Helena Tao relies on a regimen of five pills a day to deal with the extreme mood swings brought on by her bipolar disorder. Then came Shanghai’s lockdown.
A frantic online search eventually secured new supplies, but only after she had spent two painful days without her meds. “I felt like a zombie. I just lay on my bed and cried for no reason. It’s the worst state I’ve been in for months.”
Inadequate care for the mental health of Shanghai’s 25 million people is one of the major hidden costs of the government’s nearly two-month lockdown of the financial hub in the name of ending the community spread of the coronavirus.
Despite having more psychiatrists and psychologists than any other Chinese city, its medical profession has strained to respond to a wave of stress, anxiety and depression, much of which has gone untreated. As many as 2 in 5 residents have reported symptoms of depression, according to a recent survey conducted by Data-Humanism, a popular blog.
Since the central Chinese city of Wuhan instituted the world’s first citywide lockdown in response to an unknown pathogen in early 2020, psychologists have watched with concern to see how severe and long-lasting the effects of prolonged periods of isolation could be on mental well-being.
In China, the debate about the psychological burdens that began in Wuhan has returned dramatically in recent weeks when, two years into the pandemic, families in one of the wealthiest cities in the country found themselves suddenly confined at home, unable to buy food, secure medication or get a straight answer about how long the policy would last.
Local officials, overwhelmed with complaints about logistical failures, demands for clearer information and pressure from superiors to stop the virus from spreading, have had little time to dedicate to mental health.
During Tao’s two days without medication, she called both her neighborhood committee and an ambulance for help, without success. Instead, she turned to volunteer-run online forums to secure pills and seek assistance. “Being locked down at home can make you feel more aware of your own emotions,” she said. “For people like us, the more you focus on yourself, the more painful it becomes.”
George Hu, head of the Shanghai International Mental Health Association, said that “a lockdown of this scale is virtually unprecedented in the world” and is distinct even from Wuhan in that it is harder for the local population to make sense of what is happening.
Because medical professionals are among only a handful of people able to travel freely across the city, Hu and his colleagues have been traversing empty streets after work to ensure that patients with diagnosed mental illnesses have access to controlled medications.
For the once comfortable middle class in Shanghai to be suddenly consumed by basic safety and physiological needs like access to food can be extremely disorienting, said Hu, who is also chair of mental health at United Family Pudong Hospital. “It tears the rug out from under you because a person learns to navigate the world from a secure base, believing the reality they know is trustworthy and reliable. The lockdown has caused some to question that now.”
According to official media reports, China’s policy choice is stark: The nation either perseveres with “zero covid,” or it lies down and accepts a tsunami of infection and death. As public health policy has blended with a top-down political campaign to prove that the Chinese Communist Party is capable of defeating the virus, there has been little space to adopt a middle way of gradually reopening while continuing to selectively test, trace and isolate to slow the spread.
Also, largely missing from official statements is any acknowledgment of the toll on mental well-being, but it has been a prominent concern for the population of Shanghai, where queries in April for “counseling” on the search engine Baidu rose by 253 percent. Operators at the city’s official mental health hotline told state media that calls had tripled, with the vast majority asking about lockdown-related problems.
Even with the skyrocketing numbers of calls for help, research suggests there could be many more people suffering from mental health problems who don’t know they should seek professional assistance. According to 2021 research by Peking University, only 9.5 percent of patients diagnosed with depressive disorders in China are treated at professional institutes, and among them, only 0.5 percent have received appropriate treatment.
It may be months, if not years, before psychologists get a true sense of the scale of damage to mental well-being caused by lockdowns like Shanghai’s. No incident of suicide has been officially attributed to the policy, and experts caution that a single stressor is rarely to blame. But unofficial lists of collateral deaths maintained by independent Chinese media include a number of suicides in which a mental health crisis may have been triggered by the pressures of isolation or deepened by inadequate care.
Despite global data showing mixed evidence for lockdowns leading to suicides, a study of excess deaths during the 76-day Wuhan lockdown found the number of people taking their own lives rose by about two thirds from February to April 2020 compared with the year before.
As a de facto stress test for China’s mental health care, the lockdowns have revealed gaps in serious need of addressing, according to Fan Xiaoduo, a psychiatry professor at the University of Massachusetts Chan Medical School. “I hope it’s a wake-up call for the government and the general public,” he said. “A lot of people don’t get that there is no health without mental health and that mental health is for everybody, not just people with severe depression or significant behavioral issues.”
Fan has been working with Chinese institutions to set up more community care, rather than the current system, which centralizes care in major hospitals. “It’s not rocket science, but it requires political will and top-down engagement from the government,” he said.
One resident in Shanghai shared an account of taking in her neighbor, a woman in her mid-20s who had been made homeless in the early days of the lockdown, only to realize that her newly adopted flat mate was suffering from severe anxiety and insomnia in what appeared to be a breakdown.
Over days, having become an unwitting caregiver, she tried to find help by calling a psychologist she knew for advice and arranging for the woman’s parents to come to Shanghai to collect her. At one stage, she called the police but was told that “epidemic prevention is greater than everything else.” Eventually, the neighbor was reunited with her father.
The episode made her rethink an earlier acceptance that preventing the virus was of primary importance. “I saw myself in her, so that’s why I took the initiative to help, just as if I was supporting a version of myself pushed into severe anxiety and depression,” she wrote in an account shared with The Washington Post on the condition of anonymity for fear of reprisals.