Organizers: Hugh L. Shapiro, University of Nevada, Reno; Nancy N. Chen,
University of California, Santa Cruz
Chair: Judith Farquhar, University of North Carolina, Chapel Hill
Discussant: Arthur Kleinman, Harvard University/Harvard Medical School
This panel asks two questions about psychiatry in China: first, how does social transformation influence the experience of disease; second, what forces within Chinese society inform the practice of psychiatry? The panel addresses the changing context in which psychiatry has been practiced: ranging from the late nineteenth-century introduction of biomedical specialty, the psychobiology of the 1930s, the use of Soviet forms in the 1950s, to contemporary psychiatric practice which includes international diagnostic categories, psychopharmaceuticals, and culture-bound syndromes that are recognized, adopted, contested. Changing ideologies and notions of mental health specifically will be examined.
Shapiro's paper situates what was understood as "female madness" during the Republican era along a spectrum of self-injury, problematizing this phenomenon as a strategy of protest. Chen's paper analyzes the cultural context of mental health care in contemporary China, emphasizing the role of family members and state institutions in the experience of mental illness and the management of its care. Lee's paper captures the epistemological and social forces that have transformed what had been perhaps the most stable diagnostic category in China this century, neurasthenia. Phillips' paper elucidates the impact of the economic reforms on mental health services while showing how concomitant social change transforms the epidemiology of mental illness. Judith Farquhar, author of Knowing Practice, is Chair. Arthur Kleinman, the preeminent authority on psychiatry in China, is Discussant.
Bringing together psychiatrists with social scientists, this panel aims to link changes in Chinese psychiatry not only to sociocultural context but also to global agencies and categories.
Swallowing Needles, Swallowing Gold: Female Madness as Self-Mutilation and
Protest in Early Twentieth-Century China
Hugh L. Shapiro, University of Nevada, Reno
This paper attempts to show that the problemization of "female madness" by Republican era (1912-1949) psychiatry brings to light a strategy of protest among women in Beijing and its hinterland. To this end, three inter-related arguments are developed. First, Chinese psychiatrists of the period traced female madness to the stress of the traditional marriage system; suggesting an etiological shift away from the late imperial emphasis on menstrual function and on such stimuli as anger and fright. Second, this clinical preoccupation chronicled, in detailed medical case histories, behavior that might be construed as protest, in a region of north China that lacked the institutions of marriage avoidance witnessed, for instance, in the Canton Delta. In addition to flight, the behavior of escape included self-injury, of which madness was one articulation. This raises the third point.
Destruction of the body was a principal form of female resistance, a response dictated by subjective limitations. At one pole was suicide, committed often by swallowing household items (needles, match-heads, opium, gold). What remained were degrees of self-pollution: fasting, sleep deprivation, illness, self-mutilation, and madness.
This paper aims to make some headway on the complex problem of intention: whether women manifesting what was then understood as the symptomatology of insanity, in the context of rejecting marriage, did so consciously or unconsciously; whether this behavior was a mindful manipulation of widely recognized symbols of subversion, or as James Scott suggests, a form of protest so embedded in cultural practice as to be subconscious.<
Diagnosis
Postponed: Shenjing Shuairuo and the Transformation of Psychiatry in Contemporary
China
Sing Lee, Harvard University
Shenjing shuairuo (SJSR) used to be the most common diagnostic category for non-psychotic mental disorders in China, and continues to be a highly popular lay category of suffering among Chinese people. But substantial evidence indicates that this ubiquitous disease condition has languished dramatically, ostensibly after the 1982 publication of Arthur Kleinman's seminal study of 100 SJSR patients in Hunan, when he concluded that 87 percent of them suffered from major depression and responded favorably to tricyclic pharmacotherapy. Intended or not, this study created a nosological crisis among Chinese psychiatrists. Although depression was previously unfamiliar to them and considered very rare among Chinese people, they have increasingly conformed, in clinical practice as well as in research, to American psychiatrists' epistemological view that SJSR is but a form of atypical or misdiagnosed depression. This dramatic change reflects, inter alia, the hegemony of American nosology and China's increased openness to the international world after the Cultural Revolution was officially over. It is also reinforced by the rapid growth of the Chinese pharmaceutical industry and the resultant economic forces which, by appropriating SJSR as a pharmaco-responsive form of biological depression, privilege antidepressant therapy above tackling the social sources of suffering and powerlessness. From a sociosomatic perspective, the transformation of SJSR from a disorder of somatization into a disorder of affect mirrors China's increasingly capitalist modes of production according to which manual and mental workers are divided and hierarchized.
The Influence of Social, Political, and Economic Factors on the Evolution of
Mental Health Services in China
Michael R. Phillips, Beijing Hui Long Guan Hospital
The transformation of China's mental health care system during the economic reform era provides a dramatic example of how social, political, and economic factors affect the evolution of mental health services. Social changes have increased the demand for specific types of services: counseling services for persons with life crises, geriatric services, drug and alcohol treatment services, children's services, and, most importantly, inexpensive long-stay institutional care for persons with chronic mental illness whose families are unable or unwilling to care for them. But the dramatic reduction of government support for welfare services (including health services) that occurred as part of the development of the "socialist market economy" has forced providers to focus on expanding profit-making inpatient services rather than on developing the high-quality outpatient and community services that are most needed. Moreover, the fragmented administration of mental health services across multiple industries at multiple administrative levels makes it extremely difficult to coordinate the development of services and to establish uniform standards of care. It is, therefore, likely that the costs of care will continue to spiral upwards, the huge regional disparities in services will increase, access to services will become more and more inequitable, and the burden of mental illness in the community will rise.