What lies be­neath

Suicide preven­tion aware­ness and an un­der­stand­ing of de­pres­sion crit­i­cal, Bei­jing ex­pats say

Global Times – Metro Beijing - - FRONT PAGE - By Clau­dine Housen

Kather­ine Manser (pseu­do­nym), 25, from the UK has a good life. She has a de­gree from a rep­utable univer­sity, a lov­ing and sup­port­ive mother, an un­der­stand­ing boyfriend and a me­dia-re­lated job in China’s cap­i­tal. She also has chronic

de­pres­sion and an anx­i­ety dis­or­der, which means she of­ten bat­tles feel­ings of de­pres­sion and even sui­ci­dal thoughts. Manser was di­ag­nosed at 23 but said the “first at­tack she had that was rec­og­niz­ably de­pres­sion” dates back as far as age 16. “There is a stigma around men­tal health treat­ment in the UK. I had just as­sumed that I had been brought up on books and mu­sic by all th­ese won­der­fully de­pressed peo­ple, [and] it was kind of my lot in life to be un­happy,” Manser re­calls of her teenage self. “I am ob­vi­ously work­ing to break th­ese thought pat­terns now.” She is one of many peo­ple with de­pres­sion that be­lieve more needs to be done to cre­ate a bet­ter un­der­stand­ing of de­pres­sion and ad­dress the de­vel­op­ment of sui­ci­dal aware­ness. A March 30, 2017 World Health Or­ga­ni­za­tion (WHO) re­lease de­fines de­pres­sion as “a com­mon men­tal ill­ness char­ac­ter­ized by per­sis­tent sad­ness and a loss of in­ter­est in ac­tiv­i­ties that peo­ple nor­mally en­joy, ac­com­pa­nied by an in­abil­ity to carry out daily ac­tiv­i­ties for 14 days or longer.” Peo­ple with de­pres­sion nor­mally ex­pe­ri­ence loss of en­ergy, a change in ap­petite and sleep­ing habits, re­duced con­cen­tra­tion, in­de­ci­sive­ness, feel­ings of worth­less­ness, guilt or hope­less­ness and thoughts of self-harm or suicide, the re­lease said. The WHO es­ti­mates that over 800,000 peo­ple com­mit suicide each year – that’s one per­son ev­ery 40 sec­onds. Also, de­pres­sion is the most com­mon psy­chi­atric dis­or­der in peo­ple who com­mit sui- cide, ac­cord­ing to the In­ter­na­tional As­so­ci­a­tion for Suicide Preven­tion (IASP). The ISAP launched World Suicide Preven­tion Day in 2003 and re­ceived an en­dorse­ment from the WHO. The day was rec­og­nized on Septem­ber 10 un­der the theme “Take a minute, change a life,” through which IASP en­cour­aged peo­ple around the world to look out for those who are strug­gling be­cause “of­fer­ing a gen­tle word of sup­port and lis­ten­ing in a non-judg­men­tal way can make all the dif­fer­ence.”

Mak­ing an ef­fort

“So­ci­ety needs to make a greater ef­fort to in­te­grate the men­tally ill and men­tal health­care into the com­mu­nity,” said Menser. “I think if there were less stigma at­tached to it there would be less of a worry that you would never get a job or re­la­tion­ship and that you are just go­ing to be un­happy, mis­er­able and alone your whole life.”

Ac­cord­ing to Menser, the stigma of be­ing la­beled “de­viant” is one of the pri­mary rea­sons peo­ple with de­pres­sion do not al­ways seek help un­til the sit­u­a­tion is quite out of hand. With the ma­jor­ity of the ex­pat com­mu­nity in Bei­jing be­ing in their early 20s to late 30s, the sense of be­ing seen as dif­fer­ent from the norm can also be an im­ped­ing fac­tor.

“I think we need to be teach­ing kids more em­pa­thy, more ways to talk about their emo­tions that are con­struc­tive rather than very, very neg­a­tive all the time, and I think we need to be catch­ing men­tal health prob­lems sooner be­cause quite of­ten they are left to de­velop and fes­ter,” she said. “I suspect that for my­self, had I sought treat­ment, a di­ag­no­sis, some con­crete plan of ac­tion when I was a lot younger, I highly doubt that I would be in the same state that I am now.”

An­other rea­son suicide aware­ness preven­tion needs to be fur­ther pro­moted in the ex­pat com­mu­nity is their tran­sient life­style. Peo­ple who do not plan to stay in one place for very long do not al­ways see the value in in­vest­ing in long-term or ex­pen­sive ac­tiv­i­ties, and for some ex­pats, coun­sel­ing falls into that bracket. Menser said she knows for­eign­ers in China who be­cause they are only here for a short pe­riod, do not see the value of join­ing a sup­port group.

“The ex­pat cul­ture of heavy drink­ing, heavy par­ty­ing and very tran­sient friend­ships can ex­ac­er­bate things,” she said. “I also think that a lot of peo­ple think that be­cause they are just here for six months they don’t need to deal with the prob­lem at hand. That at­ti­tude is fine when life is easy, but life could throw you a curve ball.”

How to help some­one who is sui­ci­dal

Suicide preven­tion starts with rec­og­niz­ing the warn­ing signs and tak­ing them se­ri­ously. Talk­ing openly about sui­ci­dal thoughts and feel­ings can save a life, ex­perts say. “Usu­ally, peo­ple will reach out. No­body wants to die. What they want to do is to end the pain,” said Qin Xiao­jie, the founder and ex­ec­u­tive di­rec­tor of Can­dleX, a Bei­jing-based sup­port group for both ex­pats and Chi­nese who have de­pres­sion, bipo­lar dis­or­der and anx­i­ety. “Peo­ple will al­ways send sig­nals. If they talk about it in plain words, don’t ig­nore it.

Data on the IASP web­site cor­rob­o­rates her state­ment. Ac­cord­ing to the site, peo­ple who have lived through a suicide at­tempt “of­ten de­scribe re­al­iz­ing that they did not want to die but in­stead wanted some­one to in­ter­vene and stop them.”

“Some­times they say that they made a pact with them­selves that if some­one did ask if they were okay, they would tell them ev­ery­thing and al­low them to in­ter­vene. Sadly, they of­ten re­flect that no one asked,” the site went on to men­tion.

Ac­cord­ing to Qin, there are roughly four stages to de­pres­sion that leads to sui­ci­dal thoughts. The first is the ideation stage in which an in­di­vid­ual will feel like they do not want to live, but not harm them­selves. The sec­ond is the con­flict stage where “one voice be­comes stronger,” fol­lowed by the plan­ning stage and then the im­ple­men­ta­tion stage.

She said friends and fam­ily of peo­ple at risk for suicide should look for sub­tle changes in the per­son’s speech and man­ner­isms. For ex­am­ple, they might talk less, start giv­ing away things or say­ing good­bye to peo­ple. When things like th­ese start to hap­pen, she said it is okay to talk to that in­di­vid­ual and ask whether they are feel­ing sui­ci­dal.

“It’s okay to ask. The re­search sup­ports it,” said Qin. “When they tell you, lis­ten. Be pa­tient. Don’t tell peo­ple they can­not feel that way be­cause they have a fam­ily, a good job and so on. Don’t give ad­vice. Lis­ten with qual­ity and don’t force them.”

She also cau­tioned peo­ple with loved ones in such sit­u­a­tions to “be re­al­is­tic” in their ex­pec­ta­tions as de­pres­sion is not some­thing that one can just snap out of.

“The more you love them the less pa­tient you are be­cause you want them to get bet­ter,” she said. “[How­ever,] if they lose the peo­ple they love the most they might stop try­ing.”

Find­ing sup­port in a for­eign coun­try

All the in­ter- vie­wees agree that hav­ing a sup­port sys­tem is essen­tial for any­one with de­pres­sion, es­pe­cially if one has had or is at risk for sui­ci­dal thoughts. But for some of the ex­pats with de­pres­sion liv­ing in Bei­jing, this can be quite chal­leng­ing.

Manser is one of the luck­ier ones; she sees a pro­fes­sional ther­a­pist once a fort­night. But that comes with a hefty price tag of 900 yuan ($137) per hour at an in­ter­na­tional hos­pi­tal, and that is on health in­surance from her home coun­try that her mom helped her pur­chase.

“A lot of peo­ple wouldn’t have the fi­nan­cial re­sources to see a ther­a­pist,” said Manser.

She said out of ev­ery­thing she has tried, ther­apy has helped her the most. “It has given me a much greater un­der­stand­ing of men­tal ill­ness, and it is nice to have some­body to talk to that has no emo­tional con­nec­tions with you. You can be as un­pleas­ant, scary and as mad as you like, and there is no emo­tional judg­ment: it is free­ing,” she said.

An­other op­tion open to for­eign­ers with de­pres­sion in China is sup­port groups made up of peo­ple go­ing through a sim­i­lar ex­pe­ri­ence. One such group is Can­dleX. The group of­fers

con­fi­den­tial meet­ings for peo­ple n need and has reg­u­lar meet­ings in English ev­ery econd and fourth Tues­day of the month. Ben Allen (pseu­do­nym), 53, from Canada, op­er­ates a WeChat-based sup­port group to help peo­ple with de­pres­sion. The group has around 65 mem­bers, about a third of which are for­eign­ers liv­ing in China. There are also in­ter­na­tional hos­pi­tals like Raf­fles Med­i­cal that have English­s­peak­ing clin­i­cal health psy­chol­o­gists on staff and lo­cal hos­pi­tals like the Hui­long­guan Hos­pi­tal in Bei­jing, but per­sons seek­ing help there might need speak Chi­nese. For those who can­not af­ford a ther­a­pist, Manser rec­om­mends sup­port groups like Can­dleX. “Ther­apy is ex­pen­sive; that is why I think groups like Can­dleX are so im­por­tant be­cause the key com­po­nents of ther­apy: some­one who might have seen more things than you, some­one to re­mind you that what you are feel­ing isn’t ab­hor­rent or ab­nor­mal, group sup­port, just em­pa­thy and hu­man warmth com­ing off some­body else, you can get all that at sup­port groups,” she said.

“When you sit in a group of say eight peo­ple and six or seven of them are say­ing yes I’m oc­ca­sion­ally sui­ci­dal, it is such a re­lief to know that you are not the only per­son who, oc­ca­sion­ally, ev­ery now and again, can’t see the point of liv­ing. It is nice.”

Photo: Cour­tesy of Pere Ibañez

De­pres­sion is the most com­mon psy­chi­atric dis­or­der in peo­ple who com­mit suicide, ac­cord­ing to the In­ter­na­tional As­so­ci­a­tion for Suicide Preven­tion (IASP).

“For some­one liv­ing with de­pres­sion, talk­ing to a per­son they trust is of­ten the first step to­ward treat­ment and re­cov­ery,” said Shekhar Sax­ena, a WHO men­tal health ex­pert.

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