基督教箴言报 现代中国关注精神健康

中间色、令人安慰的山水画、窗沿上摆放的证书，田国颜（音译，Tian Guoyan）的办公室跟世界其他地方的心理顾问诊所没什么两样。但这是在中国，加拿大精神病学家菲利普斯（Michael Phillips）回忆道，仅在20年前，他的本地同事向邻居隐瞒他们的工作，因为邻居们担心精神病是可传染的，认为精神病医生可能从病人那里感染精神病。

　　田女士是中国一个新的、发展迅速的职业的先行者。越来越多心理治疗医师和顾问挂出他们的营业招牌，例如叫“幸福天堂”或“情绪经理人”。但他们表示，在这个狂躁的社会中他们不能指望跟得上需求，台风式的变革已经撕碎了普通人的生活。越来越多人转向宗教寻求安慰，或者去造访田女士那样的顾问。尽管难以获得可靠的数字，但心理学者估计中国大约有2000名合资格的心理顾问。

　　北京师范大学心理学院院长车宏生（Che Hongsheng）表示，社会发展越快，人们生活节奏越快，他们的压力就越大，许多人感到失去平衡，而平衡对中国人来说有重要的意味。

　　田女士表示，在中国，和心理相关的污名仍然没有抹掉，但已经褪色。至少对妇女来说如此，妇女占田女士顾客总数的近80%。田女士解释说，这里的男子受到的教导要他们压抑情绪，否则丢脸。

　　中国妇女特别容易受到压力的影响：中国年龄介于15至34岁的女性的自杀率世界最高——几乎是全国平均水平的两倍。田女士的顾客（每小时支付40美元，让田女士他们成为中国的富裕精英）告诉她，最大的挑战之一是要依靠自己——中国曾一度提供所有东西。

　　田女士表示，许多人无法了解自己，在这个社会中，个人传统上隶属于集体，“你应该为你的家庭、国家、组织着想，却不想自己。在成长过程中很多人会告诉我要做什么——我父母、我大哥、我老师、媒体。焦点从来就不在个人，而是在集体利益。”

　　这种方式迎合了中国的共产主义权威，让关注个人的心理疗法变成自我实现的反革命。直到邓小平引入改革开放政策后心理学才复兴。尽管如此，田女士抱怨说政府对这个行业的支持远远不够。他们没有意识到社会不能这样病态。

　　然而，北京心理危机研究与干预中心的总干事菲利普斯博士表示，在过去几年，当局对精神健康的态度已经发生极大变化，“有一种动力……这对那些致力于精神健康的人来说是积极的”“仍然有许多问题，但趋势看起来非常棒。”

　　他表示，特别是政府对自杀开放得多，“他们没有把问题扫到地毯底下；这是一个巨大的变化。”上月的官方报告显示自杀意图是中国2005年第二大受伤原因，仅次于交通事故。

　　受害者很少求助，主要是因为无法在附近获得帮助。卫生部副部长王陇德（Wang Longde）在上月的国际精神健康日的演讲中表示，大多数地区缺乏精神健康问题预防网络，而且公众对精神疾病的了解水平不高。两年前的调查显示60%的农村中国人不知道“消沉（depression）”是什么意思。

　　菲律普斯坚称，在自杀流行的农村，关键问题不是缺乏咨询服务，而是农民家中有很多农药。这意味着自杀意图以死亡告终的机率不同寻常的高。菲利普斯认为，“是生是死跟你有多想死没什么关系，跟你用哪种农药关系很大。”

　　农业部上月宣布将停止五种毒性最强的农药的生产。菲利普斯认为尽管这无法制止（自杀）行为，但将减少死亡的人数。当局还在一些地区成立危机热线，专业团队制定新的心理顾问标准，剔除那些没有受过恰当训练的人，提供更多有熟练的顾问。

　　随着越来越多中国人明白心理问题需要帮助，可能就有更多人寻求帮助。田女士表示自己比几年前忙多了，她认为在未来几年她将忙不过来。（作者 Peter Ford）

In modern China, eye on mental health

Most psychotherapists and counselors are setting up shop as Chinese struggle with the demands of a rapidly changing society and the profession loses its stigma.

Beijing - The neutral colors, anodyne landscape paintings, and diplomas ranged on the windowsill make Tian Guoyan's office much like a psychological counselor's clinic anywhere else in the world.

But this is China, where only 20 years ago, recalls Canadian psychiatrist Michael Phillips, his local colleagues hid their work from neighbors who feared that mental illness was infectious, and thought that such doctors would have caught it from their patients.

Ms. Tian is pioneering a new and rapidly growing profession in China, as ever more psychotherapists and counselors hang out their shingles with names such as "Happiness Heaven" or "Mood Manager." But they cannot hope to keep up with demand, they say, in a turbulent society where a typhoon of change has torn through ordinary people's lives.

"The faster society develops, the faster people's lives become, and the more stressed they get," explains Che Hongsheng, dean of Beijing Normal University's psychology faculty. "Many people feel they are losing their balance, and balance matters a lot to Chinese."

More and more of them are turning to religion for solace or visiting counselors like Tian, a forthright and reassuring woman who sold a successful company to train as a psychotherapist. Though reliable figures are hard to come by, psychologists estimate that there are some 2,000 qualified counselors working in China.

The stigma attached to all things psychological in China "is still hanging over" the profession, she says, but it is fading. At least it is fading for women, who make up nearly 80 percent of her clientele. "Men here are taught to suppress their emotions, or they lose face," Tian explains.

Chinese women have proved especially vulnerable to stress: Chinese females between the ages of 15 and 34 have the highest suicide rate in the world – one that is almost double the national average.

Among the biggest challenges, Tian's clients (paying $40 an hour for her services, which makes them a wealthy elite in China) tell her, is the new need to rely on oneself in a country where the state once provided everything.

"The old meets the new, the East meets the West, and that leaves a lot of people totally confused," says Tian. "A lot of them hold it back, but others step forward" to seek help.

Many of them, she adds, have trouble figuring themselves out, in a society where the individual self has traditionally been subordinated to the collective. "You should think for your family, your country, your group, never think for yourself," Tian explains. "As I grew up there were tons of people telling me what to do – my parents, my elder brothers, my teachers, the media. The focus was never on the individual but on the benefit for the collective interest."

That approach suited China's communist authorities just fine, and made psychotherapy's focus on individual self-realization counterrevolutionary. For years, psychology was condemned in China as a decadent bourgeois indulgence and it was only reinstated as a subject for study after Deng Xiaoping introduced his "reform and opening" policy at the end of the 1970s.

Even so, Tian complains, the government's support for the profession has proved "far from enough. They did not realize society could be so sick."

The past few years, however, have seen a sea change in authorities' attitude to mental health, says Dr. Phillips, head of the Beijing Suicide Research and Prevention Center. "There is a momentum ... which is positive for those working in mental health," he says. "There are still a lot of problems, but the trajectory looks pretty good."

In particular, he says, "the government is much more open" about suicide. "They are not sweeping it under the carpet; that's a big change." An official report last month showed that suicide attempts were the second-largest cause of injury in China in 2005, after traffic accidents. Government statistics, which some outside experts say still underestimate the problem, report around 250,000 suicides in China each year.

Few victims ever sought help, mainly because help was not available nearby. "The majority of regions lack mental-health prevention networks and the level of public knowledge about mental illness is not high," deputy Health Minister Wang Longde said in a speech last month marking International Mental Health Day.

A survey two years ago found that 60 percent of rural Chinese did not know what the word "depression" meant.

Phillips insists that the key problem in the countryside where suicide is most prevalent is not lack of counseling but the abundance of poisonous pesticides that farmers keep in their homes. That means that an unusually high rate of suicide attempts end in death. Fifty-eight percent of all fatal attempts used pesticides.

"Whether you live or die has little to do with how much you intended to die and a lot to do with which pesticide you took," says Phillips.

The Agriculture Ministry announced last month that it would cease production of the five most toxic pesticides. "That won't stop the behavior, but it will reduce the numbers who die," says Phillips.

Thirty percent of those who die by suicide and 60 percent of those who make nonfatal attempts – a large proportion by international standards – have no diagnosable mental illness. Suicidal tendencies are "usually prompted by intense interpersonal conflict, typically with the spouse," says Phillips, whose team carried out the largest study of suicide in China.

Still, authorities are setting up crisis hot-lines in a number of regions, while professional groups set new standards for psychological counselors to weed out those without proper training and to provide more skilled counselors.

That will take years, psychologists agree. In the meantime, as more Chinese understand that "between very serious psychiatric illness and simply being confused there are psychological problems that need help," as Mr. Che puts it, more may seek help.

"I am much busier now than I was a few years ago," says Tian, who later this month will become one of the first batch of counselors to receive a professional qualification from the China Psychology Society. "And in another few years I will be overbooked."