In modern China, eye on mental health

Most psychotherapists and counselors are setting up shop as Chinese struggle with the demands of a rapidly changing society and the profession loses its stigma.

The neutral colors, anodyne landscape paintings, and diplomas ranged on the windowsill make Tian Guoyan's office much like a psychological counselor's clinic anywhere else in the world.

But this is China, where only 20 years ago, recalls Canadian psychiatrist Michael Phillips, his local colleagues hid their work from neighbors who feared that mental illness was infectious, and thought that such doctors would have caught it from their patients.

Ms. Tian is pioneering a new and rapidly growing profession in China, as ever more psychotherapists and counselors hang out their shingles with names such as "Happiness Heaven" or "Mood Manager." But they cannot hope to keep up with demand, they say, in a turbulent society where a typhoon of change has torn through ordinary people's lives.

"The faster society develops, the faster people's lives become, and the more stressed they get," explains Che Hongsheng, dean of Beijing Normal University's psychology faculty. "Many people feel they are losing their balance, and balance matters a lot to Chinese."

More and more of them are turning to religion for solace or visiting counselors like Tian, a forthright and reassuring woman who sold a successful company to train as a psychotherapist. Though reliable figures are hard to come by, psychologists estimate that there are some 2,000 qualified counselors working in China.

The stigma attached to all things psychological in China "is still hanging over" the profession, she says, but it is fading. At least it is fading for women, who make up nearly 80 percent of her clientele. "Men here are taught to suppress their emotions, or they lose face," Tian explains.

Chinese women have proved especially vulnerable to stress: Chinese females between the ages of 15 and 34 have the highest suicide rate in the world – one that is almost double the national average.

Among the biggest challenges, Tian's clients (paying $40 an hour for her services, which makes them a wealthy elite in China) tell her, is the new need to rely on oneself in a country where the state once provided everything.

"The old meets the new, the East meets the West, and that leaves a lot of people totally confused," says Tian. "A lot of them hold it back, but others step forward" to seek help.

Many of them, she adds, have trouble figuring themselves out, in a society where the individual self has traditionally been subordinated to the collective. "You should think for your family, your country, your group, never think for yourself," Tian explains. "As I grew up there were tons of people telling me what to do – my parents, my elder brothers, my teachers, the media. The focus was never on the individual but on the benefit for the collective interest."

That approach suited China's communist authorities just fine, and made psychotherapy's focus on individual self-realization counterrevolutionary. For years, psychology was condemned in China as a decadent bourgeois indulgence and it was only reinstated as a subject for study after Deng Xiaoping introduced his "reform and opening" policy at the end of the 1970s.

Even so, Tian complains, the government's support for the profession has proved "far from enough. They did not realize society could be so sick."

The past few years, however, have seen a sea change in authorities' attitude to mental health, says Dr. Phillips, head of the Beijing Suicide Research and Prevention Center. "There is a momentum ... which is positive for those working in mental health," he says. "There are still a lot of problems, but the trajectory looks pretty good."

In particular, he says, "the government is much more open" about suicide. "They are not sweeping it under the carpet; that's a big change." An official report last month showed that suicide attempts were the second-largest cause of injury in China in 2005, after traffic accidents. Government statistics, which some outside experts say still underestimate the problem, report around 250,000 suicides in China each year.

Few victims ever sought help, mainly because help was not available nearby. "The majority of regions lack mental-health prevention networks and the level of public knowledge about mental illness is not high," deputy Health Minister Wang Longde said in a speech last month marking International Mental Health Day.

A survey two years ago found that 60 percent of rural Chinese did not know what the word "depression" meant.

Phillips insists that the key problem in the countryside where suicide is most prevalent is not lack of counseling but the abundance of poisonous pesticides that farmers keep in their homes. That means that an unusually high rate of suicide attempts end in death. Fifty-eight percent of all fatal attempts used pesticides.

"Whether you live or die has little to do with how much you intended to die and a lot to do with which pesticide you took," says Phillips.

The Agriculture Ministry announced last month that it would cease production of the five most toxic pesticides. "That won't stop the behavior, but it will reduce the numbers who die," says Phillips.

Thirty percent of those who die by suicide and 60 percent of those who make nonfatal attempts – a large proportion by international standards – have no diagnosable mental illness. Suicidal tendencies are "usually prompted by intense interpersonal conflict, typically with the spouse," says Phillips, whose team carried out the largest study of suicide in China.

Still, authorities are setting up crisis hot-lines in a number of regions, while professional groups set new standards for psychological counselors to weed out those without proper training and to provide more skilled counselors.

That will take years, psychologists agree. In the meantime, as more Chinese understand that "between very serious psychiatric illness and simply being confused there are psychological problems that need help," as Mr. Che puts it, more may seek help.

"I am much busier now than I was a few years ago," says Tian, who later this month will become one of the first batch of counselors to receive a professional qualification from the China Psychology Society. "And in another few years I will be overbooked."

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