The lesson of untimely death: No one is immune from depression

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Mental depression, a subject once largely taboo in China, has been catapulted into public discussion by the untimely death of popular Hong Kong-born American singer Coco Lee.

The mental affliction that Winston Churchill described as his "black dog" cut short the singer's life at age 48, after she attempted to take her own life and fell into a coma.

Lee was one of the most successful singers in Asia. She was the first singer of Chinese origin to release an English-language album in the world and also the first to perform at the Academy Awards, where she wore a red qipao and sang the theme song from the film "Crouching Tiger, Hidden Dragon."

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Yet behind the sunny demeanor that endeared her to fans lurked a darker side. Her sister said in a statement that Lee had been suffering from depression for years.

As tributes poured in, the shockwaves of her death rippled across the Chinese-speaking world and beyond, evoking discussion of unaddressed mental health issues.

"There is a common perception that people who have worldly fame, wealth and high social status are happy, and that depression only happens to the less successful. That's totally wrong," Dr Feng Qiang, a psychotherapist with Shanghai East Hospital Affiliated to Tongji University, told Shanghai Daily.

There's certainly abundant evidence to back that up.

In 2003, Hong Kong singer Leslie Cheung committed suicide after battling severe clinical depression for more than a year. In 2017, Chester Bennington, lead vocalist of American rock band Linkin Park, took his own life after struggling with depression almost all his life. A year later, celebrated American fashion designer Kate Spade committed suicide after suffering from severe depression and anxiety.

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Many celebrities around the world, from all different fields, have admitted that they have suffered from depression at some stage of their lives -- among them actress Marilyn Monroe, singers Lady Gaga and Bruce Springsteen, US astronaut Buzz Aldrin and author J.K. Rowling. Even Abraham Lincoln admitted to bouts of melancholy.

Depression, along with anxiety, obsessive-compulsive disorder and addiction, are now the four most commonly diagnosed mental health issues in the world.

According to a report published by British medical journal "The Lancet" last year, more than 280 million people around the world were suffering from depression. Authored by 25 experts from 11 countries, the report sought to give advice to sufferers and their families about what depression is and how to deal with it.

The report said that the lifetime incidence rate of depression is 10.6 percent on average, meaning that a person has about a one-in-10 chance of being clinically depressed sometime during their lifespan.

The COVID-19 pandemic worsened the situation. The World Health Organization recently reported that depression and anxiety cases increased by about a quarter in just the first year of the pandemic.

Major depression can appear in many forms: long-term feelings of sadness, hopelessness and emptiness, loss of interest or pleasure in activities once enjoyed, sleep pattern changes, weight gain or loss, fatigue, and very low self-esteem.

Some patients may also report symptoms such as headaches, dizziness and diarrhea.

At present, medications and cognitive behavior therapy are among the most common forms of treatment for the affliction.

"It felt like my body and brain just stop working," said Hong Ye, a patient who has been in periodic treatment for depression for three years. "During the worst period, I couldn't get out of bed. I didn't bother getting up to wash or eat. I immersed myself in thoughts of self-pity and regret."

Medication has put Hong half way to recovery, but she said she still feels that she's "not fully herself."

"I'm a mechanical designer, and before I was depressed, I was efficient and had a quick mind," she said. "But now, it seems that I'm incapable of doing complicated work or multi-tasking like before. I am often absent-minded. I don't know if it's because I'm not fully recovered or because of the side effects of the medication. But overall, I am better than before."

Shanghai-based psychotherapist Xu Peng, who specializes in the relationship between mental health and the organization of daily life, described depression as a status of self-attack and self-obsession.

"The main cause of depression is that patients are used to neglecting their own feelings and do not accept their real needs," he told Shanghai Daily. "So they attack themselves mentally as not good enough, not strong enough."

He added, "No matter how they look from outside – such as Coco Lee, she never seemed depressed at all on stage – they are battling an inner storm. What we need to do is to help them realize their real needs and feelings, and help them accept themselves."

The case of Japanese tennis player Naomi Osaka is another case in point.

In 2021, Osaka withdrew from the French Open, admitting that she had been struggling with depression for three years.

"Though the tennis press has always been kind to me, I am not a natural public speaker, and I suffer huge waves of anxiety when I have to speak to the world's media," she wrote in a statement. "I get really nervous and find it stressful. So here in Paris I was already feeling vulnerable and anxious, so I thought it was better to exercise self-care and skip the press conferences."

Later, her sponsors and other athletes praised her courage in coming forth to talk about her mental health issues.

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Although it is widely reported that long-term depression may lead to other major diseases, such as heart and brain blood-vessel problems, depression is still very misunderstood and undertreated. According to the report, around half of patients are not receiving proper treatment.

The situation in China is more concerning.

In 2021, Professor Huang Yueqin with Peking University Sixth Hospital, one of the leading psychiatric hospitals in China, issued a report on "The Lancet Psychiatry," saying that only about 10 percent of clinically depressed patients in China were diagnosed and treated.

"There are still some discriminatory attitudes toward mental health," Xu said. "For example, some patients hesitate to seek help because they worry that their diagnosis might affect their jobs. Some schools don't protect their students' privacy very well, so students suffering mental problems choose to keep it to themselves."

Then, too, sufferers cope with a long tradition of families who sweep such issues under the rug amid a belief that mental conditions carry shame.

But progress is being made, step by step.

"Now young people around 30 are more open about mental health issues and not afraid to talk about their problems," Xu said. "This is a good start."

Feng said his clinic also is getting busier. Parents bring in children with mood swings, and often the parents are diagnosed with problems as well. Seniors, including many who live alone with family far away, find the clinic helpful and often come on the recommendation of neighbors.

"We now use many online platforms, such as WeChat, short-video platforms and livestreaming, to educate the public about mental health," he said. "In Shanghai, knowing is the first step of understanding."

So what's the best course of action if a friend or family member needs help?

Feng says the first step it to closely watch for behavioral changes.

"If a diligent person suddenly becomes lazy for no reason, or an extrovert becomes isolationist and isn't willing to go out, or a rigorous person becomes absent-minded and often makes simple mistakes, then we might suggest they seek professional help," Feng said.

Most of all, compassion and understanding are needed.