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    Therapy Via Text: In Rural China, a New Outlet for Troubled Teens

    Mental health is still stigmatized across the countryside, but with growing options online, therapy is slowly catching on.

    Every year, during China’s college entrance examination or gaokao, all that’s abuzz in the town of Hechuan in Yongxin County town in the eastern Jiangxi Province is the highest scores or admissions to the country’s top schools.

    If a local student makes it into one, neighbors and relatives bask in their success at banquets hosted by the parents. Sometimes, the community even hangs up a banner congratulating a triumphant student.

    But such “model students” are few and far between. In Hechuan, most teenagers are over-disciplined, subjected to excessive expectations, and constantly compared with their peers. All the while, their own efforts go unrecognized.

    Parents of such students care more about academic performance and class rankings than their children’s emotional wellbeing. Eventually, the sustained pressure to maintain high grades spawns hormone-fueled clashes between pubescent children and their parents. The result: “problem kids” and broken parent-child relationships.

    It’s why Hechuan’s teenagers are troubled. Some are burnt out, some are depressed, and others are addicted to online games. Many drop out of school to just stay at home, sleep irregular hours, and make little contact with the outside world. To break the habit, their parents eventually force them into counseling.

    That’s where mental health professionals Shu Huai and Weiwei come in.

    Originally from Yongxin county, both women say their own personal struggles inspired them to join the profession. Shu and Weiwei also add that in providing the town’s residents with the urgent counseling they need, their own lives have changed for the better too.

    In urban China over the last few years, mental health is now generally recognized as a problem on par with any physical disease. But across vast rural swathes of China, the field is still heavily stigmatized, and the psychological wellbeing of teenagers is particularly dire.

    Although problems manifest in different ways, they often share similar root causes, say both counselors. In Shu Huai’s observations, it’s either that the parents are overbearing or that the kids lacked companionship when they were younger.

    Acquired Empathy

    Five years ago, Shu Huai was a middle-school Chinese language teacher popular with her students. But like many of Hechuan’s parents, raising her own daughter proved a challenge.

    Shu was always eager to excel when she was growing up and, as a mother, imposed similar expectations on her daughter. She would sometimes even stand and watch over her daughter’s shoulder as she did her homework.

    In stark contrast to herself, Shu says her daughter is naturally undisciplined. Her grades in elementary school were good but declined in middle school. Since then, the gap between her and her classmates has only widened, leaving Shu often anxious and, at times, even angry.

    Shu admits her daughter attempted to confide in her, but only received a terse reply in return: “All you need to think about is your studies,” Shu would say. As time went by, her daughter eventually gave up trying to talk to her.

    This only increased Shu’s anxiety, first leading to insomnia and then a lack of appetite, which caused massive weight loss.

    That’s when Shu finally turned to a former mentor and psychologist for help, who suggested she study and obtain a counseling certificate herself to learn and adjust to her mental state. The entire process — from studying, to taking the exam, to officially becoming a counselor — took her just two months. Shu recalls hoping that her daughter might even follow her example in academics.

    Even after obtaining her certificate, she continues to study using audio and video tutorials online. A few years ago, she became particularly interested in psychoanalysis and began searching for case studies, theories, and books by well-known teachers.

    In the last couple of years, her interest in case studies has continued. Every now and then, she buys a package deal of courses and cases on multiple online platforms or makes appointments with professional supervisors to discuss cases they’ve previously encountered.

    Since Shu began working as a counselor five years ago, her daughter’s grades haven’t soared with the extra encouragement as Shu once expected. But then, her daughter’s grades aren’t as important to Shu either.

    As she counseled more and more troubled teens in Yongxin County, Shu slowly realized that her previous approach to education was unhealthy. From a mother who once only cared about grades, Shu is now willing to sit down with her daughter just to truly listen to how she feels.

    “The truth is that her personality has always been fundamentally different from mine. She’s not naturally competitive,” says Shu. “I was the one standing behind her pushing her. She was so young back then, and it couldn’t have been easy to bear the kind of burden I put on her.”.

    “I used to think that, as my daughter, she absolutely had to stand out from the crowd, but now I believe that what really matters is whether she’s satisfied with her own progress.”

    A teacher at a special education school in Yongxin County, Weiwei works part-time as a mental health counselor. Some children in her class have autism or cerebral palsy; some are intellectually disabled; others are deaf. Weiwei often feels that the thoughts and feelings of such children are more delicate than others.

    When she first started teaching, Weiwei recalls feeling uncomfortable. The children’s comprehension skills were poor, and no matter how many times she repeated herself, some seemed unable to remember what she taught. On occasion, she suspected the children did it deliberately to wind her up; sometimes, she was afraid it was because she was not up to the job.

    Unwilling to let her colleagues know how insecure she was, she recalls often crying in secret.

    Once, just before Father’s Day, Weiwei said in class: “Fathers all love us very much…” But before she could finish, a little boy abruptly burst into tears. She found out later that the boy’s father was a migrant worker in the city and came back home only once a year.

    She says deaf children would sometimes run over and ask her: “Teacher, some people were staring at me just now — do you think they were talking about me?”

    In them, she saw her younger, self-conscious, insecure self. Her parents were migrant workers, too, so she was sent to live with her uncle’s family, and they valued boys more than girls. Back then, only the headteacher of her elementary school class willingly listened to her feelings.

    Weiwei hopes to play the same supportive role for her students. After starting at the special education school, Weiwei wondered if studying mental health would give her insights into her students’ state of mind. This reflection inspired her to become a counselor.

    Since she began counseling part-time, she’s gradually realized: “These children sometimes don’t know that their behavior will make others angry, so their disobedience is not necessarily due to my lack of ability. I now think that the most important thing is not their grades, but that they enjoy coming to school.”

    She empathizes not only with the children, but their parents as well. On several occasions, she cried with parents as they explained their child’s circumstances at home. She believes that empathy is a two-way street. “When I show them I understand that it is not easy for them, they also understand that it is not easy for me as a teacher. It’s a reciprocal process.”

    The Divide

    Even by China’s standards, Hechuan is considered small: it takes just 20 minutes to drive across the town, and its population is less than 100,000. Mountains fence the town in on three sides, and its only link to the outside world is a long, narrow corridor to the north.

    With no high-speed rail, or even regular trains, people here rely either on buses or their own cars — it was connected to a highway only a few years ago.

    And just like most small towns across the country, it’s easy to see that education is paramount for the community. Within Hechuan’s area of just under 50 square kilometers are nine primary schools, six middle schools, and one vocational institute. But for further studies, the choice is limited.

    The closest city, Ji’an, is more than 100 km away and has just one university; the best in the province, Nanchang University, is at least three times as far. This is possibly why the town’s parents rarely hesitate to impose lofty expectations on their children, firm in the belief that only education can change one’s destiny.

    But when the stress takes its toll on students, desperate parents send their “bad kids” for mental health counseling. Shu Huai says parents primarily hope therapy will help their children become “good” and dutifully return to their studies, rather than caring about their psychological well-being.

    The county itself was officially declared poverty-free in 2018, and Hechuan is considered its most prosperous town. But according to Shu, left-behind children — kids of migrant workers left with relatives — in the county account for around 30% of the town’s students. And among the children who come to her for counseling, the share is closer to 60%.

    Shu says that due to low income levels in the county, some parents often accept contractual work in Guangdong, Jiangsu, or Zhejiang provinces to make ends meet. The moment the first child no longer needs nursing, parents leave to work in the city, only returning two years later to have a second child. Then, they go out to work again, leaving both children with elderly relatives.

    “The third grade is generally when children begin to cultivate basic learning and living habits — but, in the absence of parental guidance, these children often lack confidence,” says Shu.

    “When they reach middle school, their problems bubble to the surface: the boys fight, skip classes to play games in internet cafés, and form little gangs. Meanwhile, the girls are often distracted from academics, choosing to spend more time instead on their physical appearance and social relationships.”

    By this time, she says, such students completely exceed the control of their grandparents. Even if the parents come back home to discipline them, it rarely helps — their methods are often limited to beating and scolding the children.

    Ripples in the Pond

    When Shu Huai obtained her certificate, mental health counseling was virtually nonexistent in Hechuan.

    In-person consultation resources are still extremely scarce in the region: there are no psychiatric hospitals in the town and very few clinics offering psychological counseling in regular hospitals, let alone private psychologists.

    Most residents turn pale at the mere mention of the phrase “mental health”; if someone in the family develops psychological issues, however minor, no one dares speak out about it until they absolutely have no choice. Most believe the tiniest bit of “gossip” will quickly spread across the entire county.

    For those in need of therapy, the first step to finding a counselor near them is an internet search. They contact Shu Huai through the details mentioned on her website and public WeChat account, progressing to confide in her later through instant messages and phone calls.

    After making contact online, patients often make appointments to meet Shu in person. Most who request such offline meetings are uneducated parents worried about their children’s progress at school. “Maybe it’s because people in small towns only feel like they can trust you if they see you in person,” says Shu.

    She’s discovered that around two-thirds of her patients believe mental health counseling is a last resort. Seeking her out online and deciding to give her services a go takes great courage, she says.

    Shu once received a call from a man who worked in the city as a plasterer, who said his daughter back in his rural hometown had serious psychological problems. He asked Shu when she would be free, hoping she’d help his daughter.

    It was only when they met that Shu realized the man had decided to call because his daughter’s situation was so out of control that he felt he had nothing to lose.

    Consultations conducted purely online are a little more complicated. Shu recalls being contacted by someone who’d been urged to see her by his father. The young man had seriously limited social skills and was paranoid about always being watched.

    When he walked alone, he often had hallucinations that he was being chased and was terrified of being assaulted. Though he lived in Hechuan, Shu was unable to see him in person and could only communicate with him via text on WeChat. When Shu urged him to talk, he was totally uncooperative.

    Despite Shu’s best efforts to earn his trust, he only sent her a total of around 15 messages, most of them monosyllabic like “oh,” “okay,” or “alright.”

    About this experience, Shu says: “It’s really sad, but there’s nothing you can do.” Fortunately, since then, the young man has looked back over the messages she sent him, and has reported feeling better.

    Weiwei believes that in-person consultations help counselors better evaluate a patient’s personality and problems by observing their appearance, clothing, expressions, and mental state. It’s also easier for counselors to adjust their approach when they can see the patient’s reactions to questions in real-time.

    But in online consultations, Weiwei can’t be sure whether the patient really trusts her or how truthful they’re being. Through text-only conversations in particular, she can’t even accurately judge the patient’s tone or know how her own tone is received. This creates serious communication barriers, she says.

    Though Weiwei has only offered her services for a short time and hasn’t taken on many cases, she still insists on answering questions visitors leave on her platform.

    Though she can’t divine the psychological problems of the people around her, on the internet, Weiwei has discovered that ostensibly functional members of society may force a smile as they endure huge psychological burdens.

    “Sometimes I feel that this small town is like a closed lake; unless there’s a huge disruption, you don’t see any waves on the surface,” says Weiwei.

    “It’s only when people discover that someone in their family has a serious psychological problem, or when they hear a news story, for example, about a child jumping off a building, that they pay any attention to mental health. After all, people are more likely to care about things related to themselves. Even if they sometimes see one or two messages on their phones about mental health, it doesn’t leave a lasting impression unless the person is directly affected.”

    But the last few years have witnessed much change. With the internet’s capacity to bring people together, Hechuan’s residents have at least one vital outlet for their hidden problems.

    A version of this article originally appeared in Code for Life. It has been translated and edited for brevity and clarity, and published with permission.

    Translator: Lewis Wright; editors: Xue Yongle and Apurva.

    (Header image: Gary Waters/Ikon Images/People Visual)