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Issue Introduction: Psychoanalysis in China

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Psychoanalysis was first introduced in China in 1912, but was suppressed, along with almost everything Western, with the founding of the People's Republic in 1949. After Mao's death and the end of the Cultural Revolution – the most recent of many widespread traumas in China – China rapidly opened up to many Western ideas and technologies. Analysis arrived first in the early 1980s, followed by psychodynamic training in the late 1990s through programs offered by the German and Norwegian institutions, and through extended visits to Europe by Chinese mental health leaders. More recently the International Psychoanalytical Association, the Chinese-American Psychoanalytic Alliance, and other groups including the International Psychotherapy Institute, of which I am former director, have offered psychoanalytically oriented training more widely in China. At the same time, many psychoanalytic texts have been translated and published, including several of mine.

The encounter between psychoanalysis and analytic psychotherapy – actually psychotherapy of all persuasions – with China and the Chinese is a complex, interesting, and often puzzling matter. It has been fascinating to me, because of all the countries in which I have taught, this culture is the most difficult to understand. The isolation of China from the West for more than half of the 20th century, the enigmatic quality of China's cultural assumptions when viewed from our Western perspective, the often adversarial nature of Chinese-American political relationships – all have meant that we come to China almost as from another planet. We believe we have something to offer the Chinese and their nascent mental health system, and those Chinese colleagues who want to work with us believe also that we have something to offer. But there is much more than a language barrier to negotiate in the process of rapprochement with our Chinese colleagues and students. There is the gap of understanding of more than 2500 years between two great cultures that developed mostly in isolation from each other and along very different lines. This is embodied in different structures of our spoken and written languages, because some concepts and ways of thinking simply do not translate. There is also the difference of Western ideals of democracy and individual autonomy from Chinese values of orderly hierarchy and loyalty to group and family. The West's 18th Century Enlightenment has no Chinese equivalent. In the West, a social revolution has gone a long way to liberate women, whereas gender equality has only recently surfaced in China where boys had been favored and men were dominant – until the shortage of girls gave women more power in choice of husbands.

To teach in China is to learn about China, and to reassess our own unquestioned assumptions. We are only just beginning this lengthy process. If we do not do bring an open mind, we will be like an imperial power trying to impose a system of thought on a supposedly lesser group. Since the Chinese do not see themselves as inferior even if they do want to know what we bring, such an imposition simply will not work.

Therefore, to introduce this issue of IJAPS and to orient our study, I want to summarize some relevant aspects of Chinese history and culture. Perhaps the first thing to understand is a commonplace: China, with 1.3 billion people, has more than one-sixth of the world's population. It has 55 minority groups and a vast landmass of more than 3.7 million square miles, the third largest area of any country. So in many ways, we might think of it both as many countries with differing areas and populations, and as a single country with a unified authoritarian government. The Chinese middle class has a population of something like 250 million, already the largest middle class in the world. With increasing urbanization, China's middle class may number more than 600 million by 2025 (Wang, 2010).

China is not a religious country. Its shared set of assumptions are still basically Confucian despite the presence of other influences: Daoism, Buddhism, and even a small amount of Christianity. The basic tenet of Confucius (who lived in the 5th and 6th centuries BCE) is the “Five Great Relationships” that outline the hierarchical organization of a well functioning society and family. The relationships are those between ruler and subject, father and son, husband and wife, elder and younger brother, and friend and friend. Wives are subject to their husbands (Hammond, 2004; Schwartz 1985). The Communists added the principle that loyalty to the work group should be above loyalty to the family, but this idea is in tension with the old values. This set of principles is deeply embedded in both the conscious and unconscious psychic organization of every Chinese colleague and patient we have met, and of Chinese institutions. It has not changed through the various revolutions, wars and social changes, although perhaps some evolution has begun in the last 20 years. However, Confucianism runs alongside other currents of philosophical thought. Probably the most important one is Daoism, also developed in the 6th Century BCE by Laozi. Daoism is a polar opposite to Confucianism. Confucianism is positivist, while Daoism is skeptical, teaching that everything should be questioned, that there are no sure answers. Since action based on knowledge often makes things worse, the best way to live is by seeking harmony with the natural flow of events, the “Dao,” best exemplified as “doing nothing” while living in a small quiet village. So there is tension in the Chinese psyche between Confucian reverence for authority and Daoist continuing questioning of authority and accepted principles. Later, Buddhist influence from Northern India offered a philosophy of surmounting suffering by learning to renounce the attachments of this world. These great systems of thought are not distant philosophies, but remain as everyday constituents of the Chinese mind and social structure (Hammond, 2004; Schwartz 1985).

Chinese culture is more than 5000 years old. For most of history, China has arguably been the most advanced culture on earth. But the last 500 years have been harder for China while the West has become more advanced. In the last 170 years, China has been repeatedly traumatized, beginning with the decline of good government in the later Qing Dynasty as agriculture and government failed to keep up, the economy sagged and European powers introduced opium and the Opium Wars to force China to submit to European economic domination. This was followed by Sun Yatsen's revolution and a brief period of independence, the civil war between Chang Kai-Shek's Kuomintang and Mao's Communists, repeated invasions and severe maltreatment by the Japanese, and then the victory of the Communists in 1949 with the founding of the People's Republic of China. While these wars were almost continually traumatizing to China, with many deaths and cycles of hardship, what followed during Mao's rule was even more severe. Mao shook things up every few years to demonstrate and consolidate his power and to keep those closest to him from wresting power from him, imposing widespread social and economic decrees without any understanding of the consequences – which were invariably devastating. The Great Leap Forward and the starvation after Mao's imposition of radical but ineffective agricultural policies created the widespread destruction of the greatest famine in the history of the world in which between 30 and 40 million people died. These serial upheavals culminated in the Cultural Revolution between the mid-1960s and the mid-1970s. Mao unleashed this wave of destruction through the instrument of the youth brigades of Red Guards who, acting without authority except the words of Chairman Mao, introduced anarchy, destroyed existing social structure, and sent a whole generation of intellectuals, academics and other leaders from all levels to the countryside for ‘re-education’, which meant depriving professionals and academics of the opportunity to work, robbing children of their families, and depriving China of effective leadership.

With Mao's death, this ended. Under new and forward-thinking leadership beginning with Zhou Enlai and Deng Xiaoping, China rapidly opened up, at first to the technologies of the West, and then slowly to Western ways of thinking. Socially, perhaps the biggest change – again introduced without real understanding of the consequences – was the introduction in 1979 by Deng Xiaoping of the “one child policy” intended to solve the problem of out-of-control population growth. This law covers majority Han urban families, although there are exemptions for rural families and minorities. It has perhaps prevented the population from swelling another 300 million in the last 30 years. The one child policy meant the end of privileging sons, and especially the eldest son, and changed the nature of Chinese families absolutely. At first, many girls were abandoned or put up for adoption because couples wanted boys, but this resulted in a shortage of girls as the ratio of boys to girls changed from the usual 105 to 100, to 114 to 100. This severe shortage of girls has meant that girls came to be well-regarded, too, as evidenced by the way that young marriage-age women now have an advantage in being able to be choosy about men, often considering many pampered young men too narcissistic for their taste.

The resulting difficulties have been both psychological and practical. All parents’ future hopes focus on one child who can feel under enormous pressure to fulfil parental expectations. Our experience during teaching in meeting young mental health professionals and patients was that young people who could successfully stand pressure often become doctors or psychologists. Those who cannot have become patients, their histories similar, the outcome vastly different. In addition, because China effectively has no economic safety net or national retirement plan, the one child will be expected to care for aging grandparents and parents. So a child spoiled by four grandparents and two parents – the so-called “six-pocket child” who received treats from all six – now has the daunting prospect of supporting these parents and perhaps grandparents in their old age.

So in sum, we have a younger generation made up largely of only children, prized and pampered, pressured and ambitious. Their parents come from a multiply traumatized population that often alternated roles of perpetrating and receiving injury in the last round of the many Chinese traumas. They carry the mixed inheritance of intergenerational trauma, with parents who themselves often were unable to have the education these children can now enjoy. They also carry the enormous burden of fulfilling those parents’ unfulfilled dreams. We must add to this that these young people – from whom we draw many of our current Chinese students in analysis and psychotherapy – come from a generation on the move, in transition from the traditional Confucian ways of old China and of their parents that valued group and family foremost, towards a set of values of autonomy and ambition of the individual, values more familiar to Westerners. These are not easy things to juggle in personal or professional development!

The collection of papers and essays in this issue of IJAPS ranges broadly. I am grateful to the contributors from China, Europe and America who have given us many vertices from which to understand Chinese history and current development, as Western psychoanalysts and Chinese mental health colleagues encounter one another. We open with an account by Xu Yong and his senior colleagues of the Shanghai Mental Health Center, on the growth of training in psychoanalytic therapy there, and his application of analytic thinking to work with his patients. We follow this with two accounts of work with Chinese patients. The first, by Shi Qijia and myself, details the lessons of his encounter with a couple. The second from Zhong Jie, a senior psychologist and current candidate in psychoanalytic training, documents his struggle to incorporate analytic ideas into his psychotherapeutic practice, confronting the tension between the assumptions underlying analysis and those of Chinese mentality.

The next two pieces describe a research project headed by Tomas Plaenkers of the Sigmund Freud Institute in Frankfurt, Germany. Friedrich Markert from Frankfurt collaborated in this extraordinary qualitative research. The two papers by Plaenkers and Markert vividly document the trauma of the Cultural Revolution and its transmission from traumatized parents to their children. This widespread trauma has not been well understood in the West, but is an unconscious undercurrent of virtually every clinical encounter I have had in China. I do not think it is possible to understand Chinese patients without a constant awareness of this period of national and personal trauma. The clinical presentation of trauma is vividly illustrated in the next paper, an account of a couple Dr Jill Scharff and I saw daily for five days. The couple is a particularly important unit because it sits at the center of the crosshairs that bind history and the family. The penultimate article, by Sverre Varvin and Alf Gerlach, describes training programs developed in China over the last two decades, largely under their pioneering leadership.

The last piece is an unusual collection of four “Letters from China.” Two young Chinese colleagues document the impact of psychoanalysis on their early careers. Qi Wei, a current resident in psychiatry, and Gao Jun, a recent PhD graduate in psychology, have both served as translators for IPA congresses in China, and for Americans and Europeans teaching in Shanghai and Beijing. Two recent analytic graduates from the United States, Caroline Sehon, a child and adult psychiatrist, and Janine Wanlass, a child and adult psychologist, both traveled to China for the first time to attend the 2010 IPA Congress in Beijing, and to teach elsewhere. I think you will find these four personal stories interesting and inspiring.

It has been a privilege to work with our Chinese and international colleagues, and at times with Chinese patients. I am grateful to all the contributors to this issue of IJAPS who have generously helped to enhance our understanding. It is my hope that this collection of papers will contribute to the development of psychoanalysis in China, and to the growth of mutual understanding between our Chinese colleagues and ourselves.

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