I went to China this summer to try to "understand the Chinese urban experience, and see a bit of how psychiatry is practised", that was the idea anyway. It was more of a scoping exercise, and I didn't really think it through. The research part of my trip went reasonably well, and I was able to make contact with a consultant interested in the environmental aetiology of mental illness, and hopefully we should be collecting usable data soon. However, from the month I spent on the schizophrenia ward of a psychiatric department in China, going on ward-rounds, talking to patients, and talking to relatives, I have been left with a pervasive unsettled feeling that is complicated to explain.
What I remember are the stories, told by patients, and more often not by their families, of the individual struggles, both against everyday life, but also against things indescribable... society, I guess. stigma, definitely. institutions, perhaps.
The doctors were lovely, dedicated, yet there was a brisk matter of fact atmosphere. There was a recognition that weeks of intensive hospital stay followed by cold turkey wasn't the best management, however the responsibility for service change and redesign lay somewhere else, higher up in some bureaucratic chain.
The patients had travelled vast distances sometimes across provinces to seek help at the large metropolitan centre where I was at. In a country of only children, with very strong reciprocal familial obligations, the devastation was implicit and unsaid.
Those were the lucky ones. There is national health insurance in China, but only if you have a job, have good huco (area registration- insurance is scare in rural areas), or families are rich enough to afford the monthly payments themselves. I wonder how many patients have simply been abandoned by their families. Mental illness is very much a luxury.
There is so much more to say, but I need some time to let things sink in. Feeling unsettled is mixed in with frustration, powerlessness, and many many more questions. China has a very different way of doing things, and is it really my place to try and change things?
