German wine in an American bottle: the spread of modern psychiatry in China,1898–1949

Introduction

Chinese psychiatry in the modern sense came from the West. However, there is little historical research that takes a comprehensive look at the development of psychiatry in China by examining the processes in which Chinese practitioners accepted or rejected the various strains of academic thought that were coming from the West before 1949. Indeed, the present state of Chinese psych-iatry cannot be separated from its adaptive historical development dating back to its initial contact with Western psychiatry.

The aim of this paper is to investigate the roots of Chinese psychiatry in the early twentieth century. It examines materials related to the emergence of psychiatry in China and especially the major publications in the field that appeared in China before 1949. Keeping in mind the international scholarly exchange in the field of psychiatry among various Western countries, especially between America ¹ and Germany, it compares and analyses the major strains of academic thought that began circulating in China around 1900. In doing so, this paper suggests how Chinese psychiatry developed in the first half of the twentieth century through a process of cultural adaptation at the academic level. At the same time, it exposes a previously missing link between psychiatry in Germany and China.

A brief history of psychiatry in China before 1949

Traditional Chinese Medicine (TCM) had been dominant in China before Western medicine was introduced systematically around 1900. TCM was based on a natural philosophy that emphasized both the body and mind (Kleinman, 1981: 95–111). In fact, mental illnesses were even described in ancient Chinese medical books more than 2000 years ago. Until the Qing dynasty (1644–1912), however, mental illnesses were treated separately from other medical illnesses and recorded as a sub-category, Shen Zhi Men 神志门, in some traditional Chinese medical books, such as Zheng Zhi Zhun Sheng 证治准绳 (published in 1860) and Gu Jin Tu Shu Ji Cheng – Yi Bu Quan Lu 古今图书集成•医部全录 (published in 1934). However, psychiatry did not develop into an independent branch within TCM until the late nineteenth century when Western approaches to psychiatry were introduced into China (Xia and Zhang, 1981; Xu, 1995).

After the loss of a series of wars, including the Opium Wars (1839–42, 1856–60) and the first Sino-Japanese War (1894–95), some Chinese elites doubted the strength of their own culture (Qu, 2005: 48–54, 60–1). As a result, they became eager to learn more about Western science and technology in order to increase the standing of their country (Xu, 1995). At the same time, different fields of scientific knowledge and technology, including medicine, were being brought to China by scientific missionaries ² (Wang, 1997: 158–62), who passed on a great deal of Western scientific knowledge when spreading the Christian doctrine. Naturally, modern psychiatry was imported into China as a part or sub-discipline of Western medicine.

In the late nineteenth century, American and British missionaries transported Western psychiatry to China and established the first asylums. These missionaries gained the trust of the Chinese by sponsoring charitable activities, teaching scientific knowledge, publishing books and saving lives. The first asylum, the John G. Kerr Refuge, was established in Guangzhou in 1898 by an American Christian, John Glasgow Kerr (1824–1901). He was a medical missionary who had graduated from Jefferson Medical College in Philadelphia and came to China as part of an American Presbyterian mission. More asylums and psychiatric clinics were then opened successively in China’s major cities, such as Peking (1906), Shanghai (1935), Chengdu (1944) and Nanking (1949).

In 1904 Japan started a war against Russia over control of Northeast Asia, which resulted in the partial occupation of the southern and northern parts of Northeast China by Japan and Russia, respectively. These two powers established institutions to care for the mental health of their veterans and immigrants in the major cities within their areas of control. A Japanese clinic was opened in Shenyang (1914), a Japanese hospital for the insane in Dalian (1935), and a Russian asylum in Harbin (1910). It is worth noting that in the late nineteenth century, Japanese and Russian psych-iatry mainly followed the German school, particularly influenced by Emil Kraepelin (Hashimoto, 2013; Korolenko and Kensin, 2002; Utena and Niwa, 1992).

In 1947, according to the census of the health department of the Republic of China, there were only 6 mental hospitals in mainland China, all of which were located in major cities. At the time, there were 895 beds available for the mentally ill, which accounted for only 1.8% of the total number of beds in Chinese hospitals (Cheng, 1948b). In China, psychiatry was usually the last choice for medical students because the field was not well respected, as it was in Germany. Indeed, before 1949, there were only 50 trained psychiatrists who actually remained in the profession (Young and Chang, 1983). Moreover, there were only a few nurses who had any kind of special psychiatric training (Bowman, 1948).

Andrew H. Woods (1872–1956), an American, offered the first formal courses in Western psychiatry in Guangzhou in 1910. He was appointed Professor of Neuropsychiatry at Peking Union Medical College (PUMC) in 1919 and offered the first neuropsychiatry courses in 1922. Shortly after, in 1928, the first neuropsychiatric department was established at PUMC (Chen, 2010). Woods’ example was then followed by R.S. Lyman (1891–1959) from John Hopkins Hospital, who visited many universities in China to teach psychiatry and train practitioners. Around this time, Fanny Gisela Halpern (1899–1952) from Vienna also taught neuropsychiatry and a little psycho-pathology at Shanghai Medical College as well as St. John’s Medical College in Shanghai (Westbrook, 1953; Young and Chang, 1983). Collectively, these Western professionals trained the first cohort of Chinese neuropsychiatrists and encouraged some of them to study abroad between the 1920s and the 1940s. Beginning in the mid-1930s, courses in neuropsychiatry were being offered by Western-trained Chinese neuropsychiatrists such as MinYu Ling 凌敏猷 (1902–91) and YouQi Huang 黄友岐 (1907–93) in Changsha in1934, and YuLin Cheng 程玉麐 (1905–93) in Nanjing in 1936; other Chinese scholars followed later. After 1950 most of the prominent neuropsychiatrists in the country had been trained in China (Xu, 1995).

Before 1949 there were also no psychiatric associations or journals in China. The first professional journal Chinese Journal of Neurology and Psychiatry 中华神经精神杂志 appeared in 1955, and the first formal classification of psychiatric diseases in China was proposed 3 years later. Also, before 1949, no more than 10 translations or monographs related to psychiatry had been published (Luo and Niu, 2003), and only a few psychiatric articles appeared in general medical journals. Moreover, there was very little scientific research being done in the field at the time (Young and Chang, 1983). ZongHua Su 粟宗华 (1904–70) and YingKui Xu 许英魁 (1905–66), for example, published their research in neuroanatomy and neuropathology in an international English-language journal Archive of Neurology and Psychiatry around 1940. According to Pearson (1991), both the practice and further development of Chinese psychiatry was somewhat hindered, not only by the lack of properly trained personnel, but also by limited financial resources.

Channels of communication between China and America

As shown in the brief history above, most of the Westerners who helped bring psychiatry to China were either born or educated in America. All of them had a medical degree and had been trained in fields such as anatomy, neurology or neuropathology. Correspondingly, almost all the psychiatry-related courses they offered in mainland China were said to be neuropsychiatric in their orientation (Westbrook, 1953). The use of foreign terms seemed unavoidable in neuropsychiatry, as in other branches of medicine, especially in connection with its anatomic and physiological aspects (Lyman, 1937). Thus, from the very beginning, Chinese practitioners approached psychiatry from a biological perspective rather than a psychological one.

Although historians maintain that psychoanalytic theory was warmly embraced by American psychiatry, psychoanalysis was not introduced to China in the medical field. Instead, it came to China via a Japanese channel as part of a new trend in art and literature. Consequently, the influence and popularity of psychoanalytic theory was largely limited to the realm of Chinese literature and literary criticism from the 1920s to the 1930s (Shi, 2008).

The most influential Chinese scholars in psychiatry – YuLin Wei 魏毓麟 (1899–1967), ZhiLiang Gui 桂质良 (1900–56), and four others mentioned above, Su, Cheng, Xu, and Ling – received Western medical training in China in the 1920s and 1930s. Their education was largely rooted in the somatic perspective that was prominent among scholars in Germany during the second half of the nineteenth century (Xu, 1996). After completing their studies in China, they were encouraged by the foreign scholars mentioned above to further their education in the West. Among them, Cheng and Xu went to the German Institute for Psychiatric Research in Munich in 1931 and 1938, respectively; Emil Kraepelin had been its director until 1926, and Kurt Schneider later became the director of its clinical section. Both Cheng and Xu also later went on to America for further training. In the 1940s, Huang, ZhengYi Wu 伍正谊 (1912–96), ZhenYi Xia 夏镇夷 (1915–2004) and GuoTai Tao 陶国泰 (b.1916) studied in the neurology or neuropathology departments of various universities in America (Chen, 2010). These pioneers studied neuropathology, neurology or psychiatry, but not psychoanalysis. When they returned from abroad, they went on to make vital contributions to the development of neuropsychiatric research in mainland China.

In the early years of psychiatric training in China, not only were most of the teachers foreigners, but also the textbooks were written in foreign languages. Of those used in the 1940s, the best known were English translations of German books, for example, Kraepelin (1902) and Bleuler (1924), the latter being the Swiss-born psychiatrist who revised Kraepelin’s system (Bleuler’s 1911 description of schizophrenia was not translated into English until the 1950s) (Young and Chang, 1983). The 1902 and 1924 translations were made by men who worked and were educated in America, and in particular both of them had been students of Adolf Meyer, considered by American psychiatrists to be one of their most illustrious predecessors and a crucial link between Europe and America (see below). Furthermore Dr Robert P.K. Wang, another student of Meyer, took on the difficult task of providing official Chinese translations for neuropsychiatric terms (Lyman, 1937).

America’s contribution to modern psychiatry in China cannot be ignored. American missionaries and physicians came to China and helped to establish the first mental institutions and research facilities; they also trained the country’s first native professionals and sent them to study abroad. They thus planted the roots of modern psychiatry in China in a very practical sense. However, in order to assess fully the achievements of the American school of psychiatry in China before 1949, the actual content of what was being taught and relayed across the oceans has to be examined as well.

Psychiatry in America before the 1940s

The paradigms that underpin psychiatry today are still those that were largely formulated during the nineteenth and early twentieth centuries. This was an era of brilliant achievements within the history of psychiatry as a whole (Beumont, 1992). From the middle of the nineteenth century to around 1930, German psychiatry came to replace the French humanitarian genre as the dominant school of thought. With its strongly biological emphasis and a high degree of professionalization, it became the reference point for the field across the globe (Shorter, 1997: 71–81). From 1933 to 1938, however, German psychiatry suffered a great loss as many psychiatrists emigrated to the USA. As a result, this soon became the pivotal centre of psychiatric thought (Peters, 1988). Prior to World War II (1939–45), American psychiatry was biological in its focus, but this changed shortly after the war as the emphasis shifted towards a psychoanalytic approach (Sarason, 1988: 214).

Despite these dynamics, the European school of thought continued to play a dominant role in America until the end of 1930s. In fact, some research departments followed strictly the German tradition, which meant that there was hardly any American tradition in psychiatry (Barton, 1987:17; Shorter, 1997: 15). Before the 1940s, there were only a few significant American innovations to speak of in the field. In 1965 Benjamin Rush (1746–1813) was recognized as the founder of American psychiatry by the American Psychiatric Association (APA). However, he did little to serve as a beacon for the future, but agreed with his European colleagues that the brain was the origin of mental illness (Shorter, 1997: 15).The identification of a new form of neurosis – neurasthenia – by George Miller Beard (1869) and the rest cure were virtually the only American contributions to the emerging discipline. As noted by Smith Ely Jelliffe, an American psychiatrist who had studied with Emil Kraepelin, American psychiatry in the first quarter of the twentieth century was ‘pre-eminently Kraepelinian psychiatry’ (Brink and Jelliffe, 1933). The American contribution lay in its expansion of psychoanalysis and a new form of biologically-based psychiatry which began from the 1970s (Beumont, 1992; Shorter, 1997: 229). Given this historical background, it can be said that China encountered the European psychiatric heritage via America.

Between 1890 and 1914 ‘many of the great figures in German medicine began to explore the medical world on this side of the Atlantic’, noted the historian Thomas Bonner (1963: 139), and they were responsible for sparking the interest of their students about opportunities in America. Adolf Meyer (1866–1950) was among the first of a small migration of physicians from German-speaking countries to America that began in 1890. As the figure with an extraordinary personal influence there, from the 1910s to the 1940s Meyer has been referred to as the ‘American Kraepelin’ (Shorter, 1997: 101, 109–12) because he introduced Kraepelin’s system in the Worcester asylum where he was a neuropathologist in 1896 (Meyer and Winters, 1951: 523), and helped to spread Kraepelin’s views among the American scientific public (Peters, 1990). His rejection of Kraepelin’s nosology in later years led the country in a psychoanalytic direction. Although Meyer never achieved international renown and hardly any of his work has been translated into German, he always kept up a lively intellectual exchange with his colleagues in Germany as well as August Hoch in the McLean Hospital (Sutton, 1986: 149–50), who had been trained in Europe and also helped to interpret Kraepelin’s system to American academics. Furthermore, with the effort of Charles W. Page, Henry Smith Noble and Diefendorf, Kraepelin’s system ‘slipped from the interpretive grasp of Hoch and Meyer and began a new, independent journey of transformation’ in America (Noll, 2011: 74–109).

After completing his doctorate under August Forel in Zurich, Meyer had been unable to find a university position in Europe. He emigrated to the USA in 1892 and opened a neurological practice with an emphasis on clinical neuropathology. When his mother recovered rather miraculously from a severe depression, he shifted his interest to living subjects and later became a psychiatrist (Lidz, 1966). In his approach, he did not follow the German and Swiss physiological medical tradition that neglected the holistic human organism and subjective psychological issues. Instead, he proposed a psychobiological perspective in 1909 (Wolpert, 2006: 148–9) that emphasized the importance of the personality structure and its reactions – examining how patients reacted to live events and the illnesses within their bodies – which contrasted with Kraepelin’s concept of endogenous psychosis. Meyer believed that mental illness resulted from personality dysfunction rather than from the pathology of the brain.

However, given that Meyer was always rather eclectic and absorbed ideas from a variety of sources, he never developed his own school of thought or a cohort of disciples. In fact, he never published a comprehensive collection of his papers or a textbook during his lifetime (Peters, 1990). He failed to provide any kind of organized constructs and abstractions that could form the basis for future development or be used as reference points for psychotherapy and patient treatment. Many of his students went on to make significant contributions to American psychiatry, though not necessarily as Meyerians. Few of them recognized his intellectual contribution to the field or to their own work. Posthumous evaluations of Meyer’s approach have also tended to label it as ‘almost entirely sterile’ (Double, 1990). Nonetheless, Adolf Meyer was a successful reformer and activist who was largely responsible for the pragmatic, instrumental and pluralistic character of American psychiatry (Beumont, 1992; Lidz, 1966).

Meyer’s teachings in China

Before 1898, no attempt had been made in China to create a designated place for the confinement of the insane; the mentally ill were simply kept at home. The strong tradition of familial guardianship and the stigma attached to mental illness in Chinese culture prevented the development of a system of trustee care (He, 2002). The local law enforcement bodies only became involved in such matters when the family could not guarantee the necessary level of security. Indeed, it is quite telling that physicians did not play a significant role in the discourse on criminal insanity during the later Qing dynasty (Ng, 1990: 166). The concept of forensic psychiatry was first brought to China from Germany by Ji Lin 林几 (1897–1951) in the 1930s (Wang and Chang, 2009: 401–7). Around 1900 there was little awareness of mental illness among the Chinese public, and it received little attention, except when it came to matters of public safety. There was almost no information or statistical data about the prevalence of mental illness (Cheng, 1948b). The introduction of European knowledge and practices – including moral therapy, a regular schedule of activities for patients, effective treatments, asylums and hospitals in major cities, and modern psychiatric settings for teaching and research in universities – thus sparked major ideological and institutional changes in the Chinese medical landscape.

Another factor in this process of change was the experience of the first generation of Chinese practitioners in the field as they studied abroad. Gui and Su, for example, went to Johns Hopkins to work with Adolf Meyer from 1925 to 1929 and from 1935 to 1938, respectively. In 1947 Xia was at Cornell University where Meyer had been Professor of Psychiatry from 1904 to 1909; he studied with Oskar Diethelm who had been a student of Meyer. These Chinese pioneers all claimed that they were influenced by the American school of thought and by Adolf Meyer in particular. They maintained that psychiatry and neurology were inseparable. Correspondingly, a fundamental knowledge of neuroanatomy and neuropathology, as well as clinical neurological experience, was considered to be very important for a good psychiatrist in China (Liu, 2012). This was exactly the same view that Meyer propagated in America when he began his career. But this was also, in fact, one of the firm beliefs in the psychiatry of Carl Wernicke and the so-called Breslau school of neurology. However, Meyer’s later incomplete theory of psychobiology and his nomenclatures, such as ‘ergasiology’, ‘pathergasias’, ‘premorbid personality’ and even ‘parergasia’ – a term coined by Meyer in the mid-1920s that he believed should replace schizophrenia in clinical usage – were not really recognized by Chinese professionals. The same holds true for Meyer’s use of the ‘reaction type’, which was an idea first proposed by Karl Bonhoeffer in the form of ‘acute exogenic reaction types’ in 1908 and then further developed by Eugen Bleuler (Neumarker, 2001; Wolpert, 2006: 171–87).

Around 1921, R.S. Lyman, a student of Adolf Meyer, commented on the link between Meyer and Chinese psychiatry: ‘Some changes may have occurred in Meyer’s teachings when they were carried to China, but that does not break their claim to inheritance from him’; he also noted that ‘there has been increasing expression of appreciation for neuropsychiatric opinion in China’ (Lyman, 1937). Through the pluralistic character of American psychiatry and Adolf Meyer’s approach in particular, Chinese scholars encountered various theoretical perspectives coming from Europe, but filtered through an American lens. Chinese scholars adopted many aspects of Meyer’s method, such as his emphasis on the diversity of patients and the need to collect patients’ personal histories (Lyman, 1937; Young and Chang, 1983; Zhao, 1929: 50–4), but these were actually ideas that had been proposed by European scholars, including Wilhelm Griesinger, Emil Kraepelin, and others. In fact, Meyer had adopted the practice of gathering facts from and about patients from Kraepelin (Wolpert, 2006: 147–54).

As the Chinese university atmosphere was largely Western-oriented and characterized by a pluralistic and instrumental way of thinking during this time (He, 2006), the eclectic and inclusive nature of Meyer’s teachings seemed to be common sense for Chinese psychiatrists. There was also a tradition of taking the practical portions of new kinds of knowledge and adapting them to fit the existing Chinese philosophical framework (Woo, 1991). Consequently, the acceptance of a new medical approach was largely dependent on its demonstrated effectiveness (He, 2006: 22). The scientific tradition of German psychiatry and its medical paradigms was thus appreciated by Chinese scholars for its factuality as it was based on definite observations and descriptions as well as applicable guidelines and rules.

Modern psychiatry was thus applied and accepted as a branch of medicine, but it was clinical psychiatry that received the most attention. As early as 1912, J. Allen Hofmann reported on cases of psychosis at the John G. Kerr Refuge in Guangzhou, diagnosed using Kraepelin’s classification (Hofmann, 1912). Additionally, Georg Schaltenbrand, the only German neurologist on record to visit China during this time, described and analysed the patients in PUMC according to Kraepelin’s classification (Schaltenbrand, 1931); Schaltenbrand had come in 1928 to work as an associate neurologist at PUMC. Thus, in the first half of the twentieth century, Kraepelin’s dichotomy and his aetiological-prognostic approach were considered reasonably helpful by psychiatrists working in China. This dichotomy, as well as most of the iconic terminology associated with Kraepelin, such as the term ‘autointoxication psychosis’, were included in the first official Chinese publication on the subject – Psychopathology Terminology 精神病理学名词 (1937) – which was recognized by the National Ministry of Education; all the terms were left in German (Zhao, 1937). The term ‘atypical psychoses’ was not included in this official publication; it denoted a group of illnesses other than schizophrenia or manic-depressive psychosis, in French or Japanese terminology, but it seems that Chinese psychiatrists held a more positive attitude to Kraepelin’s system.

Pragmatic thinking from America, which pervaded the Chinese medical world during the first half of the twentieth century, accelerated the actual use of diagnosis and therapy methods even before the theoretical ideas behind them were digested systematically. For instance, effective measures such as fever therapy, protracted narcosis, sedative drugs, psychotherapeutic interviews and occupational therapy were used for selected patients in the 1920s and 1930s (Lyman, 1937; Young and Chang, 1983). Furthermore, the so-called Mental Status Examination (MSE) was considered to be a crucial diagnostic step (Lyman, 1937). A lobotomy, for example, was first performed in 1938 by Su (Wang, 2005: 1–3). By the 1950s, EEG, ECT, biofeedback, lithium, insulin, electro-shock and chlorpromazine were also in general use (Liu, 2012: 27–39; Young and Chang, 1983).

The famous landmark publication of Germany psychiatry, namely Karl Jaspers’ Allgemeine Psychopathologie, was first accessible for the Chinese audience as a Japanese translation published in 1953 (Utena and Niwa, 1992). An English version did not appear until 1963, owing in part to ‘untranslatable German concepts printed in italics’ (Havens, 1967) and ‘its completely different philosophy’ for American readers (Peters, 1988). Another reported reason was that Adolf Meyer in particular did nothing to promulgate Jaspers’ ideas in America (Beumont, 1992). The phenomenological approach or empathy associated with Jaspers, i.e. attempting to delve into the patient’s own inner experiences and to formulate this experience as precisely as possible, was almost never discussed in mainland China before 1949.

It should be noted, however, that psychoanalysis, which was largely welcomed by American psychiatrists, had not been generally recognized as one of the main achievements in psychiatry at the time because it was based on subjective postulation. As psychoanalytic theories could not be proved or disproved by experimental data or consistent clinical observation, it was considered a matter of personal opinion as to whether it should be accepted by practitioners or not. Consequently, it was not seen as an applicable treatment method in China. Taking political events into account, around 1929 TCM was increasingly labelled as a pseudo-science by the Western medical community in China (Tao, 2010). Within TCM, however, psychotherapy was already being used widely, although it was usually practiced in an unstructured manner (Liu, 1981). For example, a psychotherapy called Huo Tao 活套 that aimed to induce different affective reactions in various emotionally disturbed patients was proposed as a treatment by ZhenHeng Zhu 朱震亨 (1281–1358).

Analysis of the cultural adaption process

During the introduction of modern medicine to China, practical effectiveness was a key factor in the acceptance of specific disciplines and methods by the Chinese medical community. Modern anatomy, physiology, pathology and even surgery were thus recognized and accepted shortly before and after the establishment of the Republic of China. The process of ‘Suspect-Try-Convince’ (Xiong, 2011: 578–82) that Western medicine underwent in China had been largely completed before modern psychiatry emerged on the scene. This meant that the way had been paved for it to make inroads in the Chinese medical landscape where other branches of medicine had already been accepted. Around 1900 in China, there was a lack of breakthroughs in the treatment of psychosis, in contrast to the advances taking place in other branches of medicine (Pearson, 1991). But since the close relationship between mental illnesses and cerebral pathology had already been well established, psychiatry in China put down its roots in neurology. There was no competition between the physiological and psychological approaches which had been the case in other countries such as America. Rather, the neuropsychiatric perspective was dominant throughout the entire process. Medical academics in China were convinced that Chinese psychiatry would benefit from its close association with the rest of Western medicine.

Moreover, the idea that mental illnesses are diseases of the brain, which reflected the entirely somatic-orientated psychiatry of Wilhelm Griesinger and Carl Wernicke in Germany, echoed the Chinese saying Xin Zhu Shen Ming 心主神明. ³ In TCM, each emotion was thought to be related to a specific organ in the body which meant that any emotional disturbance was thought to originate from a corresponding organ. Illnesses characterized by unusual or unconventional behaviour were thus treated in a similar way to somatic manifestations. Consequently, it is not surprising that, as Lyman (1937) pointed out, ‘there was no antagonism between neurology and psychiatry for a long period of time in China’.

Furthermore, TCM also relied on observations and descriptions for both diagnosis and treatment. Although it has not been discussed in depth whether clinical presentation or prognostic implication should receive more attention, the classification of mental illnesses in TCM was also based on a catalogue of symptoms associated with the concept of a disease pattern. A few records of the symptoms and syndromes of mental illnesses were quite similar to the descriptions of them in modern psychiatry (Tseng, 1973). Thus, descriptive psychiatry, as represented by Emil Kraepelin, Eugen Bleuler, Kurt Schneider and other German psychiatrists who adopted the principle from Karl Ludwig Kahlbaum, was not difficult for Chinese scholars to understand and accept as they were still greatly influenced by TCM, despite their Western-style medical training.

However, in general, Chinese scholars only had fragmented and inconsistent contact with various Western psychiatric theories. For example, Cheng (see above), who studied in both Germany and America in the 1930s, pointed out in a 1925 editorial that ‘psychoanalysis represented the European school while Adolf Meyer represented the English-American school’ (Cheng, 1948a). It was not until the 1960s, with the publication of a Chinese translation of Wilhelm Mayer-Gross’s Clinical Psychiatry, that the Chinese audience became aware of the general global status of the field and the various schools that existed. Given that the Chinese version was published without the consent of the author, it would probably have surprised him to hear that his book created quite a sensation in China as it ‘brought in a fresh wind’ (Wang, 2006).

Finally, any arguments about the legacy of Adolf Meyer in Chinese psychiatry have to take into account the historical and political environment in which the field developed. Western medicine functioned much like a colonial influence in China. The term German-Japanese medicine and its counterpart Anglo-American medicine have been used frequently in Chinese medical history. This interaction with Western medical traditions not only resulted in disputes between TCM and Western medicine, but also reflected conflicts and tensions between various schools within the Western medical community in China. The latter had more to do with differences in the channels of communication as well as regional particularities within China than it did with the actual scholarship and teachings involved (Jin, 1985: 125–38).

In summary, before 1949 Western psychiatry travelled to China mainly by way of America. However, the process by which ideas were accepted was not merely one of replication, but rather active selection. Thus, despite the fact that there was little direct contact between Chinese and German psychiatry between 1898 and 1949, a process of cultural adaptation took place: the German wine was kept, but the glittering American label on the bottle was stripped away.