Inventing madness

Inventing madness

 Office of the Dean November 6, 2018

New book by UCI historian traces how madness became mental illness in modern China

How and why did understandings of “madness” change in China? In her new book, The Invention of Madness: State, Society, and the Insane in Modern China, Emily Baum, associate professor of history at the University of California, Irvine, traces a genealogy of insanity in early twentieth-century China, revealing the complex ways that “madness” was transformed in the Chinese imagination into “mental illness.” Through archival research, including police records, Baum introduces readers to patients of insane asylums, Chinese beliefs about insanity and wellness, and more. Below, Baum discusses the book in conversation with Jeffrey Wasserstrom, UCI Chancellor’s Professor of history.

JW: One attraction of your book is that, along with arguments, you include details about some people who ended up in asylums or whose relatives were placed in them early in the 1900s. Was it difficult to find the sorts of materials needed to allow you to bring flesh-and-blood individuals into the project?

EB: Much of my research was based on police files held at the municipal archives in Beijing. In the early twentieth century, the Beijing public asylum was administered by the municipal police force, and they tended to take very detailed records about the people they institutionalized – records that included names, ages, family backgrounds, occupations, and oral testimonies from neighbors, family members, and sometimes even the mentally ill themselves. Although these records were, at least to some degree, altered by the functionaries who transcribed them, they still shed light on a whole group of individuals who would otherwise have been completely lost to history.

What was particularly fascinating about these police files was that they gave voice to some of the most marginalized people in urban China – the poor, the illiterate, and the dispossessed. In their oral testimonies, these people often spoke quite passionately about the circumstances that had led to their incarceration. One example I give in the book centers on a Manchu functionary who had recently been laid off from his job. He was destitute, freezing, and entirely alone, and one day he decided to throw himself at the mercy of the police. In his testimony, he explained that he experienced intermittent insanity – which I suspect was caused by poor diet, exposure, and stress – and asked to be admitted to the asylum, where he would be treated, fed, and given a warm place to stay. Although the case is fairly short, these sorts of details go a long way toward humanizing otherwise “voiceless” individuals. While they paint a vivid picture of the type of suffering many people experienced at the time, they also highlight the particular strategies that they used to survive. Taken cumulatively, it’s possible to gain a much deeper appreciation of what everyday Beijing society was like at the turn of the twentieth century.

JW: What do you think someone unfamiliar with Chinese history would find most surprising about Beijing asylums of the early twentieth century--or about how mental illness was understood or people deemed as being "mad" were viewed and treated?

EB: There’s quite a lot that I think readers would find surprising. One point I like to bring up is that, prior to the twentieth century, the Chinese didn’t think of the brain as playing an important role in bodily functioning – and when it came to madness, they didn’t think that the brain played any role whatsoever! For most practitioners of medicine in China, madness was believed to be caused by a wide variety of influences, be they physical, emotional, psychological, or even supernatural. But the brain almost never factored in. It wasn’t until the arrival of Western physicians and missionaries in the late nineteenth century that madness tentatively began to be localized in the brain, though even then, Chinese medicine practitioners were loath to accept this idea uncritically as “truth.”

On that note, moreover, readers might also be interested to learn about the strange types of treatments that were used on the mentally ill at the turn of the twentieth century. In China, physicians often attributed the onset of madness to an accumulation of mucous in the chest, so they often tried to treat the insane by forcing them to vomit. Western physicians, meanwhile, didn’t possess any better insights into curing the disorder. Anti-depressants and anti-psychotic drugs were still decades away from being developed, and even the lobotomy – previously thought about as a miracle treatment for mood and personality disorders – had yet to be “discovered.” Instead, most Western treatments at the time would look positively foreign to contemporary eyes: protracted narcosis (the practice of putting the insane to sleep for prolonged periods of time), hydrotherapy (dunking the insane in steamy baths or wrapping them in cold towels), and occupational therapy (putting the insane to work). At Western-managed hospitals in China, these methods were hailed as the most modern and humane treatments available.

JW: What about China specialists? Do you have a sense of what part of your findings seem most unexpected to them?

EB: When China specialists talk about mental illness, they tend to throw around the word “stigma” quite a bit – as in, mental illness is highly stigmatized in China and people are therefore reluctant to talk about it or seek treatment. While that’s certainly the case today (at least in less developed areas), my research shows that the widespread stigmatization of the insane is actually a somewhat recent phenomenon. While I by no means romanticize the treatment of the mentally ill in late imperial China, medical and legal records do show that such people weren’t automatically treated as outcasts. More commonly, and provided they weren’t violent, most mentally ill people continued to participate in family and community life to the extent that they were able. My hypothesis, then, is that mental illness only came to be known as a definitively stigmatized condition following the arrival of Western missionaries in the nineteenth century, who either misinterpreted or purposely exaggerated the medical, political, and legal mechanisms that were used to keep the insane from disrupting the social order.

JW: When China specialists hear that your book is about ideas relating to madness and the treatment of those deemed "mad" in early twentieth-century Beijing, I bet one writer whose name pops into their mind is Lu Xun, due to his authorship of "Diary of a Madman," still one of the most famous Chinese short stories ever published. Scholars in the humanities who were trained in the West in the 1980s, as I was, no matter what country they focus on, are likely to think of someone else, Michel Foucault, the French theorist whose best known books include Madness and Civilization. How do you deal with Lu Xun in your book?

EB: Both Lu Xun and Michel Foucault come up in several contexts throughout the book. For readers of this Q&A who are unfamiliar with Lu Xun, his short story “Diary of Madman,” which was published in 1918, is often thought about as the first truly modern piece of writing in China. “Diary of a Madman” tells the story of a man who, having convinced himself that his relatives are cannibals and are preparing to eat his flesh, slowly descends into lunacy. By the end of the story, readers come to realize that the “cannibalism” to which he refers is in fact a metaphor for the man-eat-man nature of Chinese society – and that the madman, by recognizing the cannibalistic impulses of his fellow men, might actually be sane.

Most scholars of China who have written on “Diary of a Madman” use the story to explore the iconoclasm of the May Fourth era or the shift to vernacular language in modern Chinese literature. Although there’s some of that in my book, too, I mainly look at “Diary of a Madman” from a more literal vantage point. Throughout the story, Lu Xun discusses the ways in which the madman was treated – both medically and morally – by his neighbors, family, and physicians. Given Lu Xun’s own brief medical training, I suspect that much of what he describes was quite reflective of contemporary social and therapeutic trends. In other words, rather than interpreting “Diary of a Madman” metaphorically, I approach it as a literal lens onto the everyday treatment of the insane.

JW: What about Foucault?

EB: Foucault is obviously a figure that looms large in global histories of madness – often because historians are trying to disprove or debunk him! One of Foucault’s major claims is that there was a “Great Confinement” of the insane that started in Europe in the mid-seventeenth century. In tandem with the rise of political absolutism, he claims, more and more people were characterized as “mad” and confined to public institutions – often simply for having affronted the social order through activities like begging or prostitution. Setting aside the historical accuracy of such a claim, I do entertain the possibility that similar impulses occurred in early twentieth-century China. Following the fall of the Qing dynasty and the expansion of the police force in Beijing, there was, for the first time, a broad effort on the part of the municipality to identify and incarcerate individuals who refused to abide by certain social norms. However, this effort did not come close to Foucault’s imagined “Great Confinement,” mainly because the police lacked the resources they would have needed to institutionalize large swaths of the population. What happened, instead, was that most of these individuals were removed from the city and sent to live with their families in their natal homes.

More generally, though, one of the things that’s so brilliant about Foucault was his ability to historicize so many of the concepts that we take for granted today, such as the very idea of “mental illness” itself. Borrowing the language of Foucault, one of the main goals of my book was to trace a “genealogy” of the mentally ill in modern China. Similar to the Western world, the idea that someone could be mentally ill (rather than simply “have” mental illness) is a comparatively recent notion, and the complex matrix of institutions, treatments, and discourses that reinforced such an identity arose in response to several interlocking political, economic, and intellectual trends. In other words, “mental illness” is a highly contextual condition, and it’s therefore possible to trace its birth and evolution over time. In that sense, I was very much inspired by Foucault’s writings on sexuality and taxonomy, alongside his writings on madness more specifically.

JW: What is the best memory you have of your time digging for archival evidence in China and what is your worst?

EB: Most people are already aware that archival access in China is quite “delicate,” for lack of a better word. I don’t think I know a single historian who hasn’t been denied entrance to an archive or refused access to a document. For me, this came quite early in the process, when I tried to look at medical records from the neuropsychiatric ward of the Peking Union Medical College, a Western-style teaching hospital that was established in Beijing in the 1910s. While these records were open to historians not so long ago, they have somewhat recently been shut down and I was never able to view them. To this day, I still wonder how my book would have been different had I been able to look through this trove of materials.

Nevertheless, I was fortunate to have had access to the Beijing police files, which, as I’ve mentioned above, were fascinating in their own way. Probably my best memories were the times when the file unfolded like a mystery – when the police were tracking down witnesses and family members in an effort to piece together a complex case. One lengthy example that’s featured in the book examines an incident where a husband and wife are found screaming at one another in the street. The wife accuses her husband of physical abuse, the husband accuses his wife of being insane, and the police are forced to determine which party was telling the truth. It’s a situation that one could imagine unfolding in any geographical context, but what made it so fascinating was the way in which the police attempted to adjudicate and resolve it. I won’t spoil the ending, but suffice it to say, case files such as these do much more than shed light on the condition of madness; they also reveal much about patriarchal politics, gender roles, and new policing technologies in the modern era.

To learn more about The Invention of Madness, please visit,