[The government has deployed
extensive resources to address the spike in depression and anxiety. But social
stigmas and long-term challenges remain.]
By Vivian Wang and Javier C. Hernández
But rather than hide those
feelings, as would have been common just a few years ago in a country where
mental illness has long been stigmatized, Dr. Zhang consulted therapists. When
friends and colleagues checked in on her, she openly acknowledged that she was
struggling.
“If we can face such a huge
disaster as this outbreak, then how could we not dare to talk about something
so small as some mental health problems?” said Dr. Zhang, an imaging
specialist.
The coronavirus pandemic, which
started in China, has forced the country to confront the issue of mental
health, a topic long ignored because of scarce resources and widespread social
stigmas. In the Mao era, mental illness was declared a bourgeois delusion and
the country’s psychiatric system was dismantled. Even today, discrimination
persists, and many people with mental illnesses are shunned, hidden at home or
confined in institutions.
But after the coronavirus outbreak,
that kind of neglect has become increasingly untenable. The uncertainty of the
pandemic’s early days has combined with the grief and terror of the subsequent
weeks to leave a trauma both personal and collective.
At the height of China’s outbreak,
more than a third of people around the country experienced symptoms of
depression, anxiety, insomnia or acute stress, according to a nationwide
survey by a Shanghai university. An expert in Beijing recently warned
that the effects could linger for 10 to 20 years.
Because of the Chinese government’s
top-down leadership, officials have mobilized quickly to provide help. Local
governments have set up hotlines. Psychological associations have rolled out
apps and held online seminars. Schools are screening students for insomnia and
depression, and universities are establishing new counseling centers.
But the country also faces serious
challenges. There is a dearth of therapists for the country’s 1.4 billion
people, with fewer than nine mental health professionals for every 100,000
residents as of 2017, according to the World Health Organization.
China’s centralized political
system, for all its strengths in mobilizing resources, may also create problems
of its own. The government has curbed
public mourning and suppressed
calls for accountability over early missteps, pushing a
simplified narrative
of China’s triumph over the virus.
Still, the hope is that the
pandemic could propel a long-term shift in the conversation around mental
health in China, with advocates pointing in part to high-level government
orders to improve treatment.
Because of the pandemic, they are
braver in coming to ask for help,” Du Mingjun, a psychologist in Wuhan, said of
the influx of people she had seen seeking treatment this year. “More and more
people are accepting this. That is new.”
Ms. Du was one of the first
witnesses to the crisis’s mental health toll. On Jan. 23, the day Wuhan locked
down, she and her colleagues at the provincial psychologists’ association
helped launch a government-backed 24-hour hotline, placing ads in newspapers
and posting on WeChat to reach a city suddenly convulsed by fear.
Immediately, they were inundated. A
woman called because her parents were in separate hospitals, and trying to run
between the two had left her on the verge of collapse. A man was taking his
temperature every 30 minutes, terrified of falling ill. A 12-year-old boy
dialed on behalf of his mother, explaining that he was worried about her. At
the peak, the hotline managed between 200 and 300 calls each
day, Ms. Du said.
As the situation improved, the
calls tapered off. By late October, there were around 10 a day. Some callers
were still seeking help for trauma related to the outbreak, brought back by
news reports, or old photos glimpsed on cellphones. But others have come
looking for help with more mundane issues, such as academic pressure or
arguments with family.
“I think this change is here now,
and there’s no way to stop it,” Ms. Du said. “We all lived through this
together, and it was continuously unfolding around us. So the collective
consciousness of our community is very deep.”
Around the country, schools have
expanded mental health counseling and encouraged students to take time to
unwind, as the Ministry of Education has warned of “post-epidemic syndrome.”
Officials have said that after months of stressful lockdowns, students might be
more likely to have conflicts with parents and teachers.
Even before the pandemic, the
trends in students’ mental health were worrying. A Shanghai official said in
May that suicides among K-12 students were on the rise, with stress
arising from academic pressure and domestic disputes.
While the rollout of services has
been spotty, educators and students say the campaign has helped break
stereotypes about mental health. In the northern province of Hebei, officials
have produced cartoons to help students understand trauma. In the southern city
of Guangzhou, students are writing letters about anxiety and practicing
breathing exercises.
Xiao Zelin, a junior at Sun Yat-sen
University in Guangzhou, said he suffered anxiety and insomnia when he returned
to campus this fall. After months of being cooped up at home, he struggled
adjusting to crowds of people. His appetite was poor and he couldn’t seem to
relax.
Mr. Xiao had never visited a therapist
before, but he spoke with a counselor provided by his university. The
counselor, he said, helped him understand what he was going through and to be
patient with himself. Mr. Xiao suggested his classmates sign up as well.
“In the beginning I was lost,” he
said. “Now I’m feeling much better.”
Liang Lingyan, a psychologist in
Shanghai, said the government there had also arranged more community services,
such as home visits for seniors who live alone.
“After the epidemic, people are
paying much more attention to health, especially mental health,” she said.
“This will be a long-term change.”
Despite the efforts, cracks in the
system remain.
There are signs that those who need
help have difficulty finding it. One survey by Chinese researchers found that only 7
percent of patients with mental disorders had sought online help during the
pandemic, despite the introduction of apps and websites by the government.
There are also too few high-quality
training programs for mental health professionals, said Yu Lingna, a
psychologist from China who is now based in Tokyo. Even if those were expanded,
training people would take time.
“I expect we will be in a state of
inadequacy for our lifetimes,” she said.
For Dr. Zhang, the imaging
specialist who worked in Wuhan, the feeling that she had betrayed her family
lingered, even as state media feted frontline doctors for their contributions.
Her father recovered but her parents treated her coldly.
Studies suggest that medical staff
may be particularly vulnerable to the pandemic’s aftershocks, with one
study finding that over half of Chinese health care workers surveyed showed
symptoms of depression. While many of those symptoms faded as the epidemic
ebbed, others, such as a sense of guilt over losing patients, could
persist, experts said.
Dr. Zhang said she found therapy
unhelpful, but she eventually found other sources of comfort. She immersed
herself in the writings of Wang Yangming, a Ming dynasty philosopher. “It is
easy to catch the thief that lives in the mountain, but hard to catch the thief
that lives in the heart,” he wrote.
She also eventually left her job at
the Wuhan hospital and is now living in Chengdu, in the country’s southwest,
spending time with her husband and daughter. She is hopeful that one day her
parents will understand her decisions.
Dr. Zhang has often
emphasized that her experience is not unique. Many of her former
colleagues are also still grappling with the scars of the outbreak, she said,
and she was heartened that many of them had also turned to friends or
therapists.
“Any big crisis like this is bound
to leave people with some sort of pain,” she said. “There’s nothing shameful
about it.”
Albee Zhang and Liu Yi contributed
research.
The Substance Abuse and Mental
Health Services Administration National Helpline offers free and confidential
information on mental health treatment and services, 24 hours a day. Call (800)
662-4357 or TTY: (800) 487-4889.
