Without any care

By Xuyang Jingjing Source:Global Times Published: 2013-1-20 18:53:01

Inset: Relatives cry over the body of a woman covered up with a cloth, who fell from the 19th floor of a residential building in Chaoyang district, Beijing, in September 2011. The woman, who was less that 30 and had a 10-month-old baby, is thought to have committed suicide after suffering from postnatal depression. Photo: CFP
Inset: Relatives cry over the body of a woman covered up with a cloth, who fell from the 19th floor of a residential building in Chaoyang district, Beijing, in September 2011. The woman, who was less that 30 and had a 10-month-old baby, is thought to have committed suicide after suffering from postnatal depression. Photo: CFP

Nobody can imagine the pain of depression, said Liu Ye. She described what it felt like during the worst days: "I couldn't sleep even for one minute at night. I tossed and turned in bed, sweat soaked the sheets. My heart started to race, my breath shortened."

She constantly thought about ending her life and even attempted to do so a few times. But the thought of her family kept her going.

Liu was 23 when she was diagnosed with severe clinical depression.

There are tens of millions of people in China suffering from this disease. While awareness of the disease has increased, many are still unwilling or unable to get help due to a lack of awareness, persistent stigma and limited medical resources.

Clinical depression, or major depressive disorder, is a type of mental illness characterized by "sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration," according to the World Health Organization. The disease can significantly impair one's ability to function.

Globally, depression is estimated to affect more than 350 million people of all ages. At its worst, depression can lead to suicide, leading to about 1 million deaths a year, according to WHO statistics from last October.

Everyone may feel down from time to time, but it's difficult to imagine what patients with depression go through.

Liu was always been a good student and very competitive. After she graduated, she became a high school English teacher in Tianjin in 2006. At 23, she was confident and excited about the adventure that lay before her.

But almost immediately, she started to crumble under the pressure of the new job and her own expectations to excel. She became anxious, couldn't sleep at night and couldn't work efficiently. In class she was unable to focus and felt like she was failing as a teacher.

She was unhappy, and nothing could cheer her up. All the things she used to enjoy didn't seem to bring joy. She lost her appetite, lost interest in everything and constantly felt tired.

Liu, now 30, later wrote a blog about her fight with depression. "I became so desperate about life. I had lost the last shred of confidence and I felt I could do nothing,… that I'm useless. I felt I was a burden to my family."

In those days, Liu often thought about suicide. She said she thought about different ways of ending her life, especially when she couldn't sleep at night. She attempted suicide three times.

Back then she didn't know anything about depression. Depression is already the fourth most serious disease in the world and the WHO estimates that by 2020, it will become the second most common disability in the world.

Rising calamity

Research done between 2001 and 2005 in four provinces in China found that about 17.5 percent of the population suffer from some form of mental disorder, with the prevalence of mood disorders at about 6 percent, according to an article published in 2009 in The Lancet, one of the world's leading medical journals.

It's reported that there are 30 million people suffering from clinical depression, while more than half of these have never sought medical help.

The number is rising, which is consistent with observations around the world. Nationwide surveys conducted in the 1980s and 1990s showed the prevalence of depression was about 0.1 percent, said Xiao Jing, a psychology lecturer at Beijing Normal University, but he estimates it is now at between 5 and 8 percent.

Better and more diagnosis could be one of the reasons for the change, explained Xiao. Both patients and doctors are now able to identify mood changes as a disease better than before.

Depression can be caused by a number of factors including personality traits, environment, or personal experiences. The rise in depression is also commonly related to changes in lifestyle and the increased pressure of modern life. "Rapid urbanization has changed our life; we live in much faster pace, and face more pressure from work and life, and these are common triggers for depression," said Xiao.

In 2005, popular TV host Cui Yongyuan revealed to his audience that he had suffered from severe depression for two years. It was probably the most prominent case at a time when clinical depression remained a somewhat mysterious condition. Last March, a microblog user left a message online saying that she was suffering from depression and had decided to end her life.

Depression is now increasingly talked about. People sometimes even joke about feeling depressed or do quick online tests to see if they fit the symptoms. Yet more awareness doesn't necessarily mean more understanding about the disease.

Many people don't think it's a condition that needs to be treated, experts say. More importantly, people feel ashamed about having clinical depression and so suffer in silence.

The WHO has pointed out that fewer than half of people with depression receive treatment.

Overcoming stigma

In China, long-standing social stigma is a major obstacle. In rural areas in particular, people lack awareness and those with depression are often written off as being simply too lazy to do anything, said Xiao. Other times, people with mood disorders are considered insane and patients and their families are usually embarrassed or ashamed to do anything about it.

A lack of understanding is another factor. People mistakenly believe that they can simply get better through sheer willpower. An online survey by the World Psychiatry Association and sohu.com in July 2012 showed that about 45 percent of respondents said they wouldn't go to a hospital if they had depression. Over 75 percent of them believed that they would not need to see a doctor or be medicated.

Among those who do choose to seek help, most visit general hospitals, which highlights the importance for doctors in community hospitals to receive psychiatric training and learn how to recognize and diagnose depression.

The survey showed that of the patients who went to treat cardiovascular, gastrointestinal or other diseases in general hospitals, over 20 percent also had clinical depression or anxiety disorder, said He Yanling, director of clinical epidemiology at Shanghai Institute of Mental Health, the Xinhua News Agency reported in July last year. But the diagnostic rate in general hospitals remains abysmal.

There are about 20,000 registered psychiatrists in China, which translates to about 15 psychiatrists per million people, according to Xinhua. There are also around 40,000 certified counseling psychologists in the country, but they do not have the legal right to prescribe medication for depression but only offer counseling as a complement to treatment.

Not only is professional help limited by these numbers but the abilities of these professionals vary greatly. Many people who suffer from depression have been bounced around between several different doctors who all fail to give them the help they need.

Xiao explained that for mild depression, medication and counseling have similar effects, but for severe depression, medication is almost always needed to stabilize the condition while a combination of counseling and medication seems to work the best.

Unhelpful doctors

In October 2006, Liu went to a hospital in Tianjin for the first time. The doctor asked her to take a diagnostic test on a computer and then prescribed her anti-depressants such as Prozac as well some traditional Chinese medicine methods.

Liu went to see the doctor for about two months, but each time the doctor only took a few minutes to renew her prescription.

By November that year, Liu's condition was only getting worse and the doctor suggested that she be hospitalized to receive more radical treatments such as electroshock therapy.

Begging off, Liu decided to seek help elsewhere. Some general hospitals didn't have the resources to help her. She tried a counselor who fed her "chicken soup for the soul" encouragement, which put her off.

Liu then went to see a different psychological counselor in Dalian who used a type of cognitive behavior therapy. Despite initially being resistant, Liu eventually cooperated and learned to use the techniques taught by the therapist to self-adjust.

Zhang Jin, deputy managing editor of Caixin Media, wrote on his blog in August last year of his struggle with depression. He described three counselors he went to. One only offered positive encouragements, another tried to give practical advice such as telling him to find an easier job, while the other spoke about psychoanalysis and the subconscious. He said that it felt it was more difficult to find a good psychotherapist in China than a good medical doctor.

The government has just passed a law on mental health which supports the training of mental health professionals and aims to strengthen doctors' abilities to diagnose mental disorders more promptly.

Liu has made a full recovery and has returned to work. She now has a 9-month-old baby boy. She made her story public, helping people suffering from the disease. Liu is also studying in her spare time to pass the test to become a certified counseling psychologist.

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