I have wondered about how differently psychiatry is practiced across the world. China has the largest population of any country in the world and this now stands at just over 1.3 billion. The Chinese Psychiatric association have their own psychiatric diagnostic system the Chinese Classification of Mental Disorders. There are many differences between the CCMD and western diagnostic systems such as ICD-10 and DSM-IV. For instance a form of meditation/exercise Qijong (which involves making use Qi which is thought of as a form of energy in the body) may lead to mental illnesses such as psychosis and such illnesses have their own category. Practising western psychiatry this concept of recognising and harnessing inner energy (Qi) seems to be very different from the biopsychosocial approach that I use. On the other hand, the chinese culture has developed over many thousands of years and there is currently debate about the significance of written symbols in china that date back tens of thousands of years. I often wonder at how the wisdom passed down from one generation to another compares to science particularly if this accumulates over millenia. However any knowledge passing into use in medicine must prove itself in the testing ground of scientific research, and if this knowledge shows a truth about the world around us then with good science it should pass the tests.
Depression in China has been suggested to be different from depression in the west in that there is supposed to be a greater expression of bodily complaints, which in psychiatry we refer to as somatising. Some research also showed that there was a much lower prevalence of depression in China than in other western countries – indeed up to several hundred times lower. This raised a very important question. Why is the prevalence of depression much lower – is it a real difference or is depression culturally different and not picked up by western instruments for detecting depression?
This question was asked in a 2001 study by Parker and colleagues in the American Journal of Psychiatry when they reviewed various research on this topic. This is a fascinating paper and got me to reflect on many issues about diagnosis as I read through it, and its well worth a close study. In the paper, they identify many reasons why there may be such a difference. The first point to note however is that there is no single chinese ethnicity. In the paper, the authors refer to at least 55 different ethnic groups in China. Lower prevalence rates of major depression have been found in chinese people living in western countries but here the authors caution about the possible influences of their native culture. The suggested cultural influences on illness behaviour are profound and include the role of family and community, wider cultural events in China, the meaning of depression and fatalism. What was really interesting was that the concept of neurasthenia which was popular in the UK in the early 20th century resonated in Chinese culture when it was introduced there because of the ease with which it could fit with the understanding of an imbalance of Qi. From the author’s discussion, there is evidence of a debate between the use of the term neurasthenia which is considered to be a neurological illness and depression which is considered a psychiatric illness. In the UK a similar debate has existed between Chronic Fatigue Syndrome and Neurasthenia. The authors also discuss the role of stigma. The article ends with a question about western psychiatry – do we underdiagnose neurasthenia or is depression underdiagnosed in China?
The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor.