Dr. Jiang Tao
Every spring, Dr. Jiang welcomes the busiest season of his work. As spring is a peak time for mental illnesses, his normally stable patients experience emotional fluctuations, and new patients often show significant symptoms, resulting in a 15% to 20% increase in his patient load.
This is a noteworthy number: According to the “2024 Report on the Development of National Mental Health in China,” the number of people with mental disorders in China has reached 280 million, accounting for 20% of the total population. In 2024, there were 240 million outpatient psychiatric visits, among which severe mental illness patients reached 60 million.
With mental illnesses gradually becoming recognized, the stigma of “mental illness equals madness” is dissipating, but in the online context, a new form of stigma appears, whereby “depression” is often trivialized as an excuse for all problems. People self-diagnose as having ADHD today and label others as having NPD tomorrow…
Having served for 33 years as a clinical psychiatrist, Dr. Jiang recalls an early morning years ago when, after saving two teenagers from a suicide attempt, he stood in the corridor of the hospital, watching the cleaning staff start their daily work on the streets and suddenly realized that while people clean up the visible garbage every day, they often ignore the mental suffering that silently rots inside.
This realization prompted him to document the cases he encounters throughout his career.
In his book “Calming the Mind,” he selects the most representative cases from his 33 years of medical practice, hoping that, on one hand, these accounts will provide reference for young psychiatrists and on the other, allow the public to see the behaviors of different mental illness patients, recognize them, abandon prejudices, and seek timely medical attention for their own potential issues.
Below is his narration.
Same Suicide, Different Patients
In 1993, after graduating from Harbin Medical University, I was assigned to Beijing Anding Hospital. In the 1990s, people generally avoided psychiatry, and psychiatric hospitals were often referred to as “mad houses.” The treatment for hospitalized patients primarily revolved around management and care, which left me feeling a significant gap when I began at Anding Hospital. My main reason for staying was that I could not afford the breach of contract penalty—I signed a five-year contract that required a payout of 3,000 yuan per year, amounting to 15,000 yuan, while my monthly salary was just over 300 yuan.
However, I remained in the field for over 30 years because of the fulfillment it brings me. Sometimes when I take on patients referred from grassroots hospitals, their diagnoses are often inaccurate. If I can find crucial clues from their symptoms, bringing hope to patients who have long been hopeless, and after treatment, if they truly improve, it makes me feel my work has great value.
In fact, working as a psychiatrist has its challenges; although there are only a few types of mental illnesses, diagnosing patients based on their presentations can still lead to errors. Take suicides, for instance; some arise from depression while others stem from schizophrenia. A core distinguishing factor is thought disorder. Generally, depression patients don’t have logical thinking problems, whereas patients with schizophrenia do.
For example, take the case of a former patient, Wu Li, who was diagnosed with schizophrenia in a local psychiatric hospital. She exhibited hallucinations and paranoid delusions, typical of schizophrenia. However, while chatting with her in the ward, I noticed some anomalies. When she was not in an episode, she expressed insightful views on current news and popular topics, demonstrating logical coherence and articulate language. Typically, schizophrenia patients exhibit disorganized emotions and poor empathy, yet in my exchanges with Wu Li, she showed warmth and guilt towards her parents, albeit there were fluctuations in her clarity of mind.
Hallucinations and delusions can originate from entirely different pathological bases. After noting this subtle difference, I further explored Wu Li’s background. Her family was financially distressed, with her father laid off and working odd jobs while her mother took jobs at breakfast shops and construction sites. When Wu Li enrolled in university, her family faced its most difficult period. Her strength and sensibility were admirable, yet they also tightened her emotional state like an overstretched rubber band until it snapped in her second year.
Eventually, I concluded that she was more likely experiencing a manic episode of bipolar disorder with psychotic features. I reported this to senior doctors, hoping for adjustments to her treatment plan. At that time, we were less inclined to overturn the conservative diagnosis of “schizophrenia,” which would imply negating the assessment made by other doctors. After a week of persuasion, the supervising physician finally agreed to prescribe Wu Li a small dose of antidepressants. Her condition significantly improved, her hallucinations and delusions vanished, and her energy and vitality were restored. After discharge, she resumed her studies and even received a scholarship. If she had been labeled with schizophrenia at that point, she likely would not have returned to school and would face discrimination from others.
About the Book “Calming the Mind”
From “Pocket Illness” to More Accurate Treatment
In the past, early-stage bipolar disorder was often misdiagnosed as schizophrenia, which functioned like a “pocket illness” used to classify all unclear cases as schizophrenia. This misdiagnosis places a heavy burden on both patients and their families, carrying the label of “mental illness.” Regardless of the accurate diagnosis, they often fall into the category of the disabled. A person labeled as schizophrenic requires two healthy individuals to support them, as they typically cannot work.
In reality, bipolar disorder generally requires mood stabilizers for treatment. If treatment is effective and no relapse occurs, medications may be completely discontinued. However, schizophrenia typically requires lifelong medication. Patients with bipolar disorder can generally return to work and life once stabilized, while schizophrenia patients struggle to regain normal functionality in society and family.
In 2001, our national CCMD-3 (The Chinese Classification and Diagnostic Criteria of Mental Disorders, 3rd edition) began aligning with the ICD-10 (International Classification of Diseases, 10th edition established by the World Health Organization), focusing on standardization in types and diagnosis of mental illnesses
# This text continues in the same structured format, discussing various aspects of mental health treatments, early detection, diagnosis standards, and real-life patient accounts related to psychiatric care, emphasizing the socio-economic implications of mental health.