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PHOTOS BY SIMON SONG
The Parkview Gardens complex, on a busy road opposite a tree-lined Guangzhou
lake, looks like an upscale Hong Kong housing estate. Arab women in veils,
blonde toddlers and Chinese residents walk briskly around the well-manicured
gardens, tennis courts and giant swimming pool.
Yet, this yuppie paradise almost became suicide ground for Wang Liping, a
61-year-old retired banker. "I was just about to jump off from here,'' Wang
says matter of factly, pointing out a small window on the 11th floor of his
block.
I look through the window down a light shaft and cringe with vertigo. The shaft,
its outlines broken by a net of clothes lines and window frames, is cold and
silent. It would have been where Wang would have ended a five-year battle
against severe depression.
He is not alone. He belongs to a startlingly large emerging legion of depressed
urbanites in the Middle Kingdom. More than 26 million people have been
diagnosed with depression throughout the country, according to figures released
by the China Medical Association at a summit meeting of Asian psychiatrists
last month. In Guangzhou, official news media estimate that at least 580,000
residents suffer from depression. That is almost 6 percent of the population.
There was no word for it in the Chinese vocabulary until relatively recently.
It has now even become trendy to start a conversation by saying: "I am very yu
men [depressed].'' Yi yu zheng, literally "the depression
syndrome,'' has started to feature in the media, along with suicide stories.
Cui Yongyuan, a popular CCTV talk show host, is the latest to announce that he
too suffers from depression.
Growing numbers of doctors from general hospitals or mental institutions have
also jumped on the bandwagon to publicize their psychiatric services, although
few qualify as psychotherapists or psychiatrists.
On the same bandwagon are multi-national pharmaceutical companies and their
mainland joint ventures, touting their wares to China's pill-popping millions.
Official media report that sales revenues for antidepressants, mostly
manufactured by foreign companies and their Chinese joint ventures, reached
almost one billion yuan (HK$960 million) in 2004, up 40.6 percent from the
previous year and more than double the 2002 figure. That figure is expected to
skyrocket in 2005 to two billion yuan.
None of this helped Lu Ye, ironically a senior manager at the Guangzhou Health
Bureau, who leapt to his death because of depression, according to The New
Express News, a local paper.
Paradoxically, it appears to be China's burgeoning prosperity that has opened
this can of worms, says Pan Jiyang, chairman of the Department of Psychiatry at
Jinan University in Guangzhou. Pan says depression has always existed in
Chinese history but has only come to be diagnosed during the last decade.
Lu was stressed out by his postgraduate studies and became more distressed after
he missed out on a job promotion, Pan says.
"China is going through a dramatic transformation. Social conflicts have become
more complicated. The pace of life is much faster. And competition for jobs is
more fierce,'' Pan says. "But the welfare system and healthcare haven't caught
up.''
There's an alarming increase in the number of elderly depressed who often lose
much of their sense of identity on retirement and are not cared for properly by
their offspring, who defy traditional values and are entangled in the everyday
struggle to succeed, Pan says.
It is likely that depression has been a major factor in the lives of millions of
Chinese for at least the last century given the wars, floods, famines, the
Great Leap Forward and the Cultural Revolution that have repeatedly fractured
the psycho-emotional bones of a nation in turmoil.
Wang, who has been treated by Pan ever since the retired banker looked down that
air shaft, is typical.
"It has deep roots in my heart's wounds,'' Wang sighs, handing me a stack of
neatly typed documents - his autobiography, which he hopes a newspaper will
publish to enlighten other patients.
According to rigid Maoist doctrine, Wang was doomed even before his birth. His
grandfather served as a diplomat in Germany for a Qing emperor and took a
German woman as his concubine. Wang's father was a Kuomintang naval captain.
His uncle, another KMT naval officer, escaped to Taiwan.
That upbringing was enough to pin down Wang as a class enemy. "I was very hurt
and sad because of this heavy millstone [the family background] I had to carry
on my back,'' he says.
After his university graduation, Wang's "bad birth'' earned him a job in a
remote town in Guangdong.
When the Cultural Revolution began, he was among the first to be dragged to
struggle meetings. He was forced to carry a huge placard emblazoned "Remaining
evil elements of KMT'' around his neck and was tortured until he passed out.
But that didn't throw him. "I was young. And the whole of China was mad at that
time,'' he recalls, adding that 20 percent of his bank's staff were branded
"bad elements'' and persecuted.
He was later sent to work in a coal mine for 12 years and witnessed numerous
mining accidents. By the time he returned to Guangzhou to work in a bank, he
was 40. Grabbing at the last bit of his youth to relaunch his career, Wang
worked diligently. He was promoted and was finally allowed to join the Chinese
Communist Party.
"The political oppression was gone. So was the family millstone,'' he says.
Internal bank politics sidelined him and he was sent to another remote town to
carry out the bank's poverty reduction campaigns. There he witnessed blatant
corruption among rural cadres. He reported the cases but to no avail.
He began to experience migraine, insomnia, anxiety, sweating and bad moods. "I
had all this anger inside me. I felt useless,'' he says.
Wang returned to Guangzhou in 2000. A physician prescribed him a large dose of
antibiotics for his fever. For a week, even though drugged with sleeping pills,
Wang could sleep for only about an hour a night. The suicidal thoughts began.
"I cried many times and didn't want to talk to anyone or answer the phone. I
don't know where I got so many tears from,'' he recalls.
He sought help from a neurologist who had been giving him sleeping pills and
painkillers for his migraine and insomnia. The neurology department of that
general hospital normally looks after stroke patients.
By then, Wang had read about depression in the newspapers and asked the doctor
about it. The doctor, agreeing with Wang's self-diagnosis, prescribed
Alprazolam and Prozac. Wang was put on drips and kept in a ward for more than a
month.
He has since also visited Chinese herbalists. He was hospitalized several times
in different hospitals, where he shared wards with schizophrenics, Alzheimer's
disease patients and other depression victims from all walks of life, including
high school students, college professors, retired cadres and redundant workers.
Prozac is among the most popular antidepressants in China. Its name in Chinese, Bai
You Jie, means "free of a hundred worries.'' Wang's hundreds of
worries, however, grew despite his months on various antidepressants. He
started to plot his suicide.
One night, minutes before his fateful appointment with the light shaft, his wife
woke up and took him back to the hospital's neurology department.
Finally he was transferred to the psychiatric department of another hospital and
was prescribed larger doses of antidepressants.
Five years on, Wang can sleep better and has even finished writing a novel about
the Cultural Revolution. And he has become philosophical about his losses.
"It's a long war. I am old, I don't care,'' he says, adding that long-term
medication has been his savior.
Wang is lucky. At least he can afford antidepressants costing more than 10 yuan
a tablet. He can only claim about 100 yuan from medical insurance. Public
health care is no longer free, he says. "It's now socialism with Chinese
characteristics. Hospitals have become enterprises making money from
patients,'' he says.
Wang is now on less medication, one tablet of Seroxat a day. Seroxat,
manufactured by Tianjin Smith Kline & French Laboratories, is another
popular antidepressant.
The precautions on Wang's medication include a long list of possible adverse
effects: Insomnia, loss of appetite and sex drive, nausea, sweating, blurred
vision, dizziness and liver problems.
"You wouldn't dare take it if you study the side-effects,'' says Wang.
Others are not so convinced that foreign drugs are the answer and have sought
other treatment. Chen Gang, a high school teacher, says two years of
acupuncture have ameliorated a nine-year battle against depression.
"My doctors didn't mention any side-effects,'' Chen says of the physicians who
prescribed him anti-depressants. But, he says, he noticed on the packet that
the drugs could have adverse side-effects.
Chen is a typical white-collar worker who was pushed into depression by stress.
He became an insomniac and began to lose weight after taking a job at a private
high school in Guangzhou. At one point, he says, he became so depressed he was
unable to walk. He resorted to acupuncture for migraines.
Wei Fengpo, 77, head of the acupuncture center at Jinan University's affiliate
hospital, prescribed acupuncture after he diagnosed Chen with "anxiety.'' His
kidney qi was weak, his blood was "depressed'' and his liver needed to
be "dredged.''
Chen complied with Wei's directives religiously for two years. "I have a
philosophy major,'' he says. "I believe in the yin and yang in Chinese
medicine.''
Wei remembers how weak Chen was on his first visit. "He leaned on his wife. His
voice was so weak he sounded like a mosquito.''
Wei has been practicing traditional Chinese medicine since 1952. He recalls that
depression was first diagnosed just after the Cultural Revolution ended and was
branded a "neuro-dysfunctional symptom.''
"We didn't publicly announce it back then,'' he says. Nonetheless, as early as
the 1970s, Wei was advocating incorporating acupuncture into psychiatry. No
funding, however, has been available.
Wei's retired surgeon wife and sister-in-law don't follow his counsel. They have
been on anti-depressants for years. Wei says they believe in drugs instead of
Chinese medicine.
"They have all sorts of complaints from depression,'' Wei says. "It's like a
frog has pains all over its body after being stepped on by a cow. That cow is
depression.''
Jinan University's Pan Jiyang began to encounter growing numbers of depressive
patients in the mid-1980s when he was studying psychiatry at Zhong-shan
University in the city.
"At that time, the government's awareness [about depression] was low. And
hospital staff training was insufficient,'' Pan says.
"Even now many so-called psy-chiatrists have only received training in applied
psychology and very few in clinical psychology.''
The most common symptom of depression is loss of appetite, usually spurring
patients to first visit physicians for digestive complaints, only to be
dismissed by doctors who find few digestive abnormalities.
Most mainland psychiatry hospital sections merely brand depression as
"psychological problems'' instead of depressive problems.
"The Chinese don't like admitting to depression. It's about face. Patients are
still discriminated against,'' Pan says.
Having done post-doctoral studies and undertaken clinical training in psychiatry
in the United States, Pan believes the Chinese have a genetic predisposition
toward depression. He cites a report in Science magazine that people
with certain variations in the 5-HTT (a neuro transmitter) gene exhibit more
depressive symptoms. Pan believes most Chinese belong to this category.
"There has been depression since ancient times,'' he says. "Now there are more
stimulants to trigger depression in our genes.''
Pan sees at least 15 patients each morning. He counsels them for five minutes
before prescribing anti-depressants. "I don't have time to chat with them.
We're like physicians, prescribing drugs,'' he says, acknowledging that almost
all the major international drug companies aggressively tout their products to
mainland hospitals. The most popular anti-depressants are Seroxat, Sertralin,
Cipramil, Luvox and Prozac.
Brushing off questions over whether it is proper for him to have received
commissions from drug manufacturers, Pan says the firms finance his travels to
speak to seminars they sponsor. By contrast, Pan says, he receives only 50,000
yuan from the government for any research project on depression.
"The pharmaceutical factories promote their drugs in order to help doctors
understand depression,'' he says.
rose.tang@singtaonewscorp.com
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