Mental health in China was not something you talked about in polite company until after the Sichuan earthquake. The collective outpouring of grief at this time raised the need for a professional approach to countering bipolar disorders, depression and suicide. Today most people I know living in China admit to ‘losing it’ now and again; long working hours including weekends, leaving the support network of friends, family and familiar surroundings, cultural misunderstandings and the rapid pace of change makes many people fairly fraught in Beijing.
Recently one of my friend’s wanted counseling. I heard that Clinical Psychologist Stephen-Claude Hyatt was running an ‘anger-management’ seminar for 30RMB (3 GBP). Colleagues who are his private clients say that he has ‘transformed their lives’. Cheap and curious, I recommended that my friend and I both attend his class. I was pretty nervous about what to expect because in England most people don’t ‘do therapy’. However, when I got there I found the room packed with about 150 people including senior representatives of embassies, companies and NGO’s. Wow I thought – Beijing is an angry place.
I was still a bit cynical about the subject matter until I listened to what Stephen-Claude had to say. He asked us to raise our hands if we were ‘angry’ people. As an English person I had always been taught to control my anger so I really did not think that I had an issue. I mentioned this to Stephen-Claude who said that “What do they say about the kids who shoot up the class in the US?” – “but he was so quiet” etc. It was then that I began to realize that everyone gets angry but that they just suppress or exhibit it in different ways. The interactive therapy session became increasingly fascinating because there were people from every country in attendance. Chinese people and those working in the diplomatic community are brilliant at ‘keeping face’; I wondered if all these ‘suppressants’ were about to explode and shoot up the class? We broke into small groups to debate the issue.
The second part of the class was about ‘trigger points’ e.g. to help us recognize what makes us angry, to process our feelings constructively and to resolve the issue at the root cause in the right environment. Attendees spoke about the time they had been ‘angriest’. Many issues were relationship based but it was salutary for me to observe, as maybe the only British person in the room, that many had been most provoked when passing through immigration in Heathrow. After the class we all decamped to an Italian restaurant and discussed the seminar over a cappuccino. All agreed that mental health was a big issue for the expatriate community. We admitted that Beijing is a place where it is easy to get angry because as foreigners we do not understand what is happening much of the time. We all resolved that it was 30RMB well spent.
Interview: Dr Stephen-Claude Hyatt, SOS International (Beijing/Tianjin)
What is your Job?
Full time Clinical Psychologist at SOS International. Most of my work is one to one patient/doctor relationship clinics. Companies and Embassies take cover with SOS and then their employees make bookings. Individuals can also purchase membership from SOS and see me on a personal basis. The majority of my time is spent at the clinic but we also undertake group training on mental health seminars within companies, international schools and embassies.
What pro-bono work does SOS undertake?
I think pro-bono work is important and I am keen to provide mental health support to those who cannot afford to pay for SOS membership. Personally I used to work for the Agape Centre before I started working full-time. I also conduct three hour classes on “Anger Management” and other psychological issues without seeking payment. These classes often attract up to 250 people. I also run internal seminars at Embassies and companies where staff attend for free. This type of workshop however is usually paid for by the organization, or it is part of the membership package they have with SOS. The types of topics covered include:
- How to Adjust to a new culture
- Recognizing developmental and learning disorders in children
- Drugs and teens – How can you tell?
- Children and Divorce
- Raising 3rd Culture Children
- Stress Management
- 21st Century parenting
Were you involved in Pro-bono work after the earthquake in Sichuan?
Following the earthquake, the Chinese Government was aware that they had the army to reach the victims and the paramedics to treat their wounds. They did however recognize that they lacked the mental health expertise to help the victims recover from the psychological upset.
The Chinese Government were very quick to invite mental health experts already in China to focus their efforts on recovery in Sichuan. NGO, Care for Children, invited me to be apart of their response team to the disaster, and the Jamaican Embassy undertook a fundraising event and paid for me to go down to Sichuan. My involvement in the project was important for me, as I wanted to go and help to give back to my home which is now China.
In Sichuan my work was mainly to ‘train the trainers’ e.g. for example to lecture the medical students in trauma therapy and how to respond, and I also trained other volunteers as well as staff at the Orphanages that Care for Children overseas. Most of this training work took place in Sichuan but some of the training also took place in Beijing under the directive of Red Cross. For example 3-400 individuals from Beijing volunteered to go down to work in earthquake relief and I trained them prior to departure at the university. Some of my mental health work was also undertaken with the foster parents of children who were orphaned by the quake. My role was to teach the parents how to promote mental recovery.
How were your prepared to do this stressful work?
No amount of ‘training’ can prepare you for working in the field of trauma unless you have actually had to deal with the situation for real. I gained this experience shortly after I g aduated from university. I was working at a high school for boys in Jamaica. 53 boys went on a biology trip to study marine plant life. Two boys got into trouble and started to drown. A number of other boys went to assist them, and at the end of the day, four boys ended up dead. There were 49 boys who witnessed the event at close quarters, and all 49 boys were traumatized. It was the first therapeutic recovery issue that I had to manage single-handedly.
Following this tragedy I was invited by the Jamaican Ministry of Education to become part of a Trauma Response Team. This new role meant that I began to work in schools across Jamaica as part of a specialized unit responding to trauma arising from natural disaster, road traffic accidents and general types of violence.
What are the most common mental health disorders you treat in Beijing?
Most of my patients in Beijing are expatriates or returnee Chinese (Chinese who have lived abroad and then come back to China) but increasingly I am beginning to see some local Chinese patients. For returnees and expatriates the most common concern is “Adjustment Disorder” resulting in depression and anxiety. Adjusting to life in China is very difficult especially for returnees because it may literally be a different place to the one they left twenty years ago because of the rapid pace of development. Adjusting to life in China may cause past psychological challenges to surface resulting in panic.
The second most common issue diagnosed in Beijing is mood disorders, including depression and bipolar disorder . Finally I also undertake a lot of work in the field of “marital enrichment”. These people I would call “clients”, not patients. They do not have a psychological disorder for the most part; rather, they simply want to improve their lives during a stressful period. This area is very important because a lot of marriages come under pressure during a period of transition between cultures and people need help to adapt to the reality of their new situation.
I know you run popular anger management seminars in Beijing. Are people in Beijing angrier than in other countries?
Most people try to mask their anger. Chinese people for example are not likely to show their anger to foreign people, but this does not mean they are more or less angrier than others. I think that Chinese spend a lot of time trying consciously to accommodate foreign people, which is good, but this may mean a denial of true emotions. Some people need to learn how to deal with suddenly being exposed to foreign people. They literally have not been used to seeing black and white people on the street, in some of the more rural townships .
Is there a best way to deal with anger?
Anger is an issue in Beijing, and any other city in the world . Internalizing the anger can be just as damaging as being explosive. People have to begin to go through three stages:
1) Recognize that emotions like anger are necessary
2) Be aware of what is causing the emotion
3) Find appropriate ways to deal with the emotion
In other words anger is just an emotion. It is an important part of being human, as it helps us to cope or adjust . You do not need to suppress it but to find an appropriate way of dealing with it and addressing the issues behind it. For example if I recognize that I am getting angry I, will acknowledge this anger and identify it for what it is. But if I realize I may lose control due to the anger, then I just stop talking. Then I recognize that there are primary and secondary reasons for my anger. Primary anger comes from the thoughts we have, or how we process the particular stimuli that is causing the anger, which will lead to a physiological response; for example, increased heart rate shouting, violence etc. Secondary anger is the underlying emotional causes of the anger, which are usually other emotions which feed the anger; for example, guilt, annoyance, sense of betrayal etc. The primary and secondary reasons for the anger both need to be addressed. The third stage of anger management is to find a suitable environment at the right time to address these issues. For example this is the time to address the issue of what ‘caused’ the outward manifestations of your mood swing; e.g. lack of love, need for sympathy, being teased, over-work or challenges of relocation. These we call the triggers.
Do Chinese people seek help with mental health needs?
Increasingly Chinese people are seeking help with issues related to mental health. The Sichuan earthquake removed a veil to reveal the reality of mental health. The Government recognized that they had the medical staff, the physiotherapists and the crisis management infrastructure to deal with the disaster but that the one thing they lacked was the mental health experts to promote recovery. Recognizing a need, the Chinese Government was extremely quick to respond and to seek assistance from the foreign community in China. As a result of the earthquake, mental health was recognized as a real issue and the Government has begun to sponsor counseling services across China.
On a personal level I have begun to see an increasing number of Chinese parents who are keen to make the best provision for their children’s development. I do a lot of counseling with schools and parents are beginning to recognize that there are issues with their children that counseling could address. Parents are increasingly open to having their child assessed. For example if you can diagnose that a child has Attention-deficit Hyperactivity Disorder (ADHD) or some other learning challenge, you can treat the causes and the child can go on to perform well academically. Individuals have to deal with a phenomenal pace of change in China over the last thirty years; the influx of foreigners, rapid urbanization and competitive business and education practices can all impact mental health. Beijing has become so urbanized and modernized over the last three years that it really is a different place to live in now, than before the Olympics.
How do you stop yourself getting depressed when listening to problems all day?
There are five ways in which I keep myself balanced:
1) Understand the parameters of my job
First you need to understand the difference between the two aspects of my work – counseling and psychotherapy. Much of my work is counseling; this involves listening to people’s problems and helping them to try and find a way to get through them. Psychotherapy is much deeper; more invasive. This is when you actually work to change the mental processes of the patient and the way they think, feel and act. My aim is to help the patient first to understand what happened then to change their mental processes to impact the way in which they think, feel and act. There are two stages to this work:
i) Understand what happened: e.g. why you shouted, cried, broke down, hit someone.
ii) Change your cognitions: teach people to change the way in which they process, accept and respond to the triggers that cause the actions in step 1.
2) Receive proper training
Before embarking on this career you have to undergo rigorous professional training. Most major health clinics or institutions would not accept someone with only a bachelor’s degree. You have to have a masters or doctorate which is specifically subject related. However, some people may not have a Masters of Doctorate, but they have specialized training at the diploma level, and this is also fine. Some people for example have specialized training in family based therapy. Psychology is a very broad based topic. Practitioners need to be taught how disorders can affect them and their personality.
3) Suitable personality
Ability to handle the pressures of this job also depends on your own personality. You have to make time to laugh and play. I remove myself from the working environment and do something totally unrelated; see friends, go to the gym in a good hotel or just relax at home with a book.
4) Undergo personal psychotherapy
You have to be able to avoid the risk of ‘transference’ and ‘counter-transference in your work. This risk would occur if I myself had issues with my parents or siblings and I started ‘transferring’ these concerns of mine to the patient and letting it affect my diagnosis of their issues. For this reason it is of vital importance that those who practice as psychotherapists have themselves gone through therapy, to address whatever issues or baggages they may have. Therefore, a part of our postgraduate training involves us becoming clients or patients, and working through our own issues, and you will not be licensed to pratice until you successfully come same.
5) Get Away
I make sure that I have the opportunity to get away for the odd day or weekend. It’s important to take a “Beijing break” to regain a balanced perspective.
What was the subject of your doctorate?
I recently completed a doctorate into the subject of “men’s help seeking behavior”. My basic conclusion is not that men are less likely to visit the doctor than women because of genetics but because they have engendered behavior; that is, society dictates to them how they should act as men.
I studied two groups of men. College aged men in Kingston, Jamaica and Beijing, China. The social pressures on men in Jamaica and Beijing are quite different. In Jamaica men would often not seek help with illness until it was too late to treat the condition because they were scared of being seen as a ‘sissy’ man. In other words a guy who went to the doctor was perceived as a ‘weak’ man or girly man.
In China the reasons for men delaying their visits to the doctors were different. I found that they had so many other pressures on their lives that their health became a secondary concern. Having a good future and especially a financially secure future is a more pressing issue. For example a Father will not pay money to visit the Doctor because he would rather save the money to pay for his child’s education.
I learned a great deal about the difference in men’s help seeking behavior. By undertaking this research I can think of new ways to help men change their lifestyle to live a physically and mentally healthy life as the two are closely connected.
What are your goals for 2010?
I feel very fortunate and want to find new ways to give back to society. As you empower individual people you empower a nation. You have to work with one person at a time. There are a few specific areas in which I would like to help people to help themselves in 2010:
1) Men’s therapeutic groups
I would like to set up some groups for men only to discuss their issues and to help each other. These therapeutic groups would help people to undertake social interaction to help themselves.
2) Drug Intervention programmes
I would like to set up some groups specifically to help foreign teens and adolescents with drugs related issues. There are no residential detoxification centers for foreign young people in Beijing. I would like to help this group with marijuana, ecstasy and cocaine addiction issues. In the longer term I would like to create residential facilities to help this age-group to cope with the issues surrounding addiction and experimentation.
The sign off on my email is ” After each tragedy find some time to PLAY, because our greatest glory lies not in never falling, but in rising every time we fall”. Everyone experiences failure. I want to ensure that people make it through the sense of failure we all feel from time to time. I do not think that any relationship can be deemed strong unless it has experienced a testing period and survived. I encourage people not to run away from their problems, but to stand up to them and celebrate the victory when they are overcome.
As seen in the Charitarian Issue 1 – January 2010
