Doing Research on the History of Madness in China
The tight connection between Western Imperialism and philanthropic undertakings is widely recognized. I shall argue that the Asylum for the Insane in Canton was a striking symptom of the imperialistic attitude, an attitude which could be termed one of 'double-intrusion' because of the obvious attempt to teach the Chinese what is 'normal' and what is 'abnormal'.By Angelika C. Messner
Canton 1898: The medical missionary John Glasgow Kerr (1824-1901) establishes the first 'Asylum for the Insane' that has ever existed in Chinese history. One of the main purposes of this asylum was, in the words of Kerr, 'the change [of the insane] from the treatment and influences of heathen relatives.' ('The 'Refuge for the Insane', Canton', The China Medical Missionary Journal 12, 4 (1898), p. 178).Western psychiatry, an invention of nineteenth century Europe, is well known as an extraordinarily controversial field of study. The view of psychiatry as representing essentially the history of humanism (Zilboorg, 1967) stands in direct opposition to the view of psychiatry as representing one constituent part in the process of developing industrialization and technology in Europe and North America since the eighteenth century (Foucault, 1961). The latter approach is fundamentally based on the critique of Modernity (Enlightenment), which focuses on the dichotomy between ratio and madness. This view led to the fact that different 'expel-mechanisms' (appearing first around the eighteenth century) aimed at the elimination of madness. Notions entertained by medical missionaries on the relatively infrequent prevalence of insanity in China - when compared to Europe and North America - which they attributed to the 'phlegmatic temperament of the Chinese' and the generally quiet lifestyle in China, should be read merely in the sense of their own representations. Such notions betray their mostly affirmative support for the project of 'modernity', including the generally attempted 'cultural hegemony' on the part of Western countries (Said 1979) against the backdrop of evolutionary, biological, and racist patterns.
Idiots
Examinations of Chinese medical discourse in late imperial China indicate many heterogeneous notions, explanations and methods of treatments on dian, kuang, xian, and feng. Whereas the first three terms can be traced back to the Wushier bingfang of the Mawangdui-corpus (300-200 BC) and the Huangdi neijing (200 BC - AD 800), feng does not appear until the Qing medical discourse (where it indicates an unfathomable form of madness, but also leprosy or rabid dog). This term also appears in the judicial discourse of the Qing era, where it indicates a particularly threatening state of insanity, which demands special attention from family and village community. Whereas the medical discourse informs us of the possession by demons or the prevalence of wind in different organ systems, both of which have to be cast out, the judicial discourse provides no explanation. Judicial discourse on madness in Chinese history shows that since early times (Zhouli) it has been a kind of weakness afflicting the very young or old, the 'idiots and imbeciles'. Such persons were granted special consideration in law until the turn of the twentieth century and were judged as having 'lessened criminal liability' (Bünger 1950:6). Medical discourse in late imperial China shows two dominant patterns of explication: possession of demons and an explanation within the 'medicine of systematic correspondence'. Many texts indicate that families accepted any form of explication, as long as the doctor or shaman called could succeed in healing. The central concept of madness within the medicine of systematic correspondence was of disharmony (madness due to yinyang imbalance, disturbances in body fluids connected to qi-disturbances inside the body, e.g. qi reversal, states of repletion (shi) and depletion (xu), and disharmony of emotional states). The most crucial point in this discourse on madness is that although madness was also described in terms of 'mental' symptoms and 'mental' illness throughout, these terms were by no means perceived as forming a single and separate category standing in opposition to a single physical category. This is also evidenced by various theories appearing in late imperial China, such as the prominent role of the study of heat (heat as the origin of all diseases, and hence also for madness) as well as different attempts to locate the cause of madness (kuang for instance) as 'fire on the yangming meridian', or on the spleen-organ system, or on the liver and gall bladder, or on the heart, where the accumulation of sputum or wind were seen as causes, as well as on sudden frights, and the like. Even such approaches which attempted (since the seventeenth century) to subsume different forms of madness under the category 'shenbing' - indicating a conceptual extraction of madness from other illnesses - remained fundamentally within the general systemic approach both in diagnosis and treatment. Since the two fundamentally interwoven spheres were not divided and cannot simply be reduced by an exclusion of a single element from the whole, madness tended to figure rather as a 'quantitative' alteration of normal health; in this, madness did not differ from other illnesses and was not considered a different state, which would imply a fundamental 'qualitative' difference between insanity and health. The latter general conception of disease appeared at the beginning of the nineteenth century in Europe; and although Wang Qingren (1831) first mentioned the idea of the brain as location for the 'outbreak of epilepsy (xian)' (whether influenced by Western thought or not), this viewpoint did not achieve any significance within general medical discourse on madness until the 1930s.
Paradox
The focus on the brain as locus for the outbreak of madness was the main challenge to the Chinese explanation of madness posed by Western medicine - and not only to the Chinese medical discourse on madness, but also for philosophy, because now the brain and not the heart had to be perceived as the location for thinking. Another challenge was posed at the socio-political level: the institutionalized care of the insane. The question as to why Western-style psychiatry did not take root in China (Lin 1985) can be answered at different levels: although the involvement of China in war after war can be seen as an important hindrance, the historically rooted cultural perception of 'normality and abnormality' seems to have been much more important. Starting from the results on the Western history of madness, Chinese history shows at least two paradoxes. On the one hand, since early times within the medical discourse on madness, madness has been considered to be just one illness among others. However, this is not to be confused with the developing 'medicalization' (Foucault 1963) - a complex process which gradually subdues a population to the power of the physician and the state (Foucault determined the beginning of this process in Europe to be at the turn of the nineteenth century). On the other hand, judicial discourse on madness in China shows that since early times it has been considered a kind of weakness. In the West, a similar special concern for the insane is not paid before the nineteenth century. This is not to be confused with the special attention given to it within the Chinese context mentioned above: while in the West - based on the 'qualitative' conception of madness - medical authority became juridical authority. At the same time, this was never true of China, where the family remained the main carer of any of its afflicted members. Perhaps more than in other fields of historical research, explorations into the history of madness in China demands a highly reflective and clearly formulated methodological basis. Mindful of the fundamental challenge posed by any attempt to privilege the norms of agency and responsibility (based on Foucaultian theory), we should nevertheless be aware that Foucaultian results reflect a European Weltanschauung and are based on the given 'dichotomy between ratio and irratio', which cannot be applied sui generis as a heuristic concept to the Chinese history of madness.
Dr Angelika C. Messner is attached to the Institute for Chinese Studies, at the Christian-Albrechts-University in Kiel, Germany. She can be reached at messner@sino.uni-kiel.de.