China's quake survivors: Counselors offer patience and encouragement
A gargantuan task – some 2 million are said to need psychological care – is complicated by stigmas attached to mental illness.
Zhang Boxi leans solicitously toward the old woman weeping softly as she speaks. From time to time, he offers her a few encouraging words. Mostly, though, he just listens.
Dr. Zhang is one of some four dozen psychological counselors working in Sichuan Province's temporary housing camps, seeking to give solace to survivors of last year's earthquake.
It is a gigantic task: Zhang Kan, one of China's top psychologists, estimated that 2 million quake victims were in need of some sort of psychological care after the disaster. Zhang Boxi and his colleagues have so far reached 200,000 of them.
For many, counseling remains taboo
It is a task made harder by the fact that most of the victims are relatively uneducated country folk, for whom mental illness is taboo and psychological counseling means nothing.
"Our office sign does not say that we do psychological counseling," says Zhang, a young volunteer from the city of Tianjin, near Beijing. "We offer 'tutoring,' because people won't acknowledge that they have psychological problems."
Many do, of course, after a tragedy which killed an estimated 80,000 people and left millions homeless. Although "95 percent of survivors recover by themselves after a few months," says Zhang, "5 percent cannot."
Some suffer from depression, explains Fu Chunsheng, deputy director of the Mianyang office of the government-affiliated Chinese Academy of Sciences project for which Zhang works. Others show symptoms of post traumatic stress disorder.
"They are always thinking about the earthquake, but they avoid talking about it," Dr. Fu says. "They are on edge, very alert; even a tractor driving by will scare them."
Giving people space to talk
The elderly lady with whom Zhang talked on a recent visit, and whom he asked to be identified only as "Granny Fu," initially said she did not want to talk about the earthquake. Zhang did not insist.
Granny Fu lost her husband, a daughter, a son, and a grandson in the quake. "I feel better when I don't talk about it," she said. "Whenever I do the memories come back."
Scarcely had Zhang sat down in Fu's cramped but impeccably tidy room in her barracks-like row of temporary housing, however, than she gave vent to her memories.
Whenever she mentioned something positive – a surviving grandchild's facility for English, for example, or her third daughter's pregnancy – Zhang gently pounced on the nugget of good news and played it back to his patient in a heartening comment. Occasionally he raised a wan smile.
"I just listened, and if I caught anything positive I'd remind her and reinforce it," Zhang explains later. "It would be better if the victims could talk to neighbors and friends about their feelings, because their support is better than ours. But it is quite common that they don't want to talk to each other. They still can't."
Aid workers, officials, get help, too
The counselors with the Chinese Academy of Sciences program are working not only with ordinary citizens, but also with especially vulnerable groups of people who have been on the front lines of the disaster's aftermath, such as doctors and nurses, teachers, and local officials.
Last month, Feng Xiang, the deputy head of public affairs for Beichuan, one of the worst-hit towns, hanged himself. He was unable, it seemed, to bear the pain of his young son's death and the burden of his workload, "and he never expressed his feelings to his wife or his friends," says Fu.
Mr. Feng was not the first Beichuan official to commit suicide.
"Civil servants are under particular pressure," explains Fu. "People want to know where their permanent houses are. They compare their situation with other people's, and they complain if they are not happy. Feng had lost a son, and he got no rest. We've found that civil servants are often too busy to see us."
Follow-ups could last several years
Many ordinary people, meanwhile, are too ashamed or uncertain to approach the psychologists. "People would not come to us voluntarily," recalls Zhang, "so we distributed questionnaires and screened all the victims. We've done that three times now. If someone shows signs of problems we will visit them and say we have heard they've been upset recently."
Those follow-up visits could go on for five years, experts say, drawing on the experience of natural disasters elsewhere that shows how problems can suddenly erupt in previously untroubled survivors.
Even so, a lot of potential patients will likely slip through the counselors' hands, given how understaffed their project is. "We could have another 10 counselors here and it would not be enough," complains Zhang, who ministers to the 5,000 residents of this temporary camp with the help of two other psychologists.
There is one hopeful sign, however, Zhang says. After several months of work "some patients are beginning to come here voluntarily to talk to us, and telling their neighbors that the doctors can help. That is a great thing."