SEARCH

SEARCH BY CITATION

Keywords:

  • Chinese culture;
  • defense;
  • psychoanalysis;
  • psychoanalytic psychotherapy;
  • China;
  • cultural conflict;
  • ONENESS (He-Yi)

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Despite differences between Chinese culture and Western culture (Sun, 2004), modern Chinese are gradually accepting psychoanalysis and psychodynamic therapy as options for dealing with psychological problems and inner conflicts (Gerlach, 1999). Through my own experience of being analyzed and vignettes from my clinical practice as a Chinese analytic psychotherapist, I argue that: (1) although there are conflicts at philosophic and cultural levels between Chinese culture and psychoanalysis, modern Chinese may have varying experiences in psychoanalytic and psychodynamic situations and (2) such cultural conflicts cannot be ignored or regarded only as defenses in the psychoanalytic situation in China. Copyright © 2011 John Wiley & Sons, Ltd.


INTRODUCTION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Chinese mainland society changed rapidly after 1976 at the end the Cultural Revolution. Since then, Chinese have gradually regained aspects of their traditional culture. The beliefs that stem from Confucianism, Daoism, and Buddhism are now much stronger in common Chinese families and individuals than before 1976. Psychoanalysis, as a general theory of personality and as a clinical theory came from the West, first introduced into China in the 1920s. But it was abandoned under the strong influence of the Chinese political system in the period from 1949 to 1976. It only returned to mainland China during the 1980s, at first mostly in academic settings. Beginning in the 1990s, psychodynamic clinical training programs were established in Shanghai, Beijing, and Wuhan by German and Norwegian psychoanalysts. Psychoanalysis and psychodynamic therapy have been gradually accepted by modern Chinese mental health professionals and patients as an option for dealing with psychic problems, and the relationship between Chinese traditional culture and psychoanalysis is now discussed both inside China and by international psychoanalytic societies (e.g. Gerlach, 1999; Ng, 1985; Rascovsky, 2006).

Rapid economic changes in mainland China during the past three decades have accompanied large-scale social changes in Chinese society. First, the process of urbanization produced cultural gaps between urban and rural areas. Chinese city-dwellers have a better chance of finding various kinds of mental health agencies and psychotherapy – including psychodynamic therapy – than the rural farmers. In the countryside, it is still much easier to find a witch than a qualified mental health service provider. Additionally, there is a generational shift in attitude: Young urban Chinese, born perhaps after 1980, are likely to have stronger motivation and a more open mind about visiting a psychotherapist or counselor for help than their elders. Professional mental health care is more accepted by young and educated Chinese.

Second, along with the gradual opening of the Chinese political system since 1980, mainland Chinese now have more freedom to find their traditional beliefs, especially those grounded in Confucianism, Daoism, and Buddhism. This rediscovery has helped to strengthen their cultural roots and historical identity. Paradoxically, at the same time, educated Chinese now come more easily into contact with the contrasting cultures from elsewhere in the world, and are exposed to religions, beliefs, and values from beyond China. This process has been supported by the new technologies of remote communication. So the process of rediscovering their own Chinese cultural roots now runs into the process of globalization, and it may be that the old cultural roots will once again fall behind.

The present paper addresses two questions: (1) Are there essential conflicts between psychoanalysis and Chinese culture, especially in mainland China? (2) What would these conflicts mean for the introduction and conduct of psychoanalytic and psychotherapeutic practice in mainland China?

CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Because psychoanalysis was born within Western culture, I want to look for some principal points of difference between China and the West in general before dealing with the special differences between psychoanalysis and Chinese culture. I think there are three levels of important difference.

Philosophic Level

The concept of ONENESS (He-Yi) is probably the most important Chinese philosophical idea for understanding the relationship between humans and nature. Traditionally, Chinese believe that there is no conflict between nature and human beings because men come from nature. To the Chinese mind, to go into nature and be a part of it is an ideal, especially for those who believe in Daoism. This belief exists in many ancient Chinese folk tales, and also deeply influences Chinese everyday life through religion, Chinese medicine, social interaction, playing at games such as Taiji, and even eating and drinking tea. The basic philosophical ideal of oneness supports the Chinese belief in keeping harmony (He-Xie) and peace (He-Ping), and is the most important principle in Chinese society and family, and also in the Chinese mind and heart. Necessarily, then, needs for freedom, autonomy or earning respect are secondary principles that are controlled by the overriding principle of oneness.

Social Level

Confucianism, traditionally the dominant religion in Chinese culture, helped establish a long, stable authoritarian political and cultural system that has often been despotic. For thousands of years, with the help of Confucianism, Chinese dynasties systematically established implicit principles and explicit laws which constrained Chinese people through respect for authorities and authority figures: Ancestors, the emperor, officials, parents, teachers, doctors, and so on. The most important part of respect for authority in daily life operates within the family. Even if modern Chinese parents do not determine who will be a wife or husband for their children nowadays, strong control by parents is still found in Chinese families, especially within the more traditional families of the countryside. This authoritarian system complements the political system that “naturally” grants leaders unquestioned power for controlling people and resources. This socially despotic system, present for millennia, has roots in ancient Chinese culture and is still an important part of modern Chinese culture. The Chinese despotic system, although not unique in human history, has been remarkably stable. It is still a major feature in modern Chinese culture (Sun, 2004, pp.9–11).

Psychological Level

Living in this authoritarian culture, common Chinese have to develop defenses and emotional attitudes in order to cope adaptively (Sun, 2004). For example, it is common experience to have deal with a leader's excessively dominating orders or comments – asking employees to work for the leaders’ private needs; ordering subordinates to be available by mobile phone 24 hours a day; giving work tasks on weekends without respect to the subordinate's private time. The most common defense is to fashion a kind of social split, showing an agreeable attitude in the surface while harboring disagreeable thoughts inside. Instead of refusing directly or fighting with the leader, the unwritten social rules unconsciously constrain Chinese, encouraging them to repress their true feelings in order to achieve surface harmony in social conversation. This way of dealing with authorities unconsciously promotes inhibition of inner psychic autonomy, and leads to the repressed buildup of latent aggressive feelings. Hence, this authoritarian system functions to instill a social system in which individual wishes are repressed, and each person learns to sacrifice personal expression in favor of the collective and the family. In my opinion, this kind of repression is not mainly about the feelings of guilt, but is organized around fantasies of fear of being abandoned or destroyed by the authorities or the family.

At the same time, parts of Daoist and Buddhist beliefs also support Chinese repression of aggression and feeling peaceful, at least on the surface. In contrast to Confucianism, Daoism and Buddhism offer philosophical and operational ways for Chinese to escape from inner conflict by splitting negative feelings when meeting powerful authoritarianism in a social context. Instead of choosing to fight, Daoism and Buddhism imbue Chinese culture with a good way of escaping by keeping private wishes or fantasies hidden, and by providing an acceptable route for dealing with their defensive feelings and repressing their aggression. For example, the idea of reincarnation is a typical Buddhist belief that helps Chinese bear suffering in current life in order to gain hope for happiness in the next. The fundamental Dao idea of oneness, the idea of integrating with nature, encourages people to escape from their psychological conflict during their lifetime through devotion to this integration.

WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

While it is difficult from a social-psychological point of view to understand exactly how these cultural characters influence the ordinary Chinese mind, from a psychoanalytic perspective it appears that individualization for a Chinese is unconsciously impeded or even arrested altogether by these cultural factors. This does not mean that Chinese people have no individual biography, individual conflicts or feelings. But the way they pay attention to their individuality or conflicts, develop them, and show them in the public, utilizes that special Chinese attitude of submission towards authorities and the group. Here psychoanalysis, both as a philosophy rooted in European focus on the individual, and also as a method of working with patients towards understanding their individual unconscious conflicts and promoting their process of individualization, comes into conflict with the traditional Chinese culture. As a Chinese psychoanalytic psychotherapist and analytic candidate, I want to share some of the conflicts that I have experienced whilst trying to perform psychoanalysis or psychodynamic psychotherapy in China. The fact that these have puzzled me so much is the motivation for writing this paper.

First, at a more philosophical level, the goal of psychoanalysis as helping an individual to be more independent and having more freedom for autonomous decisions, leads to the idea of keeping more individual boundaries between the self and the collective or the family. This conflicts with the basic Daoist idea of oneness and the harmony it promotes. Here, I want to report a brief case history that illustrates the personal conflicts I have experienced regarding this.

When Ms B, a 46-year-old Chinese woman, entered my office for the first time, she was cleanly dressed and appeared well educated. She seemed to be upset but was suppressing her feelings. I observed that when she talked about traumatic experience, she made slight smiles. She had been married for 20 years, and now had an 18-year old son. Her complaints related mainly to her difficulty with painful suffering in her life, for which she wanted help coping. After the first session, she began weekly psychodynamic psychotherapy, and finished ten sessions before terminating her treatment.

At three days of age, Ms B's parents sent her to another family because she was not a boy. From then on, she lived with her adopted parents and grandfather. Her adopted parents seldom took care of her in early childhood. Instead, the grandfather was the only one she felt to be emotionally close. She felt warmly cared for by him. When she was four-years-old, during the Cultural Revolution, her adoptive father was criticized, and the grandfather committed suicide. Ms B always felt guilty about her grandfather's death. She said: “I should not have gone out to play at that time! If I had been in the house, grandpa would not have committed suicide!” From then on, no one seemed take care of her for the duration of the Cultural Revolution. Her father had to go to work everyday and accepted the criticism. Her mother was frequently in a bad temper and beat her.

In school, Ms B studied hard and was always praised by her teachers. When she graduated from nursing school, she worked in a local hospital and became a professional nurse. She met her husband and found him to be sincere and reliable. They married six months after they met. However, her husband changed his job two years after they married, and from then on seldom came home to be with Ms B because of his work. Consequently, Ms B had to raise their son by herself. She told me that she always felt sorry for herself when she was alone.

During the following sessions Ms B reported that she tried her best to satisfy her mother and husband without complaining, even though her sadness and anger towards them were frequently so strong as to be unbearable. I got the impression that she had a strong tendency to repress her ambivalent feelings of love and hate towards those she loved. She said that she really wanted my suggestions, that she wanted me to give her some direction about her life. At first I considered this to be a defense against a deeper understanding of herself. After her son hurt himself when he had a conflict with Ms B's husband, Ms B said she wanted to quit therapy and to stay with her son in order to help him recover and pass his college entrance exams. I was surprised, and suggested to her that we schedule another session in order to discuss this.

In the last session, Ms B reported that she dreamed that a tiger came from the top of the mountain, tracking her and her husband. They ran together into a farmer's house. Then they were separated. She hid in a room and didn't dare to come out. I asked, “Do you have any idea who is the tiger in your dream?” She told me that I was probably the person inside the tiger. I suggested that she might fear that therapy would destroy her marriage. After we discussed this openly, she confessed that she had this fantasy. She told me that keeping her marriage stable was the most important thing in her life. She worried that the therapy might challenge her beliefs and change the stability of her life. That is why Ms B thought that she had ‘enough’ insight into herself after ten sessions, and that she had decided to quit therapy. After she left my office, the next patient said that Ms B had a remarkable smile when she passed him.

The case of Ms B gave me a lot to think about. Even though I believe she left me because of unbearable hatred towards her original mother, and that she unconsciously transferred these feelings to me, as a Chinese psychodynamic psychotherapist, I need to ask myself: “Is facilitating my patients’ individualization the best thing just because I believe that my Chinese patients can benefit from this kind of therapy?” Even if it seems so to me, will this make them feel more distant from their conception of Chinese paradise? Furthermore, as a Chinese, I have to ask myself: “Does the Chinese fundamental philosophical idea of oneness need to be discarded in my own mind if I accept psychoanalysis.” Or: “Can the idea of keeping harmony in relationships only be regarded as the repression of unbearable separation from significant objects?” Unfortunately I have no clear answer to my questions!

The philosophical and social conflict between Chinese culture and psychoanalysis can also be seen in my own experience in analysis. I was first trained in psychodynamic psychotherapy by Dr Tomas Plänkers in the Chinese-German Academy program from 2000–2004. After Dr Irmgard Dettbarn, a training psychoanalyst from Berlin, came to Beijing in 2007, I took the opportunity to undertake a training analysis with her beginning in 2008. Yes, this training analysis not only helped me to understand more about myself and integrate inner conflicts, but it also let me be thoughtful in regard to these cultural conflicts, and it let me think about how to work with Chinese patients with the respect to our culture. Self-experience on the couch helped me to face this conflict by containing my own negative feelings. The growing understanding of myself allowed me to see the conflict between my own wish to be more autonomous or individualized, and it let me explore the cultural influence of authorities in my own life. For myself, I choose to be more individualized in my life. But I continue to think about when and whether my choice should be the same as my Chinese patients’ choice. Here, I would like to present the problem that I encountered with another of my patients, Mr H.

Mr H, a polite 21-year-old undergraduate, talked easily about his problems from the beginning. Mr H told me first that he could not get along well with his father, and was always unhappy being with him, even though there were few important conflicts in his family. His mother, who had studied some courses in psychology, suggested that he see me to talk about his unhappiness. We agreed on meeting once weekly from then on. A year later, Mr H graduated from university and found a job in a large Chinese company. We had to change our meetings to an evening because he worked in the daytime. At this point, we also agreed that if he could not make the appointment, he must tell me at least 48 hours before our scheduled session.

One day Mr H left a message on my practice phone, telling me that he had to cancel our session the next day because his boss required him to work the next evening. When we met in following session, he expressed his guilt towards me and, at the same time, asked me whether we could change our agreement to a new policy that if he were unable to attend, he must tell me at least 24 hours before our session, not 48 hours as previously agreed, because he found that he could not control his work schedule. When I first heard his request, I had the fantasy that he was like his boss and giving me orders that I could not refuse. But after we openly discussed the difficulty, including an exploration of his transference, I had to face the reality that we could not change his boss and or the culture of his company. Then it was easier for me to agree that I would not charge him for canceling 24 hours in advance.

Two months later, I got another call from Mr H one morning. He told me that his boss had asked him to do a presentation that evening, and so he could not meet with me. In the next session, I asked Mr H's about his feelings regarding missing the session. He reported feeling that things were beyond his control and that he was completely constrained by his boss. At this moment, it seemed to me that I had choices with Mr H. My first choice was to discuss with him why he could not refuse his boss and come to visit me as planned. I could pursue a line of inquiry about whether there were any problems in our relationship? That means I would be focusing on his defenses, and trying to help him become more assertive and independent. A second choice would be to empathize with him and debrief his feeling of being controlled in the social context. That means I would be identifying with our authoritarian culture, and would not only regard his behavior as purely defensive. As a Chinese psychodynamic psychotherapist, I felt it appropriate to first choose the second, more empathic way with Mr H, but, later, I also pursued the first option by exploring his option to be more assertive. I think that Mr H has the right to choose his own way of adapting to our culture, and his own optimal life adjustment, his own route to what he might consider paradise, regardless of whether this paradise belongs more to Eastern or Western culture.

DISCUSSION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

Almost three decades ago, Ng (1985) discussed several areas that might produce difficulty for the practice of psychoanalysis in China: (1) the Chinese traditional concept of psychiatric illness focuses on unbalanced relationships or disharmony between person and nature; (2) the limited theoretical and empirical psychoanalytic research related to Chinese psychosexual development; (3)the commonly shared belief that “family dirt should not be aired outside the family” means that Chinese family members have a higher barrier than Westerners to opening themselves to psychotherapy with non-family members because of a special kind of cultural shame; (4) Chinese are used to authoritative or directive help within mental health rather than the non-directive ways of psychoanalysis. Although it seems that in the 21st century, cultural conflicts between psychoanalysis and Chinese culture are still intense, the application of psychoanalysis to Chinese patients has not been rejected in mainland China (Gerlach, 1999) and Taiwan (Rascovsky, 2006) in the past three decades. Instead, the seeds of psychoanalysis have gradually grown since the 1990s. As a Chinese, my own experience with psychoanalytic training and practice has begun to stimulate my thinking about how psychoanalysis best works in China despite the cultural conflicts. I believe we need more time to understand the conflicts between psychoanalysis and Chinese culture, which should neither be ignored nor regarded as defenses in the psychotherapeutic or psychoanalytic situation.

As a Chinese psychoanalyst, it is not easy to identify both with psychoanalysis and with Chinese culture. But, I feel lucky to have the opportunity to think carefully about how to apply psychoanalysis in China. Perhaps it is better for me not to be preoccupied by the differences between Western or Eastern perspectives, but to see things from inside the gap between them in order to develop deeper insight into each unique psychoanalytic situation with my patients. Of course, I think Chinese patients are each unique, not only because of the contrast with Western religion and philosophy, but also because of internal cultural diversity. Perhaps it is lucky both for psychoanalysis and for many Chinese that not all Chinese are quite so loyal to the basic philosophy of oneness, as more of them now choose pragmatism as their basic philosophy. Every Chinese person knows the famous Chinese saying: “No matter white or black cat, the one who can catch the mouse is good cat.”

ACKNOWLEDGMENTS

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES

This research was supported by the National Natural Science Foundation of China ( project number 30900401 ) and the Major Issues of Philosophy and Social Science Research Project founded by the Chinese Ministry of Education (grant no.: 05JZD00031). An earlier version of this paper was presented at the 1st IPA Asian Conference in Beijing, October 21–24 2010.

I would like to express my heartfelt gratitude to Dr Tomas Plänkers, who led me into the world of psychoanalysis and gave me much useful advice concerning this paper. I am also greatly indebted to Professor Mingyi Qian of the Psychology Department of Peking University, who has taught me and helped me greatly for the past 12 years.

REFERENCES

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. CONFLICTS BETWEEN PSYCHOANALYSIS AND CHINESE CULTURE
  5. WORKING WITH CHINESE PATIENTS: CULTURAL CONFLICTS AND MY DILEMMA
  6. DISCUSSION
  7. ACKNOWLEDGMENTS
  8. REFERENCES
  • Gerlach, A. (1999). Psychoanalysis in China – the current state of the reception of our discipline. International Psychoanalysis, 8(1), 4243.
  • Ng, M. L. (1985). Psychoanalysis for the Chinese: Applicable or not applicable? International Review of Psycho-Analysis, 12, 449460.
  • Rascovsky, A. (2006). Contemporary psychoanalysis in ethnic Chinese societies: New developments. International Journal of Psycho-Analysis, 87, 573575.
  • Sun, L. J. (2004). The deep structure of Chinese culture. Guangxi: Guangxi Normal University Publishing House, pp. 227285.