You’re Not Crazy: Mental Health in China

Nobody talks about mental health and despite the social stigma, it’s a commonality between us all. Psychological health knows no discrimination. We all know someone who is facing some kind of unseen battle.

Did you know that in the United States, only 41 percent of the people who had a mental disorder in the past year received professional health care? Well, consider that and consider how psychological health is far less accepted in China. When it comes to East vs West, most of us know that in the West, mental health awareness is on the rise, which means that gradually, more people are opening up to the idea of acceptance and therefore seeking treatment. Since 1949, the month of May has been known as “Mental Health Awareness Month” in the U.S. and October 10 now serves as “World Mental Health Day.”

It’s certain that China needs to up its game to follow suit with America, Britain and countries which are attempting to rewrite history where mental health is concerned. With more than 54 million people in the country suffering from depression, prevalence rates in China are similar to global rates (4.2 percent compared with 4.4 percent). Depression leads to national costs of 7.8 billion USD every year in lost workdays, medical expenses and funeral expenses. Interestingly, the World Health Organization (WHO) reports that 1 USD of investment in treatment for depression and anxiety leads to a return of 4 USD in better health and ability to work. So, why hasn’t China started to focus on investments in professional help and rehabilitation yet?

Unfortunately, there are insufficient resources and service capacities in China, and therefore, also in Dongguan. According to the WHO, a nationwide survey of 500,000 men and women in China demonstrated that there is a correlation between major depressive disorders, rural residency and low-income status. China struggles to have access to professionals and specialists in this field of expertise. However, things are gradually starting to open up, with some positive changes on the horizon.

Facts and statistics aside, mental health is a very real issue among all of us, whether we have had a certain experience ourselves, or we know someone who has, or still is. Deep down, we all know the severity of the impact of some of these conditions, for example depression. We all have known or heard about someone who could no longer bear the day-to-day plight and released themselves from any burden by taking their own life. This illness manifests itself in all sorts of ways. From being unable to get out of bed in the morning, to feeling completely isolated, to the extreme cases which end in suicide, the one thing that unites humanity across the community and across the world is our need for communication and support. This includes the less severe problems which we face every day—unless we know acceptance, freedom to express, communication and support, these small issues can transform into very serious compromises.

Many years ago, my mother was diagnosed with schizophrenia, which meant that she couldn’t always tell the difference between what was real and what was not. She also became addicted to alcohol. Throughout my life I have wondered why. I have questioned what could have been done differently, what could have stopped her from being swallowed by such a venomous disease. However, it seems that it’s something we may never really know, as it occurs so intrusively within the individual themselves. After studying psychology at college and obtaining my BA degree in counseling, I still don’t have the answers. After questioning human psychology and behavior for most of my life, I still don’t have the answers. After carrying out the parts of this story, I still don’t have the answers. However, I do feel closer to the truth. One thing is for sure: Mental health is nothing to be ashamed of, instead, it is something that needs our unity and support, in order to understand and conquer it in the best way possible.

One important message from this is that it’s okay to not be okay, and whether seeking professional help, joining an organization, or simply expressing yourself to someone you trust, your well-being is important. And don’t forget, laughter really is the best medicine! So, keep them awful puns and “dad jokes” coming. All jokes aside, if you would like to contact us with regards to the professionals within the article, or have any other related queries, please don’t hesitate to contact us at editor@heredg.com.

Depression

Moving away from home can lead to feelings of homesickness and low moods. According to the Anxiety and Depression Association of America (ADAA), 322 million people worldwide live with depression. It is a fact that the term “depressed” is commonly plucked from our daily lexicon and used inaccurately. Everybody experiences low moods or days where they don’t feel 100 percent themselves, especially as a result of life’s biggest stressors and tests; but depression as a diagnosed psychiatric disorder represents something more severe, and with a tendency to persist.

Depression occurs more often in women than men, and similarly, manifests itself in various ways depending on the person and their lifestyle, sex and age. For example, the ADAA states that in men, depression often manifests as tiredness, irritability and anger, and they show more reckless behavior. Whereas with women, the condition tends to develop into sadness, worthlessness and guilt. Holistically speaking, each person has their own experience and each case has its own characteristics.

Examining the situation for Dongguan, expats in particular, moving away from home and family can lead to certain feelings of homesickness and low moods, which perhaps for some will lead to depression. Whatever the reason, or the case, it is important to seek professional help, or at least talk to someone you trust so they can guide you in doing so. The good thing about Dongguan is that there is plenty of sunshine on a regular basis throughout the year. Have you heard of the relationship between depression and Vitamin D deficiency? Numerous scientific studies over recent years show there is a clear positive correlation, as published by Springer, among other credible sources.

Cranes’ Singing Psychologe
Cranes’ Singing Psychology, situated in Nancheng opposite the Kande Hotel, is a center in which Peter Zhang, a qualified psychologist, meets with clients on a daily basis. With around 20 percent foreign clients and 80 percent Chinese so far, he offers a bilingual service which takes a holistic approach, focusing on the person themselves, and not their condition as its own entity. Peter is Chinese; however, he has multiple international qualifications aside of his bachelor’s degree attained at Peking University, some of which I spotted pinned up on his wall inside of the room in which he consults with his clients. While we chatted there, I felt relaxed, and honestly, there really were no language barriers at all. The space is adorned with water-related items and art pieces, and there was an endless supply of coffee. Not only the space but talking with Peter was calming. He embodies a soothing presence and it seemed clear to me that he’s in the right profession.

Peter’s clients come to him with a range of psychological disorders, including depression, anxiety, addiction, etc. Peter explained that he understands to some of those suffering from depression, suicide is a “short-term solution.” Of course, it is a very raw subject, but at its worst depression can lead to this irreparable course of action. With regards to the client, Peter described the importance of consideration to the individual’s relationships with all those around him/her, and that to work on their psychological health means, “Listening to them, encouraging communication, managing expectations and handling each area that must be addressed one by one.”

Offering a range of therapies and treatments, Peter discussed group therapy, one-to-one counseling, Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT) and even hypnotherapy, all of which he is experienced in. Peter also explained the more contemporary approach to traditional CBT, known as Acceptance and Commitment Therapy, aka ACT, he said, “This new generation of cognitive behavioral therapy creatively uses mindfulness, meditation, acceptance, cognitive dissociation, self-background, clear value and committed actions. The biggest difference is that it emphasizes focusing on the current and comprehensive acceptance of the current experience.” He believes that this type of therapy will eventually open-up in China—I truly hope that he is right.

Anxiety

Anxiety disorders are more common than most of us realize.More recently, I have heard some of my Western friends open-up about their anxiety issues, which I personally think is effective progress—a reflection of today’s positive direction in which mental health awareness is heading. It’s true that anxiety disorders are more common than most of us realize and even though they are highly treatable, only 36.9 percent of those suffering receive treatment.

Anxiety is a complicated disorder with several specific types. Anxiety is diagnosed when a person has an external response (such as a lot of fear) in a situation and cannot control their reaction. This feeling remains even when the stressor is removed. Anxiety disorders range from simple nervousness to panic episodes. The five major types of anxiety disorders are Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder (PD), Post-Traumatic Stress Disorder (PTSD), Social Anxiety Disorder (SAD) or specific phobias.

In 2012, China passed its first mental health law. The bill called for more facilities, an increase in their staff and efforts to raise awareness of the issue in schools, universities and workplaces. It advised against confining sufferers against their will. More recently, in December 2016, the State Council issued a policy document that specifically takes into account common mental health disorders such as depression and anxiety. This document signed by 22 ministries and state bodies, called for a multisectoral approach to addressing mental health disorders.

Independent Psychologist
According to Mexican psychologist Lizzy Barocio, “Anxiety is an unpleasant sensation of intense disturbance and a very intense fear of the symptoms. Some symptoms that put you on alert about anxiety are physical manifestations such as: tachycardia (fast heart rate), shortness of breath, palpitations, tightness in the chest, sweating, and/or hot or cold sensations.” She added, “There are cases of patients who develop alertness and hypervigilance, impulsivity and it is also important to note that it is not ruled out that an anxious patient has difficulty with attention span and concentration.”

Lizzy explained that clinical psychological care helps with specific treatments to diagnose the type of anxiety disorder that the patient suffers from and the first interventions are aimed at reducing the symptoms of anxiety and the incapacities that this produces. Then, the aim is to study the factors that originated or maintain the disorder, especially since sometimes the individual could also suffer from depression, for example.

As a clinical psychologist with her degree in psychology, Lizzy is a clinical specialist, specializing in clinical psychodiagnostics, systemic therapy and clinical sexology. As Global Doctor’s former inhouse psychologist, Lizzy now is offering private sessions as she currently works independently. She provides sessions in Spanish, Portuguese and English. While discussing her work and the society’s healthcare situation, Lizzy and I talked for a long time, it was easy to talk to her. She was clear about her boundaries and she seemed very professional.

In order to diagnose an individual who may be suspecting of an anxiety or other psychological disorder, Lizzy described, “Initially, a clinical interview is carried out to obtain the necessary information, before a clinical psychodiagnosis is performed through psychological tests and, if necessary, at the same time medical studies to obtain the appropriate diagnosis and proceed to an individualized treatment.”

While working in Dongcheng’s renowned clinic, sometimes it was necessary to work alongside the psychiatrist for pharmacological treatment. Medication and hospitalization are conventional methods in China at the moment. Lizzy added, “Regarding the treatment, the most fundamental thing for me is to achieve a balance between the environment and the types of treatments, and the particular problems and needs of each patient.”

Youth

Students who receive social, emotional and mental health support achieve better academically.Did you know that 50 percent of all mental health conditions start by 14 years of age, but most cases go undetected and untreated? According to the National Alliance on Mental Illness, the two most common conditions among children and adolescents are anxiety followed by depression, but children can have other difficulties that affect their ability to fully take part in and benefit from their classroom experiences. These include attention deficit-hyperactivity disorder (ADHD), autism spectrum disorder and eating disorders.

In Dongguan, many private schools don’t currently invest in school counselors, despite the imperative difference that having one can make. Do you remember your school counselor? Perhaps you just had a nurse you could visit and talk to. Last year, after suggesting myself as acting school counselor for the school I was teaching in, I was granted an unused office. Due to my degree and basic training in counseling, and my principles regarding psychological and emotional support, I wanted to open up lunchtime sessions for students to come and sit with me and talk, so I took a kettle, mugs and a stash of tea, and delivered a class to all on the importance of psychological health, and when and where to find me. Two main things were clear: one—there was a desperate need for somebody to step into this role and offer unconditional support and full confidentiality; and two—the fact that someone did, made a difference.

Students expressed all kinds of issues; from schoolwork struggles, to “coming out” as homosexual, to past experiences of child abuse. In the six months that I carried out this supplementary service, the cases that were brought to light demonstrated the need for this service in schools. When I finished my contract, I spoke to the head of English again in the hope that the school would hire a professional or at least have another able volunteer to step in. As for those students who visited, my door remains open.

Cereal Psychology
Situated in Nancheng, currently in the process of relocating, Cereal Psychology is a Chinese center which focuses on youth and family counseling. An emerging sector, it was great to be introduced to a company which supports international mindedness in terms of psychological needs and understands the cultural differences which cause certain restrictions. With plenty of international training, Carina Lau is a national second-level psychology consultant, specializing in child and adolescent psychology. As well as seeing Chinese-speaking adolescents and families in her office, Carina is also hired by some schools to work in classrooms.

We discussed teenage students within schools in China, and how they face immense pressure from all angles. Teachers and parents have sky-high expectations due to the fierce competition of the country’s education system, and that’s additional to the usual challenges teens face, such as puberty, the start of relationships and social pressures. Then there is the dreaded “Gaokao,” which literally means “higher (education) examination” in Mandarin. Carina spoke about the importance of family and parental support during difficult times like this. “Often when in difficulty, kids and teenagers can benefit just from being heard and unconditionally supported.” Research demonstrates that students who receive social–emotional and mental health support achieve better academically. It’s important that schools and parents know how to alleviate their stress, isn’t it?

According the U.S. Department of Health and Human Services, one in five children and adolescents experience a mental health problem during their school years. Admittedly, some schools in China do hire school counselors. For example, Utahloy International School Zengcheng. This does, however, seem to be certain international schools so far. “Every year when there has been a teenage suicide, I will receive lots of calls from the schools.” Carina explained. The sad thing is that there should be preventative measures taken by schools, not reactive.

Addiction

Is it easier to succumb to addictions because you are less accountable in being away from your hometown?Broadly, addiction refers to a condition in which a person is dependent (physically, psychologically, or both) on a substance—or even the inability to stop engaging in certain behaviors—such as gambling, eating or working—despite adverse consequences. In fact, there is scientific evidence that addictive substances and behaviors share a key neurobiological feature—they intensely activate brain pathways of reward and reinforcement, many of which involve the neurotransmitter, dopamine. Something to consider for expats specifically is this: is it easier to succumb to addictions and certain behaviors because you are less accountable in being away from your hometown and family?

When you think about it, alcohol as a suppressant or a means of escapism makes sense. Sometimes people head to the bar after a hard day at work. Sometimes you have a couple of drinks for “Dutch courage” if you’re nervous about something. Alcohol is associated with relaxing, socializing and even therapeutic means. What about the expressions “numbing the pain with alcohol” and “drowning my sorrows?” They evidently demonstrate a semantic association of beneficial effects from alcohol. On the contrary, withdrawal symptoms and the emotional effects that alcoholism can have on family members are far from therapeutic. Something I read in a recovering alcoholic’s personal blog stuck with me. It was basically the fact that often, we drink because of our problems, but what we don’t realize, is that drinking is usually the source of many of our problems. Of course, there’s a difference between recreational drinking and addiction, but alcohol dependence must start somewhere, right?

Every Sunday at 10 am, a copy of HERE! is presented on a table at the Starbucks opposite of Burger King at One Mall, Nancheng. Closed sessions are for English-speaking alcoholics and recovering alcoholics only. Occasional open sessions occur, for example when I attended to engage in the experience. The founder of DG AA ensures that he stays the full hour, due to the fact that his past experiences with other AA groups have shown people to turn up at the last moment. In the case of a (recovering) drug addict attending a session, they too will be accepted and supported.

“Admitting that you are powerless against alcohol is the first step. For me it started off with the fear and anxiety; the fear is crippling.” Being addicted to alcohol is different to enjoying a party binge now and again. As the founder of DG AA put it, “An alcoholic will never be cured or fully recovered; it’s just a matter of being a recovering alcoholic. It’s all about taking 24 hours at a time.” It’s worth knowing that for those who achieve remission of the disorder for five years, scientists report, the likelihood of relapse is no greater than that among the general population.“The Big Book” written in 1939 by one of the founders of the original AA, describes how to recover from alcoholism and “Daily Reflections” is another book which states a different snippet of text for each day, in guiding the recovering individual. I was told that this is a very important companion.

Interestingly, the DG AA founder has a passion for traveling and recreating cuisine and he feels that cooking is calming. In fact, unlike alcohol, cooking is therapeutic. Any healthy hobby that physically or mentally occupies an individual means a deviation from stress, anxiety, fear and a distraction from reaching for the craved substance. A healthy form of escapism. That is why emotional and creative outlets are important, whether for yourself, or to encourage a friend or family member to stay clean or stay sane. When I questioned him on what advice he would give to an individual who suspects someone may be an alcoholic, the voice behind the support group said, “Be there for them. Listen to them. And sometimes, just be there with them and don’t even talk.”

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