Doctor, Doctor: Is Depression Different in China?

Studies in the field of cultural psychology have suggested that Chinese people tend to express psychological distress in much more psychical ways than people from other cultures. In particular, psychologists now believe that certain clusters of physical symptoms often reported by Chinese people should be diagnosed as clinical depression and treated as such, even though these symptoms vary considerably from those reported by depressed individuals elsewhere in the world. An interesting historical example of this comes from the 1980s, when the Chinese Minister of Health told American Psychiatrist and Medical Anthropologist Arthur Kleinman that mental illness did not exist in China. Indeed, figures indicated that the depression rate in China was only 2.3%, compared to America’s 10.3%. However, a different illness known as neurasthenia was very common, with symptoms such as dizziness and chronic pain. After careful examination of 100 patients with neurasthenia, Kleinman concluded that the majority of them were actually suffering from depression.

This phenomenon whereby psychological disorders manifest physically is known as somatisation. In the past, these differences were attributed to the Chinese being a less sophisticated and emotionally immature people, incapable of “properly” expressing their feelings. Other researchers suggested that the Chinese language was incapable of conveying emotions, but this research was heavily biased in favour of the English language. Nevertheless, contemporary studies continue to find a greater degree of somatisation among Chinese people. For example, a 2001 study conducted at The University of New South Wales found that depressed Malaysian Chinese individuals were more likely to report physical symptoms than depressed Euro-Australian individuals. Likewise, a 2004 study at the Massachusetts General Hospital found that 76% of Chinese Americans diagnosed with depression reported physical complaints. The authors suggested that Chinese Americans on the whole do not see a low mood as something worthy of being reported to a doctor. However, other researchers are arguing that the actual lived experience of depression is culturally shaped, and that if depressed Chinese people report more headaches, for example, it’s because they do in fact experience more headaches.

Applicants for Psychology or Medicine might want to use this example to consider to what extent medical science and psychology can produce objective results. What are the implications of the idea that symptoms can vary significantly across cultures? Applicants for Anthropology may want to think more broadly about cultural differences, and students wishing to apply for Linguistics should consider the extent to which differences in language may play a role.