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Tuesday 25th October 2016

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21st July 2006

"Ever more people today have the means to live, but no meaning to live for."—Viktor Frankl

WASHINGTON—Healthcare professionals and policymakers worldwide could learn a lot from Jill Ku.

A veteran radio broadcaster, Ku listens for hours every week to hotline callers from China. The calls are recorded at Radio Free Asia’s headquarters in Washington, where I work, and broadcast to tens of millions of listeners inside China.

Callers vent frustrations, ask about life outside China, complain about government bureaucrats, and lament years lost to political chaos and war. Many aim simply to find meaning in lives shifted on their axis by China’s metamorphic lurch into a modern, market-driven economy.

"I have only one wish before I die," one man, a retired cadre with a terminal case of cancer, says. "I need to pour out the words piled up in my mind for the last 50 years."

"I heard your report on China’s high suicide rates," a worker from the booming southern province of Guangdong says. "I know it’s the truth, because I myself have tried committing suicide. I feel frustrated over the futility of life—there’s no hope as long as we live in our current system. Many of my friends feel the same way."

Proliferating hotlines

Broadcasts such as Ku’s have proliferated in China since the early 1990s—roughly in parallel with the country's economic boom. Aware of the vast despair among China’s have-nots, official Chinese media have welcomed the hotline phenomenon.

"Listeners can call in to talk with the show’s hosts and can...bare their souls to the whole city," the Communist Party newspaper, The People’s Daily, wrote not long ago. "Many people have regained their once-shattered confidence by tuning in or being an active participant in the program."

Fewer Chinese are dying prematurely from disease and hunger these days; fewer are wholly consumed by the desperate quest to stay alive. But the stories they tell leave no doubt that China’s economic transformation—unprecedented in human history—has come at a great psychic cost indeed.

Vast social changes have increased demand for crisis counselling, drug and alcohol treatment, children’s services, and institutional care of psychiatric patients whose families are unable or unwilling to look after them, Michael R. Phillips, of Beijing Hui Long Guan Hospital has written.

At the same time, however, cuts in welfare services and the drive for profit have “forced providers to focus on expanding profit-making inpatient services rather than on developing the high-quality outpatient and community services that are most needed,? he writes.

"It is, therefore, likely that the costs of care will continue to spiral upwards, the huge regional disparities in services will increase, access to services will become more and more inequitable, and the burden of mental illness in the community will rise," Phillips concludes.

According to groundbreaking reports by the Disease Control Priorities Project , depression and suicide rank fourth and eighth among China’s top 10 causes of death.

China, further, has the highest female suicide rate on Earth. Substance abuse and other extreme responses to stress are also on the rise.

Treatment options for city-dwellers are few, and for peasants they are nonexistent.

Fully one-third of China’s 7.8 million people with schizophrenia and 95 percent of those with affective disorders are thought to have never received formal psychiatric diagnosis or treatment.

New focus on mental health

In a positive development, international health experts and nongovernmental agencies have begun paying far more attention to mental health in China and other developing countries than was previously the case.

The World Health Organization, World Bank, and DCPP have all taken up the issue, and all recommend more aggressive public health interventions—including the use of older, low-cost medications.

The road ahead is long. In a sobering June 2006 report for the Population Reference Bureau, Heidi Worley finds that "depression is now the fourth-leading cause of the global disease burden and the leading cause of disability worldwide" and can simply no longer be ignored.

Questions ahead

Back in Jill Ku’s studio, the anguish of many callers is palpable.

Much of it is specific to China, related to aggressive censorship, official corruption, and lax oversight of key industries.

Much also echoes the lament of any reasonably savvy human in the 21st century. Why don’t I have time for anything I enjoy any more? Why am I so lonely? Why isn’t my family close?

Like people everywhere, they harbour nostalgia for a simple time that is mostly imagined: The Way We Never Were.

And yet so many of their specific miseries seem the result of China’s headlong charge to modernize—to consume, to rush, and to pollute the way we in the industrialised West have done for decades, in our tireless quest for bigger-better-faster lives.

But what does any of that matter, we might ask, without a bit more genuine happiness along the way? Maybe a bit of Tai Chi or ancient Buddhist meditation will help us figure it all out.

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