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I requested that Nicholas Eberstadt print his important essay in this journal because it summarises the most important large-scale trends in China's demographics that give China its current profile, and that point to population problems and vulnerabilities for the next twenty to thirty years.
Psychotherapists and psychoanalysts usually ignore such large trends within their own societies, focusing instead on the intimacies of suffering in individuals and families that seek their help directly, leaving policy worries to others. I remember the metaphor from my medical school days of the doctor in the emergency room who fixes broken leg after broken leg, never thinking about the hole in the sidewalk outside the emergency room door into which unsuspecting victims fall one after another. The metaphor is comparable to the current problem of treating one addict after another without attention to the flood of excess painkillers that creates epidemic addiction. As mental health practitioners, we need to attend to the social context that drives the individual suffering we treat.
In China, large-scale changes in population trends and government policies constitute this context. Even while in China, as throughout the world, psychotherapists cluster in urban centres and a majority of psychotherapy patients are better educated with better incomes, much of the worst suffering goes on in rural areas or in poor urban settings. At the very least, we need to be aware of the skewing of mental health needs and the forces on individuals and families that produce mental health vulnerabilities, even if many of the individuals who find their way to us are protected from these vulnerabilities by their relatively privileged status.
Nicholas Eberstadt's fine essay points to trends about which many analysts and therapists working or teaching in China will have some awareness. The point is that taken together, they outline the sweep of major vulnerabilities in China's future. These large-scale socia