Ethnos

Journal of Anthropology

ISSN: 0014-1844 (Print) 1469-588X (Online) Journal homepage: https://www.tandfonline.com/loi/retn20

Feelings Run in the Family: Kin Therapeutics and

the Configuration of Cause in China

Teresa Kuan

To cite this article: Teresa Kuan (2019): Feelings Run in the Family: Kin Therapeutics and the
Configuration of Cause in China, Ethnos, DOI: 10.1080/00141844.2019.1634614

To link to this article: https://doi.org/10.1080/00141844.2019.1634614

Published online: 25 Jul 2019.

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ETHNOS
https://doi.org/10.1080/00141844.2019.1634614

Feelings Run in the Family: Kin Therapeutics and the

Configuration of Cause in China
Teresa Kuan
New Asia College, Chinese University of Hong Kong, Sha Tin, N.T., Hong Kong SAR

ABSTRACT
Drawing on fieldwork conducted in a clinical setting in China, this article makes a
contribution to the special issue’s examination of the ambiguity of kinship’s
mutuality by engaging systemic family therapy. Family therapists are no strangers to
the negative in family life. ‘We-ness’ could be a suffocating embrace and potentially
the nourishing condition for even the most severe of psychiatric diagnoses. While
practitioners understand the purpose of treatment in terms ‘individuation’, I argue
for seeing family therapy as a technology of kin therapeutics for working on
relational tangles that have caused someone to take responsibility for something
she or he cannot control. While systemic therapy may appear to valorise a self-
determined, rational subject, I highlight instead what practitioners themselves know
all too well – that human lives are interconnected, and I underscore the existential
import of their concern for the entangled adolescent therapeutic action works to set
‘free’.

KEYWORDS Kinship; contagion; therapy; psycho-boom; China

In a research institute for family therapy in Kangzhou,1 a group of psychotherapists

observes from behind a one-way mirror a couple having a discussion about a topic
they disagree on. On this particular day, the child who brought the family sits across
from her parents. She is 15-years-old, on anti-depressants, and doing regular therapy
elsewhere. She has been instructed to stay out of her parents’ discussion. Meanwhile,
sensors have been attached to her fingertips for the purpose of tracking her arousals,
indicated by changes in body temperature, heart rate, and skin-conductance. Two
assisting therapists sit behind a computer set up behind the girl as they watch
graphic bars fluctuate. Their job is to take notes on when they happen in relation to
what pieces of conversation. These notes will be relayed to the senior therapist observ-
ing from behind the mirror in what they call the ‘arousals report’.
The father and mother, who divorced five years ago, had no sooner agreed on a topic
to discuss than a heated argument began. It concerned a recent incident: an audio
recording the daughter made of a paternal aunt and an older cousin lecturing her at

CONTACT Teresa Kuan tkuan@cuhk.edu.hk

© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 T. KUAN

a family dinner. She had made a casual remark about school being a waste of time,
inspiring her relatives to launch into what she experienced as personal criticism.
Mom is upset her ex-husband did nothing to stop them. Dad, for his part, saw no
problem with letting his daughter hear an important reminder from some other
adults, because he is chronically worried about the misfit between her lazy tendencies
and the pressures of social competition. Mom is upset about the sense of doom he is
always trying to convey. ‘The time you spend with her is very little’, mom says to dad,
Yet you will spend an hour encouraging her, and then an hour attacking her. You only stand in
your own position. Why did you have to attack me after we divorced? Well what is in the past is
in the past. But she will remember these things in her heart!

Dad responds defensively, and the estranged couple continues to argue about mom’s
tense relationship with her former in-laws, their suspicion of her character, how to
parent an adolescent with depression, and more about past hurts. ‘You never have
any faith (xinren) in her’, mom protests, ‘You never had any faith in me either’.
Neither feels understood by the other party, and they have no trouble filling up the
half hour they have been allotted for having the ‘Conflict Discussion’, part of the clinical
protocol used at this institute, designed for assessing the relationship between the pre-
senting problem of the ‘identified patient’ (IP) on the one hand, and family relation-
ships on the other.
At the end of the half hour, one of the assisting therapists calls out ‘time’s up’. On the
other side of the one-way mirror the senior therapist draws the curtain closed. She
begins the discussion by inviting her colleague, a senior psychiatrist, as well as the refer-
ring therapist to comment. The rest of us, junior trainees with the odd exception of the
one anthropologist, have side conversations about the mother’s eloquence. Her talk was
full of speech patterns with tremendous rhetorical effect. It was like watching a play. The
therapist meanwhile is more interested in the clinical work to be done. After the arou-
sals report is given, she makes the following comment:
This is a very typical divorced couple, there is a lot of hate in their conversation. The daughter is
very helpless, she cannot move. How to bring the child out by allowing her to experience the
pain? Talk therapy is not going to be effective. You have to intensify their pain, let them experi-
ence not having yet divorced.

Before exiting the observation room to join the family on the other side, she character-
ises this case as ‘a surgical case’ (kaidao ge’an).
Why would family therapy be likened to surgery? Isn’t therapy supposed to provide
comfort and support? What does the therapist intend to cut? What can family therapy
reveal about kinship and contagious connections? My answer to these questions is based
on intensive fieldwork I conducted between February through July 2016 in my role as an
intern at this institute (to be referred to as ‘the Institute’), followed by ongoing conver-
sations with informants, short visits back to Kangzhou, and self-study of the pro-
fessional literature. Why family therapy would be likened to surgery relates to the
observation made in the introduction to this special issue: ‘the poisonous and nutri-
tious, are all intertwined in family life over generations’. This is hardly news to
 ETHNOS 3

family therapists, who specialise in understanding and addressing the ambiguity of

kinship. What one of its founders has called ‘we-ness’ could also be a suffocating
embrace and potentially the nourishing condition for even the most severe of psychia-
tric diagnoses (Bowen 1978). Marshall Sahlins’s construal of kinship as ‘mutuality of
being’, a conjoining of existence realised in and through mutual participation, is
specified and complicated at a level of detail that is highly instructive for the anthropo-
logical study of contagion in kinship. Not only do kin ‘live each other’s lives and die
each other’s deaths’ (2013: 28), they might also feel each other’s feelings, love and hate.
Recent studies of the psy-disciplines in anthropology commonly relate its various
manifestations to political-economic shifts and the big context of neoliberalism. In
this literature, inspired primarily by Nikolas Rose, scholars understand neoliberalism
as entailing not only the implementation of policies that radically minimise the role
of national governments in regulating economic activity, but also, a whole set of cultural
ideas and practices that appear to foster and enrich psychological life in the interests of a
socioeconomic order that depends on an intensification of subjectivity in certain classes
of people (Kuan 2015; Lester 2017; Matza 2012; Tran 2015, 2016; L. Zhang 2014, 2015,
2017; Y. Zhang 2014; Zigon 2010). These studies effectively problematise therapeutic
culture and practice by relating empirical observations and textual critique to an
inquiry into productive modes of power that entail the conduct of conduct.
In this article, I take family therapy as an interlocutor to be engaged in the classic
spirit of enlarging the universe of human conversation (Geertz 1973: 14). Here,
family therapy is simultaneously an object of inquiry and a conversation partner for
problematising what I would like to call ‘the sub-social’, a level of social life that is par-
ticularly susceptible to contagious connections.2 The sub-social is neither world history
nor personal experience, but instead the immediate social relations that constitute local
worlds and persons (cf. Whyte and Oboke, in this issue). Otherwise known as ‘kinship’,
we find at this level unequal relations of power and routinised forms of violence as
much as shared affection and deeply felt commitments. More a problem than a given
(Han 2012), attunement to this meso-level focuses attention to an area of life in
which people invest so much of their energy (Carsten 2004: 9). It is the area of life to
which many ritual technologies are addressed, a domain of human experience that
invites a mediated response because the problems that can arise in intimate relations
are difficult to address in the course of everyday life.
Michael Peletz, in trying to make sense of a remark made by a Malay man with
respect to their local system of kinship – ‘you give flowers, but get shit in return’ –
observes in anthropology a ‘limited ability to address effectively the Janus-faced dimen-
sions of the human experience … ’ (2001: 413–414). Interestingly, this level of sociality
is also a level some family therapists endeavour to keep in sight, having watched their
practice change dramatically in the wake of their own version of the postmodern turn,
which shifted attention away from family systems and observable interactions to inner
experience and the construction of meaning (Minuchin, Nichols, and Lee 2007: 1–2).
‘This progression is puzzling’, the authors of a training textbook write in their introduc-
tion, as the ‘great innovation of family systems theory’ was the discovery of ‘the funda-
mental interconnectedness’ of human lives (1). In anthropology, Peletz observes,
4 T. KUAN

interconnectedness and ambivalence can be found throughout the ethnographic record,

from classics such as Evans-Pritchard’s The Nuer to relatively more contemporary eth-
nographies such as Wikan’s Managing Turbulent Hearts and Trawick’s Notes on Love in
a Tamil Family. The focus on ‘formal interrelations’ and the ‘reproduction of corporate
groups’ explains the neglect of ambivalence in the classics (417), while contemporary
work simply does not explain ‘where all this ambivalence is coming from’ (428).
Peletz explores possible reasons in noting that, ‘kinship is heavily freighted with
moral entailments in the form of expectations and obligations that are often burden-
some or impossible to fulfill’ (415), but this essay ‘Ambivalence in Kinship since the
1940s’ is very much a programmatic one.
I cannot offer a definitive answer to the question of where kinship ambivalence stems
from, but I take this special issue as an occasion for exploring how kinship gets confi-
gured and problematised as cause in a situation of misfortune – namely, illness – in
different ways and places. Doing so gets at the heart of enduring anthropological ques-
tions about personhood, relatedness, and contexts.
The ontology of family therapy resonates with a reversal of causality proposed by the
introduction to this special issue, specifically its discussion of pre-genetic, pre-medical
understandings of heritage: it is time in place, or the ‘permanence of ties’, that can
explain traits of resemblance, not genetic inheritance. Place ‘inherits its inhabitants
and impresses its character upon them’ (Müller-Wille and Rheinberger as quoted by
Meinert and Grøn, this issue). The notion of contagion, however, is foreign to family
therapy. Their metaphors are directly and indirectly derived from cybernetics. They
get at dynamics by speaking of systems, and of forces that ‘run the circuits’ (Bowen
1978: 479). While the surgery metaphor invoked at my field-site relates directly to
organic life in a way cybernetic language does not, it descended from a theoretical fra-
mework that begins not with epidemic patterns and the notion of spread (Grøn and
Meinert 2017), but with biological fusion and cell division (Bowen 1978: 354), a
totally different scale of life process. Where the two frameworks do converge, family
therapy and the special issue’s focus on contagious connections, they converge on the
notion of influence (if conceived as flow), circulation, communicability as communi-
cation, and stickiness (Grøn and Meinert 2017; Meinert and Grøn, this issue). The ques-
tion of what runs in the family is also a question of how connections constitute the
person, taking as prior susceptibility over entities whose boundaries can be compro-
mised, affection rather than infection (ibid). In family systems theory, boundaries
between persons are by no means a given. In a situation involving a suffering adolescent,
the problem is thought to lie in the con-fusion of roles and responsibilities, in the entan-
glement of seemingly discrete persons.
In this article, I argue for seeing family therapy as a technology of kin therapeutics
for working on relational tangles that have caused someone to take responsibility for
something she or he cannot control. Focusing on a therapeutic encounter that actua-
lises, with the help of a material apparatus, a particular way of conceiving persons
and causes, I offer an account of how family therapy answers the central questions of
the special issue – ‘What runs in the family?’, ‘How?’ and ‘How to respond?’ If the
sub-social is a problem that can, in a situation of misfortune, invite a response, then
 ETHNOS 5

systemic therapy is one possible response. I think of systemic therapy as belonging to a

larger family of ritual technologies for treating sub-social troubles: it configures
immediate social relations as the experiential dimension to stress and act on by identi-
fying entanglement as the conduit for the run of feelings and resentments, and by pro-
blematising the con-fusion of selves.
While systemic therapy may appear to valorise and have as an impossible end goal a
self-determined, rational subject with its focus on adolescent health and development, I
highlight what practitioners themselves know all too well – that human lives are inter-
connected, and I underscore the existential import of their concern for the entangled
adolescent therapeutic action works to set ‘free’. Therapy provides a means to map
out possibilities for modulating the experience of intersubjectivity – in local idioms
that conceive of a freedom to choose between immersion or separation, participation
or observation, feeling bothered or not feeling bothered – while underlining the uncer-
tainty and vulnerability that accompanies the effort to change a pattern or a system.
This paradox speaks volumes to the special issue’s interest in the ‘hauntology’ of
kinship (Meinert and Grøn, this issue).

Between the Particular and the Universal: Family Therapy as a

Technology of Kin Therapeutics
The Institute is a product of the unique historical moment in which China finds itself
today. While the senior clinicians primarily work in public hospitals either in Kangz-
hou or another major Chinese city, the Institute is embedded in a private wellness
company founded by an overseas Chinese businessman from a wealthy real estate
family. The wellness company appears to be a hobby endeavour for the Chairman,
one he takes very seriously as he is an advocate of self-care and systemic thinking.
His family and their family business have benefited from family therapy, hence,
seeing the rise in divorce rates in Kangzhou, along with the emergence of other
social problems related to the family, the Chairman created the Institute in collabor-
ation with the Institute’s Clinical Director. We find at the Institute a confluence of
transnational capital and global expertise in China’s emerging market for private
mental health services. This new sector, a product of a short-lived certification pro-
gramme first launched by China’s Ministry of Labor and Social Security in 2002
more in the interest of promoting labour diversification than in promoting mental
health (Huang 2014), is a relatively unregulated ‘jianghu’ realm,3 populated by thera-
pists with various levels of training who were able to enter the field very quickly
thanks to the programme’s low admission threshold and lax requirements. Private
companies registered as education or consulting companies have flourished, with
some attracting talent from the state sector, i.e. psychologists and psychiatrists who
have spent their careers working in very different institutional and regulatory
environments (Huang 2017).
The Institute, my field-site, is an example of a private company that has attracted
into its clinical team well-established professionals and early career therapists belonging
to the ‘academic camp’ (xueyuan pai). Its state of the art facilities – therapy rooms
6 T. KUAN

connected to observation rooms by way of one-way mirrors and audio-visual technol-

ogy – and its singular focus on family therapy is a major attraction.
The clinical protocol adopted by the Institute was first developed in Hong Kong by a
therapist and researcher named Wai-Yung Lee and her clinical team. Tracking the
arousals of a child or adolescent during a 30-minute ‘Conflict Discussion’ is the first
step in assessing the relationship between symptoms on the one hand, and family
relationships on the other. The conflict discussion is then followed by a ‘Debriefing’
during which the arousals report is shared with the family in relation to a baseline, a
different set of numbers recorded over a 10-minute period before the conflict discussion
begins. In a key article Lee and her colleagues published in their professional journal
Family Process, it is noted that while previous studies have measured ‘changes of the
child during exposure to simulated video or audio of interadult conflict’ to understand
how children respond to conflict, few studies have used actual conflict, possibly because
researchers in the field feel it would be ‘unethical’ to do so (Lee et al. 2010: 44). At the
time of the article’s publication, the design of the study was not only unusual for its use
of actual conflict, there were virtually no studies exploring the use of conflict for clinical
purposes (Lee et al. 2010: 45).
While Lee and her colleagues presented the use of biofeedback data as having the
potential to ‘speed up the clinical process’ (Lee et al. 2010: 45), some practitioners in
mainland China appear to see the protocol as a way to help legitimise psychology in
the eyes of ordinary people. In a WeChat group dedicated to discussing family
therapy theory and clinical practice, one member wrote,
Many Chinese people do not believe the phony promise of psychology (xinli zhe yitao), they
believe in hospital pathology reports, reports issued by machines, they don’t believe in the
talk of counselors. This project of Lee’s joins these two things well.

There may be something uniquely Chinese about the attraction to physiological data,
and something uniquely Chinese about the meaning of such data in the context of
family therapy, which involves not only airing dirty laundry to strangers but airing
dirty laundry in a morally fraught situation. Anti-individualist in its orientation, the
kind of family therapy practiced at the Institute aims to shift a family’s attention
away from the symptoms of the identified patient (IP) to hidden conflicts in the
family. Lee and her colleagues note in their Family Process article the difficulty of not
suggesting blame in such an endeavour (45).
One might say such a protocol was developed to facilitate psychotherapy in a culture
where people dislike confrontation; if one assumes both Hong Kong Chinese and main-
land Chinese are conflict avoidant then the protocol is already well adapted to its new
soil. But a reading of the research literature on ritual practices suggests that the need to
address hidden conflicts without suggesting blame is extensive. The practices I have in
mind deal specifically with the sub-social, taking the occasion of an illness to address
tensions that are typically not amenable to airing out in the context of everyday life.4
Such rituals universally involve local idioms, shared symbols that give meaning to pro-
blems, and specialists who facilitate the work of sorting through relational histories. In
Botswana, when a Tswana or Kgalagadi person falls ill, the family may invite a specialist
 ETHNOS 7

to determine the cause of the illness. The dikgaba or anger of a senior relative is usually
the reason, but that person may not realise she or he was even angry in the first place.
Dikgaba is instead ‘diagnosed by means of its effects’, and the anger of the offended is
not so much a discrete emotion category than a way to identify the disappointments
that easily and commonly arise in relations that are not defined by lineal-based auth-
ority (i.e. patrilineal), but by expectations of intergenerational care and affection (e.g.
the relation between a maternal aunt and nephew) (Lambek and Solway 2015 [2001]:
136). Furthermore, because dikgaba is an emotion that circulates, that is to say, it
does not reside within a single individual, ‘At the dikgaba ceremony, the entire
family is “cooled” by the aspersion of medicated water’ (139).
In eastern Uganda, a specialist who is being consulted about an illness will not focus
on the symptoms but on relationships: who is the agent behind the misfortune, and
what does that agent want? As Susan Whyte explains,
Determining the cause of a misfortune always involves a consideration of the possible motiv-
ation of the agent and this in turn involves moral reflections not only about the agent, but
about the victim and the people responsible for the victim. Are there obligations that have
not been met? (1997: 32)

While a diviner depending on specialty may either consult with spirits or examine eso-
teric books, Whyte likens Nyole divination to legal proceedings because its usefulness
emerges from a weighing of the evidence – exploring and narrowing possibilities by
way of discussion, questions about relationships are asked, and confirmations given
(70). What is most relevant to highlight for my purposes here is the fact that a
victim is a victim not because, as in the previous case, a senior relative has been disap-
pointed, but because the victim has been ‘cursed’, for unfulfilled obligations, unpaid
debts, and bruised feelings that occurred in ascendent generations.
Why should a person suffer for the ‘sins of the father’, and if illnesses have biological
causes why do the Nyole think of relations as ‘causes’? The answer lies in differential
configuration of cause, a narrowing of the field of action to the domain of kinship in
the case of kin therapeutics, from a multiplicity of possible causes. Specialists of the
sub-social do not see biophysical individuals but rather relational ecologies that need
resetting (cf. Whyte 1997: 78). Matters commonly construed to be individual, i.e.
responsibility and experience (namely, the experience of the effects of others’
actions), are in fact transpersonal matters for such specialists. At the level of the sub-
social, these matters are distributed across the span of a network in ways that defy ontol-
ogies of physical cause and bounded individuals (cf. Sahlins 2013: 46). It is the reason
why an instructor of a basic course in structural family therapy5 I once attended asked a
large audience of trainees if we ‘believed’. ‘Do you believe that everyone is affected by
relationships (shou guanxi de yingxiang)?’ ‘Do you believe in family therapy (ni xiang
bu xiangxin jiating zhiliao)?’ These questions had to be asked because the IP in a live
case demonstration came with a diagnosis of compulsive disorder and diabetes. How
could the latter, I wondered to myself, be caused by relationships? As far as the
master therapist leading the course was concerned, parental conflict that cannot be
articulated (shuo bu chulai) has become a part of the body in dribs and drabs (diandian
8 T. KUAN

didi), over time, an imperceptible process that constituted the ‘identified patient’ as the
person who expresses tension on behalf of the family system.
On behalf of – this is key to understanding the ontology of systems therapy. There is
an implicit theory of somatisation that presumes ‘the run’ of things within a family
system, including the ‘responsibility’ for maintaining the system. That an IP has
adopted a role she or he need not play is the insight a session aims to realise, but it
is not at all easy to go from symptom to relations, thus, the invention of the biofeedback
protocol. The issue the protocol addresses is not only suspicion of the ‘phony promise of
psychology’ in the eyes of Chinese people, but more precisely, making possible the work
of bringing the hidden, the unsayable, and the imperceptible to surface. Idioms and
devices found in kin therapeutics provide a way to confront the hidden reasons
behind relational problems, to say and do what otherwise could not be said and
done. In Nyole divination, there is the ‘authoritative third voice’ of the spirits consulted
and Arabic books examined (66), while the process of sorting through is conducted in
the subjunctive mood. Doing so ‘allows people to avoid confrontations with one
another and with unpleasant information’ (Whyte 1997: 24). The symbolic mediation
ritual technologies provide mitigates the discomfort, for social life must go on after
all is said and done.

Separated Yet Stuck Together

The psychiatrist and the therapist, let us call her Dr K, have left the observation room to
join the family in the therapy room. They start a conversation organised around the
arousals report. The psychiatrist asks the girl if she felt the changes. It is the first step
in externalisation: you have had an arousal, yet you did not even know it. Dr K then
asks the family if they understand what the data represents, then reports, ‘She was
having a response from the very beginning. Skin conductance was especially high.’
Once they correlate the IP’s arousals to the moment her father began speaking, the
girl was more than happy to explain how she feels really uncomfortable when her
father defends himself, and she proceeded to list the man’s many flaws.
Dr K goes on to explore, in different directions, what she calls the family ‘labyrinth’,
including the incident involving the audio recording. The girl insists she didn’t start
recording right away, nor did she play it for her mother right away. Her ‘bad mood’
is blamed for her having ‘blindly passed words on’ (xia chuan hua). The mother at
this point picks up the story by telling Dr K she was not in just any kind of bad
mood, quickly turning what began as the daughter’s grievance into her own. What
she heard in the recording was not merely a lecture but a ganging up her father did
not protect her from. Mom then stresses the injustice of the situation by saying, ‘She
is [already] taking medication every day, and doing psychotherapy every week.’ Break-
ing from the fierceness she had displayed up to this point, she begins to weep, ‘In this
kind of situation, I am going to give her a psychological suggestion (xinli anshi), we are
going to be okay (women hui hao).’
It is not long before Dr K asks a question that bears the signature of systemic think-
ing. Having heard a story about one particular incident in which the daughter was
 ETHNOS 9

spanked for rebelling against her father, she asks the teenage girl a provocative question:
‘Whose emotion is this?’ Meaning, with whose emotion were you rebelling with?
The way in which this question was posed is precisely the kind of thing junior trai-
nees watch for when they study recorded live sessions as a way to sharpen their own
technique. Trainees admire Dr K’s precise use of language. One particularly witty
trainee in my study group was fond of likening Dr K’s style to knife throwing,
‘killing at every level she descends down into’ (yi dao, yi dao sha xia qu). Had she
asked, ‘Is your emotion yours or your mother’s?’ my study-mate pointed out, the
knife would not have been as quick.
A sample of questions asked and observations made provides a glimpse of how Dr K
descends deeper and deeper into the labyrinth, starting with ‘I want to return to this
assessment.’
‘What exactly happened? What were you responding to [at this moment of arousal]?’
‘If your mom is so strong, why do you feel like you need to protect her?’
‘With divorce, everyone could just leave everyone else alone (dajia keyi zai bu guan
dajia). It’s hard to control other people anyway. Why do you think they are still trying
to change each other if they are already divorced?’
‘What were you thinking when you made the recording?’
‘Actually these are both people you do not want to give up. […] But there are other
things that you can do. You have played the role of the mediator for too long. It is going
to affect your development. Your observations of them are too detailed, too meticulous.’
And then, the final cut, ‘You are 15-years-old, why do you have depression? What
distresses you (ni xinteng shenme)? Does your depression have something to do with
maintaining your parents’ situation (ni de youyu gen baba mama weichi qingkuang you-
meiyou guanxi)?’
With this question, the father excuses himself to go to the bathroom. A loquacious
girl suddenly appears perplexed. Dr K suggests they wait for dad to come back before
continuing. A tense silence hangs over the room.
The conversation continues when dad returns. The girl admits it has become increas-
ingly difficult to handle her schoolwork; the burden makes her want to ‘collapse’. Dr K
responds with a classic family therapy formulation: ‘Putting too much energy here,
things won’t be so smooth in the outside world.’ She continues to explore the family
system, before introducing another provocation, directed at the IP: ‘See everyone is
so entangled. And you enjoy watching them fight on (ni xiangshou tamen da xia
qu).’ Dad, who had become increasingly quiet during the debriefing, suddenly speaks
up. He tells Dr K he finally feels understood, agreeing with her reinterpretation of
the audio recording incident. Then, there is an outburst. The girl berates her father
in a sharp voice, ‘You approve whatever benefits you!’ And then proceeds to tell Dr
K that before their appointment, he warned his family against believing what a psychol-
ogist might have to say.
This was a pivotal moment in the session. The therapeutic process with the help of
the biofeedback data has effectively staged evidence for ‘we-ness’ in the laboratory-like
theatre of the family therapy room. ‘You are not well on behalf of your mother (ni wei ni
mama bushuang)’, Dr K says to the girl, ‘Your mother hasn’t even gotten emotional and
10 T. KUAN

you are already jumping up.’ A transpersonal distribution of anger and resentment has
been demonstrated, indicating a con-fusion of selves and the run of emotions between
people who have shared time in place. They are kin after all, people who ‘partake of each
other’s sufferings and joys, sharing one another’s experiences’ (Sahlins 2013: 28). In this
particular case, a daughter has put herself in her mother’s position, feeling her feelings
for her, just as mom had put herself in her daughter’s position, reading dad’s every
‘attack’ on their daughter as a personal attack on her. This sort of ‘we-ness’, what the
therapists at the Institute call ‘entanglement’ (jiuchan), is poisonous rather than nour-
ishing. It is the reason why surgery is required.

Enter Family Systems Theory

The biofeedback protocol adopted at the Institute is highly unique and not at all repre-
sentative of more general trends in China’s psycho-boom, a heterogeneous landscape
composed of many other models and practices such as cognitive behavioural therapy,
sand-play, psychoanalysis, and mindfulness.6 The kind of family therapy practiced at
the Institute is not representative either – Virginia Satir’s approach to family therapy
has in fact enjoyed more popularity in China because it appeals to trainees’ quest for
personal growth by way of learning psychotherapy and techniques for emotional
expression. Systemic therapy is difficult to learn and train, a factor that may limit its
growth, but it is exceptionally good to think with.
That the Institute imported a protocol invented by an American-trained researcher
in Hong Kong expresses a confluence of transnational capital and global expertise in
China’s emerging market for private mental health services. Lee’s protocol is based
on family systems theory and the concept of triangulation, first developed by Murray
Bowen, one of the founders of family therapy (Weinsten 2013). The concept of triangu-
lation, based on Bowen’s identification of the triangle as the basic ‘molecule of any
emotional system’ (1978: 198, 469), begins with an interesting premise: ‘Most people
cannot tolerate more than a few minutes on a personal level. When either party
becomes anxious, he begins talking about a third person (triangles in another
person), or the communication becomes impersonal and they talk about things’ (499).
There is nothing wrong with a triangle. In fact a triangle is ‘the smallest stable
relationship system’ (Bowen 1978 469–470). The triangle only becomes problematic
once the issue of individuation, also known as differentiation, is factored in. (This is
translated as fenhua in Chinese.) Differentiation refers to the degree to which a
person is able to remain ‘objective’ even while engaged in ongoing human intercourse.
Anxiety determines differentiation (361). Relationship-oriented, poorly differentiated
people put too much ‘life energy’ into seeking ‘love and approval’ (474). Highly differ-
entiated people on the other hand are ‘more contained’ (462), more ‘self-determined’
and ‘goal-oriented’ (473–474). Although Bowen has plenty of examples of how undiffer-
entiation shapes human relations in the workplace, sometimes taking the family-like
‘administrative system’ at Georgetown Family Faculty as exemplary, ultimately this
theory is addressed to the treatment of mental illness. Bowen spent a significant part
of his career investigating the role of the family in schizophrenia in a famous NIMH
 ETHNOS 11

study that moved entire families into his ‘Laboratory of Adult Psychiatry’ to be observed
naturalistically (Weinstein 2013: 109–136).
In the theory, clinical relevance starts here: When two people enter into a marriage,
their respective levels of differentiation will determine the degree of their fusion. Bowen
argues, using a metaphor that is central to his conceptualisation of how things run in the
family, ‘The way the spouses handle the fusion governs the areas in which the undiffer-
entiation will be absorbed and the areas in which symptoms will be expressed under
stress’ (1978: 476). Triangulation can happen in any kind of relationship: shifting
tension to a third party serves to ‘relieve the tension between the first two’ (478), a
micro-dynamic difficult to perceive. New third persons will be triangled in when
forces fail to shift, and, Bowen continues,
In periods of very high tension, a system will triangle in more and more outsiders. […] The
family thus reduces the tension within the inner family, and it can actually create the situation
in which the family tension is being fought out by outside people. (479)

Whatever the case may be, a simple triangle or an expanding set of interlocking tri-
angles, triangles provide a ‘circuit’ in which ‘tensions’ may shift and ‘forces’ may run.
Bowen explains:
In emotional systems such as an office staff, the tensions between the two highest administrators
can be triangled and retriangled until conflict is acted out between two who are low in the
administrative hierarchy. Administrators often settle this conflict by firing or removing one
of the conflictual twosome, after which the conflict erupts in another twosome. (199)

In the context of the family it is usually a child who gets triangled, suffering the ‘always-
lose outcome’ of a ‘triangular game’ replayed over many, many years (200).7 In a rela-
tively recent Family Process article discussing triangulation, the authors explain how a
child or adolescent may be pushed out or pulled into a marital system (Bell et al. 2001),
adding a level of specificity missing in the original theory. A difficult child may either
provide a shared focus (‘pushed out’ – tends to happen to boys), or play the mediator
(‘pulled in’ – tends to happen to girls unless there are sisters), diffusing the tension in a
marital dyad.
There is a lot to say about the unexamined assumptions in Bowen’s writing – his
idealisation of an autonomous self appears to be the most problematic. But it is impor-
tant to note that Bowen insists undifferentiation is not psychopathology (1978: 200). He
writes, ‘I have never seen a family in which the “emotional fusion” phenomenon is not
present. Theoretically, emotional fusion is universal in all except the completely differ-
entiated person, who has not yet been born’ (1978: 494). It is also worth noting that
Bowen was a neurosurgeon before he turned to psychiatry, having been inspired by
some years serving in the Army. He found in those specialties the stimulating intellec-
tual challenge of having to solve the most pressing of problems, and recalls trying to
build an artificial heart in the wake of multiple surgical deaths (1978: 483). The level
of difficulty may be harder to imagine in the case of family therapy because human
relations are human relations and seemingly within the sphere of human control. (‘If
you will it, change will come!’) But psychotherapists in general and family therapists
12 T. KUAN

in particular know all too well how thorny the human psyche, or as Bowen calls it, the
‘family ego mass’ can be.
This image of the ego mass, a ‘clump’ of seemingly discrete individuals,8 is important.
In doing fieldwork and working as an intern at the Institute, I had to fight my tendency to
take interest in the details of people’s experiences and learn instead to watch and listen for
what the supervisor called ‘relationships’ – guanxi, guanxi, guanxi. Everyone, myself and
all the other trainees, were often critiqued for being led away by the ‘content’ (neirong). It
is not easy to sense and perceive relationships, actually, those lines of affect and influence
that make it difficult to tell where one person ends and another begins. I was once given
an assignment to edit a therapy session for senior therapists to use in future workshops
and presentations. That was the last time I received such an assignment, because my video
edit, according to the supervisor, grossly missed relational ties for individual experiences. I
thought at the time that if I represented each family member’s experience of others, I
could give a picture of the whole. I was concerned with having a fair balance between
‘voices’, but the supervisor was interested in material that revealed the ‘we-ness’ of the
family.9 To this day, I do not know how I would edit the case I was assigned differently,
because the invisible thread the supervisor spoke of – ‘following the vines to feel the
melons’ (shunteng moguo) – remains somewhat of a mystery to me. While this sense
of mystery is also felt by practicing psychotherapists who accept that systemic thinking
requires years and years of training, I attribute my own shortcomings to the way anthro-
pologists tend to bifurcate social reality into society/culture/orders on the one hand, and
individual experience and ‘agency’ on the other, leaving the meso-level scale of systems
relatively under-theorised.
Like the image of the ‘ego mass’, the surgery metaphor invoked at my field-site is also
highly important for understanding the mode of perception systemic therapy demands
– a unique inflection of family therapy that happens to be good to think with. In the
discipline of surgery on biophysical bodies, live demonstrations have been and continue
to be indispensable for demonstrating new surgical techniques for operating on the
tangles of flesh and capillaries that lie beneath the skin.10 Arguing from the systemic
perspective, it is the same for techniques for cutting emotional entanglement: they
are learned by watching an experienced therapist at work. To learn how to define the
surgical field (and not be led away by content), how to enter and navigate a tangle,
and how to intervene (i.e. cut) in an effective way (precise use of language), a prac-
titioner must first learn to perceive in a particular way. Systemic therapy is not
merely talk therapy, even though talk is involved. It is action-oriented, dramatic, and
temporally contracted. ‘If family therapy is like surgery’, a study-mate once remarked
when I highlighted Dr K’s surgery metaphor for discussion, ‘then psychoanalysis is
like Chinese medicine’.

Entanglement is the Conduit, the Family an Ego Mass

Between the Conflict Discussion and the Debriefing, mom joins her daughter on the
other side of the coffee table, leaving behind her ex-husband on the other sofa,
stewing and glaring in their direction. As the two chat, mom works on peeling the
 ETHNOS 13

shell off a hard-boiled egg and feeds it to her, her 15-year-old daughter, who expressed
as she chewed her worry that maybe mom had been too ‘fierce’ (xiong) during the dis-
cussion, possibly leaving a bad impression on all the teachers on the other side of the
one-way mirror.
We discussed this in my study group when we re-viewed the recorded version of
this session a few weeks later. ‘[The egg] was delivered directly into her mouth
(zhijie song dao zuiba li)!’ the junior therapist leading the study group exclaimed,
noting how precious this kind of information is.11 While my study-mate stopped
short of labelling the dyad’s behaviour, it is tempting for me to see them as an
‘undifferentiated ego mass’. I am reminded of one of Durkheim’s illustrations of
mechanical solidarity: in a society of polyps where stomachs must work together,
‘an individual cannot eat without other individuals eating’ (1973: 78). The parallel
is not entirely fanciful. China experienced a major historical transformation in
recent decades, shifting from a highly centralised socialist economic system to a
decentralised, information- and innovation-driven market system that relies on econ-
omic diversification and the development of a particular kind and class of human
subject who can compete and thrive. As in Russia where psychological expertise
happens to be well aligned with the needs of shifting economic arrangements – as
described in Matza’s work on finishing schools for elite children (2012) and Zigon’s
work on drug rehabilitation for heroin addicts (2010) – in China too the ‘guidance
of selves’ is no longer wholly dependent on political indoctrination, ‘it has been allo-
cated to “experts of subjectivity”’ (Rose 1996: 151). After all, the identified patient at
the centre of this case is a teenager from a middle-class family who is expected to go to
college and ‘get a good job’. She can only succeed on this track if she can master
herself, be as Bowen puts it more ‘self-determined’ and ‘goal-directed’ (1978: 473-
474). But this teenager is too entangled in the family triangle, and her role as the
mediator consumes the energy she could be using elsewhere. ‘Putting energy here,
things won’t be so smooth in the outside world’, Dr K declared.
The purpose of therapy at the Institute is not to resolve marital conflicts, nor is it to
‘cure’ adolescents of depression, bipolar disorder, school refusal or whatever other con-
dition that has become a family’s focal point. The Institute takes almost no interest in
psychiatric diagnosis, because the purpose of therapy is individuation (fenhua). The
therapist on this case works very quickly. Soon after the family’s entanglement is exter-
nalised, Dr K asks the girl whether she wishes to continue playing the mediator role, and
they explore why she ‘enjoys’ watching her parents fight. ‘Maybe I’m looking for a sense
of existence (zhao cunzai gan)’, the girl suggests. ‘Right, the existence of family’, Dr K
says. ‘Maybe it’s a matter of habit’, the girl adds.
Dr K is not interested in fixing an answer, but offers the observation that the family
has not yet learned how to separate (fen), even though the couple is five years divorced.
Clearly the jural cut was not enough, and sometimes, individual family members need
help to, ‘rise up out of the emotional togetherness that binds us all’ (Bowen 1978:371).
How to translate the language of systems therapy into terms an anthropologist could
understand? What is the re-interpretation I can offer?
14 T. KUAN

Bowen’s idealisation of objectivity and rationality, and the distinction he makes

between fusion and individuation could be faulted for reproducing a long-standing
hierarchy between the faculty of reason and human emotions in developmentalist the-
ories of the mind. But I would argue that his vocabulary merely draws on readily avail-
able cultural idioms for the purpose of handling an existential, ethical problem – i.e. the
question of how to modulate the experience of important relations. There is a striking
parallel between how the anthropologist Michael Jackson thinks of binaries such as
reason/emotion, self/other, subject/object and the pragmatics behind Bowen’s distinc-
tion between fusion/individuation (2013). Rather than take these binaries as ‘competing
ontologies’, Jackson argues, they ought to be construed as terms that capture polar
potentialities in a person’s experience of other people and things, ‘the sense that we
are at times actors, in control of our situations, and at other times at the mercy of cir-
cumstances’ (201). By the same token, we may identify fusion and individuation as two
existential modalities to which experience is potentially open to: one could be totally
immersed in ongoing human intercourse, or standing apart from what is happening.
In family therapy, immersion is not necessarily a problem if one is able to stand apart
even while immersed. It has been explained to me that one could be ‘interconnected
without being entangled’. Entanglement on the other hand, is a problem, especially
where an adolescent who is suffering difficulty with schoolwork is concerned. Ironically,
Dr K will often point out in the cases she handles, there is enjoyment in the entangle-
ment, even if the entanglement is also a source of pain. Recall Dr K’s provocation to the
IP in this particular case, ‘See everyone is so entangled. And you enjoy watching them
fight on.’ This enjoyment is ambiguous, just as the contagious pleasure of eating with
family can also be infectious for the obese (Grøn 2017). For the adolescent who both
suffers and causes parental conflict, pleasure and pain are indistinguishable. How to
make a separation in a situation such as this? Surgical cuts are made with questions
asked and observations made.
Following the outburst, the teenager informs Dr K that her father is ‘not objective’, to
which Dr K quickly retorts, ‘You are not objective either. Let us stop if we cannot
discuss’, cooling the heat in the room. The conversation begins anew with Dr K recog-
nising the parents’ shared love for their child, and everybody’s shared pain, ‘What is
really affecting your child is the negative energy ( fu nengliang) in your talk. It is hard
to tolerate. It is also hard for the two of you to tolerate.’
Mom retorts, ‘What’s intolerable is that I still have to interact with him.’
Dr K, ‘You still have not separated even though it has been a while. You can only co-
parent if you put the anger down.’
Mom notes that her daughter still needs her father, and then continues with the same
complaint, ‘But I wish I didn’t have to have any connection with her father.’ When he
has hurt their daughter, she explains, she has to deal with him. With the audio recording
incident she did not mean to get involved, just as her daughter had not intended to play
the recording for her. ‘I wasn’t supposed to say anything but I couldn’t help myself.’ So
she confronted her ex-husband in WeChat.
Dr K advises the mother, ‘You also have to accept that his way of doing things are his
way of doing things’, consequently inspiring the senior psychiatrist, who had been
 ETHNOS 15

mostly quiet during the debriefing, to chime in suddenly, ‘Dad has his reasons too’, as if
to give support as the only other man in the room. But Dr K insists on the theme she has
been working hard to develop, and contends, ‘Whether he has his reasons is not some-
thing you can control.’ That everyone is trying to control everyone else has confused
proper roles and positions.
‘It’s true,’ mom says reflectively, ‘[it’s all] a mess (tai luan le)’.

How to Respond?
Toward the end of the session, the father and mother put their questions to Dr K:
‘Should I keep my opinions to myself?’ ‘Should I participate less?’ Dr K’s response
was subjunctive in mood, ‘We’re not here to tell you what to do today. We’re only
doing an assessment.’ This clinical language, along with the biofeedback protocol and
the whole technological set up, obscures the moral effort to cut contagious connections
where connections have become poisonous – channels for ‘negative energy’. Obviously
the therapeutic encounter is neither about the arousals nor the report. The report is a
device that allows family members and the therapist to say things to one another they
would not be able to say otherwise, having ‘outsourced’ the problem to an external, non-
human, seemingly neutral third party – a processing machine attached to sensors.12
Doing so is clever indeed, because the protocol bears the authority of science and medi-
cine, while stealthily entering into and then bringing to light the vine-formation of the
family through veins opened by the art of indirection.
Does therapy in fact ameliorate the problems that have arisen in the families that
have sought consultation at the Institute? To what extent does ‘surgery’ release an ado-
lescent from entanglement, setting her on the path toward greater ‘self-determination’,
such that she may stand apart from what is happening in the family? These are not
questions I can answer because I did not follow these families into their lives; the
project was designed to study the work of therapy. However, observations scholars
have made about the subjunctive mood of rituals are suggestive: technologies for
solving relational problems are never complete in their effects. Consider a point
Michael Puett makes in his discussion of the broader theoretical significance of the
Records of Rites (Liji), a classic ritual text from early China. Puett argues that such
texts should be taken as pragmatic rather than descriptive; the world of the ancients
was not as harmonious and cyclical as such texts might suggest. Their purpose was
to map ‘various patterns of interaction with the goal of altering those interactions in
favorable ways’ (2014: 224), favourable from the perspective of humans. The ancients
did not have a special relationship with the cosmos, better than us moderns, but
knew instead that: ‘The energies in one’s body are never fully harmonised; the world
is never fully domesticated; the gui [ghosts] are never fully transformed into ancestors
… ’ (225). This is precisely why rituals are needed. They do not work. ‘Or, more pre-
cisely, they work only as a constant process’, Puett continues, in which ‘dangerous inter-
actions are endlessly being worked on, mapped, classified, and transformed – endless
because these transformations never work for any lengthy period of time’ (226).
16 T. KUAN

Puett suspects rituals have the power that they do because they underline a certain
problem that afflicts the human condition in general, embedded as it is in relational
webs that include other humans, non-human animals, the environment and weather
conditions: ‘there is never an easy solution to how these relations can be improved’
(230, emphasis added).
I draw on Puett not because there is something Chinese about the therapeutic prac-
tice I have described here – match a Chinese empirical case with Chinese ritual theory. I
draw on Puett because he makes a broader point that articulates with anthropological
observations about the vulnerability of human efforts to improve sub-social problems.
Going back to the Nyole again, Whyte tells us they take the reasons proposed in divina-
tion as conditional, knowing that relational problems ‘are never really settled; they are
constantly being reformulated in social life’ (1997: 82). The exploration of possibilities
in divination – possible agents and possible causes – is an uncertain endeavour because
a Nyole person is involved in multiple relationships marked by differing norms and
obligations. Thus, a person who goes to ask is entertaining a multiplicity of possible
causes, while a single consultation involves an eventual configuration of a single
cause to act on. There is no pretence that solutions are lasting. Instead, the effect lies
in the moral effort made, to develop ‘ideas that form plans of action’ (60). At the
very least, the creation of certainty out of uncertainty in Nyole divination can move
a client ‘from inertia to purposeful activity’ (Michael Jackson quoted in Whyte 1997:
81). Trying is the end rather than the means.
Bowen’s theoretical text offers a certainty in his own local idiom that sounds as lovely
as a cyclical, harmonious cosmos: ‘Those with the most ability to distinguish between
feeling and thinking, or who have the most differentiation of self, have the most flexi-
bility and adaptability in coping with life stresses, and the most freedom from problems
of all kinds’ (Bowen 1978: 355–356). Free from problems of all kinds? Like the comple-
tely differentiated person who ‘has not yet been born’ (494), such a life has not yet been
lived. Like harmonising bodily energies, domesticating the world, and transforming
ghosts, ‘freedom’ – i.e. the freedom to choose between immersion or separation, partici-
pation or observation, feeling bothered or not feeling bothered – is never fully achieved,
or to put it differently, is always only transitory. But mapping out these modalities of
being as possibilities for how to live is a precondition for therapeutic action. These pos-
sibilities inform the pivotal question Dr K directed toward the IP at the end of the
session: ‘Do you wish to continue playing this mediator role?’ It is another way of
asking, do you wish to continue to control and take responsibility for something you
cannot control and do not need to take responsibility for?

Coda
Somewhere on the Chinese Internet, I have lost track of where, an essay on family
therapy describes the Chinese family as a ‘mud pie’. One well-respected therapist-psy-
chiatrist told me in an interview that Chinese families tend to be ‘backward’ (luohou), a
developmentalist term that became popular in the market reform era to criticise things
and practices that have supposedly held China back. At a two-day academic conference
 ETHNOS 17

I attended in 2016 on the theme of modernity and the family, another therapist-psychia-
trist described contemporary Chinese as living in paradox having to reconcile the virtue of
self-effacement as prescribed by Confucian teachings on the one hand, and the individua-
lisation (gexinghua) that has come with marketisation on the other. Undifferentiation was
not ‘handled’ (chuli) before the market transition, this psychiatrist argued, and this has
become a matter of clinical significance regardless of a family’s background. He illustrated
this point with an example of mothers in the city of Chengdu who do not allow their adult
sons to sleep with their wives behind closed doors, playing to the audience’s familiarity
with the insufferable mother-in-law/daughter-in-law tension.
On the one hand, I refuse a culturalist reading of family patterns and of the kind of
therapy I observed at the Institute, partly because trainees are taught that ‘culture’, like
the psychiatric symptom, can also deflect attention from problems too sensitive to
touch.13 On the other hand, the world historical dimension of family therapy’s emer-
gence cannot be ignored; the linking of economic reforms with ‘human modernisation’
goes back to the first decade of the post-Mao era, well before the psycho-boom. It was
exemplified in the construal of China’s population problem as a quantitative and quali-
tative problem in the writings of state technocrats (Bakken 2000: 60–66).
An examination of the developmentalist aspect of family therapy shall be left for
another occasion since the scope of this article is not historical transformation but
rather the sub-social level of immediate social relations. Scaling down the inquiry, a
different level of systematicity becomes apparent. Here, it is worth noting that indivi-
duation is not exactly the same thing as individualisation, and the difficulty of individ-
uating oneself in relation to significant others is conceived in systemic theory as a
problem that afflicts all human beings, including Murray Bowen himself, who fre-
quently describes having difficulties in the banal situation of office politics – ‘I
noticed that when I was away on trips I was much clearer and more objective about
work relationships, and that the objectivity was lost on returning to work’ (1978: 485).
This article has taken the theme of this special issue, kinship as contagious connec-
tion, as an occasion for attending to how causes of misfortune and responses to sub-
social problems are configured in different times and places, taking family therapy
both as an interlocutor and as an object of inquiry. Marshall Sahlins’s romantic con-
strual of kinship as ‘mutuality of being’, our collective point of departure, has been cri-
ticised for neglecting the ‘cold shivers’ kinship may trigger (Carsten 2013: 246), and the
run of poison in families (Meinert and Grøn, this issue). Family therapists are no stran-
gers to the negative in kinship. ‘We-ness’ could be a suffocating embrace and potentially
the nourishing condition for even the most severe of psychiatric diagnoses.
But there is a trace of what family therapists deal with in Sahlins, when he defines kin
as people who ‘partake of each other’s sufferings and joys, sharing one another’s experi-
ences even as they take responsibility for and feel the effects of each other’s lives’ (Sahlins
2013: 28, emphasis added). A recurring theme in the cases seen at the Institute is an ado-
lescent’s sense of responsibility for keeping parents together, having absorbed feelings and
resentments run amok. Therapy stages and externalises the con-fusion of selves and the
run of emotions in the process of de-individualising and redefining the symptom, so as to
set an adolescent ‘free’ – free from the constrictions of ‘emotional togetherness’, and free
18 T. KUAN

from the taking of responsibility one does not have to take. The therapeutic response is as
provocative as the entanglement is habituated, ‘you enjoy watching them fight on’, the
therapist says, suggesting the pain is actively made rather than passively suffered.
Objectivity and subjectivity, as Michael Jackson has argued, may be taken not as
competing ontologies but rather, two existential modalities to which experience is
potentially open (2013). Family therapy offers the hope, in the idiom of freedom, of
exerting control not over what other people do and say but instead, over the experience
of significant human relations. One might say the modulation of experience is a mental
quarantine, modelled in the therapeutic encounter in a metaphorical surgical removal.
But the quarantine is as transitory as life is processual.14 This is the reason why I have
been ambivalent about reading the therapeutic practice described in this article as a
movable element in a formula of power, because confidently doing so could suggest
therapeutic effects are more complete than they actually are. Maintaining a certain
level of differentiation while in the midst of ongoing human intercourse, the source
of so many vexations and unspeakable things, is a persistent problem that ‘cannot be
left alone’ and ‘can never be resolved’ (Bubandt 2014: 42). The subjunctive mood of
family therapy, the underlining of the uncertainty of causes and effects by ritual tech-
nologies more generally, presents a haunting image of the elusiveness of a life free of
relational problems.

Notes
1. Kangzhou is a pseudonym for a metropolitan city in the People’s Republic of China.
2. The ‘sub-social’ is a concept I once played with in a conference paper, and I failed to define it in a
clear and concrete way. I thank Cheryl Mattingly for encouraging me to take up this concept
again, in the context of a written commentary that mentions this earlier conference paper
(2017).
3. The literal translation is ‘rivers and lakes’, but the term has long been a trope in the Chinese
cultural imagination. Huang has summarised its long 2000 year-history as such:
Writers across different genres have associated it with a variety of themes: hermitic exist-
ence beyond the mundane world, the vagabond way of life, the underworld of secret
societies, and more recently in martial arts (wuxia) fiction and films, the fantastic
world in which heroes with kungfu skills compete with their opponents. (2017: 10)
4. Comparison between therapy and ritual have been made before: the practice of occupational
therapy in a spinal cord unit in an American hospital has been analyzed as a kind of secular
ritual that deploys aesthetic devices to facilitate a transition from despair to hope, from being
estranged in one’s own body to feeling at home (Mattingly 1998); the ritual practice of zar pos-
session amongst Hofrayati women in Sudan has been compared to psychotherapy and the
pursuit of ‘insight’ (Boddy 1988), which recently inspired a comparison going in the other direc-
tion, Internal Family Systems therapy (IFS) at a eating disorders clinic in the United States has
been likened to the way the Zar cult provides to distressed Hofrayati women a language and a
means to live with the zairan that possessed them (Lester 2017).
5. Structural family therapy is also systemic in its orientation but it differs in emphasising the con-
fusion of roles as the problem to be worked on, for example, a son who has become a mother’s
confidante or emotional caretaker.
6. Lee’s protocol has been recognised by the American Family Therapy Academy (AFTA), earning
her an award in 2014. Murray Bowen was AFTA’s first president.
 ETHNOS 19

7. Nyole people often interpreted the misfortunes of women and children as a consequence of
somebody else’s problematic relation to an agent, for example, the conflict a husband has
with his agnates. Whyte, citing an earlier publication, has called this the ‘“innocent victim”
pattern’ (1997: 32).
8. This is a term I borrow from Bowen, who used ‘clumps’ to describe the factions that would form
at his clinic over the sharing of gossip (1978: 485).
9. To be more specific, clinical material revealing ‘we-ness’ is usually found in what systemic thera-
pists call ‘patterns of transaction’, translated as hudong moshi in China. I leave the discussion of
this for another occasion because there are many types to go through, and also an intellectual
history to trace – one that, interestingly enough, goes back to Gregory Bateson’s explanation
of gender difference in Naven.
10. See for example Jarrín’s research on plastic surgery in Brazil (2017: 159–160).
11. The Conflict Discussion is partly intended to serve this function, i.e. allow for naturalistic obser-
vation, as the assisting therapists in the room are only there to give instructions and keep time.
12. The term ‘outsourced’ comes from a discussion I had with the junior therapist leading my study
group in which I shared about the Azande’s use of oracles to deal with social tensions.
13. This of course does not mean that family therapy is not interpreted in culturalist terms in
China’s psycho-boom, the Institute only happens to be unusually strict in its training.
14. The great paradox of family therapy consists of its anti-individualist understanding of a psychia-
tric condition on the one hand, and its valorisation of objectivity and detachment on the other.

Acknowledgements
I wish to thank Robert Desjarlais, Susan Reynolds Whyte, Karin Zachmann and Susan McKinnon, who,
at different venues, served as discussants of early versions of this paper; colleagues and students at the
CUHK anthropology Friday Seminar in which I presented a longer version; and fellow participants at
the Gynotech Workshop organised by HKU’s HKIHSS, and the ‘Living Well in China’ conference
hosted by the Long U.S.-China Institute at UC Irvine. Susan McKinnon and Horacio Ortiz read full ver-
sions of the manuscript and provided feedback I will continue to think with. Thanks to Lotte Meinert and
Lone Grøn for putting this special issue together. Finally, I wish to thank the anonymous reviewers for
helping me sharpen the argument, and most especially, the clinical director of the Institute, for the pre-
cious opportunity to study systemic thinking and engage in inter-disciplinary conversation.

Disclosure statement
No potential conflict of interest was reported by the author.

Funding
The fieldwork for this project was fully supported by a grant from the Research Grants Council of the
Hong Kong Special Administrative Region, University Grants Committee [Project No. CUHK
14610115].

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