Psychiatry in China

Firstly I'd like to warn you that this is not going to be a well-researched blog post, in the slightest, but the stuff is out there if you'd like to look it up.  My friend and fellow Fogarty scholar in Beijing has written a compelling story about psychiatric needs in China which can be found on his blog here:  INSERT BLOG LINK

and in the past few months the New York Times has written a story about rising psychiatric problems that go unheeded in China as well: LINK iF POSSIBLE

I have read both of those articles and also have just heard that China is not a good place to be mentally ill.  Stories that stick out in my mind include a schizophrenic that was denied treatment by authorities multiple times, was being kept by his family despite their continued protests that they could not care for him, and ended up killing several people due to voices and hallucinations. (please note the details of this story could be mixed up, I am just telling what I remember).  I have also heard that if mentally ill people DO end up getting residential treatment, its more like prison with very little treatment or progress towards re-joining society involved.

Two things have made me think about this issue a little more.  Yesterday on my way to the train station, in a part of town I had never been in, I passed the "Beijing City Rehabilitation and Research Center".  The title of that institution, at least in English, is so successfully ambiguous that its impossible to tell what they actually do -- but the word Rehabilitation made me think of psychiatric disorders, after which the word 'Research' kind of sent a chill down my spine.  Its definitely possible to do psychiatric research in a safe and responsible way, but so far what I've seen in China of IRB committees and the 'hurdles' of human subjects research makes it seem much easier to do that research than in the states, with much less oversight.  That combined with the lack of adequate consideration for the mentally ill makes me shudder at the word research.  Of course, I could be completely wrong about that building, and the huge sprawling expanse of white chinese tile and gated entrances revealed nothing about its identity.

The other event happened to me several weeks ago, when I was riding the metro.  I was standing in the end car, near the drivers, and suddenly I smelled something horrible and felt someone brush past me.  At first I thought it was a train worker, since he was dressed in worker's clothing, but then I noticed that his hair was completely in disarray, unlike any other Chinese person I've ever seen) and his neck was incredibly dirty.  And then I noticed the visible shrinking of the people near him, who seemed to be commenting on his smell as they moved away.  He stood at the window of the conductor's compartment, muttering to himself, and then he started banging on the window with rhythmic precision, but no aggression, even when his banging went unanswered.  Then he turned around and sat down in the seat across from me, rocking and twitching, when it became obvious that he had some sort of mental retardation based on his facial features.  He might have been born the way he was or he might have had some sort of mental illness on top of that, it was impossible to tell in that brief encounter.

Deciding what to do in this situation is difficult - do you give him money?  He wasn't asking for it but clearly needed it, but who knows if he'd know what to do with it.  Many people just moved away down the metro car, something which maybe he noticed and maybe he didn't, but part of me feels is a horrible repudiation of his status as fellow human being which he probably notices at least in part.  However, he did smell really bad and he had already displayed his strength by banging on the train door - who knows if he'd suddenly decide to hit someone?  I eventually moved down the train too, ashamedly, but I didn't want to be alone in the compartment with him, just in case, especially in a foreign country where I don't really speak the language to explain an incident.  As I was standing guiltily at the next doorway, waiting to get off, I saw an act of compassion that made me feel simultaneously worse about myself but better about our collective treatment of this man - a lady offered him her box of rice and meat.  While not the perfect answer to the situation (how could there be?), this was perhaps the best thing that could have happened in that train car, at once affirming his existence and providing him with a basic need.  I know there are people like this all over the world, and our treatment of them is far from perfect in the US, but somehow the image of this man has stayed with me, as a symbol of a failure of many people to care for those on the fringe all over the world.