Talking Past One Another: Mental health in a City of Hypochondriacs

A graphic video that sent shock waves throughout Hong Kong and disrupted “business as usual” for many commuters of the city’s public transit system surfaced on the Internet last month.  The video, depicting a man engulfed in flames on the train in the process of self-immolation, belies a social issue  more disquieting than what appears to meet the eye. Dubbed the “fire bomber,” the press was quick to identify man as 60-year old Cheung Kam- Fai. Any initial claims of terrorism were soon dismissed on the grounds that this act was performed by a “mentally disturbed man” who -- to the collective exhale of the public -- acted alone. Almost immediately,  hush-hush whispers soon gave way to a barrage of rumors. Of the more obscene comments I overheard, one was from my co-worker who said that Cheung was rumored to have had “sexual intercourse with a dog.” 

What I found most disturbing about this case was not a lack of sympathy for the 17 burn victims at the crime scene, or even the unpreparedness of a public transit system in a city where large portion of the population commute via MTR. Even the photos of the witnesses standing idly by at the crime scenes recording the crime scene with their phone (while others attempted to stamp out the fire) were unfortunately yet another textbook example of the bystander effect, and nothing to write home about. 

What was troubling was that while people were busy comparing who had a more gruesome video of the crime scene, the elephant of a question that everyone, including the press, clearly overlooked was: Who was this man, and what pushed him over the edge? And secondly, could this tragedy have been prevented? 

First of all, talking about this doesn't make it any less of a tragedy. 

I don’t believe in romanticizing or giving undue attention towards people who have caused civilian harm. But scrounging around on the web, I found neither evidence that could either confirm my colleague’s claim about Cheung’s act of bestiality or debunk it. SCMP’s coverage of Cheung portrayed him as a man who suffered a “poor relationship with his family and had disputes with his wife. Officers believe the move was prompted by his personal and family problems," they further go on to say. 

Pardon me for this, but this sounds like a watered down and incorrect diagnosis of a much graver and deep-rooted problem if I’ve ever heard one. I’ve always had this suspicion that mental health was not something openly talked about, but this points to something much deeper. Mental health in Asia is not only stigmatized; any discussion of it is largely frowned upon.

When it comes to general physical illness, Hong Kong doctors should win a Guinness World Record for the sheer volume of pills dispensed. Some of my worst memories as a child in Hong Kong involve collecting my color-coordinated bags of pills, techni-colored cough syrups for morning, mid-day and night consumption, and even an inhaler… all for a mild cold. 

It’s almost as if, in keeping with the stereotype about Hong Kongers being frugal -- Hong Kongers need ensure that they get their bang for their buck by overcompensating on their medication regime. If, god forbid, someone sneezes on the MTR, Armageddon happens, all hell breaks loose, and dirty glances are thrown with impunity towards the poor man who didn’t happen have a Kleenex on hand. After the SARS epidemic, Hong Kongers take flu shots ahead of time, wear masks on the street, and take preventative measures at all costs. Compared with its Western counterparts, there is no doubt that of the 7 billion population, I would guess that at least half are raging hypochondriacs, myself included. 

Ironically enough, the same standard of wariness does not seem apply for mental health and well -being.  

There are cultural reasons for this stigma. In various stages of my life, from my more teenage –angst years to more recent episodes, I’ve-- shall we say-- tested the waters by telling my mother that I’m unhappy. As a take-no-shit kind of proverbial Asian woman who has had to weather many hardships, she has invariably shut me down every time.

“You have everything- a good family, a roof over your head, a good job and discretionary money to spend… how can you be unhappy?” She scoffs, clearly displeased with her ungrateful daughter’s antics. 

My mother is not malicious, and she means no harm (and for the most part, I was just griping). But replay this conversation with a child with actual depression, and you can understand how guilt seeps in and how feelings can easily be re-directed internally. Never mind the fact that mental health often has very little to do with one’s socioeconomic background, or the fact that anxiety and depression are often linked to selfish capitalist societies. It's no coincidence that Hong Kong readily comes to mind as the prototypical poster child for this kind of society. 

 In a city of hypochondrias, the pill is king and triumphs both sleep and exercise. 

In a city of hypochondrias, the pill is king and triumphs both sleep and exercise. 

This conservatism towards the open discussion of emotions  – which I’ll call “talking past each other”— in Hong Kong is exacerbated by the fact that concern with saving (or losing) face (mianzi) infiltrates many parts of daily life. Mental illness is often reserved for the weak, social pariahs and the outcasts, and can even be a source of shame. I wouldn’t say that this is endemic only to Asian culture, but feelings are not as openly discussed as say, their Western counterparts. 

The problem is not helped from a systemic level too. At a bare minimum, The Mental Health Association in Hong Kong and its website is neither intuitive or user friendly. 

This extends to the world of academia too. In the cutthroat world of academia in a city where stress is the common currency of a success-obsessed economy, an SCMP post further reports that  “in 2016, 22 students committed suicide, eight of whom were at university.”

Unfortunately, community may be the last thing that is available outside the school gates. In Hong Kong, simple supply and demand economics dictates that the system is already strained and overcapacity. In both the private and public sector, there are simply not enough practitioners.  A recent study also by SCMP revealed that "the number of new psychiatric cases registered in the specialist outpatient clinics in public hospitals has grown from 39,770 in 2009/2010 to 47,958 in 2014/2015" but we haven't seen a corresponding increase to meet this need. 

The patient-doctor ratio of 4.5 psychiatrists per 100,000 people, of which only 330 are accessible through the public sector is likewise minute compared to the Western counterparts. We are short-staffed for a city of our size, according to the WHO. 

Waiting times are also dragged on for notoriously long periods, and we haven’t even factored in the onerous process of getting ahold of the actual drugs. The longest wait to see a doctor in a public hospital comes in at about just over three years, or 166 weeks, which may about three years too late for a patient with a critical condition. 

Fortunately, there is a light at the end of the tunnel. The Chinese University in Hong Kong is on the preventive track of reducing suicides rates by instilling mandatory educational programs, and similar education campaigns are raising awareness about an issue that cuts across the fault lines of one of the city’s most taboo issues. In the shifting cultural tides, attitudes are changing with conversations with students that peace of the mind is just as important, if not even more so, than scholastic achievement.

Unstable people who have not received adequate treatment often act out with vengeance only as a last resort. In an alternative universe, people like Cheung with a more severe case of mental illness history could be tended to.  In an alternative universe, a greater weight placed on fleshing out the “family and personal problems" may even have have deterred him from launching a firebomb. In an alternate universe, it wouldn't take a tragedy like a video of man in tattered flames burning innocent civilians to bring a conversation like this to the table. 

If Hong Kong hypochondriacs demonstrated even an ounce of their preventative approach to physical health towards mental health, we would already be halfway there.

It's time to stop talking past each other. The system may be broken, but it is not irreparable.

 

Sharon Lam