China's fight against the coronavirus was largely over, but Zhang Xiaochun, a doctor in Wuhan, sank into depression, convinced that she had failed as a daughter and mother. She agonized over her decision to continue working even after her father became seriously ill. She was worried about her little daughter, who she often left home alone.
But instead of hiding those feelings, as would have been the case just a few years ago in a country where mental illness has long been stigmatized, Dr. Zhang therapist. When friends and colleagues checked in with her, she openly admitted that she was having problems.
"If we can face such a major disaster as this outbreak, how dare we not talk about something as small as some mental health problems?" said Dr. Zhang, an imaging specialist.
The coronavirus pandemic emerging in China has forced the country to grapple with the issue of mental health, an issue that has long been ignored due to scarce resources and widespread social stigmas. During the Mao era, insanity was declared a bourgeois sham and the country's psychiatric system was dismantled. Discrimination persists today and many people with mental illness are shunned, hidden at home or locked in institutions.
But after the coronavirus outbreak, this type of neglect has become increasingly untenable. The uncertainty of the early days of the pandemic has combined with the grief and terror of the weeks that followed to leave a personal and collective trauma.
At the height of the outbreak in China, more than a third of people across the country had symptoms of depression, anxiety, insomnia, or acute stress, according to a nationwide survey by a university in Shanghai. An expert in Beijing recently warned that the effects could last 10 to 20 years.
Due to the top-down leadership of the Chinese government, officials have quickly mobilized to provide assistance. Local governments have set up hotlines. Psychological associations have launched apps and held online seminars. Schools screen students for insomnia and depression, and universities are setting up new counseling centers.
But the country is also facing major challenges. According to the World Health Organization, there is a shortage of therapists for the country's 1.4 billion people, with fewer than nine mental health professionals per 100,000 population as of 2017.
China's centralized political system, for all its strengths in mobilizing resources, can also create problems of its own. The government has slowed public grief, suppressed calls for accountability for early missteps and pushed for a simplified portrayal of China's triumph over the virus.
Still, there is hope that the pandemic could fuel a long-term postponement of the mental health conversation in China, with proponents in part pointing to high-level government orders to improve treatment.
"Because of the pandemic, they are more courageous to ask for help," said Du Mingjun, a psychologist in Wuhan, of the influx of people she saw looking for treatment that year. “More and more people are accepting this. That is new. "
Mrs. Du was one of the first to witness the psychological strain of the crisis. On January 23, the day Wuhan closed, she and her colleagues from the Provincial Psychologists Association helped set up a government-sponsored 24-hour hotline, advertise in newspapers, and post on WeChat to help out a city who is suddenly shaken by fear.
Immediately they were flooded. One woman called because her parents were in separate hospitals and trying to run between the two had left her on the verge of collapse. A man took his temperature every 30 minutes because he was afraid he would get sick. A 12-year-old boy voted on his mother's behalf and stated that he was worried about her. At the climax The hotline managed between 200 and 300 calls every day, said Frau Du.
Dec. 21, 2020, 7:46 p.m. ET
As the situation improved, the calls subsided. At the end of October it was about 10 a day. Some callers were still seeking help with trauma related to the outbreak brought back through news reports or old photos on cellphones. But others seek help with more mundane issues like academic pressures or family disputes.
"I think that change is here now and there is no way I can stop it," said Ms. Du. “We've all been through this together and it has continuously developed around us. So the collective consciousness of our community is very deep. "
Schools across the country have expanded counseling and encouraged students to take time to relax as the Department of Education has warned of “post-epidemic syndrome”. Officials have said that after months of stressful bans, students may be more likely to have conflict with parents and teachers.
Even before the pandemic, trends in student mental health were worrying. A Shanghai official said in May that suicides among K-12 students are on the rise, with stress caused by academic pressures and domestic disputes.
While the rollout of services has been sparse, educators and students say the campaign helped break stereotypes about mental health. In northern Hebei Province, officials produced cartoons to help students understand trauma. In the southern city of Guangzhou, students write letters about anxiety and practice breathing exercises.
Xiao Zelin, a junior at Sun Yat-sen University in Guangzhou, said he suffered anxiety and insomnia when he returned to campus this fall. After being locked at home for months, he struggled to get used to the crowds. His appetite was bad and he could not relax.
Mr. Xiao had never seen a therapist before, but he spoke to a counselor from his university. The counselor, he said, helped him understand what he was going through and be patient with himself. Mr. Xiao suggested that his classmates also register.
"In the beginning I was lost," he said. "I'm much better now."
Liang Lingyan, a psychologist in Shanghai, said the government there has also organized more community services, such as home visits for seniors living alone.
"After the epidemic, people are paying a lot more attention to health, particularly mental health," she said. "This will be a long-term change."
Despite the efforts, cracks remain in the system.
There is evidence that those in need of help are having trouble finding it. A survey by Chinese researchers found that only 7 percent of patients with mental disorders had sought online help during the pandemic, despite the government launching apps and websites.
There are also too few quality training programs for mental health professionals, said Yu Lingna, a psychologist from China who now lives in Tokyo. Even if these were expanded, human training would take time.
"I assume that we will be in a state of inadequacy for our lives," she said.
For Dr. Zhang, the imaging specialist who worked in Wuhan, persisted in feeling like she had betrayed her family even as the state media celebrated frontline doctors for their contributions. Her father recovered, but her parents treated her coldly.
Studies suggest that medical workers are particularly vulnerable to the aftershocks of the pandemic. One study found that more than half of the Chinese healthcare workers surveyed had symptoms of depression. While many of these symptoms faded as the epidemic subsided, others, such as guilt about losing patients, could linger, experts said.
Dr. Zhang said she didn't find the therapy helpful, but eventually found other sources of comfort. She immersed herself in the writings of Wang Yangming, a philosopher of the Ming Dynasty. "It is easy to catch the thief who lives in the mountain, but difficult to catch the thief who lives in the heart," he wrote.
She also eventually quit her job at Wuhan Hospital and now lives in Chengdu, in the southwest of the country, to hang out with her husband and daughter. She hopes that one day her parents will understand her choices.
Dr. Zhang has emphasized many times that her experience is not unique. Many of her former colleagues are still grappling with the scars from the outbreak, she said, and she was encouraged that many of them had reached out to friends or therapists as well.
"Any major crisis like this will put people in pain," she said. "There's nothing shameful about it."
Albee Zhang and Liu Yi contributed to the research.
The National Drug Abuse and Mental Health Administration Helpline provides free and confidential information about mental health treatments and services around the clock. Call (800) 662-4357 or TTY: (800) 487-4889.