Trapped in a private hell

SHE is attractive, beaming her open smile across the table. Expensive sunglasses, perched on her head, restrain a sweep of glossy hair which falls to her shoulders. She said she would wear black, and she has: a designer T-shirt and dark jeans, relieved only by the brightness in her face. But at 23, Vanessa's tale is a dark one. The story which comes tumbling from her lips is of teenage depression which teetered on the brink of suicide, of confused rage which had her spewing curses and obscenities at her parents. She tells of being tied, screaming, to hospital beds; of being injected with high doses of tranquillisers and being wired and subjected to electric shock in a Kowloon hospital. Are the perfumed women and manicured men lunching at white-draped tables around us, straining to catch her words? Engrossed in her tale she seems oblivious of the rise and fall of voices, the odd pools of silence. 'No one knows about mental illness here in Hong Kong,' she says. 'Hong Kong is such a commercial city. Speed is important, efficiency, effectiveness. People work under great competition; there must be pressure. 'Before I had this illness, people used to say chisin [crazy] very easily. But since I have had this, when people say this, even lightly, I feel very bad. Everybody is a little chisin,' she adds. As mental illnesses go, Vanessa's began as a schoolgirl's depression. It is a problem which is stirring greater concern among psychiatrists. The Hospital Authority is drawing up plans for an awareness campaign, to be launched in the new year. More people are seeking - or being forced to seek - help for delusions and depression, and some psychiatrists blame Hong Kong's overblown need for success, punctured recently by the first stabs of unemployment. The first in-depth study of youth suicide in Hong Kong last year found an alarmingly high rate of female suicide. More than 70 per cent of young suicides had shown psychiatric disturbances, one-third had been depressed, and high numbers had been unemployed or had dabbled in drug-taking. At 16, Vanessa, the middle daughter of a businessman, completes Form Five in Hong Kong and leaves her family home in Western to finish high school in Canada. So far, a familiar story. 'I was always in the care of my guardian, my father's friend. They were very strict; I could not go out, and if my friends telephoned me at 10pm they would scold me. I had no one to talk to, and I became very depressed. So depressed that I did not want to live any longer,' she says. 'I telephoned my father in Hong Kong. I can't remember what I said, but the hidden meaning was 'I don't want to live any longer; I want to die but I don't dare'.' She was luckier than other teens far from home. Her father flew to Canada and brought her home. But once back in Western, her behaviour remained perplexing. 'I just stayed in bed for two weeks. No one knew what I was doing; I didn't know either.' Finally, on a pharmacist friend's advice, the family consulted a psychiatrist. With regular visits and long-term medication, the 17-year-old was able to attend high school in Hong Kong. 'But I didn't want to take the medicine, because if I took the medicine, I would be a patient. I thought: I'm not a patient, I'm better now,' she said. 'Then the HKCEE came; it was a difficult period. My moods changed all the time and I scolded people. I had a mood disorder. 'The doctor sent me to St Theresa's Hospital to have electro-convulsive therapy.' She concentrates to recall the sequence of events, taking herself back to the anaesthesia before the current is hooked up and applied to both sides of her head. 'The doctor makes you go to sleep. Then you have negative and positive wires.' She indicates her temples. 'It is very quick, just a few seconds. It destroys the over-active cells. My parents were very worried; they asked the doctor: 'Will it affect the brain?' The doctors said the cells would grow again, that this was a very old, traditional treatment. 'Some people say more than 12 times is harmful. I had six or seven. Each time after the ECT I lost my memory. All those memories about what had happened, what I had done, what had made me sad, all was lost. 'Gradually all those memories reappeared. After a few weeks, a month, it came back slowly, slowly. But immediately after - nothing.' Still on medication, and in her late teens, she was determined to join the herds of people jamming the streets, the MTR, the phone and fax lines of the territory in a daily stampede. 'I was a little better, but when I came out of hospital I had a lot of anxiety, I was very afraid of the outside world, about how people look at me. 'My colleagues didn't know I had a problem; I could still manage a relationship with them. Then, for my job, I went to study in a technical institute and the problem returned. 'Many people don't know they have depression, but if you don't know and don't take care of it, it will get worse,' she says, takes care over each word. 'I scolded my father, I scolded my mother. I used foul language. I used it to scold my uncle. It's uncontrollable.' Vanessa was admitted to the private Hong Kong Sanitarium behind Happy Valley, where her condition worsened despite constant tranquilising injections. 'It was a craziness, a madness. My doctor said the injections should even make an elephant sleep, but I couldn't. 'The nurse-in-chief expelled me when I scolded her, and I had to go to Kwai Chung hospital. The private hospitals couldn't accept me.' Time is suspended as she reflects on her experiences in Kwai Chung, a hospital which takes tricky and recurrent mental cases, where stigma is applied with a lighter brush than the infamous Castle Peak. 'I was tied down by the nurses.' She pauses and laughs, surprised at the sound of her own words. 'I thought this only happened in the movies. I never thought I would be tied down by anyone. 'I totally lost control. I remember now, but at the time I didn't know what I was doing. I screamed the whole night and kept all the patients awake. They moved my bed to the dining room because I was so destructive. 'But they had no injections in this hospital. They cure people by the environment. The doctors come to the wards frequently and the nurses come and really want to talk. 'Student doctors came from China. They came in a group and they all sat around me and talked to me. I spent a month in Kwai Chung hospital. All the beds were full in my time, December 1993 to January 1994. 'I met a 70-year-old woman who lost her legs on the railroad. She said she had been standing by the road one day and just fainted. The train came along and chopped her legs. Her psychological problems started after that.' Vanessa pauses, summoning a favourite memory: 'The old lady smiled and said 'Young girl,' Your problem is just a small potato. You are still young, the problem you face is not great. You have a bright future. See me? I will live to 100 years old.' The hospital was a microcosm of society. She speaks of the prostitute, the young people, the father, mother and their two daughters who were constantly in and out. 'Outside, people think: 'Ugh. Mental hospital. Chisin.' You think inside it is hung po, scary, terrible. But it is a society.' She gestures towards the windows, behind which Chater Road rushes past. 'Think about this society. It is still hung po.' When the Kwai Chung doctors released her, she had calmed down, promising to stick with the medicine for the next five years. 'The doctor said: 'Don't think you are a patient. Think of it as vitamins to keep your body in good health. 'After I was released I was at home for six months. I was worried about how society saw me, about meeting people. But my parents were so supportive. 'It was August last year, the school year was coming up. My mother sat on my bed and spoke to me very quietly. She said: 'So do you have any plans? Do you want to work or go back to school?' These were patient, parental concerns.' It took quite some courage to face the Kowloon International School, to finish Forms Six and Seven, with telephone counselling from her Kwai Chung doctors. It will take even more to face the lecture halls of the University of London, where she has accepted a place to study economics and geography. Vanessa will test her new wings this week. But as she packs and prepares to leave, a disturbing phone call weighs on her mind. 'I have a friend I met in Kwai Chung. I used to scream at her and scold her. Now I can handle my life, I can work, I can go anywhere,' she says. 'But then I had this phone call from her.' A deep sigh. 'She said: 'I went back to Kwai Chung again last month. I didn't take the medicine. My parents don't care. My husband, he doesn't know what I am thinking'.' Is it parental love and support which has made the difference between the nurtured confidence of one woman, and the abyss yawning before her friend? 'Some people, when they get out they will follow the instructions of the doctor, they will get well easily. If you have any type of mental illness, don't think 'How do people look at me?' The most important thing is how you look at yourself. 'I understand things now. I'm already 23. I have to face and deal with my life positively.' Vanessa's mood is determinedly happy, and her Kwai Chung doctor, Hung See-fong, is pleased with her progress. But for each patient who leaves, there are many who return time and again - up to 40 per cent will be re-admitted. And there are those who can never come back. 'There is evidence of an increase in the suicide rate, in the rate of drug abuse, in the rate of young offenders,' says Dr Hung, head of the hospital's six-month-old adolescent unit. 'Ten to 15 per cent of all adolescents have some sort of problem. Those who are in-patients have psychoses, schizophrenia, mood disorder; and there are a few who have eating disorders or obsessive disorders, compulsive behaviour, attention deficits, hyperactive behaviour. 'In the Yau Ma Tei Child Psychiatric Centre, we see around 10 new referrals a week, which is about 400 to 500 a year. Of course, there's always a degree of resistance. No one likes to be called psychotic. 'But commonsense tells us Hong Kong is changing. There are a lot of problems. People are going to work and leaving their children behind; there is a lot of unemployment. There is a rising trend of depression.' THE head of the new psychiatric unit at Pamela Youde Nethersole Eastern Hospital, Dr Orlando Tang Wai-nang, also blames this stressful, addictive city. 'There is a rise in depression. Some say the seeds were sown years ago, when Hong Kong was rosy, in the economic boom,' he reflects. 'Striving for production, striving for economic growth, for efficiency, is making everybody stretched beyond their own capabilities. 'Family life suffers. Children are left with their grannies or with Filipina maids, kids may read undesirable comics or take drugs. There are mainland mistresses and astronaut families separated by the Pacific Ocean. 'When the parents realise, they say: 'I should have been here.' 'But the economic downturn has spawned new cases. Before, parents couldn't spend time with their children so they bought them things, games and clothes. Now, one of them may be unemployed and there is stress. 'Perhaps this is the price of productivity.' Chief executive of Castle Peak Hospital Dr Ng Hon-shing admits having 1,800 psychiatric patients in a hospital which officially has 1,741 beds. All patients are gazetted - admitted against their will. 'We do have overcrowding in the hospital. The psychiatric unit in Eastern Hospital has only been open for a few months and it is one of the attempts to meet the need for extra beds,' Dr Ng says. 'But in this hospital we have accumulated patients. Some cannot be discharged for various reasons and we are admitting more than we can discharge. 'In Hong Kong, the psychiatric services still have a lot of room for development. But people are becoming more educated about psychiatric illnesses, and now they come to us. That is an important factor.'