Some thoughts on the common issue of psychotherapy in different cultures — report on the China conference of psychoanalysis

Zeping Xiao*

·Editorial·

Some thoughts on the common issue of psychotherapy in different cultures — report on the China conference of psychoanalysis

Zeping Xiao*

Distinguished Chairman, Dear colleagues, ladies and gentlemen,

Good morning! It is my great honors to have the presentation here, share my thoughts with you, you may agree or disagree but start a discussion, as Chinese says: (Pao Zuan Yin Yu) throw away a brick in order to get a gem;

Today in this hall , more than 1000 colleagues from almost 30 different countries, nations or districts,get together, to share our common interests on Psychotherapy, your valuable contributions is highly concern by all colleagues, I am sure.

In the next few days, we will have many discussions on different aspects of psychotherapy. Among the audience, not only the psychotherapists, but the psychiatrists, psychological counselors and general medicine professionals are included as well. As the theme of the congress is “The Contribution of Psychotherapy to Global Health”, I would like to discuss some common issues about psychotherapy instead of the technique or theory of any therapy schools. I think,sometimes we need some kind of helicopter view towards our daily work, what seems very familiar to us maybe loose our fantasy for innovation. Or we say to find the chance to see the root and leaf at the sametime.

1. Why psychotherapy is needed

1.1 The main character and function of psychotherapy,especial the function of setting

In simple words, the main character of psychotherapy is talk cure, and the key function is to help people healing mental suffering. Psychotherapy offers the opportunity that people can go deeper into his inner world, more conscious towards conflict,negative emotion and traumatic suffering; May change the cognition and behavior manner, and reconstruct the personality.

But as you know, psychotherapy has a long history but only more than 100 years till now. Today so called psychotherapy came from west. But in all kinds of nations and cultures there should have curing way towards human being’s soul suffering.

The Chinese Traditional Medicine (CTM) plays the main role to people’s health, especial the body health in Ancient China, also the Confucianism, Taoism and Buddhism deeply influence people’s inner life then.CTM focus on the comprehensive point of view to both body and soul and their interaction as well. Buddhism lead people go deeper and deeper of the inner world,somehow like Psychoanalysis Taoism show people how to cope with surrounding smoothly, something similar to the cognitive-behavior therapy. Confucianist composed the main part of superego and strengthen ones social ability.

But comparing with old Chinese treating methods,modern psychotherapy develops more practical technique, especially the therapeutic setting, you pay the hours and it belongs to you: the space and time.You can say anything you want, you are unique, and seems equal with the therapist since you pay. Somehow it changes the general state of relationship among people, e.g in China before, it was not usual to discuss your own and private life with a stranger, even a doctor,where people much easier to complain body discomfort instead of inner feeling or emotion.

Also, “just talk, be paid?”, Now people accept it. And therapeutic relationship can be reliable and independent to other relationships in the reality.

1.2 How human being dealing with mental suffering and mental disorder in the history and another culture circumstance.

In the past, Chinese had very tight interpersonal relationship and hierarchical societies. As the traditional value men and women play different role, men are active for all kinds social affair and responsible for the family finance, women more stay at home and take care of the whole family. It seemed people care more on body health. Mental health was not big topic and mainly supported by the large family.

Religion also played an important role then. In ancient China, even the emperor or queen were converted to Buddhism, and practiced the Ren or Vipassnana, been sensible with the inner would and outside nature world. Also Taoism helped the intellectual people understanding the trauma and dealing with conflicts.

Today, in Tibet, almost all people are Buddhism,there almost has no psychotherapy, very few psychiatrists.

I had been 10 days in Brunei, it seemed totally difference world for me then: everyday five time pray when the air full of imam high and deep sounds,very like the dialog between human and heaven.Pity I had no opportunity to investigate whether they have psychotherapy or not, and what kind of psychotherapeutic setting, but people live well there.

Many time, we could go back a step to have a look at history, or climb up higher in our mind to observe a totally different culture: how they deal with the similar problems or life conflicts, which can widen our view and calm down our heart, to be more capable to get proper empathy and understand rightly what our patient or clients tell us, what is their original way to cope with the conflict and the daily life.

Two times I had the chance to live longer in other country, 11 months in German in 1999; 9 months in UC Berkeley of United state, and many short time visits to different countries. The longer staying the deeper knowing people there, I find much more common or overlapped part among people than difference in the deep part of our heart. My experience tell me that the distance between people is according to the distance of their spirits, neither the culture nor the geographical distance or whatever else. i.e. the person nearby maybe not the heart friends, vice versa. Chinese words: “Zhi Chi Tian Ya, Tian Ya Zhi Chi”

So, during therapeutic session, we should ask the question:” now, how far between us in fact”, you and your patient... Maybe much more distance than you imagine, maybe closer but you do not realize...

1.3 The key of psychotherapy : treating by heart not only by technique

Since the therapeutic setting, psychotherapy has the freedom and commercial trait. Compared with other deep and close relationship, it is much easy to end the therapeutic course. It changes somehow the Chinese life style. But the dynamic strengths and power is beyond your imagination, it means culture and custom do in fl uence people unconscious behavior and subject imagination. This moment there are two scenes in my mind.

In 1999, I was a visiting scholar in Sigmund Freud Institute in Frankfurt am mine. As part of the training course as a trainee analyst, I had 4 times a week selfexperiences then.

One day, my training analyst told me that she canceled the next day’s session and I agreed. Maybe I was so deep immersed in the psychoanalysis at thattime; it was almost the only thing in my mind then. The second day, I forgot the date was canceled but appeared in front of the door and pressed the bell. She opened the door, was astonish and spontaneous word: “we have no session today”... I was so embarrassed and my face turned red...she closed the door; I rode back, 40 minutes distance. My analyst had no fault of course.I remembered clearly my feeling that moment, very often I thought if I met the similar situation in Shanghai,how I could deal with my client or training analyst. I know there is cultural tacit agreement, only be known by your compatriots from the same country even the same province or city. My analyst show the principle, I accepted it and understand more and more along with time passing. I must say the colleagues of SFI at thattime helped me to go through the resistant stage with my analyst. One of them is Tomas Plaenkers who is in the audience here and now. Thank all of them.

Another was I got it in 2010, when Asia Psychoanalytic congress held in Beijing. One colleague from United state report his case, a Japanese man who visit and work in USA for years. After hundreds hours,both the analyst and patient were dissatisfied with the effects at last, which confused the colleague, it was not a usual situation as a quite experienced analyst with decades professional career. I remembered the colleague said that the purpose of his coming to Beijing to join the Psychoanalysis Asia conference was just want to know what would be the Asia colleagues opinion or suggestion on this case, help him to understand and go through with the difficulty. I was deeply impressed by his modest and responsible attitude as a professional towards patient and his own problems.

So, Culture, custom or value, just as the ground earth we live every day, the air we breath every moment, they influence us everywhere, but we only can feel them when we wake up from our Customary or habituation. So, for us as psychotherapist, even analyst,or psychiatrist, you never can understand exactly what the subject objective facts really is. Be patient and modest, especial when encountering with another culture, no matter to input or output knowledge. For such complicated, deep and wide mental phenomenon,we must be careful and prepared for it.

Then, how to understand others well, by heart instead of by language. Unconscious is usually more powerful than conscious to work on it. One way to know another culture is to live there years, to have a friend there for years and involved into daily life including all kind conflicts and difficulties. Along with the time passing, you could feel、concrete、extract and purify everything by the first hand.

Here, I sincerely thank our foreign colleagues,because of you, the bridges build up, and Chinese colleagues got to learn modern psychotherapy, which benefit so many people, even the whole China now.Also it results of our coming together for such a big congress. The whole society starts to pay more attention on psychotherapy.

I would like mention two people as the representatives here, one is Prof Norman Sartorius,and he is almost the most famous psychiatrist in world today. More 30 years before, he help Chinese Psychiatry went into the worldwide professional field. I know him since 1990, he helps Chinese colleagues cross several generations, help us made a lot of connections with WHO and colleagues in different countries.

Another is Mrs Magarete Haass Wiesegart,she is almost the mother of the first generation of Psychotherapist after culture revolution in China. She had been a foreign student of Beijing University in 1976,with her deep emotion related to China or Chinese culture; she built up German- Chinese Academy for Psychotherapy. With her leadership and dedication,many German even European colleagues from different Psychotherapy schools came to China for teaching and training. She founded the framework that different schools work together, so we can have a big and comprehensive congress today.

They represent all colleagues from different countries that help us. Now more than 30 years passed, the past seeds become tall trees, nowadays psychotherapy has been a formal profession as she should be. Psychiatry and psychotherapy, like two wheels of the car, will have enormous contribution and guarantee to people’s Mental Health in China. We do thank all international colleagues, thanks a lot for your internationalist help.

So, the ways, to feel one’s heart to know the person and get close to his culture even his country. The world is connected by people’s hearts not whatever else. In the therapeutic sessions, without sincerely empathy,even with rich techniques, could not expect a good longterm effectiveness.

2. Common topics and aims of Psychotherapy among different schools or nations

No matter what kind of psychotherapy, or any therapy with psycho-therapeutic function, will confront the similar topics or problems.

2.1 body and soul, drug or talk?

Initial assessment is very important to get right diagnosis and treatment plan. Very often medication is prescribed by most psychiatrists first. In China, people seems more depend on drug therapy, like Chinese usually have more somatic complain instead of emotional or mental one.

So, body or soul, drug or talk cure? Short or long term? Symptom focus or deep therapy orientation?As an experienced professional you know the answer quite easy. But there must be some differences among different schools in different country. Seems not so much argues with the treatment of psychosis, but there are some in front of non-psychotic patients:depression, anxiety, personality disorder, stress disorder and so on. We have some treatment guidelines, but still many argue between psychiatrist and psychotherapist,analyst and behavior- cognitive or family therapist.Communication need go deeply. Obviously, integration is the tendency, human being mind never separate fixed into different parts

2.2 Conflict and trauma

How we adjust the conflict and trauma, is close to your culture and social custom. The Chinese writer Yu Hua,in his novel Brother, say ” China take 3 decades go over what Europe spent 3 hundreds year to pass by, you can image how much stress of people inner side should stand and deal with. The most challenging point was the value and living style change: in the past people were dependent on DANWEI(单位). When the society asks them to have more individual independence;some people lose the safety and identity toward the new situation. How to judge the stress level when a young therapist meets an old patient? A foreign training therapist meets a Chinese trainee? What should be right? People indicate and investigate. Now religion again becomes a hot topic, like psychotherapy, which show the society here starts to pay more attention to human inner world looking for the belief or trust.But is there universal value principal in the world? Do we respect and understand enough to the culture?Discussion is still going on, like what we do here in the Congress, many seminars and conferences focus on it.

2.3 Life and death: the culture and religion roots

One of the roots of suffering and anxiety is death frighten or threaten. but different cultures have different understanding and coping style. Many years before, I read “Tibet Death Book”, Carl Jung wrote the preface for the English version. It was a total new point of view for me when I read it, it open a quite new and full of curiosity field. The cognition on death can strongly influence the attitude towards life. Recently,meditation, a modify method from Buddhism Vipassana practice, is quite hot, and was found to be effective to relief anxious, could integrate body and soul into more balancing state.

You see, like the world become easy to reach place to place. The barrier of different school or field are broken somehow, more integration. But in clinical practice, still need to clarify many things such as treatment principle, boundary, indicator and so on,these days some seminars go deeper on it .

2.4 Ultimate model of the philosophy: Tai Chi diagram Vs ancient Greek mythology

In fact, every culture even every person, has his own image about truth, perfect performance and so on.So called the ultimate model of philosophy, will be different between Gender, nation even generation. But it does influence people’s value system and decision making process. There are differences between east and west, just like ZHOUYI, Tai Chi diagram represent the Chinese philosophy ideal, compare to the ancient Greek mythology represent western philosophy roots.They are different. Who is better is not my point here,what we should pay attention to is that they influence our judgment and the strategy dealing with conflict, self identity even self esteem.

Psychotherapy let two big cultures west and east meet on one’s deep heart. Do we prepare well to realize the underground or potential debate there? If we could not confront it sensibly and flexibly, it maybe would result in new conflict in the clients or patients mind.

Now it is the time, all colleagues come together and discuss these deep and careful but not compulsively input or ignore its existence. I think with the case analysis, offer us many chance to go into detail and show up the entire phenomenon vivid and concrete

3. Psychotherapy is unique? Is there any substitute to it?

As we discuss at first, before Modern psychotherapy come to our life, there were many ways used to deal with any kinds of suffering or mental pains, which reflect our root of the culture on mental life. And it should be concern before we start new methods. In another words, sometimes psychotherapy is not the only way for healing mental illness.

As always, family is most important unit in any society, family or social support is the most important resource for human being to get safety and share happiness. Religion help people to accept and deal with death threaten, is helpful to reduce the stress, anxious and negative emotion.

Also, China is a socialism country, as the common value, Altruism social circumstance could release the individual interpersonal conflict, and help to go through the traumatization life events. Wenchuan earthquake in 2008, the whole nation work together to overcome such a big traumatic event, At last, the relative researches show that the incidence rate of PDST and depression is lower than the history case and worldwide as well, very impressive.

Since the quick development of information technology, now the earth becomes like a village. We can reach with each other in seconds by email, micro blog, wechat and cell phone, no matter where you are in the world. But the inner distance between people do not become as close as we expect. The countries’or districts’ conflict never stop, war threaten never disappear.

So, at the same time, we start the individual psychotherapy, should devote ourselves to build up more psychologically smooth society inside the country and worldwide as well: less hostility more trust; less defense more understanding and support. In fact, the biggest war is not by weapon but human thoughts,so called fighting for the right philosophy. Perhaps,psychotherapist can do more and let the world better and better for human being mental living. More tolerance and understanding toward different national social and value system, more space and peaceful time for entire human being’s development. One Buddhism aphorism says “the heart is clear then the landscape is clear”, the heart is the point.

Dear colleagues, thank you for your attention to share my thoughts with psychotherapy in my mind now.As I say before, “To throw out a minnow just want to catch a whale”. What we are longing for is to hear your voice and response now and in the long future.

Thank you!

[Shanghai Arch Psychiatry. 2016; 28(4): 181-184. doi: http://dx.doi.org/10.11919/j.issn.1002-0829.216013]

Dr. Zeping Xiao is the deputy director of the Shanghai Health Bureau, chief psychiatrist and professor of psychiatry at the Shanghai Jiaotong University School of Medicine. She was Vice President of the Pacific Rim College of Psychiatrists, Chairman of the Chinese Psychiatric Hospital Association,Chairman of the Psychoanalysis Committee of the Chinese Mental Health Association and a board member of the International Federation for Psychotherapy, the Chinese Psychiatry Society, and the Chinese Neuroscience Society Psychiatry Division. Dr. Xiao is also the co-editor-in-chief of the Chinese Journal of Behavioral Medicine and Brain Science, and an editorial board member for the Journal of Shanghai Jiaotong University (Medical Science) and the Shanghai Archives of Psychiatry.

Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

*correspondence: Professor Zeping Xiao. Mailing address: RD South Wanping 600, Xuhui District, Shanghai, China. Postcode: 200030.E-mail: xiaozeping@gmail.com