China Discovers the Couch: Interesting article on the emerging psychotherapy industry in China by an LA Times staff writer who ties the appeal of and opportunity for ‘the couch’ to the rapid changes in Chinese society, seemingly oblivious to the irony that classical Freudian psychoanalytic theory largely ignored social stresses in favor of internal ‘neurotic’ ones fueled by conflicts and ultimately referrable to upbringing. The Chinese situation offers a fascinating opportunity to observe the propagation of the ‘psychological-mindedness’ meme through a naive society, both for the similarities and differences from the late 19th century spread of the therapy paradigm in Euro-American society.
Watching this trend raises many fascinating questions for me. Is the transition from a ‘planned economy to a free-market system’, as the author suggests, really the source of a dawning recognition by masses of Chinese that they ‘just aren’t happy’? Is there more stress in the current ‘competitive’ society than there was under state socialism? The article mentions corruption, layoffs and unemployment, and increasing class distinction. The famous 19th century French social theorist Emile Durkheim wrote of the relationship between societal suicide rates and various types of social stress; we have a naturalistic laboratory here to test his theories prospectively instead of merely retrospectively. If social change is driving the Chinese to increased distress and the need for therapy, how explicit will the equation between personal distress and social conditions be made by Chinese therapists? This has been a longstanding agenda of the radical therapy movement in the West, combating the classical internal-conflict paradigm and having therapists play a role in consciousness raising and catalysis of social change? Can Chinese therapists who themselves were raised for most of their lives in a totalitarian, anti-individualistic system easily incorporate an analysis of role of their clients’ social situations in their distress, or will this be ignored?
In terms of the social stresses and psychological dsistress they induce, should the Chinese and Euro-American routes to the ‘free-market’ economy be considered different routes to the same final common pathway, or quite distinct? Which is more true: that therapy become more possible or more necessary in a capitalist system? What role might the therapy paradigm play in increasing class distinctions in Chinese society between the growing urban professional class and the rural peasants?
One of the changes noted is the rapid explosion in Prozac prescriptions in China in the past several years. I would like to see an examination of how Eli Lilly penetrated the Chinese market; I am sure that in recent years, as their market share and profitability withered in the US market with the expiration of their patent and the emergence of competing drugs, they had been salivating over the potential Chinese market. What role does securing Chinese receptivity to Prozac play in driving home the psychological meme in Chinese society? In general, one of the great unresolved debates for me in Western mental health care revolves around whether changing therapeutic options in a sense create the need for themselves. This may be economic — as in the arrival of Prozac creating a market for itself — or memetic, as in starting to see everything as if it is a nail once you have a hammer in hand.
The article mentions that the demand for therapy has been driven by the penetration of internet access and Western media into the Chinese middle class. However, the portrayal of emotional distress and mental health care in the Western media has been anything but favorable; how will that influence Chinese expectations and demand?
In a society where people venerate their ancestors more than we do in the West, will the psychotherapeutic exploration of one’s upbringing challenge tradition, or itself be minimized in Chinese therapeutic technique? (Certain Western therapy techniques almost entirely dispense with exploration of the past in favor of problem-centered or cognitive explorations; will these be favored?) What influence, if clients’ upbringing is explored, will China’s one-child-per-family policy be seen as having on psychological health. I am curious about the differences in a society in which there is virtually no notion of a sibling relationship; it seems to me an entire category of intimacy, and the lexicon that goes with it, has been surgically excised from a society’s psyche.
What will we see in terms of gender differences in presentations to or access to therapy? Can therapy practices paly a role in adjusting gender inequality in Chinese society? Will the growth of psychological-mindedness contribute to a feminist movement and other movements for social equality, e.g. gay rights? This is especially important in light of the burgeoning penetration of HIV/AIDS into Chinese society and its concealment by Chinese government policy.
In the face of a rapid explosion of the need for mental health services, can state-sponsored social and economic planning influence the development of a system for care delivery that would be more equitable and responsive than the ‘free-market’ mental health care system? Can a developing mental health care system avoid the trap of tailoring itself to clients’ ability to afford the services rather than to their need for services? How essential, as opposed to optional, will the right to mental health services and emotional wellbeing be seen as being?
Finally, if Bush is reelected, is there a market for my services in China that might make it attractive for a disaffected US psychiatrist to consider emigrating? <grin>