative moral economy based on caring for
the welfare of the family over that of individuals.
Using the example of Gandie, this chapter has examined the com-
plex processes through which surgery is constituted as lacking efficacy
and the influence of these processes on health-seeking practices. Gandie
rejected surgery because by doing so he reproduced his social identity

and his relationship with his family and thereby expressed a particu-
lar disengagement with the commodification of health care. Indeed,
Gandie’s rejection of surgery may be seen as a moral response to cri-
sis based on parameters (such as morality but also filial responsibility)
formed historically, which to some extent persisted beyond their condi-
tions of production but which were also newly activated by the socio-
economic conditions of reform. Gandie’s family’s insistence that he
undergo surgery embodied their care and concern for him. Conversely,
his self-abnegation functioned to reproduce Gandie’s sense of respon-
sibility and care toward his family. Perceptions of the present society
as corrupt and of hospitals as money oriented powerfully informed
Gandie’s attitude. Yet rather than take his judgment at face value, as
evidence that corruption is an ineluctable fact, I regard it as a social fact,
which carries the important social effect of producing new ways to deal
with corruption and constituting alternative moral worlds. For instance,
perceived immorality reproduces a sense that social networks are vital
to guarantee fair treatment, and—vice versa—their presence produces
a given treatment as fair, reliable, and efficacious. Sufferers’ active
engagement in the diagnosis and healing process—by cross-checking
hospital prescriptions with more trusted practitioners, purchasing medi-
cations in local clinics, and avoiding treatment they regard as expen-
sive yet ineffective—is also a moral response to the commodification of
health care, as they strive to reproduce a moral universe in the face of
market challenges.
The relatively high incidence of cancer in the area of Langzhong no
doubt influences responses to illness and affects attitudes toward seeking
treatment and trust in its efficacy. In particular, stomach and esophagus
cancer, the two types of cancer with highest incidence locally, are noto-
riously difficult to detect, and when the sufferer begins to feel unwell,
cancer is usually already at an advanced stage. Likelihood of late diag-
nosis is also increased by villagers’ hesitation and delay in visiting the
city hospital (the nearest place where cancer can be diagnosed) for a
checkup. Late diagnosis in turn sharply decreases the likelihood of suc-
cess of any intervention. When the rare villager invests in surgery and
dies in the process or shortly after, this only reinforces perceptions that
cancer cannot be cured, that surgery is pointless, and that doctors advise
in favor of it only with revenue in mind (given the cost is so high and
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
Family Relations and

Contested Religious Moralities
Youhui: At New Year we burn paper money.

Meimei: In our house we won’t; my grandma is a Christian.
Youhui: And what on earth is Christianity?
—March 27, 2005
This remains one of my favorite fieldwork moments. Two girls, ten-

year-old Youhui and twelve-year-old Meimei, discussed local customs.
In the case of the former, Uncle Wang’s granddaughter, her grand-
mother followed “traditional customs” with regard to offering paper
money and incense to the kitchen god and to ancestors. For Meimei,
whose grandmother was a devoted Christian (even though she rarely
had the time to attend masses and refused to attend illegal family
churches in the village), offering paper money and incense was a thing
of the past, a “meaningless waste of money” (a frequent statement).
As did all Christians I encountered, Meimei’s grandmother repudiated
these practices since converting to Christianity.
This chapter examines the ways in which individuals’ and families’
religious allegiances intersect with practices of healing and mourning.
Ritual practices can gain or lose legitimacy and efficacy depending on
whether they are categorized as superstition or as traditional customs—
as “real” or “fake.” Conversely, references to tradition, development,
and science entail contrasting—albeit not dichotomous—claims to
moral behavior. The extent to which resorting to different ritual and
religious heritages overlap is tied to the complex relationship between
belief and practice. In families afflicted by cancer, religious allegiances
influenced both how they treated cancer and their behavior after their
Family Relations and Contested Religious Moralities     231
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.
Spirit Mediums and Ritual Revival:

Religion, Tradition, or Superstition?
It is undeniable that since the death of Mao (1976), China has witnessed
an apparent resurgence of religious practices. The extent to which these
practices embody continuity with the past or a break from it has been
hotly debated. Helen Siu proposed that the socialist state penetrated
private lives to such an extent that it caused a total break with tradition.
Present practices may resemble those of the past, she argued, but they
are a mere “recycling of tradition,” devoid of its original meaning. As
she put it, “The features of traditional village life that scholars see being
revived in the 1980s—from popular rituals to the territorial identity
based on communal and kinship ties—differ substantially in form and
meaning from their counterparts in the past” (1989, 292). In her view,
the practice of socialism destroyed most of the social bases of popu-
lar rituals and weakened religious belief (300). For Sulamith and Jack
Potter, by contrast, the resurgence of ritual life is “not simply a matter
of persistence or ‘survival’ of ‘traditional’ practices,” but rather these
practices had never really been uprooted during the collective period,
because the state had not substantially changed the economic base and
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
and accepted throughout Chinese history, as they were suffused with

the state (2008a, 7). The first attack on these traditions came when
Protestantism proposed a competing definition of civilization intended
to debunk the Confucian model. Building on the Protestant distinction
that places religion above magic and popular ritual practices, the terms
“religion” and “superstition” were introduced to China at the end of
the nineteenth century from Japan (11). Attacks on Confucianism and
“feudal superstition” were later waged by the May Fourth movement
in its embracing of Enlightenment values and scientism (Duara 1991)
and subsequently by the Communist state. While the Communist state
ultimately aimed to eradicate both religion and superstition, the fiercest
attacks were against the latter.
With the onset of reform after Mao’s death, the state became more
tolerant of “popular religion” and “traditional customs.” As Sydney
White puts it, “traditional culture” is a valued part of modernity in
post-Mao China, and as such it lies outside of the “progress vs. back-
wardness continuum” (1997, 305). When practices previously seen
as superstition are reframed “as quaint and harmless ‘folk customs’
( fengsu xiguan) or ‘traditional culture’ (chuantong wenhua) not worth any
government’s while to suppress,” they also become legitimized (Chau
2005, 246; White 2001). Likewise, formerly “‘superstitious’ local cult
centers” gain legitimacy by registering as “official Buddhist or Daoist
‘venues for religious activities’” (Chau 2005, 245; see also M. Yang
2008a). In this way, local religion is transformed into a local resource,
a local enterprise exploited by local cadres, sometimes with tourism
in mind (Chau 2005, 2006; Kang 2009). If the terms “tradition” and
“religion” have become legitimizing forces within China’s modernity,
the term “superstition” has taken the place usually occupied by tradi-
tion in its dichotomous relation to modernity, development, and prog-
ress. In this role, the category of superstition is produced by the state as
a parameter against which it may define itself. Examining newspaper
accounts on shamans and magical healing from the early 1980s, Ann
Anagnost (1987) outlined the ways in which narratives of superstition
during Mao are used to condemn the leftist excesses that created the
conditions of material need that made shamans desirable. Conversely,
Emily Chao has shown how one shaman in reform China creatively
appropriated state discourse from the Republican and Mao periods.
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.”
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.
Spirit Mediums’ Efficacy and the Corporeality of Cancer

Discourses on superstition, tradition, and science powerfully inform per-
ceptions of the efficacy of spirit mediums. With regard to medical treat-
ment, the term used for efficacy is most commonly you xiaoguo—meaning
that it has an effect or a power to transform.5 The term for religious
efficacy, or “miraculous response,” as Adam Chau (2006) puts it, is ling
ying, but in my experience villagers also discussed religious practices as
having or lacking xiaoguo. Those who reject spirit mediums typically see
them as part and parcel of the denigrated category of superstition and
therefore grant them no efficacy. For those who employ them, by con-
trast, these healers’ efficacy is derived partly from their belonging to local
“traditional customs” and partly from their compatibility with “science”
is understood as a specialist study. In this guise, they are consonant with
what Chau calls “religious habitus”—“attitudes towards, and behaviours
concerning deities, sacred sites, religious specialists, religious rituals, and
supernatural forces,” determined by past and present engagement with
particular deities, sites, and ritual specialists (2006, 67).
As was the case for medical practitioners examined in the previous
chapter, spirit mediums also derive efficacy from being part of the vil-
lage’s moral economy and sociality (M. Wolf 1992, see below). This is
particularly important for religious healers who, unlike village doctors,
are outside the state’s regulatory realm both in terms of the fees they
charge and of the services they offer. For instance, the efficacy of the
feng shui master consulted by Aunt Zhang to treat her daughter-in-law’s
upset stomach following Uncle Wang’s death no doubt partly derived
from his identity as a member of the local community (he lived in the
same team dui and shared her husband’s surname).6 By contrast, a spirit
medium from beyond the sufferer’s web of personal connections is seen
to be more likely to act as a money-oriented “trickster” (Anagnost 1987,
45). While for Chau (2005) popular religion’s position within the market
as a potential source of revenue is a legitimizing force (see also Kang
2009), for Anagnost spirit mediums’ association with the market serves
to discredit them and is inversely proportional to their legitimacy and
efficacy. Indeed, as Anagnost has shown for newspaper accounts of sha-
mans, “the image of itinerant persons of unknown origin (and hence,
outside village morality)” is intertwined with “tales of imposture” (1987,
44) focused around remuneration. Their identity as “transient” figures
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:
We did it in secret, nobody knew. . . . I don’t even want to start on that

quack! He told us my husband wouldn’t live past June, but he [her
husband] did; what he told us was incorrect. [Turning to an account
of the ritual itself] First he stood by the front door, talking; then he sat
on the couch, closed his eyes, and said those words of theirs [referring
to spells used by mediums] for about an hour. The Buddha came from
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
daughter-in-law’s upset stomach. By the time I first met Uncle Wang

and his wife in August 2004, they were already convinced of the irre-
versible corporeality of cancer. This perception of his illness as rooted
in the body was reinforced by the negative experience with religious
healing. Conversely, shiniangzi’s failure supported perceptions of cancer
as a bodily problem. It persuaded Aunt Zhang of the inadequacies of
that form of treatment for cancer cases, not of its lack of effectiveness
in absolute terms. On the contrary, once Uncle Wang’s discomfort was
classified as cancer by county hospital staff, the widespread perception
of cancer as mostly incurable served to reaffirm the general efficacy
of shiniangzi and justify their powerlessness against cancer. As Bruce
Kapferer found for exorcists in Sri Lanka (1991, 80–81), shiniangzi’s fail-
ure to cure the sufferer’s physical condition is accepted as a possibility,
and this reinforces their potential for efficacy in curing other problems,
providing an internal system of legitimation. Shiniangzi’s intervention in
Uncle Wang’s case was retrospectively constituted as necessarily ineffi-
cacious because of the nature of the discomfort as not caused by spirits.
As part 2 of this book illustrated, a proliferation of more persuasive
etiologies presents alternative avenues of explanation for cancer and
entails different types of intervention.
Given the range of factors that contribute to define spirit mediums
as more or less efficacious, it would be inadequate to see perceptions that
they cannot treat cancer as an example of modernity (hospital diagnosis
of cancer) erasing tradition (shiniangzi). Shiniangzi draw on their “bag-
gage” as integral to traditional customs, but they are by no means stuck
in an indefinite, unchanging past. They also draw efficacy from “scien-
tific,” specialist study based on training with well-known practitioners
and on a written tradition. Accordingly, the failure of a medium may
not be construed as a rejection of mediums as a whole and testimony
of the inexorable march toward secularism. Rather, it tells us about
the values that the individual concerned, their family, or the local com-
munity held. In Chao’s (1999) case, it affirmed villagers’ ambivalence
toward the Maoist years. In Aunt Zhang’s case, it reinforced her distrust
of outsiders and of the penetration of market values into healing prac-
tices. As a possible way to cope with illness, resorting to spirit mediums
also articulates a particular type of moral discourse; this involves the
valuing of tradition—but not as opposed to science and modernity—
and some measure of skepticism toward outsiders and market-based
incentives, which are seen to result in cheating. Spirit mediums, as with

healers more broadly, are only adopted when they make sense in “local
moral worlds” (Kleinman 1995).
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.
Aunt Liu: But I am not educated, I can’t read.

Aunt Xu: That excuse about being uneducated . . . it has no influence,
you can learn.
Aunt Liu: My memory is bad.
Aunt Xu: I’ll write down songs for you, the words repeat themselves,
you can learn characters that way.
Aunt Liu (after a few seconds of silence): I have no education/culture,
but even I can see that all that burning of paper and incense is
a waste.
Aunt Xu: Exactly!
The merits of Christianity were also measured according to its

claims that believing in God was beneficial to their health. Comforting
Dasao’s mother about illness in the family, Ganma suggested, “Don’t
believe in Buddhism, that’s no good; you should believe in Christianity—
you feel a lot better, there are no ghosts” (March 16, 2005). I attended
two family churches during fieldwork, and in both cases some of those
present commented on how Christianity had made them healthier and
given them strength to face illness in the family. Aunt Zhao, a villager
in her early forties, argued that converting to Christianity helped her
heal from her cold. She had in fact developed tuberculosis but never
told me so, because, according to her neighbors, she feared that I might
not be willing to talk to her if I knew.11 Grandma Tang, a sixty-two-
year-old villager, explained that being a Christian had no influence on
her body/health (shenti). But then she elaborated, “The spirit/energy
condition improves ( jingshen qingkuang tigao); it’s a good religion, teaching
not to steal, rob, curse, love your country” ( July 22, 2004). There were,
however, locals who had converted to Christianity and later renounced
it because they found it inefficacious. Aunt Li, for instance, had been
converted by Aunt Zhao in 2000. She had rheumatoid heart disease and
high blood pressure and was told that Christianity would heal her. She
became a follower for three years and attended mass whenever agricul-
tural and household activities permitted, but she subsequently stopped,
disillusioned because her health showed no signs of recovery. In August
2004 she told me, “It doesn’t work, that Christianity (mei xiao)—I’m still
ill” (August 10, 2004). Indeed, Aunt Li died of a stroke in April 2006,
after refusing hospital treatment predicted to cost 2,000 yuan. For her,
Christianity was “fake” because it failed to deliver health.
If Christians made claims to a moral higher ground, as well as to a

more “developed” form of religion, for Aunt Li Christianity was “fake”
because it failed to deliver health. For others, Christian ideals such
as compassion and helping those in need are valid, but villagers who
claim to be Christians fail to comply with these ideals. In this model,
local appropriations of Christianity are discredited with reference to
Christian ideals themselves, which remain beyond scrutiny. This is the
paradigm through which Liu Min, a twenty-seven-year-old man who
lived in a village neighboring Baoma, judged the family church meet-
ings that took place near his house:
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
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 Spirit World and Belief-in-Practice

The impact of religious affiliations is perhaps greatest on mourning
customs.13 In Uncle Wang’s case, there were no disagreements: Aunt
Zhang consulted one of the local feng shui masters (who was also her
husband’s fourth brother) to establish an appropriate burial time and
location and to compile a shaoqi list. Shaoqi, literally “burn seven,” is a
list of times at which to burn incense, paper money, and firecrackers at
the grave. It should be performed seven times, every seven days, from
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).
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.
As we have seen, Christians were expected not to burn paper money,

incense, or firecrackers to honor ancestors and ghosts or to consult shi
niangzi. Implied in these prohibitions is a lack of belief in ghosts, which
renders such practices to appease ghosts unnecessary. But in turn, not
performing such rituals produced those who refused them as Christians
and as nonbelievers in ghosts. The following case illustrates this clearly.
When Erjie’s brother called, late on the evening of February 2, 2005, to
advise her to go over to see her father, she could not bring herself to make
the journey for fear of being attacked by ghosts. Even when I offered to
accompany her, she was still too frightened because there would be no
men to cast off ghosts. The following day, she praised my courage and
willingness to help in the presence of her mother and brothers. Their
unanimous reaction was that in my country we were all Christians, and
Christians did not believe in ghosts; it was thus no wonder that I was not
scared. Her mother claimed, “We [Christians] feel none of these fears.”
She explained that since converting to Christianity, she herself was no
longer scared of ghosts. The brothers and mother simply assumed that,
being from the West, I must be a Christian, and therefore I would not
fear walking in the dark without men.
This conclusion is telling of their own perception of Christianity
vis-à-vis popular religion and traditional customs. A woman who
was not scared of walking in the dark could not share their local per-
ception of ghosts. Anyone who did not believe in them was in most
cases a Christian. Therefore, the argument went, I must have been a
Christian. As this shows, “Christian” was synonymous with “nonbe-
liever in ghosts.” Erjie’s mother also confirmed this attitude toward
ghosts since conversion. In March, when Erjie asked her mother if
she had met her deceased husband in her dreams, her mother replied,
“No, there is no such thing; we Christians don’t feel anything like that”
(March 4, 2005). Whether Christians, after conversion, really do stop
being scared to go out in the dark remains a matter of dispute. Erjie
seemed to be convinced this was the case. She cited as evidence the
fact that her mother could walk around the village in the dark since she
converted, while she had never done so before. Another local woman
also noted the same shift after conversion. At any rate, walking alone in
the dark as a woman constituted her as a Christian, or, in other words,
her Christianity was produced, as well as manifested and confirmed,
in practice.
The intricate relationship between belief and practice highlighted

by these accounts requires some theoretical unpacking. A volume edited
by James Watson and Evelyn Rawski (1988) on funerary rituals offers
some interesting points for discussion. In two introductory essays,
Watson and Rawski debate the relative usefulness of focusing on praxis
or doxa in the analysis of rituals. Watson argues that performance rather
than belief is central. For him, a degree of uniformity in funerary rites
is visible across China, and the standardization of ritual practices was
central in keeping China unified (1988, 3). As he puts it, “It is irrelevant
whether or not participants actually believe that the spirit survives or that
the presentation of offerings has an effect on the deceased. What mat-
ters is that the rites are performed according to accepted procedures”
(9–10). Indeed, those performing the mourning rites might hold differ-
ent views on them while they usually agree on practice. My findings on
Christian attitudes about funerary rites show that the situation diverges
somewhat from Watson’s suggestion. Erjie’s husband’s comment that
burning paper money “is not about belief, it is a traditional custom”
(August 28, 2004) seems to comply with Watson’s views. Yet, the actual
practices of Christians suggest that some degree of belief is involved.
For them, burning paper money and incense implies believing in ghosts,
which they are not permitted to adhere to after conversion. As these
attitudes show, belief and practice are mutually constitutive and there-
fore analytically inseparable. I use the term “belief-in-practice” to con-
vey such inseparability and the immanence of belief.
Christians’ attitudes about the spirit world echo local claims sur-
rounding the presence of spirits during the Mao period. During Mao’s
leadership, and especially during the Cultural Revolution (1966–1976),
the state encouraged people not to hold funerals. A memorial meet-
ing with friends and relatives was allowed, but any references to spirits
or offerings of food, incense, or paper money were strictly forbidden,
to limit expenditure (Whyte 1988). While the extent to which these
policies were successfully implemented in the countryside is debatable,
locals claimed that the radical decrease in ritual practices resulted in
the virtual disappearance of ghosts. Baoma villagers stated that ghosts
“did not exist during Mao’s leadership.” Some conceded, “There were
[ghosts], but very few.” Anthropologists of China have so far dismissed
the state’s ability to completely “kill” ancestors (Stafford 2000, 85).
Jun Jing’s (1996) account of the effects of displacement on ancestor
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.
Mourning, the Spirit World, and Family Relations

Attendance of Gandie’s shaoqi rituals was not always even. Just fewer
than forty people were present at the first shaoqi ritual, including
Gandie’s wife, all of his offspring (three sons and two daughters), and
their partners and children; Gandie’s two brothers and their wives;
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.
doubles as an altar room where ancestor images should be displayed)

was shared by their mother and Sange’s family, Sange was expected to
hang it but had so far failed to do so. There were no other pictures of
ancestors on the wall. Instead, it was dominated by a large poster of
Chairman Mao. With Erjie’s help, Dage hung their father’s picture next
to Mao’s face. On our journey back to the village, I asked Erjie for some
clarifications. “It’s my youngest sister-in-law [Sansao]. She convinced my
youngest brother not to hang the picture. She says it’s because her son
[who is eight years old] is scared of dad. That’s nonsense. She’s scared of
him, because she was not good to him when he was alive, and now she’s
scared he will punish her” (March 19, 2005). A few days later, Gandie’s
picture was taken down by his youngest son, Sange. Dage visited Sange’s
house, confronted him, and put the picture back on the wall. This time,
however, it was slightly lower, as Erjie explained to her nephew, because
“it shares the wall with Mao, and your grandfather did not have as much
grandeur (weida) as chairman Mao” (March 25, 2005).
When I arrived at Dage’s house for the final shaoqi (March 25,
2005), he, his wife, and his two sisters were all in the kitchen discussing
the drama surrounding their father’s picture as they prepared an epic
number of dishes for lunch. Sansao had to be more or less dragged
to the table. She sat next to me, in tears, and ate very little. None of
the family talked to her. The only people who spoke to her were three
elderly neighbors. They told her not to cry and accompanied her back
to the table once, after she had run away mid-meal. At night, Erjie, her
daughter, her husband, and I walked back to Baoma, taking with us
Sange and Sansao’s son. Erjie and her husband did not miss the oppor-
tunity to interrogate their nephew about his grandfather’s picture:
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)
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
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
becoming a shaman. The outcome, Wolf proposes, depended on “cul-

tural, social, ritual and historical forces” (93). This case offers insights
on two levels of analysis I have pursued so far. First, as I have argued,
it highlights the fact that religious efficacy relies on the status of the
practitioner within the local community. It both requires a preexisting
level of sociality and produces such sociality. Second, and more per-
tinent to this case, it shows that not having such sociality, as was the
case for Mrs. Tan in Wolf ’s case and for Sansao in mine, makes these
women more vulnerable to criticism. Indeed, this is why brothers and
sisters were much more critical of Sansao than of their brother Sange,
although they were both equally guilty of not hanging the picture, she
was blamed because her status within the family was lower. At the same
time, her perceived failure in the past to fulfill her obligations to her
father-in-law reproduces her outsider status and makes future exclusion
from the family more likely. In this sense, it was Sansao’s supposed his-
tory of being uncaring toward Gandie that predisposed her to be cast
as an outsider, and it was her unfilial practices in the present (failing
to hang the picture) that reproduced her status. Practices of caring for
Gandie, even after he passed away, are central to reproducing or chal-
lenging family relations. In turn, this demonstrates that family relations
are always produced and contested through daily practices.
Conflicts between the brothers that had first emerged during
the shaoqi rituals continued for months after these rituals were over.
Margery Wolf (1968) has argued that conflicts between siblings may
be contained during the family head’s life. But after the strong father
figure who imposed harmonious coexistence between his sons passes
away, conflicts that may have been breeding for years finally come to
the surface. Dage and his wife, Dasao, continued to display their disap-
proval of Sange by refusing to reply when his son addressed them as
Aunt and Uncle. Given that using kinship terms is an important way in
which relationships of familiarity and closeness are produced (Kipnis
1997, 32–38), their refusal to respond served to negate their relation-
ship with the child and by extension his parents. Ganma explained, “He
[Sange and Sandao’s son] calls them Aunt and Uncle when he walks
past their house, but they don’t reply, so now he’s stopped calling them”
(March 28, 2005). By refusing to reply to their nephew’s greetings, Dage
and Dasao cast Sange’s family outside their kinship group and outside
their web of relations.
Dage disapproved of his two brothers’ behavior: of Erge for his

refusal to contribute to the mourning rites and of Sange for his delay in
hanging their father’s picture. Dage clearly manifested and materialized
his disapproval in two instances. The first was his decision to carry out
the ghost festival (qingming) rites in early April on his own. This deeply
hurt Erjie and took repeated apologies from Dasao, whose excuse, “He
did not mean any harm toward you,” only marginally appeased Erjie
(April 4, 2005). The second was Dage and Dasao’s refusal to host a
birthday party for Ganma in June 2005. Discussion on this took place
when all of Gandie’s offspring gathered to mark the hundredth day of
his death (May 17, 2005). Dage and Dasao were outraged that Erge
and Ersao refused to contribute to this ritual occasion, as they had done
before, on the grounds that as Christians they did not practice ances-
tor worship. Already ill disposed toward Sansao and Sange for their
limited contributions to the rituals, Dage and Dasao objected to hosting
Ganma’s birthday, stating that they had spent the most time and funds
on Gandie’s illness. After weeks of discussion, Ganma’s birthday was
celebrated at Dage’s house, but the cost was shared by all three brothers.
The day before Ganma’s birthday, Dasao felt very sick, and, presum-
ing it was Gandie punishing her, she sent her husband to burn some
paper money at his father’s grave. This eased her discomfort. Erjie com-
mented, “You just can’t say for sure with these things, but I think it was
Dad, because Dasao was not fair to Mom” ( June 20, 2005).
Dasao and Sansao offer clear examples of how daughters-in-law
bear the burden of pain for unfilial behavior: Dasao believed she was
punished by Gandie for treating his wife disrespectfully, and Sansao suf-
fered exclusion from the extended family for having objected to hanging
Gandie’s ancestral image. Sansao’s case shows the centrality of funerary
rites in reproducing social roles within the family, including suspicion
of daughters-in-law (Sangren 2000). In her work on the uterine family,
Margery Wolf (1972) suggested that a son’s tie to his wife is perceived
as a potential threat to family unity by competing with loyalty to the lin-
eage and especially his mother, father, and siblings. For Steven Sangren,
by contrast, such suspicion of daughters-in-law is foundational to the
reproduction of the family rather than being a threat to it (2000). To
the extent that the extended family united against what they perceived
to be Sansao’s unfilial behavior, this is indeed true. Such hostility toward
daughters-in-law, however—as Wolf pointed out and Yunxiang Yan has
highlighted in the current context—may just as well exacerbate divi-

sions between the married couple and the husband’s parents, giving
more power to the wife/daughter-in-law, who is “able not only to tri-
umph over their parents-in-law but also to redefine the gender dynam-
ics and family ideals as well” ( Y. Yan 2003, 111). In Sansao’s case, both
dynamics seem to be at play: Sange is partly excused as his wife alone
is blamed for lack of respect, while at other times the couple is held
equally guilty and solidarity between them is reinforced.
Ritual practices have implications wider than strictly the reproduc-
tion of the spirit world. Religious efficacy is also closely related to social
relations. The extent and mode of one’s engagement in ritual practices
serve to produce social relationships with the dead and thereby between
the living to negotiate one’s position within the family. The youngest
brother’s refusal to hang his father’s picture caused a stir in the family.
The second brother’s decision not to contribute to the mourning rites of
burning paper money also unsettled family relations. Another incident
may serve to illustrate this point. One midday in early August 2005,
as I walked to Gandie’s village, I rested for a few minutes in a shady
spot along the path, under the foliage of bamboo. Dage happened to
ride past me on his motorcycle. He seemed alarmed to find me in that
particular location, told me to quickly move away, and offered me a
lift to their house. I realized that the location I had chosen for my rest
genuinely upset him but could not fathom why he would react in that
way. I was, after all, in the shade. When we arrived, he hastened to tell
Erjie and his brothers where he had found me, and they all responded
with a mixture of amusement, surprise, and fright. It turned out that
the spot I had selected is locally known to be a place “where ghosts hold
meetings” ( gui yao qu nage difang kai hui). I was baffled and frightened by
the coincidence. But Erjie was quick to reassure me: “Don’t worry, you
have done nothing wrong. It does not necessarily mean you are unlucky.
Maybe they [ghosts] like you, that’s why you stopped where you did.
Maybe Dad wanted to see you—you’re one of the family, you were
good to him. He wouldn’t hurt you.”
Spirits are perceived to interact with the living. Considerations as to
whether they are benevolent or harmful also serve to articulate relation-
ships among the living. The perception that Gandie would not harm me
conveys acceptance of me as a member of the family, as someone who
had been caring toward him. The idea that Sansao would be harmed
by him, in contrast, served to exclude her from the extended family, to

show disapproval toward her behavior when Gandie was alive. Indeed,
“Death does not terminate relationships of reciprocity among Chinese,
it simply transforms the ties and often makes them stronger” (Watson
1988, 9). In the process, families and communities are produced through
ritualized moments of separation and reunion with the dead. In other
words, relationships with the dead also express and mold relationships
among the living.
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
money and incense, outline a particular type of moral identity based

upon traditional customs but—for those who adopt it—not opposed to
modernity. This type of moral legitimation is very harshly contested by
Christians, who brand all these practices as superstition and therefore as
outdated and deceitful. By contrast, Christianity bases its efficacy upon
claims that it does not cheat converts nor require the same amount of
financial investment as superstitious practices; in addition, it is based
upon claims to a higher moral ground as a developed and modern reli-
gious form. Divergences between these two models of moral behavior
are sometimes inscribed upon existing tensions between family mem-
bers and serve to exacerbate them. For instance, as chapter 6 illustrated,
Dage and Erge’s families disagreed on which of their sons behaved most
appropriately toward Gandie. Dage’s family argued that they contrib-
uted most to the costs because their son did not return from migrant
work and sent remittances, whereas Erge’s son returned twice in the
course of Gandie’s illness. When it came to funerary rites, Dage and his
wife again argued that they contributed the most toward these costs and
questioned Erge’s family’s refusal to fund the rites on the basis of their
commitment to Christianity.
Breaking the moral codes at the core of one religious or ritual tra-
dition because of allegiance to another allows a person to retain some
claim to moral behavior. But the controversy over hanging Gandie’s pic-
ture was of a rather different nature: disagreements did not originate in a
divergence of religious allegiances but in the supposition that they were
shared. Sansao was presumed to share the traditional belief that ances-
tor images embody the deceased. In this context, her refusal to hang
Gandie’s picture in the storage-cum-altar room she shared with Ganma
counted as evidence that she had been disrespectful toward Gandie and
therefore feared him. The refusal itself was one further instance of such
lack of filiality toward Gandie. Common parameters of moral behavior
based on traditional practices of postfunerary rites and ancestor wor-
ship served to ostracize those, like Sansao, who did not comply. In this
sense, the spirit world played a crucial part in reproducing family rela-
tions and tensions. Far from branding the present as immoral, villagers
incessantly argued over the parameters of moral behavior. Their fierce
criticism of those who acted outside of such boundaries is part and par-
cel of processes of reproduction of unequal power relations within the
family, but it is also vital to testing their limits.
Conclusion
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
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
than securing well-being. This results in delayed diagnoses and there-

fore reduced likelihood of a successful treatment, especially for diseases
such as esophagus cancer that need to be diagnosed early if there is
to be any hope for recovery. These forms of exclusion foment resent-
ment and villagers’ perceptions of themselves as second-class citizens,
largely left behind by the promise of increased wealth. As an illness
that is most often fatal, cancer comes to embody these routinized forms
of suffering and marginalization, and it offers a window into under-
standing the enduring travail and inequality that characterizes the late
reform period. While the Hu/Wen leadership has made moves to tackle
these challenges, and the twelfth Five-Year Plan (2011–2015) seems set
to continue on the same path, deep-seated inequalities remain.
Examples examined throughout the book delineate the contin-
gency—to use Lock and Farquhar’s term—of cancer etiologies and
strategies adopted in the fight for breath against and through cancer.
Habitual and ongoing practices, such as consuming salt-preserved
vegetables, alcohol, and tobacco, have become naturalized and nor-
malized and consequently place individual sufferers beyond blame.
Epidemiological findings are questioned on the basis of personal experi-
ence: a neighbor who consumed little alcohol or tobacco and yet devel-
oped cancer, or, conversely, one who consumed a large amount and
yet is healthy. Relatively recent innovations and changes that clash with
existing habits are also candidates as causes of cancer. Farm chemicals
present a case in point. Used little or not at all until the 1980s, they are
now central to farming, the need for them exacerbated by the shortage
of labor as younger villagers search for a waged occupation. Both their
discord with local practices and embodied experiences of their harm
to health (soreness in the throat after spraying pesticides and their foul
smell) reinforce perceptions of them as carcinogenic.
Cancer etiologies are deeply historical, but this does not imply
that they are produced during some indefinite past and later remain
immutable. Rather, they change in tune with their context, become
accredited or discredited, or modify their implications in line with wider
social change. Chemicals have been quickly incorporated in farming
practices, forming new habits and a new moral economy in which
perceptions of the harmfulness of chemicals have entailed a strategic
appropriation. The definition of hard work—originally crafted around
strenuous physical activities such as digging an irrigation pool out of
rock or carrying heavy loads—has been extended to include the use of

chemicals. Chapter 4 showed that attributing cancer to repressed anger
and anxiety caused by close relatives reflects as well as reproduces a
historically situated morality whereby women are expected to marry,
remain loyal to their husbands, and produce a son. Those who do not
abide by these moral norms may be blamed when cancer develops in
their husband, father, or father-in-law. However, a careful redefinition
of individual character as the source of negative emotions shows an
increasingly critical attitude as these norms become less dogmatic and
new family patterns emerge and become acceptable. Attitudes about
medical care are also equally contingent. Aversion to surgical treatment
for cancer is produced by its historical inaccessibility, but it is also rein-
forced by the current context of commodified care. Its denial in the
present also has contingent connotations: self-abnegation in favor of
protecting the welfare of the wider family, a renewed distrust toward
careers beyond one’s own social network, and a reliance on family sup-
port through care at home. This particular engagement with hospital
treatment and the importance of family relations is inextricable from
the current moral economy.
Competing moral economies are articulated through cancer etiol-
ogy: the origins of illness are variously placed upon individuals (as is the
case with bad temper), strained family relations (repressed emotions),
collective commitments (hard work, food shortage, and abuse during
the Cultural Revolution), the market (farm chemicals), or epidemio-
logically identified pathogenic practices (preserved vegetables, smoking,
and drinking). Similarly, divergent moral economies of care coexist.
Principles of Confucian filial piety demanding that children care for
parents are widely accepted, but disagreements pervade the chosen type
of care: traditional customs sanction resort to spirit mediums, while
Christian commitments deny their efficacy; care at the city’s hospital
or township clinics is seen to be necessary when the required care is
not available more locally, but it is regarded with suspicion as placed
outside the sufferer’s knowledge and connections. Different models
of how to secure care also mobilize different moral economies: engag-
ing in wage labor and sending remittances (market model), returning
home (reciprocity through presence rather than financial help), farm-
ing (subsistence and householding model), or visiting the sufferer and
offering food (householding and reciprocity). Finally, competing models
of mourning create divergent models of moral behavior: worshipping

ancestors by offering incense and paper money as opposed to Christian
prayer and Mass attendance. No clear, linear evolution has unfolded in
cancer etiologies from supposedly unscientific causalities such as hard
work and repressed emotions to epidemiologically sanctioned ones such
as smoking and drinking. Likewise, there has been no linear evolution
regarding ways to care for sufferers, from farming to wage labor or from
spirit mediums to hospitals and Christian prayer. Conflicts between dif-
ferent models of morality persist and form the very texture of what
Stephen Colliers and Andrew Lakoff describe as a “regime of living”:
“a tentative and situated configuration of normative, technical, and
political elements that are brought into alignment in situations . . . in
which the question of how to live is at stake” (2005, 23).
The contingent way in which cancer articulates particular contexts
and practices can be explained on a broad sociocultural and political-
economic level, as I have done in chapters 3 and 4. But ultimately only
an in-depth analysis of one case (Gandie) and comparisons with another
local (Uncle Wang) can do justice to the complex microtemporal transi-
tions through which sufferers and their families experience and cope
with cancer. On one level, this configures cancer as a site through which
attitudes on poverty, development, consumerism, and social change
more widely open themselves up to anthropology as sites of analysis.
In these terms, locals’ interest in cancer may be regarded as akin to
what Paula Treichler, writing on AIDS, called an “epidemic of significa-
tion” (1999).2 But my hope is that the detailed ethnographic attention
to experience provided here does much more than this. My focus on
Gandie and his family is intended to maintain a closeness to lived expe-
rience, to show that an anthropology of cancer is not simply another
form of cultural critique. This would deny the reality and poignancy
of suffering. In this commitment, I follow Arthur Kleinman’s long-term
effort to promote the study of suffering as intersubjective human experi-
ence rather than simply cultural meaning open for deconstruction (see
Kleinman, Das, and Lock 1997; see also S. Whyte 1997).
This book has responded to this challenge in a number of ways.
The study of cancer from the bottom up, focusing on sufferers’ experi-
ences, lay etiologies and coping strategies, enables as well as requires
understanding of the contexts in which cancer is lived. In chapters 5
to 8, family relations are shown to be central to the management of
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
perceive as an immoral present is not to wholeheartedly join in the new

consumerist flurry but to rearticulate morality through reliance on their
family and social networks. This response is not a static resilience of
past morality into the present nor a simple return to the past. Rather,
it acquires different moral implications in the present. The high emo-
tional and financial costs shouldered take on a special significance in
light of the commodification of care. That they were shared unequally
served to channel family conflicts.
Yan explains that “extraordinary extortion” of good Samaritans in
reform China (being extorted by the very person they helped) is the result
of legal loopholes, feelings of deprivation, and “the relationally-based
morality that justifies hostility towards strangers” (2009, 16). This last
element is most relevant in understanding how care for cancer suffer-
ers is understood and provided. Attitudes toward hospital practitioners,
who are typically outside the social network available to rural dwell-
ers, are very much consonant with Yan’s observations on the distrust of
social outsiders (19). Reliance on one’s family to offer care (by purchas-
ing medication, providing special treats, and visiting frequently) serves
to reinforce such distrust toward outsiders and, conversely, to reproduce
family relations through arguments over decisions about appropriate
care (chapter 6) and mourning practices (chapter 8). My emphasis on the
importance of the family is not to deny that there are conflicts between
its members and disagreements about how to care for a sick relative or
to mourn his death. On the contrary, Dasao insisted that her youngest
sister-in-law failed to care adequately for Gandie and Ganma, causing
much strife among their offspring. Guoyun and Guofu reacted to their
grandfather Gandie’s illness in opposite ways: one returned home twice,
the other never did but sent remittances. There was, however, no agreed-
upon moral response to Gandie’s suffering: according to their respective
parents, both Guoyun and Guofu acted in a moral fashion. Chapter
8 showed similarly that disagreements about mourning were rife, but
those relatives joining in the paper burning at the grave and Christians
abstaining from it equally made claims to a moral high ground. These
clashes are ripe examples of the constantly shifting boundaries of moral
behavior and testimony to unrelenting efforts to act morally.
Morality is negotiated not only through the coping strategies
adopted and family relations mobilized but also through attribution of
blame. Blaming cancer on water pollution, for instance, entailed a very
different moral universe than did attributing it to chemicals in food or

to distress caused by life’s many challenges. While water pollution impli-
cated the state, contaminated food by contrast placed the blame, at least
partly, upon the market economy. By allowing ambiguity about whether
the culprit was the state that failed to provide clean water, the market
economy that demanded the use of chemicals, or the individual farmer
who relied too heavily on them, farm chemicals provide an explanation
that makes moral sense to the different parties involved, allowing blame
to shift between a variety of levels. Repressed anger and anxiety chan-
neled a similar kind of ambiguity, whereby culpability could be located
upon the individual sufferer or those significant others (usually a man’s
wife, daughter, or daughter-in-law) who had caused distress.
Pondering how sufferers and their families incessantly strive to
reconstitute a moral world in the face of crisis, I have highlighted their
everyday practices and moral contestations about cancer. “The state
officials and doctors do nothing to ensure well-being,” Uncle Wang’s
wife told me, “but we villagers do—we look after each other.” Villagers
rarely see well-being as simply the absence of illness; it is produced by
the support of their family or the ability to afford a newly built house
or particular types of treatment. In their daily fight for breath—by con-
suming market food or by refusing it, by visiting sick relatives, by avoid-
ing hospitals, by arguing over how to care for the sick and how to mourn
the dead—Chinese villagers who shared their lives with me strive to
overcome illness and poverty and search for well-being as they inces-
santly redefine its parameters. Through a focus on cancer, this book has
portrayed the cultural and social settings that contemporary Chinese
villagers inhabit: not only how they care for themselves and seek care
from their families, but whether they are satisfied with the welfare that
medical institutions and the state provide.
Appendix 1
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?
Thank you for your cooperation.

Appendix 2
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 To protect my informants, all personal and place names (except Langzhong)

are pseudonyms.
2 Gan haizi may be translated as “dry child.” This is roughly correspondent to
godchild in the Christian tradition but without the same religious connota-
tions. I have therefore retained the Chinese term.
3 “Dry father” is roughly equivalent to godfather.
4 For an excellent English-language overview, see Lee Liu (2010). See Mengqin
Liu and Chen Fu (2007) for an analysis of some selected cases and Deng (2009)
for an influential report in the Hong Kong–based magazine Phoenix Weekly. See
Doubleleaf (2009) for a map of cancer villages.
5 Equally infamous are the cancer villages near the Dabao Mountain mine
in Guangdong, where the Hengshi River and underground water were pol-
luted by heavy metals following the opening of the mine. On Shangba vil-
lage, see Chuanmin Yang and Qianhua Fang (2005). On Liangqiao village, see
CNN (2007).
6 Nanfang Dushi (2007b). On the “water crisis,” see Nanfang Dushi (2007a).
7 Ganma may be translated as “dry mother.”
8 Some of the material included in the introduction was published in “An
Anthropology of Cancer Villages: Villagers’ Perspectives and the Politics
of Responsibility,” Journal of Contemporary China (2010) 19(63): 79–99. An
earlier version of chapter 3 was published as “Of Farming Chemicals and
Cancer Deaths: The Politics of Health in Contemporary Rural China,” Social
Anthropology (2009) 17(1): 56–73. An earlier version of chapter 7 appeared as
“If You Can Eat and Walk You Do Not Go to Hospital: Farmers’ Attitudes
to Healthcare in Contemporary China,” in Beatriz Carrillo and Jane Duckett
(eds.), Social Problems and the Local Welfare Mix in China: Public Policies and Private
Initiatives (London: Routledge, 2010).
9 See Sandra Hyde (2007) on the cultural politics of AIDS in China.
10 About us$60. In 2004–2005, 1 U.S. dollar corresponded to 8.28 yuan. In
2007 the value of the yuan increased to 7.50 yuan per dollar, and by 2009 it
was as high as 6.83 yuan per dollar (it continued to increase to 6.30 by the end
of 2011).
11 This point is elaborated further with a discussion of how food serves to articu-
late claims to social status in Anna Lora-Wainwright (2007).
274     Notes to Pages 20–47
Chapter 1: Cancer and Contending Forms of Morality
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
12 For an edited volume on the recent history of Christianity’s rise in China,

see Uhalley and Wu (2001). On Christianity’s adaptation to the socialist
state, see Dunch (2008); on Catholics, see Madsen’s monograph (1998); on
Protestantism, see Bays (2003) and Hunter and Chan (1993).
Chapter 2: The Evolving Moral World of Langzhong
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
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.
Chapter 3: Water, Hard Work, and Farm Chemicals
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
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.
Chapter 4: Gendered Hardship, Emotions, and the Ambiguity of Blame
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
syndromes implies that some illnesses may be understood in separation from

the sociocultural settings in which they are experienced (Hahn 1995, 8).
8 On somatisation in China, also see Cheung (1987); Tung (1994); and Zheng,
Xu, and Shen (1986).
9 Other studies on neurasthenia in China include Kleinman (1982), Lin (1989), and
S. Lee and K. Wong (1995). On mental health more generally, see Ikels (1998).
10 A study on the “Influence of Traditional Chinese Beliefs on Cancer Screening
Behaviour among Chinese-Australian Women” (Kwok and Sullivan 2006)
highlights a similar perception of cancer as brought about by negative emo-
tions and worsened by thinking about the illness (695). The perception that
anger and anxiety may precipitate the development of cancer is not pecu-
liar to China or Chinese people. Feelings of guilt, anger, and aggression fea-
tured alongside heredity and external influences in Ruth Salzberger’s study of
British cancer patients (1976, 154–155). Deborah Gordon’s study of cancer in
Italy also showed that naming discomfort as cancer, or even thinking about it,
are seen to bring about its development (1990, 289).
11 See Gandie’s family tree, chapter 5.
12 The belief that mood affects cancer is also highlighted by a study of Chinese
people working and living in London (Papadopoulos et al. 2007). Informants
were found to be reluctant to talk about cancer and believed that a happy and
positive mood would prolong survival. Accordingly, many argued that can-
cer sufferers would not be informed by the family, because this is thought to
quicken its development (428–429).
Chapter 5: Xiguan, Consumption, and Shifting Cancer Etiologies
1 Pie is the Sichuanese equivalent of nao in standard Mandarin. The meaning is

in both cases “poor” or “lacking.” The word was used to refer to living condi-
tions and diet and in the case of diet could imply both lack of food and limited
dietary variation.
2 These included herbs with calming and cooling effects (qinghuo) to be added to
his personal hot water cup, such as lotus buds (lianzi xin).
3 When I first visited the village on June 16, 2004, the family had recently bought
thirteen ducks. These were very rarely slaughtered, only for special occasions
such as birthdays. Erjie did not slaughter ducks for her father’s birthday, since
the banquet was the responsibility of her three brothers; Erjie and her hus-
band bought fireworks.
4 I had a printer in my room in Baoma village, where I often printed photo-
graphs for locals and offered them as presents.
5 Villagers over twenty routinely argued that by the age of twenty-two it was
preferable to have married. Some villagers in their twenties or thirties who
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
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.
Chapter 6: Performing Closeness, Negotiating Family Relations, and the

Cost of Cancer
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.
4 Drawing from Arjun Appadurai, Yan describes the “gatekeeping concept” as

that which “defines the quintessential and dominant questions of interest in
the region” (Appadurai quoted in Y. Yan 1996, 115).
Chapter 7: Perceived Efficacy, Social Identities, and the Rejection of

Cancer Surgery
1 See Crandon-Malamud (1991); Etkin (1988); Etkin and Tan (1994); Kamat
(2009); Moerman (2002); van der Geest, Whyte, and Hardon (1996); Waldram
(2000); S. Whyte (1997); and Whyte, van der Geest, and Hardon (2002).
2 This is not meant to suggest that socioculturally situated attitudes act as a
nocebo effect (cf. Moerman 2002), making cancer surgery clinically ineffica-
cious in my field site. Rather, by producing a perception of cancer surgery
as inefficacious, such attitudes discourage cancer sufferers from resorting to
surgery at all.
3 Useful recent overviews of these processes include Bloom, Kanjilal, and Peters
(2008) and Fang (2008). See also Lancet (2008). For a full-length volume in
Chinese on health care reforms, see Gu, Gao, and Yao (2006).
4 See Hu et al. (2008) and Tang et al. (2008) for recent analyses of health care
inequity.
5 Signs of change were, however, present already in 2002 (see Central Party
Committee and State Council 2002; Duckett 2010).
6 See the official website for RCMS, Center for China Cooperative Medical
Scheme at http://ccms.org.cn (accessed March 2007).
7 The literature on these issues is wide and growing fast. See Cook (2007),
Dummer and Cook (2007), and Sun et al. (2008).
8 On problems and countermeasures faced by health insurance systems in
Western rural areas, see B. Wang and Chen (2005). Li Shi-Gui and Zhang
Yan-Mei (2005) examine problems and countermeasures in Sichuan’s new
RCMS pilot implementation areas.
9 Migrant workers are of course an obvious exception, as they usually have
no stable pay, pension entitlements, or health insurance schemes. See Xiang
(2007) on migrants’ health.
10 Rates of reimbursement grow for lower-level care because these are less
expensive (and therefore more sustainably reimbursed) and to discourage
patients from using higher-level care unless they need to do so (Langzhong
county Health Bureau official, April 4, 2007).
11 I am grateful to Sydney White for pointing this out.
12 This is not to imply that access to care is defined only in terms of access to
biomedical treatment or surgery, nor is it to unproblematically reproduce the
hegemony of biomedicine as the only efficacious treatment. Changes in diet,

self-cultivation practices (see Farquhar 2002), and Chinese medical treatments
are employed for general health maintenance and for chronic conditions.
However, cancer is perceived to require fast intervention, making surgery the
only treatment seen to have the potential to cure cancer. This is in tune with
widespread stereotypes that Chinese medicine is adequate for chronic illnesses
(and villagers did resort to Chinese medicine to treat rheumatism and chronic
stomach conditions), but biomedicine is more efficacious in treating acute con-
ditions. See Scheid (2002, 107–133) on how these stereotypes do not always
inform action in a straightforward way.
13 On filiality, see the volumes edited by Alan Chan and Sor-Hoon Tan (2004)
and Charlotte Ikels (2004). See also The Classic of Filial Piety (Xiaojing 1975).
14 Following a statewide reforestation policy, local farmers were instructed to
plant fruit trees, and a total of 400 mu (1 mu = 667 square meters) was planted
with peach and apricot trees in 2001. According to national-level laws, the
local government was required to provide farmers who took part in the scheme
with 150 kilograms of grain per mu and with 20 yuan worth of chemicals per
year per person for the first five years (confirmed by informal conversation
with host family on January 25, 2005). On this policy and its reception, see, for
instance, Flower (2009).
Chapter 8: Family Relations and Contested Religious Moralities
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
as a form of resistance, see Ole Brunn (2003), Stephan Feuchtwang (2000),

Stephan Feuchtwang and Mingming Wang (2001), and Erik Mueggler (2001).
3 On spirit mediums in China and Taiwan, see Ann Anagnost (1987), Erin Cline
(2010), Lizhu Fan (2003), David Jordan (1972), Arthur Kleinman (1980), Erik
Mueggler (2001), and Margery Wolf (1992).
4 The expressions “yinyang master” and “feng shui master” were used inter-
changeably. There were two of these masters in the village, both men. They
were mostly consulted for building new houses, marriages, and funerals. For
a full-length study of geomancy, see Feuchtwang (1974). A recent monograph
on the topic by Ole Brunn (2003) examines its resurgence. Pamela Leonard
(1994) examines local perceptions of geomancy.
5 On the efficacy of ritual, see Emily Ahern (1979), Adam Chau (2006, chapters
4 and 6), Stephan Feuchtwang (1992), Steven Sangren (2000), and Margery
Wolf (1992).
6 The importance of locality and shared community for a healer’s efficacy is
something I have explored elsewhere (2005).
7 Writing on exorcists in Sri Lanka, Bruce Kapferer noticed a similar pattern:
“An exorcist is appealed to after other methods have been tried,” including
medical doctors and astrologers (1991, 73) and when such practitioners failed
to diagnose a particular problem (84).
8 On paper money and transactions between the living and the dead, see Hill
Gates (1987).
9 Similar claims on the relatively small cost of practicing Christianity were put
forward by one Christian informant in Flower and Leonard’s study (2005) in
Ya’an county, western Sichuan.
10 Aunt Xu had been introduced to Aunt Liu’s brother when they were young
in the hope that they would marry, but her family refused because they found
Aunt Liu’s family too poor for their daughter to marry into. Nonetheless, Aunt
Liu explained, “She said she still wanted to be my sister, so we have been
friends since then.”
11 I wonder whether this in fact reflected her experience of being ostracized by
her neighbors when she was ill, since they were so ready to explain her secrecy
about TB as fear of being isolated. Her own account that she spent “thou-
sands of yuan” on her “cold” and was hospitalized for a number of successive
periods substantiated the hypothesis that she did suffer from TB and it was not
simply a malicious rumor.
12 Writing on Hakka funerary rituals in Guangdong Province, Ellen Oxfeld dis-
putes Andrew Kipnis’ suggestion (1995) that peasants revive popular religion
as a positive assertion of peasant identity. For Oxfeld, the fulfilment of moral
obligations, not peasantness, is the chief motive for the performance of funer-
ary rituals (2004, 986). I would suggest their approaches are closer than Oxfeld
implies. In both cases, claims to moral behavior underlie the importance of

the rites.
13 On Chinese funerary rites, see James Watson and Evelyn Rawski (1988).
14 This is somewhat in contrast to Erik Mueggler’s accounts of ghosts in north-
ern Yunnan during and after the Great Leap Forward: “In the stories of the
Great Leap and the devastating famine it precipitated, Zhizuo residents drew
on exorcism rituals to develop a new mode of envisioning state power. In this
vision, the state was likened to a spectral chain, a predatory bureaucracy of
wild ghosts, dominated by the fury and resentment of the unmourned fam-
ine dead” (2001, 161–162). For Mueggler, attributing illness to possession by
ghosts served to at once blame the local state for suffering and sever connec-
tions to “real actors, policies and institutions” (48). In my case, the impact of
the state on the spirit world is expressed differently—first as a near eradication
of it, and after Mao as a license to once again engage with it—but it is in
both cases “a resource for imagining the powers of officialdom and living with
their effects” (49).
15 In fact, the final shaoqi should have been held on March 26, 2005. However,
the feng shui master advised the family to move it forward by a day because the
26th of March was the seventeenth day of the second lunar month. Since 17
contains a 7, and the rite was also the seventh of its kind, the clash of sevens
would have been inauspicious.
16 Similar remarks on the equation of the image with the god or spirit were made
by David Graham (1927), who worked as a missionary in Sichuan between
1911 and 1949. His work is examined by Flower and Leonard (2005).
Conclusion
1 This argument is developed more fully in Lora-Wainwright (2009).

2 Both Judith Farquhar (2002, 269) and Everett Zhang (2007, 492) refer to
Treichler’s phrase in their discussion of impotence in China.
References
Agamben, Giorgio. 1998. Homo Sacer: Sovereign Power and Bare Life. Stanford, CA:
Stanford University Press.
———. 2005. State of Exception. London: University of Chicago Press.
Agency for Toxic Substances and Disease Registry. 2001. “TOxFAQs for
Manganese.” http://www.atsdr.cdc.gov/tfacts151.html#bookmark02
(accessed 6/3/2008).
Ahern, Emily. 1973. The Cult of the Dead in a Chinese Village. Stanford, CA: Stanford
University Press.
———. 1979. “The Problem of Efficacy: Strong and Weak Illocutionary Acts.”
Man 14: 1–17.
Anagnost, Ann. 1987. “Politics and Magic in Contemporary China.” Modern
China 13(1): 40–61.
Anand, Sudhir, Fabienne Peter, and Amartya Sen. 2004. Public Health, Ethics and
Equity. Oxford: Oxford University Press.
Anson, Ofra, and Shifang Sun. 2005. Health Care in Rural China: Lessons from HeBei
Province. London: Ashgate.
Balshem, Martha. 1991. “Cancer, Control and Causality: Talking about Cancer
in a Working-Class Community.” American Ethnologist 18(1): 152–172.
———. 1993. Cancer in the Community. Washington, DC: Smithsonian Institution.
Bays, Daniel. 2003. “Chinese Protestant Christianity Today.” In Daniel Overmyer
(ed.), “Religion in China Today.” Special issue, China Quarterly 174 ( June):
488–504.
Beck, Ulrich. 1992. “The Reinvention of Politics: Towards a Theory of Reflexive
Modernization.” In Ulrich Beck, Anthony Giddens, and Scott Lash (eds.),
Reflexive Modernization: Politics, Tradition and the Aesthetic in the Modern Social Order,
1–55. Cambridge: Polity Press.
Beyer, Stefanie. 2006. “Environmental Law and Policy in the People’s Republic of
China.” Chinese Journal of International Law 5(1): 185–211.
Biehl, Joao. 2004. “Life of the Mind: The Interface of Psychopharmaceuticals,
Domestic Economies and Social Abandonment.” American Ethnologist 31(4):
475–496.
———. 2005. Vita: Life in a Zone of Social Abandonment. Berkeley: University of
California Press.
———. 2007. Will to Live: AIDS Therapies and the Politics of Survival. Princeton, NJ:
Princeton University Press.
Biehl, Joao, Byron Good, and Arthur Kleinman. 2007a. “Introduction:
Rethinking Subjectivity.” In Joao Biehl, Byron Good, and Arthur Kleinman
286     References
(eds.), Subjectivity: Ethnographic Investigations, 1–23. Berkeley: University of

California Press.
——— (eds.). 2007b. Subjectivity: Ethnographic Investigations. Berkeley: University of
California Press.
Biehl, Joao, and Amy Moran-Thomas. 2009. “Symptom: Subjectivities, Social
Ills, Technologies.” Annual Review of Anthropology 38: 267–288.
Blecher, Marc. 2002. “Hegemony and Workers’ Politics in China.” China Quarterly
170: 283–303.
Bloom, Gerald, Barun Kanjilal, and David H. Peters. 2008. “Regulating Health
Care Markets in China and India.” Health Affairs 27(4): 952–963.
Bloom, Gerald, and Shenglan Tang. 2004. Health Care Transition in Urban China.
London: Ashgate.
Booth, William. 1994. “On the Idea of the Moral Economy.” American Political
Science Review 88(3): 653–667.
Bossen, Laurel. 2002. Chinese Women and Rural Development. London: Rowman and
Littlefield.
Bourdieu, Pierre. 1977. Outline of a Theory of Practice. Cambridge: Cambridge
University Press.
———. 1984. Distinction. A Social Critique of the Judgement of Taste. London: Routledge.
———. 1990. The Logic of Practice. Cambridge: Polity Press.
———. 2001. Practical Reason: On the Theory of Action. Stanford, CA: Stanford
University Press.
Bray, Francesca. 1997. Technology and Gender: Fabrics of Power in Late Imperial China.
Berkeley: University of California Press.
Brodwin, Paul. 1996. Medicine and Morality in Haiti: The Contest for Healing Power.
Cambridge: Cambridge University Press.
Broomhall, Marshall. 1926. W. W. Cassells, First Bishop in Western China. London:
China Inland Mission.
Brown, Phil. 2007. Toxic Exposures: Contested Illnesses and the Environmental Health
Movement. New York: Columbia University Press.
Brown, Phil, and Edwin J. Mikkelsen. 1997. No Safe Place: Toxic Waste, Leukemia, and
Community Action. Berkeley: University of California Press.
Brunn, Ole. 2003. Fengshui in China: Geomantic Divination between State Orthodoxy and
Popular Religion. Honolulu: University of Hawai‘i Press.
Bullard, Robert (ed.). 2005. The Quest for Environmental Justice. San Francisco: Sierra
Club Books.
Calhoun, Craig, Edward LiPuma, and Moishe Postone. 1993. “Introduction.” In
Craig Calhoun, Edward LiPuma, and Moishe Postone (eds.), Bourdieu: Critical
Perspectives, 1–13. Cambridge: Polity.
Canguilhem, Georges. 1991. The Normal and the Pathological. Translated by Carolyn
R. Fawcett and Robert S. Cohen. New York: Zone Books.
References     287
Caplan, Pat. 1992. Feasts, Fasts and Famines: Food for Thought. Providence, RI: Berg.
––––––. 1997. “Approaches to the Study of Food, Health and Identity.” In Pat
Caplan (ed.), Food, Health and Identity, 1–31. London: Routledge.
Carrin, Guy, Aviva Ron, Jun Yu, et al. 1997. “Reforming the Rural Cooperative
Medical System in China: A Summary of Initial Experience.” IDS Bulletin
28(1): 92–98.
Carter, Neil, and Arthur Mol (eds.). 2007. Environmental Governance in China.
London: Routledge.
Cassels, William W. 1895. Wang: A Chinese Christian. London: China Inland Mission.
CCMS (China Cooperative Medical Scheme, Ministry of Health). 2008. “Vice
Secretary Yin Li Surveys the Ministry of Health’s New China Cooperative
Medical Scheme Research Centre” (Yin Li fubuzhang shicha weishengbu
xinxing nongcun hezuo yiliao yanjiu zhongxin). http://www.ccms.org.cn/
third-xwxx.asp?id=226 (accessed 11/28/2008).
CCMS Online. http://ccms.org.cn (accessed 7/4/2007).
Central Party Committee and State Council. 2002. “Decision on Further
Strengthening Rural Health Work” (Zhonggong zhongyang guowuyuan
guanyu jin yi bu jiaqiang nongcun weisheng gongzuo de jueding). October
19. http://www.moh.gov.cn (accessed 2/1/2004).
Chan, Alan, and Sor-Hoon Tan (eds.). 2004. Filial Piety in Chinese Thought and
History. London: Routledge.
Chan, Anita, Jonathan Unger, and Richard Madsen. 1992. Chen Village under Mao
and Deng. Expanded and Updated Edition. Berkeley: University of California
Press.
Chan, Celina, and Graeme Lang. 2007. “Temple Construction and the Revival
of Religion in China.” China Information 21(1): 43–69.
Chao, Emily. 1999. “The Maoist Shaman and the Madman: Ritual Bricolage,
Failed Ritual, and Failed Ritual Theory.” Cultural Anthropology 14(4): 505–534.
Chau, Adam. 2005. “The Politics of Legitimation and the Revival of Popular
Religion in Shaanbei, North-Central China.” Modern China 31(2): 236–278.
———. 2006. Miraculous Response Doing Religion in Contemporary China. Stanford,
CA: Stanford University Press.
Chavez, Leo, Juliet M. McMullin, Shiraz I. Mishra, and Allan Hubbell. 2001.
“Beliefs Matter: Cultural Beliefs and the Use of Cervical Cancer-Screening
Tests.” American Anthropologist 103(4): 1114–1129.
Checker, Melissa. 2005. Polluted Promises: Environmental Racism and the Search for Justice
in a Southern Town. New York: New York University Press.
Chen, Junshi, Colin T. Campbell, Junyoa Li, and Richard Peto. 1990. Diet, Lifestyle
and Mortality in China. Oxford: Oxford University Press.
Chen, Junshi, Bo-Qui Liu, Pan Wen-Harn, Colin T. Campbell, Richard Peto,
Jillian Boreham, Banoo Parpia, Patricia Cassano, and Zheng-Ming Chen.
2006. Mortality, Biochemistry, Diet and Lifestyle in Rural China. Oxford: Oxford
University Press.
Chen, Nancy N. 2003. Breathing Spaces: Qigong, Psychiatry and Healing in China.
New York: Columbia University Press.
Chen, Zhu. 2008. The Third National Survey on Causes of Death. Beijing: China
Union Medical University Press.
Cheng, Sheung-Tak. 1996. “A Critical Review of Chinese Koro.” Culture, Medicine,
and Psychiatry 20(1): 67–82.
Cheung, Fanny M. 1987. “Conceptualization of Psychiatric Illness and Help-
Seeking Behavior among Chinese.” Culture, Medicine, and Psychiatry 11: 97–106.
China Inland Mission. 1884. China’s Millions. London: China Inland Mission.
———. 1885. China’s Millions. London: China Inland Mission.
“China’s Poisoned Waters.” Channel 4. June 15, 2006. http://www.channel4
.com/more4/news/news-opinion-feature.jsp?id=299 (accessed 08/08/06).
Chinese Government Web Portal (Zhongyang zhengfu menhu wangzhan). 2008.
“This Year the Ministry of Finance Gives Sichuan’s New Rural Cooperative
Healthcare a Subsidy of 2,419,330,000” (Zhongyang caizheng jinnian xiada
Sichuan xin nong he buzhu zijin 241933 wan). September 16. http://www
.gov.cn/gzdt/2008–09/16/content_1096947.htm (accessed 11/12/2008).
Chui, Yingyu, Judith Donoghue, and Lynn Chenoweth. 2005. “Responses to
Advanced Cancer: Chinese-Australians.” Issues and Innovations in Nursing
Practice 52(5): 498–507.
Cline, Erin M. 2010. “Female Spirit Mediums and Religious Authority in
Contemporary Southeastern China.” Modern China 36(5): 520–555.
CNN. “Red River Brings Cancer, Chinese Villagers Say.” 2007. October 25.
http://edition.cnn.com/2007/WORLD/asiapcf/10/23/pip.china
.pollution/ (accessed 11/3/2007).
CNSS (China National Social Security: Zhongguo Shehui Baozhang). 2006.
“Sichuan’s New Rural Cooperative Health Care Progresses toward
Perfection” (Sichuan “xinnonghe” zai wanshan zhong qianxing). November
23, http://www.cnss.cn/yjpt/ztbd/200611/t20061123_108478.html
(accessed 11/28/2008).
Cohen, Lawrence. 1999. “Where It Hurts: Indian Material for an Ethics of
Organ Transplantation.” Daedalus 128(4): 135–166.
Cohen, Myron. 1976. House United, House Divided: The Chinese Family in Taiwan.
New York: Columbia University Press.
———. 1993. “Cultural and Political Inventions in Modern China: The Case of
the Chinese ‘Peasant.’” Daedalus 122: 151–170.
Colliers, Stephen, and Andrew Lakoff. 2005. “On Regimes of Living.” In Aihwa
Ong and Stephen Colliers (eds.), Global Assemblages: Technology, Politics, and
Ethics as Anthropological Problems, 22–39. Oxford: Blackwell.
Comaroff, Jean. 1980. “Healing and the Cultural Order: The Case of the
Barolong Boo Ratshidi of Southern Africa.” American Ethnologist 7(4):
637–657.
Comaroff, Jean, and John Comaroff (eds.). 1993. Modernity and Its Malcontents:
Ritual and Power in Post-Colonial Africa. Chicago: University of Chicago Press.
———. 2006. Law and Disorder in the Postcolony. Chicago: University of Chicago
Press.
Cook, Sarah. 2007. “Putting Health Back in China’s Development.” China
Perspectives 3: 100–108.
Crandon-Malamud, Libbet. 1991. From the Fat of Our Souls: Social Change, Political
Process, and Medical Pluralism in Bolivia. Berkeley: University of California Press.
Croll, Elisabeth. 1981. Politics of Marriage in Contemporary China. Cambridge:
Cambridge University Press.
———. 1983. Chinese Women since Mao. London: Zed Books.
———. 1994. From Heaven to Earth: Images and Experiences of Development in China.
London: Routledge.
Csordas, Thomas. 1994. “Introduction: the Body as Representation and Being-in-
the-World.” In Thomas Csordas (ed.), Embodiment and Experience: The Existential
Ground of Culture and Self, 1–24. Cambridge: Cambridge University Press.
———. 2002. Body/Meaning/Healing. New York: Palgrave Macmillan.
Das, Veena. 1994. “Moral Orientations to Suffering: Legitimation, Power and
Healing.” In Lincoln Chen, Arthur Kleinman, and Norma Ware (eds.),
Health and Social Change in International Perspective, 139–167. Cambridge, MA:
Harvard University Press.
Das, Veena, and Ranendra K. Das. 2006. “Pharmaceuticals in Urban Ecologies:
The Register of the Local.” In Adriana Petryna, Andrew Lakoff, and Arthur
Kleinman (eds.), Global Pharmaceuticals: Ethics, Markets, Practices, 171–205.
Durham, NC: Duke University Press.
———. 2007. “How the Body Speaks: Illness and the Lifeworld among the Urban
Poor.” In Joao Biehl, Byron Good, and Arthur Kleinman (eds.), Subjectivity:
Ethnographic Investigations, 66–97. Berkeley: University of California Press.
Das, Veena, and Arthur Kleinman. 2001. “Introduction.” In Veena Das, Arthur
Kleinman, Margaret Lock, Mamphela Ramphele, and Pamela Reynolds
(eds.), Remaking a World: Violence, Social Suffering and Recovery, 1–30. Berkeley:
University of California Press.
Das, Veena, Arthur Kleinman, Margaret Lock, Mamphela Ramphele, and

Pamela Reynolds (eds.). 2000. Violence and Subjectivity. Berkeley: University of
California Press.
———. 2001. Remaking a World: Violence, Social Suffering and Recovery. Berkeley:
Davin, Delia. 1976. Woman-Work: Women and the Party in Revolutionary China. Oxford:
Clarendon Press.
———. 1988. “The Implications of Contract Agriculture for the Employment
and Status of Chinese Peasant Women.” In Stephan Feuchtwang, Athar
Hussain, and Thierry Pairault (eds.), Transforming China’s Economy in the Eighties.
Volume 1: The Rural Sector, Welfare and Employment, 137–146. Boulder, CO:
Westview Press.
Davis, Deborah (ed.). 2000. The Consumer Revolution in Urban China. Berkeley:
Davis, Deborah, and Stevan Harrell (eds.). 1993. Chinese Families in the Post-Mao
Era. Berkeley: California University Press.
Davis, Scott. 1996. “The Cosmobiological Balance of the Emotional and
Spiritual Worlds: Phenomenological Structuralism in Traditional Chinese
Medical Thought.” Culture, Medicine, and Psychiatry 20(1): 83–123.
Day, Kristen A. (ed.). 2005. China’s Environment and the Challenge of Sustainable
Development. London: M. E. Sharpe.
Dean, Kenneth. 1998. Lord of the Three in One: The Spread of a Cult in Southeast China.
Princeton, NJ: Princeton University Press.
———. 2003. “Local Communal Religion in Contemporary Southeast China.”
China Quarterly 173: 336–358.
DeCerteau, Michel. 1984. The Practice of Everyday Life. Berkeley: University of
California Press.
Deng, Fei. 2009. “China’s 100 Cancer Causing Places.” Fenghuang (Phoenix) Weekly
11 (April). Also available at http://blog.ifeng.com/article/2647063.html
Desjarlais, Robert. 1992. Body and Emotion: The Aesthetics of Illness and Healing in the
Nepal Himalayas. Philadelphia: University of Pennsylvania Press.
Dong, Xiaoyu. 2001. Little Dictionary of Proverbs. Chengdu: Sichuan Phrasebook
Publishing.
Dong, Zhe, and Michael Phillips. 2008. “Evolution of China’s Health-care
System.” Lancet 372(9651): 1715–1716.
Double Leaf. 2009. “China Cancer Villages Map.” Created May 7 and updated
June 1, 2009. http://maps.google.com/maps/ms?hl=en&ie=UTF8&lr
=lang_en&msa=0&msid=104340755978441088496.000469611a28a0d8a
22dd&ll=34.098728,117.292099&spn=0.268943,0.4422&z=11 (accessed
11/12/2009).
Duara, Prasenjit. 1991. “Knowledge and Power in the Discourse of Modernity:

The Campaigns against Popular Religion in Early Twentieth-Century
China.” Journal of Asian Studies 50(1): 67–83.
Duckett, Jane. 2007. “Local Governance, Health Financing, and Changing
Patterns of Inequality in Access to Healthcare.” In Vivienne Shue and
Christine Wong (eds.), Paying for Progress: Public Finance, Human Welfare and
Changing Patterns of Inequality, 46–68. London: Routledge.
———. 2010. The Chinese State’s Retreat from Health: Policy and the Politics of
Retrenchment. London: Routledge.
Dummer, Trevor J. B., and Ian G. Cook. 2007. “Exploring China’s Rural Health
Crisis: Processes and Policy Implications.” Health Policy 83(1): 1–16.
Dunch, Ryan. 2008. “Christianity and ‘Adaptation to Socialism.’” In Mayfair
Mei-Hui Yang (ed.), Chinese Religiosities: Afflictions of Modernity and State
Formation, 155–178. Berkeley: University of California Press.
Durant, Robert, Daniel Fiorino, and Rosemary O’Leary. 2004. Environmental
Governance Reconsidered. Cambridge, MA: MIT Press.
Economy, Elizabeth. 2004. The River Runs Black: The Environmental Challenge to
China’s Future. Ithaca, NY: Cornell University Press.
———. 2005. “Environmental Enforcement in China.” In Kristen Day (ed.),
China’s Environment and the Challenge of Sustainable Development, 102–120.
Armonk, NY: East Gate.
———. 2007. “The Great Leap Backward? The Costs of China’s Environmental
Crisis.” Foreign Affairs 86(5) (September/October), 38–59. http://www
.foreignaffairs.org/20070901faessay86503/elizabeth-c-economy/
the-great-leap-backward.html (accessed 01/10/2007).
Edelman, Marc. 2005. “Bringing the Moral Economy Back in . . . to the Study
of 21st-Century Transnational Peasant Movements.” American Anthropologist
107(3): 331–345.
Edin, Maria. 2003. “State Capacity and Local Agent Control in China: CCP
Cadre Management from a Township Perspective.” China Quarterly 173
(March): 35–52.
Erwin, Kathleen. 2006. “The Circulatory System: Blood Procurement, AIDS and
the Social Body in China.” Medical Anthropology Quarterly 20(2): 139–159.
Etkin, Nina. 1988. “Cultural Constructions of Efficacy.” In Sjaak van der Geest
and Susan Reynolds Whyte (eds.), The Context of Medicines in Developing
Countries: Studies in Pharmaceutical Anthropology, 299–326. Dordrecht,
Netherlands: Kluwer.
Etkin, Nina, and Michael Tan (eds.). 1994. Medicines: Meanings and Contexts.
Quezon City, Philippines: Health Action Information Newtork.
Fan, Lizhu. 2003. “The Cult of the Silkworm Mother as a Core of Local
Community Religion in a North China Village: Field Study in Zhiwuying,
Baoding, Hebei.” In Daniel Overmyer (ed.), “Religion in China Today.”

Special issue, China Quarterly 174 ( June): 359–372.
Fan, Ruiping. 2006. “Towards a Confucian Virtue Bioethics: Reframing Chinese
Medical Ethics in a Market Economy.” Theoretical Medicine and Bioethics 27:
541–566.
Fang, Jing. 2008. “The Chinese Health Care Regulatory Institutions in an Era
of Transition.” Social Science and Medicine 66(4): 952–962.
Farmer, Paul. 1988. “Bad Blood, Spoiled Milk: Bodily Fluids as Moral
Barometers in Rural Haiti.” American Ethnologist 15(1): 62–83.
———. 1992. AIDS and Accusation: Haiti and the Geography of Blame. Berkeley:
———. 2003. Pathologies of Power: Health, Human Rights and the New War on the Poor.
———. 2010. Partner to the Poor: A Paul Farmer Reader. Edited by Haun Saussy.
Farmer, Paul, and Arthur Kleinman. 1989. “AIDS as Human Suffering.” Daedalus
118(2): 135–160
Farquhar, Judith. 1994. Knowing Practice: The Clinical Encounter of Chinese Medicine.
Oxford: Westview.
———. 2002. Appetites: Food and Sex in Post-Socialist China. Durham, NC: Duke
University Press.
Farquhar, Judith, and Qicheng Zhang. 2005. “Biopolitical Beijing: Pleasure,
Sovereignty and Self-Cultivation in China’s Capital.” Cultural Anthropology
20(3): 303–327.
Fassin, Didier. 2007. When Bodies Remember: Experiences and Politics of AIDS in South
Africa. Berkeley: University of California Press.
Feuchtwang, Stephan. 1974. An Anthropological Analysis of Chinese Geomancy. Laos:
Vithagna.
———. 1992. The Imperial Metaphor. London: Routledge.
———. 1996. “Local Religion and Village Identity.” In Tao Tao Liu and David
Faure (eds.), Unity and Diversity: Local Culture and Identities in China, 161–176.
Hong Kong: Hong Kong University Press.
———. 2000. “Religion as Resistance.” In Elizabeth Perry and Mark Selden (eds.),
Chinese Society: Change, Conflict and Resistance, 161–177. London: Routledge.
———. 2003. “An Unsafe Distance.” In Charles Stafford (ed.), Living with
Separation in China: Anthropological Accounts, 85–112. London: Routledge
and Curzon.
Feuchtwang, Stephan, and Mingming Wang. 2001. Grassroots Charisma: Four Local
Leaders in China. London: Routledge.
Flower, John. 2004. “A Road Is Made: Roads, Temples and Historical Memory in
Ya’an County, Sichuan.” Journal of Asian Studies 63(3): 649–685.
———. 2009. “Ecological Engineering on the Sichuan Frontier: Socialism

as Development Policy, Local Practice and Contested Ideology.” Social
Anthropology 17: 40–55.
Flower, John, and Pamela Leonard. 1996. “Community Values and State
Cooptation: Civil Society in the Sichuan Countryside.” In Chris Hann
and Elizabeth Dunn (eds.), Civil Society: Challenging Western Models, 199–221.
London: Routldege.
———. 1998. “Defining Cultural Life in the Chinese Countryside: The Case of
the Chuan Zhu Temple.” In Eduard Vermeer, Frank Pieke, and Woei Lien
Chong (eds.), Cooperative and Collective in China’s Rural Development: Between State
and Private Interests, 273–290. London: M. E. Sharpe.
———. 2005. “Body, Belief and the State: Three Portraits from Rural Sichuan.”
http://xiakou.uncc.edu/chapters/belief/bodybeliefstate.htm (accessed
2/12/2010).
Foucault, Michel. 2006. The History of Madness. London: Routledge.
Fowler, Bridget. 1997. Pierre Bourdieu and Cultural Theory: Critical Investigations.
London: Sage.
Frank, Adam. 2006. Taijichuan and the Search for the Little Old Chinese Man:
Understanding Identity through Martial Arts. London: Palgrave Macmillan.
Freedman, Maurice. 1970. Family and Kinship in Chinese Society. Stanford, CA:
Friedman, Edward, Paul G. Pickowicz, and Mark Selden. 2006. Revolution,
Resistance, and Reform in Village China. New Haven, CT: Yale University Press.
Furth, Charlotte. 1986. “Blood, Body and Gender: Medical Images of the Female
Condition in China, 1600–1850.” Chinese Science 7: 43–66.
———. 1987. “Concepts of Pregnancy, Childbirth and Infancy in Ch’ing
Dynasty China.” Journal of Asian Studies 46(1): 7–35.
Gaetano, Arielle, and Tamara Jacka. 2004. On the Move: Women and Rural-to-Urban
Migration in Contemporary China. New York: Columbia University Press.
Gammeltoft, Tine. 2007. “Prenatal Diagnosis in Postwar Vietnam: Power,
Subjectivity and Citizenship.” American Anthropologist 109(1): 153–163.
Gao, Mobo. 1999. Gao Village: A Portrait of Rural Life in Modern China. London:
Hurst and Company.
Gates, Hill. 1987. “Money for the Gods.” Modern China 13(3): 259–277.
———. 1996. China’s Motor: A Thousand Years of Petty Capitalism. Ithaca, NY:
Cornell University Press.
Gates, Hill, and Robert Weller. 1987. “Hegemony and Chinese Folk Ideologies:
An Introduction.” In Hill Gates and Robert Weller (eds.), Symposium on
Hegemony and Chinese Folk Ideologies. Modern China 13(1): 3–16.
Gernet, Jacques. 1985. China and the Christian Impact. Cambridge: Cambridge
University Press.
Gibbon, Sahra. 2007. Breast Cancer Genes and the Gendering of Knowledge: Science and
Citizenship in the Cultural Context of the “New” Genetics. London: Macmillan.
Goldman, Merle. 2005. From Comrade to Citizen: The Struggle for Political Rights in
China. Cambridge, MA: Harvard University Press.
Good, Byron J. 1994. Medicine, Rationality and Experience. Cambridge: Cambridge
University Press.
Good, Mary-Jo DelVecchio, Byron J. Good, Cynthia Schaffer, and Stuart E. Lind.
1990. “American Oncology and the Discourse on Hope.” Culture, Medicine,
———. 1992. “A Comparative Analysis of the Culture of Biomedicine:
Disclosure and Consequences for Treatment in the Practice of Oncology.” In
Peter Conrad and Eugene Gallagher (eds.), Health and Health Care in Developing
Societies: Sociological Perspectives. Philadelphia: Temple University Press.
Good, Mary-Jo DelVecchio, Sandra Hyde, Sarah Pinto, and Byron Good
(eds.). 2008. Postcolonial Disorders: Ethnographic Studies in Subjectivity. Berkeley:
Good, Mary-Jo DelVecchio, Tseunetsugu Munakata, Yasuki Kobayashi, Cheryl
Mattingly, and Byron J. Good. 1994. “Oncology and Narrative Time.” Social
Science and Medicine 38(6): 855–862.
Gordon, Deborah. 1990. “Embodying Illness, Embodying Cancer.” Culture,
Medicine, and Psychiatry 14(2): 275–297.
Gordon, Deborah, and Eugenio Paci. 1997. “Disclosure Practices and Cultural
Narratives: Understanding Concealment and Silence around Cancer in
Tuscany, Italy.” Social Science and Medicine 44(10): 1433–1452.
Graham, David. 1927. “Religion in Szechwan Province.” D.Phil. dissertation.
University of Chicago.
Greco, Monica, and Paul Stenner. 2008. Emotions: A Social Science Reader. London:
Routledge.
Gregg, Jessica. 2003. Virtually Virgins: Sexual Strategies and Cervical Cancer in Recife.
Stanford, CA: Stanford University Press.
Gu, Xin, Mengtao Gao, and Yang Yao. 2006. China’s Health Care Reforms: A
Pathological Analysis (Zhenduan yu chufang. Zhimian zhongguo yiliao tishi
gaige). Beijing: Social Science Academic Press.
Gupta, Akhil. 1998. Postcolonial Developments: Agriculture in the Making of Modern India.
Hahn, Robert. 1995. Sickness and Healing: An Anthropological Perspective. London: Yale
University Press.
Hann, Chris. 2009. “Embedded Socialism? Land, Labour and Money in Eastern
Xinjiang.” In Chris Hann and Keith Hart (eds.), Market and Society: The Great
Transformation Today, 256–271. Cambridge: Cambridge University Press.
Harker, Richard, Cheleen Mahar, and Chris Wilkes (eds.). 1990. An Introduction to
the Work of Pierre Bourdieu: The Practice of Theory. London: Macmillan.
Harrell, Stevan. 1979. “The Concept of Soul in Chinese Folk Religion.” Journal of
Asian Studies 38(3): 519–528.
———. 1985. “Why Do the Chinese Work So Hard? Reflections on an
Entrepreneurial Ethic.” Modern China 11(2): 203–226.
———. 2001. Ways of Being Ethnic in Southwest China. Washington, DC:
Washington University Press.
Heller, Chaia. 2006. “Post-Industrial ‘Quality Agricultural Discourse’: Techniques
of Governance and Resistance in the French Debate over GM Crops.” Social
Anthropology 14: 319–334.
Hillman, Ben. 2004. “The Rise of the Community in Rural China: Village
Politics, Cultural Identity and Religious Revival in a Hui Hamlet.” China
Journal 51 ( January): 53–73.
———. 2005. “Monastic Politics and the Local State in China: Authority and
Autonomy in an Ethnically Tibetan Prefecture.” China Journal 54 ( July): 29–51.
Ho, Sam. 1994. Rural China in Transition: Non-Agricultural Development in Rural Jiangsu,
1978–1990. Oxford: Clarendon Press.
Hofrichter, Richard (ed.). 2000. Reclaiming the Environmental Debate: The Politics of
Health in a Toxic Culture. Cambridge, MA: MIT Press.
Holdaway, Jennifer. 2010. “Environment and Health in China: An Introduction
to an Emerging Research Field.” Journal of Contemporary China 19(63): 1–22.
Hsu, Elisabeth. 1999. The Transmission of Chinese Medicine. Cambridge: Cambridge
University Press.
Hsu, Elisabeth, and Erling Hog (eds.). 2002. “Introduction to Special Issue:
Countervailing Creativity: Patient Agency in the Globalisation of Asian
Medicines.” Anthropology and Medicine (special issue) 9(3): 205–221.
Hsu, Kenneth, Wenhua Ye, Yunhua Kong, Dong Li, and Feng Hu. 2007. “Use
of Hydrotransistor and De-Nitrification Pond to Produce Purified Water.”
http://home.btconnect.com/KennethHsu/webdocs/Nitrite%20PNAS-
19Feb2007.pdf (accessed 6/3/2008).
Hu, Shanlian, Shenglan Tang, Yuanli Liu, Yuxin Zhao, Maria-Luisa Escobar, and
David De Ferranti. 2008. “Reform of How Health Care is Paid for in China:
Challenges and Opportunities.” Lancet 372(9648): 1846–1853.
Huang, Shu-Min. 1989. The Spiral Road: Change in a Chinese Village through the Eyes of
a Communist Party Leader. Boulder, CO: Westview.
Humphrey, Caroline. 1997. “Exemplars and Rules: Aspects of the Discourse
of Moralities.” In Signe Howell (ed.), The Ethnography of Moralities, 25–48.
London: Routledge.
Hunt, Linda. 1998. “Moral Reasoning and the Meaning of Cancer: Causal
Explanations of Oncologists and Patients in Southern Mexico.” Medical
Anthropology Quarterly 12(3): 298–318.
Hunter, Alan, and Kim-Kwong Chan. 1993. Protestantism in Contemporary China.
Hurst, William. 2004. “Understanding Contentious Collective Action by Chinese

Laid-off Workers: The Importance of Regional Political Economy.” Studies in
Comparative International Development 39(2): 94–120.
Hurst, William, and Kevin O’Brien. 2002. “China’s Contentious Pensioners.”
China Quarterly 170: 345–360.
Hyde, Sandra. 2007. Eating Spring Rice: The Cultural Politics of AIDS in Southwest
China. Berkeley: University of California Press.
Ikels, Charlotte. 1998. “The Experience of Dementia in China.” Culture, Medicine,
——— (ed.). 2004. Filial Piety: Practice and Discourse in Contemporary East Asia.
Ingold, Tim. 2000. The Perception of the Environment: Essays on Livelihood, Dwelling and
Skill. London: Routledge.
Jacka, Tamara. 1997. Women’s Work in Rural China. Cambridge: Cambridge
University Press.
———. 2006. Rural Women in Urban China: Gender, Migration, and Social Change.
Armonk, NY: M. E. Sharpe.
Jackson, Michael. 1989. Paths toward a Clearing: Radical Empiricism and Ethnographic
Inquiry. Bloomington: Indiana University Press.
Janes, Craig, and Oyuntsetseg Chuluundorj. 2004. “Free Markets and Dead
Mothers: The Social Ecology of Maternal Mortality in Post-Socialist
Mongolia.” Medical Anthropology Quarterly 8(2): 230–257.
Jankowiak, William. 2004. “Market Reforms, Nationalism and the Expansion
of Urban China’s Moral Horizon.” Urban Anthropology and Studies of Cultural
Systems and World Economic Development 33: 167–210.
Janzen, John. 1978. The Quest for Therapy in Lower Zaire. Berkeley: University of
California Press.
———. 1987. “Therapy Management: Concept, Reality, Process.” Medical
Anthropology Quarterly 1(1): 68–84.
Jenkins, Richard. 1992. Pierre Bourdieu. London: Routledge.
Jiang, Jianping. 2008. “Following the Spirit of the Seventeenth People’s
Congress—Striving to Promote Better and Faster Social and Economic
Development in Langzhong” ( Yi shiqida jingshen wei zhizhen—nuli tuidong
langzhong jingji shehui you hao you kuai fazhan). Langzhong Online News.
April 1. http://www.lzgc.com/htm/a6/2008/1-4/zpcb30516879.asp
(accessed 11/28/2008).
Jing, Jun. 1996. The Temple of Memories: History, Power and Morality in a Chinese Village.
——— (ed.). 2000. Feeding China’s Little Emperors. Stanford, CA: Stanford
University Press.
———. 2003. “Environmental Protests in Rural China.” In Elizabeth Perry and

Mark Selden (eds.), Chinese Society: Change, Conflict and Resistance, 205–222.
London: Routledge.
Johnson, Kay Ann. 1983. Women, the Family and Peasant Revolution in China. Chicago:
University of Chicago Press.
Johnson, Thomas. 2008. “New Opportunities, Same Constraints: Environmental
Protection and China’s New Development Path.” Politics 28(2): 93–102.
Jordan, David. 1972. Gods, Ghosts and Ancestors: The Folk Religion of a Taiwanese
Village. Berkeley: University of California Press.
Judd, Ellen. 1994. Gender and Power in Rural North China. Stanford, CA: Stanford
University Press.
Kamat, Vinay. 2009. “Cultural Interpretations of the Efficacy and Side Effects of
Antimalarials in Tanzania.” Anthropology and Medicine 16(3): 293–305.
Kane, Penny. 1988. Famine in China, 1959–61: Demographic and Social Implications.
Basingstoke, UK: Palgrave Macmillan.
Kaneff, Deema. 2002. “The Shame and Pride of Market Activity: Morality, Identity
and Trading in Postsocialist Bulgaria.” In Ruth Mandel and Caroline Humphrey
(eds.), Markets and Moralities: Ethnographies of Postsocialism, 33–51. Oxford: Berg.
Kang, Xiaofei. 2009. “Two Temples, Three Religions and a Tourist Attraction:
Contesting Sacred Space in China’s Ethnic Frontier.” Modern China 53(3):
227–255.
Kapferer, Bruce. 1991. Celebration of Demons: Exorcism and the Aesthetics of Healing in
Sri Lanka. Oxford: Berg.
Kauppi, Niilo. 2000. The Politics of Embodiment: Habit, Power and Pierre Bourdieu’s
Theory. Frankfurt am Main: Peter Lang.
Kipnis, Andrew. 1995. “Within and against Peasantness: Backwardness and Filiality
in Rural China.” Comparative Studies in Society and History 37(1): 110–135.
———. 1997. Producing Guanxi: Sentiment, Self, and Subculture in a North China Village.
Kirsch, Stuart. 2006. Reverse Anthropology: Indigenous Analysis of Social and
Environmental Relations in New Guinea. Stanford, CA: Stanford University Press.
Klein, Jakob. 2009. “Creating Ethical Food Consumers? Promoting Organic
Foods in Urban Southwest China.” Social Anthropology 17(1): 74–89.
Kleinman, Arthur. 1980. Patients and Healers in the Context of Culture: An Exploration of
the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley: University
of California Press.
———. 1982. “Neurasthenia and Depression: A Study of Somatisation and
Culture in China.” Culture, Medicine, and Psychiatry 6: 117–190.
———. 1986. Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in
Modern China. New Haven, CT: Yale University Press.
———. 1988. The Illness Narratives: Suffering, Healing, and the Human Condition.
New York: Basic Books.
———. 1991. Rethinking Psychiatry: From Cultural Category to Personal Experience.
London: Free Press.
———. 1995. Writing at the Margin: Discourse between Anthropology and Medicine.
———. 2006. What Really Matters: Living a Moral Life amidst Uncertainty and Danger.
Oxford: Oxford University Press.
Kleinman, Arthur, Veena Das, and Margaret M. Lock (eds.). 1997. Social Suffering.
Kleinman, Arthur, and Sing Lee. 2003. “Suicide as Resistance in Chinese
Society.” In Elizabeth Perry and Mark Selden (eds.), Chinese Society: Change,
Conflict, and Resistance, 289–311. London: Routledge.
———. 2006. “SARS and the Problem of Social Stigma.” In Arthur Kleinman
and James Watson (eds.), SARS in China: Prelude to Pandemic? 173–195.
Kleinman, Arthur, and Tsung-Yi Lin (eds.). 1981. Normal and Abnormal Behavior in
Chinese Culture. Dordrecht, Netherlands: D. Reidel.
Korhman, Matthew. 2004. “Should I Quit? Tobacco, Fraught Identity, and the
Risks of Governmentality in Urban China.” Urban Anthropology 33: 211–245.
Revised and updated in Li Zhang and Aihwa Ong (eds.), Privatizing China:
Socialism from Afar, 133–150 (Ithaca, NY: Cornell University Press, 2008).
———. 2005. Bodies of Difference: Experiences of Disability and Institutional Advocacy in
the Making of Modern China. Berkeley: University of California Press.
———. 2007. “Depoliticizing Tobacco’s Exceptionality: Male Sociality, Death, and
Memory-Making among Chinese Cigarette Smokers.” China Journal 58: 85–109.
———. 2008. “Smoking among Doctors: Governmentality, Embodiment, and the
Diversion of Blame in Contemporary China.” Medical Anthropology 27(1): 9–42.
Ku, Hok Bun. 2003. Moral Politics in a South Chinese Village: Responsibility, Reciprocity,
and Resistance. Oxford: Rowman and Littlefield Publishers.
Ku, Hok Bun, and Elisabeth Croll. 2002. “Social Security: Right and Contracts
in a Chinese Village.” In Robert Ash (ed.), China’s Integration in Asia: Economic
Security and Strategic Issue, 169–187. London: Curzon.
Kuwano, Hiroyuki, Hiroyuki Kato, Tatsuya Miyazaki, Minoru Fukuchi, Norihiro
Masuda, Masanobu Nakajima, Yasuyuki Fukai, Makoto Sohda, Hitoshi
Kimura, and Ahmad Faried. 2005. “Genetic Alterations in Esophageal
Cancer.” Surgery Today 35: 7–18.
Kwok, Cannas, and Gerard Sullivan. 2006. “Influence of Traditional Chinese
Beliefs on Cancer Screening Behaviour among Chinese-Australian Women.”
Journal of Advanced Nursing 54(6): 691–699.
Lampton, David. 1977. The Politics of Medicine in China: The Policy Process, 1949–1977.
Folkestone, UK: Dawson.
Lancet. 2008. “Series on Health Systems Reform in China.” Available online at
http://www.thelancet.com/series/health-system-reform-in-china (accessed
11/25/2008).
Langzhong Administrative Service Center (Langzhong shi renmin zhengfu
zhengwu fuwu zhongxin). 2008. “Langzhong: Building the New Rural
Health Care Cooperative Social Security System” (Langzhong: qingli gouzhu
xinxing nongcun hezuo yiliao shehui baozhang tixi). January 4. http://www
.lzzw.gov.cn:81/q_detail.asp?id=100005599&lm_id=1002. Also published
on Southwest Economics Network (Xibu jingji wang). http://www.swbd.cn/
zhuankan/ShowArticle.asp?ArticleID=8899 (accessed 11/28/2008).
Langzhong Rural Health Care Cooperative Management Center (Langzhong
shi xinxing nongcun hezuo yiliao guanli zhongxin). 2005. “Increasing
Knowledge, Strengthening Leadership, Meticulous Structuring and Realistic
Grasping of the New Form of Rural Cooperative Healthcare Pilot Project
Work” (Tigao renshi, jiaqiang lingdao, jingxin zuzhi, qieshi zhua hao xinxing
nongcun hezuo yiliao shidian gongzuo). December 2 speech by the vice-
mayor at the training session for the Municipal RCMS).
Larsen, Janet. 2011. “Cancer Now Leading Cause of Death in China.” Earth
Policy Plan B. http://www.earth-policy.org/plan_b_updates/2011/update96
Latour, Bruno. 1993. We Have Never Been Modern. London: Harvester Wheatsheaf.
Leavitt, John. 1996. “Meaning and Feeling in the Anthropology of Emotions.”
American Ethnologist 23(3): 514–539.
Lee, Ching Kwan. 2000. “The ‘Revenge of History’: Collective Memories and
Labor Protests in Northeastern China.” Ethnography 1(2): 217–237.
———. 2007. Against the Law: Labor Protests in China’s Rustbelt and Sunbelt. Berkeley:
Lee, Ching Kwan, and Guobin Yang. 2007. Re-envisioning the Chinese Revolution: The
Politics and Poetics of Collective Memories in Reform China. Stanford, CA: Stanford
University Press.
Lee, Sing. 1998. “Higher Earnings, Bursting Trains and Exhausted Bodies: The
Creation of Travelling Psychosis in Post-Reform China.” Social Science and
Medicine 47(9): 1247–1261.
Lee, Sing, and Kit Ching Wong. 1995. “Rethinking Neurasthenia: The Illness
Concepts of Shenjing Shuairuo among Chinese Undergraduates in Hong
Kong.” Culture, Medicine, and Psychiatry 19(1): 91–111.
Leonard, Pamela. 1994. “The Political Landscape of a Sichuan Village.” D.Phil.
dissertation. University of Cambridge.
Li Shi-Gui and Zhang Yan-Mei. 2005. “Problems and Countermeasures for New
Rural Cooperative Medical Institution of Sichuan Province” (Sichuan sheng
xinxing nongcun hezuo yiliao shidian zhong de wenti yu duice). Journal of
Chongqing Technology and Business University (West Forum) (Chongqing gongshang
daxue xue bao, xibu luntan). 15(4): 49–51.
Lin, Tsung-Yi (ed.). 1989. “Neurasthenia in Asian Cultures.” Culture, Medicine, and
Psychiatry (special issue) 13(2).
Lindenbaum, Shirley, and Margaret M. Lock (eds.). 1993. Knowledge, Power, and
Practice: The Anthropology of Medicine and Everyday Life. Berkeley: University of
California Press.
Lindquist, Galina. 2002. “Healing Efficacy and the Construction of Charisma:
A Family’s Journey through the Multiple Medical Field in Russia.” In
Elisabeth Hsu and Erling Hog (eds.), “Countervailing Creativity: Patient
Agency in the Globalisation of Asian Medicines.” Special issue, Anthropology
and Medicine 9(3): 337–358.
———. 2006. Conjuring Hope: Magic and Healing in Contemporary Russia. Oxford:
Berghahn Books.
Litzinger, Ralph. 2000. Other Chinas: The Yao and the Politics of National Belonging.
Liu, Lee. 2010. “Made in China: Cancer Villages.” Environment Magazine (March-
April). http://www.environmentmagazine.org/Archives/Back%20Issues/
march-April%202010/made-in-china-full.html (accessed 5/3/2010).
Liu, Mengqin, and Chen Fu. 2007. “A Tradeoff between Development and
Poverty—A Theoretical Rethinking of the Cancer Villages in China.” Paper
presented at the Workshop on Environment, Health and Poverty in the Context
of Building the New Socialist Countryside, Lijiang, Yunnan, June 20–25.
Liu, Xin. 2000. In One’s Own Shadow: An Ethnographic Account of the Condition of Post-
Reform Rural China. Berkeley: University of California Press.
Lo, Carlos, and Shui-Yan Tang. 2006. “Institutional Reform, Economic Changes,
and Local Environmental Management in China: The Case of Guangdong.”
Environmental Governance 15(2): 190–210.
Lock, Margaret. 1993. “Cultivating the Body: Anthropology and Epistemologies
of Bodily Practice and Knowledge.” Annual Review of Anthropology 22:
133–155.
Lock, Margaret, and Judith Farquhar (eds.). 2007. Beyond the Body Proper: Reading the
Anthropology of Material Life. Durham, NC: Duke University Press Books.
Lora-Wainwright, Anna. 2005. “Valorising Local Resources: Barefoot Doctors
and Bone Manipulation in Rural Langzhong, Sichuan Province, PRC.” Asian
Medicine: Tradition and Modernity 1(2): 470–489.
———. 2007. “Do You Eat Meat Every Day? Food, Distinction and Social
Change in Contemporary Rural China.” BICC Working Paper. http://www

.bicc.ac.uk/Portals/12/ALW%20WP%20NO.6.pdf (accessed 12/3/2007).
———. 2009. “Fatness and Well-being: Bodies and the Generation Gap in
Contemporary China.” In Yangwen Zheng and Bryan Turner (eds.), The
Body in Asia, 113–126. Oxford: Berg.
———. 2010. “An Anthropology of ‘Cancer Villages’: Villagers’ Perspectives and
the Politics of Responsibility.” Journal of Contemporary China 19(63): 79–99.
Lutz, Catherine, and Lila Abu-Lughod. 1990. “Introduction: Emotion, Discourse
and the Politics of Everyday Life.” In Lila Abu-Lughod and Catherine
Lutz (eds.), Language and the Politics of Emotion, 1–23. Cambridge: Cambridge
University.
MacFarquhar, Roderick, and Michael Schoenhals. 2006. Mao’s Last Revolution.
Cambridge, MA: Harvard University Press.
Madsen, Richard. 1984. Morality and Power in a Chinese Village. Berkeley: California
University Press.
———. 1998. China’s Catholics: Tragedy and Hope in an Emerging Civil Society. Berkeley:
Mandel, Ruth, and Caroline Humphrey. 2002. “The Market in Everyday Life:
Ethnographies of Postsocialism.” In Ruth Mandel and Caroline Humphrey
(eds.), Markets and Moralities: Ethnographies of Postsocialism, 1–16. Oxford: Berg.
Martin, Emily. 1987. The Woman in the Body: A Cultural Analysis of Reproduction.
Boston: Beacon Press.
———. 1994. Flexible Bodies: Tracking Immunity in American Culture from the Days of
Polio to the Age of AIDS. Boston: Beacon Press.
Mathews, Holly. 2000. “Negotiating Cultural Consensus in a Breast Cancer
Self-Help Group.” Medical Anthropology Quarterly 14(3): 394–413.
Mattingly, Cheryl, and Linda C. Garro (eds.). 2001. Narrative and the Cultural
Construction of Illness and Healing. Berkeley: University of California Press.
Mauss, Marcel. 1979 [1935]. “Body Techniques.” In Sociology and Psychology:
Essays by Marcel Mauss (trans. B. Brewster), 95–123. London: Routledge
and Kegan Paul.
Moerman, Daniel. 2002. Meaning, Medicine and the “Placebo Effect.” Cambridge:
Moore, Henrietta, and Todd Sanders. 2001. “Magical Interpretations and
Material Realities: An Introduction.” In Henrietta Moore and Todd Sanders
(eds.), Magical Interpretations, Material Realities, 1–27. London: Routledge.
Mueggler, Erik. 2001. The Age of Wild Ghosts: Memory, Violence, and Place in Southwest
China. Berkeley: University of California Press.
Mungello, David. 1994. The Forgotten Christians of Hangzhou. Honolulu: University
of Hawai‘i Press.
Murphy, Rachel. 2002. How Migrant Labor Is Changing Rural China. Cambridge:
———. 2004. “Turning Chinese Peasants into Modern Citizens: ‘Population
Quality,’ Demographic Transition, and Primary Schools.” China Quarterly 177
(March): 1–20.
Murphy, Robert. 1987. The Body Silent: The Different World of the Disabled. New York:
W. W. Norton.
Nanfang Dushi Bao. 2007a. “China’s Water Crisis” (Zhongguo shui weiji).
November 2. Nanfang Dushi Daily. http://www.nddaily.com/sszt/watercrisis/
(accessed 11/21/2007). Also published at http://news.163.com/07/1102/
08/3S9GGKJB00011SM9_2.html (accessed 11/18/2007).
———. 2007b. “A Diary of Death in Three Cancer Villages” (Sange aizheng
cun de siwang riji). November 5. Nanfang Dushi Daily. http://www.nddaily.
com/A/html/2007-11/05/content_299441.htm (accessed 11/18/2007).
Nelson, Richard L. 2001. “Iron and Colorectal Cancer Risk: Human Studies.”
Nutrition Reviews 59(5): 140–148.
Nichter, Mark. 2002. “Social Relations of Therapy Management.” In Mark
Nichter and Margaret M. Lock (eds.), New Horizons in Medical Anthropology:
Essays in Honour of Charles Leslie, 81–110. London: Routledge.
———. 2003a. “Paying for What Ails You: Sociocultural Issues Influencing the
Ways and Means of Therapy Payment in South India.” In Mark Nichter
and Mimi Nichter (eds.), Anthropology and International Health: Asian Case Studies,
239–264. London: Routledge.
———. 2003b. “Pharmaceuticals, the Commodification of Health and the
Health Care-Medicine Use Transition.” In Mark Nichter and Mimi Nichter
(eds.), Anthropology and International Health: Asian Case Studies, 265–326. London:
Routledge.
Nichter, Mark, and Mimi Nichter. 2003. “The Ethnophysiology and Folk Dietetics
of Pregnancy: A Case Study from South India.” In Mark Nichter and Mimi
Nichter (eds.), Anthropology and International Health: Asian Case Studies, 35–70.
London: Routledge.
O’Brien, Kevin. 2001. “Villagers, Elections, and Citizenship in Contemporary
China.” Modern China 27(4): 407–435.
O’Brien, Kevin, and Lianjiang Li. 2006. Rightful Resistance in Rural China. New
York: Cambridge University Press.
Ohnuki-Tierney, Emiko. 1993. Rice as Self: Japanese Identities through Time. Princeton,
NJ: Princeton University Press.
Ong, Aihwa. 2006. Neoliberalism as Exception: Mutations in Citizenship and Sovereignty.
Ong, Aihwa, and Stephen Colliers (eds.). 2005. Global Assemblages: Technology,
Politics, and Ethics as Anthropological Problems. Oxford: Blackwell.
Onlus-Italia. 2005. “Nitrate in Drinking Water: Health Effects.” Unpublished

report based on research in Nanchong and Suining counties.
Ots, Thomas. 1990. “The Angry Liver, the Anxious Heart and the Melancholy
Spleen: The Phenomenology of Perceptions in Chinese Culture.” Culture,
Medicine, and Psychiatry 14(1): 21–58.
Overmyer, Daniel (ed.). 2003. “Religion in China Today.” Special issue, China
Quarterly 174. Cambridge: Cambridge University Press.
Oxfeld, Ellen. 2004. “‘When You Drink Water, Think of Its Source’: Morality,
Status, and Reinvention in Rural Chinese Funerals.” Journal of Asian Studies
63(4): 961–990.
———. 2010. Drink Water, but Remember the Source: Moral Discourse in a Chinese Village.
Pan, Yue. 2006. “The Environment Needs Public Participation.” December 5.
http://www.chinadialogue.net/article/show/single/en/
604-The-environment-needs-public-participation (accessed 1/18/07).
Pandolfi, Mariella. 1991. “Boundaries inside the Body: Women’s Suffering in
Southern Peasant Italy.” Culture, Medicine, and Psychiatry 14: 255–273.
Papadopoulos, Irena, Fenglin Guo, Shelley Lees, and Melanie Ridge. 2007.
“An Exploration of the Meanings and Experiences of Cancer of Chinese
People Living and Working in London.” European Journal of Cancer Care 16(5):
424–432.
Paper, Jordan. 1995. The Spirits Are Drunk. Albany: State University of New York
Press.
Pearson, Veronica. 1995a. “Good on Which One Loses: Women and Mental
Health in China.” Social Science and Medicine 41(8): 1159–1174.
———. 1995b. Mental Health Care in China, State Policies, Professional Services and
Family Responsibilities. London: Gaskell.
People’s Daily Online. 2006a. “Premier Addresses Media on Major Issues.”
http://english.people.com.cn/200603/15/eng20060315_250735.html
(accessed 9/15/2006).
———. 2006b. “Your Guide to ‘New Socialist Countryside.’” http://english
.people.com.cn/200603/08/eng20060308_248839.html (accessed 9/15/2006).
Perry, Elizabeth. 2007. “Studying Chinese Politics: Farewell to Revolution?” China
Journal 57: 1–22.
Pesticide Action Network North America (PANNA). 2010. “Pesticides Database—
Chemicals—Triazophos.” http://www.pesticideinfo.org/Detail_Chemical.
jsp?Rec_Id=PC34613 (accessed 12/20/2011).
Petryna, Adriana. 2002. Life Exposed: Biological Citizens after Chernobyl. Princeton, NJ:
Princeton University Press.
———. 2009. When Experiments Travel: Clinical Trials and the Global Search for Human
Subjects. Princeton, NJ: Princeton University Press.
Petryna, Adriana, Andrew Lakoff, and Arthur Kleinman (eds.). 2006. Global
Pharmaceuticals: Ethics, Markets, Practices. Durham, NC: Duke University Press.
Phillips, Michael. 1993. “Strategies Used by Chinese Families Coping with
Schizophrenia.” In Deborah Davis and Stevan Harrell (eds.), Chinese Families
in the Post-Mao Era, 277–306. Berkeley: California University Press.
Phillips, Michael, Huaqing Liu, and Yanping Zhang. 1999. “Suicide and Social
Change in China.” Culture, Medicine, and Psychiatry 23(1): 25–50.
Pieke, Frank. 2003. “The Genealogical Mentality in Modern China.” Journal of
Asian Studies 62(1): 101–128.
———. 2004. “Contours of an Anthropology of the Chinese State: Political
Structure, Agency and Economic Development in Rural China.” Journal of
the Royal Anthropological Institute 10: 517–538.
———. 2009. The Good Communist: Elite Training and State Building in Today’s China.
Polanyi, Karl. 2001 [1944]. The Great Transformation: The Political Economic Origins
of Our Times. Boston: Beacon.
Porkert, Manfred. 1974. The Theoretical Foundations of Chinese Medicine: Systems of
Correspondence. Cambridge, MA: MIT Press.
Potter, Pitman. 2003 “Belief in Control: Regulation of Religion in China.” In
Daniel Overmyer (ed.), “Religion in China Today.” Special issue, China
Quarterly 174 ( June): 317–337.
Potter, Sulamith H., and Jack Potter. 1990. China’s Peasants: The Anthropology of a
Revolution. Cambridge: Cambridge University Press.
Pun, Ngai. 2005. Made in China: Women Factory Workers in a Global Workplace.
Qin Xuejun and Shi Huanzhong. 2007. “Major Causes of Death during the Past
25 Years in China.” Chinese Medical Journal 120(4): 2317–2320.
Rabinow, Paul. 1996. Essays on the Anthropology of Reason. Princeton, NJ: Princeton
University Press.
Reddy, Sanjay. 2007. “Death in China: Market Reforms and Health.” New Left
Review 45 ( May–June): 49–65.
Reed-Danahay, Deborah. 2005. Locating Bourdieu. Bloomington: Indiana
University Press.
Robbins, Derek (ed.). 2005. Pierre Bourdieu 2. London: Sage.
Rofel, Lisa. 1999. Other Modernities: Gendered Yearnings in China after Socialism.
Rose, Nikolas. 2007. The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the
Twenty-first Century. Princeton, NJ: Princeton University Press.
Rose, Nikolas, and Carlos Novas. 2005. “Biological Citizenship.” In Aihwa Ong
and Stephen Colliers (eds.), Global Assemblages: Technology, Politics, and Ethics as
Anthropological Problems, 439–463. Oxford: Blackwell.
Salzberger, Ruth Carol. 1976. “Cancer: Assumptions and Reality Concerning

Delay, Ignorance and Fear.” In Joseph Buist Loudon (ed.), Social Anthropology
and Medicine. London: Academic Press.
Sanders, Richard. 2000. Prospects for Sustainable Development in the Chinese
Countryside: The Political Economy of Chinese Ecological Agriculture. Aldershot, UK:
Ashgate.
Sangren, Steven. 1996. “Myths, Gods, and Family Relations.” In Meir Shahar
and Robert Weller (eds.), Unruly Gods: Divinity and Society in China. Honolulu:
University of Hawai‘i Press.
———. 2000. Chinese Sociologics: An Anthropological Account of Alienation and Social
Reproduction. London: Athlone.
———. 2003. “Separations, Autonomy and Recognition in the Production of
Gender Differences: Reflections from Considerations of Myths and Laments.”
In Charles Stafford (ed.), Living with Separation in China: Anthropological Accounts,
53–84. London: Routledge and Curzon.
Scheid, Volker. 2002. Chinese Medicine in Contemporary China: Plurality and Synthesis.
London: Duke University Press.
Schein, Louisa. 2000. Minority Rules: The Miao and the Feminine in China’s Cultural
Politics. Durham, NC: Duke University Press.
Scheper-Hughes, Nancy. 1993. Death without Weeping: The Violence of Everyday Life in
Brazil. Berkeley: University of California Press.
———. 2000. “The Global Traffic in Human Organs.” Current Anthropology 41(1):
191–224.
———. 2008. “A Talent for Life: Reflections on Human Vulnerability and
Resilience.” Ethnos 73(1): 25–56.
Scheper-Hughes, Nancy, and Margaret M. Lock. 1987. “The Mindful Body: A
Prolegomenon to Future Work in Medical Anthropology.” Medical Anthropology
Quarterly 1(1): 6–41.
———. 1986. “Speaking ‘Truth’ to Illness: Metaphors, Reification, and a
Pedagogy for Patients.” Medical Anthropology Quarterly 17(5): 137–140.
Scheper-Hughes, Nancy, and Loic Wacquant (eds.). 2002. Commodifying Bodies.
Thousand Oaks, CA: Sage.
Schoenhals, Michael (ed.). 1996. China’s Cultural Revolution, 1966–1969: Not a Dinner
Party. Armonk, NY: M. E. Sharpe.
Scott, James. 1976. The Moral Economy of the Peasant: Rebellion and Subsistence in
Southeast Asia. New Haven, CT: Yale University Press.
———. 1985. Weapons of the Weak: Everyday Forms of Peasant Resistance. New Haven,
CT: Yale University Press.
Segall, Malcolm. 2000. “From Cooperation to Competition in National Health
Systems—and Back? Impact on Professional Ethics and Quality of Care.”
International Journal of Health Planning and Management 15(1): 61–79.
Shahar, Meir, and Robert Weller (eds.). 1996. Unruly Gods: Divinity and Society in
China. Honolulu: University of Hawai‘i Press.
Shao Jing. 2006. “Fluid Labor and Blood Money: The Economy of HIV/AIDS
in Rural Central China.” Cultural Anthropology 21(4): 535–569.
Shapiro, Judith. 2001. Mao’s War against Nature: Politics and the Environment in
Revolutionary China. Cambridge: Cambridge University Press.
Shilling, Chris. 1993. The Body and Social Theory. London: Sage.
Shue, Vivienne. 1988. The Reach of the State: Sketches of the Chinese Body Politic.
Shusterman, Richard (ed.). 2000. Bourdieu: A Critical Reader. Oxford: Blackwell.
Sidel, Victor, and Ruth Sidel. 1974. Serve the People: Observations on Medicine in the
People’s Republic of China. Boston: Beacon Press.
Singer, Merrill. 2009. Introduction to Syndemics: A Systems Approach to Public and
Community Health. San Francisco: Jossey-Bass.
Singer, Merrill, and Hans Baer. 1995. Critical Medical Anthropology. Amityville, NY:
Baywood Publishing.
Singer, Merrill, and Scott Clair. 2003. “Syndemics and Public Health:
Reconceptualizing Disease in Bio-Social Context.” Medical Anthropology
Quarterly 17(4): 423–441.
Siu, Helen. 1989. Agents and Victims in South China: Accomplices in Rural Revolution.
New Haven, CT: Yale University Press.
Sivin, Nathan. 1987. Traditional Medicine in Contemporary China. Ann Arbor: Center
for Chinese Studies, University of Michigan.
———. 1995. “Emotional Counter-Therapy.” In Nathan Sivin (ed.), Medicine,
Philosophy and Religion in Ancient China: Researches and Reflections. Aldershot, UK:
Variorum.
Smil, Vaclav. 2004. China’s Past, China’s Future: Energy, Food, Environment. London:
Routledge and Curzon.
Solinger, Dorothy. 1999. Contesting Citizenship in Urban China: Peasant Migrants, the
State, and the Logic of the Market. Berkeley: University of California Press.
Song, Jun. 2003. The Ancient City of Langzhong (Gucheng Langzhong). Beijing: China
Tourist Publishing.
Sontag, Susan. 1991. Illness as Metaphor and AIDS and Its Metaphors. London: Penguin.
Spencer, Richard. 2006. “Villages Doomed by China’s Cancer Rivers.” The
Telegraph, May 31. http://www.telegraph.co.uk/news/main.jhtml?xml=/
news/2006/05/31/wchina31.xml&sSheet=/news/2006/05/31/ixnews
.html (accessed 12/10/2007).
Stacey, Judith. 1983. Patriarchy and Socialist Revolution in China. Berkeley: University
of California Press.
Stafford, Charles. 2000. Separation and Reunion in Modern China. Cambridge:
Steingraber, Sandra. 1999. “The Social Production of Cancer: A Walk

Upstream.” In Richard Hofrichter (ed.), The Struggle for Environmental Health:
Corporate Power and Cultural Politics, 19–38. Cambridge, MA: MIT Press.
Stevens, Richard G., Barry I. Graubard, Marc S. Micozzi, Kazuo Neriishi, and
Baruch S. Blumberg. 1994. “Moderate Elevation of Body Iron Level and
Increased Risk of Cancer Occurrence and Death.” International Journal of
Cancer 56(3): 364–369.
Sun, Xiaoyun, Jackson Sukhan, Carmichael Gordon, and Adrian C. Sleigh.
2008. “Catastrophic Medical Payment and Financial Protection in Rural
China: Evidence from the New Cooperative Medical Scheme in Shandong
Province.” Health Economics 18(1): 103–119.
Swartz, David. 1997. Culture and Power: The Sociology of Pierre Bourdieu. Chicago:
University of Chicago Press.
Szonyi, Michael. 2009. “Secularization Theories and the Study of Chinese
Religions.” Social Compass 56(3): 312–327.
Tang, Shenglan, and Gerald Bloom. 2000. “Decentralizing Rural Health
Services: A Case Study in China.” International Journal of Health Planning and
Management 15: 189–200.
Tang, Shenglan, Qingyue Meng, Lincoln Chen, Henk Bekedam, Tim Evans, and
Margaret Whitehead. 2008. “Tackling the Challenges to Health Inequity.”
Lancet 372(9648): 1493–1501.
Tesh, Sylvia Noble. 2000. Uncertain Hazards: Environmental Activists and Scientific Proof.
Ithaca, NY: Cornell University Press.
Thireau, Isabelle, and Hua Linshan. 2003. “The Moral Universe of Aggrieved
Chinese Workers.” China Journal 50: 83–103.
Thompson, Edward Palmer. 1971. “The Moral Economy of the English Crowd
in the Eighteenth Century.” Past and Present 50: 76–136.
Tilt, Bryan. 2010. The Struggle for Sustainability in Rural China. New York: Columbia
University Press.
Treichler, Paula. 1999. How to Have Theory in an Epidemic: Cultural Chronicles of AIDS.
Tsai, Lily Lee. 2002. “Cadres, Temple and Lineage Institutions, and Governance
in Rural China.” China Journal 48 ( July): 1–27.
Tseng, Wen-Shing, Tsung-Yi Lin, and Eng-Kung Yeh (eds.). 1995. Chinese Society
and Mental Health. Hong Kong: Oxford University Press.
Tung, May P. 1994. “Symbolic Meanings of the Body in Chinese Culture and
‘Somatisation.’” Culture, Medicine, and Psychiatry 18(4): 483–492.
Uhalley, Stephen, and Xiaoxin Wu (eds.). 2001. China and Christianity: Burdened Past,
Hopeful Future. New York: M. E. Sharpe.
Unger, Jonathan, and Anita Chan. 2007. “Memories and the Moral Economy of
a State-Owned Enterprise.” In Ching Kwan Lee and Guobin Yang (eds.),
Re-envisioning the Chinese Revolution: The Politics and Poetics of Collective Memories in
Reform China, 119–140. Washington, DC: Woodrow Wilson Center Press, and
Unschuld, Paul. 1985. Medicine in China: A History of Ideas. Berkeley: University of
California Press.
van der Geest, Sjaak, Susan Reynolds Whyte, and Anita Hardon. 1996.
“Anthropology of Pharmaceuticals.” Annual Review of Anthropology 25:
153–178.
van Rooij, Benjamin. 2006. Regulating Land and Pollution in China, Lawmaking,
Compliance, and Enforcement: Theory and Cases. Leiden, Netherlands: Leiden
University Press.
Waldram, James. 2000. “The Efficacy of Traditional Medicine: Current
Theoretical and Methodological Issues.” Medical Anthropology Quarterly 14(4):
603–625.
Wang, Bo, and Jiangsheng Chen. 2005. “Primary Medicare in Western China’s
Rural Areas: Problems and Countermeasures” (Xibu nongcun jiben yiliao
baozhang zhidu mianlin de wenti yu duice). Journal of Sichuan University
(Social Science Edition) (Sichuan daxue xuebao, zhexhue shehui kexue ban) 6: 20–28.
Wang, Shaoguang. 2008. “State Extractive Capacity, Policy Orientation, and
Inequity in the Financing and Delivery of Health Care in Urban China.”
Social Sciences in China 29(1): 66–87.
Watson, James L. 1988. “The Structure of Chinese Funerary Rites.” In James L.
Watson and Evelyn S. Rawski (eds.), Death Ritual in Late Imperial and Modern
China, 3–19. Berkeley: University of California Press.
Watson, James, and Evelyn S. Rawski (eds.). 1988. Death Ritual in Late Imperial and
Modern China. Berkeley: University of California Press.
Watson, Rubie S. 1985. Inequality among Brothers: Class and Kinship in South China.
——— ed. 1994. Memory, History, and Opposition under State Socialism. Santa Fe, NM:
School of American Research Press.
Weiss, Meira. 1997. “Signifying the Pandemics: Metaphors of AIDS, Cancer, and
Heart Disease.” Medical Anthropology Quarterly 11(4): 456–476.
Weller, Robert. 1985. “Bandits, Beggars, and Ghosts: The Failure of State Control
over Religious Interpretation in Taiwan.” American Ethnologist 12(1): 46–61.
———. 1987. Unities and Diversities in Chinese Religion. London: MacMillan.
Wen, Jung-Kwang. 1990. “The Hall of Dragon Metamorphoses: A Unique,
Indigenous Asylum for Chronic Mental Patients in Taiwan.” Culture, Medicine,
and Psychiatry (14)1: 1–20.
White, Sydney D. 1993. “Medical Discourses, Naxi Identities, and the State:
Transformations in Socialist China.” Ph.D. dissertation, University of
California–Berkeley.
———. 1997. “Fame and Sacrifice: The Gendered Construction of Naxi

Identities.” Modern China 23: 298–327.
———. 1998. “From ‘Barefoot Doctor’ to ‘Village Doctor’ in Tiger Springs
Village: A Case Study of Rural Health Care Transformations in Socialist
China.” Human Organization 57(4): 480–490.
———. 1999. “Deciphering ‘Integrated Chinese and Western Medicine’ in the
Rural Li-jiang Basin: State Policy and Local Practice(s) in Socialist China.”
Social Science and Medicine 49: 1333–1347.
———. 2001. “Medicines and Modernities in Socialist China: Medical Pluralism,
the State, and Naxi Identities in the Lijiang Basin.” In Linda H. Connor
and Geoffrey Samuel (eds.), Healing Powers and Modernity: Traditional Medicine,
Shamanism and Science in Asian Societies. London: Bergin and Garvey.
Whiting, Susan H. 1999. Power and Wealth in Rural China: The Political
Economy of Institutional Change. Cambridge: Cambridge University Press.
Whyte, Martin K. 1988. “Death in the People’s Republic of China.” In James L.
Watson and Evelyn S. Rawski (eds.), Death Ritual in Late Imperial and Modern
China, 289–315. Berkeley: University of California Press.
Whyte, Martin K., and William Parish. 1984. Urban Life in Contemporary China.
Chicago: Chicago University Press.
Whyte, Susan Reynolds. 1997. Questioning Misfortune: The Pragmatics of Uncertainty in
Eastern Uganda. Cambridge: Cambridge University Press.
Whyte, Susan Reynolds, Sjaak van der Geest, and Anita Hardon. 2002. Social
Lives of Medicines. Cambridge: Cambridge University Press.
Whyte, Susan Reynolds, Michael Whyte, Lotte Meinert, and Betty Kyaddondo.
2006. “Treating AIDS: Dilemmas of Unequal Access in Uganda.” In Adriana
Petryna, Andrew Lakoff, and Arthur Kleinman (eds.), Global Pharmaceuticals:
Ethics, Markets, Practices, 240–261. Durham, NC: Duke University Press.
Wolf, Arthur P. (ed.). 1974. Religion and Ritual in Chinese Society. Stanford, CA:
Wolf, Margery. 1968. The House of Lim. New York: Appleton Century Crofts.
———. 1972. Women and the Family in Rural Taiwan. Stanford, CA: Stanford
University Press.
———. 1985. Revolution Postponed: Women in Contemporary China. Stanford, CA:
———. 1992. A Thrice-Told Tale: Feminism, Postmodernism, and Ethnographic
Responsibility. Stanford, CA: Stanford University Press.
World Bank. 2007. “The Cost of Pollution in China.” http://siteresources
.worldbank.org/INTEAPREGTOPENVIRONMENT/Resources/China_
Cost_of_Pollution.pdf (accessed 8/8/07).
World Health Organization. 2011. “Viral Cancers.” http://www.who.int/vaccine_
research/diseases/viral_cancers/en/index1.html (accessed December 20, 2011).
Wright, Beverly. 2005. “Living and Dying in Louisiana’s Cancer Alley.” In Robert
D. Bullard (ed.), The Quest for Environmental Justice, 87–107. San Francisco:
Sierra Club Books.
Wu, Fei. 2005. “Gambling for Qi: Suicide and Family Politics in a Rural North China
County.” China Journal 54: 7–27.
Wu Ku-Sheng, Huo Xia, and Zhu Guang-Hui. “Relationships between
Esophageal Cancer and Spatial Environment Factors by Using Geographic
Information System.” Science of Total Environment 393(2–3): 219–225.
Xiang, Biao. 2007. “Migration and Health in China: Problems, Obstacles and
Solutions.” Asian MetaCentre Research Paper Series No. 17. http://www
.populationasia.org/Publications/RP/AMCRP17.pdf (accessed 4/25/2010).
Xiaojing (The Classic of Filial Piety). 1975. Chinese-English edition. Translated
by Mary L. Makra and edited by Paul K. T. Sih. New York: St John’s
University Press.
Yan, Hairong. 2008. New Masters, New Servants: Migration, Development, and Women
Workers in China. Durham, NC: Duke University Press.
Yan, Yunxiang. 1996. The Flow of Gift. Reciprocity and Social Networks in a Chinese
Village. Stanford, CA: Stanford University Press.
———. 2003. Private Life under Socialism: Love, Intimacy, and Family Change in a Chinese
Village, 1949–1999. Stanford, CA: Stanford University Press.
———. 2009. “The Good Samaritan’s New Trouble: A Study of the Changing
Moral Landscape in Contemporary China.” Social Anthropology 17(1): 9–24.
Yang Chuanmin and Fang Qianhua. 2005. “A Village of Death and Its Hopes
for the Future” (Siwang cunzhuang de zhengjiu yu xiwang). Nanfang News
Evening Edition, November 18. www.southcn.com/news/dishi/shaoguan/
ttxw/200511180238.htm (accessed 3/10/2006).
Yang, Dali. 1996. Calamity and Reform in China: State, Rural Society, and Institutional
Change since the Great Leap Famine. Stanford, CA: Stanford University Press.
Yang, Mayfair Mei-Hui. 1994. Gifts, Favors, and Banquets: The Art of Social
Relationships in China. Ithaca, NY: Cornell University Press.
———. 2004. “Spatial Struggles: State Disenchantment and Popular
Re‑appropriation of Space in Rural Southeast China.” Journal of Asian Studies
63(3): 719–755.
———. 2008a. “Introduction.” In Mayfair Mei-Hui Yang (ed.), Chinese Religiosities:
Afflictions of Modernity and State Formation, 1–42. Berkeley: University of
California Press.
——— (ed.). 2008b. Chinese Religiosities: Afflictions of Modernity and State Formation.
Yang, Ruby, and Thomas Lennon. 2011. The Warriors of Qiugang. http://e360.yale
.edu/feature/the_warriors_of_qiugang/2358/ (accessed 3/20/2011).
Yang, Yang. 2007. “Pesticides and Environmental Health Trends in China:

A China Environmental Health Project Factsheet.” China Environment Forum.
http://www.wilsoncenter.org/topics/docs/pesticides_feb28.pdf (accessed
6/15/07).
Yu, Dezhi. 1992. “Changes in Health Care Financing and Health Status: The
Case of China in the 1980s.” Innocenti Occasional Papers, Economic Policy
Series 34. Florence: UNICEF: 1–61. http://www.unicef-irc.org/cgi-bin/
unicef/download_insert.sql?ProductID=155 (accessed 11/25/2003).
Zhan, Mei. 2009. Other-Worldly: Chinese Medicine through Encounters. Durham, NC:
Duke University Press.
Zhang, Everett Yuehong. 2007. “The Birth of Nanke (Men’s Medicine) in China:
The Making of the Subject of Desire.” American Ethnologist 34(3): 491–508.
Zhang, Junfeng, Denise Mauzerall, Tong Zhu, Song Liang, Majid Ezzati, and
Justin Remais. 2010. “Environmental Health in China: Progress towards
Clear Air and Safe Water.” Lancet 375: 1110–1119.
Zhang, Li. 2001. Strangers in the City: Reconfigurations of Space, Power, and Social
Networks within China’s Floating Population. Stanford, CA: Stanford University
Press.
———. 2002. “Spatiality and Urban Citizenship in Late Socialist China.” Public
Culture 14(2): 311–334.
Zhang, Li, and Aihwa Ong (eds.). 2008. Privatizing China: Socialism from Afar. Ithaca,
NY: Cornell University Press.
Zhang, Xianliang. 1994. Grass Soup. London: Secker and Warburg.
Zhang, Yanhua. 2007. Transforming Emotions with Chinese Medicine. Albany: State
University of New York Press.
Zhao, Ping, Min Dai, Wanqing Chen, and Ni Li. 2010. “Cancer Trends in
China.” Japanese Journal of Clinical Oncology 40(4): 281–285.
Zheng, Yanping., Leyi Xu, and Qije Shen. 1986. “Styles of Verbal Expression
of Emotional and Physical Experiences: A Study of Depressed Patients and
Normal Controls in China.” Culture, Medicine, and Psychiatry (10): 231–243.
Zigon, Jarrett. 2008. Morality: An Anthropological Perspective. Oxford: Berg.
Index
Bold page numbers refer to figures.
Abu-Lughod, Lila, 119 barefoot doctors, 36, 57, 205, 208–209,

Agamben, Giorgio, 100 210
Agency for Toxic Substances and Disease belief-in-practice, 247–248
Registry, 96 Biehl, Joao, 23–24, 33, 263
agriculture. See farming biological citizenship, 92–93, 94, 97, 115
AIDS, 18, 24, 26–27, 31, 34, 37 biosociality, 92, 114
alcohol consumption: cancer linked to, 24, blame: avoiding, 102, 145, 163–164,
27, 38, 102, 145, 158–160, 162, 172; 170; on cancer patients, 5, 25, 27,
gender differences, 159–160, 163–164; 97, 131–132, 142, 170; on family
research on, 279n16; social pressures, members, 132–135; for suffering, 170;
145, 159–161, 163 on women, 134–135, 136–137. See also
ambiguities: of cancer etiologies, 130, 138, cancer etiologies
142, 171, 265; of emotions, 138; moral, bodies: commodification, 35; contingent
42, 47, 50 experiences, 259; dichotomy with mind,
Anagnost, Ann, 233, 236 129; emotional effects on, 119–120,
ancestor worship: altar rooms, 67–68, 148, 127–130, 136; fatness, 258; female,
249–250, 249; in collective era, 248; 26, 122; filial piety and, 217; health
images, 249–251, 252. See also ghosts; perceptions and, 258–259; social
mourning practices; popular religion context, 26, 50. See also health; illnesses
anger: cancer linked to, 22, 119, 130–132, Bourdieu, Pierre, 152, 154, 155, 166–167,
134–135, 138, 140, 278n10; causes, 120, 204, 219–220, 279n9
126, 131–132; danger of, 133; repressed, Brodwin, Paul, 226
22, 27, 33, 126, 127, 130–131, 151–152, Brown, Phil, 98, 102
170–171; tempers, 131–132, 137, 138, Brownell, Susan, 76
140, 142. See also emotions Buddhism, 233
anthropology: of religion, 232; salvage
paradigm, 8. See also medical cancer: of bladder, 215; as bodily
anthropology problem, 239; cervical, 137, 170, 202;
anxiety: cancer linked to, 119, 134–135, as embodiment of social suffering,
139, 278n10; of cancer patients, 21–22, 108; incidence in Langzhong,
139–140; causes, 120, 126, 131–132; 2–4, 85–87, 228–229; leukemia, 56–57,
of family members of cancer patients, 135; of liver, 3, 83, 84, 85, 135; lung,
177, 186–187, 193; herbal treatments, 83, 85; moral economy of, 179–180;
177, 193 nasopharyngeal, 85; prevention efforts
by individuals, 115; prostate, 2; public
Baer, Hans, 18, 19 meaning, 135–136; stigma associated
Balshem, Martha, 102, 170, 172 with, 25, 26. See also esophagus cancer;
Baoma: in collective era, 52–55, 56–58; stomach cancer
as fieldwork site, 2, 8–13; location, cancer clusters, 102, 170. See also cancer
52; migration from, 54, 59, 72, 77; villages
population, 52; view of, 62; village cancer counties, 84
secretary, 63, 64, 65, 68, 69–70, 78, cancer deaths: in Baoma, 2–3, 117–119,
222–223 215; in China, 3, 83; inevitability,
314     Index
220–221; resilience of families following, 211–212, 215–216; perceived efficacy,

25. See also deaths 203–204, 214–215, 228–229, 281n2. See
cancer diagnosis: case studies, 3, 11, also surgery
73, 140, 144, 180, 216, 237–238, cancer villages, 3–4, 84, 94, 273n5. See also
239; delayed, 19, 228; nondisclosure, cancer clusters
139–141; obstacles to early, 259–260 Canguilhem, Georges, 136
cancer etiologies: ambiguity, 130, 138, 142, Cangxi county, studies of cancer and diet
171, 265; blame on patient, 5, 25, 27, in, 158–160, 159, 161–162, 164
97, 131–132, 142, 170; changes, 145, capitalism. See market economy
169, 170–173, 260–261; in Chinese Caplan, Pat, 166
medicine, 130–131; competing, 24, care for cancer patients: decisions by
26, 92, 101–102, 113–114, 259, 261; family members, 50, 140–141, 179–180,
contingency, 260; environmental factors, 188, 194, 197–198; differences within
5, 83–84, 97–98, 102; family conflicts, families, 139, 188–192, 198; effects on
33, 131–137, 142, 261, 265; farm caregivers, 177, 186–187, 193; by family
chemicals, 23, 30, 84, 101–102, 108, members, 145–146, 169, 187–193, 199;
265; fate, 170, 171; food consumption, relationship reinforced by, 193. See also
4, 30, 85, 102, 109–113, 145, 164–166, cancer patients; health care; health care
167, 168–169, 265; gender and, 38, costs
133–134; hardship, 102, 104, 106, Center for China Cooperative Medical
141–142; intersubjectivity, 108; locals’ Scheme (CCMS), 208
understandings of, 4–5, 21–22, 25–26, Center for Disease Control (CDC),
27, 29–30, 260, 264–265; moral Langzhong county, 95–96, 98, 99, 100
economy of, 22–23, 24, 114–116, cervical cancer, 137, 170, 202
145, 172–173, 264–265; political and Chan, Anita, 41, 45, 46, 47, 162–163
economic contexts, 28, 29–30, 37, Chao, Emily, 233–234, 239
45; popular understandings, 25, 26; Chau, Adam, 236, 256
scientific bases, 26, 158, 164; smoking Chavez, Leo, 202–203
and drinking, 24, 27, 38, 85, 102, 145, chemicals. See farm chemicals; pesticides
158–160, 162, 172; social relations and, chemotherapy, 148, 149, 180–181, 182
22, 131–138; state and, 92–93, 94–101. children: gan haizi, 1, 10, 273n2;
See also emotions; water pollution; work grandparents’ care for, 71, 73, 81, 123,
cancer patients: attitudes, 5–6, 19–20, 124, 146, 191; moral economies, 80;
220, 222; care for family members, one-child policy, 59–60, 72–73, 77, 138.
31–32, 218–219; eating, 22, 151, 153, See also education; families; filial piety
154–156, 259; effects of anxiety and Chinese medicine: authority, 36; cancer
stress, 139–140; effects of illness on etiologies, 130–131; cancer treatments,
family members, 157, 177, 179–180, 181; doctors, 56–57, 209, 237; hard
185–187; emotions, 25, 139, 140, work as cause of illnesses, 103–104;
278n12; engagement in treatment, 228; integration with Western medicine,
experiences, 22, 262; as moral subjects, 130, 277n6; qi, 127–128, 130, 136,
94, 105; refusing treatment, 21–22, 31, 277n3; use of, 281n12; view of female
182, 214–220, 227–228; social suffering, bodies, 122
173, 259; spiritual strength, 220; Christians: in Baoma, 27–28, 240–241;
suicides, 2, 31, 117, 194, 201, 220–221. health benefits of beliefs, 241–243;
See also care for cancer patients missionaries, 28, 209, 233; morality,
cancer treatments: chemotherapy, 148, 242, 257; mourning practices, 50, 262,
149, 180–181, 182; costs, 180–182, 264; nonbelief in ghosts, 246, 247, 248;
184, 193, 195–197, 201–202, 210, proselytizing, 240–241; Protestants,
Index     315
233; seen as fake, 241, 242–243; views Das, Veena, 20, 32, 170, 171, 193, 197
of spirit mediums, 32, 261; views of daughters-in-law: conflicts, 132–133,
traditional religious practices, 230, 231, 251–252, 253, 254–256, 257; relations
240–241, 244–246, 247, 248, 254, 257. with in-laws, 124–125, 192, 251; status
See also religion in family, 253
citizenship: biological, 92–93, 94, 97, 115; Davis, Deborah, 70
Chinese, 42, 43 Dean, Kenneth, 232
Cohen, Lawrence, 32, 212–213 deaths: in Cultural Revolution, 56; family
Cohen, Myron, 192 members blamed for, 132–135; in
collectivism: agricultural, 52, 54; end of, famines, 55; at home, 222; maternal
58; establishment, 52; food shortages, mortality, 18; suicides of cancer
23, 30, 113, 145, 152–153, 166, 200; patients, 2, 31, 117, 194, 201, 220–221.
local cadres, 57–58; moral economy See also cancer deaths; funerals;
and, 40–41; nostalgia for, 44–46, 79, 81; mourning practices
social relations and, 40, 58; state-owned debt, 66, 77
enterprises, 41; villagers’ experiences, diet. See food
30, 45 disclosure and nondisclosure, 139–141
Colliers, Stephen, 262 divorces, 72, 124, 126, 134, 139, 142, 143
Comaroff, Jean, 23 doctors: barefoot, 36, 57, 205, 208–209,
Comaroff, John, 23, 133 210; of Chinese medicine, 56–57, 209,
commensality, 187 237; corruption, 213; distrust of, 204,
commodification of health care, 24, 35, 212–213; incomes, 209; social position
206, 212–213, 221, 226–227, 261, 264 in villages, 214. See also health care
communism. See collectivism practitioners
Confucianism: criticism of, 233; ethics, 227; Dong, Zhe, 204, 207
filial piety, 216, 217–218, 227, 252, 261; drinking. See alcohol consumption
gender roles, 121; morality, 42; rituals,
232–233. See also ancestor worship eating. See food consumption
consumerism, 46, 48, 80, 108, 153, 212. See economic reforms, 18–19, 22–23, 35,
also market economy 58–61. See also market economy
consumption, 30, 144, 162, 259. See also Edelman, Marc, 111–112
alcohol consumption; food consumption; education, 42–43, 55, 60, 69, 74, 75, 80
smoking efficacy: of cancer treatments, 203–204,
Cook, Sarah, 207–208, 211 214–215, 228–229, 281n2; cultural,
corruption: in health care system, 206, 203–204, 217–218; economic, 203, 213;
210, 213, 227; of local officials, 60–61, religious, 236, 253, 255; social, 203–204,
69–70, 77–78, 183–185, 197, 218, 223 214, 217–218; of spirit mediums, 236,
Crandon-Malamud, Libbet, 28–29, 30, 36, 237–239, 256
105, 168, 219 emotions: cancer linked to, 133–135,
cremation, 69, 183–185, 194–195 142; of cancer patients, 25, 139, 140,
crime, 46, 68 278n12; Chinese views, 119–120; effects
Croll, Elizabeth, 44, 46 on body, 119–120, 127–130, 136; family
Cultural Revolution, 1, 45, 55–57, 135, relations and, 118–120, 126–127, 199;
204–205, 218, 247 links to illnesses, 126–130, 135–137,
culture: social inequalities and, 217–218; 140, 151–152, 277n3; repressed, 27, 33,
traditional, 8, 233, 235, 239 142; social role, 119–120, 199. See also
anger; anxiety
Daoism, 233 environmental controls, 3, 84, 98, 99.
Das, Ranendra K., 32, 170, 193, 197 See also pollution; water pollution
316     Index
environmental injustice, 97 115–116, 260; minimizing use on food

esophagus cancer: in Baoma, 86–87, for home consumption, 109–111, 168.
118–119; as choking illness, 6, 144–145; See also pesticides; water pollution
deaths, 3; diagnosis, 260; explanations, Farmer, Paul, 18, 135–136, 215
132, 133–135, 138, 139, 170–172; in farming: animals raised, 65, 68, 110–111,
Langzhong, 2, 228; in past, 29, 86–87; 275nn8–9; cash crops, 110, 112, 113;
risk factors, 84, 85, 145; as spitting collectives, 52, 54; crops, 63–64;
illness, 29, 86–87; suffering caused, 17; economic reforms and, 58–59, 79;
treatments, 25, 180–181, 215 food for home consumption, 23, 63,
ethnographies, 23, 36, 39, 41, 46, 61 64, 81, 109–111, 112, 113, 168; grain
etiologies. See cancer etiologies production, 54, 63–64, 64; incomes,
expenses: of families, 68–70, 71, 74, 81, 59, 65, 79; responsibility system, 58;
182; funeral, 69, 183–185, 184, 195; subsistence, 39, 40, 41, 93, 111–112,
marriage, 68–69. See also health care costs 258; taxes, 62, 69; value to families,
23, 79–80, 81; work, 103, 106, 258,
families: care for cancer patients, 145–146, 260–261; yields, 54
169, 187–193, 199, 264; cohesion, 135, Farquhar, Judith, 36, 47–48, 259, 260
143; costs of cancer, 178–179, 180–187, fatness, as indicator of health, 258
186, 188–189; extended and nuclear, feng shui, 51–52, 234, 236, 237, 243–244,
70–71; gender roles, 33, 261; health care 283n4
roles, 31, 35–36, 261, 262–263, 264; fertilizers, 94–95, 96, 107–108. See also
health effects of care for cancer patients, farm chemicals
157, 177, 185–187, 193; importance, 47, Feuchtwang, Stephan, 256
49, 264; incomes and expenses, 68–70, filial piety, 216, 217–218, 227, 252, 254,
71, 74, 81, 182; meals shared, 187; 261
moral economy of, 198–199; networks, food: contaminated, 109–113, 115, 265;
59–60; savings and debt, 66, 77; cooking, 67; genetically modified,
solidarity, 195; structural changes, 70; as 110–111, 112, 113; hierarchies of
support systems, 47, 59–60, 70–72. See value, 167; homegrown, 23, 63, 64,
also children; grandparents; marriages 81, 109–111, 112, 113, 168; market
family conflicts: among siblings, 133, purchases, 63, 167, 168; moldy,
189–190, 191, 253–254, 280n2; on care 164–165; organic, 113, 276n9; quality
for cancer patients, 139, 188–192, 198; differences, 110–111, 112; safety
economic context, 142–143; illnesses regulations, 113; at schools, 75–76;
linked to, 126–127; stress as factor in shortages, 23, 30, 54–55, 113, 145,
cancer, 33, 131–137, 142, 261, 265. See 152–153, 166, 200; special treats for ill,
also daughters-in-law 156, 182; taste for, 166–167, 219. See also
family planning, 59–60, 72–73, 77, 138 preserved foods
famines, 54–55, 152–153, 166, 200 food consumption: cancer patients’
Fan, Ruiping, 226–227 inability to eat, 22, 151, 153, 154–156,
farm chemicals: ambivalent attitudes 259; in collective era, 54–55;
toward, 94, 112, 115–116; benefits, 94, correlations with cancer, 158, 159;
107, 112–113; cancer linked to, 23, 30, effects of cancer, 87, 144–145; family
84, 101–102, 108, 265; criticism of, 24, mealtimes, 187; illnesses linked to, 30,
107–108; fertilizers, 94–95, 96, 107–108; 259; importance for health, 22, 29, 153,
food contaminated with, 109–113, 115, 156–157; as sign of health, 22, 144,
265; hard work with, 107–108; increased 151–155; in urban areas, 276n9; variety
use, 94, 107, 260–261; market economy of foods, 164, 167
and, 23, 24, 107–108, 111, 113, Foucault, Michel, 136
Index     317
funerals: expenses, 69, 183–185, 184, Hardon, Anita, 203

195; fines for avoiding cremation, 69, hardship (xinku): cancer linked to, 102,
183–185, 194–195; traditional customs, 104, 106, 141–142; in collective era,
243–244. See also mourning practices 104–105; of migrant workers, 141–142;
women’s experiences, 118–119,
Gao, Mobo, 44 120–126, 141–142
gender: of children, 73; division of labor, hard work. See work
120–122; patriarchal relations, 120–121. Harrell, Stevan, 70
See also marriages; men; women healing practices. See Chinese medicine;
gender roles: cancer etiologies and, health care; spirit mediums; Western
133–134; challenges to traditional, medicine
131, 137, 141, 143; in market health: consumption practices and, 144,
economy, 121, 141; traditional, 33, 151–155, 162; intersubjectivity, 34;
120–121, 132, 261 perceptions, 258–259, 265
generational differences: care for patients, health care: in collective era, 57;
198–199; food preferences, 167; moral, commodification, 24, 35, 206, 212–213,
46–47, 78–82; views of work, 105–106; 221, 226–227, 261, 264; cultural
of women, 124–125, 138, 141 factors in choices, 202–203; by family
genetically modified (GM) foods, 110–111, members, 31, 35–36, 261, 262–263,
112, 113 264; informal sector, 206; local context,
geomancy. See feng shui 208–212; national context, 204–208;
ghost festival (qingming) rites, 254 perceived efficacy, 203–204, 213–215; in
ghosts, 240, 246, 247–248, 255–256, reform era, 18–19; in rural China, 57,
284n14 204–212, 219; social nature, 34; state
Goldman, Merle, 42 system, 36, 57, 204–207; technology,
Good, Byron J., 170 24; transmission of medical knowledge,
Good, Mary-Jo del Vecchio, 139–140 36; in urban areas, 205, 206, 225. See
Gordon, Deborah, 140, 171 also hospitals
grandparents: care for grandchildren, health care access: affordability, 19, 259;
71, 73, 81, 123, 124, 146, 191; energy, barriers, 5–6, 35, 197, 201–202, 206,
79; farming, 70–71, 79–80; past 211, 259; social relations and, 203–204,
experiences, 78. See also daughters-in- 217–219; structural factors, 203;
law; generational differences urban‑rural disparities, 202, 209–211
Great Leap Forward, 52, 54–55, 152–153, health care costs: for cancer, 149, 180–182,
200, 284n14 184, 193, 195–197, 201–202, 210,
Great Proletarian Cultural Revolution. See 211–212, 215–216; cancer diagnosis,
Cultural Revolution 19; effects on family, 195, 196; for family
Gregg, Jessica, 137, 170 members of patients, 185–187, 195;
Guangdong Province, 1, 45, 66, 194, 197, of households, 69; increases, 206, 209;
273n5 medicines, 196, 209, 213, 279n6; paying
guanxi, 43, 47, 59–60, 77, 160–161, 163, for, 31–32, 42–43, 57, 261; perceived
180, 199 efficacy and, 203; state funding, 57, 74,
75, 205; surgery, 210, 215–216, 225;
habitus: eating and health, 144, 152, user fees, 205, 206
154, 169; expectations and, 219–220; health care practitioners: bribes, 206, 210,
formation, 167, 219–220, 279n9; 227; distrust of, 140–141, 204, 212, 225,
religious, 236; “Uncle Norman,” 166. 259–260, 261, 264; profit-oriented, 75,
See also xiguan 204, 212–213, 214, 226–227, 259–260;
Hann, Chris, 40 trusted, 213–214. See also doctors
318     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
illnesses associated with, 37–38, 103; Yan, Hairong, 141

moral economy of, 114; pride in, 79, Yan, Yunxiang, 43, 46–47, 70, 125,
105; sacrifices for others, 103–105, 108; 142–143, 180, 197, 254–255, 263, 264
of students, 80; value of, 21, 37, 153, Yang, Mayfair Mei-Hui, 232–233
258. See also migrant workers; wage labor
Zhang, Everett Yuehong, 36–37
xiguan (habit), 145, 154–156, 157–158, 163, Zhang, Li, 43
169, 173 Zigon, Jarrett, 49
Production Notes for Lora-Wainwright |
Fighting for Breath
Jacket design by Julie Matsuo-Chun
Text design and composition by Jansom
with display type in Chaparral and
text type in Baskerville
Printing and binding by Sheridan Books, Inc.
Printed on 60 lb. House White, 444 ppi.
CHINA ANTHROPOLOGY
“Fighting for Breath is a well-written, ethno-

graphically grounded, and anthropologically
compelling book. It is theoretically sophisti-
cated and clearly the work of a serious China
scholar and first-rate medical anthropologist.
Cancer has received much less attention in
these fields than it deserves, so this volume
fills an important niche.”
—Arthur Kleinman, Harvard University
“This is a powerful, timely, well-crafted

ethnography that should appeal to a broad
jacket art: audience. What sets it apart from many
(front) Rapeseed fields in Baoma China ethnographies—rural or urban—is how
village; (back) burning paper money the exceptionally close relationships that the
at a family grave in Meishan (photos author formed with the village families with
by the author, 2005).
whom she lived and worked are placed at the
jacket design: center of her analysis. This ethnographic and
Julie Matsuo-Chun emotional intimacy sets the stage for a num-
ber of truly brilliant insights and contribu-
tions to key scholarly debates.”
—Sydney White, Temple University
UNIVERSITY of
HAWAI‘I PRESS
Honolulu, Hawai‘i 96822-1888

LORA-WAINWRIGHT, Anna. Fighting For Breath - Living Morally and Dying of Cancer in A Chinese Village

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

LORA-WAINWRIGHT, Anna. Fighting For Breath - Living Morally and Dying of Cancer in A Chinese Village

Uploaded by

Copyright:

Available Formats

FIGHTING FOR

LIVING MORALLY AND DYING OF

University of Hawai‘i Press

All rights reserved

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

University of Hawai‘i Press books are printed on acid-free

Designed by Janette Thompson ( Jansom )

Part 2: Making Sense of Cancer

Part 3: Strategies of Care and Mourning

and Volker Scheid offered a good basis on medicine in China, as well as

Guoyun Erge and Ersao’s son (seventeen in 2004), trained

Uncle Wang’s Family

Pengjie Wangge’s wife, migrated with her husband and

Other Key Informants

In August 2004, I first visited the only surviving courtyard house in

Making Sense of Cancer

are extremely unlikely to be classified as “cancer villages” according to

Fighting for Breath

significantly, strenuous physical work, food shortage, and humiliation

to overcome these barriers. What I found is that in at least some cases,

Structure of the Volume

Entering the Field

choose a family on my behalf, I set out on my first morning in Langzhong

Becoming accepted did not, of course, mean becoming one of

Cancer and Contending

This book offers an account of how families strive to make sense of

Suffering and Inequality

Chinese experienced a similar decline in the aftermath of reforms, as

produce perceptions of treatment as a waste of resources and make

Social Suffering and What Is at Stake

in the local context and, conversely, experiences of cancer strengthen or

Suffering, Subjectivity, and Resilience

from the forces of collective history within which it is embedded” and

displayed a clear resilience in their ongoing efforts to make ends meet,

Making Sense of Cancer and the Multiple

cancer to any of the contending causalities available to them depends

Families, Social Relations, and Managing Illness

but rather, as efforts to minimize the financial impact of cancer, they

demand more attention from her son and daughter-in-law. By contrast,

Such a focus on sufferers has a number of advantages. First of all,

Medical Anthropology of China

As this study centers on how healing is experienced and molded by

during Mao individual desire was unacceptable, and as a consequence

Situating an Ethnography of Contemporary China:

Much scholarship on the relationship between the economy, moral-

instance, workers in a state-owned distillery studied by Jonathan Unger

I outline an emergent moral economy that combines past and present.

Failure of Morality and Villager-State Relations

have become mainly the responsibility of individual families. Li Zhang

One important parameter villagers use in their evaluations of the

government” (2003, 231). Proclaimed nostalgia for Mao’s China, then,

Declining Morality among Villagers?

while downplaying a person’s obligations to the community and other

obligation. To portray this in a broader context, she employs Caroline

Experiences of cancer are instances in which social and moral fault

The Evolving Moral World

Langzhong city is located in a hilly area in the northeast of the

feng shui (commonly translated as geomancy), in the hope of attracting

Langzhong under Mao

surname (cf. R. Watson 1985), collectivization entailed a pooling of

at worst. While Malthusian cycles of famine surely affected villagers

effects of humiliation during the Cultural Revolution on people’s men-