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The Invention of Madness: State, Society, and the Insane in Modern China Review

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The Invention of Madness is one of those solid books which as a scholarly work it is hard to raise many objections to, and which has a simply satisfying feel to it. Emily Baum's work on the development of "modern," Western, psychology and mental health in China during the Imperial and Republican eras has a clear path of the introduction and growth of Western psychological concepts in China, cogently incorporates traditional Chinese notions of sanity, and which cleverly shows how power structures, perceptions, politics, and notions of modernity, rather than objective scientific truth, drove and shaped China's system of madness and psychology.

Baum's mostly chronological text starts off by discussing traditional Chinese approaches to madness under the Qing dynasty in the 19th century, notably based upon a Chinese idea of the heart being the center of mental capacities, and thus advocating for treatment based upon various remedies designed to get rid of mucous in the chest. Other origin sources were believed to be spirits, or more prosaically, stress such as the civil service examinations. But there was not a formal science of treatment of the insane and thus there was a mixture of shamans, folk healers, doctors, whatever people could find to attempt to cure family. Chinese insane were mostly dealt with on local, decentralized levels, and were mostly left unconstrained - although sometimes this relatively "liberal" attitude could be matched by extreme cruelty and degradation.

The introduction of Western psychological approaches started with the creation of an asylum in Beijing, in response to the need to appear modernized and respond to Western pressure for a change in Chinese treatment of the mentally ill. This led to their institutionalization and the creation of a dedicated psychological infrastructure. But this was also utilized by Chinese poor to provide some food, housing, and security by claiming mental illness.

Psychology however, also changed for the middle and upper classes. In the 1920s in Beijing new private clinics and medicines promised to treat psychological problems. In doing so, these entrepreneurs tried to associate madness with stress and mental overwork, to better sell their products. They used a mixture of traditional Chinese terms about madness but added on Western and "modern" psychological words as well.

This is expanded on in following chapters, discussing the continued development of Chinese traditional medicine and Western medicine, starting with the introduction of Western psychiatry - a previous omission of the modern Chinese mental health infrastructure. This was completely ineffective at actually producing cures, but was vigorously embraced by the Chinese Nationalist government to instill an image of itself as a modernizer. This was further used in the concept of mental hygiene in the 1930s, which sought to clean society of its mental problems to promote greater efficiency, productivity, and order, to indoctrinate the population with the values of the Kuomintang. The New life Movement showed this most visibly, which was justified on Confucian principles but constituted a modern psychological revolutionary program. For many regular Chinese people however, they were less concerned with either modern scientific psychiatry or traditional Chinese medicine, but whatever worked - and would willingly use both. Attempts at reconciling them were made by Chinese physicians who continued to insist on the importance of the heart in mental processes, while the introduction of medical terms often drew upon traditional Chinese concepts - such as the very phrase for mental illness, jingshen bing, where jingshen implied the balance of jing and shen and was inherently linked the body and its balances, rather than a Cartesian focus on the mind as a separate entity. Chinese patients continued to express their woes in traditional Chinese psychological theories, even if they sought treatment in Western psychological institutions. Chinese doctors too, would seek to deal with madness in a more holistic way of treating patients as people, examining their contexts and utilizing Daoist notions of individual wellbeing, and sometimes teaching Western psychologists about their theories. The introduction of Western psychology was thus not just a one way street, but one where Western psychologists too would learn from the Chinese.


As a neophyte on the subject, on of the elements I most appreciated was its initial outline of Chinese ideas on psychological healing and mental health - notions which were much more physical and based on an idea of forces, orders, and harmony, perhaps more akin to what the Greeks traditionally believed with their interest in the bodily humours and the balance of forces in the body, than our modern conceptions which stem from Descartes at the least and doubtless include a heavy Christian element of the separation of the soul and body. Keeping the 6 fu organs and 5 zang organs, each responsible for different cognitive and emotional elements, in balance was a crucial feature of the Chinese system, and ways to fix issues which would be regarded as mental and psychological by Occidental observes were definitively bodily in nature - such as using oils to purge mucous. Furthermore, Chinese thought located the mind and thinking powers in the heart, not in the brain as in Western thought.

It has been increasingly recognized, at least since Foucault, that psychology is a domain where objectivity and scientific rationality are less important than power relations. This was well on display in the Chinese case, as the actual, verifiable benefits of Chinese mental health and sanity reform were exceedingly difficult to actually find. There was no real indication that the "modern" insanitariums and mental health facilities offered any real advantages over traditional Chinese mental healthcare. Rather, the real impetus and development came from the desire to portray China, and especially Beijing, as modern, scientific, cleanly, and civilized, in international eyes. Thus Beijing's system had to be overhauled to meet these international expectations of what mental health care and treatment of the insane should look like, rather than being driven by any verifiable success.

China's psychological infrastructure was thus shaped by norms, rather than internal needs. related to this is its excellent investigations of how common, poor, Chinese people used the asylums to their benefit, finding food and shelter for the most wanting as they put themselves (or were put there by their families), to be able to escape complete deprivation on the streets. This institution was used and taken advantage of by ordinary Chinese people, who found ways to make it work for them that were radically different than the way it was intended to impact Chinese society. Further evidence of the ways in which the introduction of Western psychological mental healthcare had unintended consequences and interactions was shown by its inability to evict its competitors from the public sphere, as the Chinese continued to visit a heteroclectic variety of both Western and Chinese options to attempt to cure their disorders. It reminds oneself very much of the Chinese approach to religion, where Chinese people have been notably flexible and practical, choosing whatever religious and spiritual teachings and concepts seem to work, without necessarily rejecting others.

There is also an excellent discussion of racial properties of Chinese people and their proclivity to madness. In a time when a focus on national characteristics seemed almost all-devouring, with massive attention paid to attempting to understanding different national types, psychology attracted its share of this as well - with the praising of Chinese people for being some of the most sane and least impacted by mental problems of any people in the world.

Some parts of the book are oversold however. There could have been an expansion of the promised section on the utilization of psychology as an anti-Communist tool, which was said to feature as a component of the New Life Movement, as Communist was declared to be a mental disorder - but whose section in the book is rather short. Although it might have extended the book overly too much, integrating what the Chinese Communists thought about mental health and psychology could have been fascinating - was there any discussion of this matter during the period when the Chinese Communists were engaged in the civil war with the Nationalists, or were the Chinese Communists less "advanced" in their usage of psychological concepts, relying more on traditional Chinese psychological beliefs? And what about when the Communists came to power? The Soviet Union was famous for using psychology to portray any opponents of Communism as mentally ill; did anything equivalent to this happen in Communist China? And the book is overwhelmingly focused on Beijing, rather than China as a whole.

There could also have been more of an East Asian integration, such as contacts with Japanese psychologists and training with Japan. It has been noted substantially elsewhere that many of the important students, thinkers, and writers who would be instrumental in the 1912 Revolution came from studies in Japan, with significant numbers of Chinese students going there. What were links like with Japanese psychologists and their studies, the only other independent East Asian nation (other than Taiwan to the South, in South-East Asia), and the only one undergoing Westernization and substantially further advanced along this road vis-à-vis Japan.

An excellent and highly recommended book for learning about the development of psychology in China and understanding the creation of the modern idea of madness in a global concept.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2021 Ryan C Thomas

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