In a grim coincidence, a 36-year-old man rampaged through a Chinese elementary school with a knife on Dec. 14, the very same day as the horrific attack at Sandy Hook Elementary School in Connecticut, which killed 20 students.

The Chinese knife attack wounded 22 kids and an 85-year-old woman at Chenpeng village in the southern province of Guangxi. (Gun ownership is tightly controlled in China, where mass attacks usually involve men with a knife, cleaver, or machete.) The high number of casualties is just the latest in a string of school attacks, and it underscores inadequacies in the country’s antiquated—and in some places virtually non-existent—system for diagnosing and treating citizens suffering psychiatric distress.

Chinese society has experienced enormous stress in the past two decades, brought on by rapid urbanization, a growing wealth gap, and most of all, a deterioration of traditional family structures. “Our cities are getting bigger and bigger, but families’ capabilities for dealing with problems are weakening,” said Chinese police official and criminal profiler Li Meijun.

Most of the Chinese victims on Dec. 14 were pre-teens who suffered head wounds. Local media reported that suspect Min Yingjun was a local villager suffering from a mental disorder. Immediately after the knifings, he was subdued by security guards posted at the Chenpeng school and others across China since a series of attacks against students began in 2010.

The spate of stabbings began in March of that year, when a man in Fujian province went on a slashing spree outside a primary school, killing 8 and injuring 5. The attacker was a jobless doctor who reportedly was venting frustration after a failed romantic relationship. Over the next two months, four similar incidents took place in southern and inland China, leaving more than eight primary and kindergarten students dead and 57 injured. The timing of the four incidents suggested the possibility of a “copycat” phenomena, in which criminals mimic sensational incidents after learning of them from media. The stabbing spree alarmed government authorities, who enhanced security at schools; a Chinese regulation now also requires people to register with their national identity cards when purchasing large knives.

But schools are still coming under attack. Two months ago, three students were killed and 13 injured when a man with a machete rampaged through a private daycare center in Guangxi. Although they usually garner less media coverage, other incidents of violence appear to have similar roots: the attackers are usually Chinese men who are either mentally disturbed or distressed by personal disputes, economic pressures, or unhappy love affairs—or a combination of the three.

Just Thursday, a day before the Guangxi stabbings, police announced they’d apprehended a 25-year-old suspect who’d confessed to slashing the faces of a number of victims—mostly young women—on Beijing’s heavily travelled #5 and #10 subway lines. (Several days earlier, the Chinese Twitter-like microblog called Weibo had circulated reports of a serial subway slasher.) The suspect had “taken revenge on society because of relationship frustrations,” the police report said.

Chinese remain reluctant to institutionalize relatives with psychiatric disorders because of the heavy social stigma and costs involved; many are sequestered at home and treated privately (or not at all.) However as China’s economic downturn churns on—and rapid urbanization and dislocation continues—the psychological stress on its citizens can only get worse. Institutions that are many decades behind the West in handling mentally disturbed patients are now being pressured to dramatically boost their capabilities, because Chinese families can no longer cope.