We hear a lot about depression these days. People say they are depressed about the economic outlook or the Sars outbreak. Heart-throb Leslie Cheung Kwok-wing was depressed before he took his own life.
Is this the same problem, only magnified? If so, when is it time to start worrying? In the clinical sense, the answer is very precise. An occasional day or two of being depressed is nothing to be concerned about. Indeed, it may be a necessary mechanism - a sort of homeopathic reality check. It is also perfectly normal for depressed feelings to expand due to highly stressful events like bereavement, job loss or a family crisis.
Generally speaking, however, alarm bells should ring when a bout lasts more than two weeks and is dominated by very low feelings, loss of interest in pleasure, abnormal irritability (especially among teenagers), unusual weight loss or gain, sleep disturbance, fatigue, abnormal self-reproach, poor concentration and/or morbid thoughts of death or suicide. Some forms of depression are complicated by other troubles, such as occasional manic episodes. These consist of a week or more of persistently elevated mood in which the person speeds up, becoming distracted and reckless.
Luckily, serious depression - the sort that needs immediate attention - brings changes not just to a person's subjective feelings, but also changes in behaviour, as mentioned previously, which should be noticeable to other people.
However, as rigorous as the defining process is, depression is a fuzzy target. It can look and feel very different to different people. For one thing, the symptoms in the clinician's bible, the Diagnostic and Statistical Manual of Mental Disorders are mostly drawn from the experiences of Westerners - the raw material used by the American and western European academics, the arbiters of the world's psychological canon.
Very different symptoms can arise from corresponding internal and external stress factors when they are filtered through contrasting cultural norms. The least documented of these syndromes generally crop up in societies remote from the world's psychological hub, such as Hong Kong, South Korea or Japan. They are often experienced and talked about in quite different ways, and may not respond to the same treatment.
Syndromes embedded in Asian cultures include the Chinese pa-feng (a phobic fear of wind), the Japanese taijin kyofusho (the intense fear of one's body parts - or odour, for example - being offensive to others) or the Malaysian and Indonesian psychosis latah (the irresistible impulse to mimic people). Hwa-byung is a suppressed anger syndrome common among middle-aged Korean women. The condition seems to be a sort of culture-bound safety valve, the result of a lifetime of bottled-up emotions. Symptoms include a lack of concentration and palpitations.