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This essay begins with the position that the controversy between Chinese and Western researchers over the nosological status of neurasthenia arises logically from their discrepant epistemological theories of disease. Next, it traces Chinese psychiatrists' continued effort to reorganize neurasthenia in a tradition that not only conforms substantively to Western cultural assumptions but also results in its transformation into the pro fessional discourse of "depressive neurosis. " Evidence is then gathered to show that the ICD-10 construal of neurasthenia as a chronic fatigue disorder misrepresents the inherently variegated illness experience of Chinese neurasthenic patients and may, ironically, commit a category fallacy. A plea for considering illness experi ence in psychiatric taxonomies ends the paper.

This volume presents how high performing education systems over the world are constantly innovating their educational policies to nurture their citizens for the challenges of the future economy and the anticipation of the unknown. This volume includes a state-of-the-art review of the literature in this field, several commissioned focal chapters focusing on the distinctive case of Singapore and internationally commissioned chapters of several other accomplished education systems around the world. A comparative study of Singapore against other high performing education systems is included to provide greater insights to the possible applications to other education systems

Background: Most studies agree that mental illness brings a heavy objective and subjective burden of care on the family and especially the caregivers. However, very little attention has been paid to the wider context in which this burden is shaped and sustained.Material: In-depth interviews were conducted with 11 caregivers in Hong Kong and Taiwan and subsequent analysis identified four major themes: mystical knowledge beyond understanding, persistent self-blame and lay explanation, inertia of caregivers and non-responsive service system, and unsatisfying encounters with medical staff.Discussion: The results of the study indicate that these families did not get the services they needed. In spite of recounting many system failures, most respondents attributed their situation to tragedy and misfortune at personal and family levels. Such a discourse is closely connected to a wider context of health and social care. The Hong Kong subjects complained more, felt more helpless, and had more persistent self-blame and lay explanation than the Taiwanese subjects.Conclusions: To reduce such experiences, this paper calls for inclusive policies for the family, new education strategies and reflections on the roles of mental health professionals in empowerment and advocacy beyond conventional treatment, counseling and education.

Although the predominantly somatic presentation of distress has been used to explain low rates of emotional illnesses and health service use in Chinese communities, this concept of somatization has not been examined by concurrently studying the profile of somatically and psychologically distressed Chinese individuals. A random population-based sample of 3014 adults underwent a structured telephone interview that examined their sociodemographic characteristics, somatic distress (Patient Health Questionnaire-15, PHQ-15), non-specific psychological distress (Kessler Scale-6, K6), health service use, and functional impairment. Four groups of individuals identified by PHQ-15 and K6 cut-off scores were compared. Results showed that PHQ-15 and K6 scores were positively correlated. The large majority of respondents (85.9%) reported both somatic and psychological distress. The proportions of Low Distress Group, Somatically Distressed Group, Psychologically Distressed Group, and Mixed Distress Group were 69.2%, 5.0%, 15.8%, and 10.0%, respectively. Specific age range, male gender, greater family income, higher education level, and retirement were associated with decreased odds of somatic and/or psychological distress. Although psychological distress best predicted impairment, somatic distress best predicted health service use. Mixed distress predicted most impairment and health service use. Thus, psychological distress and somatic distress commonly coexist across Chinese sociodemographic groups. This speaks against the conventional notion of somatization and is consistent with recent findings of a higher prevalence of emotional illnesses in Chinese people. That psychologically distressed individuals are more impaired but less inclined to seek help than somatically distressed individuals may partly explain low levels of help-seeking for mental disorders found in epidemiological studies.

Introduction: This study examined public attitudes toward Severe Acute Respiratory Syndrome (SARS) in Hong Kong three months after the peak of the 2003 outbreak in order to shed light on SARS-related complaints received by the Equal Opportunities Commission of Hong Kong. Methods: A cross-sectional telephone survey was conducted three months after the SARS outbreak of 1,023 randomly selected Chinese-speaking residents in Hong Kong. Results: Most of the respondents (72.2%) reported worry about contracting SARS. They attributed their anxiety to the perceived danger of the disease, the government's unsatisfactory style of crisis management, and inconsistent health information dissemination. The majority of respondents endorsed up to 3 avoidant (67.8%) and 3 imposing (72.7%) attitudes toward individuals and/or situations considered to be at risk of spreading SARS. Logistic Regression analyses indicated that the odds for avoidant and imposing attitudes increased significantly for those who were middle aged (35-54), employed full-time or part-time, and worried over contracting SARS. Conclusions: Public attitudes that endorsed avoidant and imposing behaviors were common during the outbreak of SARS. While essential for preventive health practices, they might bring about workplace conflicts, stigma, and other negative interpersonal experiences. These problems may complicate public health efforts to control the epidemic. They may also suggest ways in which societal preparedness for future emerging infections can be improved.

It has been estimated that there are now about 100 million economic migrants 'floating' in China's cities and towns. Although these rural people are subjected to profound discrimination vis-‡-vis employment, welfare, court-ship and legal rights, their mental health problems are largely unknown. The present study examines retrospectively the psychiatric morbidity and treatment of 112 migrant workers who were hospitalized in the only psychiatric hospital in Shenzhen, China's first special economic zone, over a 2-year period. The most common reason for hospitalization was socially intolerable behaviour and the most common diagnosis was schizophreniform psychosis. More female than male patients seemed to have social precipitants, which were most commonly labour conflicts and love or marital problems. Most patients improved with treatment but, because of the lack of health insurance coverage, 25% of them were discharged against medical recommendation. Since access to health services for less socially disruptive psychiatric disorders among migrants is greatly limited, empowering social and health policies are essential for enhancing their health status. The findings of the present study challenge the Chinese state as to how far it should pursue rapid economic growth without giving adequate attention to its adverse impact on the nation's health and health care.

Although gastrointestinal and other somatic symptoms are common in patients with anorexia nervosa (AN), and a growing cross-national literature indicates that not all anorexic patients exhibit the core diagnostic symptom of fat phobia, the relationship between somatic symptoms and anorexic illness remains unclear. Our objective was to evaluate gastrointestinal dysfunction (GD) in Chinese patients with fat phobic (FP) and nonfat phobic (NFP) anorexia nervosa. A total of 113 FP- and 28 NFP-AN outpatients underwent standardized clinical assessment and completed a new 8-item GD scale and other psychopathological measures. A majority (79.4%) of AN patients reported at least some gastrointestinal complaints on the GD scale (Cronbach's alpha = 0.78). FP-AN patients scored significantly higher than NFP-AN patients. The FP-AN with high GD group reported a higher level of specific and general psychopathology than the FP- and NFP-AN with low GD groups. Contrary to expectations, gastrointestinal symptoms were more common in FP-AN than NFP-AN patients. FP-AN with high GD was more severe than FP- and NFP-AN with low GD. The current fat phobic conceptualization of the anorexic illness may overlook its phenomenologic heterogeneity and reify a dichotomy that is inconsistent with patients' varied experience of food restriction.

Deep China investigates the emotional and moral lives of the Chinese people as they adjust to the challenges of modernity. Sharing a medical anthropology and cultural psychiatry perspective, Arthur Kleinman, Yunxiang Yan, Jing Jun, Sing Lee, Everett Zhang, Pan Tianshu, Wu Fei, and Guo Jinhua delve into intimate and sometimes hidden areas of personal life and social practice to observe and narrate the drama of Chinese individualization. The essays explore the remaking of the moral person during China's profound social and economic transformation, unraveling the shifting practices and struggles of contemporary life.

Background: Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants. Method: One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested. Results: FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy. Conclusions: Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.