Social change and mental illness behind knife attacks

August 29, 2013 by Timothy Beardson

The recent knife attack in a branch of Carrefour in Beijing serves to remind us of the occasional series of knife attacks in China, frequently on groups of children. This was particularly marked in 2010 and 2012. We saw headlines such as “Seven injured in knife attack in south China” and “String of school attacks raise questions about school security” The Chinese public was shocked at the number of attacks and victims – across the country from north to south, east to west.
There were calls from the public and the government for security guards at schools and kindergartens with batons, helmets, pepper spray, police on duty and a ‘shoot to kill’ policy.
Official explanations of the motivation tended to the personal: quarrels, unemployment, money troubles, occasional mental illness and various forms of “revenge”. However academics leant towards bigger forces such as wrenching social change in China and large numbers of undiagnosed mentally ill people.
The whole world of less educated, older and vulnerable people has turned upside down in contemporary China. In Maoist times there was a partially adequate simple health system based on the work unit, to which all were attached. In additional there were children and a tradition that adults looked after their elderly. The Mao-era health system has been scrapped principally as a result of a rush to embrace market forces: public flotation or at least the need for enterprises to aim for profitability. These factors have eliminated company housing, health provision and much other social support.
At the same time the number of children born each year since the early 1970s has fallen by 40%. This is not the result of the one-child policy, which was only introduced in 1979, but due to the effects of such phenomena as urbanisation, more women in the work force and later marriage. This has been accompanied by the sporadic introduction of modern medicines and surgery, which are partially associated with an increase in longevity.
The reduction of the young thus goes hand-in-hand with an increase in the old and therefore a transformation of the once-healthy dependency ratio of workers to retired. This has two effects: adults now increasingly find themselves unable to care adequately for their elderly; and there is now the likelihood that this exploding phenomenon will land on the state’s budget at a time when it will be highly stressed with other challenges.
Older and retired workers are thus a problem that society finds it difficult to address. It is not surprising that there are sectors of society feeling unappreciated and unsupported. This is not only a problem for the old. Tens of millions of workers have simply no training to find adequate employment in the modern Chinese economy.
The other factor is mental illness. China is serious short of mental health practitioners. This contributes to the pervasive under-diagnosis of mental illness. Dr Han Buxin of the Chinese Academy of Sciences estimated in 2010 that 2-3% of the population – around 35m people – is mentally ill. China has neither the institutions nor the staff to handle this issue. In 2009 it was reported that China had 14,000 psychiatrists and psychologists, the same as France, with a twentieth of the population. Lest we think this study is an outlier, there is a WHO study published in The Lancet in 2009 estimating the mentally ill in China at 17%.
Associated with mental illness is the analysis that many Chinese people were uprooted during Mao Zedong’s Cultural Revolution to the point of complete disorientation and loss of a normal value system. Many of these have not re-engaged with regular life.
We might feel that the regularity of the reporting of knife attacks in China demonstrates an extraordinary and unusual situation. In 2010, seemingly a bad year for such attacks, more than 20 children and adults were killed by knives and meat cleavers. However, in the first four months of this year around 1,600 were injured and eleven were killed in London alone by knife attacks. In very inexact terms that puts the murder by knife toll in the city of London in 2013 65% higher than that of 2010 for the whole of China.
The caveat here, as always, is that we must recognise the intrinsic weakness in Chinese data. Any kind of international comparisons between China and the world are vulnerable to weak Chinese data-gathering.
The discussion so far seems to suggest that Britain is rather more inured to the prospect of such incidents than is China, where substantial coverage in state media follows these appalling events. There are clear differences between China and Britain. In London the motivation seems often to be about robbery or gang violence, whereas in China it seems generally to be random, aimless and unconnected with the victim’s status, personality or identity.
Second, the victim is often said to be suffering from mental illness. Furthermore, there is a high rate of Chinese victims being children in schools and kindergartens.
What do we learn from this dystopic situation? First, that the incidence of such events could well be less in China than elsewhere. In Britain they are frequently associated with crime; in China this seems not to be the case. The concern for China is the number of undiagnosed and untreated mentally ill in the country, the traumatic nature of recent Chinese political history, the regular focus on small massacres rather than one-on-one or gang attacks and the specific tendency to choose children as victims.

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