I have just returned from 21 days in China. I don’t think I have ever worked so hard or eaten so well. If anyone is interested, I will send you a list of the places where I spoke and the people whom I met. A lecture in China usually lasts for 3 hours. Almost every night there was a banquet and often one at lunch too. Most of these arrangements were made by Zhang Haiyan. She is the young psychiatrist who was in analysis with one of our group and who is now in Canada. There, she has just begun her psychoanalytic training at the Toronto Institute. Her professor in China was Richang Zheng, a nationally famous psychologist who seems to know every one in China interested in psychotherapy and psychoanalysis. I was passed on from one person to another all issuing invitations for me to speak—so that before I left for China, there were only two free half days in my schedule and these were filled when I got there.
I did a large number of supervisions and also consultations as well as speaking to many heads of departments and programs and individual psychiatrists, psychologists and counselors. This is a very long email so I will put a table on contents here and you can print it out and read it at your leisure or skip the parts that are of no interest. Tomorrow I will try to post a description of what is happening with the two-year training program.
PARTY CONGRESS
I heard from a number of people “in the know” that the forthcoming party congress is expected to have some rulings on mental health that will mean more money for training in all mental health fields—we will see.
CHAIRMAN MAO
People talk openly about their dislike/hatred of Chairman Mao. There is a genre of Chairman Mao jokes many of which seem to be puns (I was told that they were not funny if translated.) The Cultural Revolution, the famines of the late 50’s and early 60’s are also spoken about totally openly. For example, I had thought that the famines were the result of the flooding of rivers and most importantly of poor transportation so that food could not be brought from areas where it was plentiful to other regions. Chinese colleagues smiled pityingly when I said that and said that the problem was that the government in its race to industrialize was desperate for iron. Each rural family had to produce huge quantities of pig iron in their back yards with primitive charcoal furnaces. Entire provinces were denuded of trees. All cooking pots went into the smelters and communal dining rooms were instituted in each village. The farmers did not have the time to farm. There was not enough food in the village dining halls. Millions starved to death.
EDUCATION
The government is pouring money into building universities. For example in Chengdu which has 20 or so universities, each university is building or just has built a new campus in the suburbs, each with room for another 40,000 students. Admission to a high ranked university is very competitive. From our point of view some of the universities have odd names: Sports University, University of Nationalities, University of Economics and Finance. Most of these have undergraduates with other majors than the name implies, but very strong graduate departments in the field named by the university.
I previously posted about the requirements for medical, psychological and counseling degrees. Many of the psychiatrists who are interested in psychotherapy (after 5 years of undergraduate training leading to a Bachelor of Medicine, 4 years of Psychiatric Residency and a hard exam for certification) choose to get PhDs in psychology after that rather than doctorates in medicine because psychotherapy training is better in departments of psychology. Because psychiatrists have only Bachelors Degrees in Medicine, it is almost impossible for them to get work in the U.S.
There is also an undergraduate social work degree. The national government is pushing these programs because they want to end spousal abuse and that is an area in which social workers are involved. At a number of universities, the psychology departments had new buildings with cognitive science, neuroscience, etc., etc departments with state of the art equipment.
PSYCHIATRIC HOSPITALS
I visited several. All but one that I visited were affiliated with medical schools and the medical schools were part of universities, much as things are here. All of them were quite modern and lovely. Set in gardens and parks. My lectures were attended by psychiatrists, psychologists, nursing staff and others. I was very impressed by the level of competence and interest. Patients in need of hospitalization (and this Is not just homicidal or suicidal patients but depressed, schizophrenic and other sick people) are admitted and remain for a month or two until they are better. It reminded me of psychiatric hospitals here in the 1950’s and 60’s before the insurance companies took over. Fees are such that middle class people can afford them. I visited one brand new private hospital. It was unbelievable. It was more like a spa than a hospital and the fees were correspondingly higher. Treatment at the places I visited (and please recall that I was invited to places interested in psychotherapy) consisted of psychotherapy and psychopharmacology where appropriate. I posted some weeks ago about the government’s concern that drugs are being used excessively and prescribed by general practitioners rather than by psychiatrists.
PRIVATE TREATMENT COMPANIES
I spoke at two large psychotherapy companies. These provide psychotherapy to employees of Chinese and multinational corporations. They have lots of money and employ counselors mainly and some psychologists.
CHILD THERAPY
I met a number of child therapists. Some are in private practice; some are working in the schools. They come from a variety of disciplines and all that I met are very interested in further training. They do play therapy and work with the families.
HOTLINES
I spoke at the Youth Hotline. It was founded about 16 years ago by an extraordinary woman, a senior editor at a major press. It advertises nationwide and perhaps 150 volunteers work there. Most are mental health professionals; but some are editors, professors of English, etc. All are given training. There are also many other Hotlines in the country: Suicide, Familial Abuse, etc All are loosely affiliated with each other.
STUDENT HEALTH
I spoke at two student health services. Each was headed by a well-trained psychologist and staffed by other psychologists and counselors. All were desperate for more training. As far as I could tell all universities have these services. They treat undergraduates primarily. Some also treat graduate students and faculty. The amount of treatment they can offer varies from a few sessions to medium and long-term treatment. There is NO alcoholism, and NO drug abuse among the students though I have heard that there is some alcohol use and drug use in coastal cities. Depression and anxiety are the main problems. It is my impression that the suicide rate among undergraduates is lower than in the U.S. They see some eating disorders, but all the people I spoke with said that the rate was higher in the high schools. There is the usual sprinkling of schizophrenic patients, problems with parents, relationship problems.
MOBILITY
There is, compared to the U.S., an astonishing amount of mobility of all kinds. Many people I saw with PhDs come from the antonymous regions and have peasant parents. This speaks to the Chinese government’s emphasis on education and the competitive exam for places in universities. People are constantly moving to other cities. It is not unusual for married couples to live in different cities because better jobs are available elsewhere and the push to earn money is very strong. Many married couples live in different cities and their single child lives in yet a third city with the grandmother (Since the age of retirement is 65, grandmothers in China are available to play the traditional role of child care giver. Television commercials for such things as Pampers or baby food show happy, healthy infants and children and smiling grandmothers). There is also a huge amount of change of profession. Young people must choose a major on beginning their undergraduate education. Often there is strong pressure from parents to choose one or another field of study. Later, people change their occupations at an astonishing rate.
ENGLISH PROFICIENCY
I gave one lecture to about 150 undergraduate students, most of whom were majoring in psychology and social work. The first most striking thing was that about 90% of them had excellent almost unaccented English. This is a result of the government pushing English from nursery school on. Two year olds on the street said “Hello” as their parents beamed. People over 40, in general, have had to try hard to learn English. They suffered first from the lack of education during the Cultural Revolution and then from not having learned English as young children. One lecture I gave took place in a rented lecture hall at one of the best English schools in Shanghai. This was a large building of classrooms, computer rooms, lecture halls and lounges with pool tables, TVs coffee machines and signs that read “Only English can be spoken here”. Many of the Chinese I met carry little pocket electronic devices that you can punch in words in English or Chinese and get a translation
MARRIAGE & DIVORCE
I spoke with and also heard about a large number of women who were unhappily married. The story was almost always the same. They said that they thought they had never really loved their husbands. Some described their husband as “good men” but said they had no feelings for them. Some said that their husbands had had affairs and some were themselves engaged in affairs. There was a longing for romantic love. (There is a long tradition of romantic love in China.) The women I saw were roughly from the same social-economic strata as my patients in America, but the rate of infidelity was much higher with the Chinese. I do not know the figures on the divorce rate in China, but my guess is that it is high. It is also not unusual for married couples to live in different cities because better jobs were available elsewhere and the push to earn money is very strong
MY IMPRESSION OF THE CHINESE
It is presumptuous to speak about an impression of 1,300,000,000 people of 54 different nationalities or even to think of having an opinion, but here goes. I have liked, almost without exception, and felt very much at home with all of the Chinese I have met. They are very warm, physically affectionate. Women I have just met hug me goodbye. Everyone took my arm as we walked together or crossed a street (a hair-raising enterprise in China. They have twelve lane highways, everyone has a new car with leather seats, BMW’s abound, but no one seems to have invented traffic lights.) The humor of the people I have met is much like mine—lots of laughter. It is polite to ask questions about hometowns, occupations, costs of apartments and even about fees and salaries. I had been told that the Chinese would not be willing to discuss problems in their families or anger with their parents. This has NOT been my experience. The people I saw in consultation were very open about difficulties in their families of origin. One woman said that she “hated’ her mother and was not sorry when she died. On the other hand, the parents and their opinions play a larger role in the lives of Chinese adults than they do in the lives of most Americans I have seen.
PSYCHOPATHOLOGY
A large number of women reported that they had been sexually abused as children by older male relatives—usually the men ranged in age from 15 -22 and in one case was mentally retarded. No one reported abuse by a father or older male. All regarded the abuse as a traumatic event and described changing from a happy successful child to a depressed one after the abuse. Many of these women but not all—although they had graduate degrees, came from peasant families. I saw one woman with MPD. The incidence of “neurotic symptoms” circa 1890 was much higher in China than what I have seen here. These symptoms were present in women—also in men—who were not borderlines. It was like a trip down memory lane. People also spoke of emptiness, but it did not seem to have the same significance that it would have here. With almost everyone that I have seen in China, difficulties were described more in terms of what it felt like rather than in terms of difficulty in functioning. Almost everyone was more dramatic in his or her presentation than I’ve seen in America.
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