Ni Yang
ABSTRACT
This article analyses Lü Nan’s photographic series The Forgotten People through the lens of the history of psychiatry and mental health stigma in China from the post-1949 period to the early twenty-first century. It explores how Lü’s humanising approach challenges public perceptions of patients with psychiatric conditions and portrays them with dignity and empathy despite systemic marginalisation and neglect. Against the backdrop of China’s shifting political, social, and medical landscapes during a period of rapid transformation, this article argues that Lü’s work was groundbreaking and continues to illuminate the intersection of stigma, violence, and isolation while offering a powerful critique of prevailing societal attitudes. His photography reaffirms the humanity of these “forgotten people” and, through a compassionate lens, calls for deeper reflection on mental illness and a greater awareness of the human rights issues faced by the mentally ill. Lü Nan’s work ultimately encourages a critical rethinking of cultural perceptions, social responsibility, and the meaning of dignity within Chinese society.
Keywords:
Lü Nan; Chinese psychiatry; mental health stigma; documentary photography; cultural history
INTRODUCTION
The history of psychiatry has been described by Edward Shorter as ‘a minefield’. In China, the history of psychiatry stretches back thousands of years, with mental illness historically viewed as a manifestation of both physical and spiritual imbalances. Treatment often involved a combination of traditional therapies, such as herbal medicine, acupuncture, and religious rituals. The collective social mindset placed strong emphasis on an individual’s responsibility for their actions, including that of the mentally ill, who were expected to be accountable for their behaviour. The body was regarded as a vessel of moral principles, embodying a space for the practice of ethical behaviour and societal norms. As Li Yaming notes, ‘a mind that failed to control the body’s actions effectively was still considered a moral failure.’167
Following the establishment of the People’s Republic of China in 1949, the new government made the construction of public health and medical systems a top priority in national reconstruction. In August 1950, the PRC government established four guiding principles for healthcare at the First National Health Conference:
- Healthcare workers should serve the broad masses, such as workers, peasants, and soldiers.
- The primary focus should be on prevention.
- Traditional Chinese and Western medicine should be closely integrated.
- Health work must be integrated into mass movements.168
Mental health, as an integral part of public health, gradually began to gain attention in national policies. However, political movements continued to shape its development. In 1958, during the ‘Great Leap Forward’ campaign, discussions at the First National Conference of Psychiatric Specialists in Nanjing ultimately concluded with an agreement to abandon Western-style medical treatment, which was seen as a form of individualism. Mental health treatment shifted focus towards political education.169 During the Cultural Revolution, mental illness was imbued with a different political significance. The label of mental illness became synonymous with incorrect political thinking and a lack of enthusiasm for the communist agenda, making it a potentially dangerous designation for anyone.170
After the Four Modernisations under Deng Xiaoping from 1977, China’s gradual reintegration with the international community and rapid industrial and technological advances spurred economic growth at an unprecedented rate. Alongside this rapid development, sweeping social changes heightened ‘psychological pressure and stress’,171 creating new needs for mental healthcare to meet. Market reforms such as decollectivisation, privatisation, and marketisation of institutions fostered the rise of what Kleinman et al. call ‘a new moral person who is both more autonomous and unstintingly affirmative of his or her personal happiness’.172
Simultaneously, the photography world saw a growing interest in marginalised communities. Reacting against the highly ideological nature of previous photography, photographers worked to free the medium from its narrow role in serving state propaganda and political interests. Instead, they aimed to return photography to a more personal and experiential practice, allowing photographers to focus on these groups with a professional rationale.173 In this context, Lü Nan used his The Forgotten People: The Condition of China’s Psychiatric Patients to raise critical questions: Is the suffering of those facing mental health challenges truly understood and adequately cared for by society? Do their struggles reflect deeper societal and structural problems? Has society provided enough support and resources for mental health patients? By documenting these individuals in their everyday realities, Lü Nan directly confronted the marginalisation of mental health patients within the social fabric, exploring society’s attitudes and responses, and exposing the complexity and profound implications of these issues.
I. LÜ NAN (1962–)
Lü Nan, born in Beijing in 1962, graduated from the Department of Journalism at Beijing Television University (now Open University of China). Through an introduction by a neighbour who was a magazine photographer, Lü joined Nationalities Pictorial 民族画报 in 1986, working for five years as a darkroom technician.174 Nationalities Pictorial first launched in February 1955 under the State Ethnic Affairs Commission. It serves as an essential medium for ethnic and united front work,175 with a mission to ‘influence, indoctrinate, and mobilize non-CCP persons and organizations to serve the Party’s objectives’.176 It employs strategies domestically to win over ‘citizens that are not Party members; members of non-communist parties; intelligentsia outside of the CCP; ethnic minorities; [and] religious groups’.177 However, Lü Nan showed little interest in this job, often arriving at work late after sleeping in. Although he accepted his superiors’ criticisms without resistance, his behaviour did not change, as he was already preparing to become an independent photographer.178
Mental health issues had long been overlooked in China’s health and development policies, as discussed above, whereas the burden of physical illness was much more extensively documented.179 From 1989 to 1990, driven by curiosity about the lives of the mentally ill and in consideration of ‘some kind of social function’,180 Lü Nan embarked on his project. He worked closely with 14,000 people suffering from various mental disorders in 38 hospitals across 10 provinces and cities in China. In his effort to provide a thorough and comprehensive portrayal of the living conditions of the mentally ill, Lü extended his work beyond hospitals, photographing in private homes and even among the homeless.
Susan Sontag in her book On Photography states of Diane Arbus’s photographs of ‘monsters and borderline cases’ that ‘though most viewers are ready to imagine that these people…are unhappy, few of the pictures actually show emotional distress…but, rather, their detachment and autonomy’.181 Lü Nan shared a similar view, explaining in 2008: ‘I regard them as people. For me, there is no difference between rich and poor, no classes or social divisions. First and foremost, they are “people”. In any given environment, I focus on what it means to be human, and whether every gesture can reflect their mental state… my emphasis is always on the person’.182
Guided by this perspective, Lü Nan aimed to capture the profound humanity and dignity of each individual in his photographic work. As Peter Barritt has observed, ‘compassion is at the very core of humanity in medicine’,183 Lü Nan similarly approached his subjects with deep empathy and respect, viewing them as emotional individuals with their own stories, rather than simply as cases. Through his lens, each gesture and expression of the psychiatric patients offered a subtle reflection of their inner world, with each scene portraying their story as ‘people’, not merely ‘patients’, thereby affirming their dignity within the social framework. This perspective, rare in the medical and social environments of the time, afforded psychiatric patients a level of respect and understanding that was seldom seen. On a broader societal level, misunderstandings and negative labels surrounding psychiatric patients within traditional Chinese culture often subjected both them and their families to social exclusion and discrimination.184 Lü Nan’s photography takes on a challenging role in such a context; his images dismantle prejudices and labels, seeking to shift societal perceptions of psychiatric patients. By adopting a more human-centred perspective, he encourages a deeper, more empathetic understanding of this group.
II. STIGMA AND VIOLENCE
The stigma of mental illness is widespread across cultures and societies,185 with family and employment environments being two of the main sources of negative attitudes.186 In numerous societies, mental health patients often avoid disclosing their conditions due to the fear of discrimination and may refrain from seeking professional assistance. Such stigma pressures patients into missing early-stage treatment and rehabilitation opportunities, leading to further deterioration of their conditions. In Asia in this period, these effects were particularly acute, with a 1982 study finding an average delay of 1,078 days between recognising initial symptoms and seeking help from mental health professionals—compared to just 324 days for Western patients.187 This bias impacted patients’ health choices and significantly hindered family acceptance and social support networks.
In China, mental healthcare faced complex challenges. Society generally regarded psychiatric patients as individuals to be managed and controlled, rather than as autonomous individuals with needs and dignity.188 Patients and their families frequently endured considerable social pressure, fearing ostracisation due to ‘family stigma’.189 This traditional perspective on mental illness often isolated patients from broader society, depriving them of equitable access to education, employment, and healthcare services.
Violent behaviour exhibited by psychiatric patients is a significant factor contributing to their stigma and discrimination, with direct caregivers—including nurses, doctors, and family members—often being the main targets.190 A 2015 study in Europe and North America found that between 75% and 100% of psychiatric nurses experience patient aggression at some point in their careers. Furthermore, 28% of patients display violent behaviour prior to admission, while 31% continue to exhibit violent tendencies following discharge.191 Public fear and prejudice towards psychiatric patients frequently arise from concerns over potential violence. Violent behaviour among psychiatric patients is complex, with causes that can include worsening symptoms, emotional instability, and communication challenges. These actions are seldom intentional; rather, they are often beyond the patient’s control, a by-product of their condition. Nonetheless, such incidents heighten societal fears, casting psychiatric patients as ‘dangerous’ or ‘unpredictable’, thus deepening their stigma and discrimination.
In rural China in the late twentieth and early twenty-first century, most individuals with mental disorders (over 90%) lived with their families, who typically served as their main caregivers.192 Limited medical resources, social stigma, and financial barriers in these areas created significant obstacles to adequate care and treatment for psychiatric patients. A Chinese study from 2001 looking at schizophrenia indicated that financial hardship was the primary reason why 35.3% of these patients remained untreated, suggesting that medical costs exceeded what their families could afford. Additionally, 29.5% of patients received no treatment because their relatives did not acknowledge the presence of mental illness.193
This underscores the limited understanding of mental health issues and common misconceptions surrounding mental disorders in rural communities at the turn of the twenty-first century. In these areas, individuals with mental illness were frequently seen as a ‘family issue’ rather than as patients in need of specialised medical care. Such views prevented many from receiving timely diagnosis and appropriate treatment, often leading to deterioration in their condition. Furthermore, the lack of scientific awareness about mental illness meant that family members often overlooked or misinterpreted symptoms, viewing them as ‘personality flaws’ or ‘domestic conflicts’. This neglect not only delayed necessary treatment but also severely impacted patients’ mental and emotional well-being, heightening their sense of isolation and helplessness.
Figure 1: Lü Nan, Wang Mingcai, aged 28, has struggled with his illness for five years, during which his family admitted him to a hospital for treatment once. Due to his violent tendencies, his family ties him to a tree during the day and to his bed at night. This practice has continued for the last two years (Guizhou, 1990), in his Bei yiwang de ren 被遗忘的人 [The Forgotten People].
In the foreground of the image, Wang Mingcai is positioned near the right, with the direction and placement of the tree trunk guiding the viewer’s attention toward his body and the rope binding him to the tree. The vertical lines of the trunk add a sense of depth to the composition, symbolising both confinement and restriction—the tree trunk itself has become a tool of his restraint. The natural environment in the background starkly contrasts with his predicament, suggesting that despite being surrounded by nature, his life is filled with limitations and restrictions. Light plays a critical role in this photograph, illuminating Wang’s face and upper body while creating expressive textures and shadows on the tree trunk and his clothing.
Wang Mingcai’s posture and gaze are at the heart of the photograph’s emotional impact. He stands with a fatigued stance, his left leg bent and his body leaning against the tree. His gaze conveys hostility and despair, suggesting an apparent animosity toward the photographer. However, his relaxed right hand, not clenched into a fist, indicates that he does not intend to attack. The subtle droop in his eyes and his furrowed brows reflect the fatigue brought on by prolonged mental strain and physical confinement. This expression reveals the burden he endures due to his ongoing mental suffering and the family and societal approaches to managing his condition.
This photograph reveals the societal attitudes and practices surrounding mental illness, particularly in a resource-limited environment. Wang Mingcai’s method of ‘treatment’—being tied to a tree during the day and to a bed at night—demonstrates a severe disregard for his basic human rights, yet it also appears as his family’s final resort. This powerful image highlights the complexity of caring for individuals with mental illness in a society where understanding and resources are limited, casting light on the tension between care and control.
Figure 2: Lü Nan, Tao Shimao, aged 22, is the only university student from his village. During a winter break, he suffered his first mental health crisis, tragically killing his mother and injuring his father (left). In great fear, his family confined him to a stone house. His meals are brought daily by his 85-year-old grandmother (right), who, despite everything, remains the one who cares for him most deeply (Sichuan, 1990), in his Bei yiwang de ren 被遗忘的人 [The Forgotten People].
Brendan Kelly argues that ‘the historical experiences of the mentally ill, however, repeatedly highlight the need for pro-active consideration of protections for their human rights and dignity’.194 In some impoverished areas, balancing human rights with safety often proves challenging, forcing families to adopt extreme measures to protect their members. In this photograph, the stone house, more accurately described as a stone prison, becomes a barrier between the family and Tao Shimao, symbolising both the fear of his condition and the helpless isolation it entails. The house’s rough texture exudes a heavy sense of oppression, and this enclosed environment not only physically confines Tao within but also metaphorically reflects the family and society’s isolation and alienation of people with mental illness. The house structure resembles a cage, locking Tao within a solitary space, embodying his loneliness and helplessness amid mental illness.
Outside the wall, two figures sit—Tao’s father and his 85-year-old grandmother. The father sits on the ground with his head lowered, fists clenched, conveying a tense and pained posture. This stance reflects his complex emotions toward his son, filled with both fear of Tao’s loss of control and perhaps a mixture of sorrow and powerlessness. This posture reveals his helplessness in facing Tao’s uncontrollable condition and the inner struggle between familial duty and personal fear. The grandmother, with her hand on his shoulder, seems to be consoling him, her expression one of care and concern. Her posture radiates warmth and acceptance, indicating a deep affection for Tao despite his behaviour. As the eldest family member, she may exhibit greater tolerance toward him, conveying a love that transcends fear. This warmth stands in stark contrast to the cold house and the oppressive atmosphere.
One of the photograph’s most striking details is the hand reaching out from the stone house on the left side of the frame. It is both hidden and prominent, symbolising Tao’s confinement within the house, unable to experience freedom, while subtly hinting at his longing for connection with his family and the outside world. The position and gesture of the hand seem to be a struggle to reach beyond the wall, expressing a yearning for connection and a need for familial and societal support. This hand enhances the image’s dramatic and emotional tension, embodying a conflicted sentiment: it highlights Tao’s profound loneliness and inner struggle, while simultaneously evoking the paradox of longing and separation, symbolising an unbridgeable distance within the family.
Figure 3: Lü Nan, Miao Yujiu, aged 33, has been suffering from mental illness for nine years, with one hand chained for four years. During the first five years of his illness, the family relied on selling possessions and borrowing money to hospitalise him six times in hopes of a cure, but saw no improvement and eventually abandoned further treatment. Due to his destructive tendencies, his family had no choice but to restrain him with a chain (Shanxi, 1989), in his Bei yiwang de ren 被遗忘的人 [The Forgotten People].
In many Asian countries, including China, a cultural model profoundly influenced by Confucian ideology prevails.195 This framework prioritises family duties, interdependence, and a collectivist approach, where personal well-being and success are intrinsically tied to family harmony.196 In such a value system, the family is seen as the most critical support structure, with strong reliance on material, social, and emotional support between members, particularly during times of illness or adversity.
In Miao Yujiu’s case, his family provided nearly every form of support, from essential daily care to emotional reassurance. They took on the primary role in managing his mental health, attempting to aid him through the strength of family ties. Yet, despite their committed efforts, they ultimately had to give up. This decision underscores the intense pressures and helplessness that families face when confronting mental health challenges. Lacking resources and effective healthcare support, even the most devoted families find it hard to sustain the long-term care demands of a patient. In the end, their choice was not a matter of apathy but an acknowledgment that they had reached their limit.
Miao Yujiu sits at the centre of the frame, flanked by two brick walls forming an angle behind him that heightens his sense of confinement. The linearity of the walls defines the frame’s boundaries, intensifying the spatial constraints and conveying his inescapable predicament. Light streaming in from the upper left illuminates Miao Yujiu’s face and upper body while casting strong shadows on the walls, creating a dramatic contrast in black and white that accentuates his isolation within the setting.
His attire is worn and unkempt, and he is wrapped in an old blanket, which reflects the harshness of his living conditions and his abandonment by society. A chain binds his wrist, extending downward to an iron ring, a detail that underscores his bleak confinement. Miao’s expression is a mix of resignation and detachment, as though he has become accustomed to this restrained existence. His gaze shows a profound fatigue, seemingly accepting his fate without resistance, reflecting both his inner loneliness and his suffering.
The brick wall behind him plays a vital visual role, with water stains and marks that enhance the image’s texture and symbolise coldness and indifference. This enclosed space isolates Miao Yujiu entirely from the outside world, transforming his dwelling into a place that resembles a prison cell rather than a home. Ran Mao-Sheng argues that housing instability is a significant indicator of risk, increasing the likelihood of hazardous behaviour and medication non-compliance among mental health patients.197 In Miao Yujiu’s case, this isolating environment only intensifies his solitude and suffering; he is confined not only by his illness but also by the unfortunate abandonment of his family and society.
CONCLUSION
Through his portrayal of the oppressive, isolated, and impoverished conditions faced by psychiatric patients, Lü Nan delves into the complexities of violent behaviour among them. Rather than merely being seen as perpetrators of violence, these patients are positioned as victims within a broader societal context. Lü Nan also challenges the stereotypes often associated with mental illness, pointing out that the stigma surrounding psychiatric conditions often neglects the underlying social hardships and psychological anguish experienced by the patients. He brings to light their dignity and complexity as individuals, not just as medical cases, but as people full of vitality, emotion, and hope. Lü Nan never portrays them as ‘inhuman’ or ‘other’, always honouring their uniqueness and intrinsic worth. This approach is deeply connected to his understanding of ‘what it means to be human’; he is not just concerned with the patients’ conditions, but with their wholeness as human beings. In Lü Nan’s work, the gazes and postures of psychiatric patients often convey a profound inner pain and struggle, yet they also hint at an unspoken hope, however brief or fragile it may be—‘all human wisdom is summed up in two words? – waiting and hope.’
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