What lies beneath
Suicide prevention awareness and an understanding of depression critical, Beijing expats say
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.”
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.