Hidden Away — page 2

Money Disorder
Born to peasants in china's south central province of Sichuan, Song L. had wanted to go to Shanghai for as long as he could remember. For him, China's biggest city was where dreams were made, where farmers morphed into millionaires. In truth, Shanghai is also where thousands of migrants lose their way in a pell-mell rush to riches. Fudan University professor Ji estimates that the incidence of mental illness among China's 100 million migrants might be twice as high as in the rest of Chinese society, due to the pressures of existing on the margins both economically and socially. But when Song headed to the big city in 2000 for construction work, he knew only of Shanghai's possibilities. At first, things went well for the then 19-year-old, but an altercation with a co-worker who accused him of shoddy workmanship cost him his job. "I couldn't eat, I couldn't sleep and I felt dizzy all the time," Song recalls. "When I closed my eyes and tried to sleep, I had nightmares where everything was spinning."

Song soon landed another job, but the dizziness didn't subside—a dangerous condition for a man who was supposed to make his living scrambling up the half-built skeletons of Shanghai's skyscrapers. He was quickly fired again. After 19 years in a tightly knit village, he was now alone in the city. "No one could help me," says Song. "All I had to keep me company were my thoughts, but my thoughts were already bad." Details of events after his second sacking are jumbled in Song's clouded mind: there was a desperate 16-hour, standing-room-only train ride up to Beijing, where he had heard of a job opening; a curt foreman who wouldn't take Song because he didn't look sturdy enough; and—the final blow—a robbery that stripped him of most of his savings. After that, Song wandered the streets for days—or was it months? He doesn't remember. Everywhere he went, the dizziness followed, even to the jail where Song was locked up for 30 days as a vagrant. "Sometimes I would see other people like me, alone, walking the streets, and I wondered if they had problems too, and wanted to make friends," he says. "But when I would go up to them, they would turn away."

One morning last spring, Song decided he wanted to die. He gathered his final pennies, bought some pesticide and swallowed it. When he woke up in a hospital, a nurse derided him for being cowardly and a drain on medical resources. "The nurse told me not to waste her time," says Song. "She said I was so stupid that I couldn't even kill myself correctly." Upon finding out that Song had no money, she forced him to check out of the hospital the next day, even though his throat still burned from the poison. No one came to pick him up, because no one knew he was there. Even today, Song does not know what to call the dizziness and bad thoughts that continue to haunt him. He has never heard of the word depression. All he knows is that he is a failure. "I cannot go home now," he says. "I would be an embarrassment to my parents and they would lose face in our village."

	Mental illnesses account for five of the 10 leading causes of disability in Asia

The vast majority of China's burgeoning mental-health patients suffer in silence. The nation's psychiatrists have seen a remarkable upswing in the kinds of mental disease linked to fast-paced societies, particularly depression and anxiety disorders. But, says Professor Ji, "Outside the big cities, most doctors have never heard of things like anxiety disorders or obsessive-compulsive disorders or even depression. So most people are never treated." According to the Global Burden of Disease survey, mental health constitutes only 2% of China's health budget, but psychiatric disorders account for 20% of the nation's health burden. The situation is particularly acute for serious mental diseases. The same study asserts that although 60% of schizophrenics are treated in hospitals in the U.S., 90% of China's schizophrenics remain hidden at home without access to medication or therapy. "Many people in China just want to hide the mentally ill person at home," says Du of Huashan Hospital. "They don't want outside people to see their crazy relative and think they are crazy too." Not that most could afford the cost of treating such major illnesses. Only about 15% of mainlanders currently have health insurance, and in most places expensive antipsychotic medicine is not subsidized.

The continuing stigma of mental disease in China—and, indeed, in much of Asia—is so pervasive that even the caregivers fall prey to misconceptions. Nurses who worked with Canadian psychiatrist Michael Phillips in the town of Shashi in central China confided to him that they didn't tell their families the true nature of their work, because it was widely believed that mental illness is contagious. Such ignorance isn't surprising given that many nursing schools in China don't even offer courses on psychiatry—it only became a formal discipline in mainland universities in 1995. There are only 2,000 fully qualified psychiatrists for a country of 1.3 billion people, compared with 10.5 psychiatrists per 100,000 in the U.S. The majority of China's psychiatrists never chose their field: they were assigned to it by their medical school.

Nevertheless, there are hopeful signs that China is trying to combat its growing mental-health scourge. The country recently passed a law that tries to address the basic rights of victims through education and increased funding for mental-health care. But as is often the case in China, the law has been implemented fully only in the big cities. In Shanghai, mental hospitals are clean, safe and orderly. But several Western-trained Chinese psychiatrists in the metropolis wonder whether overmedication is the cause of the eerily quiet halls. Indeed, the country still combats mental health by focusing on control—a fundamental difference with the West, where psychiatric disorders are recognized as a medical condition that often can be treated with therapy as well as drugs. By contrast, in East Asia social deviance is an issue typically addressed by the law. In China, it is the Ministry of Public Security that oversees many of the country's mental-health policies, not the Ministry of Health. Until recently the security bureau was also in charge of the nation's suicide statistics—and did not make them public. "We are still not facing up to our mental-health problem fully," says Du. "Unless all of us face up to the crisis, things will not change enough. We will be rich, but we will be sick."

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