The Madness of China’s Mental Health System
One of the country's leading activists and health advocates explains the tragic irony of mental health in China today: Many who need treatment won't get it, while many who don't are forced into treatment to silence political dissent.
According to a 2009 article in the British medical journal The Lancet, as many as 17.5 percent of China’s adult population may suffer from some kind of mental illness. Yet mental health remains a vexing, and in some cases taboo, topic in China. The trauma and reversals of recent decades, from the Cultural Revolution to the current all-consuming drive for wealth, from shifting family structures to the migration of millions of people each year from villages to cities to find work, all have put invisible strains on the people living through these vast changes. Some recent headlines from the past year indicate that untreated mental illness may be becoming a more acute problem in China: a series of grisly attacks by middle-age men on school children, some of them deadly, caused a great public panic. The suicides of several young workers at a factory in southern China assembling iPhones likewise raised questions about where migrants (most workers are living far from home) can turn to for emotional support in difficult times.
Meanwhile, even as many people who need medical attention are unable to receive help — either because it is too costly or because of the great social stigma attached — there are others who are healthy but are labeled "mentally ill" by authorities seeking a reason to detain them in mental-health hospitals, as the New York Times recently documented. One man mentioned in the article, for instance, is 54-year-old Xu Lindong, who was forced to spend six and a half years in mental hospitals and subjected to 54 electric-shock treatments following a land dispute. (A recent New Yorker article explored the interest — and confusion — among some in China regarding the ideas of Sigmund Freud.) This is the tragic irony of mental health in China today: Many whose lives could be improved will never receive medical attention, and many who don’t need it are held in confinement in the name of medicine.
In this context, I would like to offer my own personal story. I was trained in medicine in the 1980s and subsequently worked for a government health institute and then for a private NGO dedicated to AIDS awareness, which brought me into contact with marginalized populations and stigmatized people in China, including those wrongly labeled as mentally ill. I have seen people sent to mental hospitals for being gay, for domestic disputes, and for political dissent.
I was born in 1963 and grew up in a small town in Anhui province. The first person I remember being described as mentally ill was my father. He was a police officer in the 1950s; he found his work very hard to do, and by the time he left his job in the late 1950s, he hated politics. During the Cultural Revolution, which began in 1966 and lasted for 10 years, he spent time in a labor camp. There were two words people used during my childhood to describe people with a mental illness: One was fengzi, which means a dangerous person without restraint or a conscience. The other was naozi shou ciji, which means someone with a mind broken by pain or stress. That was what they said of my father. He was not ever formally diagnosed because there was very little understanding of mental health at that time in China; under Mao Zedong, it was seen as a sign of weakness. I think my father’s problem was not mental illness, but instead that he had an independent mind. He read a lot and thought differently about the world. In the 1970s, people often used the label of mental illness for people like that.
In secondary school, I had to decide between focusing on science or on politics and literature. My father said to me, "If you study politics and literature, you will have to lie. But if you study science, it has nothing to do with politics." He also made the argument: "Even if you are put in prison, the police will be kinder to you if you are a doctor." After the Cultural Revolution, many families encouraged their children to study science, engineering, and medicine. That is how I came to attend Shanghai First Medical College, which I entered in 1981.
During that time, interest in Western notions of mental illness grew quickly. The 1980s were a period of relative openness in China, when foreign ideas on everything from art to politics to medicine to environmentalism began to flood into China. During the Cultural Revolution, psychology was considered a "pseudo-science." But after 1986, I remember a lot of lectures at university on psychology and psychoanalysis. In 1987, I helped to translate two chapters from an English-language book about psychological counseling and crisis intervention. I graduated in 1988 and moved to Beijing, where I got a job as a health researcher for the National Health Education Institute, which is part of the Ministry of Health. I remember in 1989 when the ministry established the first suicide-prevention hotline in Beijing. By no means did Chinese health professionals understand or accept mental health issues the way Westerners did in those years. Still, the trend was clearly toward a more progressive understanding, focused on improving the lives of patients.
In 1995, I founded one of China’s first NGOs, the Aizhixing Institute of Health Education, with a mission of increasing awareness, treatment, and prevention efforts for HIV/AIDS in China. My work brought me into contact with some of the sub-populations most affected by the disease, including gays and lesbians, drug users, and sex workers. All suffer great social stigma in China. Until 2000, being gay was technically classified as a mental illness in China, but gay people still suffer extraordinary discrimination. I remember in 1997, when a 30-something lesbian woman attended a meeting held by Aizhixing on lesbian rights. She was quick and energetic. She told me her family had sent her to a mental hospital for six months because she was not married and they thought something must be wrong. She asked me, "Was this the right approach?" Of course I told her it was not. We talked about the confusion on the hushed topic of sexuality and mental illness.
In the past 10 years, I believe that an increasing number of healthy people have been hospitalized as "mentally ill." This is troubling to me. The trend began with the government crackdown on the dissident religious group Falun Gong, which was banned in 1999. The authorities labeled members of the group as mentally ill — and therefore an alleged threat to social stability — and used that as pretense to confine them. When the government saw that approach could be useful, it expanded the strategy to target a broad swath of political dissidents and petitioners.
Because of my own work on the controversial topic of AIDS, I have been detained three times, and in May 2010 I left China because of increasing political pressure. I have crossed paths with many activists and NGO leaders in similar positions; we all want to improve the lives of people in China, but the government finds our work threatening. We did not form organizations to be against the Chinese government, but we are sometimes considered by the officials to be dissidents or troublemakers. One example is Zhou Yi Juan, a Buddhist nun who in 2005 organized a memorial in Tiananmen Square to the victims of the June 4, 1989, massacre. Afterward, she was forced to enter a mental hospital for psychiatric treatment. In 2007, Aizhixing supported her with a fellowship to write a memoir about this experience; two years later, she took legal action and sued the hospital. I believe that these cases should be known more widely.
Today in Beijing three government branches operate mental hospitals: the health department, the police department, and the civil affairs department. This is troubling evidence that mental health is not seen as a medical issue, as it should be, but as a matter of social stability and a concern of law enforcement. This attitude leads to abuses, and there is no appeal process for people like Zhou Yi Juan. In Zhejiang province, an official document dated March 23, 2010, and published online details the collaboration between the local police and health departments on mental health, which is wrongly described as first and foremost a social stability issue. In a troubling return to the climate of suspicion my parents experienced during the Cultural Revolution, neighbors in Zhejiang are encouraged to report on each other if they suspect mental illness.
These examples represent only a small glimpse of the vast confusion over mental health in China. These are tragedies the world should know about. The impulse to hide the problems is the worst approach.