Confiding in strangers: trust and mental health service use in China

Research on trust has formed a dichotomous conceptualization of trust as established through either institutional support or relational norms, neglecting other possibilities. Drawing on Simmel’s theorization of the Stranger and Zelizer’s relational perspective, I argue that “stranger trust” is another mode of trust that frames the trusted person as a Simmelian stranger through interactional negotiations. Using interviews with mental health service consumers in China, I address the question: how do participants of therapeutic relationships form trust under the unfavorable institutional environments for mental health services in China? My findings show that participants in therapeutic relationships create trust by framing the service provider as a “Stranger.” This mode of trust-building consists of three components: (1) a moderate interpersonal social distance, (2) differentiation from other types of relations, usually through monetary payment, and (3) a depersonalized discourse of emotions. From the client’s perspective, the establishment of stranger trust mitigates the risk posed by a lack of institutional regulation for mental health service provision. This study calls attention to how relational practices create and maintain trust in settings with weak institutional support for trust.