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

The first English-language monograph on the history of madness in modern China, this book offers far more than a compelling story with new information. With clear writing and persuasive argumentation, Emily Baum argues that the treatment of “mad” people and evolving understandings of madness reflect China’s engagement with Western medicine and science, as well as with modernity itself. Following current interpretations of modernity as an interpolated and ongoing encounter, Baum treats Chinese people’s responses to Western psychiatry as means of molding imported institutions and ideas for themselves. She grants agency to intellectual elites and the gravely poor, noting that literary disquisitions and everyday applications of medical care alike constituted key facets of “inventing” forms of modern madness that suited a panoply of needs.

In order to analyze Chinese modernity through the story of madness, Baum crafts a narrative that is simultaneously diachronic and synchronic. She traces developments in the understanding of madness from the nineteenth century through the onset of war in 1937 but focuses on Beijing and periodically isolates specific moments to explore the intersections between madness and gender, chronic poverty, and the reconciliation of Chinese and Western medical nosologies and treatment regimes. Such deft combination of two distinct types of historical narrative is difficult to achieve. Baum makes the sutures seamless, granting her readers a pleasurable encounter with a world that is at once deeply contextualized and subject to seismic shifts.

Chapter 1 introduces madness in late imperial China as a temporary condition rather than an ontological state. No single medical theory or legal definition applied. Families and patients resorted to a variety of interpretations and treatment methods, including religious healing. The dominant medical theory located pathology in the chest, beginning when an excess of mucous obstructed the function of the seat of consciousness: the heart. Based on an androgynous body, this theory displayed no obvious gendered component. In contrast, both cultural explanations of madness were distinctly gendered. The first theory posited that the root of madness lay in excessive emotion—primarily worry for men, and a host of emotions for women (jealousy, lust, grief, etc.). Many people identified with these experiences and displayed sympathy for those who displayed pathological responses thereto. The second theory attributed madness to moral transgressions. This linked the condition to guilt and shame and caused families to hide or confine their mad relatives.

Baum presents these nineteenth-century interpretations as indigenous constructions of madness, wholly consonant with Chinese medical theory and cultural practices and betraying no influence of Western beliefs. Her close attention to this “pre-contact” moment allows her to analyze ensuing developments as Chinese responses to and adaptations of [End Page E-1] Western ideas. It also sets up the narrative in keeping with medical anthropology frameworks that treat illness as a simultaneously biological and cultural phenomenon. Perhaps fortuitously, this also accords with Chinese understandings of mental illness, both then and now, and therefore supports an analysis that grants ontological parity to Chinese and Western belief systems.

Chapters 2 through 7 move from the founding of the Beijing insane asylum (the nation’s first) in 1908 through the eve of war in 1937. Chapter 2 details the tremendous pressure that both the late Qing and Republican governments faced to prove their political legitimacy by policing the public in a manner that, Baum argues, transformed madness from a temporary condition to a permanent identity that marked one as deviant and open to discipline. This she terms “an act of political invention” (62) because it satisfied political rather than cultural needs. Chapter 3 employs a clever interpretation of agency to argue that Beijing poor who availed themselves of free institutionalization at the insane asylum served their own needs but also legitimized the expansion of police power and expanded definitions of madness to include socially troublesome but not necessarily ill individuals.

Though not directly juxtaposed in Baum’s structure, chapters 4...