Abstract
This article focuses on the psychotherapy debate in China that was triggered by the country’s mental health legislation. Seeing the release of the draft Mental Health Law in 2011 as a “diagnostic event” (Moore in Am Ethnol 14(4):727–736, 1987), I examine the debate in order to unravel the underlying logic and ongoing dynamics of the psycho-boom that has become a conspicuous trend in urban China since the early 2000s. Drawing on my fieldwork in Beijing and Shanghai, I use the two keywords of the debate—“jianghu” (literally “rivers and lakes”), an indigenous term that evokes an untamed realm, and “profession,” a foreign concept whose translation requires re-translation—to organize my delineation of its contours. I describe how anticipation of state regulation prompted fears and discontents as well as critical reflections and actions that aimed to transform the field into a profession. The efforts to mark out a professional core against the backdrop of unruly jianghu further faced the challenge of an alternative vision that saw popularization as an equally noble cause. The Mental Health Law came into effect in 2013; ultimately, however, it did not introduce substantive regulation. Finally, I discuss the implications of this debate and the prospects of the psycho-boom.
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Notes
The Chinese expression “xinli re” is translated literally by Li Zhang (2014) as “psy fever.” I prefer “psycho-boom,” a term borrowed from Bach and Molter (1976) and Schülein (1978), for its association with encounter groups and the human potential movement that once flourished in the United States and, on a smaller scale, some other Western countries. Much of the work of these movements had taken place outside the institutionalized disciplines of psychiatry and psychology.
For the full text of the announcement, see http://www.chinesepsy.org/article.php?id=2027&fuid=71.
In addition to the “jianghu versus profession” debate discussed in this article, there is a “debate within the debate” that pertains to the competition between psychiatry and psychology over the jurisdiction of psychotherapy. I will deal with the latter in another article.
Most of my fieldwork was conducted in Beijing, but I also made regular trips to Shanghai. These two cities, along with Wuhan, are generally considered the heart of the psycho-boom and home to a convergence of renowned therapists.
Western-style psychotherapy has taken a tortuous path since its arrival in China during the Republican period. After the founding of the People’s Republic in 1949, it was repudiated for its Western origins and alleged antagonism to the official ideology. See Huang (2015) for a historical overview. For official accounts of Chinese psychiatry and psychology, see Li, Chang, and Tong (2006) and Qian et al. (2002).
My informants often used the abbreviated title “Ministry of Labor.” The ministry was merged with the Ministry of Personnel to form the Ministry of Human Resources and Social Security in 2008. But most of my informants clung to the old title until quite recently. In this article, I follow their customary usage except when describing recent developments.
See Huang (2014:194–195) for an exemplary advertisement.
The Sino-German Course was widely known as the cradle of Chinese psychotherapy. Almost all of the field’s current leaders graduated from its first class (1997–1999). See Simon, Haaß-Wiesegart, and Zhao (2011) for its key members’ collective memoir.
The ascent of these teachers contributed to a psychoanalytic dominance in the psycho-boom. However, in China the denomination tended to be used in a loose and imprecise way. For a realistic sketch that shows the excitement of this trend in its early stages, see Chang et al. (2005). See also Huang (2015:16–17) for a recent attempt to map the landscape of psychotherapy in China.
See Li Zhang (2014:290) for a similar finding.
Around 2010–2011, therapists in Beijing typically charged 300–500 yuan for a 50-min session (1 USD = 6.3–6.8 yuan at the time). During the same period, a session (30 min) in a public hospital cost 30 yuan according to the rate set by the Beijing Municipal Bureau of Health in 2006.
Notable examples include the incorporation by the Communist Party of “psychological harmony” (xinli hexie) into its ideology of “constructing a harmonious society” (goujian hexie shehui) (CCP Central Committee 2006). The state also invested profusely in building psychological services in schools, communities, the military, the police force, and prisons (See Yang 2015 for an ethnography of such services for the unemployed in an outlying district of Beijing). At the end of 2004, the state-run Chinese Central Television began broadcasting the psychotherapy show “Psychological Interviews” (xinli fangtan), which ushered in the blossoming of programs that featured therapists.
My translation largely follows that of the final version by Michael Phillips and his colleagues at the Shanghai Mental Health Center (Chen et al. 2012).
While using the United States as an example, I recognize that there are substantial variations among Western countries regarding the historical evolution of psychotherapy and counseling as well as the boundary between them.
It might derive from the term “xinli weishing zixun” (mental hygiene consultation), which was coined by the eminent psychologist Ting Tsan (1910–1968) in the 1940s.
I give my informants pseudonyms and alter their identifying features to protect their confidentiality.
Article 18 obviously allowed psychological counselors to practice psychological counseling though what it was and how it differed from psychotherapy were unclear. However, my informants were preoccupied with its prohibitive effects.
In Beijing, Shanghai, and many other cities, one could not register a company whose title contained “psychotherapy” or “psychological counseling.” The exact reason was unknown. Perhaps the local bureaus of commerce were not willing to sanction practices that they considered quasi-clinical in nature. Therapists thus set up companies bearing other titles to get around the obstacle.
Psychological hotlines, mostly affiliated with hospitals or social organizations, were popular during the 1990s. They were the only places where one could gain practical experience before private psychotherapy facilities sprouted up amid the psycho-boom.
All these authors find the significance of jianghu as a descriptive or analytic category through their informants’ allusions to the term.
The idiom refers to those who become monks later in life rather than in childhood or adolescence.
The term reappeared in recent times, but it has lost its previous association. Now it indicates working conditions that are as “free” as being self-employed or freelancing.
Dr. Yang was the co-organizer of the Sino-Norwegian Course (zhongnuo ban), whose influence rivaled that of the Sino-German Course. The program derived from her collaboration with the Norwegian analyst Dr. Sverre Varvin, formerly vice president of the International Psychoanalytical Association. The talk was later published as Yang (2011).
Deng Xiaoping, the architect of the “Reform and Opening” policy, used the same term to denote his reversal of the Maoist preference for political commitment over technical expertise. More emphasis was placed on merits and credentials as the reform was launched. However, there are crucial distinctions between his use and that of my informants. Deng aimed to change the principles concerning the selection and promotion of cadres—those who occupied functionary posts in the then all-encompassing danwei system. The reform he initiated gave rise to a technocracy that privileged the kinds of experts conducive to industrial development, for example, engineers (Andreas 2009; see also Kirby 2011). In contrast, my informants live in a world in which a labor market has existed for some years and is taken for granted. They are keen to pursue a career in one of the consulting professions which dominate the discussions on professionalization in capitalist, post-industrial societies.
These leading figures had studied the qualification standards, ethical codes, and relevant legal regulations in North America, Europe (especially Germany due to the influence of the Sino-German Course), Taiwan, and Hong Kong before drafting their own criteria. A psychologist—the entry-level rank—requires a doctoral degree from a registered program or a master’s degree plus 150 h of practice supervised by a registered supervisor. The code of ethics upholds the principles of informed consent, confidentiality, and the maintenance of professional boundaries.
The full text of the document can be found at www.cpsbeijing.org/cn/files/jswsf2.doc. It was written by the psychologists who controlled the administration of this inter-disciplinary organization. One of its aims was to confront psychiatrists. Psychologists, including professors and college counselors, were upset that the draft law did not accord them the same legitimacy granted to psychiatrists. Like psychological counselors, they would suffer from the confining of psychotherapy practice to medical facilities. The psychologists I knew were not frightened since they assumed that their institutions could offer sufficient protection. Nevertheless, the feelings of being denigrated by physicians were common. A ferocious battle between the sibling disciplines ensued. As mentioned earlier, I will discuss this “debate within a debate” in a separate article.
“Academy” (xueyuan) was another term that was contrasted with jianghu in the debate, as in the opposition between the “academy-based fraction” and the “jianghu-based fraction” (jianghu pai). It was often used interchangeably with “profession” as the advocates of professionalization came from academic psychiatry and psychology.
In the National Vocational Qualifications, a psychological counselor was classified as a kind of “business and service industry personnel” (shangye yu fuwu renyuan). This implies that it was a low-skilled job—a fact that contradicted the popular imagination and was seldom acknowledged.
Business associations composed of private counseling centers existed in some cities, but they relied on the sponsorship of officially-sanctioned associations and had meager influence.
A short clause on confidentiality was added to Article 18. In Article 46, the specification of degree requirements was deleted.
In China, psychiatrists are in effect medical personnel who perform the work of psychiatrists in the developed countries. It is not until 2014 that the state made standardized residency training the prerequisite for a specialist. The educational backgrounds of psychiatrists in China also vary widely. An earlier, small-scale survey (He, Zhu, and Zhang 2002) revealed that less than 40% of psychiatrists had a bachelor’s degree in medicine (5 years of study after high school). A recent, more extensive survey (Liu et al. 2013) found that the rate had increased to around 50% with an additional 6% having a postgraduate degree.
American-style popular psychology, which is virtually inseparable from self-help, also enjoys a prominent presence in China. For a useful review, see Hendricks (2016).
Such social heat and liveliness is a quality appreciated or even desired in a number of settings in Chinese societies. See Chau (2006) for an exposition of its local variant “red and fiery” (honghuo) or what he calls “red-hot sociality” in the context of popular religion.
Jinghong Zhang (2014) also argues that jianghu in the broad sense can denote an intellectual pursuit or a quest for truth and authenticity.
The jianghu brotherhood is formed among males as a local expression of masculinity (Osburg 2016). The relationships in the psycho-boom, a social space dominated by young and middle-aged women, have a different quality.
The forum’s title had two versions. The shorter one was “Private Practice in China: Getting by in an Academic or Jianghu Way.” In the longer one, the subtitle was replaced by “The Path of Professional Growth of the Academy or the Commercialized Model of Jianghu.”
Almost all the popular and scholarly discussions on the Mental Health Law had focused on involuntary admission. This bias was probably due to the “bei jingshenbing” (literally “being mentally-illed”) scandal that was associated with the political abuse of psychiatry (Wu 2016).
Not a single character was altered in Article 51 (originally Article 46). Two sentences were added to Article 23 (originally Article 18). One asked psychological counselors to improve their competence and comply with practice standards. The other mentioned the principle of confidentiality.
While previously almost all the psychiatrists and psychologists who pursue private practice would do it outside their “within-the-system” work, now some of them might quit their jobs to engage in full-time private practice.
The startup frenzy took shape as the state declared “mass entrepreneurship and innovation” (dazhong chuangye, wanzhong chuangxin) a national policy. Some therapists joined this trend, setting up companies that used digital technologies to serve patients, practitioners, and the public. These companies have instigated another thriving scene and become the new driving force of the psycho-boom.
The most well-known lawsuit involved a private facility in the Southwest City of Chongqing that offered gay conversion therapy composed of hypnosis and electric shock. The court ruled that the agency made false claims about the “treatment.” The fact that homosexuality was not a mental disorder was also mentioned. The case was widely covered by international news venues, mostly framed as a LGBT rights issue (for example, Davis 2014 and Powell 2014).
This guideline, published in January 2017, is the first policy directive that specifically addresses psychological services. The document is peppered with cheering words, and it does mention the plan to build up a cross-ministry and cross-disciplinary system of training, registration, and accreditation. It also proposes to grant a certain authority to professional organizations in order to facilitate their self-regulation. On that account, it is a step forward from the Mental Health Law.
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Acknowledgements
This study was supported by Desmond and Whitney Shum Fellowship, Harvard-Yenching Doctoral Fellowship, and Australian Centre on China in the World. I’m grateful to Arthur Kleinman, Zhang Jinghong, and Gong Yidong who read the draft and gave me helpful comments. The two anonymous reviewers provided criticisms and suggestions that were detailed and insightful. I have incorporated most of them into the final version. I must also thank Marie-Louise Karttunen for her masterful copyediting. My deepest gratitude goes to the therapists who share their life stories and experiences with me during this long research journey.
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Huang, HY. Untamed Jianghu or Emerging Profession: Diagnosing the Psycho-Boom amid China’s Mental Health Legislation. Cult Med Psychiatry 42, 371–400 (2018). https://doi.org/10.1007/s11013-017-9553-8
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DOI: https://doi.org/10.1007/s11013-017-9553-8