Are China’s Soldiers Psychologically Fit for Modern Wars?

The People’s Liberation Army (PLA) has captured headlines in recent years for its renewed confidence and assertiveness. The image of Chinese soldiers, carefully crafted by propagandists, paints them as men of steel – fearless and unstoppable. But what is really behind the façade?

Despite their fierce public persona, soldiers are human beings like the rest of us, made out of flesh and blood and vivified by emotions. While it is important to understand the PLA’s hardware buildup, this article seeks to understand the psychological health of servicemen, crucial to morale and combat effectiveness, yet often veiled by the hard exterior of propaganda. How widespread are mental disorders in the PLA? Does the PLA have a modern and well-constructed mental health service infrastructure? If not, are there improvements in the making? Ultimately, what are the implications for a PLA in the midst of reform?

So far, PLA mental health infrastructure is still in its nascent stage. Despite changes in the making, there are key institutions that have yet to witness any significant reform. For this research, I consulted 27 articles from 17 Chinese military medicine and psychology journals.

Concepts and Definitions

Studies by Chinese researchers have repeatedly shown that at least a quarter of PLA servicemen suffer from some sort of psychological problem – a number comparable to that of the U.S. military. However, the U.S. military has been a wartime army in active global conflict since 2001, while the PLA fought its last major war in 1979. What accounts for this discrepancy? Given the highly stressful nature of modern war, one should question the PLA’s state of mental readiness.

Mental wellness, as defined by the World Health Organization, is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” When translated into military terms under the Chinese context, military mental health is measured, as one journal article put it, by “the soldier’s adaptation to the military environment in a positive and cheerful way. This is specifically expressed in good cognition, positive and stable emotions, noble feelings, strong will, good character, and harmonious interpersonal relations.”

Mental Health Surveys

Anxiety and mood disorders are the most common mental health issues among PLA servicemen. A 2015 study in the Journal of Preventive Medicine of Chinese People’s Liberation Army (解放军预防医学杂志) found that anxiety, fretfulness, and depression are present among one-fourth of service members. This is an improvement from 2009, when the depression incidence rate among 4,346 young soldiers was 36.33 percent.

In addition, 40 percent of 5,000 soldiers interviewed for the 2015 study expressed sexual repression.

Another salient point is psychological problems caused by sleep disorders. A 2016 study of 415 members of an armored unit found 81.2 percent suffering from a severe sleep disorder and 23.1 percent psychologically distressed.

A 2014 study based on 760 service members identified the following stressors influencing their mental wellbeing: work-related stress (64.7 percent), interpersonal tensions (30.2 percent), worries about the future (28 percent), poor self-regulation (27.8 percent), lack of understanding and support from family members (24.5 percent), dissatisfaction with current salary and benefits (23.6 percent), poor physical condition (21.8 percent), bad work environment (18.9 percent), too much work-related travel (13.9 percent), marriage and family issues (12.4 percent), and crude behavior from superiors (10.7 percent).

The most comprehensive study, published in 2016, is based on 53,847 service members from all five PLA branches. The research found the Strategic Support Force the healthiest mentally, followed by the Ground Force, Navy, Air Force, and Rocket Force. Unsettlingly, almost one in three (29.7 percent) PLA servicemen were found in the study to be psychologically distressed.

Compared to studies of previous years, more PLA service members are scoring lower on the Symptom Checklist-90/SCL-90 questionnaire, which indicates improvement in mental wellbeing. At the same time, the incidence rate of psychological problems, at 29.7 percent, nearly doubles the 2005 rate of 16.5 percent. This shows polarization, where a segment of the PLA population is becoming healthier mentally while the rest are getting worse.

Female service members suffer psychological problems at a greater rate (36.5 percent) than their male counterparts (28.6 percent). Besides the current political turbulence that is causing anxiety in the military, the survey attributes the high female distress rate to intensified training, workplace inequality, busy family life, and possibly an unsatisfactory sex life. Yet an increased incidence of mental health issues in female service members is not always the case; a 2015 study examining the Second Artillery Force (now Rocket Force) concluded men were more stressed than women.

The highly educated have consistently scored better in their ability to cope with stress. Officers and noncommissioned officers are also less inclined toward having mental problems. Social support, especially in a time of instability, helps soldiers reduce stress. But professional counseling and intervention have proven time and again to be the best methods in ameliorating psychological troubles.

Environmental Stressors

Stress is said to be the cause of 50 to 80 percent of all illnesses and researchers have found a strong correlation between stress and psychological disorders. There are four environmental stressors in the military: the natural environment (heat, cold, altitude, and humidity); artificial environment (acceleration, vibration, noise, and radiation); social and psychological environment (loneliness, living and working in confined spaces, and living a secluded, mundane life); and operational environment (continuous operation, inadequate sleep, and danger).

A difficult natural environment takes quite a toll on mental health. With the exception of coastal regions, China’s borderlands are rugged and uninviting. The border with Russia and Mongolia consist of steppes, deserts, mountains, and dense forests. Subzero temperatures in the winter are common. Xinjiang, although at a milder climate, has large swaths of deserts and towering ranges bordering the Central Asian states. But China’s warm relations with Russia and the Central Asian republics means that the northern border is no longer heavily militarized. The focus of national defense is mostly on the Sino-Indian frontier – which rests on the so-called Roof of the World – the southeastern seaboard, and the picturesque, yet lonely, South China Sea islets.

According to research from the PLA Third Military Medical University (renamed Army Medical University in June 2017), the plateau environment has the worst effect on PLA mental health. The incidence rate for mental problems there is very high, at 43.03 percent, with nearly one in two soldiers (46.62 percent) suffering from anxiety or depression. This is due to the extreme Tibetan climate, where the air is thin, ultraviolet radiation strong, weather unpredictable, vegetation scarce, sources of water hard to locate, and temperature fluctuations dramatic.

Conditions at high altitude weaken the mind and body, making both susceptible to illness. One 2015 study found that soldiers in Tibet had higher levels of psychological distress in every category when compared to the national average. Measuring 191 soldiers stationed at 3,000 meters above sea level, another study found that 51 (or 26.7 percent) had altitude sickness, a condition that negatively affects the overall functioning of the mind and body.

Nevertheless, the situation is not always grim. A 2017 survey of 4,080 PLA service members (588 officers, 1,998 non-commissioned officers, and 1,494 soldiers) stationed at locations 2,000 to 4,900 meters above sea level across the Tibetan Plateau recorded 7.8 percent showing positive symptoms of post-traumatic stress disorder – a notable 8.7 percent reduction when compared to findings of a corresponding study published in 2006. After three months of military exercises in Tibet, 88.4 percent of an armored brigade from China proper reported they felt mildly fatigued, 10.3 percent somewhat fatigued, and only 1.3 percent considerably fatigued.

The incidence rate of psychological disorders is significant in the hot and maritime environments as well, respectively at 41.1 and 37 percent. SCL-90 results from surveying 174 soldiers stationed on the Paracel Islands in the South China Sea showed higher than average scores on the following symptoms: obsessive-compulsive tendencies, paranoid ideation, interpersonal sensitivity, and hostility. Another study of a garrison on an unnamed rocky island showed 35 percent of those interviewed had emotional problems, 80 percent suffered from sleep disorders, 60 percent felt homesick, and many were concerned about their future. Out of a garrison of 1,455 on another unnamed island,114 (around 8 percent) had suicidal thoughts.

The State of PLA Mental Health Services

The Gulf War was a turning point for the PLA in understanding modern warfare. While Chinese generals were dazzled by the display of the United States’ high-tech firepower, they were equally shocked by American psychological operations that obliterated Iraqi troop morale and caused surrender and desertion en masse. Modern wars are high-stress wars. The First Gulf War serves as a stark reminder of the need for a robust PLA mental health service system.

Although the study of military psychology in China began in the 1960s, it was completely abandoned during the Cultural Revolution until its reinstatement in the late 1980s. The earnest construction of a mental health service system only began in 2005 with the founding of the All-Army Military Psychology Training Center at the Engineer Corps College. Mental preparation training officially became part of the PLA’s curriculum in 2008. By 2011, all three of the PLA’s military medical universities offered a military psychology major.

Currently, different studies show varied levels of mental health service availability – in some cases at the battalion, others at the company level. But there are numerous problems confronting PLA mental health services, according to a 2016 Chinese article investigating this matter. First of all, there is still confusion between mental health services and ideological and political education. This is a holdover from the Mao era, where the cure to psychological problems was more political study. Consequently, mental health services fall under the command of the political department, which is tasked with propaganda and indoctrination. Following the political department’s lead, the medical department provides services and the training department determines how much time is allocated to psychological training. Second, there is a shortage of military psychologists and psychiatrists. Third, mental health is still not a part of annual physical examinations. Fourth, there is no digitized database of mental health records, which makes sharing patient information difficult. Finally, different military regions use different models of mental health evaluations. A systematic way of measuring mental health has yet to be adopted.

Although the PLA lacks a complete, professional mental health service system, researchers are making improvements through experimental projects and observations of foreign armies. The U.S. military, the world’s leader in military mental health, is the PLA’s object of emulation. Compared to the PLA, the U.S. military’s program is much more systematic and holistic, combining mental preparation training, creative stress relief programs, and professional intervention. There are frequent discussions in Chinese military medical journals of U.S. psychological resilience training programs. Chinese studies have shown that psychological resilience training – an important part of the U.S. military training curriculum – during any period of a soldier’s service works to reduce the incidences of psychological disorder. A 2014 resilience training experiment that combined confidence building, roleplaying, and team spirit exercises yielded very positive feedback. Another study, offering a range of suggestions on mental training, referred to the U.S. experience throughout.

Lingering Questions

Chinese researchers have made strides in investigating the PLA’s mental health issues. However, there are remaining terrae incognitae waiting to be explored.

The issue of sex, briefly mentioned in two studies as stressors, deserves better investigation. However, since sex is still somewhat of a taboo subject in China, especially when it comes to the military, we can only imagine from limited sources how this basic human function influences PLA servicemembers mentally. In the last five years, there exists only one survey on the subject, which found that the attitudes of 1,450 young male soldiers toward sex, love, and sexuality are largely conservative and traditional.

The psychological effect of the anticorruption campaign in the PLA is another subject yet to be discussed in-depth. Taking a page from history, Stalin’s bloody purge severely weakened the Red Army’s fighting capability and decimated its esprit de corp. The current purge of PLA old guards, though nowhere near the scale and destructiveness of Stalin’s carnage, most certainly has a role in causing anxiety and other mental disorders among servicemembers. However, due to political sensitivities, we might never discover the true impact of these events.

The contradiction between Marxism and religion means communist armies, like China’s, do not have chaplains. (There are political officers instead.) As a fountain of divine care, chaplains play an important role as counseling psychologists under a sacred aura. China, a multiethnic, multiconfessional nation, has witnessed the retreat of Marxism and a revival of religiosity. But as an armed wing of the Chinese Communist Party, the PLA, for ideological reasons, is not going to embrace chaplains anytime soon. Moreover, no research has been done on the role of religion as it relates to PLA mental health, which could help us understand the future role of religious leaders in this matter.

Conclusion

The PLA, in the midst of a massive reorganization, has a lot of work to do in catching up with the rest of the world in military mental health terms. This research shows that despite having a quarter of its servicemembers suffering from psychological problems, the PLA’s mental health service network remains underdeveloped. While the propaganda machine still occasionally trumpets the PLA’s revolutionary tradition of living “hard and plain,” it is necessary to recognize that the nature of war has changed dramatically since Mao, and victory cannot be guaranteed without a modern, systematic mental health service infrastructure.