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

In this breath-taking book, Emily Baum tells the story of how Chinese urbanites came to embrace Western psychiatric practice and biomedical conceptions of mental health. The crux of the narrative centers on the period between 1908, the year Beijing erected its first insane asylum, and 1937, the summer of which witnessed the Japanese invasion of the city. In the short span of three decades, Chinese families learned to exploit municipal aid by seeking a temporary reprieve for their deranged relatives; private clinics claimed success in treating mental problems through a syncretic merging of Western and Chinese medical theories; a blossoming patent medicine industry sold pills that allegedly strengthened the brain or cured nervous disorders; a growing contingent of the urban intelligentsia came to embody a neurasthenic identity; and psychologists, educators, and other scientifically-oriented elites engineered a vision of society that linked the health of the human mind and behavioral norms to the fitness of the Chinese nation. The major archival sources that inform the study come from the Beijing Municipal Archive and the Rockefeller Archive Center. This is supported by a robust and compelling list of published materials in Chinese and English.

The institutional centerpiece of Baum's study is the Beijing Municipal Asylum, initially established as an organ attached to the Inner City Poorhouse in 1908. For reasons of overcrowding and the gradual realization of its aim to maintain public order, the asylum was detached from the poorhouse, moved to a separate courtyard near Anding Gate in northeastern Beijing, and became an independent entity in 1918. For the first two and half decades of its existence, the police force and other non-medical personnel overlooked the facility, which was always under-resourced and overcrowded. Consulting neuropsychiatric experts only on a sporadic basis, these civil servants took it upon themselves to adjudicate the admissibility of prospective inmates—an important decision given the paucity of funds that the municipality typically allocated to the establishment. Despite the various limitations, the erection and presence of the asylum transformed official and popular attitudes toward madness, from a symptomatic expression of ulterior natural (and sometimes supernatural) causes to an independent epistemological concept and medical condition. Throughout this period, both the asylum staff and families who came for help relied on premodern organic understandings of the body, especially the discharge of phlegm, as the basis for identifying madness.

The monopoly of Chinese medicine came to an end only when the Nanjing government took an active interest in engaging Western biomedical practitioners. According to Baum, the watershed turning point occurred in 1933, when the state-of-the-art Peking Union Medical College (PUMC), funded by the Rockefeller Foundation, proposed to work with the municipal government to modernize the asylum. This collaboration rebranded the institution as the Beijing Psychopathic Hospital, overhauled its infrastructure, and turned the management over to a trained neurologist, Wei Yulin, who immediately replaced its Chinese medicine practitioners with a new generation of biomedical physicians, nurses, and social workers. Although the new PUMC cohort insisted on a paradigm shift in what to call their inmates—from "lunatics" (fengren) to "mental patients" (jingshen bingrcn)—Baum argues that their actual approach to managing mental illness remained strikingly reminiscent of the earlier approach adopted by the municipal police: custodial confinement, restraint, and therapeutic targeting of the physical body. One of the most gripping subplots of the book centers on the revision of the Republican penal code: from the absence of a clear instruction on how to handle the insane criminal to relieving the mentally ill of legal responsibility and moral culpability. This definitive revision was cemented in 1935 when PUMC experts worked closely with state functionaries to craft the new legal statutes, which now specify the requirement that the insane be placed under guardianship at an appropriate facility.

In addition to institutional, epistemological, and forensic changes, the book follows the popularization of psychiatric...