Photographing the Invisible: Mental Illness in China
This post was written by Project Pengyou intern, Ellen Hao.
Ming Li, a 36-year-old farmer, has suffered from severe depression for 18 years. He lives on the outskirts of Yuncheng, Shanxi, and is just one of 173 million people in China who suffer from mental illness. But of this population, over 94% will never get professional diagnosis or treatment.
In his photo essay, Hao Wu followed Li, capturing his daily life. In Li’s village, depression is seen as the 娇气病 of city people, whose pampered lifestyles make them frail and spoiled. In reality, rates of depression are inversely proportional to education level and economic status—in rural areas, the suicide rate is double that of the city’s. No one outside Li’s family knows of his condition. In the village, mental illness only has two forms: melodramatic people overstating their sadness, or psychosis. When they ridicule mental illness, Li can only chuckle along. He is alone in many of the photos.
On a normal day, Li and his father wake up at 6am to work the fields. The family owns over 10 acres of land, but only Li and his parents can work—his wife cares for their two children at home. He rarely speaks to his family about his condition.
Every year, his family income totals 50,000 yuan. Add on his children’s annual school fees, 10,000 yuan, and then his monthly 500 yuan medicine, and the costs mount. “If I did not have this illness, even with more work and more suffering, I could handle so much more. As it is, I can only barely survive,” said Li.
“I deeply want to become part of family life, to help ease the burden my parents face, but right now I can only use reason to care for my family. After a day of work, the only thing that makes me happy is seeing my kids, but I don’t have the energy to spend time with them.”
During Wu’s documentation, Li had a relapse, and was hospitalized for the second time. Chances of complete recovery are low after two relapses. The doctors have told Li that he will have to spend the rest of his life relying on medication.
“I am still young,” Li said, “I want to take control of my life.”
At the hospital, Li is silent for most of his stay. His daily activity consists of two electrotherapy sessions, and a nurse connecting him to an IV drip, offering a chance for conversation. The distance between the hospital ward and the electrotherapy room doesn’t amount to even 500 meters, but Li’s pace is unusually slow. “The electric current is not strong, it’s more like someone is massaging his temples.” From Li’s perspective, the therapy only helps as a way of relaxing, without solving the deeper problems.
In one photo, Li walks in the garden outside his ward. It is August and the night is balmy. Li has taken two pills, but cannot sleep. “My thoughts are slow and my mind is confused, I don’t know what I should do next, and I don’t know how to do it,” Li said. “It’s as if everything around me doesn’t exist, my mind is completely blank.”
A History of Invisibility
As a country, China’s options for mental health treatment are deeply lacking. Too few mental health hospitals exist, and the ones that do are heavily understaffed. China only has about 20,000 psychiatrists—only one for every 70,000 people. Many of these psychiatrists have only minimal training.
After 1949, Mao Zedong’s new government closed many of the psychiatric hospitals, which had been opened by Western missionaries in the 19th century. Even before, psychosis meant social death in China. Seriously ill people were defined as not fully human in traditional society, and could not give or receive gifts at weddings, funerals, and other social occasions.
The lack of knowledge is clearest in the poorest and most remote areas. Between 2005 and 2009, Chinese health-care workers found more than 250 people with several mental illnesses locked inside their homes, some iron-shackled. While this may sound cruel and barbaric, many families are ill-equipped to care for their mentally ill relatives.
Young Chinese photographer Yuyang Liu documented these struggles in his ongoing project, “At Home with Mental Illness”. Desperation, rather than cruelty causes families to restrain mentally ill family members. During his travels, Liu met 24-year-old Jianwen Pang, who was diagnosed with schizophrenia. After he set a fire inside their home, his family decided to lock him with a chain, afraid of another hallucination. Another family of five consisted of four mentally ill members, all of whom were supported by their 83-year-old grandmother, Mei Lin.
“I don’t want to photograph how miserable they are even though some of the pictures will inevitably convey that, but I want to focus more on the support between them and their families, and capture the viewers’ attention that way,” Liu says.
In May 2013, the nation’s first mental health law was finally enacted. This includes doubling the number of trained psychiatrists, increasing salaries, and government reform targets seek to increase access to continuing medical treatment for 80% of people with severe mental illness. The First Specialized Hospital of Harbin is dedicated to mental health, and represents a new vision of treatment. Involving both patients and families in treatment decisions, the hospital has established a group for patients’ relatives to share experiences and thoughts, provided patients with more information about their conditions and medication, and increased local community awareness. Another organization is Tulip, an NGO in Shanghai that arranges peer support groups for people with depression and bipolar disorders. KaJin Health, a new tech startup, uses Wechat to connect Chinese-speakers with therapists, and overcome urban-rural divides.
In one of Wu’s photos, it is Lantern Festival, and the village is full of fireworks. Li sits alone on the balcony. He is talking on his phone to friends from peer support group. They have never met offline, because Li lives so far from the city. The people in the group describe their conditions and their pain, but also share stories about recovery. For Li, talking to them is the only time he can relax.
That day, Li made one wish: to have a better harvest, so that he can save up money to go to Beijing and seek treatment. There is still a long way to go, for Li and for China.
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