When psychiatry encounters local knowledge of madness: Ethnographic observations in a Chinese psychiatric hospital

Abstract

As the number of psychiatric hospitals are on the rise in China, this article examines how the psychiatric discourse as articulated by hospital staff interacts with local cultural understandings of madness/mental illness, as well as how such interactions impact patients and families’ reception of psychiatry. Data comes from 16 months of fieldwork in a psychiatric hospital in South China. We show that psychiatric professionals at the hospital attempted to establish their professional authority by discrediting other cultural epistemologies embraced by patients or families, such as religious and traditional Chinese medical understandings. Despite the quick effect of psychopharmaceuticals to control symptoms, the psychiatric perspective ultimately fell short in addressing the social and moral struggles faced by patients, such as patriarchy and gender-based violence. Moreover, as psychiatric professionals unreflexively used certain problematic local concepts to convey a biomedical and even genetically-determined account of mental illness to patients and families, they risked entrenching the stigma of mental illness and disempowering their clients. To improve the quality of mental healthcare, to make clients feel culturally safe and respected in clinical encounters, psychiatric professionals in China should develop a more holistic approach that takes into account the biological, psychological, and sociocultural aspects of mental illness, that recognizes the diverse sources of help clients may rely on. They should also develop a critical awareness of the language they use and of the power dynamics in which they and their clients are situated.