My wife and I are psychoanalysts with a special interest in training therapists in China. This niche has given us an opportunity to learn about Chinese culture and Chinese patients over the last 15 years.
We recently participated in a symposium themed “The Thinking Heart,” held at the Freud Museum in London (and available online). Together, we presented on a topic that has emerged as a new way of thinking about depression in young Chinese patients: empty heart disease.
Professor Xu Kaiwen, deputy head of the mental health education and counseling center at China’s top-ranked Peking University, first described empty heart disease (or kongxin bing in Chinese) at an education conference in 2016. It pertains to students who have succeeded in gaining admission to elite universities but arrive there with “empty hearts,” feeling no sense of purpose in their lives.
Many Chinese students show a single-minded devotion to their academic efforts. They forswear other interests, limiting leisure activities and even friendships along the way. For their efforts, they reach the pinnacle of success: just what their parents wanted for them.
But now they face a question not found on any exam: Why does it matter?
For many of these high-achieving Chinese students — by one estimate, more than 40% — the victory is empty. They feel a sense of inner utility: an emptiness about their life and achievements. Imagine being so young, so hardworking and single-minded — and so defeated.
The response to this preliminary research has been widely corroborative. One anonymous student writes: “I’m a member of the 40 percent, and possibly even more severe … In fact, I’ve thought about ending my life more than once” (Fu, 2016).
One psychology student opined that it is not just the heart, but a case of an “empty self” because these young people fundamentally do not know who they are. Such feelings are rapidly growing more common, particularly since the beginning of the pandemic.
We see a similar phenomenon in the context of Western culture as well; consider the archetypal adolescent search for meaning in their lives. It is common for teenagers and young adults, with their newly acquired capacity for abstract and symbolic thinking, to ask the great questions about the meaning in life; to search for that meaning, and to fear the complexity of the world. Teen angst is nothing new.
Empty heart disease, by contrast, is something more. It fits not within the realm of normal adolescent existentialism, but rather on a continuum that includes chronic, often debilitating anxiety, as well as depression and frequent suicidal ideation.
The reason for this difference is largely cultural. Empty heart disease has likely been magnified by the One Child policy; Most Chinese adolescents and young adults are only children and therefore are the sole carrier of their parents’ hopes and legacies. This phenomenon only grows when Chinese culture insists that they fully devote themselves to the future of their families. On a wider social level, empty heart disease is a product of too much ambition and too much responsibility for the future of these young people’s families.
In a clinical capacity, my wife and I have seen many young people feeling depressed and unable to satisfy their parents’ demands. One of our patients, a 14-year-old girl, formed a suicide club. “Dying doesn’t matter,” she told us. (Her parents worried themselves sick over her safety.)
Another 14-year-old girl whose father was alcoholic and mother terribly depressed heard hallucinatory voices. Diagnosed as psychotic, she dropped out of school, claiming that she could support her mother who should leave her father. The voices turned out to be those of her parents arguing and not psychotic at all: just her parents’ conflict ringing in her head. Her sad and desperate preoccupation with her parents’ conflict was consuming her (Scharff, 2021).
Empty heart disease: A historical context
Baudelaire, in his famous 19th-century poem “Fleur de Mal,” described a feeling of impoverished emptiness, captured by an image of a king of a rich land where it rains all the time and who has a feeling of numbness and inner death. The sociological concept of anomie described by Talcott Parsons (1951) links such feelings to an absence of a set of agreed-on norms that then gets inside people. Andre Green (1999) wrote about “the dead mother” inside many desperate and empty patients. His dead-mother complex offers a psychoanalytic explanation for an inner emptiness intertwined with the existential dread that was also described in 20th-century existential psychiatry.
In China today, with its rapidly shifting social expectations, we can see how individuals feel excluded and left behind even as they climb ladders of success. But that is not so different than the fate of many of our American young people, who get lost in drinking and partying in a desperate effort to cover an inner sense of meaninglessness and dread of the future.
While it’s not a new way of feeling, thinking of the many varieties of empty hearts, East and West, helps us to understand modern versions of inner utility as we attempt to help our patients find meaning in their lives.