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China Discovers the Couch

Author: Ralph Frammolino

Date Published:
Publisher: Los Angeles Times Valley Edition

Stressed by rapid social change, the nation turns to psychology. The challenge is to adapt Western therapy to an Eastern culture.

BEIJING - Step back, Confucius. Move over, Mao. Dr. Freud is making the rounds. Once vilified by the Communists as a remnant of bourgeois imperialism, the practice of psychology - and especially the Western ritual of going to a therapist - is gaining popularity in this land of budding capitalists.

China's newfound fascination with the subconscious comes amid wrenching social changes that are reshaping a nation seeped in values of self-reliance and self-discipline. As this country accelerates from a planned economy to a free market system, people are feeling the shock of increased competitiveness, elevated stress levels and the dawning recognition that an awful lot of folks just aren't happy.

"Everything's changing, including people's behavior, customs and beliefs," said Zhang Kan, president of the Chinese Psychological Society. "Some people want to keep the traditions, but it is not possible. Maybe you can keep what's essential, but you have to change to fit in the world."

Now, it seems, China is shrinking to fit.

Those within psychology circles say a growing number of the burgeoning middle class, armed with Internet access and images of therapy from movies such as the Hong Kong blockbuster "Infernal Affairs," are seeking professional help to soothe their angst.

The sales of Prozac in China have nearly doubled in four years, said an Eli Lilly & Co. spokesman.

One-third of those polled in a recent nationwide survey said they felt frustrated, angry or listless. Suicide is now the leading cause of death among young adults. Divorce, while still a modest 16% by some figures, is rising.

The demand for help has government officials scrambling to seize control of a therapy industry that has sprung up virtually overnight and includes many self-styled counselors trying to make a quick buck.

Meanwhile, universities are adding psychology departments, hoping to keep pace with a surge of students who now see the human mind as a career gold mine. The number of university psychology departments and the figure for grad students have doubled over the last five years - to 40 and 4,000, respectively, according to professional sources.

They're entering a growth market.

Zhang, a 33 year old radio station employee who gave only his family name, said he had "no concept" of what therapy was all about when he contacted a Beijing therapist via the Internet a year ago.

Now, after intense counseling, his troubled marriage is healing and he describes the talking cure like a pro.

"It's a process during which a therapist and client communicate with each other, and through that communication they can discover problems under the surface," said Zhang, who is not related to the psychological society president.

The vast majority of Chinese, however, are not so ready to swap Confucius for the couch.

In a land where 70% of the people are peasants, most are too busy eking out a living to worry about emotional fulfillment. And if they did, what with an average per capita annual income of $1,000, many couldn't afford the $20 to $100 an hour therapists here charge.

Even those who can afford it are put off by the fact that the Chinese word for psychologist means "heart reason consultant," implying that a client who comes to see one has something wrong with his or her mind.

And if Chinese get past that, they are uncomfortable with an approach that often calls for exploring family skeletons or divulging secrets to a stranger. That's far removed from the Confucian tradition of venerating ancestors and, above all, saving face.

"Chinese people are taught this way," a local businessman, who declined to give his name, said as he relaxed recently in Beijing's popular Lotus Lane bar district. "If you have any problems, you go to your parents. And if your parents can't help you, you bear them yourself."

During Mao Tse-tung's 1966-76 Cultural Revolution, political ideologues attacked psychology as a "pseudoscience" of capitalist expansionists. Hard-liners shut down human behavior research, destroyed psychology libraries and forced human behavior researchers to perform manual labor, such as raising pigs.

Yet the post-Mao economic reforms initiated 25 years ago unleashed social forces that have splintered China into a class based society, and left both the haves and have nots struggling with immense change.

Layoffs. More demands at work. Less time for friends or family. Pressure to keep up with the Fangs.

"If the rich are getting richer and the poor getting poorer and you tell people, 'Don't envy rich people,' it won't work," said Wang Kegiang, a therapist in Dalian, a coastal city 290 miles southeast of Beijing. "People still feel unbalanced."

"Besides that are all the problems of corruption and the pressure of educating children and unemployment," he said. "All of these problems are causing instability in China, in the society."

For many Chinese, the most troubling sign of increasing instability has been a parade of news stories unheard of in years past. Overwrought college students pour acid on zoo animals, kill roommates with a hammer and step in front of trains.

The Education Ministry has responded by working on a psychological screening test for incoming university freshmen, an in April 2003, the Ministry of Labor and Social Security issued the country's first professional standards for therapists. Within eight months, it licensed 2,600 psychologists, according to a statement issued by the ministry.

"Psychological problems have become a major challenge to people's mental health and an important, reason for social instability," the statement said. "And psychotherapy can help people solve their psychological problems using scientific ways and methods."

Training in those methods and ways still lags far behind the West, though. Prospective therapists can sit for the licensing exam after 720 hours of study and practice, say those in the field. That compares with a minimum of a master's degree in psychology and 3,000 hours of supervised experience to practice in California.

But it's a start, many say, and the regulations will be tightened as the government continues to weed our self styled shrinks who "rip people off," one government official said.

"Many people are doing this because it is a moneymaking market," said Li Yanyan, who works at the government's research Institute of China Standardization, which is reviewing the therapist regulations for final approval.

Legitimate therapists such as Wang, in Dalian, attest to the growing demand. An educator for 30 years, Wang is typical of China's first wave of therapists, many of whom are doctors or teachers and work in the field part time.

Wang said he sees clients for 25 hours a week and has tracked demand for his services by the prices hey are willing to pay. He doubled his fee to $73 an hour, and "still people have to make appointments and can't get the time" from me.

Some parents, he added, willingly pay up to $240 and hour to send their child for help with anxiety before a crucial school exam, a kind of therapeutic doting that he and others said stems from their government's one child family policy.

Enacted in the 1970s, the policy has spawned a wave of youngsters and young adults who have become a core constituency for therapy. Referred to as "little emperors and empresses," many lack the social skills to cope in an increasingly competitive world as they enter college or the work place.

"Most of my clients are well educated. They have money. They need attention. They need people to hear, to listen," said Bi Jinyi, a Beijing therapist with a popular website.

They have to be strong in front of the people they know, but they are weak inside," Bi said. "Most of them need to be told: 'You have no problems! Cut it out! Get to work!' "

Bi - who specializes in "love, marriage, divorce and sex" issues - has a master's degree in psychology and tends to clients during evenings and on weekends, after hours from her regular job as a senior non-weaponry purchasing agent for the military.

One third of her clients, she said, need about four sessions to solve their problems. The rest take longer to deal with meatier issues, such as domestic abuse, or attend group counseling sessions, including a relatively new one on road rage.

Because there's no Chinese phrase for the condition, Bi calls her gathering the "I-am-so-angry-with-somebody-in-my-way" group. She teaches group members how to control their anger through breathing and visualization. Membership, she said, has swelled each time she has held the five-week session, and at last count was 19.

"It's quite popular, you know," she said.

Psychologists in general have become more popular in China in part because of the 2003 outbreak of severe acute respiratory syndrome. To help calm a worried public, they left their offices and took to the airwaves, ran hotlines and visited patients, families and medical personnel in hospitals.

Even as their prominence grows, however, Chinese psychologists find they aren't completely content themselves. They want more than a warmed over version of Freud or other Western therapies to use in a culture with an Eastern take on life.

As a result, the government funded Institute of Psychology, part of the Chinese Academy of Sciences, is conducting research to come up with guidelines showing what constitutes good mental health in this country.

Researchers have also given an Asian twist to the Minnesota Multiphasic Personality Inventory, a widely used psychological assessment test.

Psychologists such as Wang Denfeng say the bigger challenge is to create a new brand of therapy that suits Chinese sensibilities and culture.

"Personality is the basis for psychotherapy," said Wang, a Peking University psychology professor. "But the Western personality theory cannot fit the Chinese people and the Chinese culture. People in different cultures think and act differently."

Wang, who has studied Chinese personality for 20 years, cited as an example a person who takes risks. In Western personality theory, he would be considered an extrovert, which is a positive thing.

But the Chinese would see that person as driven by intense emotion, not a good thin. "The Chinese think: This is not a careful man," he said.

Despite, such cultural differences, the kind of talk therapy pioneered by Sigmund Freud more than 100 years ago seems to be a good enough fit for some in this post-Mao society. Case in point: Zhang, the radio station employee.

Zhang said he decided to look into therapy when he began suffering from a mysterious illness that medical doctors couldn't diagnose.

He made contact with Bi, the Beijing therapist, and the two began weekly chats. Eventually, Bi said, she discovered the cause of his ailment: unresolved guilt from an extramarital affair. Zhang had taken up with another woman because he was angry that his wife's personality sourced after marriage.

"He wanted the affair to show, hey, you've got to respect me," Bi said. "But after the affair, he was guilty because his wife loved him deeply. So in his subconscious, he persuaded himself that there was something wrong with him. The punishment was feeling sick."

Now, after a year of therapy, Zhang has ended his affair, made amends with his wife, and the couple have a 2 month old daughter.

Zhang said he never gave a second though to talking to a therapist.

"I think the most important things that you find a correct way to solve your problems," he said, shrugging off any Confucian reluctance. "I believe that telling the truth is much better than covering it."

Bu Yang and Yin Lijin in The Times' Beijing Bureau contributed to this report.