We are excited to announce a new title in the Studies of the Weatherhead East Asian Institute book series: The Invention of Madness: State, Society, and the Insane in Modern China, published by the University of Chicago Press. The book’s author is Emily Baum, an Associate Professor of History at the University of California, Irvine.
Throughout most of history, in China the insane were kept within the home and treated by healers who claimed no specialized knowledge of their condition. In the first decade of the twentieth century, however, psychiatric ideas and institutions began to influence longstanding beliefs about the proper treatment for the mentally ill. In The Invention of Madness, Emily Baum traces a genealogy of insanity from the turn of the century to the onset of war with Japan in 1937, revealing the complex and convoluted ways in which “madness” was transformed in the Chinese imagination into “mental illness.”
Focusing on typically marginalized historical actors, including municipal functionaries and the urban poor, The Invention of Madness shifts our attention from the elite desire for modern medical care to the ways in which psychiatric discourses were implemented and redeployed in the midst of everyday life. New meanings and practices of madness, Baum argues, were not just imposed on the Beijing public but continuously invented by a range of people in ways that reflected their own needs and interests. Exhaustively researched and theoretically informed, The Invention of Madness is an innovative contribution to medical history, urban studies, and the social history of twentieth-century China.
We thank Dr. Baum, an alumna of the Weatherhead East Asian Institute’s Master of Arts in Regional Studies – East Asia (MARSEA) program who earned her PhD from the University of California, San Diego, for taking the time to discuss her book with us. Please read the following Q&A to learn more about the research and questions that drove her project.
What drew you to the topic of mental illness during your graduate work in Chinese history?
Whenever I’m asked this question, I always wish I had a more interesting story to tell! The truth is that I stumbled on the topic somewhat randomly. When I started graduate school, I knew that I was interested in modern Chinese history, but I had no idea about what I wanted to write my dissertation on more specifically. Current events pointed me in the direction of mental illness. In the early 2010s, there happened to be a spate of incidents in China in which mentally ill men had entered elementary schools and stabbed children to death with cleavers. In a series of investigative reports, journalists for major media outlets like the New York Times wondered why the Chinese government wasn’t doing more to promote access to affordable psychiatric care. At the time, it struck me that not much was known about the antecedents of modern psychiatry in China or the reasons why mental illness remains such a taboo topic in China today. On a somewhat less academic note, too, the topic resonated with my longstanding fascination with illness and deviance – subjects that transcend geographical and temporal boundaries. When I went abroad to Beijing during the summer after my first year in graduate school, I typed the Chinese term for “mental illness” into the search engine at the Beijing Municipal Archives. To my surprise, thousands upon thousands of documents appeared, all related to the first public insane asylum in China. At that moment, I knew I had struck upon my future dissertation topic, and I decided to stake my claim to the subject.
What developments allowed psychiatric ideas and institutions to begin influencing Chinese society and medical care in the 1900s? What became of the healers who, before then, treated people who were considered insane?
Interestingly, at the time that psychiatric ideas were beginning to penetrate China in the early twentieth century, the psychiatric profession was experiencing a crisis of confidence. There hadn’t been any major breakthroughs in psychiatric treatment, asylums in the United States and Western Europe had high rates of recidivism and exceptionally low rates of cure, and psychiatrists were beginning to think that mental illness was perhaps incurable. Somewhat counterintuitively, then, the reason that psychiatric ideas and institutions were able to take root in China had very little to do with their effectiveness. Rather, the cause for their (fairly limited) success had much more to do with the political aspirations of the Chinese state. This was a time when science and biomedicine were seen as the secrets behind Western strength and power, and many intellectuals were looking at scientific disciplines with rose-colored glasses. At the same time, the Qing dynasty and subsequent Nationalist Party (Guomindang) were both fascinated by the disciplinary potential of institutions like asylums, prisons, workhouses, and reformatories. In many ways, the adoption of the asylum was more symbolic than practical: it was a way of signaling to the Western world that the Chinese were capable of undertaking systemic change.
Because psychiatric treatments were largely ineffective, however, “traditional” healers not only continued to attract patients, but they also continued to stake a claim to the superiority of their own knowledge and practices. Well into the 1930s, physicians of Chinese medicine contested the assertion that mental illness originated in the brain. And since asylums and psychiatrists were still exceptionally limited in China – they were mainly confined to urban areas like Beijing, Shanghai, and Guangzhou – the vast majority of Chinese people continued to patronize the same types of healers that had been used throughout the imperial era.
How does the history of the treatment of mental illness in China compare with the history of the treatment of mental illness in other countries during the first decades of the twentieth century? How did ideas about psychology and medicine circulate between countries in this period?
Much of what was happening in China in the first half of the twentieth century was inspired by psychiatric treatment in other parts of the world. Prior to that time, Chinese ideas about madness were actually quite similar to medieval European ideas about madness. In both cases, patients and healers believed that the affliction was caused by some combination of bodily imbalance, demonic possession, environmental stressors, or otherworldly forces. By the early twentieth century, however, the Western world had developed an entirely different understanding of madness, namely, that madness was in fact a “mental” illness caused by some defect in either the structure or function of the brain. This belief was accompanied by several interrelated assumptions: that the mentally ill needed to be treated by specialized psychiatric practitioners, that mental illness should be considered a unique type of disease (different from, say, liver disease or kidney disease), and that psychiatric patients needed to be cared for within the unique institutional space of the asylum or psychopathic hospital. Although we consider these ideas fairly commonplace today, they were actually radical departures from the way madness had historically been conceptualized.
It wasn’t until the late nineteenth and early twentieth centuries that the concept of “mental illness” penetrated the Chinese imagination. (In fact, the Chinese term for mental illness, jingshen bing, was a Japanese neologism that only entered the Chinese vocabulary in the twentieth century.) This shift happened largely as the result of two contemporary forces: an influx of Western physicians and medical missionaries coming to China to establish hospitals and teach biomedicine, and an outflux of Chinese intellectuals going abroad to Japan, the United States, and Europe to study “Western” disciplines like psychology and psychiatry. Combined with the fact that Chinese political regimes were more open to these sorts of disciplines than they had been in the past, psychiatric ideas and institutions were able to gain a stronger foothold in the Republican period than they were in the Qing. Nevertheless, the explanatory and therapeutic limits of scientific psychiatry meant that its influence remained relatively finite in early twentieth-century China. While countries like France, England, and the United States had established a fairly robust public asylum system, asylums were scant in the Chinese context. And while the mentally ill in the Western world were attended to by psychiatrists, psychologists, and other types of mental health specialists, insanity in China was not yet definitively seen as a distinctive “type” of illness. This meant that the mentally ill continued to be treated by the same types of healers who would be called to treat any other ailment a person might fall prey to.
What kinds of sources and archives did you consult while conducting research for this project?
Most of my sources came from two main archives: the Municipal Archives in Beijing and the Rockefeller Archive Center in Tarrytown, New York. Although these collections are located at opposite ends of the globe, they ended up being central to my project because they both contained information about the first public asylum in China, the Beijing Municipal Asylum (Beijing shi fengren yuan). When this asylum was established in 1908, it was administered almost entirely by the Beijing police force. Luckily for my purposes, the police were very good at keeping detailed records about the people they chose to institutionalize. These records, which could range from a few sentences to several pages, often included descriptions of the mentally ill, oral testimonies from family members and neighbors about the patient’s condition, and brief medical records from physicians employed at the asylum. When read collectively, they allowed me to develop a picture of the everyday workings of the institution and the role it played in the management of municipal order. When read individually, they also shed light on the often-desperate conditions in which impoverished families were forced to live in Republican Beijing. Many of the people institutionalized at the asylum came from exceptionally poor households, and they frequently threw themselves at the mercy of the police because they could not afford any other treatment.
The role that the Rockefellers played in this asylum is a totally different story. In 1934, after the Nationalist Party had risen to power, the asylum was transferred from the control of the police and placed under the administration of the Peking Union Medical College, an American teaching hospital that was funded, in large part, by the Rockefeller Foundation back in New York. At the time, the Rockefellers were very interested in improving mental healthcare for people around the world, and they threw millions of dollars into the endeavor. In Beijing, physicians at the Peking Union Medical College decided to completely renovate the old asylum and turn it into a state-of-the-art psychopathic hospital, complete with the most modern facilities. The Rockefeller Archive Center contained hundreds of pages of files documenting the medical and administrative changes that this handover entailed. Together, these two sets of archives enabled me to trace a history of the first public psychiatric facility in modern China – a facility that, in many ways, represented a microcosm of the vicissitudes of psychiatric treatment in the early twentieth century more broadly.
How, as a historian, did you build your scientific knowledge about psychiatry and psychology in order to research and write about this subject?
Lots of people ask me if I have any training in psychiatry, and though I wish I did, I can truthfully only consider myself a doctor of philosophy! That said, I didn’t find it necessary to have an advanced level of scientific knowledge in order to write this book. My goal wasn’t to retroactively diagnose patients or interrogate the clinical efficacy of psychiatric treatments; instead, I was more interested in the conversations that ordinary people were having about what mental illness was, what caused it, and what sorts of treatments were both the most humane and the most effective. Although I didn’t have any advanced training in scientific psychiatry, I spent quite a lot of time reading works of history and anthropology about mental illness around the world. To understand the trends and debates that were occurring in China, it was imperative to be able to situate Chinese psychiatry within global flows of knowledge. In graduate school, I was lucky to have been able to work with Andy Scull, a renowned expert in the history of madness who has published extensively on the topic. Working with him gave me a solid grounding in topics like the historical genesis of psychiatry, the history of the asylum, and theoretical trends in medical anthropology, historical sociology, and disability studies. Although The Invention of Madness is solidly historical, I wrote it with the intention of appealing to readers with a range of disciplinary interests.
Something that routinely surprised and, well, astounded me during the course of my research was the blatant hypocrisy of Westerners when it came to the treatment of mental illness in China. Far too frequently, Western missionaries and physicians would characterize a disfavored practice as culturally “Chinese” when, in reality, they were doing the exact same things back in their home countries! For example, American missionaries in the early twentieth century often denounced the Chinese practice of allowing the mentally ill to roam around at will, unguarded and uninstitutionalized. Yet, at the same time they were denigrating these trends in China, a major international conference in Belgium determined that the most effective way to rehabilitate the mentally ill was not by institutionalizing them, but rather by allowing them to go about their business
undisturbed – in other words, exactly what the missionaries had observed in China! In other cases, American physicians condemned the fact that policemen at the Beijing Municipal Asylum often resorted to chaining up the criminally insane. Deriding these practices as evidence of the backwardness of Chinese customs, Western doctors attempted to enlighten the Chinese about the superiority of “scientific” psychiatry. Contemporaneously in the United States, however, an entire movement was underway to draw attention to the extensive abuses in the American asylum system. And in their own hospital wards, Western physicians still restrained the insane – they just did so using straitjackets instead of chains. Rather than acknowledging the universal challenges of humanely caring for the mentally ill, Westerners in China preferred to condemn local practices as culturally and intellectually inferior.
Can you tell us briefly about your current research project?
Much as I enjoyed working on The Invention of Madness, my next book will be on a completely different topic. I’m currently pursuing a project on fortune telling and divination in the People’s Republic of China (1949-today). This book will be a bit of a departure for me, because it involves a mixture of archival and ethnographic research. I’m looking at the people who both seek astrological advice and those who provide it – fortune tellers, feng shui masters, glyphomancers (people who choose the most advantageous name for a child based on the number of strokes in a character), and other types of diviners, shamans, and purveyors of the supernatural. Despite the fact that the Chinese Communist Party has been trying to eradicate these so-called “superstitious” practices for many decades, they have persisted with a dogged determination. Today, fortune telling in China remains ubiquitous; people not only visit flesh-and-blood diviners but they also seek astrological advice on apps and social media. I was drawn to the topic not just because it’s fascinating in and of itself, but also because it provides the opportunity to ask bigger questions about the relationship between politics and culture both in China and around the world: namely, how is it possible that a condemned, outlawed, and “unscientific” practice has managed to remain such an integral element in the very fabric of people’s lives?