Abstract
This ambitious edited volume aims to give readers a broad overview of the history of psychiatry and mental illness in China, from the late Imperial period to the present day. Consisting of 10 chapters, the volume touches on themes as varied as late Imperial medicine and its approach to treating emotional and behavioural disorders, twentieth-century missionary medicine and its reframing of madness as ‘mental illness,’ and the increasing popularity of psychotherapy in contemporary China. As one of the only published monographs in the field of Chinese history to address this topic, Psychiatry and Chinese History provides a much-needed overview into changing constructions of madness in China across time.
As editor Howard Chiang points out in his introduction, the present historiography on the subject of psychiatry in the non-Western world largely tends to centre on one of two themes: colonial psychiatry and its pathologization of indigenous populations, and the use of psychiatry as a tool of political repression. These themes are, on the whole, refreshingly absent from this volume. In contrast, the essays in Psychiatry and Chinese History are generally more concerned with demonstrating how evolving psychiatric discourses can be used as a lens to uncover implicit cultural values and beliefs. Organized chronologically, the essays collectively reveal how evolving interpretations of madness ‘reflect the social and cultural reality at the time’ (p. 180).
The volume begins in the late Imperial period, with an essay by Brigid Vance on dreams and nightmares in the late Ming dynasty (1368–1644). Focusing mainly on a compendium called Forest of Dreams, Vance underscores how nightmares were assumed to be pathological symptoms, and were therefore ‘treated’ either through the correction of physical and/or spiritual imbalances or through the rectification of moral transgressions.
The next two essays address the different treatment options available for emotional and behavioural disorders within the Chinese medical canon of the time. Hsiu-fen Chen’s essay demonstrates how changing emotional conditions were aetiologically related to changing bodily states, and thus physicians could employ either emotional manipulation (such as talking cures) or drug therapies to achieve a positive outcome. Fabien Simonis expands on this line of thinking in his excellent and richly supported essay on medical therapies for ‘psycho-behavioural’ disorders in the late Qing (1644–1911). Explaining how madness was often linked to the xin – a concept rendered uneasily into English as the ‘heart-mind’ – Simonis convincingly shows how Qing physicians could trace insanity to both somatic and psychic processes ‘without cognitive dissonance’ (p. 60).
The following four essays move into the Republican period (1911–49), a time that saw sweeping changes to the treatment of madness as a result of the influx of new psychiatric epistemo-logies and the establishment of Western-run psychopathic hospitals. Peter Szto and Zhiying Ma both examine a US missionary hospital in Guangzhou (Canton) known as the John Kerr Refuge for the Insane. While Szto is concerned with the architectural design of the Refuge, Ma’s essay centres on the psychiatric discourses employed by its missionaries. In a clever reading of her sources, Ma shows how these missionaries condemned the Chinese family as an ‘iron cage’ of confinement and domestic cruelty, yet simultaneously overlooked the fact that their own institutions and treatment methods had become ‘iron cages’ of control unto themselves. Wen-Ji Wang’s essay on ‘tropical neurasthenia’ cogently describes the diversity of opinions on why foreigners were often struck with nervous illnesses upon venturing abroad, and Hugh Shapiro’s look into female mental disorders argues that new psychiatric discourses traced the origins of women’s insanity back to the misery of the patrilineal household, rather than to the patient’s physiology or gender.
The final three essays move into the second half of the twentieth century, and together show the range of approaches adopted by state authorities and medical practitioners to address the problem of mental illness. Geoffrey Blowers and Shelley Wang discuss how psychotherapy flourished briefly in China in the 1930s, but was then attacked and excised under Mao in the 1960s; Harry Yi-Jui Wu’s interesting study of a psychiatric hospital in post-World War II Taiwan shows how physicians attributed psychic suffering to specific sociopolitical events in a ‘veiled social criticism’ of contemporary Taiwanese politics (p. 181); and Hsuan-Ying Huang’s extremely well-written essay on the so-called ‘psycho-boom’ in contemporary China argues that the recent popularity of Chinese psychotherapy can largely be attributed to state initiatives that have turned therapeutic training into a middle class commodity.
Due to the relative paucity of scholarship on this topic, Chiang’s selection of essays naturally covers a wide range of subjects, approaches and time periods. However, the overall volume could have benefited from a closer integration between the various chapters and an increased effort at dialogue between the different authors. Although Chiang’s clearly written introduction and Nancy Chen’s brief afterword do a nice job of putting the essays into conversation with one another, the individual authors do not take up this task themselves. When combined with the unevenness in the quality of the essays – both in terms of their theoretical contributions and in terms of their general readability – the result is that the volume can sometimes read more like a collection of standalone essays than a coherent whole.
Shortcomings aside, however, this volume adds much-needed insights into a sorely understudied subject in Chinese history. Although probably best suited to readers with at least a modicum of familiarity with Chinese history, this compendium will also be useful to medical anthropologists and historians of medicine in general. Scholars will certainly build on these essays as the field continues to advance.