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The history of psychiatry and madness in modern China has recently become a growing field of scholarly interest. Although many researchers focused on specific institutions, cities, and medical figures, the present study provides an analysis that covers a longer time span, documenting how mental and nervous illnesses in China were conceptualized in the Western medical discourse between the 1840s and the 1930s. In particular, the present study investigates the causes that these primarily missionary medical accounts attributed to the diseases, particularly regarding specific racial or cultural characteristics of the Chinese. Furthermore, in lieu of describing this Western involvement as “colonial medicine” or “imperial medicine”, the study re-examines these accounts to better understand the nature of Western medical and psychiatric services in modern China.