Beijing, May 14, 2001: Greetings from China!

Believe it or not, although I am having a wonderful experience and being exposed to many, many new things, I also find time to think of CHARG and all my friends and relatives back home and hope you are all doing well. It is a little strange to be so out of touch!

Our Colorado mental health delegation landed in Hong Kong on May 12 after a 14 1/2 hour flight from L.A., then departed a couple of hours later for Beijing, where I have been ever since. It is a new experience for all of us who are used to being honchos in the mental health field to be herded around by our tour guides, but they are a tremendous help and without them we would be quite lost! Beijing is hot and the air is full of either smog, haze or dust - explanations vary - but it is very impressive. In many ways quite converted to capitalism, with McDonald's, Starbucks, and modern skyscrapers with corporate names up in neon. Our hotel is very much like a fancy hotel in the states, even to the fact that we can get CNN and Fox Sports on the TV in our room. English is everybody's second language here, and the signs around the city are usually in both languages. Good thing, because my spoken Chinese is limited to an attempt to say hello, thank you and goodbye.

In other ways we are clearly in a very different culture. Bicycles everywhere (Beijing has 13 million people and 9 million bikes), including some with one wheel in front and two behind, more often than not carrying unwieldy loads of strapped-on boxes containing who knows what. Beautiful temples throughout the city. Went to Tiananmen Square and it is as huge as they say, with a big picture of Chairman Mao looking benevolently down from the gate into the Forbidden City. We arrived on a weekend and spent the first couple of days doing tourist things - Tiananmen, the Forbidden City, the Summer Palace, and of course the Great Wall which was totally awesome (a good chance to use that phrase without exaggeration), a strenuous but rewarding climb. Everywhere people try to sell you souvenirs - even more persistent than those guys you see on Mexican beaches. Food is delicious and invariably served family-style on a huge lazy Susan in the middle of a round table. Just grab whatever you want from the dishes that keep appearing.

Today was the first day for professional visits and dialogues. In the morning we visited the student counseling department at Beijing Normal University (which means Beijing Teacher's College). Very friendly discussions with three women about how they work with students who have problems, especially depression or suicidal tendencies. They work to prevent suicide by mobilizing community resources rather than coming in with professional "interventions" or involuntary treatment. Thus, they talk to peers and family members about keeping an eye on someone with a problem. Not unlike the supportive community we have at CHARG. They make a very clear distinction between "mental health issues" (major mental illnesses requiring medical treatment) and "psychological problems" (generally, adjustment issues, anxiety, OCD etc.) Most of their psychiatrists seem very familiar with DSM-4.

Some of the social/cultural roots of the problems their students face are interesting. The "one child per family" policy, for example, which was instituted for population control, has resulted in a generation of students who are unused to being in larger groups, which adds to the culture shock when they enroll at the university. I asked a question about lesbian or gay students - are they accepted, do they face discrimination which increases risk for depression or suicide? The reaction was an uncomfortable one - the Chinese professionals didn't seem to want to talk about this issue and in fact seemed unaware that there was much homosexuality if any on their campus. It was clear that gay/lesbian students would try their best to keep their preference a secret - in fact, it is still considered illegal. I expect this issue will emerge for them in the years to come.

This afternoon we visited the Beijing University Institute of Mental Health, a public hospital with general adult, children's and geriatric wards, plus a special "VIP" ward for foreigners and patients with lots of money. Our hosts had special interest in ADHD and substance abuse issues. I promised to send them some information from Dr. Dodson's presentations at the recent CHARG conference, as they have very little information about adults with ADHD, though they are aware of the potential problems. ADHD itself has only recently been recognized as a disorder. Alcoholics Anonymous is also only a few months old, and was brought to China by one of the women we met, who learned about it at a conference in Minnesota. In general, our hosts seemed very well informed and aware of the challenges they face - including the fact that psychiatry is not a popular branch of medicine here. There are only 10,000 psychiatrists in the whole country of 1.3 billion people. They do utilize some traditional Chinese medicine approaches, especially when problems are relatively minor, as side effects are thereby essentially avoided. We observed a patient at the hospital receiving electric acupuncture with low-voltage needles, and were told it has been effective in reducing depression and schizophrenic hallucinations.

I had better log off for now before I rack up too much more debt to the hotel business center. An hour on line comes to 180 Yuan which is about $20-25. We visit a high school tomorrow, go out to eat Peking Duck tomorrow night, then the next day head on to Xian in central China. In Xian I will get to do a brief presentation about CHARG and our empowerment ideas, which I am looking forward to. The people we will be talking with there are the ones on this trip who work most specifically with consumers who have schizophrenia and other major mental illnesses. I hope Harold Maio would approve of how I am describing them!

I will try to send more in a few days. Keep the home fires burning, and I will hope to be talking to many of you before long! David

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May 18, 2001

Greetings to all! The experience in China continues to be even more than I could have hoped for. For the last few days we have been in the city of Xian, the ancient capital of China located right in the geographic center of the city. We combine sightseeing and professional activities and are getting to know each other well as a group in addition to learning more and more about the Chinese people and culture. The people are incredibly friendly and outgoing and don't seem to care at all that our respective governments are at odds!

This is the city where I had the chance to meet with a group of people from a local mental health center and hospital and tell them about CHARG. They were very interested and commented that there is really nothing comparable here. They did try developing jobs for their mental health consumers and it worked for a while (selling things that they made) but they had to discontinue it when they couldn't make it work financially. This developed into a conversation about Colorado's Consumer Case Manager Aide Program that RATC does. There was a lot of good give-and-take discussion. I left them with several of our new brochures (congratulations to the consumers whose pictures we used; your likenesses are now being passed around in China!) and also copies of the article we had published.

The mental health center also has several interesting programs using acupuncture, brain wave therapy, and a blood oxygenation project, all of which we saw in action. I can tell you all more about how they worked and our reactions to them when I see you. They do use Chinese medicine and herbal treatments, but seem to rely more heavily on the same meds we use - risperdal, olanzapine, etc.

Time for me to go - leaving for the next city of Guiyang. We visited the famous terra cotta soldiers here yesterday, which I don't have time to describe but I brought a nice book back!! Love to all, David

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May 19, 2001

Hello CHARG friends, I am now in Guiyang which is a fascinating city set among dramatic hills in southwestern China. Much less westernized than any other place we have been. Western tourists are a distinct oddity. Tonight three of us decided to forge out on our own - after a taxi ride downtown we ended up at a great restaurant where nobody spoke a word of English and the menu was all in Chinese. They kept looking expectantly at me (the only man, hence of course the one in charge) and I finally located a few words from my phrase book and my guidebook like "dumplings," "chicken," "vegetables," "meat with noodles," etc. and they returned with a FEAST which was the best food we have yet had in China. Everybody in the restaurant was delighted with us and many pictures were taken, many toasts including one with mao tai, an industrial-strength item which I can still feel in my belly. On the street we encountered a couple who were getting married and they insisted on pictures with us. Etc. etc. - we are quite an attraction.

We have not had any professional visits since my last email. Today was a travel day (more "Red tape" than we are used to at home, but overall our tour guides do a great job of shepherding us through baggage check-in, getting on our planes, etc.) and now the weekend is here so we will be tourists until Monday when we visit a couple of more mental health facilities. Tomorrow we will be driven for a couple of hours through some reportedly beautiful scenery to see the highest waterfall in Asia. I continue to have a very rewarding experience and am in love with the spirit of the Chinese people. I am incredibly grateful to have had the chance to have these experiences. Thank you to all who are keeping the ship afloat in my absence, Margie, Laura, Jennifer S. (who had all of a week to get to know me before I disappeared) and all the rest of you who I don't have time to name but you know who you are!

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May 21, 2001

I continue to enjoy my stay in the beautiful city of Guiyang in south-central China. We got here on Saturday, and yesterday (Sunday) went for a long bus trip to the highest waterfall in Asia. It was awesome, as you Might expect! This area is beautiful and makes me think a little bit of Denver - Guiyang is 6,500 feet above sea level, and it is in a region which is so mountainous that only 3% of its land is flat. They are masters at building terraces and grow lost of rice. The views of water buffaloes pulling plows through the rice fields is classic.

Today we visited the Psychiatric Division of the Guizhou Medical Institute and Hospital. We were divided into two groups, one focusing on "psychiatric" issues (i.e., major mental illnesses requiring meds), and the other on "psychological" issues (those problems we would treat with counseling/therapy). These two areas are much more separately defined than in the U.S. I asked them what ideas they might have about integrating hospital treatment with community=based services, and this led into a discussion of their limited efforts (to date) to utilize their "neighborhood committees," which address general needs, birth control, neighborhood cleanup, etc., to better refer and track people with mental illness.

Then this afternoon we visited Guizhou Normal University and had probably our most positive interactive experience yet. We were ushered into an auditorium to general applause from our professional hosts and a large number of students (30-40). Very interesting presentations from our hosts who were quite candid about some of the challenges of promoting mental health within the Chinese culture. For example: pressures of limited living space increase stress and make intimacy difficult for couples. Stigma of the mentally ill is reinforced by the stereotype of the "madman" and the use of certain derogatory words. The English "abnormal," for example, translates to a Chinese word meaning "disgusting or bad." "Drug" becomes "poison!" The shyness of Chinese people in social settings makes group therapy difficult. The image of the doctor is also different: they are not viewed as scientists (as in the U.S.) and are closer to the daily lives of their patients. On the other hand, however, they are trusted perhaps too much, sometimes virtually worshipped, and there is a strong belief that the doctor should be strong and decisive and the patient passive (sounds familiar).

We heard about "traditional Chinese medicine" approaches such as acupuncture and herbal treatments, which are sometimes jealously kept secret and passed down within families. The dominant model is Western medicine, and there is much arguing back and forth between Western medication-oriented treatment and the traditional Chinese methods.

Two students from the university came to my room afterwards and talked with Frank Gordon (my roommate) and me about lots of topics. It was great to have such a personal interaction with such friendly and engaging people ... which could be said about practically everyone we have met!

Tomorrow we leave for Hong Kong, where I will just be a tourist for a couple of days. The professional part of the trip is over and several of the delegation members are heading straight home tomorrow. We had a farewell dinner tonight which was attended by some of our Chinese hosts. This may be my last message back to the CHARG website, so I take this opportunity to say it has been an even more wonderful experience than I had imagined to be here, but I am also looking forward to seeing everyone again before long!

Your faithful correspondent, David

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