MENTAL HEALTH IN CHINA: HISTORY, FREUD, LACK OF CARE AND HIGH NUMBERS

MENTAL HEALTH IN CHINA


inside mental hospital
According to the World Health Organization, 7 percent of China's population “about 100 million people’suffers from some form of mental illness. Most of them get no professional help and are left to their own devices. A 2010 Lancet study estimated that roughly 173 million Chinese suffer from a mental disorder. If this statistic is true it means that nearly one in five adults in China has a mental disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders.

In 2010, a number of attacks on schoolchildren, some of them by people with mental illness, brought attention to China’s mental health problem. “The increase of social problems, competition, the rich-poor gap as well as other psychological obstacles means the number of people suffering from mental disorders is on the rise,” Cao Rifang, the deputy secretary of the Hangzhou Association for Mental Health, told Inter Press Service. “These patients are in an unstable condition, and if there is inadequate care, these people can easily hurt others. China has no complete care system to take care of mental disorders.” Hangzhou is where one of the attacks on schoolchildren took place. [Source: Asian Times, Kent Ewing, May 8, 2010; Mitch Moxley, July 9, 2010]

In 2009, mental surpassed heart disease and cancer as the biggest burden on China's health care system. Even so, according to a 2009 report in London's Telegraph newspaper, there are only 4,000 qualified psychiatrists and another 15,000 doctors working in psychiatric hospitals to serve China's 1.3 billion people. Psychiatric hospitals are scare and some of them are used more as lock-down centers for petitioners Party than facilities to help the mentally ill. See Petitioners [Ibid] .

Psychology, psychiatry and counseling are rather new fields in China, where Confucian hierarchy has traditionally provided stability and people “ate bitter” during times of suffering and didn’t talk much about their feelings. “Chinese traditionally don’t like to articulate their emotions,” one psychologist told the Los Angeles Times. Asian societies as a whole have traditionally put on emphasis maintaining a stiff upper lip. Remaining strong and getting over problems rather than talking about them. Those that seek help are often stigmatized as weak and crazy.

Incidents of reported depressions at the Shanghai Mental Health Center have quadrupled in the last decade. When Chinese get depressed they often complain of dizziness, headaches and sleeping problems rather than sadness and loneliness. Depression and other mental illnesses are increasingly being recognized as bonafide illnesses. Stress, the rat race, pressure to keep face and the drive to improve and maintain one’s status have pushed an increasing number of people over the edge.

Psychology was discredited in the Mao era and dismissed as a fake science. Mental problems were seen as the result of politics rather than psychology. Psychiatry wasn't really practiced in China until the 1980s. Before that mental patients were generally treated with acupuncture. "We use drugs," one doctor told travel writer Paul Theroux about the treatments used today, "and we talk to them. There are not many violent cases, but we have many depression. That seems to be a Chinese problem. About 70 percent of our patients are schizophrenics. Doctors in factories refer people to us, and we treat them."

History of Mental Health in China


dissidents placed in mental hospitals
Mental health problems have traditionally been treated with Chinese medicine, and more recently drug-focused psychiatry. Evan Osnos wrote in The New Yorker, “For most of Chinese history, mental illness carried a stigma of weakness so intense that the siblings of a disturbed person could have trouble finding a spouse. Mental health was left largely to herbalists, who tried to rebalance the seven emotions---happiness, anger, sadness, fear, love, hatred, and desire---and to witch doctors, who sought to calm the unhappy spirits of ancestors or encourage patients to adjust to life's setbacks. At the time of the Communist revolution, in 1949, China had some sixty psychiatrists for a population of nearly five hundred million.” [Source: Evan Osnos, The New Yorker, January 10, 2011]

Gabrielle Jaffe wrote in the Times of London, “When the Communists came to power...all forms of psychotherapy were banned. The only psychological practices allowed were those that were Russian-approved, such as Pavlovian social conditioning.” During the Cultural Revolution mental illness was declared a bourgeois self-delusion and the sick were treated with readings from Chairman Mao. The practice of psychiatry was outlawed and Mao said all mental illnesses could be attributed to an inadequate understanding of class struggle. Many Chinese suffering from mental illnesses were removed from hospitals and sent to labor camps in the countryside due to their “counter-revolutionary” behavior.

“Life under Chairman Mao was even less congenial to soul-searching.” Osnos wrote. “When the Great Leap Forward, launched in 1958, resulted in a famine that killed between thirty and forty-five million people, the Party barred any studies of its psychological impact on the population. That was true as well for the Cultural Revolution, which began in 1966 and unfolded on a scale of barbarity that the Chinese do not often discuss in detail. In Zhejiang Province, more than nine thousand people were officially "hounded to death"; children denounced their parents, and political targets were paraded in stadiums packed with screaming crowds; students at a Beijing girls' school beat their vice-principal to death with nail-studded planks; in 1968, in at least two provinces, political zealots ate their victims.” [Osnos, Op. Cit]

“Ten years later, when Deng Xiaoping took control of the country, the government pursued only the most notorious killers and torturers. A more exhaustive accounting, or process of reconciliation, might have threatened the Party and delayed an economic recovery, and Deng issued a final resolution in the hope that "debate on the major historical questions will come to an end." (An early draft was revised, because Deng found it "too depressing.") People returned to their factories and offices, often alongside their tormenters and victims. Ordinary Chinese were willing to aid in the forgetting, not only because they were poor and determined to get on with their lives but because so many had been victims at some moments and perpetrators at others.” [Ibid]

“Before long, economic rebirth was transforming China with unprecedented wealth but also with radical change: history's largest human migration sent a hundred and thirty million citizens to cities in search of jobs, and left almost sixty million growing up apart from one or both parents. An affluent new class emerged, creating a gap between the rich and the poor that is approaching the size of America's. Hundreds of local colleges opened across the country, luring students and draining their families' savings, and churning out more graduates than the economy could absorb, fuelling an atmosphere of brutal competition.” [Ibid]

Lack of Care for the Mentally Ill in China


mental patient abuse
There are only 17,000 psychiatrists in China, one tenth the number found in many developed countries in proportion to the population. Put another way, there are 1.3 psychiatrists per 100,000 people in China compared to 14 per 100,000 in the United States and 25 per 100,000 in Iceland. One study conducted in Shanghai found that the majority of families there felt serious stress but only 2 percent said they sough any kind of psychological help and only 19 percent said they would even consider the idea.

China still uses state-run mental health hospitals to keep political prisoners and people deemed a threat to the government (See Petitioners). The World Psychiatric Association has criticized China for using psychiatric practices as a political tool. The group pointed to the forced hospitalization of Falun Gong cult members on the ground they were delusional and the imprisonment of political and labor dissidents in mental hospitals.

Health officials have finally recognized the with major research into mental illness included in the government's current five-year plan. But still there is a lot of work that needs to be done. In Beijing, where there were only 6,900 psychiatric beds in 2010 for the more than 150,000 people estimated to suffer from mental disorders, six new mental health clinics are planned. [Source: Asian Times, Kent Ewing, May 8, 2010; Mitch Moxley, July 9, 2010]

Only 1 in 12 Chinese needing psychiatric care ever sees a professional, according to a study last year in The Lancet, a British medical journal. China has no national mental health law, little insurance coverage for psychiatric care, almost no care in rural communities, too few inpatient beds, too few professionals and a weak government mental health bureaucracy, Chinese experts in the field say.

Evan Osnos wrote in The New Yorker, “Big cities in China have mental hospitals, but they are still building up the range and capacity to deal with the widespread problems of day-to-day life. In 2005, the head of a Beijing suicide hot line told me that the service was so understaffed that the average caller needed to hang up and redial about eight times in order to get past the busy signal. (Later, the hot line added staff; today, the average caller dials twice to get through.) [Source: Evan Osnos, The New Yorker, January 10, 2011]

Sharon Lafraniere wrote in the New York Times that the Health Ministry’s own mental health bureau, established four years ago, consists of three people. Yan Jun, the director of the bureau is a public health specialist, not a psychiatrist. Every few years, China’s news media declare that a national mental health law is speeding toward adoption. The first draft was written half a century ago. Asked how many revisions it has undergone, Dr. Ma Hong of the Peking University Institute of Mental Health said, “Countless.” [Source: Sharon Lafraniere, New York Times, November 10, 2010]

“Most psychiatric hospitals are financially unviable, said Yu Xin, who directs the Peking University Institute of Mental Health. One, in Hubei Province, opened a box factory in the 1990s to stay afloat. The fee structure is so absurd, he said, that hospitals can charge patients more for computer-generated diagnoses based on filled-out forms than for sessions with actual psychiatrists.” [Ibid]

Despite government efforts to expand insurance coverage, a senior Health Ministry official said in June 2010 that in recent years, only 45,000 people had been covered for free outpatient treatment and only 7,000 for free inpatient care because they were either dangerous to society or too impoverished to pay.

Chronic shortages of both doctors and facilities ensure that what care exists is limited. China averages just one psychiatrist for every 83,000 people---one-twelfth the ratio in the United States---and most lack a university degree in any subject, much less mental health, Dr. Ma told the New York Times, “Professional psychiatrists in China are like pandas,” said Zhang Yalin, assistant director of the mental health research institute at Central South University’s medical school. “There are only a few thousand of us.” [Ibid]

Lack of Respect for Psychiatry in China

Sharon Lafraniere wrote in the New York Times, “Psychiatry’s bottom-of-the-barrel image in the medical community deters students from joining the profession. Dai Jun, a 24-year-old medical student in Wuhan, in central China, said he studied psychiatry when he enrolled at Nanjing Medical University six years ago because it was the only specialty with an opening. As an intern, he noticed that psychiatrists were not treated or rewarded like other doctors.” [Source: Sharon Lafraniere, New York Times, November 10, 2010]

“Patients often give surgeons and other specialists “hongbao”---envelopes of cash that can make up a third of a doctor’s income---in exchange for better treatment. Psychiatrists get neither hongbao nor respect. “People think, “Oh, you are constantly locked up with crazy people. Maybe you are going to go crazy yourself, or you are already crazy. That is why you want to do this,” Mr. Dai said. At his first opportunity, he switched to orthopedics.”

“Although research is scanty, a recent Health Ministry survey suggests that the need for more specialists is growing fast. The study found that the incidence of mental disorders had climbed more than 50 percent from 2003 to 2008. Although some of the increase was because of greater awareness and reporting, Dr. Ma argues that the incidence of stress-related disorders like depression and anxiety has shot up.” [Ibid]

“Chinese society is just changing too fast for people to adjust to it,” she said. The government recently pledged to invest more in mental health care, mostly by pouring billions of dollars into new and renovated psychiatric hospitals. Many psychiatric hospitals are more than half a century old and located---by design---far from cities. China added 50,000 psychiatric hospital beds from 2003 to 2008. But it needs more: Tibet, a region nearly three times as big as California, lacks a single psychiatric institution, the Peking University mental health institute says.

Psychological Problems in China


detaining healthy people
When asked what problems he sees most often among his patients, Zhong Jie, psychoanalytic an assistant psychology professor at Peking University, told The New Yorker, "If a grandfather, for example, was criticized and abused in the social upheaval of the nineteen-sixties and seventies, then he couldn't take care of his child, so the child was raised in a chaotic situation and had to develop defensive ways to cope." In that way, the Cultural Revolution can produce marital or family problems that trickle down to a third generation. "From my point of view, the upheaval never ended," he said. "It repeats within the family."[Source: Evan Osnos, The New Yorker, January 10, 2011]

Zhang also treats patients who during childhood were separated from their parents, because of the demands of their parents' work. "This can create a lot of trauma for a child," he said. After a moment, he added, "My experience was like this." His parents, who were laborers in Sichuan Province, sent him, at age four, to be raised by grandparents. "This led to a very complicated life," he said, with a slight smile. He recently divorced. "It's sad, but it's the reality." He was spending a lot of time with his own analyst: four hundred and eighteen sessions and counting. "I told my analyst that maybe the separation explains why I work very hard on my work, and why I keep a distance in interpersonal relationships." He laughed awkwardly. "It's easy to understand, but it's a little bit hard to change. That's why I need more sessions." [Ibid]

Elise Snyder, an associate clinical professor of psychiatry at Yale who provides analysis to Chinese patients over the Web via Skype told The New Yorker she heard the story of a man in his early twenties in a gritty, industrial city who is saving up for sex-change surgery; in the meantime, his father has suggested a local therapy that involves learning to box in order to become more masculine. A few days later, Snyder received a briefing on an elite graduate student who was paralyzed with the fear of failing the English exam that is required for study abroad. In some instances, younger students spoke candidly with her about their lives. In a classroom at one university, a well-dressed undergraduate raised her hand and said, "Sometimes I go a whole month where I hardly eat any food. I drink only liquids, and I have trouble sleeping." [Ibid]

Psychological Problems and the Mao Era


healthy people in mental institutions
Evan Osnos wrote in The New Yorker: “To capture contemporary China's specific combination of stresses, the analyst Huo Datong separates problems into two categories: jiating xiaoshi , or household issues---the private dynamics of couples and families---and guojia dashi , national issues, the things, as Huo puts it, that “are handled by the ruling Party on a national level and which people are never supposed to express doubts about: politics, freedom of speech, the right to demonstrate, and religion.” owever, the more time I spent among China's new therapists and patients, the more these two realms seemed to be indistinguishable.” [Source: Evan Osnos, The New Yorker, January 10, 2011]

Zhang Jingyan, a retired art-history professor in Chengdu who was 12 when the Cultural Revolution broke out told The New Yorker,"I went to watch, and it was terrifying. I watched people being thrown off buildings," she said. "I couldn't move or run away. I was completely frozen by it. And then I felt ashamed: Why don't I have more class consciousness? These are the enemies of our class! How come other people are capable of hitting them, and I'm not?" [Ibid]

“Zhang's father was a senior Party scholar at Sichuan University, and his stature made him a target for persecution.” Esnos wrote. “He was beaten, humiliated, and assigned to hard labor; he had cirrhosis, but his political status made it impossible for him to get decent care, and he died at forty. Zhang built an academic career and a family, but, over time, she became haunted by a sense of loss.” "What do I want in this society? Where do I fit in? Where is my place?” she asked, “These are the things that have always bothered me. It didn't affect my work, but, spiritually, I always felt that I was lacking something." [Ibid]

Zhang has come to see a symmetry in China's lurch from political mania to capitalism at all costs. "We had a mission---to liberate the world!---and then, all of a sudden, that bubble burst, and none of it was true. So what were we to do now? That's when we started making money, and now we cling to our money. But it can't bring us spiritual satisfaction." As Zhang sees it, that's the modern Chinese predicament. For all that separates her experience from that of a factory worker on an assembly line in Shenzhen, she empathizes with the factory worker. "We all need to know the value of our own existence," she said. "If they don't see the value of their existence, then they won't see the meaning of living." [Ibid]

“Psychoanalysis may give the Chinese a vocabulary for discussing the effects of the Cultural Revolution, or the true costs of a frantic sprint to prosperity, or the toll of life under authoritarianism,” Osnos wrote, “but I find it hard to picture the latest Freud Fever lasting long here. Three or four years on the couch is an eternity in China, and an absurd mismatch for the life of an iPhone assembly-line worker. China is more likely to absorb the most practical of Freud's ideas and discard the rest, as it has with Marxism, capitalism, and other imports. With luck, it might leave behind more than a few people inclined to demand respect for the value and idiosyncrasy of individual minds.”

Attacks by Mentally Ill on Schoolchildren in China

Reporting from Xizhen in southern China Sharon Lafraniere wrote in the New York Times, “After five months in a rundown ward at the Hepu County Psychiatric Hospital, Yang Jiaqin no longer suffers terrifying hallucinations. Still, his wife dares not mention children, not even their own, for fear of unleashing the demons that possessed him one day last spring. On a warm, sunny afternoon in April, Mr. Yang burst from his home in this rural village near the Vietnamese border, carrying a kitchen cleaver. He encountered three youngsters headed home from school on the dirt path outside. He hacked two primary schoolers, badly wounding both, and slit a second grader’s throat, leaving him dying on the ground. Then he moved on. By the time police officers caught up and subdued him, he had slashed two more people to death.” [Source: Sharon Lafraniere, New York Times, November 10, 2010]

“The victims’ families have focused their rage on the police. Three days earlier, Mr. Yang had struck a neighbor in the head with an ax, but was not detained. “They are completely responsible for this,” said Wu Huanglong, the second grader’s father. “They did not protect us.” But Mr. Yang’s doctors see a bigger failing. Despite clear signs of schizophrenia, Mr. Yang had received medical care for just one month in the previous five years.” “If he had been given medication and treatment, his illness would not have developed,” said Chen Guoqiang, the psychiatric hospital’s chief doctor. “If he had been able to control his hallucinations, he would not have killed anyone.”

Too often, the official response to mental illness is to look the other way. The government authorities, already shaken by an attack the previous month in which eight schoolchildren were stabbed to death, threw a news blackout over the Xizhen incident lest it inspire copycats or incite further outrage. At least three of six men whose attacks near schoolyards this year left 21 people dead had earlier appeared deranged or suicidal, according to news reports. But in the highest-level statement on the killings, Prime Minister Wen Jiabao said only that China needed to resolve “social tensions” underlying the attacks.

Sad Story of Mentally Ill Man that Attacked Children

Sharon Lafraniere wrote in the New York Times, “Like much of rural China, Xizhen, in southern Guangxi, one of China’s poorest provinces, is isolated from services. Here, several hundred villagers tend fields of towering green sugar cane and cassava plants, sinking wells for water and chopping wood for fuel. Untrained practitioners who call themselves doctors handle most medical needs. The nearest hospital is an hour away by car.” [Ibid]

“Yang Jiaqin was a local health care worker. Although neither he nor his wife, Wen Zhaoying, had medical training beyond high school, the two dispensed care for years from a tiny clinic opposite Xizhen’s primary school. Five years ago, Ms. Wen said, it became obvious that her husband was the one who needed treatment. Always excitable and easily frightened, she said, he became obsessed with the notion that people were after him.” [Ibid]

“One night that autumn, he fled his house during a raging storm. Relatives found him the next day pacing near a pond, covered with scratches, shaking violently, she said. “It was very scary,” he told her. “People were chasing me all night.” Relatives ferried Mr. Yang to the Hepu County Psychiatric Hospital, a sprawling, ramshackle collection of one-story buildings outside Beihai, the closest city. Administrators say the hospital’s five doctors serve a region of more than one million people.” [Ibid]

“There, Ms. Wen said, a psychiatrist prescribed medication that helped calm her husband. Still, his episodes grew more severe. In 2007, she said, Mr. Yang leaped from a third-floor window to escape imaginary pursuers, breaking his leg. In 2008, he fled Shenzhen, where he had become a migrant worker, and called the police from a Shanghai television tower, threatening suicide. Doctors at a Shanghai psychiatric hospital diagnosed his condition as schizophrenia, administered antipsychotic drugs and, a month later, set him free.” [Ibid]

“Family members say that was Mr. Yang’s last encounter with a mental health professional. Mr. Yang refused doctors’ advice to return to his local psychiatric hospital, his wife said, so she went alone, Shanghai prescription in hand. Without examining her husband, she said, a psychiatrist decided that he was not psychotic and changed his medication. By last spring, Mr. Yang, 40, was afraid to leave his dim mud-clay house. “All he did was stay home and cry,” Ms. Wen said. Last April 9, the demons inside him took control.” [Ibid]

“That evening, Mr. Yang smashed through the wooden door of his 63-year- old neighbor, Wu Wenguang, and struck him in the head with an ax. At the hospital where doctors stitched his wound, Mr. Wu said, the local police chief told him: “When crazy people hurt somebody, there is nothing we can do.” Ms. Wen said the police found her husband at home that Friday night but told her the matter was best settled privately. “None of this would have happened” had they arrested him, she said. In a statement, the police insisted that they had searched fruitlessly for Mr. Yang, then told his wife he should turn himself in. Ms. Wen said she began arrangements that weekend to admit her husband to a hospital. Mr. Yang’s 74-year-old mother, Pei Renyuan, said her son warned that he would kill himself and “take all of you with me.” Mr. Yang’s younger brother was assigned to watch him.” [Ibid]

“The following Monday afternoon,” Sharon Lafraniere wrote in the New York Times, “Wu Junpei, a spirited 8-year-old who loved to draw, sing and practice gymnastics, left school with friends, taking his usual shortcut past the Yang house toward his home 10 minutes away. Mr. Yang jumped onto the path with a cleaver and slashed a first grader, who fled. Then he turned on Junpei, slicing his arm and neck in quick succession. Wu Zunwei, the boy’s 14-year-old cousin, was next. “I fell to my knees and begged him, “Please don’t hurt me,” Zunwei recalled. Mr. Yang slashed his shoulder. “He didn’t say anything,” Zunwei said. “He was crying.” Wu Huanglong, 43, raced over on his motorcycle to find his son lying, face up, on his blood-soaked navy backpack. “When I saw his eyes were staring up at me,” he said, “I thought to myself: “This is it. I am finished. I have lost everything.” [Ibid]

“Running from house to house, Mr. Yang killed a 70-year-old woman who was making firecrackers, and a man who was watching a television drama on his sofa. He slashed the man’s wife and a girl drawing well water. The police, who seemed so quick to dismiss Mr. Yang’s earlier attack, were suddenly energized. Junpei’s 20-year-old sister said riot police officers descended on the hospital that night, wrapped Junpei’s corpse in a sheet and drove off with it, ignoring her screams of protest. The county government has yet to release the body, Mr. Wu said. Villagers say that is probably because Mr. Wu refuses to sign a declaration that no one is to blame for his son’s death in exchange for about $19,000 in compensation.” [Ibid]

“Dr. Chen, the psychiatric hospital’s chief doctor, said Mr. Yang’s rampage occurred because “he has never been under systematic care.” His family, he said, “did not take his illness seriously enough.” But he also said that his own hospital sometimes released mental patients purely because families could not afford treatment. “The government has to invest more so that we can take care of all the patients who need treatment, regardless of whether or not the family can pay for it,” he said.” [Ibid]

“Dr. Chen and another hospital doctor say Mr. Yang’s condition has now stabilized. Their goal is to send him home. But Ms. Wen said she could neither care for him nor cover the cost of continued treatment. If she does not pay, she said, hospital officials have warned that her husband will be released to her custody. Junpei’s mother often shows up to burn incense on their doorsill, wailing in the gathering dark. She and her husband say Mr. Yang’s family is pretending that he is mentally ill to protect him. Ms. Pei, Mr. Yang’s mother, said she could not face the woman’s grief or her own shame. As soon as she sees her, she shuts the doors.

More Attention on Mental Health in China After Foxconn Suicides and Kindergarten Murders


protest over mental health law
Recently “there have been signs that the pressure is greater than anyone imagined. In January 2010, a nineteen-year-old named Ma Xiangqian jumped from the roof of his factory dorm at Foxconn Technology, where he had worked seven nights a week, eleven hours at a stretch, making electronic parts, before being demoted to cleaning toilets. In the months after Ma's death, ten other workers committed suicide at Foxconn factories, which make iPhones and other products. Articles in the Chinese press asked whether suicide was spreading at Foxconn like a virus or if the cluster of suicides was any larger than the usual rate for a factory as big as a city. Foxconn boosted wages and installed nets around the roofs of its buildings. The suicides diminished as abruptly as they had begun.[Source: Evan Osnos, The New Yorker, January 10, 2011]

“In the West, the iPhone suicides, as they were known, sounded like a classic sweatshop case, but in China mental-health experts traced the deaths to deeper roots. Foxconn wasn't "any different from any of the other big companies who are doing the same thing," Michael Phillips, a Canadian who heads the suicide research and prevention department at the Shanghai Mental Health Center, told me. Beyond the drudgery of the assembly line, workers in their teens, or barely out of them, were struggling to live far from home, save money, meet spouses, and educate themselves in their time off, all under the eye of a state with no organized outlet for complaint. If the suicides revealed cracks in the world of migrant labor, another macabre phenomenon exposed the stresses mounting in one more demographic: in a series of murderous attacks over the summer, middle-aged men in financial or psychological trouble set upon young children in their classrooms or near the schools. The killers all had grievances against landlords, neighbors, or others. China has strict gun controls, so the attackers used cleavers and hammers, and the killings terrified a public that, because of the one-child policy, is uniquely sensitive to school violence.”

The iPhone suicides and the kindergarten killings focussed attention on a startling fact, published last year in the British journal The Lancet: nearly one in five adults in China has a mental disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, a figure that put China in the ranks of the most mentally ill countries in the world. Scientists debated whether the estimate was too high, but other figures are beyond dispute: Suicide is the leading cause of death among young people. Only one in twenty Chinese people with a mental disorder has ever seen a professional about it.

Lack of Care for the Criminally Insane in China

Sharon Lafraniere wrote in the New York Times: “The dearth of care is most evident when it comes to individuals who commit violent crimes. For example, after Liu Yalin killed and dismembered an elderly couple cutting firewood in a Guangdong Province forest, he was judged to be schizophrenic and released to his brother. Unable to afford treatment, the brother flew Mr. Liu to the island province of Hainan, in the South China Sea, and abandoned him, a Chinese nongovernment organization, Shenzhen Hengping, said in a recent report. Last year, Mr. Liu killed and dismembered an 8-year-old Hainan girl.” [Source: Sharon Lafraniere, New York Times, November 10, 2010]

“”The government doesn’t want to cough up the money to treat these people, so they just give them back to their families,” said Huang Xuetao, a mental health lawyer and one of the authors of the report. Left to their own devices, some relatives resort to heartbreaking solutions. In 2007, He Jiyue, a government psychiatrist, discovered a 46-year-old man locked behind a metal door in a stinking room in a rural Hebei Province home. The man was mentally ill, his aged parents told Dr. He. They had locked him up after he attacked his uncle.” [Ibid]

“That was 28 years earlier. The man, a high school graduate, could no longer speak. “I said to the parents: “How could you do this to somebody?” “ Dr. He recalled. They replied, “We had no choice.” In the past three years, Chinese mental health workers have rescued 339 other people whose relatives were too poor, ignorant or ashamed to seek treatment. Some, shackled in outdoor sheds, were---treated just like animals,” said Dr. Liu Jin, of the Peking University mental health institute.” [Ibid]

Sigmund Freud in China

20111130-Freud_LIFE.jpg
Freud
Sigmund Freud is surprisingly popular in China. Gabrielle Jaffe wrote in the Times of London, “His books are sold in every major bookstore. His face is recognizable enough to feature in television adverts. His ideas are found all over China’s webscape, including pop culture sites that normally focus on figures like “Britney Spears.” On these sites Freud’s theories about sex often get the most attention.

Freud’s theories were brought China by foreign-educated studenst in the 1910s. Students used to justify their demands for social reforms. Evan Osnos wrote in The New Yorker, “Freud was translated into Chinese as early as the nineteen-twenties; one scholar, Gao Juefu, had wondered if psychoanalysis might combat Chinese superstitions, though he found some of the sexual theories "preposterous." Over the years, modernist writers such as Shen Congwen, Lu Xun, and Qian Zhongshu drew on Freud to express ideas about individuality, but his following was limited. In the eighties, before the crackdown at Tiananmen Square, an interest in psychoanalysis became a symbol of openness for a generation of elite college students, a fad known as Freud Fever. In some cases, their enthusiasm outpaced their information: Huo Datong, one of China's earliest aspiring analysts, moved to Paris in 1986 to study with his idol, Jacques Lacan, who, he soon found out, had been dead for five years. [Source: Evan Osnos, The New Yorker, January 10, 2011]

Cong Zhong, a professor and psychoanalyst at Beijing Medical College, told the Times of London, “deep down, Chinese people have the sam repressed feelings, desires and problems. In some ways psychoanalysis is particularly suited to our society. The typical one-child family makes relationships with one’s parenst very intense, so the Oedipal drama is more apt.” he also feels Freud’s ideas about repressed sexuality are relevant in Chinese society, where Victorian-style morality is still pervasive.

William Wan wrote in the Washington Post: “To understand the hunger for Freud in China, Snyder's students say, one must understand that the professors who would have trained this generation of doctors and therapists were mostly wiped out in the Cultural Revolution of the late 1960s - sent to farms for reeducation, chased out of academia or simply banned from studying Western theories.” [Source: William Wan, Washington Post, October 11, 2010]

Ji Xuesong, a psychiatrist and an associate professor at Peking University's Institute of Mental Health, told the Washington Post he first came across Freud's works as a teenager. "Freud talks a lot about penis and vagina," explained Ji, now 37. "As a teenager, I was naturally looking for books on sex so I picked it up. But I couldn't understand anything. I'm pretty sure, looking back, that the translator of the book himself didn't understand." [Ibid]

“The mystery of Freud stayed with him through medical school, where psychoanalysis was tantalizingly mentioned in textbooks. But Ji could never find a full course, much less a practitioner who could teach him how to use Freud's theories to help his patients. Instead, mental health training focused almost exclusively on learning which drugs were prescribed for which diagnoses.” [Ibid]

“Therapy treatments are rare in China, Ji and other doctors said, partly because of the convenience of drugs in the face of overwhelming caseloads, a shortage of mental workers and the expense therapy requires. But in his spare time, Ji tried to learn psychoanalysis on his own, fumbling through translations and attending visiting lectures from foreign experts. Ji - whose patients include those with severe mental illness as well as middle-class professionals struggling with depression - even tried out the little he understood on a few wealthier clients who requested long-term therapy. "It was a disaster," he admitted with a sigh. "It was as though I were a book sitting in that chair. I had the knowledge, but no real clue how to do it." [Ibid]

“During one recent lecture to doctors from Liaoning province, Ji rendered his newly acquired knowledge into more palatable terms for his Chinese audience: Freud's idea of the subconscious, he explained, is like the ghosts of Chinese superstition - they may move among us completely invisibly, but they are powerful forces nonetheless. Likewise, he said, the Oedipal complex is not so different from what many in China call the "little emperor" syndrome as a result of China's one-child policy, where every child feels his or her mother's love belongs entirely to the child and no one else.” [Ibid]

“Later, in his office, Ji talked about how good it feels to finally understand and employ Freud's theories. But even as Freudian theory is taking off in China, he noted, other theories are also beginning to emerge. Of late, he said, he had started studying yet another branch of psychology, almost as eclectic in China as Freud was just a few years ago. He picked up a pen and asked a visitor to look at it carefully, to follow it as it moved lower and lower..."I've started to learn hypnosis," he said with a grin.” [Ibid]

Therapy in China

Evan Osnos wrote in The New Yorker in 2010, “I started coming to China fifteen years ago, and, until recently, I had never heard anyone mention a therapist. The concept of discussing private troubles and emotions with a stranger runs counter to some powerful Chinese beliefs about the virtues of "eating bitterness" and the perils of "disasters that come from the mouth." These days, the Chinese are increasingly willing to pay to talk. Arthur Kleinman, a Harvard psychiatrist and China specialist, said, "This is radically distinctive from the past." As he sees it, a mental shift has occurred, in "the very words used to talk about the self, which were always available to people if they wanted them, but were regarded as selfish and egocentric." The Chinese call it the "psycho boom." [Source: Evan Osnos, The New Yorker, January 10, 2011]

“American psychoanalytic institutes often have trouble finding willing patients; Chinese programs have the opposite problem. When Beijing University held a series of lectures on Carl Jung a few years ago, it could admit only a quarter of the people who wanted to attend. Even so, China and Freud are still getting acquainted. In Beijing, I watched a visiting analyst address his audience with a joke?"What is a psychoanalyst? A Jewish doctor who can't stand the sight of blood"---which his Chinese listeners greeted with respectful silence. The deeper divide, however, may be more subtle, between a theory that Freud hoped would "disturb the world" and a Chinese philosophical tradition that values harmony and accommodation as the route to fulfillment. Will a Chinese patient be more comforted by a therapy that advocates autonomy and independence---or by one that promotes accommodation to the constraints of a system?” [Ibid]

“China has already imported other Western therapeutic models, including systematic family therapy, C.B.T., and sandplay (the practice of using a sandbox and miniature figures to express oneself), and China has been granting credentials in counselling since 2003. (The license is not widely respected; it is granted by the Ministry of Labor and Social Security, rather than by the Ministry of Health, and it requires no clinical experience.) Psychoanalysis, for all its troubles in America, benefits from brand recognition among China's cachet-conscious middle class. "When they want to buy a new bag, they buy a Gucci," Kleinman told me. [Ibid]

“Likewise, he added, "Psychiatrists in the elite institutions have come to associate psychotherapy with psychoanalysis"---with Freud. In addition to Snyder's program, German analysts have been teaching psychotherapy in various forms for more than a decade, and so has, more recently, a Norwegian group. In 2008, the I.P.A. began teaching full-fledged analysis to the first round of Chinese candidates. A project is under way to retranslate Freud, directly from the German. Some earlier translations were secondhand, having begun in German and passed through English and Japanese before landing in Chinese. Others took liberties. To appeal to readers, one edition of Freud's autobiography depicted him rattling off classical Chinese allusions with the fluency of a Confucian scholar and bidding farewell to Austrian colleagues by cupping his hands in front of his chest.” [Ibid]

“Zhong Jie...is an assistant psychology professor at Peking University, and he is one of nine Chinese candidates receiving full analytic training from the I.P.A. On the side, he provides psychoanalytic therapy, for fees ranging from thirty-five to seventy-five dollars an hour, and he was eager to show me his consultation room: a red Oriental rug, a chaise longue, an armchair. I half expected Freud to appear in the doorway wreathed in cigar smoke. "I had it specially made," Zhong said of the furniture. "It's a Central European style." Zhong is thirty-six, with a round face and tidily parted hair. He gestured for me to try the couch, placing a cream-colored napkin across the pillow. I lay down, and the room was silent. "When a patient arrives, I close the door and draw the curtains, and he can look at the plain wall," Zhong said. "No distractions." [Ibid]

Psychotherapy Television in China

Evan Osnos wrote in The New Yorker: “A few years ago, Chinese television launched a program called "Xinli Fangtan"---"Psychology Sessions"---in which people sit at a heart-shaped table and talk with a therapist about their troubles. It provides a running tally of the side effects of the national growth spurt: bankruptcy, extramarital affairs, gambling, health-care costs, unemployment, loneliness. Unlike Americans, who can look comfortable divulging details of their private lives on Dr. Phil's stage set, the guests on "Psychology Sessions" favor earnest, if hasty, disguises. One woman told her story from behind a large pot of bamboo. A couple and their young son wore oversized baseball caps and sunglasses, which made them look like a blind family at a ballgame. The titles of the episodes are crafted to drop a scrim of propriety over the indignities of modern life: a dysfunctional rich family tells its story in "Millions of Wealth, Millions of Hatreds"; the sad tale of an affair is titled "An Encounter with My Husband's Close Female Friend." [Source: Evan Osnos, The New Yorker, January 10, 2011]

Elise Snyder and Skype Psychoanalysis in China

Elise Snyder, an associate clinical professor of psychiatry at Yale who, has organized American analysts to provide analysis to Chinese patients over the Web via Skype. In the early 2000s during a trip to Chengdu, she discovered that students were eager to be analyzed but had trouble finding anyone to do it. She began flying to China regularly, and found that word had spread among leading psychiatry and psychology departments. "I had become, in a minor way, sort of famous in China," she said. [Source: Evan Osnos, The New Yorker, January 10, 2011]

By late 2010, the list of Chinese patients in Skype analysis had grown to forty-one; forty more were in a less intensive treatment---psychodynamic psychotherapy. Evan Osnos wrote in The New Yorker, “For patients, Skype means getting used to the pixellated face of their therapist. "I have to tell her I'm crying, because she can't see my tears," Chen Yuying, a fifty-year-old mother in Shanghai, said of her analyst, who's on the Upper East Side. Chen hopes that "someday I can fly to New York and lie on the couch and have the real experience," but, until then, "it's wonderful." She went on, "There has never been a person so unconditionally accepting of me." Skype has become so routine among Chinese patients that Shmuel Erlich, an Israeli analyst, says he met a woman in Beijing who "was astonished that there was some other kind of analysis."

In 2009 Snyder started a Web-based training program in psychotherapy that has students in twelve Chinese cities. The first thirty graduated last fall; a hundred more are in the pipeline. Tuition is sixteen hundred dollars for thirty weeks of classes and yearlong case supervision. (The cost of analysis is extra, adjusted to what the patient can afford---between five and forty dollars an hour. Some Americans do it pro bono.) Topics presented at their conferences included things like "A Psychoanalytic Interpretation of Dieyi Cheng in the Film 'Farewell My Concubine, '""Use of Images in Chinese Ancestor Worship" and "Psychodynamic Mechanisms of Frigidity in Women".

Is There Really a Place for Psychotherapy in China?

William Wan wrote in the Washington Post: “Raised in a culture that stresses agreement over discord, the Chinese students have been reluctant at times, according to some supervisors, to engage in the confrontation necessary to push patients into self-examination. And in a culture where filial duty is hugely valued, it can be tricky to push patients to examine the ways in which their parents have screwed them up. The language barrier has proved troublesome as well. Because of the gender-neutral pronouns in Chinese, for example, the students often use "he" and "she" interchangeably - a frustratingly important distinction in Freudian theory.”

Evan Osnos wrote in The New Yorker, “Jose Saporta, a clinical instructor in psychiatry at Harvard Medical School, taught in Snyder's program until last spring, but now he warns of the "dangers of psychoanalytic evangelism." Psychoanalysts face a "tremendous seductive power" in teaching in China, he said, because "people latch on to your every word and they treat you like a rock star, when, in the United States, nobody cares!" Saporta told me that he thinks psychotherapy should grow in China, but more slowly.” [Source: Evan Osnos, The New Yorker, January 10, 2011]

“Snyder believes that Saporta overstates the obstacles that culture presents. "I think that the Western analysts who worry about the analyzability of the Chinese are held in the thrall of fantasies of 'the inscrutable Oriental,' " she wrote recently. She is equally wary of patients who invoke Confucian explanations for their behavior or argue, as she puts it, that "you cannot analyze me because you do not understand my culture." "When patients invoke Confucian values as the source of their anxiety and guilt, analysts are familiar with such defensive maneuvers and look more closely at the relationship with the actual parents," she wrote. Snyder told me that the emerging rifts among foreign analysts in China are akin to "priests in the Middle Ages fighting about how many angels can dance on the head of a pin." [Ibid]

“Those tensions obscure a more fundamental question: should the Chinese even bother with a therapeutic approach that the West has so vigorously discarded? When I asked Frederick Crews, a retired Berkeley professor and Freud critic, about psychoanalysts touching down in China, he said, "We have had a bad habit of dumping disapproved or dangerous materials---cigarettes, chlorofluorocarbons, toxic components of old computers---on less developed countries, without regard for the consequences. Will this be another instance, in the realm of psychological treatment?" [Ibid]

“China's urgent need for mental-health treatment should not be invoked as a reason to promote psychoanalysis, he said. "Troubled people in China are entitled to get the best Western knowledge about their conditions. Then they can decide whether to adopt, adapt, or discard what they've been told." Crews cited America's "poisonous recovered-memory movement," and said China holds the "worrisome potentiality for a new recovered-memory movement on a vastly larger scale." The Chinese, he added, might do well to recall Freud's purported comment to Jung on the way into New York Harbor, in 1909: "They don't realize that we are bringing them the plague." [Ibid]

Image Sources: YouTube, Wikipedia

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, The Guardian, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2008 Jeffrey Hays

Last updated July 2011

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