How to recognise depression and deal with it
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.
Equally culture-bound is anorexia nervosa. But it is better known because it is specific to North America and western Europe, where most psychological discourse takes place. It mostly affects young women, who dangerously restrict their food intake. The disorder is the result of a cocktail of influences and circumstances surrounding the woman's relationship to her own body, food and role models. An emphasis on the importance of high self-esteem is also a probable contributing factor. Focusing intensely on the self as a means to fulfilment contrasts with collectivist societies in which fulfilment is more typically encouraged through experiences of sharing and mutuality.
All of this gives us clues about how respective cultures go about dealing with serious psychological problems. In the individualistic West, the patient is treated principally in isolation from their social support system, using talk therapies and prescription drugs. This fits with individualism in some ways. But it is also somewhat ironic, since intense interest in the value of the self at the expense of others may be part of the problem in the first place.
In collectivist societies like Hong Kong, the psychological symptoms of an individual are more difficult to tease apart from a person's social self. Because people feel more connected to their family and social circle, being treated in isolation is incongruous. Because the cultural parameters are different, distress itself is also likely to be understood and experienced differently.
Asian approaches (and those adopted by cross-cultural practitioners) often involve a mix of traditional medicine and treatment, meditation and different kinds of religious practices. A common local perspective is to look at psychological problems in purely physical terms and to treat symptoms with traditional Chinese medicine and through changes in behaviour supported by family and community members. This avoids culturally incompatible talk therapy - and conventional drug therapy, which is frequently too harsh for the average Asian metabolism.
Because the term depression is in such widespread use, an awareness of its meaning is useful to a community's mental health - especially what is normal and what should be expected. But there are many other surprising syndromes through which psychological distress can be communicated. Pa-feng, taijin kyofusho and latah can all give a person the tools to make sense of their troubles, to meaningfully articulate them and, hence, to better tackle them with culturally sensitive support.
One person's depression, as the New York Times noted, may be just another person's hwa-byung.
