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Life and Death in Shanghai.

Life and Death in Shanghai, by Nien Cheng, softcover, 547 pp, $17.95, ISBN 978-0-8021-4516-1, New York, N.Y., Grove Press, 1986.

This is a firsthand account of the author's experiences during the Cultural Revolution in China, including more than six years in solitary confinement in People's Detention Center No. 1.

The widow of an official of Chiang Kai-Shek's regime and an employee of Shell Oil, Cheng fell under suspicion of conspiring with foreigners against the Chinese Communist regime. As the author writes: "The events are recorded in the chronological order, just as they occurred. Every word spoken at the time, the reader will soon understand, was vitally important. Indeed, my survival depended on what was said to me and by me. I had ample time again and again to recall scenes and conversations in a continuing effort to assess their significance. As a consequence, they are indelibly etched on my memory."

The book was called to my attention recently by a physician who endured a "re-education" program for "disruptive physicians" here in the U.S. (1) Indeed, there are alarming parallels to the psychological methods used in China, including isolation of the target and subjugation to constant "struggle sessions" in an effort to get the subject to confess. The purpose is not simply to convict someone of an offense, but to gain the victim's full cooperation and acquiescence, and to secure statements to incriminate others. The goal appears to be to destroy independent thinking altogether and to achieve a result like in George Orwell's 1984, where Winston Smith discovers that he loves Big Brother.

At the time of the Cultural Revolution, as in 1984, it was exceptionally difficult to be correct because the correct view could change drastically from one day to the next, depending on the outcome of the constant power struggles within the Party.

Cheng steadfastly maintained her innocence and demanded to speak to the prison interrogators so that the mistake that led to her arrest could be cleared up. She did not believe the promises of "lenient treatment" if she "cooperated." Indeed, if she had confessed to whatever she thought they wanted, the results might have been death in a prison camp.

Prisoners were supposed to spend their time reading and memorizing the thoughts of the great Chairman Mao. Cheng was actually able to turn the tables on her tormentors to some extent through her clever use of the words of the Chairman himself.

Cheng nearly died in prison, owing to starvation diet, extreme cold, and other deprivations. She endured a trip to the prison hospital, at a time when Chinese medicine and medical education, like the rest of Chinese institutions, were being crushed, and doctors "learned to be doctors by being doctors."

Yet the doctors helped her by ordering "special food," so that she got perhaps a bit of rotten fish or pork or a blob of fat to supplement the rice and cabbage. A few kind prison guards did what little they could for her without extreme peril to themselves. One day, someone even hid two boiled eggs under her rice. For all their efforts, the Chinese Communists did not succeed in extirpating the last vestiges of humanity from their people.

Cheng writes: "For many years, the official propaganda machinery had denounced humanitarianism as sentimental trash and advocated human relations based entirely on class allegiance. But my personal experience had shown me that most of the Chinese people remained kind, sensitive, and compassionate even though the cruel reality under which they had to live had compelled them to lie and pretend."

Citizens of the former Soviet Union have said that one of the worst aspects of life under Communism was constant immersion in lies. The same seemed to be true in China. As one of Cheng's acquaintances said, "Why assume anybody should be honest? After what you have gone through, you should know that to be honest is suicidal. Dishonesty is the best policy nowadays!"

Cheng was eventually released and "rehabilitated," but she was told: "Once an accusation is made by a senior source, it can never be clarified, only shelved. You don't expect the senior source to admit he made a false accusation or a mistake, do you?" Fortunately, Cheng was eventually granted permission to leave China. She became a U.S. citizen, and died in Washington, D.C., at age 94--likely too soon to hear physician expatriates from Communist countries lament that the repressive apparatus has followed them. In the U.S., too, once tarred with an accusation, a physician is never fully exonerated.

From Cheng's account we can learn about the impact of the Great Proletarian Cultural Revolution (GPCR) on individuals, but the statistics on this 10-year period of loss and destruction are still a state secret. Two million or more Chinese may have been killed and another 125 million were persecuted during this time. (2)

The American medical literature has little to offer, either on the psychological methods used by the Chinese Communists or the mass mortality that Communism has caused. In the 1970s and early 1980s, there were some articles about the GPCR, which ended around 1976. The negative effects of destroying medical education and shipping a third of the professors to the countryside to do farm labor were acknowledged, but there was generally favorable treatment of the barefoot doctors and the overall effect of Communism.

For example, Victor Sidel wrote in 1975: "The changes in healthcare in China would, I believe, have been impossible except in the context of revolutionary change in the entire society. As we think about the necessary changes in our healthcare system, we will, in my opinion, have to examine those changes in the light of the maldistribution of resources and of power in our entire society." He thought that the Chinese experience "teaches us that we must broaden [our efforts] to include major social changes as well." He described the "profound upheaval" of the Cultural Revolution as a time when the "pendulum swung widely from emphasis on the 'expert' toward emphasis on the 'masses.'" (3)

Grey Dimond did write about the devastating effect of the GPCR on some professionals, (4) but earlier he had come to the conclusion that, "at first analysis [China] seems to have lowered standards to achieve quantity. A more reasonable analysis is that China has made priority decisions." (5) He also wrote: "The good achievements of the Cultural Revolution would continue; the excesses would be eliminated." (6)

American academics were apparently willing to accept serious "flaws"--such as mass casualties--because of their dedication to egalitarianism and concepts such as "putting prevention first" and "team effort." Even in the acknowledged absence of statistics, prestigious American physicians visiting China were willing to believe what they were told, that as a result of the victory of the Chinese Communists in 1949, astonishing advances were made in controlling public health threats, reducing infant mortality, and bringing basic healthcare to the masses. (7)

Western medicine could learn a lot from the "unique approach of the People's Republic of China," according to Paul Altrocchi, another of the Walter Durantys in American medicine. The Chinese health services aims to "serve the people," he explains. It emphasizes the importance of preventative medicine over curative treatment, and it involves each Chinese citizen intimately in his or her own healthcare and maintenance, and in the health of others. In China, being healthy was a duty to one's self, one's commune, and the state, "in order to create a viable and productive society that can achieve its stated goals" Altrocchi speaks in glowing terms about the mass campaigns launched by the political leadership. He writes that "patients receive encouragement and motivation toward wellness by studying the ideology of Chairman Mao, reinforced by hospital-based political health workers" [emphasis in original]. (8)

Cheng's faith and courage are inspiring, and her eloquent account is worth reading for its own merit, as well as an antidote to the pervasive, unrepentant Marxism in the politically approved medical literature. Like Solzhenitsyn's Gulag Archipelago, it is must reading for Americans who need to understand the human cost of Communism, which, unlike the horrors of Nazism, has been largely ignored by "mainstream" sources.

Reading Cheng should force one to question the noble-sounding ideological premises of Communism. It might also draw attention to the disturbing parallels in the treatment of our nation's own intellectuals and physicians who dare to dissent from the accepted political tenets, as well as in the rhetoric of "healthcare reform." This book is even more timely now than it was in 1986.

(1.) Orient, JM. A tale of a "disruptive" physician. J Am Phys Surg 2013;18:57-58.

(2.) Yongyi S. Chronology of mass killings during the Chinese Cultural Revolution (1966-1976). Online Encyclopedia of Mass Violence; Aug 25, 2011. Available at: Accessed Aug 12, 2013.

(3.) Sidel VW. Medical care in the People's Republic of China. Arch Intern Med 1975;135: 916-926.

(4.) Dimond EG. The breaking of a profession. JAMA 1984;252:3160-3164.

(5.) Dimond EG. Medical education and care in People's Republic of China. JAMA 1971;218:1552-1557.

(6.) Dimond EG. Medical education in the People's Republic of China at the close of the Cultural Revolution. JAMA 1978;239:653-655.

(7.) Abrams HK, Hsiao S, Stuart DG. Healthcare and medical education in the People's Republic of China. Ariz Med 1977;34: 561-564.

(8.) 8. Altrocchi, PH. Healthcare in China--an individual responsibility. West J Med 1979;131: 558-562.

Jane M. Orient, M.D.

Tucson, Ariz.
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Author:Orient, Jane M.
Publication:Journal of American Physicians and Surgeons
Article Type:Book review
Date:Sep 22, 2013
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