From time to time on the internet, we see people on social networking sites or forums hurling insults and personal attacks at people who are suffering or experiencing psychological problems, labelling them as "psychopaths" or "lunatics". On the other hand, when a good article or video about psychological problems appears, it is widely praised and disseminated. Especially in recent years, several psychology-related public websites have been doing well, and many of their articles are read by 100,000+.
This seems to be indicating a serious problem, as many Chinese people deny the existence of psychological problems or related symptoms, despite having them. Even those who attack people with mental illnesses online or in reality are likely to include some who have similar problems themselves.
A literature review published in the United States in 2016 caught our attention in relation to the psychological problems of Chinese international students, entitled 'Mental Health Concerns of Mainland Chinese International Students in the United States: A Literature Review' (by Kaifang Zheng and Cirecie West-Olatunji).
In their review, a 2013 Yale University statistical survey of mainland Chinese international students revealed that 45% of the Chinese students who participated in the survey reported symptoms of depression and 29% reported symptoms of anxiety (Han et al., 2013), but only 4% of the participants reported using mental health counselling services on campus.
In addition, a 2011 study by Cheung of 203 Chinese students, including 144 from mainland China, gave even higher figures: 47.5% of participants had symptoms of depression and 48% had symptoms of anxiety. And most of these individuals had not sought professional mental health services (Cheung, 2011).
In comparison to US college students overall, only 12.8% and 13% of US college students reported being diagnosed with depression and anxiety in 2009 (American College Health Association, 2010), and 11% of US students sought campus counseling services in 2014 (Gallagher, 2014).
In comparison, the proportion of Chinese students with depressive symptoms is more than three times the average of US college students diagnosed with depression, and less than one in ten of these symptomatic Chinese students have sought counselling, compared to 86% of symptomatic US students.
The review gives an answer to this question: Asian international students, including those from mainland China, show greater discomfort and shame about counselling than their American counterparts (Yoon & Jepsen, 2008).
Stigma comes from the stigmatization of psychological problems: the stigmatization of mental health problems can lead to feelings of shame and embarrassment, thus discouraging Chinese international students from seeking help from mental health services (Heppner, et al., 2006).
Why then is there a stigma attached to mental problems in China?
Helen Verdeli, a professor of psychology at Columbia University who has studied depression in different cultures and settings for many years, believes that one reason why Chinese students do not seek psychological help is that "there is a value in Chinese culture of being able to endure hardship, of being able to suffer. Chinese people don't hesitate to get glasses when they can't see well, but they don't seek help from professional services when they are in psychological distress."
The persistent 'stigma' of depression and other mental illnesses often prevents patients from receiving proper medical care. It is totally unacceptable that patients who are already suffering from depression should be stigmatised or blamed for their illness," said WHO Representative to China Schröder. We should actively and openly support friends and family members who suffer from depression and eliminate discrimination and 'stigma'."
The above figures show that the number of people suffering from depression in China accounts for nearly 4% of the country's total population and that China accounts for 1/6 of the total number of people suffering from depression worldwide, indicating that the proportion of people suffering from depression in China is still very high.
WHO also points out that in 2014, Russia and the United States had an average of 11 and 12 psychiatrists per 100,000 population respectively, while China had an average of only 1.7 psychiatrists per 100,000 population (a total of only 23,000 psychiatrists), a ratio only one-seventh of that of Russia and the United States.
This shows that there is an urgent need to expand the mental health workforce in China.
WHO also calls for the "stigmatisation" of depression, which often stems from ignorance of the illness and misperceptions of the extent of suffering. Reducing discrimination and 'stigma' therefore requires the efforts of the entire Chinese society.
However, because of cultural differences, there is still a "stigma" attached to mental health issues such as depression in Chinese society. When I was studying in the US, for example, depressed people would come forward and say, 'I'm not feeling well, I'm sad, I might be depressed, can you help me? But when I see depressed patients in my country, the first thing the person expresses is often physical symptoms, and often they are not yet able to face up to and accept that there may be problems with their mental health.""
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