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The March 2016 issue of Culture, Medicine & Psychiatry is here! Over the coming weeks, we will feature article highlights from a selection of the newest research published at our journal. To access the full issue, click here.

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In today’s article highlight, we examine Jie Yang’s research in “The Politics and Regulation of Anger in Urban China” (accessible here.) Yang’s article ethnographically maps the connections between statewide therapeutic programs and the management and expression of anger amongst largely working-class, urban Chinese men and women.

Yang begins by noting that urban social workers and other clinicians place a strong emphasis on the treatment of negative psychosocial symptoms, and frequently relate poor physical health– as well as social unrest– to unmanaged expressions of anger. Their agenda reflects that of the Chinese state, which simultaneously values individuals’ happiness and pathologizes anger. Amongst the working class and the poor in China, however, some social ills which lead to detrimental emotional outbursts are indeed related to the state’s management of social life. Yang cites one example in which a Chinese man masterminded a bus explosion which resulted in numerous fatalities. His outburst was a heated response to the government, which repeatedly failed to approve his pension and dismantled his street stall: his only source of income. Thus anger proves to be a harmful, yet powerful, mechanism for the working class to vocalize frustrations with the government and injustices stemming from the failings of the state.

The author continues by describing a range of anger “genres” employed by the Chinese working class. These “genres” describe performative types of anger expression that have different roles depending on the nature of the injustice one is responding to. One form of expression, maije, is a form of public cursing– often on the street– to widely verbalize one’s frustrations and vulnerability due to poor working conditions. Another form, xiangpi
ren, refers to “a human punching bag,” or someone who does not outwardly respond to an injustice and seems to passively internalize their negative emotions. The advantage to this form, however, is that such individuals may be preparing for a specific opportunity to “rise up” in protest.

In addition to the array of expressions and forms that anger may take, Chinese individuals have an equally pluralistic selection of therapeutic interventions to manage or alleviate their anger. This includes Confucian, Daoist, Western, and folk Chinese remedies for psychological distress. Conversely, therapists who serve the state have social access to this range of modalities and psychological concepts, thus arming them with various mechanisms for managing and controlling “angry” individuals.

After exploring genres of anger in greater detail, both from the individual and clinical perspectives, Yang closes by positing that “the domestication of anger is key to sustaining
stability in the Changping factory and in China at large. It contributes to the relative
peacefulness in China amidst widespread socioeconomic transformation.” As therapists and state-employed clinicians seek to tame anger, so too do they attempt to recast anger as a personal expression of injustice rather than a social symptom of widespread unrest. Anger thus remains a prominent vehicle for the expression of individual as well as social injustice across a shifting socio-economic landscape.

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In 1989, our June special issue centered on the theme of neurasthenia: an illness category made most recognizable in current medical anthropology by Arthur Kleinman in his book Social Origins of Stress and Disease: Depression, Neurasthenia, and Pain in Modern China (1988.) Neurasthenia is a flexible diagnosis that encompasses a set of broad psychosomatic symptoms: fatigue, emotional unease, irritability, and bodily pains. It has fallen in and out of favor throughout history, yet in China and other Asian countries, it continues to be used to describe psychiatric distress. The special issue was published during the final year of Kleinman’s tenure as the editor-in-chief of Culture, Medicine & Psychiatry, and represents the culmination of research carried out throughout Asia on the diagnosis and treatment of the illness. You can access the full issue here.

The focus of this From the Archive feature is Tomonori Suzuki’s article on the diagnosis and treatment of neurasthenia in Japan. Unlike China, where neurasthenia continued to be clinically relevant through Kleinman’s research in the 1980s-1990s, the disease category fell out of its original use in Japan following World War II. Suzuki writes that this shift was not directly due to changes in Western psychiatry, in which European and American physicians replaced ‘neurasthenia’ with new categories under the umbrellas of neuroses, depression, or anxiety. These shifts may have influenced psychiatric disease models elsewhere, but in Japan, neurasthenia was instead rebranded and treated via a different historical pathway.

Morita, a renowned Japanese psychiatrist who lived in the late nineteenth and early twentieth centuries, was the first to suggest that neurasthenia was not exogenous: in other words, it did not stem from social disorder on the outside, but from psychological unrest within the mind. His therapeutic regimen for this newly-conceived “neurasthenia” became widely adopted, even into the contemporary age. Thus neurasthenia– while formally removed from the diagnostic lexicon– took a new form with an accompanying treatment as proposed by Morita.

Following WWII, when Japanese medical practitioners did begin to employ American principles of psychiatry, clinicians began to replace “neurasthenia” with the new category “neurosis.” Although this aligned with shifts in the nature of treatment that occurred in other places where biomedicine was practiced, Japan was unique in that many patients labeled as neurotic nevertheless sought out Morita therapy: a treatment initially designed to ameliorate an illness closer to the original form of neurasthenia. Some patients also opted for Naikan therapy, another indigenous psychotherapy based on Buddhist principles similar to those woven into the practice of Morita therapies. While the importation of “Western” diagnoses of neurosis brought with it accompanying forms of therapy native to Europe and North American, Morita and Naikan proved to be durable therapies equipped to treat Japanese patients with illnesses somewhere within the neuroses-neurasthenia spectrum.

Although the author notes that the use of these therapies (in the 1980s) could decline as Western models of psychotherapy continue to spread, Suzuki’s research into Japanese psychiatry practice revealed that many patients continued to seek out indigenous Morita and Naikan therapies. The two treatments’ focus on inner self-mastery, connectedness to the social and physical worlds, and the minimization rather than elimination of symptoms echo native Japanese spiritual beliefs, making these therapies legitimate alternatives to imported models of treatment. In sum, though the category for neurasthenia changed across time, foreign models for the conceptualization of mental illness did not always neatly correspond to foreign models for treatment. For the Japanese, local therapies such as Morita and Naikan proved to be quite resilient, as the therapies adapted to address psychiatric disorders despite the repackaging of mental illness into new forms.