Mao, the Chinese Freud?

When the young Chinese woman heard a mysterious voice asking, "What's under your pillow?" she felt sure that the answer was a "biological radio apparatus" put there by a special agent who suspected her of crimes against the state. She grew agitated, her head ached, and she began to hear loud speeches emanating from an unseen source. Then she became a patient in the psychiatric section of the Third Teaching Hospital in Peking. Before long her headaches disappeared. She recognized that her idea of being spied upon was "ridiculous," realized that she had been hallucinating, and expressed confidence that the voices she heard would eventually go away.

The woman's aberrations and the progress she is making toward recovery typify both the kind of mental illness found in China and the apparent success of Chinese treatment methods. That is the conclusion of Physician Victor Sidel, chief of the department of social medicine at New York's Montefiore Hospital, and his wife Ruth, a psychiatric social worker, who toured hospitals in mainland China for a month last fall. Writing in a recent issue of Social Policy, the Sidels describe the Chinese approach as a blend of both old and new. "The watchword of the entire enterprise," they say, is Mao's exhortation, "Let us heal the wounded and rescue the dead." Its framework is "a powerful community mental health design" not unlike what some American experts advocate for the U.S.

To Arm the Mind. Much of this effort is directed toward treating schizophrenia, which is the diagnosis in more than half of all China's psychiatric cases; paranoid forms of the disorder are especially common.

Chinese psychiatrists treat the ailment in a spirit of optimism, emphasizing persuasion rather than force. Involuntary commitment, for example, is rare. Instead, family and friends convince patients that they need help and gently urge them to enter a hospital.

Once committed, the patient may be treated with chlorpromazine, a powerful tranquilizer that is widely used in U.S. mental institutions. Chinese psychiatrists also use acupuncture experimentally "for relief of excitement."

The focus of treatment, however, is psychological, not physical. That treatment is based neither on Pavlov nor on Freud, whose theories have had no influence in China since the People's Republic was established in 1949. Instead, both psychiatrists and their patients study the popular slogans and the philosophical essays of Mao "to arm the mind to fight disease." The idea is to use Mao's thought to separate fact from fantasy, and to concentrate on the present rather than the past, the intellectual rather than the emotional.

Both individual and collective techniques are used. In "heart-to-heart talks" with their psychiatrists, patients are encouraged to analyze their symptoms in the light of Mao-thought and to "struggle against their disease" as if it were an external enemy. Though self-reliance is encouraged, patients get warm support from everyone around them. From the moment they enter the hospital, they are paired off with other patients in a buddy system; partially recovered patients help the more disturbed new arrivals. In addition, there are frequent group sessions, led by psychiatrists, in which patients "investigate" their problems together.

The collective approach continues when the patient leaves the hospital. "The Chinese try to bring the resources of the entire community into play," the Sidels write. Family, neighbors and fellow workers are expected to take an interest in every discharged patient and help him make the transition from hospital to home. As a result, the country seems to have eliminated most of the social consequences of mental illness. There is little stigma attached to it, and the patient does not lose his place in society. For one thing, he escapes the unemployment problems that plague recovered mental patients in the West. He is paid even while he is ill, and either gets his old job back or is given a similar but less demanding one.

Though schizophrenics in the U.S. often spend most of their lives in institutions, those in China are hospitalized an average of only 70 days. Moreover, the Chinese report that only one out of five recovered schizophrenics needs to be rehospitalized.

The Sidels admit that they do not know what to make of this and concede that the impressive figures may be wrong. Perhaps the Chinese are more tolerant of unusual behavior than Westerners and are therefore slower to send patients to hospitals. On the other hand, the Chinese system may really work better than any in the West.

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