The fact that believers are mostly women is a prominent aspect; the feminization of Chinese Christianity often emerges in the stories and is analysed by literature [34,35]. Protestant Christianity practiced in domestic and private settings - through meetings, prayers, and the study of the Bible - results in a social space strategically occupied by women in contrast with male public spaces. This consists in a renegotiation and transformation of gender perspective and of the traditional Chinese patriarchal system [36,37]. Nevertheless, this causes very high social costs, as reported in a number of studies on female migration and on the relation between gender and migration [38-45]. In fact, since they are mostly mothers, daughters and wives, this deeply affects the whole nuclear and extended family. Most married women not only left their husbands in China, but also their children, causing intense suffering for both parts, as frequently emerged in the course of the care relationship. Suffering is worsened by the reported impossibility of getting in contact with their family, even by phone, because they are afraid of being found in Italy and repatriated. Suffering and nostalgia, split with the family and loneliness are powerful feelings emerging from all people encountered.

Religion: Domestic Christianity and new religious movements

What everyone reports is a recent conversion, whose process is started by a personal choice characterized by deep internal conflicts, since believing constitutes a social and political transgression.

Faith seems to represent an important psychological resource in particularly critical phases of life, an inner response shared with the faith community. According to our experience, conversion to Christianity usually does not develop individually, but especially through mothers, maternal aunts, or through friends who are already believers and carry out proselytism. In the cases observed, proselytism from unknown people has never occurred, precisely because of the secrecy of the domestic churches. These are a few examples:

In 2010 I returned to my parents’ home because it was a very difficult period for me. My husband never came home in the evening and wasted our family money. I wanted to kill myself. My mother, who had converted just before me to the church of Quan Neng Shen, spoke to me for the first time about God and told me that he loves men and knows their suffering. I began to attend the church; I converted too (Chen, 10/2016).

In 2005 my mother began to attend the official Christian church. At that time she was facing a difficult period of her life, she felt misunderstood. It seemed that people she gets close to did not appreciate her and instead of being grateful they were hostile towards her. Then she met a very kind Christian Canadian girl who started talking about God to my mother. My mother was very impressed and after a while she started attending the domestic Church. She also talked to me about it and at the beginning I was sceptical, I did not think I needed it, but after many years I gained faith. I saw my mother so changed, she found an inner peace that had made her quiet and then I also get closer to God (Ping, 7/2016).

Family, social and government repression of Christianity in China (pre-migratory events)

Capillary control of the territory and repression aimed at eradicating domestic cults is performed through different methods and various permeable levels of power: social, scholastic, working, family. It aims at marginalizing and banishing people suspected to practice their faith, as well as relatives, friends and acquaintances of people identified as Christians. This strategy often targets family relationships in order to destroy them. Fellows are frequently solicited to report also their own relatives. This seems to produce domestic violence caused by a feeling of rage of some family members against the converted ones. For example:

My father and our relatives did not agree with my mother being a Christian. In China there is not freedom of faith, we have to be faithful only towards the Party. My father continued to oppose to my mother’s faith and, whenever she came back from meetings with other believers, he offended her. Even though I was a little girl, I remember that my father began to hit my mother. I tried to endure this violence for a certain period, but one day I decided to help my mother. I think it was in 1995 and, while my father was beating my mother with a belt, I run to hug her and my father also hit me. (…) I ask my mother why my father treated us in that way, maybe he didn’t love us? My mother answered that he loved us, but the reason why he was beating us was because the Government did not allow people to have a Christian faith (Chen, 10/2016).

In April 2014 a neighbor of mine reported to the police that I met with people of the group [of the domestic church] in my house. The police went to my home when I was not there. They found my documents and also the Bible. They threaten my husband. He get angry with me and when I came back home he beat me. In July 2014, he divorced and I went to live by myself (Ju, 06/2016).

Family violence is described as acts performed to stop feelings of tension and fear that affect all people close to who believes, and also to get safe from a series of normative prohibitions (access to school, work and social welfare).

I always tried to make proselytism with my family; in 2012 they began to come to our meetings. But then my mother cried when talking to me, saying that if I would have continued like this, I would have lost my job and I would no longer be able to follow the Communist Party. My mother was also worried that all welfare measures by the government would have been cancelled. She feared that when I would have had some children, they would have not be able to attend the University and neither my sister’s ones (Lee, 09/2016).

The systematic banishing is acted in the society through important forms of discrimination:

At work, when they discovered that I was a Christian, they put me to read counters during the night, alone in the shift. They lowered my salary and changed my tasks, this was not my job. They marginalized me; everybody stopped talking to me (Yue, 01/2017).

When I was at school, one day the headmaster called me and told me that here in China is not allowed to believe. Some days after he called me again and he wanted me to sign a paper where it was written that I would have abandoned my faith. I did not want to sign and they marginalized me. In China, believers are considered as inferior; people with something wrong. They called my mother and I had to leave the school and I became a welder (Bai, 06/2016).

Narratives show that discrimination is acted at different social levels. Physical violence is acted by law enforcement, usually when the police burst into private houses during religious meetings. Violence aimed at destroying or seizing religious texts are reported. Those raids frequently include data recording, threats and blows literally described as “furious” and “rough” repressive practices. Those defined as “tortures”, instead, are performed inside temporary detention structures such as barracks, police headquarters or “surveillance houses” (Kanshou suo 看守所).

In those contexts people are interrogated, intimated not to adhere anymore and, most of all, pushed to report their leader or referral pastor and the members of their religious community through practices defined as tortures acted with rage by law enforcement.

With my neighbor we went together knocking at the doors in order to make proselytism. One day we knocked at the door of a man we knew and the son of a relative of this man reported us to the police. On the same day, the police brought us to the police headquarters and interrogated us in two different rooms. The policeman asked me: “Who sent you to make proselytism? How many people do attend your church?” I was very afraid and I did not answer. The policeman begun to hit me and insisted with questions. I only admitted that I had made proselytism. Another policeman then intervened and hit me too. I fainted for half an hour and when I woke up I found a policeman who told me not to pretend, because if I would have continued to pretend they would have continued to keep me in that room. After 24 h they brought me in another police station. Four policemen brought me in a room, they interrogated me but I continued not to answer. If I would have continued not to give the information required, I would have been killed by the police. I asked which law I violated, I pointed out that I did not make politics. They answered me that I was doing proselytism, that I threatened public security. I stayed in that police station for three days, then I was very sick and so the policemen called my family to take me. They paid a fine and so I was released (Tian, 10/2016).

I was arrested and also tortured. In 2012, I was arrested while I was with other people of my church. The police came to make controls. They took us and did not transfer us to prison because a legal trial was needed, but they took us to another place for people not condemned yet. I stayed there for two days. They wanted me to say who the other people of the group were. I did not say anything and they hit me. At my arrival they threw some books on my head and my body. Then another policeman arrived, he took off his belt and started to whip me. I could not keep standing up so they continued to kick me on all my body. On the second day they tried again to interrogate me on the names of my church brothers but I continued to refuse, I did not say anything and they hit me with an electric stick. I remember a very strong pain due to electric shock. I said that what we were doing was legal and the policemen told that by believing in God and not in the Party I was acting illegally. They got even angrier; they hang me by my wrists from the ceiling with a cord. They pushed me from one side to another. I stayed hanging for 30 min. While torturing me, one of them slap me so strongly that I fell down and hit a table with my mouth. I lost all those frontal teeth. Since I fainted and they were afraid that I could die, they took me out and left me in a hospital (Mei, 05/2016).

Frequency of pre-migratory experiences related to repression: The qualitative data reported above are complemented by the quantitative assessment of pre-migration traumas and difficult experiences (pre-migration events in the LiMEs). Prior to leaving the country, the majority of our patients indicated the experiences of “loss or separation from family members” (78.95%) and of “forced separation from family members” (63.16%) as the most frequent. Such family disruptions were associated with experiences of discrimination and repression as they frequently reported the “feeling [of being] deprived of something” (57.89%), “feeling like being part of a minority”, “feeling neglected”, being “unable to return home” (55.26%), “feeling that injustice was being done” (50%), facing the “destruction of personal properties” (50%). Different forms of interpersonal violence were also reported in many instances. In the majority of cases, it was an indirect action with a deterrent effect: 60.53% of patients were “witness of violence perpetrated against other people”. In less frequent cases, as described above in their narratives, severe forms of intentional violence were experienced directly: patients reported “brainwashing” (39.47%), “being kept in isolation” (36.84%), “physical abuse” (31.58%), “detention” (26.32%), “being close to death” (21.05%), “serious injuries” (18.42%) and “torture” (7.89%).

Exiles: Internal migrations in China and transnational journey

At the beginning, repressions brought to a forced internal migration in China for a period ranging from 1 month to 4 years, mostly out of the province of origin. In this situation, loneliness and abandon of the family, children included, is reported; telephone calls are rare in order not to be traced and arrested but also not to expose other family members to any risk. In this part of wandering life, they report to have invented a fake identity and to have lived hidden, often with church brothers, afraid of being discovered. It is commonly reported that the international migratory journey is conceived and prepared during this exile period. In 82% of cases, departure is decided at least with a family member or with the religious community who often supported the high costs of the journey. 98% arrived in Italy in 2015, only 2 people in 2016, at the Airport of Rome Fiumicino, usually with a tourist visa. Italy was chosen as destination country since at that time it was easier to obtain the visa compared to other countries, due to the events EXPO and the Jubilee that made easier the release of tourist visas [39].

Coherently with narratives, LiMEs data about the journey show the presence of worries related to the interruption, maybe irreversible, of the relationship with personal and cultural origins. Most of them are concerned with the inability “to return home in emergency” (55.26%), with “family back at home” (31.58%), with “loss or separation from family members” (10.53%), with “loss of ethnic identity” (10.53%). Moreover, feelings of powerlessness and sadness prevail as they report “feeling that you cannot control the events in your life” (55.26%), and that “you do not know where you will end up tomorrow” (47.37%).

Post-migratory adaptation difficulties, structural violence and new projects in Italy

At their arrival in Italy, people describe a feeling of relief attributed to the awareness of being free to practice their faith, to follow the Christian religion individually or in the religious community, with no discrimination and marginalization. It was evident, yet at the first interviews, that religious freedom in Italy improved mood status and psychophysical conditions. Free expression of faith itself determined strengthening of confidence in the current life project and of hope in future perspectives. Nevertheless, this initial wellbeing was only temporary, because the appearance of post-migratory difficulties of life – including the necessity to relate the religious conversion to the TC – introduces a phase of new worries and fears which constitute the basis for the rising or sharpening of signs of psychological suffering.

LiMEs show that the most frequent post-migratory worry is related to the “fear of being sent back home” (81.58%). This fear must be connected with other uncertainties related to the application for international protection, including worry about the long time it takes (“the Commission took long to make a decision over asylum request”: 68.42%) and the feeling of depending from decisions which depend on other people (“feeling you do not know where you will end up tomorrow”: 73.68%; “feeling that you cannot control the events in your life”: 63.16%).

People included in the study are mostly claimants to the Court against the decision of the TC (36 out of 38). When refusing international protection applications, TCs, in their reasons for refusal letters (RFRLs), claim that the reasons leading to migration are unlikely, incredible and implausible, by using what Souter [40] defined a “culture of disbelief or denial”.

Suspicion is fully revealed in the arguments used by the TC. Passages of the RFRLs of the above-mentioned international protection requests of Mei (05/2016) and Tian (10/2016) are reported:

The story is absolutely implausible, and frequently used by international protection seekers from the Popular Republic of China. The report lacks of internal coherence in different aspects (…). It is unbelievable that the person once arrested by the police and being afraid for her life, decided to apply for the passport (…).

The dynamic of some of the reported events does not seem credible: in particular, the reasons for the arrest occurred in 2012 during a meeting are not clear, since the person did not declare any role of responsibility in the Church, as well as the reasons for the two-days detention in a “unofficial” place and for the abuses aimed at obtaining information on the same Church (…).

In the complex bureaucratic procedure for applying for international protection, the narration has a central role: this is the main instrument for granting of refusing international protection during the first interview with the TC. As regards the narrations of Mei e Feng, it has to be noticed that violence and tortures reported are not even mentioned in RFRLs. Their testimony of torture and violence is silenced and deprived of its historical and political value. Chinese refugees do not seem to be reliable witnesses. In fact, clinicians are frequently requested by lawyers to certify violence and traumas suffered in order to make an appeal against the negative decision of the TCs.

The acknowledgment of the experience of refugees and the authoritativeness of their words are more and more replaced by medical and psychological reports of the experts certifying torture outcomes or psychological trauma [20].

The right to asylum can therefore only be recognised though refugees’ diagnostically certified suffering body and the disease becomes the only reliable reason for obtaining a legal status [21]. In consideration of this aspect, the équipe was very cautious when producing this kind of certificates. The results of the appeals to the Court are still unknown. Therefore, it has to be verified weather the Judges, differently from the members of TCs, will recognise a medically and psychologically certified “status of victim”, that constitutes the privileged and exploitable field of “biopolitics of otherness” [41].

I.e., in this way the experience of refugees and the authoritativeness of their words are replaced by medical and psychological reports of the experts certifying torture outcomes or psychological trauma [20,22]. This represents a shift of power from the person to the expert depicting his/her case and the disease becomes a reliable reason for obtaining a legal status [21]. On the other hand, if clinicians refuse to produce certificates, the risk is that their applications will be rejected again. Hence, the team was very cautious when producing this kind of certificates, being aware that in the present system the right to asylum can be more likely recognised through the refugees’ suffering body.

Another important problem is related to family relationships, namely “worries about family members at home” (76.32%) who could be in danger, together with the preoccupation of being unable to return home in case of emergency (50%). Finally, social adjustment and cultural integration difficulties are also reported, like those related to “linguistic differences” (73.68%), “loneliness and boredom” (60.53%), “adjustment and coping with culture” (50%). In general, psychological and anthropological interviews point out the deep suffering of being alone, far from the loved ones. Among married women, 11 referred to have felt forced by the situation to leave their children to their parents or husbands in China. The loss of the loved ones is always mentioned during interviews, mostly as regards children, without an available project of family reunification. The absence of relatives is emphasised by the impossibility of telephone contacts. Dread of being controlled complicates the integration process by reducing the possibility to have support networks based on safe relationships. Moreover, it eliminates all possibilities of maintaining sentimental relationships of the past.

Mental distress: Qualitative observations and narratives: During psychological interviews, the evocation of events which determined persecution and forced departure immediately induces re-emergence of pain, desperation, anguish, fear and even dread. During interviews we often observed a typical transfiguration of the face: initially their expression was serene while talking about their faith, but it suddenly changed into suffering and fear when recalling what had happened in China. The fear of the capillary control by the Chinese Government deeply affected the emotional state of patients, who were also afraid that such a control could extend in Italy. In fact, they often expressed a feeling of being persecuted, even though at different intensity levels and this fear made them not feeling safe neither with Italians nor with Chinese immigrated for reasons unrelated to religious issues. In this reactive worldview, the others always represented a possible threat and it was impossible to have relationships based on trust. This was strongly influencing the adaptation process in the new context. Believers had interiorised the prohibition to freely follow their faith and to express their opinion. This condition was generating forms of self-limitation of their daily freedom of movement as well as in the socialisation process. All initiatives needed for integration, including those finalised to job search, were thoroughly weighted and reduced to the minimum. Relationships based on trust were limited to Chinese following the same religion, while the reasons behind their migration were usually hide to Italians and other Chinese. Without initial difficulties, a trustful relationship could be established with the professionals encountered during the procedure of international protection application. Empathic, supportive professional aid allowed carrying out a more effective advocacy and human right protection activity. In some cases, the feeling of anguish was connected with disturbed body feelings, together with intrusive thoughts and rumination. It was observed a chronic state of alert, a hyper-arousal, a constant feeling of irritability, tension and sense of confusion. In some of the patients, the clinical picture was mainly post-traumatic, the seriousness of traumatic experiences having determined emotional and physiological disorganisation. In other cases, anguish had mostly ended in depressive symptoms like sadness, despair and loss [42]. In this phase, the grief generated by loss of emotional and cultural referral points, the undefined legal situation and the traumatic experience, all hampered the construction of a sense of meaningfulness of their experience.

Scores at the Zung Self-Report Depression Scale (ZSDS) suggest that 41.94% of the Chinese refugee population were depressed (Mean 53.87, SD 8.2), thus paralleling the proportion of depressive diagnoses identified by clinicians. Table 4 shows that the majority of patients with ZSDS had a form of “marked depression” (35.48% of the entire sample), while only a minority had “severe depression” (3.23%). Considering that it is sometimes reported that in Chinese medical tradition depression might be perceived more somatically than psychologically [43], we performed a ZSDS items analysis in order to differentiate negative effects and ideations from more somatic experiences. In our patients this was not the case: somatic symptoms were frequent (psychomotor retardation M=3.35; fatigue M=3.03; tachycardia M=2.58) but psychological symptoms were frequent as well (personal devaluation M=3.53; feeling undecided M=3.48; depressed mood M=2.74; crying spells M=2.54).

With regards to PTSD, at the Harvard Trauma Questionnaire (HTQ) a relevant number of patients scored above the PTSD cut-off (68.7%, Mean 2.71, SD 0.49). This was not in agreement with the clinical evaluation, where the diagnosis of PTSD was less frequent (29%). This difference could be due to several factors. One possibility is that HTQ may overrate post-traumatic symptoms because in the self-evaluation patients may not differentiate between intrusive thoughts as post-traumatic symptoms at one side, and intrusive thoughts as recurrent worries and brooding on the future as part of an adjustment disorder on the other side. Moreover, sleep disorders, mood disturbances, etc., are symptoms of both conditions, and this could make easier the misinterpretation of adjustment symptoms as post-traumatic phenomena. The fact that among clinical diagnoses there was a 15.79% of adjustment disorders further support the interpretation that they were reframed as post-traumatic conditions with the HTQ. Another possibility is that at the first interview clinicians had not enough information or were unable for other reasons to detect post-traumatic symptoms, which would result in clinical underestimation of the diagnosis of PTSD. This possibility is coherent with the observation that mental post-traumatic symptoms are often underreported by patients, which is the reason for calling mental post-traumatic symptoms “invisible wounds” [26]. Moreover, in accordance to this hypothesis, studies based on clinical diagnosis usually underestimate the actual prevalence of PTSD [44].

CONCLUSION

To our knowledge this is the first study exploring the context and the reasons leading worshippers of protestant domestic churches in China to flee their country and apply for international protection in Europe, their experiences before and during migration and their mental health profile in the host country.

Our study shows that the asylum seekers were coming from 13 different regions of China, mainly located in the South-East part of the country and that they were worshippers of several different religious communities (at least nine). Domestic Evangelical Christian churches and new rituals, such as the Almighty God church, are widely spreading on the Chinese territory, as well as in the United States, and more recently in Europe.

In our sample, the majority of subjects were young educated women. We observed that conversion often followed difficult moments of their life, facilitated by the proselytism of friends and relatives. In general, we can state that numerous new conversions mostly interested women who abandoned State atheism for domestic evangelic Christianity. Worshippers adopted several forms of covert actions used as a survival strategy to escape State control. However, they were not enough in our cases. Proselytism and conversions were widely repressed inside the family as well as by the institutions (i.e., ostracism at work and school) and by the police, even though without formal incriminations or trials. In all cases, interpersonal violence was reported, frequently ending in real forms of torture. After those episodes, people abandoned their territory and loved ones, at first by displacing and hiding in other areas of China, then emigrating towards Italy. The arrival to Italy was not the effect of a real choice; it appeared to be mainly related to the easiness of obtaining a visa in that period.

Once in Italy, after a first moment of relief, psychological distress related to post-migratory life difficulties emerged in the following months. Among difficulties in Italy, the most significant were troubles in obtaining the refugee status with related fears of repatriation, the complex adaptation to the new context and culture, the worry for relatives remained in China, and the sense of loneliness.

Psychological distress mostly expressed into depression (42% of the total sample) with somatic, cognitive and emotional symptoms. Also post-traumatic symptoms were frequently reported, with a PTSD prevalence varying from 29 to 68% according to the diagnostic method used. Finally, there was a 15% of Adjustment Disorders. It was also noted a tendency to concern and suspicion about possible persecution. This lead to distrust in compatriots, because they were afraid to be reported to the Chinese government, and hence to social withdrawal from outside relationships. On the contrary, connection with people of the same religion was strengthened.

Concerning their application for international protection, we reported that the Territorial Commissions tended to mistrust their narratives hence rejecting their applications. Part of our work was aimed at writing technical records to support the trustfulness of their histories and psychopathological reactions. They were used to appeal to the ordinary Courts, according to Italian laws. The results of the appeals to the Court are still unknown and will be discussed in further research.

COMPETING INTERESTS

The authors declare that they have no competing interests.

AUTHORS CONTRIBUTIONS

The authors contributed equally to the design and implementation of the study and to the writing of the manuscript. All authors read and approved the final manuscript.

FUNDING

Not applicable

ACKNOWLEDGMENT

We would like to thank Cecilia Fazioli for the English translation, and all the scholars who shared with us reflections on this new form of forced migrations and provided insightful comments and critiques to an early draft of this manuscript.

AVAILABILITY OF DATA AND MATERIALS

The data that support the findings of this study are available on request from the corresponding author M.C. The data are not publicly available due to them containing information that could compromise patient confidentiality.

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  Table 1
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  Table 2
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  Table 3
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  Table 4