The Invention of Madness: State, Society, and the Insane in Modern China by Emily Baum (review)

The Invention of Madnesstraces how Chinese society, with its traditional notions of madness, evolved to accommodate and, to some extent, assimilate the new conceptions of mental illness during the first three or four decades of the twentieth century. Author and medical historian Emily Baum proposes the term "invention" as a useful heuristic device for analyzing the introduction and reception of modern psychiatry in non-Western societies—in this case in the city of Beijing. Madness, she contends, underwent "an ongoing process of becoming" (p. 187) during the period; its associated ideas and practices were created and re-created along the way according to the interests and needs of local actors who were brought into contact with the condition. Emphasizing concrete actions that involve knowledge production and identity formation across time, space, and society, she challenges the common imaginary that psychiatric modernity can be transplanted or adopted in a new environment as a whole and ready-made package.

Baum uses new materials unearthed from several archives, the most important of which are the Beijing Municipal Archive and that of the Rockefeller Foundation. The story of the Beijing Municipal Asylum—China's first public asylum and later a hospital where the country's initial institutionalization of psychiatry occurred—constitutes a major thread through the book. Established under the auspices of the city's police department, it eventually morphed into the Beijing Psychopathic Hospital with the aid of the Rockefeller Foundation-affiliated Peking Union Medical College (PUMC). However, the book is far from an institution-centered account; it explores beyond this unique asylum-hospital, foraying into other parts of the therapeutic landscape and Chinese society.

Medical anthropologists would feel at home reading this book as it tacitly endorses medical pluralism, the model proposed by the discipline's founders for the health care landscape of a socially and politically complex society. Arthur Kleinman, for instance, divides the medical system in 1970s Taiwan into professional, folk, and popular domains, each of which is culturally shaped and furnished with a distinct explanatory model that constructs its clinical reality. ¹Baum seems to have turned this synchronic model into a diachronic one. The book begins and closes with two apparently different yet similarly heterogeneous pictures, one set in the late Qing dynasty and the other during the onset of the Second Sino-Japanese War in 1937. The intervening chapters offer multiple snapshots of the time line spanning the two periods, with considerable attention focused on the overlaps between seemingly incompatible domains where inventions and reinventions happened. The outcome is a historical narrative that is dynamic and remarkably kaleidoscopic.

Chapter 1 (Contracting the "Mad Illness") examines an era still unaffected by Western psychiatry, a world in which madness—or more precisely "mad illness" (fengbing)—was not a discrete illness category but an epiphenomenon with a plurality of somatic, emotional, moral, and supernatural etiologies. Chinese medicine considered the heart as the locus of cognition and recognized an association between madness and mucous congestion, whereas folk religious healers invoked demonic possession as the cause. The Qing law dictated that home confinement of the insane was the responsibility of the family, but its lax enforcement made wandering patients a common street scene that Western missionaries found deplorable. The state, as chapter 2 (The Birth of the Chinese Asylum, 1901–1918) describes, shifted toward a paternalistic stance with the founding of the Beijing Municipal Asylum in 1908. This institution, initially a subsidiary of the Municipal Poorhouse, was administered by the police; it was nowhere near a modern hospital, although Chinese medicine did play a marginal role in it. Incarceration was its main function, as the police began to take those perceived as mentally deranged and threatening to the public order into custody. Through...