Book Review: The Impotence Epidemic: Men’s Medicine and Sexual Desire in Contemporary China

The Impotence Epidemic: Men’s Medicine and Sexual Desire in Contemporary China. Everett Yuehong Zhang, Durham: Duke University Press, 2015, 288 pp.

This book, revised from the author’s Ph.D. dissertation, is an ethnography of sexual impotence in urban China in the 1990s and 2000s. Focusing on two major cities, Beijing and Chengdu, Zhang draws on observations of and interviews with 350 subjects who were diagnosed with problems related to impotence and their partners. Throughout the book, Zhang successfully interweaves these patient- centered perspectives with the views of doctors (of both Western biomedicine and traditional Chinese medicine). The two major methodological interventions of this book include probing the social and cultural contexts of somatic disorders and exploring both men’s and women’s experiences (despite the more obvious relevance of impotence to men).

Combining this socio–cultural approach with an explicit analysis of gender, the book aims to challenge an understanding of impotence that is decisively grounded in the “biological turn,” which views impotence merely as a neurovascular event. Instead, the book proposes a multifaceted approach that contextualizes impotence as a living experience in terms of its socio–cultural conditions and its ethical ramifications. Considering impotence a “positive” event, Zhang argues that it “signifies the ontological shift in human existence in China from downplaying desire to promoting the desire to desire” (p. 15).

The book is divided into two parts. The first part examines the socio–cultural dimensions of impotence. Zhang’s narrative begins by looking at the rise of nanke (men’s medicine) in the 1980s, which presents a stark contrast to the history of fuke (gynecology) dating to the Song dynasty (960–1279). The recent establishment of nanke created a space in which men could be more forthcoming in revealing their frustration with sexual performance. This, according to Zhang, generated a shift in “moral symptomatology” whereby the clinical reports of nocturnal emission and sexual neurasthenia began to witness a radical decline in the post-Mao era. This is due to the all-pervasive social context of the collectivist period, during which sexual repression was promoted and individual desire was considered anti-revolutionary by the state.

In the late 1950s and 1960s, the biopolitical apparatus of the hukou (household registration) and danwei (work unit) systems turned sexual repression into a social mainstay by imposing an entrenched set of limitations on people’s mobility. According to Zhang, this dual apparatus of the Maoist state impeded the flow of people’s desire and rendered the sexual body invisible. In explaining the impotence epidemic through the history of sexual desire, Zhang uncovers the ways in which the bodily experience of impotence became both the site of nanke medicalization and the cultural threshold of post-Mao social transformations. Moreover, the gendered nature of impotence meant that both men and women were affected: Its experience by men varied by their socio–demographic background, and women involved themselves in its management with a diverse range of attitudes.

The second part of the book evaluates the quotidian ethical implications of impotence. This turn to the ethical aspects of living extends the thread from the first part of the book that depicts impotence beyond the confines of a biomedical lexicon. Specifically, Zhang’s analysis pitches the revival of yangsheng (the cultivation or nurturing of life) in the reform period as an ontological cornerstone of the contradictory sexual dynamics in contemporary China. Given its encouragement of a self-centered lifestyle, the practice of yangsheng was discouraged by the ethos of the Maoist state, which favored sacrifice of individual desire. In its current guise, yangsheng also contradicts the prevailing norm of a consumer-centered and desire-driven subjectivity, because the cultivation of life rests on a strict mode of self-regulation— especially the preservation and fostering of seminal essence (jing). In this sense, potency carries a broader meaning that refers to the vitality of the body. The revival of sexual cultivation can thus be viewed as a practical response to refiguring the ethical limits of the self and being.

No other example illustrates the working of these opposing ethical regimes better than the introduction of Viagra to China in the early 2000s. Zhang discovered that men overwhelmingly preferred to switch (rather than choose) between Viagra and yang-strengthening herbal medicines as a way to treat their impotence. Their hybridized decision merged the value of Western medicine and individual desire (Viagra) with the regimen of cultivating life in traditional Chinese medicine (herbal medicine).

From the outset, the author consistently recasts the impotence epidemic in China in terms of larger social, cultural, political, and ethical trends. At its conclusion, the book successfully moves far beyond the biological turn and provides a new definition of impotence as “a measure of the fullness of life in its ceaseless rejuvenation” (p. 224). In the process of arriving at this innovative insight, Zhang’s analysis reveals at once the cultural and moral underpinnings of China’s historical transition into post-socialism, the complex interactions between Chinese and Western systems of health care in the contemporary scene, the relation between the state and the family as sites that indexed emergent social anxieties of gender and sexuality, and the shaping of competing visions about the way to live an ethical life in a globalizing world. Written in a clear and lucid manner, The Impotence Epidemic is suitable for courses in medical pluralism, the anthropology of the body, and gender and sexuality in Chinese culture. This is a book that accomplishes what the author sets out to achieve: “a transformation in the historical, theoretical, and moral or ethical relationship we have with impotence and its ramifications” (p. 226).

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