Four Questions
Looking from this dual perspective, four crucial questions emerge.
First, how does the history of Chinese culture influence the intimacy of family life today?
China has an ancient history – more than 2,500 years – of explicitly valuing the family as the fundamental unit of social structure, a building block in each community, which is a fundamental Confucian tenet. It depicts a defined hierarchy that extends from loyalty to the emperor, to the father, the son and the whole family, and then to the surrounding social group. The configuration of this loyalty to the family and group was challenged by the social restructuring of the Communist Party beginning in 1950, then again with the imposition of the One Child Policy 30 years later, by the opening up of society of the 1980s, and again now with the ending of the One Child Policy. We do not know how this will change Chinese families going forward, but the experiences I chronicle in this book can give us a good start towards that understanding.
Second, how do the large-scale social factors influence developments inside the family, and how will these family developments, in a reciprocal way, influence the social changes to China as a nation?
China has a history of repeated social and personal trauma dating back more than 200 years. Therefore, national trauma is a central feature of modern Chinese history, from the Opium Wars caused by the imposition of the opium trade by the Western powers from the eighteenth century into the late nineteenth century; the overthrow of the final Qing Dynasty early in the twentieth century; the fight between the Kuomintang and the Communist Party, interspersed with Japanese invasions that began at the end of the nineteenth century and continued into the first half of the twentieth century; and a combination of famine and cultural disruption from the late 1950s until the mid-1970s. And, of course, there have been large scale natural disasters such as the Tangshan, Sichuan and Yunnan earthquakes over the last 50 years that caused widespread harm in focused geographical regions.
In the midst of all this, China has been rapidly urbanizing, going from a predominantly rural society in the mid-twentieth century to a predominantly urban one now. Current internal migration and rapid urbanization, the expansion of internet-driven social connectedness and the explosive growth of what already is or will soon be the largest middle class in the world all produce disruptions to family and economic life in the transition to modernization. These changes cause further strain to families, and in turn, the family strains inevitably wash back into society. We will be examining many couples and families in detail in order to see the impact of these large-scale issues on family life.
Third, how do the current challenges facing young families and couples have an impact on emerging Chinese culture?
Many news articles focus on the growing power of internet culture and the plight of netizens everywhere. But the challenges facing Chinese families extend more importantly into the usual areas of how best to use education, plans for their own new and emerging families, the changing picture of employment from predominantly state-owned enterprises to private employment and the future in a society that will increasingly have a population top-heavy with elderly, dependent citizens. The challenges facing young people include whether to marry at all, whether and how many children to have, how to include much-needed help from grandparents in child-rearing and then, very soon, how to provide for those same grandparents as they age and are no longer self-sufficient. As we will see, these are both widespread social issues and very personal matters for families. Care of the elderly, for instance, is a problem for the young parents we have seen, and it will be even more of a problem for their children as these very couples age over the next 30 years.
Fourth, and finally, how can we help our Chinese colleagues more effectively serve the mental health needs that are currently emerging?
A major feature of this book is the detailed exploration of clinical issues and the questions they raise. It is not that I and my Western colleagues can presume to personally treat the large numbers of couples, families and individuals who seek help in China. Partly it is a sign of an increasingly mature country that more couples and families do seek help, just as this is true in the West. It is a sign of the maturation of the mental health system that it understands the needs and strives to face the challenges inherent in meeting those needs. Rather, the question is how can mental health professionals like me use an enhanced understanding of China’s social system and of individual Chinese patients and families to further enable our Chinese colleagues to better serve their individual, couple and family patients who come for help, just as our patients need help in the West and just as we continually strive to enhance our understanding of patients at home?
These four overarching questions have guided me in writing this book, and I will periodically come back to them as the book documents my attempt to understand more about China through a clinical and social lens.