In the 2000s, during the era of great enrichment, the Chinese nationalist blogger Wang Xiaodong and a group of writers associated with him put together the book `Unhappy China’ (中国不高兴), a collection of complaints about the way the country was treated not just by the outside world, but by itself. One of the contributions referred bitterly to the milk powder scandal of the year before, wondering aloud how it was that its own rulers seemed incapable of stopping its people being poisoned by their own food.

Over a decade on, and it is hard to see anyone in Xi Jinping’s China being brave enough to issue an edict like this, even if it was clothed in the protective language of patriotism. Rules exist now to shush people away from anything that veers close to the space of politics.  Even so, it’s a moot point whether the country has got much happier even as it has burgeoned in power and outward confidence. It is this issue that US academic Li Zhang addresses in `Anxious China: Inner Revolution and Politics of Psychotherapy’ (University of California Press, 2020).

The inner lives of Chinese people remain one of the world’s great undiscovered areas. While physically the country has been accessible to travellers, visitors and experts from elsewhere for a number of decades, what to make of the world views, and inner aspirations and turmoils of a fifth of humanity is another matter. There have been some heroic and important attempts to conquer this territory. Arthur Kleinman, of Harvard, with collaborators has been working on mapping out `Deep China’ since the 1980s.  Jie Yang’s book on Mental Health in China managed to divide up what sometimes looks like an unmanageable behemoth into something a bit more approachable. Her work refers to the `empty heart disease’ (空心病) suffered by cadres in the Communist Party, and the `princess syndrome’ by young women burdened by ideals in China that end up leaving them forever frustrated.  In Chinese, the veteran economist Mao Yushi （茅于轼）has written about the issue of anxiety and status in post-reform China., addressing the key question of why as they grow richer, they get more miserable.

One of Li Zhang’s key points in her ethnographic study of the practice of psychotherapy in contemporary China is that indigenisation matters (she calls this by its Chinese term in her study, `bentuhua’ – 本土化). This is something that prevails whether it be in the field of economics, social organisation, or business.  China takes things from outside and then adapts and transforms them.  Interest in psychotherapy started after a conference held with Germany partners in Kunming, South West China in the late 1980s. It seemed a bold move then, to bring knowledge of a practice that was associated with western individuals and almost regarded as a spiritually corrupt bourgeois practice.

As capitalism, and consumerism, have seeped deeper into Chinese economic life (despite having little impact so far on politics) this attitude has changed.  In October 2016, the Chinese government issued `Happy China 2030: Blueprint’ (with a further document on public health supplementing this a year later, available at http://www.scio.gov.cn/32618/Document/1565200/1565200.htm). As Li says, `this is the first time that the health and well-being of the nation have been considered of paramount strategic importance and placed on the very top of the government’s agenda and long term planning’ (171). COVID19 has only reinforced this urgency.

The authorities are right to attend to this area. Fast paced changed, increased physical and social mobility, on top of a society that was already characterised by dense and complex human networks, have created something akin to a perfect storm for a mental health crisis. Urbanisation anywhere in the world has been associated with sharp increased in problems in this area. No society has experienced a vaster, faster shift of people into cities and towns than contemporary China. It is not surprising therefore that people are feeling disorientated. All of this is compounded by the social stigma that individuals suffering various forms of mental illness endure in the country. People may no longer be locked up in institutions little better than primitive prisons as they were in the recent past for suffering from schizophrenia or depression, but they often end up isolated and ostracised.

Li Zhang brings a very personal touch to this account, by talking of her own battles against depression, particularly after the death of her mother who, she argues, clearly suffered from long term issues which, in a different context, would have been manageable by treatment and therapy. This is no naïve account however of how today suddenly treatments and approaches once unavailable in China are now there to be used by everyone. As she shows, the Communist Party in the end is all about control, and in its construction of a `loving, caring’ (guanai – 关爱) discourse, this too figures as a regime and set of discourses and practices that can be used to get people to behave in ways that favour the state. `In post-socialist China,’ she states, in a key sentence towards the end of the book, `it has become more apparent that psychological counsellors and other mental health workers are becoming a new form of authority’ (153). As Foucault pointed out, medical and psychological practices were, in the end, associated with forms of power, and it is these that the government has displayed interest in. Even so, `the therapeutic state’, she says a little later, `is not monolithic.’ It operates in this area much as it does in economics or administrative governance, often organically, allowing innovation and change, till solutions appear. And in 2017, in one fell swoop, the national accreditation process for counsellors was simply stopped, creating confusion, but not, Li argues, any restraint on the rich market for help that now exists in the country.

This is a timely and important study, rich in empirical observation, and conveyed in a human and accessible way. This is a hugely important issue, and one that will almost certainly prove a great point of convergence between China and the world outside. For all the differences, one thing is clear: in the age of raging against China as a predatory, threatening state posing multiple questions for the outside world, the simple fact is that people everywhere, inside and outside the PRC, are suffering from spiritual and mental health maladies. In this area, despite all the indigenisation, we are the same, and we can seek to work together better to sort out some common answers.