A review of Spits, Chains, and Hospital Beds: A History of Madness in Republican Beijing, 1912-1938, by Emily Lauren Baum.
This widely researched dissertation explores the various narratives by which the history of madness in Republican Beijing may be recounted. Drawing inspiration from medical anthropologists like Arthur Kleinman and Byron Good and historians of science like Bruno Latour, Emily Baum invites us to shake off psychiatric preconceptions about what constitutes insanity and to focus instead on the other understandings of madness and ways of handling insane people that either remained alive or were newly emerging in early twentieth-century Beijing.
Chapters 1, 3, and 5 trace the history of the Beijing institutions that treated insane people. The first chapter concerns the municipal asylum. Founded in 1912 and originally attached to the city’s poorhouse, in 1918 it was moved to new precincts near Anding Gate north of the city. Admittance was managed by the police, who diagnosed madness based on shared cultural conceptions of that condition. Many criminals recognized as insane were incarcerated there, other “madmen” (fengzi) were committed by their relatives, and yet more inmates were caught in the streets. They were implicitly treated like delinquents and the asylum suffered from overcrowding, lack of hygiene, and lax administration.
In 1933, the municipal asylum was renamed the Beijing Psychopathic Hospital (Jingshenbing liaoyangyuan) and entrusted to the Peking Union Medical College (PUMC), a missionary-managed teaching hospital which had been treating nervous and mental disorders and intermittently run a small psychiatric ward. Financed by the PUMC and the Beijing government and placed under new leadership, the overhauled institution hired specialized staff, improved hygiene and recordkeeping, and acquired new facilities. No longer a custodial unit of the municipal police that kept “madmen” off the streets, the Psychopathic Hospital tried to cure and rehabilitate “patients” (bingren) with the latest Western psychiatric techniques, such as through drugs, work therapy, social therapy, hydrotherapy, electroshocks, and insulin shock therapy. This story is told in chapter 3.
Much of the rest of the dissertation criticizes and supplements this account, which Baum herself calls “a Whiggish narrative of institutional ‘progress’” (p. 18). Running the Beijing Psychopathic Hospital along modern scientific guidelines indeed brought it some prestige in the municipal government and among social reformers or Western-trained elites, but as Chapter 5 shows it faced the same problems of overcrowding and inefficient administration as the old municipal asylum. And despite claims to therapeutic superiority, it remained a last resort for ordinary Chinese who wanted to treat insanity.
Chapter 6 explains the features of “Chinese socio-medical culture” (p. 264) that made it unlikely for the city’s denizens to choose institutional psychiatric treatment for their mad relatives. In Chinese medical theory and popular conceptions alike, madness was “embedded within a complex web of somatic or cosmological disorders” (p 237). Unlike psychiatrists, who tended to trace madness to a specific locus in an individual body, most Chinese, Baum argues, made sense of madness within an individual’s familial or social context and within an even broader cosmological setting that included illness-causing ghosts. In such conceptions, insanity usually resulted from a “failed social transaction” rather than from the flawed physical or moral character of individuals. Beijing madmen were nonetheless doubly estranged, first from their family for not behaving normally, and then from society at large for not having a family. This chapter brings necessary complexity to Vivien Ng’s claim – made in Madness in Late Imperial China: From Illness to Deviance (University of Oklahoma Press, 1990) – that Chinese society had viewed insanity as a medical disorder, but increasingly treated it as a form of deviance starting in the eighteenth century. As categories of analysis, neither “illness” nor “deviance” can account for the intricate dynamics Baum has uncovered.
Chapter 2 concerns the ways in which Chinese intellectuals articulated madness to the issue of national modernity. They were often attracted to the scientific pretensions of Western psychiatry, especially its taxonomic efforts and its potential for instilling correct behavior into the population, but unlike many European and American intellectuals who saw the proliferation of nervous disorders as a product of modernity, Chinese intellectuals tended to portray insanity as a sign of China’s backwardness and a hindrance to modernizing ambitions. Baum finds such themes in a wide array of sources, from fictional short stories (including Lu Xun’s “Diary of a Madman” and Lao She’s “Sacrifice”) to the writings of psychologists like Gao Juefu (who translated the works of Freud into Chinese) through the ideology of the Kuomintang’s Mental Hygiene Movement in the late 1930s.
Chapter 4 discusses the emergence of medical entrepreneurs who sold treatments for insanity – from fast-acting secret pills to therapies for “nervous disorders” in specialized hospitals. Most of these treatments were “ideologically syncretic” (p. 152) mixes of psychiatric concepts with culturally Chinese views or practices. The emergence of these madness specialists signals both economic and discursive changes, more specifically a commercialization of cures for insanity and the spread of psychiatric knowledge among the educated population. This chapter also shows that madness sufferers and their families enjoyed a growing number of therapeutic choices for their condition.
Chapter 7 analyzes the tensions Baum found in her documents “between madness as a shared cultural construct and madness as a subjective experience” (p. 272). Just like the Chinese men and women studied by Arthur Kleinman in the 1970s and 1980s, the Chinese patients surveyed by Western psychiatrists in the 1930s expressed psychiatric distress chiefly in physical terms. This, Baum claims, made the “madness of the masses” objectively knowable (p. 283), allowing the psychiatrically untrained police force to recognize a person as insane in the name of common cultural orientations, even when that person protested to the contrary. By contrast, the “neurasthenic” role that some educated people lived and enacted – in part because they had embraced some Western psychological conceptions – was a subjective condition that did not easily lend itself to authoritative external statements. Both ways of being mad enabled different social roles and carried different social and therapeutic consequences for their sufferers.
An epilogue quickly surveys the problems that Western-trained psychiatrists encountered in Guangzhou and Shanghai in Republican times, and reaffirms the need to go beyond institutional and legal narratives to show how more discreet cultural and social orientations powerfully shape people’s experience of madness in any given society. Borrowing words from Robert Desjarlais’s work on Nepal, Baum concludes that these less visible epistemological formations often form “the very marrow of experience.” (pp. 311-12)
This dissertation will add complexity to the study of how modern disciplines like psychiatry integrate themselves in societies that already have their own complex epistemic traditions. It will further instruct readers about the intricate and multilevel dynamics by which specialized disciplinary knowledge is fractionally accepted, integrated, or rejected in various spheres of practice, and the consequent hybridity of modern epistemological formations, an aspect of this topic that Baum plans to develop in an eventual book.
Beijing Municipal Archives
Rockefeller Archive Center
Chinese-language newspapers from northern China
English-language medical periodicals
Chinese works of fiction
University of California, San Diego. 2013. 330pp. Primary Advisors: Joseph Esherick and Paul Pickowicz.
Image: “Old and New with the Insane in Peiping,” 1934. From: Rockefeller Archive Center, China Medical Board, Record Group P, Series 1048, Box 34, Folder 53.