Just as everything else is changing in China, so are attitudes to psychology and mental health. While mental illnesses in China continue to be taboo in much of society and social services for mental health patients are still scarce, the idea of psychotherapy is becoming more normal, especially in bigger cities. Still, it seems that Western-style psychology might take a while to catch on – as it is essentially the opposite of what is considered normal behaviour in Chinese society, a society that prizes the “normal”.

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The ‘Doctrine of the Mean’

Zhong yong, the ‘Doctrine of the Mean’ – the idea of not going against the natural order of things – is a Confucian classic. Harmony, in fact, lies at the heart of Confucianism, and is still relevant in Chinese society today: living life in a balanced way, according to one’s place in the world. As is the case in many Eastern cultures, China is a collectivistic culture; what matters is not the individual but the whole. This means harmony in the group is more important than one single individual – and in some cases, this means living in deep denial and repression for the sake of the group. The unpacking of one’s personal history and issues at the core of Western-style psychology stands in opposition to the Chinese ideas of face, the importance of the group, and zhong yong. Seen from this perspective, it seems unlikely that Western psychology could take root in China.

Differences between Western and Eastern approaches

Where Eastern cultures prioritize group harmony over individuality, the opposite is true in the West, where life is viewed through a more individualistic lens. Both Freudian and Jungian therapies emphasize the importance of airing out both subconscious and conscious thoughts. Cognitive Behavioural Therapy examines emotional and thinking habits and attempts to change one’s emotional state through changing our thought patterns. The broad tendency across all Western therapies is to encourage the expression of emotions and reactions, no matter how painful; great emphasis is placed on vulnerability and honesty. This often comes at the cost of close family relationships, as patients are encouraged to leave behind “toxic” relationships and put themselves first.

The breaking of family ties, while still extremely serious in the West, is almost unthinkable in China – indeed, expressing uncomfortable truths is a no-go in many areas of life. In this way, serious mental illnesses such as depression and bipolar disorder can go untreated for years, as many Chinese hesitate to openly express what they are going through. Psychologists Stephen F. Myler and Hui Qitong have noted that “[i]n China there is a high degree of anxiety about judgement, criticism and evaluation by the state and other people. This … makes it very hard to separate social norms from inner feelings. And it adds an extra layer of caution and suspicion when the client comes to see the counsellor.”

There is an extra layer to the issue of Western-style psychology in China. In a recent People’s Daily article, the author emphasized the need for localized or culturally appropriate therapy: “Chinese psychology should focus more on family ties and social relations, which, reflecting society, distinguish Chinese psychology from the Western system”. Both Chinese and Western psychologists working in China have become increasingly aware of this need, as culture is indeed of fundamental importance to the shaping of self.

One important factor in China is the longer period of time to gain the patient’s trust  – many patients have difficulty trusting that what is disclosed during therapy sessions will remain strictly confidential. Similarly, many will talk around their emotional turmoil rather than tackling it head-on, meaning extra patience and reassurance are required of the counsellor or therapist. These issues are of particular note with male patients, as can also often be the case in the West, as both countries are structured on a fairly patriarchal model where men are expected to “emote” less than women, if not not at all.

Another key cultural issue when dealing with Chinese patients is shame. As the bicultural Chinese-American psychotherapist Hui Qitong has stated, “Shame would be a very relevant issue to bear in mind when working with Chinese clients in psychotherapy. Characteristics like being incapable of holding down a job, establishing a family, or fulfilling the duty as a child, could be viewed as imperfect in regard to the standards of the Chinese culture and society in which one lives, and are common reason for the occurrence of shame. Family history of mental illnesses, of violence and trauma, especially childhood sexual trauma, is very sensitive information that could be shame-laden [for the individual and their family].” 

While these issues may present new challenges to therapists, there is evidence of growing interest and acceptance of Western-style psychology in China: training programs for psychologists are being implemented throughout the country, and many Chinese professionals collaborate with their Western counterparts to find new solutions. It seems that the main obstacle to the development of psychology in China is the stigma that still surrounds mental illness and the admittance of weakness, issues that may become less and less relevant as time goes by and Western-style psychology becomes more normal and accepted by the society at large.

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Keywords: Western-style psychology in China psychology in China mental illnesses in China