NORMAL AND ABNORMAL BEHAVIOR IN CHINESE CULTURE CULTURE, ILLNESS, AND HEALING Studies in Comparative Cross-Cultural Research Editor-in-Chief" ARTHUR KLEINMAN University of Washington, Seattle, Washington, U.SA. Editorial Board: LEON EISENBERG Harvard Medical School, Boston, Massachusetts, U.S.A. NUR YALMAN Harvard University, Cambridge, Massachusetts, U.SA. MORRIS CARSTAIRS Postgraduate Institute ofM edical Education and Resetlrch, Chandigarh, India VOLUME 2 NORMAL AND ABNORMAL BEHAVIOR IN CHINESE CULTURE Edited by ARTHUR KLEINMAN University of Washington, Seattle and TSUNG·YI LIN University of British Columbia, Vancouver, Canada Springer-Science+Business Media, B.V. Library of Congress Cataloging in Publication Data (Rev.) CP Main entry under title: Normal and abnormal behavior in Chinese culture. (Culture, illness, and healing ; v. 2) Includes bibliographies and index. 1. Psychology, Pathological—China. 2. Personality and culture—China. 3. National characteristics, Chinese. I. Kleinman, Arthur. II. Lin, Tsung-yi. III. Series. [DNLM: 1. Cross-cultural comparison. 2. Anthropology, Cultural—China. 3. Anthropology, Cultural—Taiwan. 4. Mental disorders. 5. Socioeconomic factors. WM31 K64n] RC451.C6N67 616.89'07'0951 80-19489 ISBN 978-90-481-8359-3 ISBN 978-94-017-4986-2 (eBook) DOI 10.1007/978-94-017-4986-2 All Rights Reserved Copyright © Springer Science+Business Media Dordrecht 1981 Originally published by D. Reidel Publishing Company, Dordrecht, Holland in 1981 Softcover reprint of the hardcover 1 st edition 1981 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any informational storage and retrieval system, without written permission from the copyright owner TABLE OF CONTENTS PREFACE ix ARTHUR KLEINMAN and TSUNG-YI LIN / Introduction xiii SECTION I: HISTORICAL AND CULTURAL BACKGROUND OF BELIEFS AND NORMS GOVERNING BEHAVIOR INTRODUCTION TO SECTION I 3 1. THOMAS A. METZGER / Selfhood and Authority in Neo-Confucian Political Culture 7 2. ANDREW C. K. HSIEH and JONATHAN D. SPENCE / Suicide and the Family in Pre-modern Chinese Society 29 3. STEVAN HARRELL/Normaland Deviant Drinking in Rural Taiwan 49 4. GARY SEAMAN / In the Presence of Authority: Hierarchical Roles in Chinese Spirit Medium Cults 61 5. MARTHA LI CHIU / Insanity in Imperial China: A Legal Case Study 75 6. KEH-MING LIN / Traditional Chinese Medical Beliefs and Their Relevance for Mental Illness and Psychiatry 95 SECTION II: CHILD DEVELOPMENT AND CHILDHOOD PSYCHOPATHOLOGY INTRODUCTION TO SECTION II 115 7. RICHARD W. WILSON / Conformity and Deviance Regarding Moral Rules in Chinese Society: A Socialization Perspective 117 8. DAVID YAU-FAI HO / Childhood Psychopathology: A Dialogue with Special Reference to Chinese and American Cultures 137 9. WEI-TSUEN SOONG and KO-PING SOONG / Sex Difference in School Adjustment in Taiwan 157 SECTION III: FAMILY STUDIES INTRODUCTION TO SECTION III 169 vi T ABLE OF CONTENTS 10. JAMES P. McGOUGH I Deviant Marriage Patterns in Chinese Society 171 11. WILLIAM L. PARISH I Family and Community in the People's Republic 203 12. HSIEN RIN I The Effect of Family Pathology on Taipei's Juvenile Delinquents 213 SECTION IV: PSYCHIATRIC STUDIES: EPIDEMIOLOGICAL AND CLINICAL INTRODUCTION TO SECTION IV 233 13. KEH-MING LIN, ARTHUR KLEINMAN, and TSUNG-YI LIN I Overview of Mental Disorders in Chinese Cultures: Review of Epidemiological and Clinical Studies 237 14. RANCE P. L. LEE I Sex Roles, Social Status, and Psychiatric Symp- toms in Urban Hong Kong 273 15. MAVIS TSAI, L. NEAL TENG, and STANLEY SUE I Mental Health Status of Chinese in the United States 291 16. MARJORIE H. KLEIN, MILTON H. MILLER, and A. A. ALEXAN DER I The American Experience of the Chinese Student: On Being Normal in an Abnormal World 311 17. ARTHUR KLEINMAN and DAVID MECHANIC I Mental lllness and Psychosocial Aspects of Medical Problems in China 331 18. JUNG-KWANG WEN and CHING-LUN WANG I Shen-K'uei Syn- drome: A Culture-Specific Sexual Neurosis in Taiwan 357 19. ENG-SEONG TAN I Culture-Bound Syndromes among Overseas Chinese 371 20. TSUNG-YI LIN and MEI-CHEN LIN I Love, Denial and Rejection: Responses of Chinese Families to Mental Illness 387 ARTHUR KLEINMAN and TSUNG-YI LIN I Epilogue 403 LIST OF CONTRIBUTORS 411 CIT A TION INDEX 413 SUBJECT INDEX 420 To our families. And to the one fourth of mankind who are Chinese about whose individual lives and emotional problems so much more remains to be described, compared, and understood. PREFACE Our purpose in assembling the papers in this collection is to introduce readers to studies of normal and abnormal behavior in Chinese culture. We want to offer a sense o/what psychiatrists and social scientists are doing to advance our under standing of this subject, including what fmdings are being made, what questions researched, what conundrums worried over. Since our fund of knowledge is obviously incomplete, we want our readers to be aware of the limits to what we know and to our acquisition of new knowledge. Although the subject is too vast and uncharted to support a comprehensive synthesis, in a few areas - e.g., psychiatric epidemiology - enough is known for us to be able to present major reviews. The chapters themselves cover a variety of themes that we regard as both intrinsically interesting and deserving of more systematic evaluation. Many of the issues they address we believe to be valid concerns for comparative cross cultural studies. No attempt is made to artificially integrate these chapters, since the editors wish to highlight their distinctive interpretive frameworks as evidence of the rich variety of approaches that scholars take to this subject. 'We see this volume as a modest and self-consciously limited exploration. Here are some accounts and interpretations (but by no means all) of normal and ab normal behavior in the context of Chinese culture that we believe fashion a more discriminating understanding of at least a few important aspects of that subject. We ask our readers to join us in thinking through the tough questions they raise, such as what are the universal and what are the culture-specific dimensions of pathology and deviance among Chinese. We recognize that certain readers may discover that we have omitted contributions that they regard as essential. While others may decide that some of our choices for inclusion are idiosyncratic. But on the whole we do believe we have represented in this book examples of much of the major work that is presently being conducted. Of course, being psychia trists we have tipped the balance in favor of studies of abnormality. But this emphasis also reflects the particular way the field has developed. Compared with research on Western cultures and even certain non-Western ones, China studies have paid remarkably little attention to individual behavior. Kinship, community organization, large scale sociopolitical and economic change have dominated the interest of scholars. While the Chinese family has been an abiding focus of concern, only infrequently has it been studied in terms of its crucial influences on individual development and the genesis and control of deviance. Studies of Chinese cultural influences on cognition, affects, coping processes, and other psychological issues, though admittedly in an early stage, have already generated considerable data, but this information has not enjoyed a wide circulation. In fact it is the editors' experience that "China scholars" ix x PREFACE often disparage psychological findings and the theories developed to explain them, making use in their stead of common sense assumptions about human nature that are naive, ethnocentric, and sometimes downright mistaken. This bias may reflect Chinese culture's own reticence about psychological and espe cially psychiatric matters. It also smacks of the "orientalism" manufactured by Western scholars to render Chinese and other Asian cultures simultaneously "different" and "exotic" yet "understandable" (cf. E. W. Said: Orientalism. New York: Pantheon, 1978). Such scholars have maintained both that there is no individuality (in the Western sense), or mentally ill persons, in Asian cultures and that Asian individuals and the mentally ill are exactly the same as in the West. Each position, readers of this volume will soon discover, is wrong. It is our intention, then, to correct this distortion by contributing substantially to the advancement of psycho cultural analyses and comparisons in the China field. We believe many of the chapters in this volume will be of direct interest to students of Chinese culture. But we also hope that they will be read by psychia trists and psychologists who are more generally concerned with elaborating a comparative science of human behavior and psychopathology. For most of what we know about these subjects has come from studies of Western populations, and thereby can only be generalized at great risk. Research on Chinese and other non-Western groups is absolutely essential if psychiatry and psychology are to become universal sciences. Finally, certain of the contributions to this volume should be of practical significance to clinicians who treat Chinese patients and plan services for Chinese communities. Clinical work among Chinese has lacked just the kind of research foundation to which this book hopes to contribute. Much of the data presented in the chapters in this collection comes from research in Chinese communities outside of China. The editors are keenly aware of this imbalance, but there was nothing that could be done to correct it since it reflects reality. Up to the present, only a very limited amount of psychiatric and behavioral science research on Chinese has been reported for the People's Republic of China. We hope that this volume will be of use to our colleagues in the People's Republic as an outline of the present status of research in this field and that some of the chapters may even be of practical help in their own research and clinical work. We also hope that it will foster further communica tion and possibly future collaboration. We want our colleagues in China as well as other readers to understand why we are not using the pinyin Romanization system for rendering Chinese terms into English. These chapters were written and collected before the widespread changeover to pinyin in North America occurred and the editors decided after carefully reviewing the issues to retain the Wade-Giles Romanization system in this volume. The editors wish to acknowledge help from many sources: the Department of Psychiatry and Behavioral Sciences, University of Washington; the Depart ment of Psychiatry, University of British Columbia; the World Federation of Mental Health; the Foundations' Fund for Research in Psychiatry; the National Institute of Mental Health; to mention just a few. Specific individuals who have