Normal and abnormal behaviour in Chinese culture

ARTHUR KLEINMAN and TSUNG-YI LIN (editors), Normal and abnormal behaviour in Chinese culture, Dordrecht, Boston, and London, D. Reidel, 1981, 8vo, pp. xxiii, 436, Dfl. 75.00/$39.50. Psychiatry as a well(?)-defined branch of medicine developed in the Western medical tradition in the early nineteenth century. The delineation of a medical field of knowledge dealing with the vicissitudes of the soul was probably stimulated by the ubiquitous dualistic body-soul conceptions so common in Western ideologies. The difficulties in studying Chinese souls, the Chinese having ceased to separate the soul from the rest of the body two millennia and a half ago, have long been acknowledged by students in the field. The book reviewed is the first anthology of modern and original research contributions on Chinese behaviour covering Chinese history of ideas, anthropology, sociology, family studies, psychopathology, and psychiatric epidemiology. The scope is broad but the book is held firmly together by the two editors, who have divided the twenty chapters into four sections, introducing each section with an editorial. The sections are: I. Historical and cultural background of beliefs and norms governing behaviour; II. Child development and childhood psychopathology; III. Family studies; and IV. Psychiatric studies: epidemiological and clinical. The editors are well-known experts in the interface between psychiatry and social studies. Arthur Kleinman, psychiatrist at the University of Washington, Seattle, is editor of Culture, Medicine and Psychiatry, a quarterly journal; his main research interests are Chinese. Tsung-yi Lin, noted psychiatrist at the University of British Columbia, Vancouver, has produced some of the most important research in Chinese psychiatric epidemiology over the past thirty-five years, and he has worked extensively in the WHO cross-cultural schizophrenia project. Six editorials and an epilogue discuss more what should be done in the field than what has already been accomplished, and repeat warnings that we have no secure knowledge. One observation that does seem to be close to the truth is a different array of coping responses in Chinese as compared with Westerners, externalizing responses notably far outweigh internalizing ones with the result that the Chinese are prone to somatize primarily mental distress. Preoccupation with somatized behaviour is apparently sanctioned by Chinese culture (and by many others). This fact is often repeated, and, for example, antidepressant medication works in Chinese patients presenting diffuse somatic complaints, irritability, and a firm conviction of some bodily and organic cause of their troubles. However, given the vanishing boundaries between the psyche and the soma in recent developments in the neurosciences, one cannot help wondering which will appear most biased in the future Chinese (and East Asian) somatization or Western mentalization? I note briefly the most impressive of the twenty chapters; Female suicide is the subject of A. C. K. Hsieh and J. D. Spence, demonstrating that for long periods of China's pre-modern history killing oneself was not regarded as a deviant practice, but at times rather an act openly praised by the state. ". .. What was deviant was not the suicide act, but the pressuring of a person into suicide" (p. 45). An enlightened and highly original dialogue between "Dr. Relativist" and "Dr. Universalist" on childhood psychopathology from a cross-cultural view is conveyed to us through D. Y.-F. Ho, who concludes, after many a delightful twist of argument, that it is possible to identify behavioural disorders regardless of culture if there is a consensus between members of the culture and outsiders that the behaviour in question is deviant or pathological. Deviant marriage patterns are described by J. P. McGough in a fine paper distinguished by skilful use of primary sources. Seemingly exotic habits like uxorilocal marriage, polyandry, spirit marriage, pawn marriage, and same-sex marriage are explained in a highly readable way. An important contribution is a review of epidemiological and clinical studies on mental disorders in Chinese cultures by K.-M. Lin, A. Kleinman, and T.-Y. Lin, including 151 references (in Western languages). The dearth of studies carried out in China proper is a source of frustration, but the situation is improving. An intriguing fact is the near-absence of alcoholism in Chinese cultures all over the world, in spite of the historical potential of the Chinese to abuse other sedatives, notably opiates. The study of non-Western cultural variations of coping mechanisms offers an opportunity to get at the meshwork where psychobiology connects with overt behaviour. The many and varied