When I first moved abroad, I was scared. I had the benefit of living with my fiancé, but when you are depressed, you feel alone even when someone you love is holding your hand. At times, I felt like I was jumping into a void and I questioned the wisdom of my decision. At the same time, I also knew that if I let clinical depression dictate what I did with my twenties, I would regret it for the rest of my life.
Over the past four years, I’ve done better than I thought I would. I’ve been able to enjoy most of my time here and manage my depressive episodes. I don’t want to prattle on like I’m an expert on dealing with depression and anxiety while living abroad. All I know is based on my own experiences, but I’d like to be able to help someone who is asking the same questions I was five years ago.
This blog entry ended up longer than usual, so I’ve split it into two parts. The second part is here.
1) Don’t listen to dumbasses
I felt like I was caught between two cultural attitudes about depression when I was growing up and neither of them were helpful. There was the Asian attitude, which was to sweep things under the rug, and then there is the American one, where everything is pathologized, medications are carelessly prescribed and you feel like something is wrong with you if you don’t run around farting glitter and rainbows all the time.
I believe both mindsets have the same root: the stigmatization of mood disorders. They are weighty and disturbing topics, so most cultures just don’t deal with them in a clearheaded and pragmatic way. No matter where you go, you will meet people who insist that depression is just laziness. I used to let those individuals upset me. They really made me afraid to be open and honest about my own experiences. The shame had a corrosive effect on my self-confidence and I was hesitant to ask for help until I reached the point of crisis. Now I know that I just shouldn’t listen to dumbasses.
Seriously, don’t let a dumbass give you medical advice. (A fancy degree does not protect against dumbassedness. I once had a psychiatrist tell me I would “grow out of it.” He was an expensive dumbass.) Don’t bother trying to make friends with a dumbass. I mean, if someone is wantonly ignoring reams of scientific evidence proving depression is a real mental disorder that requires treatment, then how you can even trust that person to pick a good movie? Just ignore them. Please don’t let their foolishness stop you from getting help.
2) Psychiatric care
When I first got here, I did not know what to expect in terms of psychiatric treatment. I was pleasantly surprised… but there are also drawbacks to care here that you need to be prepared for.
At first I went to Taipei Veterans General Hospital (台北榮民總醫院) and then National Taiwan University (台大醫院). The doctors at both were open-minded and sympathetic. They never talked down to me. My consultations were usually only about 10 minutes in length, but could have been longer if I needed more time. I did decide, however, to switch to a private clinic. The problem with the hospital psychiatry departments was the wait time, which was occasionally up to two hours, even when I had an appointment, and it was also difficult to schedule appointments with the same person. The lack of privacy at Taipei Veterans General and NTU Hospital also annoyed me. Twice, I had another patient barge in on my sessions at NTU because the nurse forgot to lock the door.
All doctors speak medical English, but it is different from talking with someone who is fluent. I highly recommend contacting the Community Services Center for a referral to an English-speaking psychiatrist. If you are already on medications, make sure to find out their scientific names and all the brand names they are sold under (the American brand name is usually used in Taiwan, but not always).
I did have an unpleasant experience with a private psychiatry clinic. It was poorly lit and dirty, with the receptionist’s alcove hidden in a corner. Patient files were strewn about and stacked haphazardly. The door to the doctor’s consulting room was wide open, even though he was sitting in it with a patient. I didn’t even take a number because I was so appalled. He might be an awesome doctor for all I know, but I just don’t trust people who can’t even be bothered to treat their patients’ confidential paperwork with respect. There’s no reason anyone should have to.
2) Face depression, even when you are feeling OK
Esme over at The Diarist coined a great phrase to describe her experience with bipolar disorder. As she puts it, phase blindness means “the inability to feel one phase when in another.” I think Jane Kenyon‘s poem “Wood Thrush” also captures that forgetfulness perfectly:
High on Nardil and June light
I wake at four,
waiting greedily for the first
note of the wood thrush. Easeful air
presses through the screen
with the wild, complex song
of the bird, and I am overcome
by ordinary contentment.
What hurt me so terribly
all my life until this moment?
How I love the small, swiftly
beating heart of the bird
singing in the great maples;
its bright, unequivocal eye.
When I am mired in a depressive episode, I find it hard to believe that I will ever feel happy again. When I am well, I tend to forget what being depressed is like, even though I have been dealing with major depressive disorder since I was a teenager. Being able to forget is both a blessing and a curse. It means I can get on with my life, but that I have often been struck unprepared.
During the first semester of my sophomore year, The Noonday Demon: An Atlas of Depression by Andrew Solomon came out. I read a review of it and thought, “Wow, I wish this book had come out when I still had depression.” I had been hospitalized after I tried to overdose my sophomore year of high school, but I didn’t expect to have another episode again.
Maybe part of it was adolescent hubris, but when I started feeling the symptoms of a depressive episode during my junior year, I ignored them, even though I couldn’t sleep and had no appetite. I let this go on for months. To make a long story short, I was hospitalized twice that semester, in part because of my prior history with depression. My college’s health services did not want to take any chances.
I felt so stupid. I felt I should have known better, but I was barely 20, attending the school of my dreams and making friends. I thought I was set up for happiness, but my brain chemistry did not agree. Since then, I’ve never felt like I can take my well being for granted again.
There is still a constant tug-of-war in my mind between knowing that I need to constantly monitor my mood and not wanting my depressive episodes to define who I am. I still struggle with it, but I’ve gotten better at striking a balance over the last few years.
In Get It Done When You’re Depressed, Julie A. Fast recommends writing a letter to your depressed self when you are feeling well. It will remind you of what you are working for when everything feels hopeless. It should be as detailed as possible and updated frequently. I have to admit, I feel really cheesy writing these letters to myself (“Dear Catherine, Many things about your life are awesome, like your cat…”), but it is like storing nuts for the winter. I think this is especially important when you are living abroad, because culture shock sometimes comes back repeatedly.
Another thing I find helpful is referring to a depression symptom checklist every so often. I actually have an app on my phone. It’s normal to occasionally feel sad, discouraged, tired, suffer from insomnia, not have an appetite, get bored with your hobbies or feel unmotivated, but certainly not all at once and not for weeks at a time. If I start checking off too many things on the list, I know it’s time to see my doctor, start exercising more (in Taipei, you can work out at a clean, well-equipped city-run sports center for only NT$50 an hour) and be more active about finding ways to get out of the house. The good thing about living in Taipei is that there are a lot of free or inexpensive entertainment options. The 24-hour Eslite bookstore is always filled with people, even at midnight, and is a nice place to just sit with a magazine.