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In the spirit of Paul Unschuld and Nathan Sivin, who have both meticulously documented and translated the traditional Chinese medical canon from its first articulation in the Huangdi neijing, Fabien Simonis presents a stunningly comprehensive look at changing conceptions of madness throughout Chinese history. Simonis organizes his dissertation into two main sections. In the first, his focus is on the multiplicity of ways in which Chinese physicians have understood and treated madness, from the Song dynasty to the late Qing. Rather than attempting to identify one overarching understanding of what it means to be mad, Simonis aims to highlight the “artificial unity” of madness (p. 9); in other words, he defines the nebulous subject of madness as the referents and performances that counted as mad in their specific historical context. As a result of his decision to avoid pinning down a single ontological subject, Simonis is able to chart the changing scripts by which Chinese doctors spoke of madness throughout time.
Chapters three and four best exemplify the historical vicissitudes of Chinese medical approaches to madness. Between the third and tenth centuries, madness was generally spoken of as a Wind illness. During the Northern Song, increased opportunities for publishing medical tracts and widespread medical activism led to the creation of a common pool of medical knowledge, which facilitated the spread of new understandings of insanity. As Simonis convincingly argues, the common recommendation to use emetics in order to treat Wind illnesses signaled the emergence of a new medical etiology which upheld mucus as the root of madness. The mucus etiology was adopted by such eminent physicians as Zhang Congzheng, who treated madness through emetics and purgatives as a way of expelling the unhealthy qi that was thought to reside in the sputum. In chapter five, Simonis expands on the increasingly widespread adoption of the mucus etiology through his description of the Zhu Zhenheng (a.k.a. Danxi) corpus of the fourteenth century. Although Simonis makes clear that the mucus etiology had become dominant by the sixteenth century, he also emphasizes the fact that most physicians employed syncretic approaches to treating madness. This point is further expanded upon in chapter six, in which Simonis invokes medical case files as examples of practices that implicitly challenged the dominant ideologies put forth in court-sponsored medical treatises. These case files helped develop a new prototype of madness as one being caused by depletion rather than over-repletion. Thus, the “caloric replenishing” movement of the early seventeenth century served as a rival to the popular Danxi corpus. The last sea change in Chinese medical understandings of madness occurred in the nineteenth century. As Simonis documents in chapter seven, physicians of the late Qing increasingly began to identify the liver as the pathological nexus of psycho-behavioral disorders. Chapters eight and nine operate almost as afterthoughts, albeit important ones. In the former, Simonis describes the symptoms and interpretations of spirit possession, while in the latter he discusses gendered aspects of madness. Although Simonis largely concludes that treatments for madness were not differentiated on a gendered basis, he also shows that late sixteenth century physicians began to identify certain scenarios by which madness could occur specifically in women (namely, menses and postpartum illness).
The second half of the dissertation is even more intellectually engaging. Here, Simonis focuses on changing legal standards in the Qing, as well as ways in which mad acts and mad speech were interpreted and adjudicated by Qing officials themselves. Simonis rightly engages with Viven Ng’s Madness in Imperial China (Norman, Oklahoma: University of Oklahoma Press, 1990) throughout much of this section. In chapter eleven, he disputes Ng’s conclusion that increasingly vigorous attempts to imprison and confine the mad during the high Qing was a result of the Manchu desire to enhance social control. Instead, Simonis posits that preventive confinement during the Yongzheng reign was actually a result of earlier Qing laws that provided lenient sentencing for homicides committed by the criminally insane. In other words, confinement of the insane was not part of a larger plan of Qing social control, but was simply a reaction to earlier laws that had treated “killing because of madness” along the same lines as “accidental killing” (pp. 457-459). In chapter twelve, Simonis continues this line of argumentation by detailing a mid-eighteenth century update to the Qing legal code, in which punishments for homicides committed by the insane reverted back to Ming-era precedents. Simonis attributes this reversion to changing assessments of justness in criminal cases. As he explains, “Perceived problems led to new solutions that created new dilemmas, for which yet other solutions were adopted in a non-systematic way” (p. 508). Chapters thirteen through fifteen are extremely engaging, as Simonis attempts to show how the mad themselves, as well as the officials in charge of adjudicating their cases, understood the world in which they lived. Chapter fourteen, in particular, includes excellent translations of complex and often cryptic poems written by madmen, and chapter fifteen highlights the ways in which these men often adopted elite vocabularies in order to express their fantasies – a tactic which was frequently condemned as seditious, and punished as such.
The historiographic contributions of Simonis’ work are obvious. Not only does he add new viewpoints to previous discussions of traditional Chinese medicine through his specific focus on madness, but he also proposes new ways to compare early Western psychiatry with traditional Chinese understandings of insanity. As Simonis explains, both Chinese madness and Western psychiatric illnesses have largely been concerned with psycho-behavioral symptoms; further, traditional Chinese medicine and early Western psychiatry have both tended to eschew mind-body dualism (p. 35). Such commonalities allow for meaningful historical, medical, and theoretical comparisons to take place across regions. Indeed, Simonis’ application of Western social and legal theory – from Foucault and Bourdieu to Gunther Teubner – showcases the fact that Western and Chinese medical culture need not always be discussed in opposition to each other.
University of California, San Diego
Qingdai wenziyu dang (“Archival Documents on Qing Dynasty Literary Trials”)
Quanguo Zhongyi tushu lianhe mulu (“National union catalogue of Chinese medical books and illustrations”)
Lufu zouzhe (“Secretarial copies of palace memorials”); Xinbu dang’an (“Archives of the Ministry of Punishments”)
Xingke tiben (“Routine memorials of the Office of Scrutiny of the Ministry of Punishments”).
Note: The latter three sources can be found at the First Historical Archives in Beijing.
Princeton University, 2010. 824 pp. Primary Advisor: Susan Naquin.