A recent video of a chained woman has raised the alarm of the poor treatment of the mentally ill in China. It's worse for women in rural areas, where the stigma around mental illness is high.
Just before Chinese New Year ended recently, a video went viral on China’s web. In a shabby space attached to a house in Feng County in Jiangsu Province, a woman, named Yang Mouxia, is seen wearing a thin top in the chilly weather. She has an iron chain and a lock around her neck.
The woman has a mental disorder. She is the mother of eight children and the wife of Dong Moumin. Since the exposure of Yang’s living conditions, several people online asked if she is the same person, who went by the name of Li Ying, who'd disappeared from Sichuan Province 26 years ago at the age of twelve.
However officials in Feng County say Yang’s DNA doesn’t match with that of the missing teenager Li. The local authorities also deny that abduction is involved in Yang’s case, although they also try their best to prohibit journalists from approaching Yang’s family and have silenced any further reports.
Yang’s case has triggered public anger and once again stirred up dark memories of the not uncommon practice of trafficking women in China. There is no systematic research or database on the trafficking of women and children in China. According to Fan Yue*, a longtime activist engaged in gender-based violence, many women have become physically or mentally disabled due to violence or self-harm after their abduction. This makes rescuing them even more difficult.
When women become "burdens"
For many of those working on China’s health and mental disability issues, the experience of the Feng County woman does not surprise them, even if they are angry.
“Such misfortune is very common in the rural areas. These women are the most marginalized beings,” said Wang Ling*, who has conducted research on the situation of people with mental disorders in rural China.
According to Wang Ling, it is very common that old unmarried men in rural areas will marry women with mental or intellectual disabilities by paying higher betrothal money to their families. Abducted women also make up some of these brides.
Women with mental disabilities still possess biologically female features that are valuable to men.
Once married, these women’s situation will be worsened if they display aggressive behavior or an inability to manage their emotions. In the countryside where sex inequality and fertility discrimination are particularly serious, women almost always exist as “someone's daughter-in-law” and are very dependent on men.
Thus, how a woman is treated is “the other family’s business.” When a woman suffers a mental disorder and is incapable of claiming her rights, she is then regarded not as an attachment but as a burden.
“Locking her up so no incident occurs and just feeding her so she survives are considered as reasonable arrangements by the neighborhood,” stated Wang Ling.
Why are these women married if they are regarded as a “burden”? “In places with low incomes, even women with mental or intellectual disabilities still possess biologically female features, their uterus and vagina, and are thus valuable to men. Therefore, they are sold to rural bachelors,” explained Huang Xuetao, a well-known lawyer in advocacy for the rights of the people with intellectual disabilities and the founder of Equity and Justice Initiative in Shenzhen city.
Examples can be found in the fieldwork of various scholars, especially in rural areas where the idea of having a son to carry on one’s name is very strong. For instance, a farmer with physical disabilities once told Wang Ling that he had bought a girl with mental disabilities for twenty thousand yuan ($3,150) as the betrothal money. After she had given birth to his child, she was taken back by her parents and was remarried again with another man to earn some more bride price for her family.
The "unlocking" program
As psychiatrist Wang Hao* noted, a decade ago it was even much more common in the rural areas to lock up a family member suffering mental disorders.
Trying to counter this issue, the country launched the Severe Mental Disorder Management and Treatment Project subsidized by Central Government, also known as the “Unlocking program”, back in 2004.
In addition, according to the “Specifications for the Management and Treatment of Severe Mental Disorders”, a comprehensive management team should guide a patient care and support team to hold at least one regular meeting every quarter to fully understand the basic situation of the registered patients and families in the jurisdiction, and to solve the problems with regards to patients’ management, treatment and recovery.
But in practice, as the case of Yang Mouxia showed, the so-called management and treatment system has failed.
Various medical resources are concentrated in first-tier cities and then gradually diluted in accordance with the administrative levels. “Psychiatric resources in the third and fourth-tier cities are very scarce and their quality is far from ideal. In rural areas it’s even worse,” pointed out Dr. Wang Hao.
A failed approach to mental health care
As one person working in the system pointed out: “There are thousands of threads on the top, but I’m the only needle with a hole to go through at the bottom... We are expected to fulfill other highly important health care goals set by the superior authorities, and mental health is not at all the priority."
Multi-tasking also exists among grassroots doctors. As the front-line personnel in the management of patients with severe mental disorders in the countryside, rural doctors are at the same time involved in the implementation of 13 other national projects of basic public health services in addition to this task.
Safeguarding a person’s basic human rights needs is the responsibility of the whole society.
As one village doctor from Sichuan Province told Singapore-based Intium Media, he is in charge of the basic health services for 1,700 patients in the jurisdiction, and among them there are three severely mentally ill patients. But he admitted that he does not have the ability to diagnose and treat mental illnesses, nor can he even name the specific diseases of the three patients.
According to Dr. Wang Hao, what was originally designed as a national project to provide primary health care services to rural residents has been reduced to a “form-filling project” where doctors and related officials are only making superficial efforts to cope with the hundreds or even thousands of forms they are requested to fill in by their superiors.
Even in Jiangsu Province, which is considered to be an economically developed region, the official data shows, as of 2020, the number of registered patients with severe mental disorders in the province is 350,000, whereas the actual number of beds in psychiatry ward per 10,000 population is a mere 3.38. There are also only 3.09 psychiatric physicians per 100,000 population.
The stigmatization of mental illness
Stigma is also the cause of a prominent problem of the unequal rights of people with mental disabilities. “When people think of mental diseases, they immediately associate it with killers and violent behavior. Yet, in fact, just like Yang, the mother of eight children, she herself is the victim of violence. Neither the press nor the society has displayed positively the injustice they have endured,” said Wang Ling.
Right from the “Unlocking Project”, the idea of managing severe mentally ill patients is to regard them as risk factors. When Wang Ling first witnessed the patients treated within the “Unlocking Project” framework in a rural mental health facility, “My tears fell. I didn't think the people I saw were people. They were like caged animals in a zoo.”
Though she has been advocating the rights of people with mental disabilities for more than ten years, Huang Xuetao said bluntly to the media: “I have never dared to touch the human rights issues of this field in backward areas.” The simple reason is that in rural places “when supporting service is absent, those so-called rights protection are just empty words,” said the lawyer.
Nonetheless, Huang continued: “Safeguarding a person’s basic human rights needs is the responsibility of the whole society. And it is the only reason why the government needs to exist."
*At the request of the interviewees, Fan Yue, Wang Ling and Wang Hao are pseudonyms.