CULTURAL REVOLUTION

To tackle its rampant levels of depression, China must deal with its recent history

This spring, a close friend of mine, Chen, went through a few months of therapy in Beijing. A 30-year-old journalist, Chen had the open mind to seek professional help after suffering with anxiety and depression for a long time. And, given the alarming rates of suicides amongst media workers (within 10 days this May, four had committed suicide), the media outlet Chen works for showed enough sensitivity to give her months off to receive proper treatment.

Chen’s experience is certainly not unique.

According to a 2001-2005 survey from Shanghai Mental Health Center, 6% of the population of six major Chinese cities suffers from lifelong symptoms of depression (5% is about average around the world). Studies on the rural population indicate even higher percentages, especially among the elderly (a study in Anhui Province says 7.2%) and the children who are “left-behind” by their migrant worker parents. A survey in Heilongjiang province indicates that upwards of 50% of the “left-behind” children suffer from depression and anxiety.

These figures together represent 90 million potentially depressed people in China. Our culture traditionally encourages people to keep their feelings inside, but the growing individualistic expression in the social media age certainly campaigns otherwise, especially among the younger generations. While it’s gradually becoming more common for people to seek mental health treatment in China, the medical infrastructure is largely insufficient, even in big cities like Beijing. Currently, there are merely 20,000 psychiatrists in the entire country, helping an estimated 100 million people suffering from various mental illnesses.

Reports say 100,000 more psychiatrists are needed in China. The country’s authority may have the capacity to quickly issue a policy project that meets this scale, but for a more effective intervention, a holistic approach is needed, starting with an examination of China’s recent history and what that’s done to its people.

In his book Where Does Chinese People’s Anxiety Come From, Mao Yushi, one of China’s most celebrated economists, looks at issues—inequality, low income, environmental issues, wealth gap, food safety among others—that have resulted in increasing anxiety in China. But even stepping back a few decades, other events have likely impacted the mental health of the Chinese: the tragic 1960s and 1970s characterized by hunger and cultural revolution; the uncertain 1980s that led to the devastating year, 1989; the legacy of an apolitical generation in the 1990s; and then the following decades of phenomenal economic growth and rapid modernization.

As Mao Yushi argues, a lack of social justice is at the root of China’s public discontent. He writes: “The government uses lies to maintain the social order; when lying becomes the habit, the public won’t believe the government even when the officials are telling the truth.”

China’s party-state has a long way to take accountability for the growing anxious population.

Chen visited Peking University Sixth Hospital, the most famous psychiatric hospital in Beijing, with rather dreadful feelings. She recalls an overcrowded ward where the doctors could barely offer more than 10 minutes to each patient. “In the hospital, I saw the confusion in people’s eyes. Many decided to look for help, but they didn’t understand what they were going through. The only pleasant feeling from the visits was probably that I was not among the worst.”

Trial and error, in the form of various medicines, is still the most common treatment advised by psychiatrists. Zhangjin, the deputy editor in chief of Caixin, China’s leading media on business and financial news, writes about his experiences as a patient being treated for depression in Beijing on his blog. In a post titled “Returning from Hell” he lists a dozen different medications he had to take within five months in 2012 to identify the right combination that eventually helped him. During the process, Zhangjin was diagnosed with severe depression and was advised to undergo electroshock treatment. He then changed to another doctor to try out another medicine.

Chen’s experience is similar.

After she received advice to take medicines from the psychiatrist, she decided to consult a private psychologist, since public therapists certified by the Ministry of Labor and Social Security Affairs or Ministry of Health Affairs have a poor reputation. She signed up for a total of 50 one-hour sessions with a therapist, whom she still meets once every two two weeks, though her condition has significantly improved. Following her psychologist’s advice, she did not take any medication.

“Taking medicines would be the more economic choice. But luckily, I learned enough about depression to know that the situation varies for everyone, and to develop confidence in my therapy,” Chen says. She spent about 40,000 RMB (about $6,500) for treatment. This amount is equivalent to last year’s total average disposable personal income in Beijing, a fee most patients Chen met in the Peking University Sixth Hospital would not be able to afford.

There are around 500 professional psychologists qualified by the Clinical and Counseling Psychology Registration System (CCPRS) of Chinese Psychological Society, an organization that advocates for psychotherapy and counseling practitioners since early ’90s. If China had intentions to develop robust mental health treatment, I wish educating qualified psychologists would be the priority.

Follow Lulu on Twitter @ninghuilulu. We welcome your comments at ideas@qz.com.

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