Confucius, a Chinese teacher, editor, politician and philosopher who lived between 551 and 479BC, taught that accepting one’s allotted role in society was imperative for the maximisation of personal and public harmony. He preached discipline, respect and humility, advocating for people to keep their emotions suppressed and their innermost thoughts to themselves in order to achieve harmony with others. Duty to one’s family was regarded particularly highly.
This is all well and good, but 2000 years of individual restraint for the good of the common cause has, arguably, contributed to China’s problems with owning up to and treating its mental health problems. Because mental illness is disruptive, and therefore contrary to Confucian ideals, it has traditionally been something to be hugely ashamed of, if not dismissed entirely. Behaviour deemed non-Confucian (and it’s not always easy to control feelings or actions if you’ve got a mental illness…) creates a barrier between people with mental illnesses and people without. So there’s long been a huge stigma, compounded by the idea that the pressures of Chinese society are responsible for some of the country’s mental health problems.
There is a serious dearth of psychiatrists in China, and little education (this article, for example, while generally positive, perpetuates the idea that people with severe psychiatric disorders are likely to be violent towards others).
This lack of knowledge is understandable to an extent, because during the Cultural Revolution psychiatry was actually made illegal; Maoist thought dictated that mental health problems were simply a lack of appreciation of the class struggle. People with mental illnesses were denounced as ‘counterrevolutionary’, and incarcerated in labour camps. So the mental health sector has had a lot of catching up to do.
Traditional family culture means people who would be treated with medication or in hospital in the UK are kept at home, ‘looked after’ by relatives whose knowledge of mental illness is shaky at best; this seems a step back to the 19th Century, when families kept their mentally ill relatives in dark rooms at home, neglected and abused. This isn’t entirely dissimilar to how the UK treated some of its mentally ill citizens, actually, but there were no others options in China, except prison. Until American medical missionary John Glasgow Kerr established China’s first psychiatric hospital in 1898 there was no dedicated psychiatric care in the country at all.
The invisibility of mental illness in Chinese society led some Christian missionaries to assume mental illness was less of a problem than in their own countries, but Kerr disagreed. Initially his proposal for a hospital in Canton received little support from either his fellow missionaries or local people in Canton, but his plan was agreed by the Medical Missionary Association on the basis that though China didn’t necessarily want a hospital, it needed one. Kerr bought land for the hospital with his own money, and built a 24-room facility – the Kerr Refuge for the Insane.
He began admitting patients in 1898, facing up to the grim realities of Chinese mental health ‘care’ as families starting bringing people to him in chains; his first patient had been chained in such a way that he could no longer walk. Kerr’s treatment was founded on the understanding that his patients were ill, and needed an environment where they were not blamed for their actions but given the best possible chance of recovery: freedom, relaxation, employment if possible, kindness and, slightly more left-field, warm baths.
The hospital flourished as local families, policemen and government officials referred patients to Kerr, paying him an annual sum to look after them. Kerr died in 1901, but his Refuge, which grew to accommodate 500 people, survived until 1937. The hospital paved the way for further psychiatric care in China but the reluctance Kerr encountered at first suggests that, had it been left to people growing up with Chinese cultural norms, such an institution might never have existed.