By William Wan
Monday, October 11, 2010; A1
BEIJING - On a recent morning, Danille Drake flipped on her computer and sat down to wait in the home office of her two-story house in Bethesda. As the screen flickered to life, she explained how she has spent her whole career learning and practicing the teachings of Sigmund Freud. And how, for decades, she has watched the slow death of his theories, abandoned in favor of antidepressant drugs and newer treatments.
But recently, Drake said, she has discovered a corner of the world where whole flocks of students just can't get enough of Freud. The computer bleeped and a grinning, bespectacled Chinese doctor popped up on the screen, waving hello.
This, Drake said, was Wan Jingjing, 35, a psychologist in Hubei province. And Psychoanalysis 101 was now in session.
For the past two years, a small army of therapists in the United States has been getting up at ungodly hours and staying up late into the night to teach the fundamentals of Freud to counterparts on the other side of the world. Their efforts have raised the practice of psychoanalysis, a type of theory developed by Freud a century ago, to new heights in China, a country where mental health has long been an underdeveloped branch of medicine.
The success of their intensive two-year training program, called the China American Psychoanalytic Alliance (CAPA), has been the result of several overlapping factors: Chinese doctors - whose training has been limited to drug prescription - are hungry for new theories and techniques to treat patients. Meanwhile, Freudian psychoanalysts in the United States - often seen as outdated, even irrelevant - are equally keen to gain new ground in China. Connecting the two sides is Skype, an Internet videoconferencing technology that didn't even exist until seven years ago.
In many ways, the mental health field in China is especially ripe for growth. Top government officials and experts have expressed concern that increasing social pressures in China - more competition at almost every stage of life, a widening wealth gap and quickly changing moral values - are straining people's capacity to cope.
A spate of inexplicable incidents this year - in which men rushed into kindergartens and randomly stabbed children - prompted promises by the government to shore up mental health services in China. There are economic ramifications as well, highlighted this summer by a string of high-profile suicides at factories producing electronic parts for Apple products, which sent business leaders searching for solutions.
For decades, China has lacked the infrastructure to deal with such problems. Compared with most developed countries, including the United States, China has just a fraction of the mental health workers per capita needed to treat patients. Complicating matters is a checkered relationship between the practitioners and government, which has been accused at times of using mental health as an excuse to imprison political opponents or to quell protests. But with prosperity and an expanding middle class, China is starting to develop a market for the long-term and often expensive therapy required by psychoanalysis.
Next week, the International Psychoanalytical Association will hold its first major conference in Beijing. And already, budding psychoanalytical associations are starting to form in China's urban centers.
The most organized push, however, has come from CAPA.
The two-year intensive training program is run out of the cluttered New York apartment of Elise Snyder. The 76-year-old psychoanalyst was nearing retirement age nine years ago when she presented a paper at a conference in China. During her visit, she was overwhelmed by the eagerness of Chinese doctors to know more. Many begged for formal training in Freudian psychotherapy.
Now, as most therapists her age are winding down, she remains a whirlwind of activity, calling, teaching, shooting off e-mails and matching students in China with new U.S. supervisors. Her living room serves as CAPA's makeshift office. An intern for the nonprofit occupies her dining-room table.
"You don't understand how exciting it is right now," she said. "The atmosphere in China, it's like what New York was in the 1960s for us psychoanalysts. The enthusiasm is incredible."A cultural mystery
To understand the hunger for Freud in China, Snyder's students say, one must understand that the professors who would have trained this generation of doctors and therapists were mostly wiped out in the Cultural Revolution of the late 1960s - sent to farms for reeducation, chased out of academia or simply banned from studying Western theories.
Ji Xuesong, a psychiatrist and an associate professor at Peking University's Institute of Mental Health, was one of the first students to sign up for CAPA two years ago.
He said he first came across Freud's works as a teenager. "Freud talks a lot about penis and vagina," explained Ji, now 37. "As a teenager, I was naturally looking for books on sex so I picked it up. But I couldn't understand anything. I'm pretty sure, looking back, that the translator of the book himself didn't understand."
The mystery of Freud stayed with him through medical school, where psychoanalysis was tantalizingly mentioned in textbooks. But Ji could never find a full course, much less a practitioner who could teach him how to use Freud's theories to help his patients. Instead, mental health training focused almost exclusively on learning which drugs were prescribed for which diagnoses.
Therapy treatments are rare in China, Ji and other doctors said, partly because of the convenience of drugs in the face of overwhelming caseloads, a shortage of mental workers and the expense therapy requires. But in his spare time, Ji tried to learn psychoanalysis on his own, fumbling through translations and attending visiting lectures from foreign experts. Ji - whose patients include those with severe mental illness as well as middle-class professionals struggling with depression - even tried out the little he understood on a few wealthier clients who requested long-term therapy.
"It was a disaster," he admitted with a sigh. "It was as though I were a book sitting in that chair. I had the knowledge, but no real clue how to do it."
So when he and other Chinese doctors heard about CAPA, they couldn't believe it. Some were even leery because of the minimal enrollment costs. (Tuition has since been raised to $1,500, which students say remains relatively low considering the hourly rate of most U.S. therapists who teach in CAPA pro bono.)
The program follows a two-year curriculum. There are 30 weeks of classes - four-hour sessions usually taught by one U.S. practitioner via Skype with 10 or so students gathered in a doctor's office. Each student receives an hour a week of one-on-one supervision. Many of the students have also undergone psychoanalysis.
In such sessions, several students have even insisted on following classical Freudian rules, lying down on a couch facing away from their therapists (or in this case, a Skype-connected laptop) as they drift through free association.A few obstacles
There have been bumps along the way. Raised in a culture that stresses agreement over discord, the Chinese students have been reluctant at times, according to some supervisors, to engage in the confrontation necessary to push patients into self-examination. And in a culture where filial duty is hugely valued, it can be tricky to push patients to examine the ways in which their parents have screwed them up.
The language barrier has proved troublesome as well. Because of the gender-neutral pronouns in Chinese, for example, the students often use "he" and "she" interchangeably - a frustratingly important distinction in Freudian theory.
One of the biggest worries, however, among the American teachers is that they will become idealized authority figures in their students' minds.
"The idea that we're going to somehow impose our views on them is not only incorrect but morally wrong," Snyder said. "There's a desire among the Chinese students to find their own way. In time, they may even develop their own system or philosophy to follow."
As one of the first graduates of the program, Ji has already begun passing on his knowledge. He now teaches courses on psychotherapy at Peking University Medical School, and the class is almost always standing-room-only. Between his counseling sessions, he gives seminars for visiting doctors.
During one recent lecture to doctors from Liaoning province, he rendered his newly acquired knowledge into more palatable terms for his Chinese audience: Freud's idea of the subconscious, he explained, is like the ghosts of Chinese superstition - they may move among us completely invisibly, but they are powerful forces nonetheless. Likewise, he said, the Oedipal complex is not so different from what many in China call the "little emperor" syndrome as a result of China's one-child policy, where every child feels his or her mother's love belongs entirely to the child and no one else.
Later, in his office, Ji talked about how good it feels to finally understand and employ Freud's theories.
But even as Freudian theory is taking off in China, he noted, other theories are also beginning to emerge. Of late, he said, he had started studying yet another branch of psychology, almost as eclectic in China as Freud was just a few years ago.
He picked up a pen and asked a visitor to look at it carefully, to follow it as it moved lower and lower.
"I've started to learn hypnosis," he said with a grin.
Researcher Zhang Jie contributed to this report.