The Filmmaker Confronting China’s Ultimate Taboo: Death

Many in China choose to keep serious illnesses to themselves in the name of “protecting” their relatives. But as director Siyi Chen explores in a new film, this secrecy can exact a heavy cost.

When my uncle was diagnosed with late-stage cancer, I was the last person in my family to be told. By the time I found out, he was already intubated in bed, and our last interaction ended with him gently squeezing my hand.

After he died, I kept wondering about how those final months could have been different. What had stopped my parents from breaking the news to me?

The answer I got: to “protect” me from the harsh reality.

Director Siyi Chen shared similar concerns when she discovered her mother had kept her breast cancer hidden from her in 2018. Chen’s mother only revealed she had cancer months after her diagnosis – and after she’d already undergone surgery.

Though her mother would eventually make a full recovery, Chen was left shocked and scared by the experience. All kinds of questions haunted her: Why hadn’t her mom opened up to her? Why do taboos around death still loom so large in China? And how should we face mortality?

In her feature documentary debut, “Dear Mother, I Meant to Write About Death,” Chen sets out to answer those questions.

A thoughtful, highly personal work, the film takes the form of a series of exchanges between Chen and her mother – interspersing Chen’s letters to her mother with footage of the filmmaker questioning her directly about her views on life and death. 

In the process, we see Chen grappling with her own cultural heritage, and trying to figure out how she really feels about all these issues. Born and raised in east China’s Zhejiang province but now living in New York, she admits that she often feels conflicted.

“I think the way Chinese parents express love is to think through everything first and then make a decision for you without actually asking your opinion,” Chen tells Sixth Tone. “Having spent some time in the U.S., I do feel communication is important, but I think sometimes it’s overrated. It can’t solve all your anxiety.”

A still from the documentary “Dear Mother, I Meant to Write About Death.” Courtesy of Siyi Chen

Chen’s mother, Dr. Shen, has no such qualms. A physician who has been working in a county hospital in Huzhou for over 30 years, she has long excelled at prioritizing efficiency over emotions. And working in the emergency room has given her a frank view of life and death. The fear of mortality, she tells her patients, is irrational.

But can Dr. Shen really face the prospect of her own death as rationally as she teaches her patients to? As Chen documents her mother’s recovery process, she gently tries to probe at the softness behind her mother’s rationality and the fear behind her strength.

Throughout the film, we also gain an insight into the tough world Chen’s mother inhabits: the chaos of Chinese emergency rooms, where doctors often live under the constant threat of violence from patients and their families.

Cases of violence against health care workers are disturbingly common in China. A 2020 survey of 3,700 Chinese medical workers found that 56.4% had experienced some form of workplace violence during the previous year. Dr. Shen is no different.

“I remember in the county hospital, there was a notice on the wall saying ‘dead bodies are prohibited here,’ to warn people off making a scene threatening doctors in the ER,” recalls Chen. “It was as straightforward as that.”

For the audience, it’s an emotional ride – and one that raises and often challenges deeply held beliefs about the meaning of empathy, strength, and love. For 31-year-old Chen, the making of the film turned into a coming-of-age experience, which taught her to accept herself.

“It’s OK to admit that you’re scared of death, but it also takes great courage to show your vulnerability, especially in front of our loved ones,” she says.

The film has already won a special mention at the Busan International Film Festival and a nomination for Best First Feature at the International Documentary Film Festival Amsterdam.

Speaking with Sixth Tone via Zoom, Chen discussed the process of creating the film, and what she learned along the way. The interview has been edited for brevity and clarity.

Siyi Chen attends the IDFA. Courtesy of Siyi Chen

Sixth Tone: How did you originally decide to make this film? And how did your ideas change over the five years it took to create?

Siyi Chen: It wasn’t my intention to make a personal film at the beginning. Instead, I was drawn to the intense doctor-patient relationship at first. At that time, there were many violent attacks on medical workers. Because I grew up in that hospital, I can see the issue from both perspectives. I understand how anxious and stressed the patients are, but I also sympathize with the doctors, who often work long hours under high pressure.

However, as I dived into this issue, I realized how complicated it is to examine our current medical system. The solution is not as simple as asking doctors and patients to behave well. Back then, I didn’t think I could handle this topic and offer new insights through the film. Then, my mom got sick, so the fear of death completely swept over me and shifted my story.

A still from the documentary “Dear Mother, I Meant to Write About Death.” Courtesy of Siyi Chen

Sixth Tone: How did you feel when your mother finally told you about her cancer? What do you think about the “don’t tell her” culture that’s so common in China?

Chen: I was upset, but fear and guilt were the dominant feelings when I found out the truth because I wasn’t able to be with her while she went through the surgery. 

I think the way Chinese parents express love is to think through everything first and then make a decision for you without actually asking your opinion. Having spent some time living in the U.S., I do feel communication is important, but I think sometimes it’s overrated, and it can’t solve all of your anxiety. 

I remember that film “The Farewell” in which a whole family decides not to tell their beloved grandma about her terminal illness. That was very interesting to me, because it was told from a Western perspective but the characters eventually come to accept an Eastern philosophy – that we each share a part of the pain through keeping it a secret.

My mom hid the news, lest I worry. But after experiencing this dramatic episode together, I was no longer a child to her. Instead, I became her caregiver, so we can at least talk about illness and death like adults now. In a sense, it’s also a coming of age story for me.

Sixth Tone: Had you discussed the topic of death with your mother before? What was it like talking about it during filming?

Chen: No, we never talked about it before my mom got sick. Our family seemed to consider it meaningless and unlucky to talk about something that has yet to come. My mom is a very strong woman, and she thinks that the fear of death is irrational. She could distance herself from this thought completely, but I couldn’t do the same. I needed a way to process it, and this film became the vehicle for that.

There are a lot of things Chinese families don’t talk about. But that doesn’t mean they don’t think about it. I remember one time seeing my grandma watching the Olympics, and I asked why she was watching the opening ceremony. She said that it could be her last chance to watch such a wonderful program. She said it so naturally, but I felt so sad when I heard it.

Sixth Tone: Do you feel you have a better understanding of death now?

Chen: Do I view it in a more philosophical way? No. When I screened this film at the Busan International Film Festival, the audience asked if I had become more optimistic about death now. It’s definitely not the case. 

In this journey to process my own fear of death, I was pulled in two different directions: On the one hand, I’m more intrigued by Buddhism and its philosophy; on the other hand, I’m drawn to things that are purely passion-driven. For example, I want to learn to dance, and do things that make me feel alive. 

A still from the documentary “Dear Mother, I Meant to Write About Death.” Courtesy of Siyi Chen

Sixth Tone: One thing that struck me in the film was that your mom wanted to quit her job after experiencing a mental breakdown, but then decided to return to the hospital after recovering from the cancer. What prompted this change? 

Chen: Just one month before my mom was diagnosed, she was quite frustrated with her job. She had a mental breakdown and wrote a resignation letter in her office. Being a physician requires you to empathize, but you can’t let your patients’ emotions swallow you up. It’s a difficult situation.

Then, while she was at this crossroads, she became a patient. This change enabled her to see things from another perspective and that revitalized her faith in her profession. For example, she realized that some treatments are painful, which she hadn’t thought about as much before. But I’m not sure if that’s a sustainable solution for doctors.

Sixth Tone: What do you think needs to be done to mitigate the tension between doctors and patients in China?

Chen: Systematic reform is needed to change the situation. For example, more mental support for doctors, better security in hospitals, and reasonable working hours. In the U.S., it’s hard to get into a hospital, and they will have lots of security guards around to prevent extreme incidents. But back in that county hospital, my mom said that even if you call the police, they are reluctant to get involved. So, doctors working in a semi-public environment like the emergency room need to stay alert all the time.

A still from the documentary “Dear Mother, I Meant to Write About Death.” Courtesy of Siyi Chen

Sixth Tone: Your film started as a journalistic endeavor, then it went in a direction you didn't expect. How did you handle this transition?

Chen: It was a struggle for me for three years. I was lost in the mental internal friction, because I couldn’t make a choice between social observation and personal story. I don’t know why; it probably has to do with my ego. 

When I went to IDFA this year, we had a discussion about the journey of making a personal film. A filmmaker said that this type of film often follows the steps from experience to process to expression. You need to fully understand what has happened before telling it. So, that could explain why it was in post-production for so long.

Sixth Tone: Do you worry if some stories are too personal to attract audiences? Is it possible to inspire public discussion through personal films? 

Chen: I think everything is public, and you are not alone in the things you experience. So, even in a personal film, there will be some universal feelings and ideas that people can relate to. Some documentaries are critical of systemic problems, but for myself, at least for now, I want to make films that are therapeutic for creators, participants, and the audience.