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A visit to and tour of the An Ding Hospital in Beijing was the
first professional meeting of the members of the People to People
Ambassador Program Stress Management Delegation. Host was Professor
Weng Yong Zhen. Attendees were Tang Yi Lang, professor of drug
abuse; He Jia Li, deputy chief psychiatrist; Cao Da Hong, deputy
chief psychiatrist; Xuke Zin, director of neurology ward; Xu Ahi
Da, deputy chief psychiatrist; Xie Jin Kang, resident psychiatrist;
and Liu Bao Feng, resident psychiatrist.
Professor Weng gave an introduction to the history of the hospital.
The hospital has three separate units and is affiliated with a
medical school. The unit we visited has 970 beds and treats all
manner of mental illness. Patients come primarily from Beijing
and the surrounding area. Family members and work units bring
patients into the facility. Payment is through work, government,
or self-pay. Average stay is two months for schizophrenia patients.
There are 18 outside-outpatient units to follow up a patient after
discharge. Treatment is primarily with drugs. Education for the
general population about mental health is needed and recognized
as a goal by the doctors here. There is a stigma in China about
mental illness. Problem of homeless mentally ill population is
small but growing in China. Ninety-five percent of the mentally
ill are treated as outpatients and live at home with relatives.
In China alcoholism has less stigma than drug abuse. Drug abuse
is not treated as a medical problem. They use detoxification as
the treatment of choice for drug users. Primary drug used and
abused is heroin-millions of addicts. For severe depression and
violent behavior problems they use drugs and electric shock therapy.
Stress is an increasing problem as the Chinese society evolves
into the twenty-first century. China lacks adequately trained
numbers of mental health caregivers and professionals. They use
a team approach now: school counselors, clinical counselors, and
occupational counselors-not really able to provide preventative
care. Need trained psychologists and nurses and therapists. Currently
have family intervention programs and trying to establish a multi-disciplinary
approach. They have AA in China and are aware of and use 12-step
approach. Have "hotlines," and mental health is taught
in schools. Traditional medicine, herbs, and meditation are not
really used. When asked about rate of meditation of common people
in China response was, less than ten percent currently do. Stress
is a term used and recognized as problem in China's current society.
A SIGN ON BRICK WALL IN BEIJING
Institute of Mental Health of Beijing Medical
University
Host at the Institute was Professor Wang Yu Feng. Attendees were
Prof. Lu Qiu-Yun, Prof. Cui Yu-Hya, Dr. Tang Deng-Hua, Dr. Fhan
Jing, Dr. Fu Yi, Dr. Li Xue-Ni, and Dr. Sheng Li.
Most of the dialogue was translated. The meeting consisted of
interaction between delegates and hospital host staff plus a tour.
Interest centered on a discussion of post-traumatic stress disorder/syndrome.
A fire occurred here in 1997 and over 300 children were lost.
A case history was presented to the delegation. The young man
was cured by electric acupuncture and oxygen. His course of treatments
ran for 80 days, each 45 minutes in duration. Post-treatment he
was taught relaxation, and his remaining phobias were removed.
His entire course of treatment was as an outpatient. Our delegates
responded with several case histories and a discussion of EMDR
and biofeedback in relation to successful treatment of PTSD/S.
We toured the facility and some of its lab areas. They currently
use neurohormone/ neurotransmitter assays to evaluate their patients.
They also are doing immunoassays. They have a CAT scan unit for
alpha/theta brain wave training. They use primarily drug therapies,
Morita counseling, group therapy, and traditional approaches to
mental illness. The large deviation from this was the use of electric
acupuncture for outpatient neurosis patients.
Tian'anmen Square
The day began with the whole group setting off from the Beijing
Hotel to walk in sub-zero temperatures but under blue skies to
the nearby Tian'anmen Square. Although the sun shone, it felt
as if Siberia was not that far away. Our excellent guide, Frank,
pointed out the major buildings surrounding the square, the largest
city square in the world, he said. When we arrived we were approached
by several Chinese people keen to sell us postcards, gloves, and
even kites. After we had spent some time in the square, Frank
took the group safely across the road to the entrance to the Forbidden
City. A huge portrait of Chairman Mao is on the wall, and he looks
across the square towards his mausoleum.
The size of the square is impressive but it is nothing compared
to the size of the Forbidden City we were about to enter. Courtyard
after courtyard are reached through magnificent ornate gateways.
A series of temples fulfilled different functions at different
times in history. The buildings, statues, and other artifacts
give testimony to a period in human history when the Chinese were
culturally well ahead of the rest of mankind. With the rapid growth
of China today, history may soon repeat itself; who knows!
Beijing Medical University
After another magnificent lunch in which we enjoyed huge portions
and heaps of hilarity, we made our way by bus to the Beijing Medical
University. There we were shown into a seminar room and met the
director, Associate Professor Qiang Zheng-Fu. After welcoming
us all he received from Dr. Charles Slater, our group leader,
a gift in the form of an illustrated book about America, signed
by all present.
We were then shown a video, with a voice-over in English, describing
the history of the Beijing Medical University and the work currently
being done there. It was founded in 1912 and was the first of
its kind in China. It has a staff of 10,000 working in 13 different
colleges and departments, providing medical training at graduate
and postgraduate levels. Many of these graduates have become famous
at home and abroad. Its library occupies 10,000 square meters
and houses 506,000 books. The university has 26 research centers
supported by government grant, showing the high esteem in which
the work is held. It leads in student selection techniques and
the clinical doctor programs receive excellent ratings. The university
has gained an international reputation in molecular biology, bone
marrow treatment for leukemia, and dental facial surgery. Internationally
it collaborates with 20 other universities on research projects.
The tour closed with a visit to the pharmacology department where
Dr. Boris Hubo described the research project begun in 1975 to
scientifically study the medicines derived from plants and animals
used in Chinese traditional medicine, which is now of great interest
all over the world.
Beijing Hui Long Guan Hospital
Today, with an early start we drove to the Beijing Hui Long Guan
Hospital, which lies 15 miles from the center of Beijing. On arrival
we were greeted by Zou Yizhung, MD PhD, who is a professor of
psychiatry and medical director of the hospital. Zang Pei-Yan,
MD, the senior psychiatrist professor, was delayed at a meeting
and joined us later in the session. There were 18 other members
of the medical staff present.
The hospital is the biggest in mainland China, with 1500 beds.
Patients come from Beijing and all over China. There is a wide
range of illness treated, and the staff seemed especially proud
of the ward for serious neurosis, which opened five years ago.
Our initial thoughts of splitting into three groups-work-based
stress, family stress, and biofeedback-was changed as the meeting
progressed. The group chose to continue a dialogue as a large
group.
Initially Professor Zou Yizhung answered a number of questions
from the delegation. He explained that stress is seen as a new
issue in China, especially work-based stress. In the past there
was no unemployment and you did not fear losing your job. You
earned the same as your neighbor and most people found work okay.
Nowadays pressure has increased; job security has dramatically
decreased, and the difference between the rich and the poor is
increasing. Stress is an issue that he acknowledged needs to be
faced. On the issue of potential child abuse, it was emphasized
that with the one-child policy this would be very rare. Each child
is cherished and this may indeed cause problems in later life
with the risk of children being spoiled and lacking the experience
of growing up with other children.
The principles of Morita therapy were explained. This is a technique
that the delegation was aware is in use in China, but we are not
familiar with it. It is a technique which originated in Japan
and at its most simple can be described as aimed to "follow
the nature." It is especially used in the treatment of compulsive
disorders. No medication is used throughout and the patient is
not prevented from continuing their compulsive behavior.
Stage one: The patient stays in a small room for seven to ten
days. There are no distractions, books, or television, and they
are alone with their thoughts. No one speaks to them, but they
are encouraged to write a diary of their thoughts one-half to
one hour per day. The doctor reads this and after a few days will
be back with some comments.
Stage two: They engage now in light work for a further seven to
ten days, e.g., cleaning their clothes, their room. Some discussion
is permissible.
Stage three: They engage in heavy work for a period, often moving
large stones. This increases their confidence that they can do
things-they feel strong.
Stage four: They go back to their community and their workplace
with some support from the psychiatrist.
Later in the session Professor Zou Yizhung presented a case study
about a 17-year-old woman who had been admitted following problems
at college with excessive hand washing. She has Turner syndrome,
a genetic disorder with only one x chromosome. She is small in
stature and there has been no development of secondary sexual
signs. A lively discussion followed, with a wide range of thoughts/suggestions
from the delegation. The issue of suppressed anger did become
a focus and it was clear that the cultural issue of it not being
acceptable for Chinese people, especially women, to express anger,
was a problem. This young woman is facing life with the feeling
that life has dealt unfairly with her, and financial problems
mean that she has no hope her medical problems will change. She
has low self-esteem. Professor Zou Yizhung and his team seemed
appreciative of the insights and help offered by the delegation
on this case.
Following lunch and a visit to the factory, we drove to the Great
Wall where extreme cold was battled to allow us to list our names
among those who had walked on the "only man-made structure
which can be seen from the moon." We diced with death on
our return to the hotel, with a roller-coaster ride back on the
mountain roads. Our driver seemed to be playing a game of "chicken"
with oncoming trucks, honking his horn madly throughout. Weary
that evening, most people made it to the plush bar in the hotel.
We agreed the day was a good one, but I suspect exhaustion accompanied
many of us to bed that evening.
Military Medical University No. 4
Our host at Military Medical University No. 4 was Major-General
Theodore Gx You, MD, professor of neurology. Dr.You had invited
about 50 of his staff to attend the meeting. He said that not
much work on stress is done in the university. He requested the
delegation members to make the presentation.
Dr. Chuck Slater introduced the delegation members and made the
introductory remarks. He enumerated the main sources of stress,
such as family dysfunction and workplace. The stress causes or
contributes to diseases, such as hypertension. In workplace it
can cause injuries and accidents, sometimes even fatal accidents,
as in the case of air traffic controllers. It can lead to violence,
such as fights and "car rage" on the freeways. Reduction
of stress helps; even persons suffering from serious illness like
cancer live longer if their stress is reduced. He is concerned
that China may experience similar stress during the transition
from agricultural to industrial economy. He invited other delegation
members to present their work.
Meji Singh presented a model of preventing work stress by developing
a network of mental health consultation services in an organization
to help the consultees achieve their work objectives and resolve
their interpersonal stress by understanding the psychological
issues involved in the situation or the person presenting problem
behavior. He used the work with an Army hospital as an example.
Ms. Carol Grainger shared her experience working in a hospital
in Saudi Arabia. The Saudi society is extremely religious. They
try to deal with stress by reading Koran. They have not yet recognized
the serious sources of stress caused by transition from traditional
to Western medicine, differential pay for the 40 percent foreign
workers who are paid according to their country of origin, women
workers, newly-trained Saudi professionals with poor work habits.
Bob Bechtel studies military bases in extreme climates causing
illnesses, fights, and absences. The solution to the stress was
to underman the positions so that the personnel had to work long
hours.
Ken MacLeod shared his work in an industry to train the selected
workers from the industry itself to act as counselors, thus creating
a self-sufficiency in the organization to deal with stress.
Carol Schneider presented her work with Veterans Administration
hospital prisoners of war from World War II and Vietnam war veterans.
They suffered from PTSD, depression, and anxiety. Initially, they
were dealing with such traumatic disorder by progressive relaxation
and desensitization. Then added biofeedback and currently, the
treatment of choice is EMDR. It is a flooding technique described
by Francine Shapiro, PhD, in her two books Eye Movement-Desensitization
and Reprocessing and EMDR. Gary Green introduced biofeedback,
how it increases school performance and reduces test anxiety.
Guilin Western and Chinese Medicine Hospital
Dr. Huang Yuan Zong of the Chinese medicine department was host.
We were given a tour of the hospital. It is a joint Western medicine
and traditional medicine hospital. We saw the herbal pharmacy
where the pharmacists make up prescriptions of up to 20 herbs
which will be brewed on the stove for 30 minutes, three times
each day.
We saw the OB/Gyn ward, the gastrointestinal ward, the cancer
ward, and the surgical ward. Cancer patients are given Western
medicine and herbs to strengthen the immune system and help the
body tolerate chemotherapy better. On the CV stroke ward we were
told that herbs are sometimes used for stroke rehab.
Farmers come to this hospital for treatment of parasites; sandonia
is the herb which will cure parasites-kill them. Western medicines
are also used.
He showed us examples of Chinese herbs-leaves, roots. Ginseng
is a root which brings up Qi. Arhat is an herb used for coughs
and respiratory problems.
We were served a tea to stop coughing and remove phlegm, and since
four of us had coughs this was very much appreciated. This is
a unique hospital in Southern China because it specializes in
the combination Western-TCM treatment. Research on the combination
treatment for cancer takes place here. Visiting Canadian professors
are there to join this research.
A doctor gave a lecture on the yin and yang aspects of TCM. Qi
and blood are important aspects of TCM. Qi is throughout the body
everywhere; it is yang. Blood is yin; combines energy of food
and water. If Qi and blood are in harmony, then the person is
healthy. If Qi is stagnated, it cannot flow throughout the body.
Meridians are the lines along which the energy flows. If one stimulates
the right acupuncture point, the Qi can be flowing again, and
yin-yang balance will be restored. He then talked about herbs-yin,
yang, and neutral herbs.
There is a factory in this building which manufactures 23 herbs.
We were given a list of the 23 medicines.
He introduced us to a Qi Gung master who passed 220 volts through
his body and transduced it to 40 volts. He had us form a circuit
by holding hands and we felt tingling in our hands. The master
also touched our foreheads and we felt electricity. All the group
members were treated individually by the master for back, shoulder,
and other pains. Dr. Huang did the pulse for everyone and suggested
herbal medicines for everyone. We all left feeling healthier and
having enjoyed this meeting very much.
Shanghai Mental Health Center
Chinese participants at our meeting at the Shanghai Mental Health
Center were Dr. Ji Jianlin, associate professor, psychiatry, Shanghai
Second Medical University; Dr. Shen Xun Shi, professor, psychiatry;
Dr. Weng Shi-Min, psychiatrist; Dr. Fang Yi-ru, associate professor,
Shanghai Second Medical University; and Ning Ying Wu, psychology
students, department of medical psychology. Mental Health Delivery
System in Shanghai
The Shanghai Mental Health Center was established in 1958 and
consists of three parts: the main hospital (1000 beds, in- and
outpatient care), the branch hospital (800 beds, in- and outpatient
care), and psychological and clinical research for epidemiological
studies of mental health. There are 160,000 chronic schizophrenics
in the Shanghai area. Most hospitalizations are for psychotic
schizophrenics, and the length of stay is 90 days. During our
tour of the inpatient area we were in a hallway when suddenly
a patient beside us began yelling very loudly. A nurse immediately
came to quiet him. We were in his space and were being disruptive.
We left quickly and quietly. The cost of hospitalization is $300
a month. Patients who cannot afford to pay are discharged and
family and neighbors are taught to care for them. Chinese traditional
medication is used only for insomnia. Psychotropics like Haldol
and Thorazine are the drugs of choice. A monthly home health visit
may be arranged with a nurse or psychiatrist after discharge.
Psychological testing includes MMPI, Wechsler Intelligence Scale,
and self-rating scales for depression like Beck's Depression Scale.
Outpatient counseling services may last for five to eight 30-minute
sessions. The most common diagnoses are major depression, anxiety,
and obsessive-compulsive disorder (OCD). There is some use of
biofeedback. Deep breathing is recommended. Many Chinese use Qi
Gung but because of the prevalence of Qi Gung psychosis there
is reluctance to recommend more use of it. Most patients expect
medication because they want more than just the doctor talking.
Patients pay for medications and the cost ranges from $20 to $30
per month. The use of Prozac will increase the cost to $50 to
$100 per month. All provider/client communication is confidential
and not subject to court order as in the US.
Until recently people in Shanghai sought help only for physical
ailments. This is changing and now a person may say they are having
difficulty coping at home, on the job, etc. Counseling occurs
in a one-to-one approach unless the individual is hospitalized,
in which case group therapy sessions are available. Outpatient
care focuses on medication compliance and assessment of symptom
reduction. There is work beginning to occur in schools for prevention
of behavior problems. Attention deficit disorder (ADD) is very
common. All Chinese parents want their boys to grow up to be dragons
(powerful) and their girls to grow up to be phoenixes (beautiful);
but alas, most grow up to be adults. The one family/one child
policy, while it is accomplishing the desired reduction in population,
is also producing "spoiled" children who do not learn
to participate in the work of the family.
In 1990 a hotline counseling service was developed to assist people
with problems in interpersonal disputes, cancer, AIDS, and crisis
intervention (200 suicide prevention calls). A total of 35,000
calls has been received. The goal of the hotline is to provide
support and prevention. Volunteer staff are trained by experienced
psychologists and psychiatrists in listening skills, how to manage
difficult calls (e.g., crying, panic, acute anxiety), and in the
technical skills of problem-solving. Answers are not provided,
but rather the caller is supported and may be referred for further
counseling and support.
Occupational stress is becoming an issue. The management style
of the boss can be a significant factor in work-related stress.
Patients are counseled to (1) just do the job even if you don't
do it very well; (2) use relaxation techniques; and (3) seek support
from friends and family to help them think through ways of managing
their stress. In white-collar jobs there is often stress because
there is not enough time to do everything. In other areas there
is not enough work to do and people are being laid off. There
have been 800,000 layoffs, primarily in the textile industry.
There are projects to retrain workers who have lost their jobs.
Marital counseling is available in Shanghai. Most problems surround
the wife's displeasure at the husband's involvement and assistance
in household chores. Domestic violence is not common. If it does
occur it is in the mountain areas of north China or southwest
China.
It is taboo to talk about sexual issues. There is beginning to
be increased talk about sexual harassment in the workplace, particularly
with joint venture companies. There are no laws governing this
area, but some are beginning to request that they be established.
Homosexuality is frowned upon by the government. There have been
fewer than 50 cases in the past year. The patient is counseled
to (1) control homosexual behavior; (2) think of themselves as
being different than they are; (3) relate more to members of the
opposite sex; and (4) seek support from family members.
Suicides do occur. In the countryside people generally use pesticides
to poison themselves. In the city they use overdose of medications,
gas, or hanging. In the past ten to 20 years hanging was a common
method.
Biographical Information
CHARLES B. SLATER, PhD, DELEGATION
LEADER
