Nowadays, if you stroll around cosmopolitan cities in China, you will not fail to notice the glaring advertisements for nanke (men’s medicine) along streets and at public transits. Unlike the clinical flyers for sexually transmitted diseases, which appear in the marginal areas of the urban space, these advertisements display a formal and professional image. The growing publicization of men’s medicine may arouse your curiosity to ask further questions: Does it imply the spread of impotence epidemic among the population? Is it a consequence of sexual liberation since the country’s opening up? How do these patients define and describe their problem, and how are they perceived by their family and in the social surroundings? What kinds of medical treatment are available for these patients? To what extent does the professionalization of men’s medicine contribute to the treatment, and how well are the medical suggestions being taken? Everett Yuehong Zhang’s ethnography about the impotence epidemic provides rich data and insightful analysis of these important but overlooked issues, and it furthers our understanding of the complexity and dynamics of post-Mao transformation.
The book is divided into two parts. In the first part Zhang focuses on the production of desire. He reviews sexual oppression and biopolitical intervention under Maoist governance and posits how the danwei (work unit), hukou (household registration), and political class system contributed to the incidence of impotence. Then he turns to discuss the post-Mao change that people were encouraged to express their concerns about sexual desire and seek medical help if necessary. Zhang does not support the presumption that the incidence of impotence increased due to the sexual activeness fueled by the ideology of liberalization, which in his view just made impotence highly visible in the public sphere. He declares that men’s sexual malfunction is not “a neurovascular event” or “a malaise of civilization” but a “social event” (100). In this sense, Zhang explores how the social transformation and bodily experiences entangled with each other in the narratives of nanke patients. Zhang lays out how intergenerational, romantic, and marital relations are inscribed in the experiences of impotence. An illuminating example from his book is the impotence of Mr. Lin (103–5), the only son of a peasant family whose suffering, in the view of Zhang, was the result of being engaged to a girl chosen by his parents. Rather than face his psychological depression, because a strong social obligation made him ignore the potential conflicts with parental dominance, Lin simply treated impotence as a physical problem and sought medication. By examining cases of impotence, Zhang reveals a complex relationship between patriarchy and masculinity, and he also presents the urgency for more gendered-neutral masculinity in the private sphere.
In the latter part of the book, Zhang finds that, on the one hand, with the withering of collectivism and asceticism, expression of the individual’s sexual desire became legitimated. On the other hand, such desire was expected to be mastered with self-discipline to fend off obsession. The author explores the ways in which traditional bodily cosmology and ethical beliefs may have restrained desire. Two influential books on nanke cautioned against excessive sexual activity (140–42). People also attached ethical implications to body malfunction, such as the association between impotence and extramarital sexual activity with other women (see the case of Ms. Liao and Mr. Xiao, 142–45). Biomedical techniques (e.g., Viagra, penile implantation) were regarded as temporary and secondary means to deal with the problem. Patients view the difficulties they encounter as being twofold: the loss of “a fullness of jing (精, seminal essence), qi (气, vital energy), and shen (神, spirit)” (181); and “life’s fullness, the capacity to open oneself to the world” (220). The revival of yangsheng (cultivation of life), advocating a moderate and balanced lifestyle, emphasized that people should self-regulate their desire so as to return to a healthy and ethical life. The conclusion suggests that the impotence epidemic is a positive sign for constructing the subject of desire in post-Mao China.
Zhang combines quantitative (questionnaire) and qualitative (literature, interview, observation) methods to offer a better understanding of impotence. The author examines information from patients of different socioeconomic status and demonstrates how multiple social forces correlate to body malfunction. Meanwhile, due attention is paid to voices from sexual partners of the patients to showcase how relationships may influence sexual life. An interesting point Zhang makes is that masculinity does not necessarily depend on sexual competence, and in some cases, heterosexual couples may find alternative options for sexual satisfaction when the male suffers from erectile dysfunction. Overall, Zhang’s analysis broadens the topic of and adds depth to the study on impotence.
Zhang’s book is an excellent case of medical anthropology. Rather than treating the body as biological and neural essence, or confining himself to using simplified dichotomies (e.g., body vs. society, biology vs. psychology), the author examines aspects of the impotence epidemic in its specific historical context. Zhang considers patients’ own voices and further contextualizes their willingness to report problems and traumatic experiences with their sociopolitical status, family, and intimate relations. Additionally, the author rejects a generalized narrative on impotence and underscores the selected cases that are seen as emerging evidence of “a terrain of corporeality” or “one thousand bodies of impotence” (74) to avoid reducing the diversity of the sufferers’ individual experiences to “a culminating point or an external end” (74).
The hybridity of the medical treatment of impotence depicted in chapter 6 is perhaps the most deftly described in the book. The chapter depicts the trajectory of sociocultural forces involved in the development of Chinese medicine in treating impotence. The reform of traditional Chinese medicine is explored with the increasing prominence of biomedicine. The emphasis on clinical reasoning and epidemiologic study facilitated the prominence of treatment that shifted from a kidney-centered to a liver-centered perspective. The transformation of a hospital into a profit-making enterprise also favored biomedicine, because doctors earned more income “by prescribing biomedicine than . . . by prescribing herbal medicine” (192). However, Zhang also pays attention to medical training and career development within “state project that integrate two forms of medicine” (191) and how traditional Chinese medicine doctors maintained ethical concerns for “the cultivation of life” (183). Zhang’s analysis displays the complex meanings of impotence from the perspective of Chinese patients: it was not only related to sexual pleasure but also symbolized the loss of vitality. The prescriptions provided by doctors attempting to combine the effect of biomedicine (such as Viagra) and traditional Chinese medicine (herbal medicine) echoed the patients’ demand for achieving confidence in sexual relations during the short term and accumulatively recovering full potency during the long term. In the end, the author regards the emerging hybrid treatment as a reflection of a cosmopolitan ethos in the post-Mao era.
Drawing from the insights of cultural elites in his probe into the history of Maoist governance, the author seems to have exaggerated the effect of sexual regulation of the country but has overlooked the active role of sexual life in relatively marginalized areas (e.g., rural communities, homosexual practices) during that period. Moreover, the author makes a strong argument that hukou and danwei systems were accountable for the impotence-induced sufferings in the Maoist period. From his viewpoint, these two systems restricted social mobility and caused physical separation between couples, thus strengthening sexual abstinence, which eventually led to the unfortunate sufferings of the impotent few. This analysis tends to underrate the agency of individuals in their pursuit of alternative ways for achieving sexual pleasure. Furthermore, the author makes an attempt to demonstrate the dramatic shift from Maoist sexual oppression to post-Maoist liberation and to criticize the discouraging role of collectivist morality against the individual’s pursuit of desire. However, other possible causes may also have led to the deprivation, especially if one considers the large population of migrant laborers in post-Mao China, who were kept apart from their wives in hometowns or were forced to live separately from their wives in male- and female-only dormitories, which was probably not due to pressure from the political culture of collectivism. One may thus find the author’s generalizations less convincing and question if any fundamental changes have taken place since the implementation of the neoliberal economy.
The book sheds new light on the underexplored issue of desire in the transformation of China. Through the specific lens of men’s medicine, Zhang reveals that Chinese culture tends to safeguard its traditional value system in resistance to the consumerism of sex and medicalization and that the sufferers of nanke tend to maintain the agency to pursue a moderate and ethical life. Such revelations may lead readers to go one step further and ask how traditional culture could survive in the post-Mao market ethos that emphasized and valued restless growth and the utmost outpouring of energy. The juxtaposed trends in contemporary China seem to lack a reasonable explanation: on the one hand, traditional Chinese belief in bodily cosmology highlights balance and mindful control of the body, as evidenced in Zhang’s interview data; on the other hand, popular beliefs propelled by Marathon Fever and various hookup apps encourage limit-pushing tapping of the body’s potential and enjoyment of sex life.
Overall, this book captures the complex interactions among bodily experiences, intimate relations, clinical practices, and the broader sociopolitical context. This is of particular value for researchers and general readers who are interested in a range of topics, including sex and desire, masculinity, gender relations, Chinese medicine and its practices, and the post-Mao transformation of morality.