The psychological weight of lockdown

Podcast

Dr. George Hu, a clinical psychologist based in Shanghai, discusses the state of mental health in Chinese cities under lockdown.

Illustration by Derek Zheng

Below is a complete transcript of the Sinica Podcast with George Hu.

Kaiser: Welcome to the Sinica Podcast, a weekly discussion of current affairs in China, produced in partnership with SupChina. Subscribe to SupChina’s daily newly designed China Access newsletter to keep on top of all the latest news from China from hundreds of different news sources. Or check out all the original writing on our website at supchina.com. We’ve got recorded stories, essays and editorials, great explainers and trackers, regular columns, and of course, a growing library of podcasts.

We cover everything from China’s fraught foreign relations to its ingenious entrepreneurs. From the ongoing repression of Uyghurs and other Muslim peoples in China’s Xinjiang region to China’s travails as it wrestles with a surging wave of COVID-19. And that’s actually what we’re going to be talking about today. It’s a feast of business, political, and cultural news about a nation that is reshaping the world. We cover China with neither fear nor favor.

I’m Kaiser Kuo, coming to you from Chapel Hill, North Carolina. Listeners to the show might recall an episode that Jeremy and I taped back in November of last year with a Shanghai-based clinical psychologist named George Hu. I really enjoyed that and apparently many of you listeners did too, to judge from some of the very kind emails we got after that show dropped. Well, as you are all doubtless aware, a lot has changed in Shanghai since we spoke six months ago.

Shanghai has had to endure one of the longest, strictest, and least competently administered lockdowns that China has faced since the initial outbreak of COVID in Wuhan in late 2019. It would be surprising if that ordeal hadn’t made an impact on the mental health of Shanghai residents. I should hasten to add that Shanghai isn’t the only Chinese city to experience lockdowns since the current wave of Omicron has started spreading in China.

Over 40 cities in China as of May 10 were in either full or partial lockdown, or had implemented some district control measures. This is according to my colleague, Nandini Venkata, who told me that on the Caixin-Sinica Business Brief, which she co-produces with me. I’ve asked George to join me again from Shanghai to talk about how the pandemic and the lockdown are affecting people in China.

Dr. George, who is a clinical psychologist and president of the Shanghai International Mental Health Association. George leads the United Family Mental Health Network in China and practices at United Family Hospitals’ Pudong Hospital, down there in Shanghai. George, welcome back to Sinica and great to see you.

George Hu: Thank you. It’s so good to be back. Thank you for having me. Especially, during such a unique time that we’re in.

Kaiser: The pleasure is all mine. George, before we get started. Thank you, first of all, for the excellent recommendation that you made last time. The book Crazy Like Us by Ethan Watters. I actually read it like straight away after talking to you.

A lot of the issues related to culture and psychology that we touched on last time. While we’re focusing in this episode on the specific circumstances of lockdown, we’ll still touch on some of this stuff. I only wish I had read that thing before I had spoken to you last time.

George: It’s a great book.

Kaiser: Anyway, George, maybe let’s start off with your own family’s situation there in Shanghai. When did you guys get locked down and for how long? Were you able to get basic supplies and stuff like that?

George: We have been actually locked down, my family and I, since mid-March. As you know, Shanghai started a citywide lockdown in two phases on March 28. That was supposed to be for four days, for the district of Pudong, on March 28.

And then, Pudong was supposed to lift this lockdown and Puxi on the other side of the river was supposed to go into lockdown on April 1 for another four days. And then, that was supposed to be the end of it. But as you know, Shanghai was actually going through a series of rolling lockdowns even before March 28.

Kaiser: Right.

George: In which different compounds, or xiaoqus (小区 xiǎoqū) as we call them, were going into lockdown in a rolling fashion in order to test the whole city. We’ve actually been in lockdown since mid-March, so it’s been a couple of months already for our family.

Kaiser: Wow. My God. Today’s May 17. Or the 18 for you all over there.

George: Yes.

Kaiser: It’s already been two full months.

George: Yes.

Kaiser: How awful.

George: Yes. It’s been two full months. To answer your question about, “Were we able to get supplies?” For the first week or two, it was shaky. I’ve got to say. For the first week or two, it was new. The lockdown was new. People were getting used to these tuangou (团购 tuángòu), or group buys, as we call them. People were not adequately prepared. Because it was, as you know, supposed to be a four-day lockdown that got extended.

And so, many people prepared for four days and were not prepared sufficiently afterwards. Food deliveries were interrupted the government or the neighborhood committees, or juweihui (居委会 jūwěihuì) as you call them, had not come up with systems adequate for food delivery to all the households that they managed.

For the first couple of weeks, it was pretty shaky. Now, I think it’s largely stabilized for the majority of the population. As we’ve gotten used to the group buy systems, as we’ve gotten used to using different platforms to order food, and as some suppliers have been able to open up and make more deliveries. Things have gotten a little bit better.

Kaiser: That’s good. That’s good to know. Shanghai is now claiming that they’ve basically squashed any community transmission of COVID-19 in 16 major districts of Shanghai. Are we pretty confident that this means a broad reopening pretty soon? You hear about sporadic openings of businesses and things like that. How’s it over there in Pudong for you?

George: Your guess is as good as mine on that. Every day, there’s new rumors about things that will open. Honestly, in terms of ourselves and my family in the neighborhood that we live in, we haven’t seen any real change. I’ve been privileged enough to be able to come to and from work every day as a healthcare worker.

I’m actually sitting in my office right now, having commuted over here from home, but many have not been able to do that. Many have had to either work from home. Or as we here in the hospital … Up to 200 staff members here are sleeping here every night, in order to ensure that the hospital can continue to run.

I have noticed, in my daily commute to and from work, that blockade and road barriers have been going up. New ones every day, which makes my morning commute route to work different every single time. I have noticed that.

Kaiser: Wow.

George: There are a mixture of opinions on what that means, but no real official announcement yet.

Kaiser: Okay. Well, it is in your capacity as a healthcare worker and specifically as a mental healthcare worker that we really wanted to talk to you today. Let’s start with a big picture. Give us a sense for how big the mental health problem that’s been brought on by the pandemic and especially by the lockdowns really is.

What do we know about the overall scale of how this has impacted people’s mental health in Shanghai and in China? Do we have any good data on that?

George: We don’t have great data yet on this particular lockdown. A lot of people are studying it and gathering data. Some initial information and studies are trickling out now, but because this lockdown is so new and so different actually from other lockdowns, we don’t have great data on it just yet.

We do have data from COVID lockdowns that were similar in some ways, different in others. We have data from lockdowns in the United States and in the West. We have some data from the lockdown in Wuhan in 2020. We have some data from previous situations, but we don’t have great data from this one.

The overall picture right now is hard to say. I think that’ll change in the upcoming months, but we have a lot of anecdotal data. We have a lot of anecdotal experiences from myself, my team, other mental health workers in the city that we speak to. We have some idea of the mental health impact of this quarantine, but the data is forthcoming.

Kaiser: No. I fully understand that it’s going to be anecdotal, but you are in the front lines. That’s why we’re really interested in hearing what you have personally seen, and what you and your colleagues have been talking about in terms of the impact on mental health.

George: Right now, we see a pretty significant one. I’ve got to say. We are two months into this lockdown. There’s several layers that myself and my colleagues have been observing as to the impact of the quarantine right now. One layer is definitely the exacerbation of any pre-existing conditions or symptoms that have already been there from before, that have been worsened by the conditions associated with the lockdown.

Kaiser: Right.

George: But also, we’re seeing a lot of other symptoms that were not there before, such as emotion regulation.

Kaiser: What does that mean?

George: It really just means people having much more difficult times controlling their emotions. Particularly, negative ones. Including things like anger, hopelessness, sadness, despair even. We’re seeing negative emotions much more easily triggered. We’re seeing emotional difficulties, relational difficulties. Difficulties between couples, family members, people that you live with being exacerbated and worsened during this period.

I think we have to remember that for much of Shanghai, and for really much of China in the modern era … People have been accustomed to living at a certain level of Maslow’s hierarchy. If we think of Maslow’s hierarchy of needs as this pyramid, where the more basic needs for food and water and warmth are at the bottom. And then, the more evolved needs, if you will, are nearer to the top. For meaning and self-actualization.

Kaiser: Right.

George: A lot of people here, most people here, I dare say, are used to living near the top of that hierarchy. Well, when the lockdown happened … All of a sudden, many of us were thrust into this situation in which it was hard to guarantee clean water or enough food. Even staple foods like rice and bread and flour.

As one of your previous guests mentioned, people were very food insecure for a time. That’s very threatening and can easily activate this fight, flight, or freeze situation and phenomena in a person. And so, much of a person’s daily, weekly resources, emotionally and otherwise, are expended on making sure that they have enough food to eat and water to drink.

Kaiser: That’s got to trigger some cultural memory among some people. We’ve talked about it on the show before. Insecurity during the Great Famine and the Cultural Revolution. That’s got to …

George: Absolutely. Absolutely. I think that research will still need to play this out a little bit, but you’re exactly right in that this hearkens back to an era that China has not seen for a time. But it does bring up questions too. I had mentioned some of the research coming out of Wuhan two years ago in 2020. Some of the psychological mental health effects of that quarantine, which was similarly harsh.

This quarantine, for many of your listeners, is pretty harsh and different from a lot of quarantines in the West. In that, most people are not allowed outside of their homes, much less out of their compounds. If a compound has any positive cases or any close contact, it’s very likely that the residents of that compound are not even allowed outside of their housing unit, outside of their homes. Some lucky ones may be able to come out of their home to take out the trash. Or to get a PCR test or an antigen test or something every day.

But for most people, they’re not even allowed outside of their home. This is a very astringent lockdown that was different from the West. It was similar to the lockdown in Wuhan in 2020, but the residents of Wuhan in 2020 had available to them … And I’m not trying to discount the significant suffering that the residents of Wuhan went through, and continue in some way to feel the effects of even today. But the residents of Wuhan in 2020 had a way to cognitively organize or to make sense of the lockdown, if you will.

​​Kaiser: That’s right.

George: It was Wuhan. It was 2020. As harsh as the lockdown was, they could make sense of it in some way. As we spoke of before last Fall, the ability to make sense of your circumstances has an impact on your resilience, on the development, if any, of symptomatology after that, on the mental health impact or psychological impact of those circumstances.

Here now, fast forward to 2022 in Shanghai, it can be argued that many residents of Shanghai two years later don’t have the same ability or don’t have the availability of a way to organize or to make sense of the severity of this lockdown, which is very difficult psychologically.

​​Kaiser: That makes just a ton of sense. It’s a very compelling argument. Of course, if you’re in Wuhan, you shoulder this responsibility. You understand that you’re sacrificing for something much bigger. It’s very much life and death. I know and I can empathize with that entirely.

Whereas, suddenly Shanghai, the wealthiest and most developed city in the country … They have almost a sense of immunity or invulnerability, and suddenly they’re facing things that they haven’t seen in many decades.

George: It’s very true. It’s very true. Like I said, people here are used to living at that very top of Maslow’s hierarchy of needs.

Kaiser: Maslow’s hierarchy of needs … Self-actualized Shanghai needs.

George: Exactly. Exactly. And so, a situation like this can be extremely discombobulating and threatening to the ego, or to the sense of an integrated self.

Kaiser: Absolutely.

George: That can have profound mental health impacts. Combined with the fact that not only are people here locked down, but many have had to continue to work remotely.

Kaiser: Right. Right.

George: Many have had to figure out a way to homeschool, or to provide online schooling and reinforce online schooling for their children. All while needing to be food insecure, water insecure. The tax on the resources are pretty significant emotionally.

Kaiser: I want to talk about education. Obviously, that was one of the huge issues that came out of our comparably much easier stay at home experience. But we’d still talk about it a lot. I have two kids and they were in high school during. They had a terrible time of it. Of course, they were old enough that they could take care of themselves. I didn’t have to organize daycare or anything like that. My wife doesn’t work.

But still, it was pretty tough for a lot of younger kids. They’ve certainly suffered the impact. But before we get to that, when we spoke last time, we talked quite a bit about how mental health is still stigmatized in a lot of China. That was changing. Obviously, we talked about how far it had come.

Have the lockdowns in some way … I’m maybe straining for silver lining here. But have they at least increased acceptance among people? Or awareness of mental health issues? Of loneliness, of things like that, of this feeling of isolation. I’ve got to think that at least there’s more sympathy for that.

George: Yes. I will say that anecdotally, among myself and my colleagues, that is something that we have observed. That the conversation socially has gone to mental health a lot more frequently during this lockdown. That people are feeling less stigmatized to discuss the emotional and relational difficulties that they’re experiencing during this time.

You can see that on social media. You can see that in conversations with people in Shanghai. People are more freely discussing mental health topics. And that’s really good. It’s a really good sign. I hope that continues. I hope that’s not just limited to mental health around the lockdown or mental health around the pandemic. I hope that conversation expands. But I will say that is a significant silver lining that I appreciate as well.

Kaiser: That’s great. I’ve got to wonder though. Have Chinese citizens … I’ve seen examples of this, but I was just wondering whether these are viral on social media only because they’re exceptional? Or because they’re the rule? But it seems like there are a lot of community coping strategies now for loneliness.

These very clever ways to do group activities remotely. Or shouting out windows and stuff like that. What can we learn from the way that Chinese people have responded? Because it does seem like there’s solidarity among people all going through this together. A kind of fellow feeling, which is maybe a silver lining of it.

George: That really resonates with me as well. I think that there is. I think that Chinese people are nothing if resilient. They are as a whole. I’m not trying to dismiss the significant difficulties that many people are having during this lockdown, because they are significant.

But on the other hand, there are a lot of stories of people banding together and people having to fill in the gaps for each other. Because this lockdown happened so suddenly. It happened just days after Shanghai announced that there would be no citywide lockdown.

Kaiser: Right. Right.

George: People were not prepared for it adequately. I think one of your previous guests discussed how the systems, the infrastructure was not prepared for it adequately. And so, people have had to fill in the gaps a lot for their neighbors and come together and provide for each other. Not only in terms of food and water and provisions, but also emotionally and socially.

There are so many stories and pictures of people being very creative with their daily PCR tests, for example. Really utilizing those times to socialize, to get exercise, to have some variety in their day. People dressing up in costumes and dressing up in formal attire, because it’s such a significant outing for them.

I think people are utilizing and their resilience in very creative ways. And so, that’s a very good thing. But that’s not to discount the fact that there are significant mental health consequences to a lockdown that pushes against a lot of our natural instincts as human beings. Our natural instincts to agency and socialization, for example. Yes, there is a silver lining.

Kaiser: George, let’s talk about the very young, and then talk about the very old. And so, children. We talked a little bit about education just now, but I’m curious. I can only just begin to imagine what it’s been like for young people in China. They’re so focused on early education.

They’re so focused on gaokao preparedness. This disruption must be really a gigantic dislocation for them. It’s got to cause quite a bit of distress. Can you talk about that?

George: Absolutely. We’re talking at two spectrums. You just brought up two opposite ends of the childhood spectrum. Here, on the one end, you have the very young children who are toddlers and in early childhood education or ECE. Preschool and things like that. And then, you have the other end, the older adolescents who are preparing for the gaokao. That, as you may know, has been delayed here in Shanghai and also in all of China due to the lockdown situation.

Kaiser: Right.

George: And so, there is a lot of gaokao distress and what that will mean for an entire generation of students who have been preparing for years and years for this one examination. There’s a significant amount of distress there. There’s a significant amount of worry. There are a lot of questions that are unanswered. That insecurity is actually the most distressing. From the mental health perspective.

Kaiser: I can imagine.

George: If we have answers or if we know … If we even think about the grief process. If I could draw an analogy from the grief process. People who have lost a loved one. That is horrible and very difficult to deal with, but you have a secure base. You know your loved one has been deceased, and that this is a grief process. An adjustment process.

Compare that to people who perhaps have a kidnapped relative or a kidnapped child. They don’t know. Their psyche is uncertain about what they should do. Is this a grief process? Is this celebration? Should I hold out hope? That’s a lot more insecure for that person.

Kaiser: Right. No closure. Nothing like that.

George: No closure. And it’s much more distressing to the psyche. I don’t want to compare, but it is analogous in some way. A lot of children here, young people with underdeveloped executive functioning, underdeveloped resources and resilience … They are very insecure about what this lockdown means for their future. Especially, if they’re preparing for the gaokao.

Now, flip to the other end, and you have children who are in the early childhood phase of their educations. They’re in a phase of their education that is probably largely play-based. Dependent on social interactions, dependent on the physical presence of a teacher and classmates, on a physical environment that doesn’t translate well to the online setting.

For those children, their education has had to largely be dependent on their parents. Or on the people that they live with. Because really, their schools … In fact, many private and international schools here have just straight up offered refunds for their early childhood students. Just because they know that the education doesn’t translate very well.

There’s significant difficulties there for those children, but also difficulties for their parents and families. In that, those children have … They need a lot more resources to take care of, to educate, to keep alive that their parents may not have a whole lot of right now.

Kaiser: I totally understand. Let’s go to the other end of the age spectrum and talk about the aged in China. First of all, there’s a lot of talk. I don’t know the numbers. I don’t think anyone has ever shown me clear numbers.

But there seems to be a consensus that the rates of vaccination among the elderly in China are quite low. Relatively low. I don’t know if you’ve seen numbers about, say, the percentage of people aged 65 or older who have had a full vaccination course?

George: I’ve seen some. I’ve seen some. They are lower than the general population. Yes. That is true.

Kaiser: Okay. Because it’s like 89% for across the population.

George: Yes.

Kaiser: I’ve heard it’s as low as 60% or 65% for the elderly.

George: I’ve seen 65%. About 65% for the elderly.

Kaiser: Are public health officials making this a priority now? Are they really pushing for … That seems like a no-brainer to me. They have this massive state capacity. Why not use it to compel the aged to be vaccinated?

George: Well, absolutely. I think that is definitely the way to go. From the public health perspective. I would have to defer to my colleagues in public health for this, but I definitely feel that is the situation and the direction to move in.

I will say that right now, during the lockdown, it is very difficult to get out of your compound. Most of the vaccination centers are closed, so it is very difficult right now to get a vaccine even if you wanted to.

Kaiser: That’s really unfortunate. Chinese people, as we all know, they pride themselves on filial piety and respect for the elderly. Since the overwhelming majority of deaths and hospitalizations that are arising from COVID are among the elderly … I think it’s clear to a lot of people that, were the zero-COVID policy to be suddenly relaxed, the elderly population would bear the brunt of deaths and hospitalizations.

George: Absolutely.

Kaiser: I’ve got to think this would change the way that Chinese think people think about zero-COVID. This is something I’ve encountered a lot talking to American friends. They’re just absolutely puzzled why China doesn’t give up zero-COVID. They settle on some bizarre explanations like, “Well, it must be that the people who manufacture these tests are in cahoots with the so-and-so’s.”

I think that’s a little farfetched. And then, other people who reach for the authoritarian argument that says, “Well, they wanted to do this anyway. They wanted to control society more tightly anyway. And so, now they’re using this.” I just don’t see anyone wrestling squarely with the fact that … A Fudan University study recently said they estimate 1.6 million deaths, if they relaxed zero-COVID.

Mostly, among the elderly. I’ve got to think that, for the vast majority of Chinese, they’re aware of the relatively low capacity to deal with a real tsunami if something like that were to happen.

George: I have a lot of thoughts on this as well. Living through this and observing the impact of the mental health impact in particular. It’s true. I think that coming out of this lockdown … Just as other pandemics moved from a pandemic to an endemic phase, this is something that can be expected.

China, in 2020, established the zero tolerance for COVID policy, which I don’t think is necessarily a bad one in theory. I also think that it worked very well for China in 2020 and into 2021. It really did. I and those around me here in Shanghai bore the benefit of that when other parts of China went into a very strict lockdown in 2020. That zero-tolerance for COVID policy allowed us here in Shanghai and in most of the rest of the country to live a near-normal life.

We were never locked in our homes, and we could continue to travel domestically and things like that. We did benefit from that. But as we move into a different phase, as the virus itself shifts, and as we move into a different phase of dealing with this … I think the question bears to be asked, “Is this still the strategy that works for China now?”

Kaiser: Right. Right.

George: Is this a strategy that is going to work for China and Shanghai going into the future? That’s a big question that is affecting people’s sense of security here.

Kaiser: There seems to be some consensus around that. Most people understand that this is not going to work in the long-term. But it’s just, how do we get there without a lot of people dying? That seems …

George: That’s the issue. I will bring up … Because there is a Chinese concept of mianzi (面子 miànzi) here, which is “Face,” or, “Saving face.” That has at least a partial something to do with what’s happening here. In that, whenever we deal culturally with Chinese folks … I, myself, am of Chinese descent. I’m an ABC. And so, I know this from my own background. We have to do so in a way that allows a saving of face.

Kaiser: Face-saving.

George: It’s just a cultural factor here that we need to deal with. But it’s not as present for perhaps people from other parts of the world. And so, I think that as China moves into the endemic phase of dealing with this virus, it’s struggling with that aspect. That cultural reality of mianzi, with taking care of its people.

Kaiser: Right.

George: I don’t want to say that mianzi is the only factor. It’s not. It’s not, but it’s something to think about. Especially, from a psychological perspective.

Kaiser: Especially, at the political level.

George: You have a lot of you have a lot of decision makers who are politicians, A. B, they’re mostly men. We’re dealing with mianzi. We’re dealing with egos. We’re dealing with a lot of things.

Kaiser: We’re dealing also with a very competitive international environment, where there’s great power yet competition.

George: Yes. It’s not lost even on non-politicians, like myself, the geopolitical realities that also impact decisions regarding COVID.

Kaiser: Sure.

George: Public health decisions. It pains those of us in healthcare that political or geopolitical factors would impact health and public health decisions, but it does. That’s the reality of the world that we live in.

Kaiser: Sure. Sure. Have people in your profession been able to deliver mental health care services online with any effect? Has that been something you’ve been able to do at all? Or have you tried to keep up the in-person delivery of care?

George: We are lucky enough in many parts of Shanghai that we have been able to keep up with in-person care to an extent. If a patient is able to obtain permission to exit their compound, if they can get a tong xing zheng (通行证 tōng xíng zhèng). Right?

Kaiser: A travel permit.

George: A travel permit to travel the streets and to come to the hospital. And if they have a negative COVID test within the last 48 hours, then, yes. They can see us in-person. For most people though, that’s probably inaccessible.

Most services have gone online with the exception of assessments. There is an online method to give assessments, but it’s not the preferred method for most clinicians. And so, most services have gone online. The difficulty though is a lot of psychiatric prescription services, which should be done face-to-face.

Kaiser: I was going to say.

George: Also, the delivery of medications. That has been severely impacted and interrupted. Not just psychiatric medications, but medications and treatments of all types. That’s been one of the things that have been very insecure for people is, if something happens to me, medically, and I need to get to the hospital.

Or if I just have a chronic condition that I need medication for. Perhaps it’s not life threatening with the proper interventions, but now I can’t get my insulin. Or I can’t get my blood pressure medication. Or I can’t get my psychiatric medication. What impact is that going to have on my health and on the health of my family and community?

For us, here at United Family, we have been privileged enough to have hospital cars that can make deliveries of most medications. For controlled medications that cannot travel in that way, our doctors actually, myself included, have been making personal deliveries. Where we get into our own cars and our own scooters and our own bicycles, and we deliver medications to the door of the compound for our patients who can’t access them otherwise.

Kaiser: That’s dedication. But in-patient programs definitely have been scaled back though?

George: Yes.

Kaiser: You’ve not been able to treat as many? Even outpatient treatments like therapy certainly have been impacted by this too.

George: For sure. Entire outpatient clinics have been closed. Especially, some of the higher risk ones, such as dental and ENT. All elective surgeries have been stopped. Basically, most things that cannot be online and anything non-emergency really has been halted.

Kaiser: We focused so far mostly on the people who have been locked in. What about the people who are essential workers? People who are doing contact tracing and the delivery drivers. The dabais, the sanitation people. The byway people.

How are they all holding up? How are the essential workers? Well, you are one. How is your staff? Your nurses and things like that.

George: Well, there’s different types of essential workers. I really consider myself very privileged. In that, I have been able, like I said, to go back and forth between my home and work. But for many of my colleagues, they have not been able to. Doctors, nurses, janitorial staff, front desk billing and cashiers, and insurance liaisons, health insurance liaisons.

They have not been able to go home. Because if they go home, then they face the possibility that they could not leave their compound to come back to work, which means that the hospital would have a difficult time keeping up. And so, many of them, like I said, have had to sleep in this hospital.

A lot of folks have had to sleep wherever they work. Factories. The workers in the compound that I live in. The janitorial staff. The security staff. They’ve all had to sleep there, and they have not gone home for months.

Kaiser: Wow.

George: They have had to also be, at the same time, food insecure and do a lot more work. Do a lot more work. The security staff, which were just really in charge of security before, now are in charge of all sorts of things. Liaising with the neighborhood committee. They’re in charge of liaising with deliveries.

They’re in charge of disseminating and passing out deliveries. They’re in charge of making sure that all of these things have come on time, and that they call the residents, and make sure they pick up the delivery of their frozen goods before it melts. There’s just a lot more things that they have to do. Wearing hazmat suits as the weather gets warmer here.

Kaiser: It’s increasingly uncomfortable.

George: But it’s interesting. Because like I said, there’s different levels of essential workers. For lack of a better way of putting it, you have the more privileged essential workers. Perhaps like doctors and nurses and government officials. And then, you have the essential workers who are migrant workers, who are a lot less privileged.

As you and I spoke about last time, the way that you organize cognitively what’s happening has an impact on the mental health sequelae or the mental health consequences of those circumstances. And so, it can be argued that for a lot of these less privileged essential workers. Their sense of agency at baseline … Their sense of agency before the lockdown was already different from the more privileged essential workers, if that makes sense.

Kaiser: For sure.

George: It’d be interesting for my research colleague to drill down deeper into this a little bit. But it’d be interesting to know whether that has an effect on the psychological consequences of this lockdown.

Kaiser: It’s a puzzle. If you’re knocked down only one rung on the Maslow hierarchy … Is it worse than being knocked down three rungs?

George: Exactly. Exactly.

Kaiser: As you said, citizens in Shanghai were told not to worry. There were no lockdowns coming. We saw this in the newspapers, and suddenly there were lockdowns. We saw other cities learn from the Shanghaiers experience with these promises made by local officials.

Some Beijingers, for example. Irrespective of all the promises, they were going out and panic buying. How does living in this ongoing state of acute uncertainty, where the government in regards to this particular issue at least is not trustworthy … How does this affect people’s mental health?

George: Well, it’s really interesting. Because for this aspect of it, I really would go back to research. Because there has been studies. A good friend of mine, Professor Brian Hall here out of NYU Shanghai, he and his team have really looked into this and identified the psychological typhoon eye effect.

For the first few weeks of the lockdown after in 2020, for example, there was this typhoon eye effect where it really didn’t have a very significant impact on mental health really at all until at least four weeks after. Where there was this delayed phenomenon that was identified. Other colleagues, such as Professor Wang Yuhe out of PKU, Peking University, have really identified communication and the governmental role and the stability that reliable governmental communication can really have on mental health outcomes.

And so, I really feel that research does bear the significant role that the government can have in communicating a message. Clear messages. While I understand that we’re dealing with a virus, and so information may change and information may look different from one day or one week to the next … I think it’s really vitally important that the government send consistent and clear messages. Even if the message is, “This may change.”

Or even if the message is, “We are not sure. We need to see how the numbers look before we make any decisions about when you will be let out.” For example. I think that this lockdown really caught Shanghai in many ways off guard. There was also a shift, as some of your previous guests discussed. A shift in power and control, where really Beijing took the lockdown arrangements over from the Shanghai City Government a couple of weeks in.

And so, that shift also had an effect on the amount of trust that people have. I remember, as I said … Shanghai or Pudong went into formal lockdown on March 28, but our compound had been in lockdown for several days before that. We were let out for eight hours from 9:00 p.m. on March 27, till 5:00 a.m. of March 28. We were released in order to go and buy provisions and buy groceries.

And so, obviously, all the residents flooded the neighborhood grocery stores. I remember standing in a two-hour line to pay for my groceries at this tiny mom and pop store. My arms were full. Bags were hanging off my shoulder and my hands, because I was balancing a flat of eggs on one hand.

Kaiser: Oh my god.

George: The lady in front of me was like, “Why are you buying so much? It’s a four-day lockdown. It’s a four-day lockdown. You don’t need that much food.” In my mind … I didn’t say this. In my mind, I was like, “Wow. My sweet summer child. You believe that this is going to be a four-day lockdown?”

Lo’ and behold, it wasn’t. But I think that the reliability of government messages, the reliability of government messengers … Whether that is the juweihui or whether that is other governmental officials. It can really do a lot and play a role here in settling and in addressing the mental health concerns of the populace.

But I will say that for many of the juweihui staff, it’s a very difficult position to be in. They are at the front lines of facing angry and distressed residents, while being essentially powerless.

Kaiser: A lot of responsibilities they’re having the shoulder. Do you think, George, that other cities around China are looking at what Shanghai is undergoing right now, in terms of the obvious challenges of providing mental health, and are instituting different measures or additional measures to try to be able to deliver those services?

If you’re in a city, if you’re sitting in Zhengzhou, Henan, or in Luoyang or something and you get to design a new mental health initiative … What kinds of measures would you recommend? Where do you think investment is most critical?

George: Wow. Well, I would definitely invest in healthcare and mental healthcare infrastructure. Making sure that adequate systems are in place in the case of a lockdown. That healthcare and mental healthcare can move forward uninterrupted. That includes online services for psychotherapy, online services for medication and psychiatric consultations, reliable and safe methods of medication delivery, and also for follow-up care.

I think that this is really vitally important. Also, adequate systems to manage those that need to be hospitalized. Because COVID, obviously, is not the only mental health or healthcare concern. These things go on and continue. That’s something that I think that we still need to learn in China. I think it’s something too that China has the ability to do. China is quite technologically advanced. China, if nothing else, has the ability to make quick decisions and to implement those decisions.

Kaiser: That much vaunted state capacity.

George: It has quite a significant amount of state capacity that can be utilized to prepare. I think that some early signs out of Beijing, which is also headed in this direction, I might add … Some early signs out of Beijing show that they are taking a page from Shanghai’s experience this year, which is good.

Kaiser: That’s awesome.

George: But this is something that I think a lot of cities here in China are looking at and realizing two things. A, we never want that for our city, but B, also that it’s possible. That it’s possible that even a city as modern and as powerful, for lack of a better word, as Shanghai can be shut down so completely.

I think that is something that was shocking to a lot of people here in China. In modern China. The post-revolution China. The jiu ling hou (九零后 jiǔ líng hòu) or the ling ling hou (零零后 líng líng hòu) China. I think that was shocking for a lot of people.

Kaiser: I got to think that the quarantine centers are a place where there’s going to be a lot of people in distress. I wonder right now, in Shanghai, are there mental health professionals that are being tasked specifically to the quarantine centers? That feels like that’s a place where they need to have people on staff there around the clock. Is that happening?

George: It’s interesting. I’m not actually completely sure that there are mental health professionals that are tasked to service the quarantine centers. I’m not personally aware of any. As I work with people who are both in the quarantine center, and also under threat of going to the quarantine center, it does seem to be that the threat of going to the quarantine center is much more distressing than the actual effects of the quarantine center itself.

Kaiser: Oh, God.

George: That having been said, not all quarantine centers were created equal. There are some quarantine centers that are much more distressing and much more intense and unsanitary than others. There are different levels of quarantine centers and quarantine hospitals, so I need to put that caveat there. Some people are quite distressed in the quarantine center and I don’t want to take away from that.

But the threat, particularly in the early days of the lockdown … When it was quite realistic, for example, that if your child tested positive, that you as a parent would be separated from your child. That your child be quarantined. Even a very young child as young as five or six would be quarantined for weeks away from any adults that they knew.

That was very distressing. Extremely distressing. And I include myself in that group of people that were very concerned about that. Shanghai has since announced earlier on in the lockdown that if parents were willing to sign a waiver form, that they would not be separated from their children.

Kaiser: No. I wasn’t even aware that had happened. That seems reasonably …

George: I think, for the most part, that fear has been addressed. But the quarantine center is not a pleasant place. A lot of people live in fear of going to the quarantine center and actually live in fear of what would happen after they return from the quarantine center.

As my psychological colleagues, my research colleagues have identified the stigma, the social stigma of COVID. The social stigma of having had COVID or having had gone to these quarantine centers. By the way, when you do, if you test positive and you go to the quarantine center … People come into your home, and they spray everything down with the bleach solution.

Kaiser: I’ve seen that.

George: And so, probably your property is damaged. You’re coming back to a situation … A friend of mine lives in the compound where they have people coming back from the quarantine center every day. They’re walking in through the gates and there’s a person with a hazmat suit and a bleach sprayer. Basically, spraying as they’re walking.

And so, the effects of that stigma too, of having had COVID or having had to go to a quarantine center can be significant as well. And that’s been identified in research. Those effects range from increased anxiety, depression symptoms, loneliness and isolation. Fear. They can be significant.

Kaiser: What strategies have you seen Chinese citizens develop to reduce loneliness and to maintain that sense of community during lockdowns? You talked about some of these. The people who dress up and stand in line. That’s all really great.

George: There’s a lot of … Everything has moved online. For the most part, for many people who are privileged enough to have a job that can move online, so that they are not necessarily under threat of being fired or laid off … I think that they have been able to really utilize the online resources to address loneliness.

But it’s a mixed bag with online resources and with social media in particular. It’s a mixed bag. Because research does show, even early research from the March 2022 lockdown in Shanghai … Early research does show that increased social media exposure does lead to increased psychological distress.

I quote my friend Brian Hall again for an early study. But at the same time, people have had to rely on online resources to work. Have had to rely on WeChat to even order food. Every single tuan gou is on WeChat. And so, it’s a mixed bag. It’s a mixed bag.

Kaiser: It’s the condition of our age. We’re totally dependent on social media, even though we know that it’s killing us.

George: It is. It is. I will say too that … If I could be so bold as to make a prediction. A future generation will look upon us in the 21st century, and our reliance on social media and our reliance on technology, in the same way that we now look upon the early 1900s and the late 1800s, where we sent children to factories. As a society, we deemed that was appropriate.

Now, we look back upon it and are shocked that we had no idea the effects that would have on children. I think that we will look upon this time as well, where we basically unleashed upon a generation of children social media, all things online, without really understanding its effects. Its negative effects. I don’t want to take away from some of the positive ways that these technologies have impacted our society.

Kaiser: Well, so did those power looms.

George: Exactly. Exactly. We industrialized as a world. Right?

Kaiser: Right.

George: But at the same time, there was a cost.

Kaiser: At what cost?

George: There was a cost. I think that we’re still understanding that cost, even during a lockdown. We are seeing some of the costs, mental health wise, of so much social media exposure. I wonder what that will look like over the long run?

Kaiser: We are seeing a lot of people who are included and a lot of people who were excluded from treatment for mental health disorders. This whole transition to online psychiatric care that’s happening in China.

George: Yes.

Kaiser: It’s a good thing. But it’s uneven.

George: Yes. You brought up the elderly before. It impacts, again, all sorts of things.

Kaiser: Absolutely.

George: They impact certain levels of society more than they do others. The lower socioeconomic classes. The elderly, who may not be as familiar with how to use these technologies. People who are poorer and may not just have access. Or may not be in a job that allows them to constantly monitor WeChat, for example, to buy food.

Kaiser: That’s right.

George: And so, it affects those segments of the population. Anything really affects those segments of the population much more.

Kaiser: Dr. George Hu. Thank you so much for taking the time to offer us this fascinating perspective. It’s always so great to talk to you. It’s amazing how well you express yourself and how familiar you are with all of this. Wow. I feel for you. I think, all of us, we wish you luck to your family and to all of your patients.

George: Thank you.

Kaiser: Hope that things get better in Shanghai soon.

George: Thank you. Thank you. I really appreciate it. Like I said, I count myself and my family as being one of the privileged ones. I feel very grateful.

Kaiser: I’m more privileged. No, I’m playing. Anyway, I do wish I were in China, but not in Shanghai. Let’s go on to recommendations now. First, a real quick reminder that the Sinica Podcast is powered by SupChina. And if you like what we do with this show and the other shows in the Sinica Network, shows like the China and Africa Podcast and China Stories and the Caixin-Sinica Business Brief, then by all means.

The way to help us out is to subscribe to the SupChina Access newsletter. Just check it out. It’s a fantastic newsletter. There’s lots to be learned from it. Jeremy and his team do an excellent job. Let’s go onto recommendations now. George, what do you have for us, man? Last time, you gave me such a good one.

George: Well, I’ve got a different book now.

Kaiser: Okay.

George: It’s called How to Raise an Adult: Break Free of the Overparenting Trap and Prepare Your Kid For Success. Maybe this speaks to the phase of life that I’m in right now. It’s a book by Julie Lythcott-Haims, who is a professor, I believe, out of Stanford University. Talking about the harmful effects of helicopter parenting and how to break free of that.

Kaiser: All right.

George: This is something that she wrote so insightfully from her own experience. Working with students who were victims of this type of parenting and how to avoid that as a parent. And so, this is something that I’ve really benefited from reading and that I recommend to all your readers who are parents. Or who are preparing to be parents or who know parents.

Kaiser: No, that’s great. I was definitely a product of a free-range upbringing. As soon as we get home, just jump on the bikes and go exploring and riding off through the world.

George: I was a mix. I was a hybrid. Helicopter at times. Free range at others.

Kaiser: I got lucky. My generation. We’ve tried to free-range our kids as much as possible. Sometimes they’re weirdly resistant to it. But great recommendation. I’ll definitely read that. Even though, I’m done with parenting. My oldest, she flies the nest this fall. She’s off to college.

George: Wow.

Kaiser: It’s unbelievable.

George: Well, you may just be transitioning to a different phase of parenting.

Kaiser: Maybe. I imagine that’s probably the case. All right. Great book recommendation. Mine is for a series of articles I hope a lot of you have already read. They’re written by Nicholas Confessore. It’s a series in the New York Times all about Tucker Carlson. The series is called American Nationalist.

It’s all about the rise of and the shaping of the worldview of this guy. It’s really especially important in the aftermath of this racist Buffalo, New York supermarket mass shooting on May 14. We have to recognize that Tucker Carlson, who is just doing so much to mainstream, “The Replacement Theory.”

This guy has blood on his hands. This is a vicious conspiracy theory that he’s spreading, and it is powering so much of the hate crime. He may not use the direct antisemitic or anti-black rhetoric in it, but he rolls right up to the edge and dog whistles the shit out of it. I think he’s got blood on his hands. He’s really poisoning discourse in America. This series is fantastic. It’s really good. It’s excellent journalism.

George: I will give it a read.

Kaiser: Thanks, man. George, so good to talk to you. Let’s do it again.

George: So good to talk with you, Kaiser.

Kaiser: A real pleasure. We’ll certainly have you back on the show again in not too long, because there’s always a lot of fertile ground to plow with you.

George: Looking forward to it.

Kaiser: All right. The Sinica Podcast is powered by SupChina and is a proud part of the Sinica Network. Our show is produced and edited by me, Kaiser Kuo. We would be delighted if you would drop us an email at sinica@supchina.com.

Or just give us a rating and a review on Apple Podcasts, as this really does help people discover the show. Meanwhile, follow us on Twitter or on Facebook at @supchinanews, and be sure to check out all the shows in the Sinica Network. Thanks for listening. We’ll see you next week. Take care.