When did “madness” become transformed into “mental illness”? How did this affect the treatment of those afflicted by such conditions? And how did it change the way those deemed mad—or mentally ill—were viewed by their families, as well as by the state, society, and medical professionals around them? Historian Emily Baum, associate professor at the University of California, Irvine, considers these questions in her recent book, The Invention of Madness: State, Society, and the Insane in Modern China (University of Chicago Press, 2018). In her work, Baum examines how people’s understandings of madness and mental illness changed in early 20th-century China and how treatment of those afflicted with such conditions moved from the home to different types of institutions.
Focusing on the city of Beijing, Baum explores how doctors, government officials, social workers, and ordinary people all participated in the transformation of ideas about madness during the first decades of the 20th century. Baum shows that this evolution was far from a top-down imposition of imported Western ideas; instead, different actors blended traditional Chinese understandings of madness with those from abroad. Again and again, “madness” was (re-)invented in response to quotidian circumstances and resource limitations. While mental health professionals and state officials sought to achieve an abstract ideal of “psychiatric modernity,” Baum argues that their efforts resulted in a story without a smooth arc—the process was, instead, contested, halting, lengthy, convoluted, and ultimately incomplete.
In the interview below, Baum explains some of the book’s findings and places it in dialogue with other works on similar topics. For more about The Invention of Madness, listen to an interview with Emily Baum at the New Books in East Asian Studies podcast, and read an adapted excerpt from the book at Aeon magazine.
MEC: Prior to the early 20th century, how was madness generally understood in China? What sort of treatment options were sought out by the families of those who had gone mad, and to what extent did the imperial state deal with the insane?
EB: One of the first things I usually explain when asked about my research is that “mental illness” is a relatively recent concept in Chinese medical history. Prior to the early twentieth century, mad people weren’t generally believed to be suffering from an illness of the brain or “mind.” More typically, madness was thought about as a transitory condition that could have been caused by any number of factors: physical imbalances, such as an accretion of mucous in the chest; environmental influences, such as laboring too intensely on a hot day; supernatural causes, like the curse of a deceased ancestor; or simply cognitive and emotional issues, such as studying too hard for the civil service exams or being heartbroken over a lost love. Because madness was believed to derive from so many different sources, people were practical when it came to its treatment. They sought the help of physicians, who may have prescribed an emetic, purgative, or cooling remedy depending on the perceived origins of the illness; but they also looked to faith healers, shamans, and religious agents. In most cases, the insane were kept at home and the imperial state didn’t intervene in their management unless they happened to commit a serious crime. Unlike France and England, which had established an elaborate state-run asylum system in the nineteenth century, no such facilities existed in imperial China.
MEC: What changed in the way people viewed madness around the beginning of the Republican Era? How did doctors and government authorities get involved in treating those deemed mentally ill?
EB: As any student of Chinese history knows, the first decades of the twentieth century were a time of tremendous change. Even before the overthrow of the Qing dynasty, governing regimes began to experiment with different approaches to managing the massive populations over which they ruled. In Beijing, the Qing opened several institutions that, in the words of the historian Janet Chen, served both disciplinary and charitable purposes. At poorhouses, workhouses, orphanages, and asylums, individuals were given food and shelter—but they were also kept off the streets and put to work. For the first time, government authorities like policemen were given the task of rounding up the homeless insane and putting them into public institutions. One consequence of these actions was that madness became more explicitly associated with poverty, deviance, and the potential for civic disorder. Nevertheless, there weren’t any strikingly new treatments for the insane during this transitional period; for the most part, the mentally ill who were housed at the Beijing Municipal Asylum were treated with the same remedies that would have been used throughout the late imperial period.
MEC: You discuss several institutions—the Beijing Municipal Asylum, the municipal poorhouse, and the Peking Union Medical College psychopathic hospital. How did these institutions differ in their treatment of the people placed (or forced) into their care?
EB: The Beijing Municipal Asylum and the municipal poorhouse were both established in 1908, and for a while they were treated as more or less the same institution: they occupied the same physical space, their residents hailed from the poorest social classes, and there wasn’t always a clear bureaucratic demarcation between those who were mentally ill and those who were simply struggling to make ends meet. The reason for the overlap had much to do with the fact that both institutions were managed almost entirely by the Beijing police force. As a disciplinary organization, the police tended to approach insanity as a primarily social concern, and their main goal was therefore to keep the insane and the indigent off the street and out of trouble. Although the police certainly wanted their mentally ill charges to convalesce while they were institutionalized, they didn’t have a lot of time or money to spend on medical treatment or rehabilitative care. As a result, most people simply remained chained up in the asylum until their families came to collect them.
Twenty-five years after the municipal asylum was established, the Beijing government replaced the institution with a cutting-edge psychopathic hospital. While the book goes into more detail about the specific details behind this institutional shift, suffice it to say that the psychopathic hospital—which was managed and staffed by the state-of-the-art Peking Union Medical College—attempted to invalidate just about everything the asylum had done. Rather than stressing incarceration, the psychopathic hospital instead emphasized rehabilitative care, and it did so through a variety of ways: occupational therapy, calisthenics, surgery, and sedatives. Underlying this veneer of medical modernity, however, the psychopathic hospital nevertheless perpetuated many of the practices it condemned about the earlier asylum—it just did so in a more “acceptable” way. For example, while physicians at the psychopathic hospital criticized the police for physically restraining their charges, the hospital did so as well, but used a straitjacket instead of a rope or chain.
MEC: One point you make is that ideas about modernity and mental illness were not simply imposed on Chinese citizens by an expanding bureaucratic state; ordinary people also took up these ideas and deployed them. What caused the popular spread of new understandings about madness?
EB: A lot of these new ideas were spread through the help of the news media. The early twentieth century was a time when the Chinese popular press was really taking off, and discussions of madness were found in highbrow and lowbrow publications alike. The Beijing police posted missing persons notices in local newspapers, and there were frequent reports about local policemen managing cases of madness—either by returning lost madmen to their families or by subduing mad people when they were causing a public disturbance. The continuous insistence on mad people as troublesome, combined with the prominent role that the police played in these media reports, introduced new associations about madness as a “social problem” that hadn’t necessarily existed before. But new ideas about madness also managed to penetrate the popular imagination in ways that weren’t so obvious or straightforward. For example, the sheer existence of new spaces for the insane, such as asylums, hospitals, and psychiatric wards, necessarily conveyed novel ideas about how madness could be handled in an institutional setting. Meanwhile, ordinary interactions—among city folk, between policemen and families, and between social workers and patients—also worked to circulate new discourses of madness in ways that weren’t always consciously didactic or aligned with the modernizing goals of the republican state.
MEC: In the mid-1920s, we see the emergence of a figure you dub the “psychiatric entrepreneur.” Who were these people, and what role do they play in the story you tell in The Invention of Madness?
EB: The psychiatric entrepreneur refers to a class of individuals who made a living by—to put it bluntly—profiting on the treatment of madness. Some established private psychiatric hospitals for elite patients, while others produced patent medicines that claimed to “cure” madness in only a few doses. What’s so interesting about psychiatric entrepreneurs was that, in their effort to monetize madness and its treatment, they were particularly effective at introducing new discourses about what madness was and who the disorder could affect.
One of the ways they did so was by promoting new categories of mental illness like neurasthenia. Although most people probably aren’t familiar with neurasthenia today, it was a wildly popular diagnosis throughout the late nineteenth- and early twentieth centuries. Referring to a whole host of symptoms including depression, anxiety, or even moodiness, neurasthenia became a catch-all diagnosis for upper-class men suffering from otherwise inscrutable psychological woes. In China, psychiatric entrepreneurs played a decisive role in introducing the concept of neurasthenia (shenjing shuairuo) to interested readers. They were so successful at doing so that even well-known intellectuals like Lu Xun and Xu Zhimo apparently consumed anti-neurasthenic medications!
MEC: Thinking about historiography, two books that feed into yours are Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China, by Ruth Rogaski, and Janet Chen’s Guilty of Indigence: The Urban Poor in China, 1900–1950. What other works—about China, social history, the history of medicine, or urban history—would you recommend be read in conjunction with The Invention of Madness?
EB: One of the things that was so satisfying about working on this project was that it gave me the opportunity to read transnationally and across disciplines. In terms of urban history, David Strand’s Rickshaw Beijing has always been extremely influential for my own thinking, not just because of his pivotal role in bringing the social dynamics of 1920s Beijing to life, but also in the way he was able to add a sympathetic human dimension to otherwise historically voiceless individuals. I was fortunate to have been writing The Invention of Madness at a time when two long-awaited works on Chinese medical history were published, Sean Hsiang-Lin Lei’s Neither Donkey Nor Horse and Bridie Andrews’s The Making of Modern Chinese Medicine, both of which are exceptionally useful for understanding the historical vicissitudes of early twentieth-century Chinese medical practice. And Arthur Kleinman’s early works, in particular Patients and Healers in the Context of Culture and Social Origins of Distress and Disease, provide an anthropological lens for understanding the cultural dimensions of mental illness in China and Taiwan.
Outside of China, too, there is a wealth of historical, sociological, and anthropological literature on madness, social deviance, stigma, and the invisible ways in which disciplinary institutions function. Andy Scull, a sociologist of enviable productivity who was also one of my mentors in graduate school, shaped my thinking from an early stage; insights from his book The Most Solitary of Afflictions, which discusses madness in eighteenth- and nineteenth-century England, run throughout my work. Finally, Erving Goffman’s Asylums, David Rothman’s The Discovery of the Asylum, Roy Porter’s Mind Forg’d Manacles, and Elaine Showalter’s The Female Malady are useful for readers interested in the institutional, social, and gendered dimensions of madness.
MEC: Finally, what are you spending your time on now that your book has been published?
EB: Academically, I’ve been looking forward to my next project on fortune telling and divination in contemporary China. I tend to gain most of my intellectual inspiration from books that have nothing to do with Asia, so I’ve been spending a lot of time reading about enchantment, magic, and the occult in Germany, France, and the United States. Outside of academics, I’ve developed a fascination with exercise physiology and have been thinking about (though will probably never follow through on) getting certified as a personal trainer. I’ve finally started listening to podcasts and am now quite obsessed with them; for anyone interested, I highly recommend In The Dark; Terrible, Thanks for Asking; and Bear Brook. And I’m totally not embarrassed to admit that I detox intellectually by watching reality television. (I will not, however, reveal which programs fill my Hulu queue.)