The recent deadly school rampage shows China is paying the price for focusing on economic growth for decades while ignoring mental health problems linked to the nation's rapid social change, according to experts.
A 48-year-old man apparently angry over a property dispute killed seven children and two adults with a kitchen cleaver at a kindergarten in northern China Wednesday -- the fifth assault on schoolchildren in less than two months.
For decades, China had been relatively free of the sort of multiple killings by deranged assailants that regularly seize headlines in the West.
But while cautioning that the causes of the attacks remain unclear, experts said that even as economic reforms have lifted millions from poverty in China, insufficient attention has been paid to psychological health.
"We have focused on economic progress but have most certainly lost sight of psychological improvements," said Ma Ai, a criminal psychologist with the China University of Political Science and Law in Beijing.
"This is because the changes of the past 30 years have been too fast."
Seventeen people, mostly young children, have died in the attacks, and more than 50 children have been hurt. Two attackers, including the man who carried out Wednesday's assault, committed suicide while another has been executed.
Why children were targeted is unclear, but Ma said the attackers may be seeking to shock the public in copycat attacks carried out in revenge against a more complicated society that they feel has wronged them.
Despite rising living standards and greater freedoms, Chinese today face new pressures unknown 30 years ago when China began opening again to the world -- particularly the struggle to keep up in a dog-eat-dog capitalist landscape.
Numerous studies have chronicled rising stress and mental illness levels.
Michael Phillips, a mental health expert at Shanghai's Tongji University, said many doctors outside major cities "don't know anything about mental illness."
A strong social stigma also prevents many from coming forth for treatment, he said.
"The stigma issue is really quite strong, but there really are a whole range of issues impinging on a lack of treatment as well," he said.
Phillips conducted a study last year that found 173 million Chinese suffered some sort of mental problem ranging from schizophrenia to alcohol abuse, and that 91 percent had never been treated.
China's national health system is widely pilloried as too costly, badly funded and marked by shoddy or indifferent treatment.
The government indicated its concern last year by announcing an ambitious plan to pump in more than 100 billion dollars to create a system ensuring basic care for all by 2020.
But China faces a huge task laying a proper mental health foundation for its 1.3 billion-strong population, Phillips said.
"In China, we know we need to go in that direction, but how to get there remains a big problem," he said.
The latest attack in the city of Hanzhong in Shaanxi province came despite a push to boost security at schools nationwide following the earlier rampages.
Chinese reporters have claimed in blog entries they have been barred by the government from independently reporting on the killings and that all media must use only versions published by official Xinhua news agency.
Han Han, an outspoken novelist who writes China's most popular blog, said in an entry last week such measures prevent a full investigation of why such attacks occur.
He said the order was aimed at avoiding embarrassment in the six-month spotlight of the Shanghai World Expo, which opened May 1.
"I just want to tell everybody, right here, that when the story of a person breaking into a kindergarten to slash up 32 children can't become news, you have all been slashed as well," he wrote.
China sees tens of thousands of protests, clashes and other outbursts each year related to property disputes, official corruption and a range of other growing pains, and the government has vowed to maintain security.
But clamping down is only one part of the equation, said Ma, who feels China urgently needs to take a more holistic approach that takes mental health into account.
"The recent cases serve as a warning," said Ma who called society an "ecosystem" made of several factors including both economic and mental health.
"If this ecosystem is not supported by mental health, all other things are built on a dangerous foundation."