Culture, Medicine and Psychiatry

, Volume 23, Issue 3, pp 349–380 | Cite as

Diagnosis Postponed: Shenjing Shuairuo and the Transformation of Psychiatry in Post-Mao China

  • Sing Lee
Article

Abstract

Building on Arthur Kleinman's seminal work in Hunan, this paper examines the social context in which shenjing shuairuo (neurasthenia), a ubiquitous psychiatric disease in China prior to 1980, is contested, marginalized, and reconstituted as the popular Western disease of depression among academic psychiatrists in urban China. It is argued that this dramatic change of diagnostic labelling is not only based on empirical evidence. Rather, it is also a product of interests and strategies that are themselves embedded in a confluence of historical, social, political, and economic forces. Specifically, China's open door policy, the hegemony of DSM discourse, the depoliticization of experience, and the transnational commercialization of suffering have all played a role in creating the new-found disease of depression. As a new social construct in China, depression may serve different social functions for different institutional groups, such as drug companies' marketing of new antidepressant therapy, and academic psychiatrists' effort to render the study of suicide more admissible to the state. Because of the government's budgetary limitations and drastic changes in health care financing, however, global diagnostic technology and markets for drugs merely reinforce people's markedly unequal access to health care, which is but one facet of the pervasive social inequity that is China nowadays.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. American Psychiatric Association 1980 Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Washington, DC: APA.Google Scholar
  2. 1987 Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R). Washington, DC: APA.Google Scholar
  3. 1991 DSM-IV Options Book: Work in Progress. Washington, DC: APA.Google Scholar
  4. 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC: APA.Google Scholar
  5. Avorn, J., M. Chen and R. Hartley 1982 Scientific versus Commercial Sources of Influence on the Prescribing Behaviour of Physicians. American Journal of Medicine 73: 4–8.Google Scholar
  6. Beard, G.M. 1869 Neurasthenia or Nervous Exhaustion. Boston Medical and Surgical Journal 3: 217–221.Google Scholar
  7. Breggin, R. and G.R. Breggin 1994 Talking back to Prozac. New York: St. Martin's Paperbacks.Google Scholar
  8. Chang, J. 1991 Wild Swans: Three Daughters of China. New York: Anchor Books, Doubleday.Google Scholar
  9. Cheng, T.A. 1995 Mental Illness and Suicide: A Case-Control Study in East Taiwan. Archives of General Psychiatry 52: 594–603.Google Scholar
  10. Cheung, P. 1991 Adult Psychiatric Epidemiology in China in the 80s. Culture, Medicine and Psychiatry 15: 479–496.Google Scholar
  11. Chinese Medical Association 1990 Chinese Classification of Mental Disorders, second edition. Hunan Medical University (in Chinese).Google Scholar
  12. Chinese Medical Association and Nanjing Medical University 1995 Chinese Classification of Mental Disorders, second edition, revised (CCMD-2-R). Nanjing: Dong Nan University Press (in Chinese).Google Scholar
  13. Cook, R. 1997 A New Prozac Nation. Postmagazine (October 26): 12–15.Google Scholar
  14. Cooper, J.E., R.E. Kendell, B.J. Gurland, L. Sharpe, J.R.M. Copeland and R. Simon 1972 Psychiatric Diagnosis in New York and London. Oxford: Maudsley Monograph No. 20.Google Scholar
  15. Cooper, J.E. and N. Sartorius (eds.) 1996 Mental Disorders in China. London: Gaskell.Google Scholar
  16. Da, D. 1993 A Preliminary Inquiry into Suicide in China. In: Social Observation in Special Zone. J. Peng, ed. pp. 492–510. Shenzhen: Haitian Publishing House (in Chinese).Google Scholar
  17. Ding, B.K., X.X. Qin, X.B. Li, Y. Wang, H.Y. Xue and X.L. Liu 1998 A Double Blind Controlled Study of Depression Treated with Sertraline and Fluoxetine. Journal of Clinical Psychological Medicine 8: 72–73 (in Chinese).Google Scholar
  18. Fairbank, J.K. 1992 China – A New History. Cambridge: Belknap, Harvard.Google Scholar
  19. Feng, J.C. 1996 Ten Years of Madness: Oral Histories of China's Cultural Revolution. San Francisco: China Books and Periodicals, Inc.Google Scholar
  20. Foucault, M. 1980 Power and Knowledge: Selected Interviews and Other Writings. New York: Pantheon.Google Scholar
  21. Gan, Y.F., Y.Y Yang, L. Xu and B.H. Ji 1998 A Preliminary Study of the Diagnosis and Treatment of Depressive Episodes in Primary Care. Chinese Mental Health Journal 12: 15–16 (in Chinese).Google Scholar
  22. Gelder, M., D. Gath, R. Mayou and P. Cowen 1996 Oxford Textbook of Psychiatry, third edition. Oxford: Oxford University Press.Google Scholar
  23. Greenberg: E., L.E. Stiglin, S.N. Finkelstein and E.R. Berndt 1993 Depression: A Neglected Major Illness. Journal of Clinical Psychiatry 54: 419–424.Google Scholar
  24. He, Z.X. 1996 Suicide and Life. Guangzhou: Guangzhou Publishing House (in Chinese).Google Scholar
  25. Henderson, G. 1990 Increased Inequality in Health Care. In China on the Eve of Tiananmen: The Impact of Reform. D. Davis and E. Vogel, eds. pp. 263–282. Cambridge, MA: Harvard University Press.Google Scholar
  26. Hong, B.S. 1996 Baiyoujie in the Treatment of Students' Emotions Causing School Refusal. Paper presented in the National Conference on Schizophrenia and Psychopharmacology, September 16–19, 1996, Hangzhou, China.Google Scholar
  27. Hsiao, W.C.L. 1995 The Chinese Health Care System: Lessons for Other Nations. Social Science and Medicine 41: 1047–1055.Google Scholar
  28. Ikels, C. 1996 The Return of the God of Wealth: The Transition to a Market Economy in Urban China. Stanford: Stanford University Press.Google Scholar
  29. Ji, W.H. and S.T. Zhai 1995 An Analysis of 3514 Calls to a Crisis Intervention Hotline. Journal of Clinical Psychological Medicine 5: 74–75 (in Chinese).Google Scholar
  30. Jin, J. 1996 The Temple of Memories. Stanford: Stanford University Press.Google Scholar
  31. Kessler, R.C., K.A. McGonagle, S. Zhao, C.B. Nelson, M. Hughes, S. Eshleman, H.U. Wittchen and K.S. Kendler 1994 Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry 51: 8–19.Google Scholar
  32. Kirk, S.A. and Kutchins, H. 1992 The Selling of DSM: the Rhetoric of Science in Psychiatry. New York: A. de Gruyter.Google Scholar
  33. Kleinman, A. 1982 Neurasthenia and Depression: A Study of Somatization and Culture in China. Culture, Medicine and Psychiatry 6: 117–190.Google Scholar
  34. 1986 Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China. New Haven: Yale University Press.Google Scholar
  35. 1988 Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: Free Press.Google Scholar
  36. Kleinman, A. and J. Kleinman 1995 Remembering the Cultural Revolution: Alienating Pains and the Pain of Alienation/ Transformation. In: Chinese Society and Mental Health. W.S. Tseng, T.Y. Lin and E.K. Yeh, eds. pp. 141–155. Hong Kong: Oxford University Press.Google Scholar
  37. 1996 The Appeal of Experience; the Dismay of Images: Cultural Appropriation of Suffering in our Times. Daedalus 125: 1–23.Google Scholar
  38. Kleinman, A. and D. Mechanic 1980 Mental Illness and Psychosocial Aspects of Medical Problems in China. In: Normal and Abnormal Behaviour in Chinese Culture. A. Kleinman and T.Y. Lin, eds. pp. 331–356. Dordrecht: D. Reidel Publishing Company.Google Scholar
  39. Lee, S. 1994 The Vicissitudes of Neurasthenia in Chinese Societies: Where Will it Go from the ICD-10? Transcultural Psychiatric Research Review 31: 153–172.Google Scholar
  40. 1996 Cultures in Psychiatric Nosology: the CCMD-2-R and International Classification of Mental Disorders. Culture, Medicine and Psychiatry 20: 421–472.Google Scholar
  41. 1998 Estranged Bodies, Simulated Harmony, and Misplaced Cultures: Neurasthenia in Contemporary Chinese Society. Psychosomatic Medicine 60: 448–457.Google Scholar
  42. Lee, S. and A. Kleinman 1997 Mental Illness and Social Change in China. Harvard Review of Psychiatry 5: 43–46.Google Scholar
  43. In press: Suicide as resistance in Chinese society. In: E. Perry and M. Selden eds. Chinese Society: Change, Conflict and Resistance. London: Routledge.Google Scholar
  44. Lester, D. 1989 Suicide from a Sociological Perspective. Springfield: Thomas Books.Google Scholar
  45. Li, Z.S. 1994 The Private Life of Chairman Mao, pp. 109–110. London: Chatto and Windus.Google Scholar
  46. Lin, Y.H. 1990 The Weight of Mount Tai: Patterns of Suicide in Traditional Chinese History and Culture. PhD Thesis, The University of Wisconsin, Madison, U.S.A.Google Scholar
  47. Liu, X.H. 1982 Neurasthenia. In: Chinese Medical Encyclopedia – Psychiatry, pp. 75–76. Shanghai: Shanghai Publishing House of Science and Technology (in Chinese).Google Scholar
  48. Liu, Z.H., Q. Yang, M.S. Huang, M.Z. Xiang, M.D. Xu, Y.H. Zhang, Y.Y. Du, G.C. Hu and L. Ye 1992 Clinical Research on Neurosis – a Summary Report. Clinical Research on Neurosis, pp. 3–4. Department of Psychiatry, West China University of Medical Sciences, Sichuan, China (in Chinese).Google Scholar
  49. Lu, Y.W. and Q.J. Shen 1995 From DSM-III-R to DSM-IV. Foreign Medicine (Psychiatry) 22: 1–5 (in Chinese).Google Scholar
  50. Murray, C.J.L. and Lopez, A.D. 1996 Global Health Statistics: A Compendium of Incidence, Prevalence, and Mortality Estimates for over 200 Conditions. Cambridge: Harvard University Press.Google Scholar
  51. Pearson, V. 1991 The Development of Modern Psychiatric Services in China 1891–1949. History of Psychiatry ii: 133–147.Google Scholar
  52. Phillips, M.R. 1998 The Transformation of China's Mental Health Services. The China Journal 39: 1–36.Google Scholar
  53. Sartorius, N. 1997 Diagnosis and Classification of Neurasthenia. In: Basic and Clinical Science of Mental and Addictive Disorders. L.L. Judd, B. Saletu and V. Filip, eds. pp. 1–5. Basel: Karger, Bibliotheca Psychiatrica. No. 167.Google Scholar
  54. Scheper-Hughes, N. and M.M. Lock 1987 The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly 1: 6–41.Google Scholar
  55. Schwarcz, V. 1996 The Pane of Sorrow: Public Uses of Personal Grief in Modern China. Daedalus 125: 119–148.Google Scholar
  56. Shen Q.J., S. Lee and H. Gao 1998 Rethinking the Epidemiology of Affective Disorders in China. Chinese Journal of Psychiatry 31: 240–242 (in Chinese).Google Scholar
  57. Tian, Z.W., H. Chen, X.Z. Zhang and J.D. Hou 1997 Rediagnosis of Neurosis at a General Hospital. Health Psychology 5: 170–171 (in Chinese).Google Scholar
  58. Tu, M.W. 1996 Destructive Will and Ideological Holocaust: Maoism as a Source of Social Suffering in China. Daedalus 125: 149–180.Google Scholar
  59. Walker, S. 1996 A Dose of Insanity: Mind, Medicine, and Misdiagnosis. New York: Wiley.Google Scholar
  60. Wang, J. 1996 High Culture Fever: Politics, Aesthetics, and Ideology in Deng's China. Berkeley: University of California Press.Google Scholar
  61. Wang, S.G. 1995 The Politics of Private Time: Changing Leisure Patterns in Urban China. In Urban Spaces in Contemporary China – the Potential for Autonomy and Community in post-Mao China. D.S. Davis, R. Kraus, B. Naughton and E.J. Perry, eds. pp. 149–172. New York: Woodrow Wilson International Center for Scholars.Google Scholar
  62. Wang, X.L., L. Li, Z.C. Wang and H.D. Xu 1997 A Survey of Current Uses of Antidepressants. Health Psychology 5: 69–71 (in Chinese).Google Scholar
  63. The World Bank 1997 Financing Health Care. Washington, DC: World Bank.Google Scholar
  64. World Health Organization 1992 The ICD-10 Classification of Mental and Behaviour Disorders – Clinical Descriptions and Diagnostic Guidelines. Geneva: W.H.O.Google Scholar
  65. 1995 World Health Report 1995. Geneva: W.H.O.Google Scholar
  66. Xu, S.H., Z.X. Gao and B.X. Xu 1993 The Application of the Diagnostic Criteria of the Chinese Classification of Mental Disorders. Chinese Journal of Nervous and Mental Diseases 19: 59–60 (in Chinese).Google Scholar
  67. Yan, H.Q. 1989 The Necessity of Retaining the Diagnostic Concept of Neurasthenia. Culture, Medicine and Psychiatry 13: 139–145.Google Scholar
  68. Yan, Y.Y. 1996 The Flow of Gifts. Stanford: Stanford University Press.Google Scholar
  69. Young, A. 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. New Jersey: Princeton University Press.Google Scholar
  70. Young, D. 1989 Chinese Diagnostic Criteria and Case Examples of Mental Disorders. Hunan: Hunan University Press (in Chinese).Google Scholar
  71. 1997 Prozac in the Treatment of Neurasthenia: A Clinical Update. Paper presented at a dinner symposium “Experiencing Prozac: A Decade of Progress in Mind,” during the Regional Meeting of theWorld Psychiatric Association, Beijing, China, October 7–10, 1997.Google Scholar
  72. Zhai, S.T. 1996 Suicide and Depression. Paper presented at the third national conference on Crisis Intervention and Prevention of Suicide, October 22–25, 1996, Guiyang, China.Google Scholar
  73. 1997a How Mild Depression Can be Recognized. Sichuan Mental Health 10: 204–207 (in Chinese).Google Scholar
  74. 1997b Crisis Intervention and the Prevention of Suicide. Beijing: Publishing House of People's Health (in Chinese).Google Scholar
  75. Zhang, J.Z. 1997 The Urgent Need to Increase General Hospital Doctors' Ability to Recognize Depression. Chinese Journal of Psychiatry 30: 195 (in Chinese).Google Scholar
  76. Zhang, M.Y. 1986 The Diagnostic Problem of Neurasthenia. Chinese Journal of Neurology and Psychiatry 19: 261–263 (in Chinese).Google Scholar
  77. 1989 The Diagnosis and Phenomenology of Neurasthenia: A Shanghai Study. Culture, Medicine and Psychiatry 13: 147–161.Google Scholar
  78. Zhang, X.L. 1994 Grass Soup. Boston: Godine.Google Scholar
  79. Zhang, B.Y., J.W. Dong, X.R. Xu, M. Ao, and P. Wong 1990 Telephone Psychological Consultation – a Summary of 100 Days of “Hopeful Hotline” Service. Chinese Mental Health Journal 4: 177–180 (in Chinese).Google Scholar
  80. Zhang, M.D., J.L. Ji, Z.M. Chu, H.J. Yan, S.H. Wong, Z. Lu, H.Y. Zhang, X.J. Cui and P.F. Yao 1995 The Shanghai Mental Health Hotline: A Report of 2144 Callers in a Year. Journal of Clinical Psychological Medicine 5: 195–197 (in Chinese).Google Scholar
  81. Zhang, W.X., Y.C. Shen, S.R. Li et al. 1998 Epidemiological Investigation on Mental Disorders in 7 Areas of China. Chinese Journal of Psychiatry 31: 69–71 (in Chinese).Google Scholar
  82. Zheng, Y.P., K.M. Lin, D. Takeuchi, K.S. Kurasaki, Y.X. Wang and F. Cheung 1997 An Epidemiological Study of Neurasthenia in Chinese-Americans in Los Angeles. Comprehensive Psychiatry 38: 249–259.Google Scholar
  83. Zhou, J.H. 1988 A Probe into theMentality of Sixty-five Rural YoungWomen Giving Birth to Baby Girls. Chinese Sociology and Anthropology (Journal of Translations) 20: 93–102.Google Scholar
  84. Zhou, X.K. 1996 How the Farmers Changed China: Power of the People. Colorado: Westview Press.Google Scholar
  85. Zimmerman, M. 1988 Why are We Rushing to Publish DSM-IV? Archives of General Psychiatry 45: 1135–1138.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Sing Lee
    • 1
  1. 1.Department of PsychiatryThe Chinese University of Hong KongHong Kong, P.R.C

Personalised recommendations