9

Most of Mao's medical problems during the first years of my service were minor—common colds and occasional bronchitis, itchy skin, corns on his feet, or lack of appetite. He was so frequently constipated that one of his bodyguards administered an enema every two or three days, and his bowel movements were a daily topic of discussion. A normal bowel movement became cause for celebration among his staff.

For me, however, the most nerve-racking problem was Mao's persistent insomnia.

He was a man of tremendous energy. In his iconoclasm and refusal to accept routine, Mao rebeled against time as well. Sleep, like bathing, was a waste of time. His body refused to be set to the twenty-four-hour day. He stayed awake longer than others, and much of his activity took place at night. If he went to bed one day at midnight, the next night he might not sleep until three in the morning, and the day after that he would not sleep until six. His waking hours grew longer and longer until he would stay awake for twenty-four, or even thirty-six or forty-eight, hours at a stretch. Then he could sleep ten or twelve hours continuously, and no amount of noise or commotion would wake him. I am not sure when the pattern began. Possibly, his biological clock had always been askew. Fu Lianzhang talked about treating him for insomnia in the early 1930s. Certainly, the two decades of revolutionary struggle before the establishment of the People's Republic and the many years of guerrilla war would have upset anyone's normal sleep patterns.

When he wanted to sleep but could not, Mao would turn to physical activity to wear himself out—swimming, dancing, walking. But he was also addicted to sleeping pills and had been for more than twenty years before I became his doctor. Fu Lianzhang had given him Veronal in the 1930s, and after 1949 prescribed sodium amytal, a powerful barbiturate, in 0.1 gram gelatin capsules. When one pill was not effective, Mao would take two, three, or four. Often nothing worked. As he grew more tired, he would become more hyperactive and would start to wobble on his feet. His staff worried that he might fall or suffer a stroke.

Even before I took up my post, Fu worried that Mao might accidentally overdose on barbiturates. Secretly, without telling Mao, he had reduced the sodium amytal in the capsules from the original 0.1 gram to between 0.05 and 0.075 grams, but Mao's response was simply to take more tablets.

I was extremely distressed to learn that Mao was taking barbiturates. I had never prescribed such powerful drugs for a patient, and I, too, was worried about the possibility of an overdose. When I first learned of his habit, I warned Mao not to take the drugs. “Then you don't want me to sleep,” he said, and insisted on continuing the medication. I had no way to stop him. He was my boss and refused to listen to me.

Then one day he called me into his room. “How many days do you think there are in a year?” he asked.

It was another of his unorthodox questions. “Three hundred and sixty-five, of course.”

“Well, for me there are only two hundred days, because I get so little sleep,” he said.

I was puzzled until I realized that he was talking about the number of cycles of waking and sleeping he went through in any given year. “If you count your days by your waking hours, Chairman, you have more than four hundred days in your year. If you look at it this way, your life is like the immortal described in the poem—‘there are no sun and moon in the hills, a thousand years slip by unnoticed.'?”

Mao roared with laughter. “If you are right, then insomnia would be a means to longevity!” He was joking, but I knew that he wanted me to do something to relieve his insomnia.

I recommended a change in strategy. While the sodium amytal prescribed by Fu Lianzhang was effective in inducing prolonged sleep, it was slow to take effect. I suggested that Mao take two 0.1 gram capsules of sodium seconal twenty minutes before his last meal of the day, which would put him to sleep quickly. After the meal, he would take one capsule of the sodium amytal to prolong his sleep. Moreover, I disagreed with Fu Lianzhang's method of secretly reducing the dosage without telling Mao. I thought Mao should be told frankly what type and amount of medicine he was taking. The medicine was being dispensed by his bodyguards, simple and uneducated young peasants with no knowledge of medicine, and with Mao's health now my responsibility, I wanted to make certain they did not give him too much.

Since Fu Lianzhang was still my boss, I first presented my suggestions to him. He agreed. But when I assured Mao that the new method would work better, he was skeptical. “A boasting doctor has no effective medicine,” he said, quoting a popular folk saying. But he agreed to try.

The new prescription did improve Mao's sleep and soon I was able to reduce the amount of sodium seconal, filling the capsule with more glucose, still to good effect. When I told Mao, he said, “Your medicine bag is full of skimpy capsules, but they still work.”

But sometimes Mao became so agitated that even my method became useless.

In fact, Mao suffered from two different types of insomnia. His biological time clock really was different, but he also suffered from what we called neurasthenia.

Though neurasthenia is no longer a recognized disease in the United States, its symptoms, by whatever name, were very common in China, and both Mao and Jiang Qing frequently suffered from them. Neurasthenia is usually induced by some sort of psychological malaise, but because admitting to psychological distress is simply too shameful for most Chinese, its manifestations are usually physical. Insomnia is the most frequent symptom of neurasthenia. Headaches, chronic pain, dizziness, anxiety attacks, high blood pressure, depression, impotence, skin problems, intestinal upsets, anorexia, and bad temper are others.

In time, I came to regard neurasthenia as a peculiarly communist disease, the result of being trapped in a system with no escape. I first became aware of the syndrome in 1952, when my elder brother suffered from severe neurasthenia, with high blood pressure as its major symptom, after being attacked during the “three-anti” campaign. After the campaign against the rightists in 1957, when so many innocent people were falsely accused, the incidence of neurasthenia increased dramatically. I had not been aware of such a high incidence of neurasthenia under the Guomindang government. Under the Guomindang, no matter how bad things got, it was always possible to run away. Under the communists, there was nowhere to go. Major psychoses, such as schizophrenia or manic depression, were more or less acceptable under the communist system, but minor psychological troubles fell under the category of “ideological problems.” For a Chinese to see a psychiatrist because of personal problems would be such an unbearable loss of face that treatment for such things did not even exist while Mao was alive. Every doctor knew that behind his patient's neurasthenia was some great personal difficulty. But the doctor's response was to treat the patient medically rather than inquire into the roots of the illness.

I never used the term neurasthenia when confronted with Mao's anxieties. Mao would have resented this and I would have been summarily dismissed. Nor did he himself use the word. When Mao took to his bed with depression, he would simply say that he was unhappy and ask me to help, which I would do by prescribing ginseng and vitamins B and C. Mao's neurasthenia manifested itself in a variety of symptoms—insomnia, dizziness, itchiness, impotence. At its very worst, he suffered from anxiety attacks. Once, in an open field, he suddenly became disoriented and would have fallen except for the help of his bodyguards. Such attacks occurred occasionally at public functions. Once Mao was meeting with an African delegation when several members of the group surrounded him, talking with great animation, gesturing and pointing at the Chairman. I could see him begin to totter, and an aide came immediately to his rescue. Wherever he went, whenever he walked or received guests, an aide was always next to him in case he lost his balance. When he was relaxed, his symptoms disappeared, and none of the many examinations I ordered of his heart, brain, or inner ear indicated any physical problem.

The underlying cause of Mao's neurasthenia was different from that of ordinary people. As the most powerful leader in the country, he was the cause of others' personal problems. Mao's neurasthenia was rooted in his continuing fear that other ranking leaders were not loyal to him and that there were few within the party whom he could genuinely trust. The symptoms became much more severe at the beginning of a major political struggle. While Mao was plotting his strategy and until he finally got his way, his sleep would be interrupted for weeks and months at a time. What I did not know when I took over as Mao's doctor was that he was then locked in a struggle over the question of agricultural collectivization and that the sleeplessness I was dealing with was a result of this political battle.

Mao's goal was to transform China—the sooner, the more thoroughly, the better. He was not satisfied with the rural reforms that had been carried out in the early 1950s, just after the establishment of the People's Republic, when land and farm tools were seized from the rich and distributed to the poor. Private ownership still prevailed. Mao wanted socialism, and that meant agricultural collectives. He did not want to wait for agricultural mechanization, for China was too poor and mechanization would take too long.

Cooperatives had been introduced into China's rural areas as early as 1953, but the rapid pace of the movement and the tendency to establish unmanageably large collectives and to deprive peasants of their tools and animals had been opposed both by the peasants and by many of Mao's lieutenants. In some parts of the country, the collectives were being abolished almost as quickly as they were formed, and Deng Zihui, the director of the Rural Work Department, was giving the orders for dissolution. Mao was furious with both Deng Zihui and other party officials he saw as thwarting his plan. Mao forced Deng Zihui to step aside and later abolished his Rural Work Department and demoted Deng to a meaningless position. “Deng Zihui supported us during the democratic revolution,” Mao told me later, referring to the period during the civil war when the party followed moderate policies of land reform, “but after liberation he went another way.” The disagreements had been particularly intense during the summer of 1955, when the party leaders were gathered at Beidaihe and Mao took his defiant swim, and they continued through the fall.

I scrupulously avoided politics when I first worked for Mao and did not realize as I was worrying about his white blood cell count, his impotence, and his insomnia that he was spending most of his time plotting a counterattack against the more conservative members of the party. Throughout the fall and winter of 1955–56, he held a series of meetings to promote his notion of socialist transformation, and in late fall and early winter he began working on a book, Socialist Upsurge in China's Countryside, gathering reports on collectivization from all over the country, editing and writing introductions to the articles himself, calling for a rapid socialist transformation of the rural areas. It was his attack on the central party leadership, a way of pushing the party toward rapid socialization, and during this time he became agitated and unable to sleep.

One day in the late fall of 1955, while still working on the book, Mao went for three days with only fitful sleep and then stayed awake for more than thirty hours straight. The sleeping pills I had given him no longer worked. He tried to exhaust himself by swimming. Then he sent for me.

He was lying on a chaise longue when I arrived at the indoor swimming pool and looked flushed, excited, and worn out. I politely refused his offer to take a swim myself, explaining that I didn't even have time for lunch—I was still working in the Zhongnanhai Clinic—let alone for a swim. “I haven't eaten either,” he said smiling, “and I haven't slept. I swam for an hour. I have taken sleeping pills three times and I still can't sleep. Are you giving me those skimpy capsules again?”

“No, the capsules are full-strength,” I assured him.

“Well, what can you do to get me some sleep?”

I suggested liquid chloral hydrate, even though Fu Lianzhang had told me that Mao did not like liquid medicine. I explained that the medicine would taste bitter—a bit hot and biting.

“That's okay,” he said. “I like hot things.”

I went to the pharmacy in Gongxian Lane, where Fu Lianzhang continued to control the drugs for Mao and the other ranking leaders, relying on a company in Hong Kong to supply medicines and medical supplies from the United States, England, and Japan. As an additional measure of safety, Mao's drugs were always prescribed under the pseudonym Li Desheng. He had taken the name, meaning “Li of superior morality,” when the party was forced to evacuate Yanan in 1947 in the face of Guomindang attack. As the pharmacist was filling Mao's prescription, Fu Lianzhang rushed in to warn me that the Chairman did not like liquid medicine and that chloral hydrate does not taste good. “If Chairman gets angry about this, what are we supposed to do?” he wanted to know.

“I have explained everything to Chairman, Vice-Minister Fu,” I responded. “He wants to try it. He's waiting for me. I have to hurry. I'll let you know later how it goes.” I turned to leave.

“How can you be so rash—not even consulting me first?” he called after me. Fu Lianzhang took his position as my boss seriously and wanted to be involved in every decision involving Mao's health. He took great pride in his longstanding relationship with Mao and was convinced both that he understood the party chairman and that Mao would always welcome and follow his advice. But Fu was no longer in regular contact with Mao. Mao and I were developing our own relationship.

The Chairman was waiting at the swimming pool, expecting me to join him for dinner. “It would be best to take the medicine first, before dinner,” I told him.

I poured fifteen milliliters of 10 percent chloral hydrate into a cup and he drank it down in one gulp. He said it did not taste so bad, that he did not usually drink wine, but that this stuff tasted like wine. “Let's see if it works,” he said.

As we ate and the medicine began taking effect, Mao began drifting into euphoria. By the end of the meal, he was ready to sleep, so tired that he did not even return to his residence at the Chrysanthemum Fragrance Study. He lay down on the bed by the side of the swimming pool, fell asleep at around two in the afternoon, and slept for ten hours straight.

His guard summoned me in the middle of the night and told me that my cannon had hit the bull's-eye.

Mao was still resting, his eyes closed, when I arrived. Opening his eyes, he lit a cigarette. “What is this miracle drug?” he wanted to know. “It's wonderful!”

“It was one of the first medicines used to induce sleep,” I told him. “Chloral hydrate first became popular in the nineteenth century and its effects are well known. Clinical studies show it to be very safe.”

“Then why didn't you give it to me earlier?”

“I knew Chairman does not like liquid medicines,” I explained. “Besides, it doesn't taste good. So I didn't suggest it until I felt it absolutely necessary.” In fact, there is no great difference in the efficacy of sodium amytal and chloral hydrate. He was near exhaustion when he summoned me, and my description of the drug's potency had had a decided psychological effect.

I think Mao knew that the causes of his neurasthenia were as much psychological as physiological, and he understood the power of placebos. Once, when he had been very ill as a child, his mother took him to a Buddhist temple to pray and burn incense for her ailing son. Mao had recovered. “I am opposed to destroying Buddhist temples,” he would tell me, even as Buddhist temples all over China were being demolished by party leaders. “Poor people need to rely on their idols when they are sick. When they beseech Buddha for a cure, all they get are the ashes from the incense they burn. But incense ashes ease their mind and help them back to health. Don't sleeping pills work the same way? Don't they just ease the mind?

“So you've kept a lot of tricks in that medicine bag of yours, huh?” Mao teased. “Okay, go home now and get some sleep. I'll start to work.”

From then on, Mao relied on chloral hydrate to sleep, often taking it with sodium seconal. In time, he became addicted to the medication not only because it put him to sleep but because it stimulated his appetite and made him euphoric as well. Then he became addicted to the euphoria, taking the pills when receiving guests and attending meetings. He also took them for his dance parties.