After death of Canto-pop star Ellen Joyce Loo, Hongkonger with bipolar disorder speaks up about mental illness to raise awareness
Her eight-year battle is waged in city where number of those who suffer is said to be vastly underestimated and a long-standing stigma persists
Kat Wong (not her real name) was only 14 years old when she first experienced extreme mood swings: she would become hyperactive one day and very emotional the next.
Her parents thought she was going through puberty. It was not until months later her mother realised something was off.
“I had lost all interest in doing anything,” Wong, now 22 and working in a pet shop, recalls. “I could not find the motivation to get up in the morning. All I wanted to do was literally stay in bed all day, so I did that to get out of school, including faking being sick.”
It has been eight years since she was diagnosed with bipolar disorder, a brain condition that causes unusual mood and energy shifts. Since then, she has been waging a long and lonely battle that has involved many relapses and several attempted suicides that left her in hospital.
The news of the death of her beloved singer, Canto-pop singer Ellen Joyce Loo, an outspoken advocate about the condition, hit Wong especially hard and spurred her to speak out about mental illness.
The singer-songwriter was suspected of having jumped to her death from her Happy Valley residence last Sunday. She was 32. Police investigations revealed there were no suspicious circumstances surrounding her death.
She was not the first celebrity to reveal a struggle with mental illness. Others have tragically fallen to depression and anxiety as well.
Singer Danny Chan Pak-keung was 35 when he resorted to suicide in 1993. It was believed he had suffered from mild depression when he was younger, and the condition worsened.
Ten years later, Canto-pop icon and actor Leslie Cheung Kwok-wing took his life at the age of 46, by leaping off a hotel in Central. A suicide note later revealed he had been suffering from depression.
More recently, singer Fiona Sit Hoi-kei, actress and pop singer Sammi Cheng Sau-man and other artists have spoken openly about living with mental health challenges.
But experts say that although mental illness is discussed more openly now, misunderstanding remains.
In 2017, the World Health Organisation (WHO) estimated about one in four people in the world, or 450 million people, were affected by mental or neurological disorders at some point in their lives. It said depression, anxiety and bipolar disorder were some of the most common forms of mental health conditions.
Bipolar disorder is believed to affect about 60 million people worldwide, but the global health watchdog said only two in every five people seek help in the year of the condition’s onset.
In Hong Kong, one in seven people, or about 13.3 per cent of the population aged between 16 and 75, suffered common mental disorders, according to a study by the Food and Health Bureau between 2010 and 2013.
Last year, Hong Kong’s public hospitals treated about 249,100 psychiatric patients – a 3.4 per cent increase from the 240,900 who sought treatment in 2016.
But experts point out local numbers are likely to be vastly underestimated. They believe there are a lot of hidden cases in society due to a variety of reasons and the public lacks awareness of the symptoms, often dismissing them as a sign of weakness.
The sufferers, subjected to a long-standing stigma, are reluctant to get diagnosed, refuse therapy or take themselves off medications early due to various misconceptions.
“Recovering from bipolar or any mental disorder isn’t the same as recovering from a cold or any kind of open wound,” psychiatric specialist Dr Rachel Cheng Shuk-yee says. “It’s a long battle. Some spend a lifetime trying to overcome their illnesses.
“In psychiatric terms, recovery does not mean the patient is free from any treatment or medication,” adds Cheng, who has worked in the public medical sector for more than a decade.
“It’s the process of finding wellness and mental stability with their help and regaining the ability to function in society again.”
Cutting through confusion
Before Wong’s bipolar disorder was diagnosed, two doctors told the then teenager she had depression. She was prescribed antidepressants for nearly a year, but her condition did not improve.
“My mom noticed I was getting too hyper all of a sudden and episodes would come and go,” Wong recalls. “I did not need to sleep at night and I talked very fast but my thoughts were scattered and made little sense.”
After consulting a third doctor, she was found to have bipolar disorder rather than depression. The two illnesses are often confused not only by the general public but sometimes even by medical professionals.
Bipolar disorder is a combination of mania, depression and hypomania. Manic and depressive episodes are separated by periods of normal mood. But not every patient will display all the elements – some may have major symptoms of depression, and that can make correct diagnosis difficult.
Psychiatrist Cheng says some patients may experience several episodes of being depressed before displaying signs of mania or hypomania. So if a bipolar patient sees a doctor while experiencing a depressive bout, the problem might end up being diagnosed as depression.
Not enough psychiatrists
Hong Kong is also severely short of psychiatrists, experts point out. There are only 330 psychiatrists working in the public sector, and they receive the bulk of severe patient cases. The private sector has only another 100 specialists.
This means there is a shortfall of about 400 psychiatrists in the public sector, taking into consideration the city’s population and WHO recommendation of one specialist for every 10,000 people. It is part of a wider chronic shortfall of doctors in general across public hospitals.
“One psychiatrist is looking after as many as 47 patients,” Cheng says, recalling her time in the public sector. “It means the time put in for each patient is limited and not ideal.”
She adds that at least 30 minutes to an hour is needed for consultations so patients can describe their condition and doctors are able to properly assess them.
To make up for the shortage of psychiatrists, public hospitals have been hiring more psychiatric nurses. Their numbers rose from 2,161 in 2011-2012 to 2,472 in 2015-2016, according to official figures.
Hong Kong College of Psychiatrists spokesman Dr Chan Lap-kei, says: “Many of those who suffer from mental disorders can only seek help from public hospitals because they have limited financial ability.”
Most patients are forced to wait as long as a year before they can be properly treated, he says.
“Their situation may not have been that bad when they first sought help, but after such a long wait without any treatment, it can only get worse.”
Another challenge is that many sufferers decide to suspend their psychiatric medication after seeing slight emotional improvement. In such situations, they may mistakenly believe they have fully recovered, or want to avoid the side effects of medication.
Cheng warns this can result in the resurfacing of symptoms, with some worse upon their return than before.
In Wong’s case, she learned the hard way after stopping her medication abruptly twice on her own, rejecting the advice of her doctors who originally misdiagnosed her bipolar condition as depression.
It was not until she saw several relapses and multiple mental breakdowns per day that she found the right doctor and finally understood the importance of medication.
Cheng says such situations are highly common.
“Patients are often rushing to be taken off a drug because they think if they’re on the medication it makes them abnormal,” she says. “The medications and therapy sessions cannot be treated as cures. They help with the symptoms.”
Fighting the stigma
Wong, the youngest of three children of an insurance agent and his wife, an executive assistant, knows the stigma of mental illness.
Her parents were shocked that their most academically successful child was mentally ill.
“My parents, especially my dad, were in denial at first,” she says. “They did not want me to seek professional help and asked that I face my problems that were making my illness worse.”
Wong had been leading a lonely battle against her condition until five years ago, when late singer-songwriter Loo opened up about her personal experience with bipolar disorder.
“I thought [here was someone who] understood the emotional turmoil I was going through,” she says. “If she could come to terms with the condition, so could I.”
Loo at the time urged the public to show sympathy for others suffering from the affliction. It was then Wong felt encouraged and not alone.
The entertainer’s recent suicide was a big blow to her.
For now, Wong is staying focused on her job and trying to remain positive with the help of her mother.
“It does not matter how other people see me, what’s important is that I am OK now and I will only get better,” she says.
“Both my parents and I are growing through this together. They have become more supportive and understanding.”
Dr Chan from the Hong Kong College of Psychiatrists says that although celebrity suicides make the headlines, mental illnesses can affect anyone and the causes may range from genetics to external factors.
“Unpleasant experiences in childhood can significantly increase one’s risk of falling victim to a mental disorder. It’s also been proven that the children of those who suffer from mental illnesses may be more susceptible as they grow.”
While awareness has increased, Chan says many remain resistant to admitting their conditions and seeking medical care.
Anyone who is ill needs treatment, he says, adding: “Mental illness is really no different than any other kind of illness.”
As for Wong, she says Loo may be gone, but the cause that the star championed lives on in her own fight against the condition. “This is why I will continue to improve in my recovery journey.”
Additional reporting by David Vetter
If you or someone you know are having suicidal thoughts, help is available. For Hong Kong, dial +852 2896 0000 for The Samaritans or +852 2382 0000 for Suicide Prevention Services. In the US, call The National Suicide Prevention Lifeline on +1 800 273 8255. For a list of other nations’ helplines, see this page