Mao Meets Freud: Stressed Chinese Seek Help in Western Therapy

By Dune Lawrence

Oct. 21 (Bloomberg) -- When Li Xianyun began working as a psychiatrist at Beijing's Hui Long Guan Hospital in 1991, she didn't discuss her job in public. People thought it was strange, she says, and assumed she worked in an insane asylum. Now, those she meets are eager to learn more about her profession.

``If I tell them I'm a psychiatrist and talk about my job, they show their admiration,'' says Li, 40. ``They want my suggestion on how to raise children and how to deal with all kinds of difficulties.''

In the past 30 years, China's Communist system of government-assigned jobs and apartments has become a capitalist free-for-all with cutthroat competition for education and work and a widening gap between rich and poor. To cope with the stress, some people are turning to a Western tool: psychotherapy. It's a radical shift in a nation where focus on the individual was discouraged by both socialist ideology and traditional culture.

``There are great changes happening in Chinese society, and people are more open and pay more attention to their inner mind,'' says Zheng Yu, a therapist in Chengdu, about 1,500 kilometers (932 miles) southwest of Beijing.

Mental-health problems affect about 15 percent of the population and account for 20 percent of China's so-called disease burden -- a measure of the financial and other effects of illness, according to the Chinese Center for Disease Control and Prevention. That compares with the World Health Organization's estimate of 13 percent for the worldwide disease burden and may climb to 25 percent by 2020.

Work Stress

Job pressures may be a contributing factor. Fifty-one percent of Chinese respondents to a survey by Hudson Highland Group Inc. reported higher work stress than a year ago. It's the second consecutive year China registered the highest levels in Asia, the New York-based recruitment firm said in an October report.

``When some people get rich, they say, `I'm successful, but I'm still unhappy,''' says Kathy Li, 37, who quit working in media in 2005 to start her own counseling business in Beijing. ``People are realizing more and more what can make them happy is not from the outside world but from the inside.''

The May earthquake in Sichuan province, which killed an estimated 87,500 people, has added to the momentum for psychotherapy. Government officials called for help from specialists in other countries to treat the mental, as well as physical, trauma from the disaster.

Outside Assistance

The need for outside assistance exposed the shortage of resources in China. The country has only 30,000 professional therapists and counselors in a population of 1.3 billion. WHO figures show 1.3 psychiatrists for every 100,000 people in the Asian nation, compared with 13.7 in the U.S.

``You can see there's a big gap,'' Kathy Li says.

During the past 10 years, the Ministry of Labor has established a certification exam for counselors, and most universities now have centers where students can go for help with stress and similar problems, as mandated by the Ministry of Education.

International cooperation is providing opportunities for training. The nonprofit China American Psychoanalytic Alliance has enrolled 57 Chinese in a two-year program taught by Americans using Skype, the Internet telephone service owned by EBay Inc. American therapists are also providing training through the Beijing Suicide Research and Prevention Center, where Li, the psychiatrist, works.

Suppressed, Banned

Psychotherapy, which gained a toehold in China with the country's first psychology institute in 1917, was suppressed as unscientific after the Communists took power in 1949 and banned outright during former leader Mao Zedong's 10-year Cultural Revolution, which ended in 1976.

China's traditional culture values ``saving face'': emphasizing the positive and addressing embarrassing issues obliquely. Both conflict with the process inherent to therapy of openly discussing problems.

Custom also emphasizes individual contributions to the group, especially the family, rather than self-fulfillment. The Communist era only deepened that idea, promoting love of the party and country over personal relationships.

Li says she didn't receive any psychotherapy training in medical school. Now, she uses counseling with many patients, partly because the Chinese have a cultural aversion to drugs.

``People tell me, `I don't want to take medication; drugs have significant side effects,''' she says.

Internal Energy

Other therapeutic options are growing increasingly popular. Liu Tianjun, 59, a professor at Beijing University of Chinese Medicine, uses what he calls China's ``own psychotherapy,'' traditional Qigong meditation, to help people harness their internal energy and promote good mental health. Zhao Xudong, 46, a psychiatrist in Shanghai, practices family therapy and sometimes hypnotherapy.

His business is already ``too busy,'' he says. ``The standby list for me is five months for new clients.''

Four days a week, Zheng Yu, the Chengdu therapist, lies down on a couch in his office and uses Skype to call his own psychoanalyst 12 time zones away in New York, a routine he began in 2005. Zheng, 38, is oriented personally and professionally toward the long-term analysis developed by Sigmund Freud in early 20th-century Vienna.

Family Dynamics

He says Freud's theory of family dynamics -- based symbolically on the Greek myth of Oedipus, who killed his father and married his mother -- dovetails with the problems of clients who are only-children struggling to gain independence from overprotective parents.

The financial crisis may increase pressures on the world's fourth-largest economy -- and potential demand for therapy -- if a slowdown in U.S. and European consumer spending hurts the export-dependent country. China's CSI 300 Index has tumbled 64 percent this year.

As more Chinese turn to counseling, Li Xianyun worries people may develop overblown expectations.

Many now ``treat psychotherapy as some miracle,'' she says. They will need to understand it is more like medical science: ``Psychotherapy cannot resolve every problem.''