A Cultural Pathway to Addressing Contemporary Mental Illness: Construction and Healing Logic of the “Virtual Illness” Concept in Shamanism in the North of China

Abstract

Mental illness has become increasingly prominent in the modern individuation process in China. Correspondingly, contemporary shamanic practices in the north of China have gradually focused on mental issues and have constructed an indigenous concept related to them: “virtual illness.” Based on many years of fieldwork conducted in the shamanic regions of the north of China, this study focuses on the healing practices of local shamans. By integrating theoretical resources on the “self” from sociology and shamanic studies, it explores the cultural practices and therapeutic logic formed by local shamans around the concept of “virtual illness” in addressing contemporary socio-psychological anxiety. Studies indicate that within the shamanic conceptual system of this region, prolonged mental distress is prone to possession by external malevolent spirits, thereby becoming a form of virtual illness. The healing process of possession-type “virtual illness” reflects the regional shamanic approach to explanation and intervention within a framework of a holistic self. This is manifested by attributing misfortune, such as failure and mental illness, to the possessed spiritual identity and conducting spiritual healing on the possessed spiritual identity, while encouraging individuals to maintain a positive and forward-looking state. Together, these actions build a positive psychological foundation for coping with mental illness, providing a unique response pathway to the mental illness triggered by the “individualized self.” Cultural healing practices in the north of China for mental illness not only adapt to the modern Chinese medical system and social context, but also offer a targeted cultural healing perspective for understanding mental illness phenomena in China’s individuation process, thereby promoting philosophical reflection on the concept of the “self.”

1. Introduction

Since China’s Reform and Opening-up,1 it has undergone a highly compressed modernization process, with the individuated self rapidly emerging. Concurrently, psychological anxiety has become increasingly significant (Xin Liu 2002; Yan 2010; Zhang 2020). Long-term mental distress, which has not been effectively alleviated, has gradually led to the search for alternative therapeutic spaces of beliefs. Within this space, some individuals with mental health issues have begun to turn to the shamanic system to find solutions. Correspondingly, the healing practices of Shamanism in the north of China have demonstrated a clear shift toward mental issues and have constructed the “virtual illness” concept closely related to mental illness. In relevant academic research, Fu and Zhang’s documentation of Manchu shamanic rituals and divinations laid the foundation for understanding the textual traditions of Shamanism (Fu and Zhang 2016); Song’s translations and annotations of Manchu shamanic invocations have constructed a systematic interpretative framework for shamanic texts (Song 1993); Guo’s comprehensive study of the shamanic abilities, soul concepts, and trance techniques of in the north of China has revealed the internal logic of shamanic beliefs (Guo 2007). However, most of the above studies focus on the compilation of traditional shamanic texts and the interpretation of shamanic belief systems, paying relatively limited attention to the functional shift in the practice of Shamanism in the north of China, specifically, its role in intervening in the treatment of mental illnesses within the contemporary social context. Even when earlier scholars addressed the therapeutic functions of shamans, their research largely proceeded from perspectives such as symbolic analysis and positive psychological suggestions, offering generalized discussions on the efficacy of shamanic healing (Lévi-Strauss 1963, pp. 167–205; Meng 2019, p. 168; Sa 2021, p. 434; Se 2015b). However, considering that the current social roots of mental illness are primarily related to the individuated self, its diagnosis and treatment should begin with the concept of self. Based on this understanding, this study focuses on the mental healing practices of contemporary in the north of China. Employing conceptions of the “self” from both sociology and shamanic studies as theoretical tools, it aims to elucidate how local Shamanism, grounded in the notion of the “holistic self” within shamanic studies, provides a targeted healing pathway in response to the mental dilemmas engendered by the “individualized self” in contemporary society, thereby prompting further reflection on the concept of the “self.”

To examine in detail the aforementioned issues, I conducted two-year phased fieldwork in the Shamanism-practicing regions in the north of China from January 2024 to early 2026. The specific fieldwork locations included Hulunbuir City and Tongliao City in the Inner Mongolia Autonomous Region and Songyuan City and Jilin City in Jilin Province. During this period, I interviewed eight shamans (Thin Shaman, Li Shaman, Ba Shaman, Bao Shaman, Old Shaman, Black Shaman, Na Shaman, and Chen Shaman) and numerous other relevant insiders, such as Mr. Daur and Reporter Tuya, who served as key informants. Owing to the widespread use of Mandarin, most communication proceeded smoothly. However, in sacred ritual contexts, the shamans primarily used traditional ethnic languages. At such times, I typically relied on my fieldwork companions for translation and explanation; individuals who possessed both minority cultural backgrounds and higher education were always willing to provide detailed clarifications. These individuals became crucial sources of knowledge during fieldwork. Several shamans, perceiving me as having auspicious “facial features” and thus a “predestined affinity” with them, allowed me to participate in their rituals and generously shared their knowledge. Even after leaving the field, I continued to seek clarification from my informants via WeChat, and they patiently answered my questions. Remarkably, many of my fieldwork subjects treated their own culture with profound respect and were deeply concerned about potential misinterpretations. They approached the origins of each concept with even greater seriousness than I did, often proactively researching and providing me with the most accurate information about their ethnic groups’ shamanic culture, expecting that I would faithfully convey their essence. These accurate and invaluable fieldwork materials laid a solid foundation for the writing and conceptualization of this paper.

2. New Understanding of Illness of Shamanism in the North of China: Virtual Illness (Xu Bing 虚病) Versus Actual Illness (Shi Bing 实病)

Shamanism is a religious tradition originating in prehistoric times whose core concepts include animism and a cosmic system constituting the upper, middle, and lower worlds (Money 2000). As spiritual leaders within their tribes, shamans can enter trance states to communicate with hidden spiritual worlds, thereby obtaining knowledge and power and providing assistance to the community (Ember and Ember 1990, pp. 268–76). The term “shaman” was originally introduced to the West by Russian explorers when they first encountered the Tungusic people in the 17th century. Eliade (2004, pp. 4–7) considered Shamanism in the strict sense to refer primarily to a religious phenomenon in Siberia (Northeast Asia) and Central Asia, equating it with the “technique of ecstasy.” Širokogorov (1935, pp. 268–76), on the other hand, specifically summarized five cultural elements constituting the shamanic complex among the Tungusic people of Northeast Asia to distinguish it from other forms of magical-religious practices and religious systems among the Tungus. These five elements are as follows: “(1) the shaman is a master of spirits; (2) he has a group of mastered spirits; (3) there is a complex of methods and paraphernalia recognized and transmitted; (4) there is a theoretical justification of the practice; (5) the shamans assume a special social position” (Širokogorov 1935, p. 274). Ethnic minorities in the north of China (specifically in the Northeast and Inner Mongolia regions) are located in Northeast Asia. Among them, several ethnic groups belonging to the Turkic, Mongolian, and Manchu-Tungusic branches of the Altaic language family once universally practiced Shamanism, thus becoming typical representatives of Shamanism and important windows for its study (Bao 2015, pp. 2–18; Se 2015a, pp. 318–35). Scholars sometimes use the terms “trance” and “ecstasy” to describe the shaman’s communication with spirits in an altered state of consciousness. Some scholars believe that these two terms are nearly synonymous, encompassing spirit possession and soul flight. Eliade, in his classic work Shamanism: Archaic Techniques of Ecstasy, defined ecstasy primarily as “soul flight,” considering it the core characteristic of Shamanism, while spirit possession was deemed secondary. Following the dissemination of Eliade’s formulation, ecstasy gradually came to be understood as an extracorporeal journey into different cosmic regions. However, scholars have critiqued this concept, arguing that it neglects the phenomenon of spirit possession occurring during spirit communication (Huang 2003, pp. 249–68). Guo (2009) noted that Eliade’s emphasis on ecstasy primarily refers to soul flights. However, her fieldwork in the north of China indicated that soul flight is not prevalent locally; instead, spirit possession is common in shamanic rituals. Possession constitutes not only an important procedure and a marker of ritual success in local shamanic practices, but also a necessary condition for becoming a recognized shaman. Therefore, this study adopts the more neutral term “trance,” encompassing both soul flight and spirit possession, to describe the practices of spirit communication among shamans in the north of China. Furthermore, through in-depth research into the history and ethnography of Chinese Shamanism, scholars have highlighted that the Manchu people, in the course of their historical development, actually possessed two types of shamans: the clan shaman (jia shaman), characterized by the absence of trance, and the wild shaman, who retained the tradition of trance. Consequently, these scholars have questioned the traditional view that the trance state is the core of Shamanism, prompting the academic community to reconsider the adaptability of Shamanism throughout its historical evolution and the consequent issues surrounding its definition (Guo 2007, pp. 15–16; Qu 2023).2

After the founding of the People’s Republic of China, Shamanism was suppressed as a feudal superstition. Following the reform and opening-up period, as religious policies gradually relaxed, shamanic activities shifted from covert to public, with increasing rituals and sacrifices. In recent years, some elements of Shamanism in the north of China have been listed as representative examples of outstanding traditional culture at various levels of the intangible cultural heritage inventory, acquiring legal status, and demonstrating a certain trend of revival (Xiaoshuang Liu 2025; Qu 2024; Xing and Murray 2018). Therefore, in the contemporary sociocultural context of China, Shamanism is not only an ancient religious form, but also a continuously evolving living cultural heritage. The contemporary revival of Shamanism in the north of China can be attributed to several factors. Many scholars have noted that, compared with traditional Shamanism, an important characteristic of its current resurgence is its increasing use in treating mental illnesses that modern medicine finds difficult to address effectively (Se 2015b). Another aspect of Shamanism’s revival is the rise of modern “Neoshamanism” in urban areas across Europe, the Americas, and beyond, a movement distinguished by its strong alignment with contemporary psychotherapeutic demands (Yuan 2014, p. 5). Thus, Western Neoshamanism has abandoned the functions of traditional Shamanism, such as blessings for the clan, and has instead focused on self-psychotherapy (Zheng 2023, pp. 4–5, 141–42). If Western Neoshamanism has strategically adjusted ritual procedures in response to psychotherapeutic needs, it can be inferred that shamanic practices in traditional belief areas, such as the north of China, may also undergo changes owing to social transformations and corresponding new social demands.

In its early stages, particularly in historical periods before modern biomedicine was established, shamans served as traditional healers responsible for treating various diseases. However, today, many shamans in the north of China explicitly state that they primarily treat “mental illness.” The Daur shaman E Lao Er noted, “The cases I see now are all illnesses that hospitals can’t cure, mostly mental illnesses, and some cases of alcoholism” (Meng 2019, p. 218). Serinqin, a shaman from Horqin Left Middle Banner, Tongliao City, Inner Mongolia, stated, “There are 404 kinds of diseases in the human world. 101 are to be treated by doctors, 101 by lamas, 101 by shamans, and the remaining 101 are for self-treatment. The illnesses we shamans can treat are neurological or psychological/mental illnesses. Diseases like liver or stomach problems, similar to these, we cannot treat” (Se 2015b). During my visits to various shamans in the north of China, many initially expressed similar views.3 The way in which shamans name their practice culture illustrates this point. For example, the Thin Shaman named his trance healing practice “He’s Massage Shop,” with the business scope listed as “Health and Wellness Services (non-medical), Traditional Chinese Medicine Health and Wellness Services (non-medical),” and legally obtained the relevant practice licenses.4 The Li Shaman’s WeChat name is “Health Psychology Mediator.”5 Furthermore, even in the large-scale traditional sacrificial rituals conducted by shamans today, such as the Ominaan ceremony, new elements have been incorporated. These include therapeutic interventions for participants experiencing mental distress during the shaman’s trance process (F. Wu 2013, pp. 183–86).

Based on this phenomenon, a disease category related to mental illness has emerged within shamanic circles in the north of China—“virtual illness” and actual illness. For instance, Sa (2021, pp. 403–11; 2024) believes that a new development among contemporary Daur shamans is that they no longer treat all illnesses but instead classify diseases into virtual and actual illness. Actual illness is primarily organic illness requiring hospital treatment, whereas virtual illness may more often refer to mental illness. Treating virtual illness has become the focus of contemporary Daur shamanic activities. Meng (2019, pp. 159–60) further confirms this view, more explicitly stating that psychological and mental illnesses such as hysteria, neurasthenia, and depression belong to the category of virtual illness, and fall within the scope of shamanic diagnosis and treatment. When I further inquired about the specific concepts of “virtual illness” and “actual illness,” compared with discussing the treatment of “mental illness” in a general sense, the shamans responded to this concept more actively and seriously—their gaze revealed a sense of pleasant surprise, as though my question had touched the core of their belief system. They clearly stated that they primarily treat “virtual illness” and are less involved with “actual illness.”6

If virtual illness and mental disorders differ in degree, what constitutes an actual illness versus virtual illness? Perhaps the similar concepts of “body illness” (shen bing 身病) and “fate illness” (ming bing 命病) among the Dong ethnic group in Hunan, southern China, can provide some understanding. A Dong ritual expert explained, “When a Dong healer diagnoses someone, they consider six major causative factors: heart, liver, spleen, stomach, kidneys, and fate. The first five cause body illness, the last one causes fate illness…. If it’s a fate illness, then using only medication to treat it will not only be ineffective but also invite ridicule from peers” (Yu 2022, p. 107). Yu (2022, pp. 115–20) explains this further. Body illness problems are primarily treated with medication by Western medicine, herbalists, etc. However, fate illness is primarily addressed by ritual specialists through a series of ceremonies—such as appeasement, sending away ghosts, expelling evil, praying for blessings, and soul retrieval—to resolve the affliction. Thus, body illness mostly pertains to diseases at the physiological level, while fate illness is connected to supernatural “fate gates” or “spirits” (typically negative forces). In the shamanic system in the north of China, the distinction between virtual and actual illnesses largely follows a similar logic.

Regarding “virtual illness,” while shamans do not have a completely unified definition of the term, most associate it with spirits, believing that such illnesses are caused by negative spiritual entities. Specific manifestations include soul loss, spirit possession, or affliction by malevolent forces. Additionally, illnesses triggered by issues with feng shui (风水) or the location of ancestral graves are categorized by some shamans as “virtual illness.” They noted that these causes could only be discerned through the spirits to which they were connected. A distinctive feature of “virtual illness” is that it typically cannot be effectively diagnosed or treated using modern medical means; instead, it requires treatment by a shaman through rituals. Local shamans sometimes use the term “ge yao de” (隔药的, meaning “medicine-blocking”) to describe “virtual illness,” indicating that the condition obstructs the absorption of medication. Only after the shaman has first addressed the “virtual illness” caused by negative spiritual entities can medication for the actual illness take effect.7 Such conditions are commonly referred to among the local people as “heart illness “ (xin bing 心病), “external illness” (wai bing 外病), or “hysterical illness” (yi bing 癔病), all of which require ritual treatment by shamans.

Furthermore, no clear boundary exists between body and fate illnesses. Among the Dong in Hunan, any body illness may become a fate illness if it is difficult to treat or owing to a sudden onset. For illnesses that herbalists cannot cure and that Western medicine is helpless against, people consider them to be caused by spiritual interference. However, regarding fate illness and its related ritual treatment, villagers mostly hold a stance of “half-belief, half-doubt,” believing that one cannot rely entirely on ritual treatment but needs to supplement it with medication. Ritual and drug treatments are not mutually exclusive; they usually work simultaneously for people’s difficult and complicated illnesses, taking turns being employed, jointly addressing people’s ailments (Yu 2022, p. 115). Shamanism in the north of China holds a similar perspective. Within cultural logic, virtual and actual illnesses can be transformed into one another. If an actual illness drags on for a long time, it can cause the patient’s “vital fire” (火力 huo li, a concept of vital energy) to decrease, making them susceptible to invasion by evil spiritual influence, thereby adding a virtual illness component. Conversely, if a virtual illness remains untreated for a long time, it may develop into a severe organic actual illness.

Regarding the treatment of these two types of diseases, Li Shaman stated, “I mainly treat virtual illness caused by evil spirits. As for the treatment of organic diseases, we can detect them with our eyes, but after identifying them, we generally advise the patient to go to the hospital for treatment.”8 Mr. Daur, who lives within the context of shamanic belief, did not agree that shamans were less involved in treating actual illnesses. He stated, “The essence of a shaman is that of a spirit medium. Whether they can treat an illness depends on their communication with ‘spirits,’ not simply defined by ‘actual illness’ or ‘virtual illness.’ I know many shamans who don’t use the concepts of ‘virtual illness’ or ‘actual illness.’ The Daur shamanic system includes the otox (斡托西, wotuoxi), specialists in treating children’s diseases; the barx (巴尔西, ba’erxi), who mainly treat sores, wounds, and bone setting, etc. Some shamans don’t treat certain diseases (so-called actual illness) not because they lack corresponding diagnostic methods, abilities, or means, but due to undisclosed reasons.”9 Regarding these “undisclosed reasons”, the well-traveled Ba Shaman stated, “We also treat actual illness. The reason we publicly claim that we only treat mental illnesses or virtual illness, rather than saying we treat biological diseases, is to avoid competing with biomedicine, which could lead to our suppression.”10

Synthesizing these statements, the contemporary distinction made by shamans in the north of China between actual and virtual illnesses, and their delimitation of the chief scope of treatment to mental illness or “virtual illness,” stems more from strategic considerations for self-preservation in a somewhat sensitive social environment—for example, avoiding direct competition with Western medicine and thus being labeled as “superstition” again. Therefore, shamans often prefer to claim that they are recognized as health psychology mediators or health and wellness practitioners, primarily able to treat mental problems, secondarily treat virtual illness, and only finally reveal that they can handle actual illness. This new definition of illness, such as the distinction between virtual and actual illnesses, is a new mode of adaptation and continuation for Shamanism in the north of China (and even other belief areas in China, such as among the Dong), under the dominance of modern Western medicine. The concept of mental illness in modern medicine, a type of “emotional illness,” has no absolute correlation with virtual illness caused by “spirits.” Moreover, mental illness can have an organic basis, meaning that it could be an actual illness. A certain gap exists between the concept of “virtual illness” in the shamanic context and the concept of “mental illness” in contemporary medicine. Why, then have the concepts of virtual and mental illnesses become linked together and spread widely in the contemporary shamanic system in the north of China? This is primarily related to the widespread psychological anxiety in contemporary China.

3. The Social Roots of Contemporary Chinese Mental Anxiety: Self-Dilemma in the Process of Individuation

Phenomena such as anxiety, depression, and sub-health are becoming increasingly common in modern society. Psychological anxiety and the consequent chronic diseases have replaced infectious diseases as primary hazard to health (Brannon et al. 2017, p. 9; Sadowsky 2021, p. 2). Although severe psychological disorders are relatively rare, common mental health issues such as psychological anxiety are highly prevalent in communities. However, the number of patients with mental illnesses receiving adequate and effective treatment is low. Zhang (2020, p. 5) highlighted that this anxious mood is particularly pronounced in contemporary Chinese society. Unlike Western societies, which have undergone hundreds of years of modernity evolution, China has experienced a highly compressed transformation of social structure and culture in over forty years since the Reform and Opening-up, leading to anxiety becoming a characteristic of the era’s collective psychological state, that is, “anxious China.”

Although mental illness has a biological basis, mental disorders such as depression are primarily viewed as being triggered by social conditions (Sadowsky 2021, p. 19). Beck and Bauman highlighted that the widespread psychological anxiety in contemporary times is closely related to the ongoing process of individuation in modern society (Bauman 2000, pp. 28–51; Beck 1996, pp. 89, 100). Individuation is a core feature of modern society. It signifies that individuals gradually liberate themselves from the hierarchical constraints of traditional feudal orders and group-centric thinking, turning toward identity construction based on personal achievement (Bauman 2000, pp. 7–8; Beck 1996, pp. 87–89). This “individuation” trend runs through the entire modern era and undergoes a profound shift with the evolution of modernity itself: from the “first modernity” characterized by linear progressivism, to the more self-critical and reflexive “second modernity” as a whole (Yao 2023, p. 2). Correspondingly, the self has become even more individualized.

The first stage of modernity extended roughly from the Enlightenment period to the mid-1980s. Bauman (2000, pp. 32–33) noted that evolutionary thinking dominated this phase. “Becoming modern” was understood as a linear progression toward some ultimate, perfect state. Although individuals had progressively shaken off the group shackles of family, monarchy, and church institutions, they were embedded within new collective identities, such as the nation-state, social class, and gender. However, beginning in the mid-1980s, society entered the stage of second modernity, characterized by the decline of grand narratives and a sharp rise in risk and uncertainty. Beck (1996, p. 9) summarized this social form as the “risk society.” In this context, “modernity” means perpetual change and endless flow, lacking a clear ultimate goal. Although individuals are structurally “disembedded,” they find it difficult to achieve successful “re-embedding.” This structural identity dilemma leads to a significant increase in the experience of uncertainty, anxiety, and insecurity within an individual’s inner experiences (Bauman 2000, pp. 28–35).

Modern societies commonly face mental anxiety caused by the process of individuation. However, by comparing the different backgrounds of the individuation processes in China and the West, we can further understand why psychological anxiety in modern China is particularly prominent. An important contextual backdrop is that China’s modernization process since the Reform and Opening-up in 1978 has presented a unique scenario in which the first and second modernities coexist, with a notably indistinct transition between the two. Over four decades, Chinese society has remained within the phase of the first modernity—characterized by optimism and a belief in linear progress. Many people harbor expectations of upward mobility, and everyday life is permeated through narratives of developmental optimism. However, the second modernity—marked by uncertainty, a heightened sense of risk, and the dissolution of grand narratives—has already closely followed. Consequently, contemporary Chinese have come of age in an environment of “affluent first modernity,” where material abundance has rapidly increased and opportunities have appeared to multiply. The greater the hope they nurtured, the deeper their potential disillusionment when confronted with the gap between aspiration and reality. Simultaneously, they are compelled to abruptly confront a “second modernity” social structure that struggles to provide stable expectations or long-term visions. This clash of diametrically opposed narratives brought about by dual modernities makes many individuals more prone to feelings of disorientation and renders their sense of anxiety particularly profound.

Second, the Western individuation process was built on long-term industrial development. The first stage of modernity involved the accumulation of substantial economic capital. Therefore, when entering the second modernity, most Western societies had already become wealthy welfare states. Even after the 1980s, as individuals began to face a future with increased risks and rising uncertainty, relatively affluent material conditions and a well-developed social security system could provide them with a considerable degree of buffer, helping to maintain the individual’s “ontological security” (Yao 2023, pp. 14–15). In contrast, China comprehensively launched its modernization process in 1978 with Reform and Opening-up. Its first modernity development stage was relatively short, and the overall capital accumulation had not yet reached the level of developed countries. When Chinese individuals similarly face the unstable prospects brought about by the second modernity, as a developing country, the anti-risk support that society can provide, such as social security, public services, and psychological resources, remains insufficient. This relative insufficiency of structural support may cause Chinese individuals to bear greater psychological pressure when facing the impact of the second modernity, thereby exacerbating the prevalence and severity of anxiety.

Furthermore, within the individuation discourse shaped by modernity, life is portrayed as an open competition; theoretically, everyone can achieve their ideal life through their own efforts. However, Chinese society continues to be deeply influenced by traditional hierarchical structures, in which the upper class and their families often occupy resource advantages and social status. This means that even occasional mobility opportunities that emerge in an uncertain modern society are mostly obtained by the advantaged class; only they can provide their children with continuous and solid support in a highly competitive and unstable environment. Social networks and media constantly display various glossy possible lives. Driven by the individuation narrative, many ordinary people appear to be optimistic about class ascension, but repeatedly hit walls in reality, finding it difficult to truly overcome structural barriers. Notably, under the intertwined influence of traditional concepts and reality, this inequality is often partially internalized and even accepted (Lu 2025). One manifestation is that, currently, many Chinese youths—as reflected on the Xiaohongshu platform—tend to attribute their plight to their family of origin failing to provide sufficient “class support,” rather than to personal lack of effort. In this process, many individuals have undergone psychological and behavioral shifts from “involution” (内卷 neijuan) to “overwork” (过劳 guolao) to “lying flat” (躺平 tangping), accompanied by a strong sense of powerlessness and mental exhaustion (Wang 2023).

The various anxieties fostered by the individuation process are further amplified through the mechanism of individualization of risk. Some scholars believe that the prominence of the individuation trend does not entirely stem from the awakening of personal autonomous consciousness but is driven more by new patterns of social structure (Bauman 2000, pp. 32–34; Beck 1996, pp. 127–29). Beck (1996, pp. 89–110) highlighted that under the conditions of a developed labor market, individualization itself has become an ideology, and productive force—social structures force individuals to plan and manage themselves as independent units. Under this logic, individuals are under pressure to actively design their lives and pursue maximum efficiency. Simultaneously, risks and contradictions that originally belonged to the institutional and structural realms, such as academic competition failure, unemployment, and lack of social security, are systematically transferred to the individual level. These systemic risks are gradually “subjectified” and “individualized,” meaning that people tend to attribute them to personal choice or ability issues, thereby actively internalizing responsibilities that inherently belong to society. Thus, structural dilemmas are increasingly transformed into psychological issues, such as self-doubt, self-blame, anxiety, inner conflict, and even neurosis. This tendency to individualize social problems and then psychologize them undoubtedly further aggravates the prevalence and severity of psychological issues.

4. The Relationship Between Constructed Virtual Illness and Mental Illness

Along with the globalization of Western biomedical languages, currently, modern medicine assumes a medicalized approach to mental illness, considering it as a biochemical disorder. However, the therapeutic effects of biomedicine on mental illnesses are insignificant. Therefore, in addition to modern psychotherapy, many Chinese people have begun seeking traditional, religious, and spiritual paths to healing (Van der Veer 2009). In this context, Shamanism has become an important option in religious therapy. As noted by a Dong ritual master when explaining health and illness, “When people are healthy, they don’t believe in ghosts, and ghosts won’t bother them. But when they are weak and ill, ghosts come” (Yu 2022, p. 59). Moreover, this concept applies to shamanic practices in the north of China. Local shamans state that majority of those who seek their help do so because “medicine is ineffective and injections yield no results,” turning to them only after conventional medicine has proven powerless. The current individuation process in Chinese society has generated many mental anxiety phenomena for which mainstream biomedical treatments have limited effectiveness. In this context, long-term unresolved mental problems have facilitated the formation of a space for belief. Many individuals suffering from mental illness turn to Shamanism for precise help under these circumstances. As aforementioned, the boundary between virtual and actual illnesses has been blurred. When an individual suffers from a prolonged actual illness accompanied by diminished vital fire/energy, an additional virtual illness may develop. Similarly, in the world of Shamanism in the north of China, the reason mental illness is often linked with “virtual illness” and even overlaps to some extent arises from the belief that, when individuals are emotionally low and lacking vital fire, they are more susceptible to possession by evil spirits.11 Moreover, the concept of possession is a typical manifestation of virtual illness, that is, as the Dong ritual expert stated, “But when they are weak and ill, ghosts come.” This state can aggravate psychological problems and even trigger an actual illness (organic illness). Such situations often require shamanic intervention through supernatural means. The process can be divided into three stages.

First, There is minor mental illness.

Second, if minor mental illness is not addressed promptly, it may develop into severe mental illness, leading to further exhaustion of energy, thereby inviting invasion and possession by external evil spirits, becoming a “virtual illness.”

Third, if severe mental illness that has already been possessed by “external evil spirits” (i.e., virtual illness) is not taken seriously, it may transform into an actual illness, that is, an organic illness. Thin Shaman specifically highlighted that once it develops to the third stage, even shamans sometimes find it difficult to reverse the condition (certainly, some exceptionally powerful shamans may be exceptions).12

In the shamanic worldview, the spiritual and human worlds continuously interact, constituting the background of daily life. When an individual is in a poor state (often described as “火力低 low vital fire”)—whether from organic illness or emotional low spirits—they are prone to disturbance by external evil, subsequently leading to the appearance of “virtual illness.” Long-standing pure virtual illness may also gradually lead to actual illness. In shamanic practice, both virtual and actual illnesses can be treated with the help of “spiritual” power. However, in shamanic tradition, there was originally no distinction between “actual illness” and “virtual illness,” nor were there corresponding concepts. Eliade (2004, pp. 215–20) noted that the most widespread explanation for illness in Shamanism is rooted in the soul—whether the soul has been lost or the person is possessed—and that only a shaman, who can see the soul, is able to cure such illnesses. Fu and Meng (1991, pp. 109–18) support this view. Through their investigation of shamanic healing practices among the Manchu people in China, they noted that, in this tradition, illness is attributed to punishment or harassment by spirits or demons. For a long time, the Manchu people sought healing for illnesses through shamanic rituals rather than medical treatment. In contemporary Western Neoshamanism, although further distinctions regarding the causes of illness have been made based on this tradition—as represented by its key figures Harner and Harner, who state that severe illnesses and injuries may arise from either spiritual or non-spiritual factors, and that the shaman’s primary role is to address the spiritual dimensions of illness—there remains no clearly defined conceptual distinction between “actual illness” and “virtual illness” within this framework (Harner and Harner 2003, pp. 19–45).

Therefore, the conceptual pair of “virtual illness” and “actual illness” lacks historical roots and represents a distinctly constructed cultural cognitive category within the contemporary shamanic regions in the north of China. The reasons why local shamanic practices construct this set of concepts and delimit the focus of treatment for mental or virtual illnesses are primarily twofold. First, there are numerous patients with mental illness in contemporary China, and mainstream Western medical treatment is ineffective. Shamanic treatment has become an important supplementary pathway that bypasses direct conflicts with the atheist ideology and the authority system of Western medicine. Second, within the shamanic “animistic” interpretive framework, mental illness that is difficult to cure over a long time is easily associated with possession by evil spirits, a typical category of virtual illness, and is precisely the area where shamanic healing excels. Third, in the context of individualization, contemporary young people from ethnic minorities in the north of China, such as the vast majority of modern Chinese youth, are gradually becoming disembedded from their families and communities, resulting in a pronounced rupture with the animistic worldview underpinning traditional shamanic knowledge. Faced with this intergenerational estrangement, shamans must develop new explanations and terminology to reach the younger generations. The conceptual pair of “virtual illness” and “actual illness” meets this need—they operate within the knowledge system of animism while simultaneously being able to interface with the discourse of Western medicine, achieving a reconciliation between tradition and modernity through fuzzy boundaries, and thereby acquiring relative acceptance. In some cases, even certain practitioners of Western medicine in China, when encountering illnesses that are difficult to diagnose or treat, suggest that patients seek help from those who are skilled in addressing “virtual illness” or “external illness”. Thus, the concepts of virtual and mental illnesses have gradually intertwined and spread in parallel within the context of contemporary shamanic treatment in the north of China, and in practices leaning toward psychotherapy, the concept of “virtual illness” has increasingly clearly indicated the phenomenon of possession.

Considering the three different degrees of mental illness aforementioned, Shamanism in the north of China proposes appropriate treatment methods. For minor mental illnesses, no shamanic intervention is typically required; they can heal on their own. If the illness develops into a possession-type virtual illness, the shaman performs a series of rituals for spiritual healing. During this period, the shaman does not enter an evident trance state. According to Thin Shaman, even when not evidently in a trance, the spirit whispers near the back of their heads, giving them inspiration. At this time, the shaman’s power is not as strong as during a trance; however, it possesses some power.13 Thus, whether a shaman enters a trance state often depends on the severity of the illness; the “virtual illness” at this stage remains within the scope that the shaman can handle independently in a conscious state. When I observed and inquired about the shamanic treatment procedures, the shamans’ performances and answers often varied. Tuya, a Mongolian reporter, explained, “Shamanic healing rituals are all in progress, often varying depending on the patient and according to the feedback opinions from the spirits.”14

As for severe mental illness that has developed into an actual illness, shamans typically conduct rituals (often possession rituals in which, unlike the passive possession of patients with mental illness, the shaman actively invites spirit possession) in a trance state to perform healing. Moreover, some shamans treat patients by transferring the illness or the possessing evil spirit from the patient to another object.15 Many shamans state that unless the virtual illness (the spiritual-level cause of illness) is removed, the actual illness (the physical-level disease) is difficult to cure completely. Once the virtual illness is addressed through spiritual means, visiting a hospital for the actual illness often leads to a swift recovery. Whether for virtual or actual illness, shamans also actively advise patients during treatment, helping them untie emotional knots, comforting them to live happily and healthily, acting as psychotherapists to some extent. This treatment method includes both transcendental and psychological counseling elements. For modern people, this may appear somewhat unusual, but some reports state that the treatment outcomes are positive and beneficial. Subsequently, whenever people feel unwell, they consult the shaman they trust.

5. Treatment of Mental Illness Through the Holistic Self-Concept in Possession-Type Virtual Illness

Studies on shamanic healing have a long history and have resulted in an extensive body of literature. The beginning point of this article is as follows: if current psychological anxiety is related to the individuated self, then will its shamanic treatment also be related to “self” construction? Thus, the concept of “self” becomes the core theoretical framework for this article’s analysis of the practice of Shamanism in the north of China in treating mental illness. Postmodern theory holds that the “self” is not a predetermined entity; rather, it is constituted through social recognition. Consequently, Rose (1990) noted that the self is an ongoing dynamic process of becoming. This process involves continuous negotiations with social expectations, individual responsibilities, and cultural norms, giving rise to fluid and diverse self-constructions across contexts and temporalities. Since its Reform and Opening-up, China has undergone a highly compressed process of modernization. Within this process, an individualized self, distinct from the traditional collectivist mode of selfhood, has rapidly emerged (Xin Liu 2002). Thus, issues related to psychological anxiety have become increasingly prominent. In this context, the diagnosis and treatment practices of Shamanism in the north of China for mental illness probably embody its re-understanding and flexible application of the “self” concept. Thus, the conception of the self in shamanic studies offers a crucial analytical lens for understanding its therapeutic logic.

The trend of individualization that emerged alongside modernization and the resultant “individualized self” remain relatively recent phenomena in historical terms. Beck (1996, p. 88) noted that before the rise of individualization, people’s ways of thinking were deeply rooted in the traditional categories of large-group societies, such as class and status. Furthermore, the understanding of “large- group” can be extended further: in even more distant prehistoric shamanistic societies, there also existed a non-individualized form of self. This form was not entirely defined by social class but was often a type of “holistic self” that integrated spirituality, community, and nature. The advancement of individualization signifies the abandonment of thought categories based on a large group that once characterized people’s lifeworld. Consequently, traditional methods of coping with anxiety and unease gradually lose their efficacy. However, anxiety and unease persist and may even intensify as risks become automatically subjectified (Beck 1996, pp. 136–53). For instance, in individualized societies, unfortunate encounters are often perceived as personal failures, thereby exacerbating self-blame and anxiety. Under the yoke of individualization, even when suffering from mental illness, people often cannot help but ask the shaman, “Why did I get sick, and not someone else?” (Meng 2019, p. 165). In contrast, in traditional societies structured around large-group concepts and corresponding holistic selfhood, misfortune is considered bad luck originating from spirits (misfortune, particularly illness, is considered to originate from invasive malevolent spiritual others), requiring rituals performed by a shaman for healing.

Le Breton (2013, pp. 17–39, 107–49) systematically elaborated on a model of the holistic self within the traditional shamanic world. He noted that, unlike the modern Western concept of the individual, which emphasizes the boundedness and independence of self-identity, in holistic traditional societies, the self and the world are intermingled and interconnected with the community, the cosmos, nature, and even the invisible “spiritual” realm. Within this worldview, the individual is open to and mutually influenced by the external world, and there exists a “porous and permeable” relationship between humans and their surroundings where all things are interconnected. Consequently, phenomena, such as a person owning multiple souls or bodies, frequently occur, reflecting the extensibility and composite nature of the self within a holistic network. The foundation of the skills mastered by folk healers, such as shamans, lies precisely in this worldview that perceives humans as a microcosm (i.e., the holistic self-concept referred to in this text) through which they proceed with healing. Mertz (1994) termed this model of open, continuously negotiated, and mutually permeable boundaries between self and other the “sociocentric self.” He argued that within such a cultural context, the self is susceptible to invasion by external factors such as malevolent intent. Benatar (2006) further highlighted that shamanic culture is precisely a sociocentric self-culture in which an individual’s mental illness is often perceived to have external invasive components, such as being caused by external spirits, not necessarily directly related to the individual. The shaman then employs the cultural logic of the sociocentric self—for example, spiritual healing—to address these external mental afflictions.

Within the context of Shamanism in the north of China, severe mental illness is considered as possession by evil spirits. At this point, humans and spirits interpenetrate, with the spiritual identity becoming part of the self, reflecting a cognitive model of the “holistic self.” Based on this concept, Shamanism in the north of China demonstrates its unique advantages in diagnosing and treating mental illnesses: it interprets issues within the framework of the “large group” rather than being confined solely to the individual “I.” For instance, misfortune, such as failure or mental illness, is explained spiritually, and the individual is not necessarily held responsible for their illness, thereby alleviating the patient’s psychological burden. Ward and Beaubrun (1980) proposed that attributing responsibility to an other (i.e., a spirit) allows possession to provide advantages to the victim, permitting them to evade conflict and guilt. Kramer (1993) noted that possession phenomena involve the internalization of the possessing “other” into one’s self, making the individual feel as if they are influenced by its thoughts and actions. Simultaneously, there are situations in which a fault is attributed to a spiritual other, thereby denying self-responsibility.

Furthermore, beyond biological treatment, additional spiritual therapy can be directed at the spiritual identity/self of the possessed negative spiritual entity, such as ritual healing performed by a shaman who can communicate with spirits, thereby increasing the confidence of patients with mental health. During a conversation under moonlight, Shaman Bao said, “Actually, we shamans don’t demand that people believe in something specific, like spirits. Rather, we want to encourage everyone to live positively, optimistically, uprightly, and with purity. Only in this way can one resist the invasion of malignant spiritual others and thus avoid the severe illnesses they trigger.”16 Thus, within the framework of the “holistic self-concept,” to maintain healthy interactive relationships (e.g., resisting external pathogenic spirits), the individual must consistently sustain a positive state. A healthy, holistic self is a prerequisite for maintaining physical and mental well-being. This exerted a subtle influence on the core believers of Shamanism in the north of China. For those who become shamans or believe in Shamanism, practicing this faith means committing to a lifetime of doing no evil and living healthily and positively. The chain reactions generated by holistic self” therapy can all be considered as manifestations of positive psychology, which is a crucial factor in maintaining mental health and aids in treating mental illnesses.

The interactions of the holistic self involve subtle interpenetrations between the self and all things. When the world plunges into uncertain darkness and the individualized self is powerless to cope with it, the holistic self emerges as a mediating harmonizing role. For example, the extreme process of individualization in contemporary China has led to severe psychological anxiety, even as individuals continue to experience enhanced self-awareness and subjectivity. However, the subjectification of risk often diverts people from questioning institutional and structural roots instead of internalizing setbacks and misfortune as personal failures, thereby intensifying mental distress. Zhang (2020, pp. 147–49) argues that this essentially disempowers people by shifting their focus from the social and political spheres to individual psychology. Attention then turns to personal matters (mental illness) and coping strategies rather than challenging the established social order, thereby depleting the potential collective revolutionary energy. To alleviate this potentially “maddening” anxiety, they often transfer responsibility to an other—”dirty things,” meaning those invisible evil spirits believed to cause misfortune. A popular video genre on the Chinese internet illustrates this.

In these videos, individuals hold green leaves or other ritual props, chant incomprehensible incantations, and perform “rituals” on their work computers. The captions read, “There’s always so much unfinished work; there must be some dirty thing (脏东西 zhang dongxi)”; “This damn job gets more miserable by the day; I’m sure there’s a dirty thing”; “There must be a dirty thing at my workstation, otherwise why would the data be so low lately?” Modern people attributing various dissatisfactions to “dirty things” essentially seek a vent between the system and the self: facing immense institutional and environmental pressure, people may dare not voice their anger openly, yet are also unwilling to fully “individualize” structural failure by blaming themselves. Thus, “dirty things” become externalized objects of attribution to alleviate the anxiety caused by failure. Even in cases of failure possibly caused by oneself, to achieve temporary psychological relief, the cause may be assigned to another, “dirty things”—as observed in a parody video, “There must be a dirty thing, otherwise why haven’t I lost any weight after dieting for so long?”17

Although the individualized self currently prevails, it is not fixed. The holistic self and individualized self adjust and switch according to environmental needs to ensure a certain health of the self, thereby salvaging before the complete collapse of the self. Even in Chinese society, which largely advocates atheism, this mechanism continues to exist. However, the manifestation of a holistic self that interpenetrates with spirituality and other forces often appears in more covert or circuitous forms: sometimes as a jocular cultural expression (such as the viral “exorcising dirty things” videos), and sometimes constructed as a disease narrative (such as “virtual illness,” closely related to and often confused with mental illness).

6. Discussion and Conclusions

In contemporary China, amid the widespread prevalence of psychological anxiety, some patients have begun turning to shamanic healing in the north of China for help. Shamans have gradually shifted their focus toward mental illness in practice, specifically developing the concept of “virtual illness” for it. Within the shamanic system in the north of China, severe mental illness primarily refers to illness caused by a persistent low mood and low energy, which in turn attracts possession by evil spirits, a type of virtual illness. Treatment involves shamans performing spiritual rituals to expel evil spirits. The diagnosis and treatment of virtual illness for mental illness embodies the therapeutic concept of the “holistic self” (also termed “sociocentric self”), which incorporates spiritual identity into the self. This treatment modality within shamanic studies, grounded in the holistic self, forms a targeted response to the primary social root of mental illness in contemporary China—the “individualized self.” Further, the modern trend of individualization and the “individualized self” concept it fosters, while seemingly strengthening personal autonomy, have made anxiety increasingly universal. In a short period, China’s experience of rapid modernization has made its social anxiety particularly prominent. Moreover, the risk individualization pattern inclines people to attribute failure to themselves, further exacerbating anxiety. The “virtual illness” category, based on the “holistic self” concept, provides a therapeutic path targeting the “individualized self”—explaining and intervening in mental illness within the framework of a holistic “large group.” For instance, attributing misfortune such as failure or illness to spiritual factors relieves the individual from full responsibility, thereby reducing the patient’s psychological burden. Additionally, the treatment involves extra-spiritual therapy directed at possessing a spiritual identity. Simultaneously, individuals are encouraged to maintain a positive state to resist the invasion of malignant spiritual others. Together, these constitute the positive psychological foundation necessary for treating mental illness.

Peters (1989) proposed that a fundamental commonality among Shamanism, yoga, and other meditation traditions lies in their transformative structures involving the acquisition of a “spiritual identity” to alter an individual’s relationship with society and the material world. However, different cultures employ “spiritual identity” in varied ways. According to Chau (2006, pp. 59–77), the religiosity of the Chinese people does not necessarily manifest as the internalized and pious faith characteristic of the Western Christian tradition—a form of belief that in contemporary Western contexts often transforms into a pursuit of “spirituality.” Instead, the Chinese spiritual self is constructed through actions, rituals, and relationships, thereby seeking security, well-being, and practical solutions to real-life problems. These traditional shamans perform healing rituals aimed at removing malevolent spiritual identities attached to patients. In contrast, Western Neoshamanism places greater emphasis on enabling individuals with mental problems to act, to some extent, as shamans, personally integrating themselves with benevolent spiritual identities for healing (Kokan 2003, p. 15). Despite their methodological differences, both use spiritual identity to achieve physical and mental healing. Thus, not only do the “individualized self” and “holistic self” evolve with the times and needs, but even within the category of the “holistic self,” different regions construct self-forms with varying emphases. This fluidity provides an important direction for subsequent research: for example, within highly individualized modern consciousness, when “I” declares “I am me,” does this self-declaration truly carry subjectivity? In cultural contexts emphasizing the “holistic self,” when a spiritual other—whether a possessing “evil spirit” or an actively invited “benevolent spirit”—integrates into the self-structure, how should the boundaries and essence of “I” be defined? What exactly is the “true self”? Or is it merely a dynamic existence that switches between different self-forms according to situation and need?