You don’t understand how exciting it is right now. The atmosphere in China, it’s like what New York was in the 1960s for psychoanalysis. The enthusiasm is incredible.1
Elise Snyder, MD, American psychoanalyst
“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.”1
Ji Xuesong, MD, psychiatrist in China
I, too, found the same excitement and quest for understanding when I visited China a few years ago. The fascination was so great that I temporarily thought of moving to practice in China upon my retirement. Yet, until 3 years ago, I knew little about psychiatry in China, nor was I particularly interested. Given my specialization in cultural psychiatry, I had strong interest in and knowledge about Chinese Americans and had developed a model curriculum for psychiatric residents.2 During that time, involvement in the Society for the Study of Culture and Psychiatry was an excellent source of knowledge and collegiality.
But psychiatry within China itself? Up until about a decade ago, that could have been considered an oxymoron. So little information was available that if the typical American psychiatrist thought about psychiatry in China at all, perhaps it was the paraprofessionals, the “barefoot doctors,” who came to mind.3 After all, as in the case of most totalitarian governments, psychiatry does not thrive in such governments—nor does truthful information. Take the former Soviet Union, where political prisoners were put in psychiatric hospitals, just as has been charged in China more recently; or Nazi Germany, where psychiatrists were often co-opted for the racial superiority goals of the government.4,5 Such governments tended to put the severely mentally ill and dissidents away, even into graves. The quest for individual insight, as in psychoanalysis, would not be desired. No wonder that in the countries where psychoanalysis was founded and developed, such as Germany and Austria, psychoanalysts like Freud had to flee, give up psychoanalysis, or be killed by the Nazis. Yet, just as China has modernized and embraced a Chinese form of capitalism, so psychiatry is becoming modernized in a Chinese form of psychiatry.
China, of course, is not monolithic culturally. There are scores of small minority groups. Because it is a country not easily understood by most Americans, care must be taken not to stereotype the people nor its psychiatric practice. The well-known psychoanalyst, Ernst Kris, in the middle of the last century, refused to treat Asian patients, saying something like: “I am not familiar with the Ego of those people.” That is an ethical stance for the time, but one that, hopefully, no longer stands.
Psychoanalysis was of interest in China until 1949. But then Mao gained control and banned it. The Chinese Cultural Revolution (1966 to 1976) disrupted family structure and devalued traditional Chinese medicine and the Confucian philosophy of life: China was left barren of medical and mental health care. Mao then established the so-called “barefoot doctors” to provide some minimal services in the countryside. (These barefoot doctors were somewhat akin to paraprofessionals used in community mental health care in the US. They were untrained citizens who had an interest in caring for others and were given basic training by professionals.) After the demise of the barefoot doctors and the beginning of more modern health care around 1980, psychiatric medications and psychiatric hospitals became more available. There was still a severe shortage of psychiatrists because a whole generation of doctors and therapists had been wiped out during the Cultural Revolution.
Since then, as China became a major economic power, the stress on society increased. Younger people moved from rural areas to the cities, disrupting family structure in a different way. The one-child family policy put extra emphasis on that child. Alcohol abuse increased as a coping mechanism. When violence and suicides rose as a consequence, the government began to make mental health a greater priority.6 The government understood that, at the very least, mental health care could keep people more productive.
The limits of pharmacotherapy as sole psychiatric treatment became apparent, and practitioners became more interested in psychotherapeutic techniques. Knowledge and skill gaps began to be filled by psycho-analysts from several countries, especially the United States and Germany, who provided training. Technologies such as Skype have also increased the ability to teach across countries.
The China American Psychoanalytic Alliance, led by Elise Snyder, has played a large role in this endeavor. However, cultural problems and challenges have also arisen. In a communist society the emphasis on the individual often causes ambivalence. In addition, because carefully worded interpretations are so important in psychoanalysis, language may be a problem. Psychoanalytic ideas have to be translated into equivalent Chinese concepts. For instance, Freud’s subconscious may be likened to the ghosts of Chinese superstition: both are invisible but nevertheless powerful forces.
Different therapies are emerging to supplement psychoanalytic therapy in China. One example is hypnotherapy—language is less important, the clinician is usually culturally congruent, and the technique can be learned quickly and readily applied. Patients can stop in after work for a quick session, and it can be quite lucrative for the hypnotherapist.7
1. Wan W. Freud coming into fashion in China. The Washington Post. October 11, 2010. http://www.washingtonpost.com/wp-dyn/content/article/2010/10/10/AR201010.... Accessed January 16, 2014.
2. Moffic HS, Kendrick EA, Lomas JW, Reid K. Education in cultural psychiatry in the United States. Transcult Psychiatry. 1987;24:167-187.
3. Zhang D, Unschuld PU. China’s barefoot doctor: past, present, and future. Lancet. 2008;372:1865-1867.
4. Chodoff P. Ethical conflicts in psychiatry: the Soviet Union vs the US. Hosp Commun Psychiatry. 1985;39:925-928.
5. Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Basic Books; 1986.
6. Grohol J. Is mental health in China getting worse? 2011. http://psychcentral.com/blog/archives/2011/09/16/is-mental-health-in-chi.... Accessed January 16, 2014.
7. Moffic HS. Psychiatry comes to China: will you? Psychiatric Times. http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatry-comes-chin.... Accessed January 24, 2014.
8. Wu C, Wang L. Psychiatric journals in China. Am J Psychiatry. 2010;167:133.
9. Phillips M, Chen H, Diesfeld K, et al. China’s new mental health law: reframing involuntary treatment. Am J Psychiatry. 2013;170:588-591.
10. Zhang Y, Young D, Lee S, et al. Chinese Taoist cognitive psychotherapy in the treatment of generalized anxiety disorder in contemporary China. Transcult Psychiatry. 2002;39:115-129.
11. Holbrook B. The Stone Monkey: An Alternative Chinese-Scientific Reality. New York: William Morrow & Co; 1981.