Why some people just won't talk about it
LONELINESS and depression are problems that cross cultural boundaries. But for Chinese people, coming to grips with those problems is likely to be more difficult.
Shame about personal problems, worry about what others think and a life centred on the family are among their reasons for such difficulties, and while therapy can help with solutions many are reluctant to seek outside help.
A group of psychiatrists and psychologists in Hong Kong for an international conference on psychotherapy for the Chinese this month, agreed that a major obstacle to Chinese people seeking is the common, deep-rooted cultural tendency to conceal personal problems.
Dr Tao Lin, from the Shenzhen Institute of Mental Health, said Chinese people are held back by a sense of shame, which had its origin in the Confucian idea of being a person of virtue. 'Chinese people are sensitive to other people's thinking or gossip about them. They will feel terribly ashamed about people's negative comments about them,' Dr Tao said.
The speakers at the Chinese University-based conference discussed how best to make psychotherapy, a Western concept which seeks to help a person overcome mental or behavioural disorders through psychoanalysis and specific treatments, more acceptable to Chinese patients.
Cultural adjustments are needed, they said. Keynote speaker Dr Tseng Wen-shing, Professor of Psychiatry at the University of Hawaii at Manoa, says the traditional concept of leading a family-centred life also makes Chinese people less inclined to seek help from the outside, especially a total stranger.
'A therapist should be careful not to become too close to a Chinese client too quickly,' Dr Tseng, a respected author of books on mental health, said. 'It is important to explain to any patient, not just a Chinese, beforehand, what the therapy is all about.' In China, psychotherapy has become available only in the past decade. And despite China's open economic policy, cultural sensitivity to shame remained unchanged, Dr Tao said. 'There was a young woman who was obsessed about how she looked. Every time before she went out, she had to spend a long time checking herself in front of the mirror. The reason, we found out later, was that she had once found herself while being out having forgotten to fasten the zip on her pants.' Unwillingness to expose their difficulties is not restricted to Chinese people living in China. Overseas Chinese have the same problem.
Herb Chew, of the Pacific Graduate School of Psychology in California, said Chinese immigrants in the United States seemed to prefer to talk to a Western therapist than Chinese one, for fear that details about their problems would be spread within the Chinese community.
The rate of use of mental health resources was also found to be lower among Chinese-Americans than Caucasians: 'Locally-born Chinese-Americans are more prone to seeking help than those who are not,' Mr Chew said.
A study by Ray Choy Yuen-ling, lecturer at the City University of Hong Kong's Division of Humanities and Social Sciences, found Asian immigrants prone to suffer social isolation. Half the 104 Chinese patients he surveyed in Sydney were diagnosed as having schizophrenia, paranoid disorder or depression.
He cited the plight of a 27-year-old university graduate from Shanghai who went to study in Sydney two years ago. Working part-time as a labourer, he was unhappy at work, easily agitated, had problems sleeping and feeling depressed after his long-time girlfriend left him.
With no sources of support, he helped himself by taking ginseng tea. After medications and relaxation therapy he was only making slight progress - perhaps because the therapist had to help him through an interpreter, Mr Choy said.
Dr Tseng said he had found Chinese patients to be, in general, more open about physical problems than the underlying emotional causes. More patients came with complaints of headache or insomnia than actually expressing feelings of loneliness, being upset or depression.
Dr Tseng, who is from Taiwan, has noticed increased interest in his work: 'My family and friends were shocked at first at my decision to become a psychiatrist more than 30 years ago,' he said.
'Later they felt my decision was quite right. By now many Chinese people have come to me for help. They opened up after becoming familiar with me.' Curing the mind was hardly a pure Western concept, he said. Hua Tuo, a well-known Chinese imperial doctor centuries ago, mentioned the importance of looking into a patient's mental state. But the science of analysing the mind never flourished in China because of social instability and social apathy towards mental patients, plus lack of public understanding of minor mental disorders, such as anxiety disorder resulting in insomnia or feelings of hopelessness.
Dr Tseng said people still trust herbal medicines or acupuncture, but he refused to comment directly on the effectiveness of such traditional methods: 'Every kind of therapy or treatment has a psychological effect on patients; it gives them hope and energy to cope with a problem. But it is important that the treatment is done professionally,' he said.
In Hong Kong, psychotherapy is a new concept to many, despite the provision of psychiatric or psychological services at major hospitals. Dr Louis Cheng Yang-ching, senior lecturer at Chinese University, said most of his patients had not come straight to him but were rather referral cases. Many developed abnormal signs after falling out with family members, spouse or mother-in-law.