Coping strategy

Dr Peter Calafiura first came to China in 1997 after finishing medical school. He enjoyed it so much he returned ten times on trips before ultimately settling in Shanghai and taking up work at ParkwayHealth, a private hospital. Dr Calafiura spoke to CHINA ECONOMIC REVIEW about developments in the perception and treatment of mental health problems.

Q: Are you seeing an uptick in patients seeking psychological or psychiatric treatment recently?

A: Yes, I believe so. Everyone is concerned about the economy. People are exposed to all the gloomy news in the newspapers or online every day; they tell me that it is incessant and never lets up. Many are also concerned because they are hearing about all the downsizing going on by the companies back home. There’s a lot of uncertainty about the future, and that particularly affects people with depression and people with anxiety disorders. Also the range of people affected is broad. In the past I would only see the workers and the middle management  – that is, typically folks who were out of the loop as to what was really happening. Now I’m seeing CEOs. Even they don’t understand what is going on in the economy.

Q: Is there a seasonal affective element you see here?

A: Yes, definitely. The sun is presently setting before 5pm. When people are getting off of work, it is already dark. The winters here are cold and damp and it has an adverse affect. The local population historically has coped with that by getting up early and going out into the morning sun. They also eat warm food like beef or lamb soup and try to add fire to their body in a traditional Chinese medicine fashion.

Q: What are the most common complaints? Loneliness? Depression?

A: The most common complaint I see in my practice is depression. There are several reasons for that. For one thing, it is a fairly common condition. On the other hand, there is a significant amount of work-related stress here. Many people have relocated to this city for work and they have temporarily lost the usual support systems they have back home. Too often the coping mechanism of choice becomes getting together with similar folks and drinking excessive amounts of alcohol, which is a depressant. For others who choose not to socialize in bars, this can be a very alienating city, especially if they haven’t established a network of friends that includes some locals.

Q: What sorts of backgrounds do your patients come from?

A:  They come from all over the world. Off the top of my head I can say that I recently saw people from China, Hong Kong, Australia, South Africa, the US and Denmark. The locals I have seen were born here, left for a number of years, and then returned. Typically, in the expat community, the father comes here for work and his wife joins him. They may also bring children with them. All or none of them may not actually want to live here. I have treated some as young as three and some as old as 65 and they all seem to come from different socioeconomic backgrounds.

Q: Are most of your clients foreign?

A: I don’t think of my patients as foreign. Personally the only race I recognize is the human race. That being said, the local folks refer to expats as foreigners. When they say that, everyone knows what they mean; someone who is here temporarily, who doesn’t speak fluent Chinese, and who may be highly educated but is ultimately rather ignorant of Chinese culture. But some expats have actually made Shanghai their permanent home. They were born in the West but clearly they are not foreigners any more. They are a form of new Shanghainese.

Q: Do expats, as a rule, have better coping mechanisms? Does this population require a particular approach compared to people residing in their home country?

A: Expats, by their very nature, are away from the social support system they had back home. This includes family and friends but may also include familiar places and favorite activities. Because things tend to be done a bit differently in China, this may be particularly stressful. Too often the brakes that were applied at home are loosened up here. This may led to excessive drinking, substance abuse and an excessive involvement in pleasurable activities that have a high potential for painful consequences. It seems that most expats consume more alcohol here than in their respective countries, even those from countries where drinking a lot is socially acceptable.

Q: How are social attitudes towards psychiatry changing in Chinese society?

A: One of the big influences, for good or bad, is Hollywood. Many young Chinese tell me they know what I do because I’m like the father on Growing Pains. And there are many more movies in which psychiatrists are portrayed in both positive and negative lights. For most Chinese, it is still something exotic and mysterious but generally perceived of as something valuable from the West. The younger generation, as they adapt to a quickly changing society, see a benefit to focusing some attention on their mental health. Many consult me, not so much for pathological issues or disease states, but rather for coping strategies. A common thing I hear from them after they begin to understand and feel comfortable with the psychiatric process, is that they wished they had come in earlier to see me.

Q: Is China producing more mental health professionals these days? What are they like?

A: My understanding is that many medical schools in China do not spend too much time, if any, on psychiatry. There are perhaps certain historical reasons for that. One may be the historical emphasis on behavioral psychology and a rejection of the theories of Sigmund Freud, the first psychiatrist. Happily, there is a growing interest in both psychiatry and psychology in China and this will encourage more people to seek training at all levels. I participated in a therapy supervision group at East China Normal University for the last year and-a-half and came across dozens of psychologists and therapists who were all Chinese. Some were clinical psychologists who trained abroad, in the US, for example. Others trained here in China in various institutes. Some had many years of training and some seemed to take a course here and there. Some had a Western approach while others had an approach that was in sync with traditional Chinese medicine. One thing they all had in common was their desire to learn and their genuine sense of caring for their clients and patients, who were all local Chinese.