“The Third Category of Mental Disorders” by Xu Youxin
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Professor Xu Youxin (surname Xu) is one of the most important psychiatrists of the generation in their 70s and 80s in China. His generation endured the breakdown of organized society in the Warlord Period, the great uncertainties of the early Nationalist era, the desperation and destruction of the war with Japan, the bitterness of the Chinese Civil War, the tumult of the radical Maoist years (including the deadly Great Leap Famine and the chaos of the Cultural Revolution), and the period of unprecedented economic reform and prosperity (capped by the current economic downturn). During that time, psychiatry as a profession has emerged in China. Xu Youxin contributed especially to the Chinese profession’s breakaway from a narrow Soviet-oriented neuropsychiatry that barely survived the criticisms and attacks of the Cultural Revolution to open to the world in the 1970s.
When I first visited a psychiatric institution in China in 1978—The Hunan Medical School which had been the illustrious Yale-in-China Medical School, the school from which Xu Youxin graduated and an early leading institution of psychiatry in China—the inpatients were almost all labeled with the diagnosis of schizophrenia and the outpatients with the diagnosis of neurasthenia. Xu’s contribution was to those who then were called neurasthenic. He advanced the importance of personality and neurotic conditions, which at the time not only were largely undiagnosed but also were regarded with some suspicion as tainted by Western bourgeois, therefore anti-communist, values.
Since the early 1990s, Chinese psychiatrists have moved rapidly to embrace depression and also anxiety disorders. More recently, there has been a so-called psychotherapy “boom,” with special interest in psychoanalytically-oriented theories and also cognitive behavioral and other techniques. But much of this movement has been spurred by Chinese psychiatrists who have been trained in European and American schools. Xu Youxin—both in his theories and in his techniques of practice—is a strong exemplar of indigenous Chinese psychiatry’s struggles to elaborate an alternative diagnostic system. While the profession as a whole has created multiple revisions of standard nomenclature and categorization (The Chinese Classification of Mental Disorders, CCMD), Xu has pushed his own ideas, and done so in such a way as to enlarge and enrich the group that falls outside of organic central nervous system pathology and functional psychotic disorders. The profession has largely followed global DSM and ICD systems, with the exception of an early effort to protect the category of neurasthenia and a tendency to follow governmental dictates in specifying psychosis due to particular politically charged subjects such as gigong or falun gong-induced psychosis. Xu Youxin, in contrast, has worked to develop his own brand of classification, a brand that seems to reach back to earlier psychodynamic, stress psychology, and neuropsychiatric formulations, and forward toward the encompassing of conditions that are relevant for counseling and psychotherapy.
Hence the paper that follows can be read as historically important because it represents the views of a key survivor, a psychiatrist who has lived through the anti-psychiatry era of radical Maoism, the era of psychiatric professionalization under the regime of economic reform and Foucault-style governmentality, and into the newest era of uncertain globalized transition toward new forms of subjectivity and moral experience.