Combating stigmas in Taiwan about mental health

While mental illness is still misunderstood and seldom discussed issue in Taiwan, professionals and support groups such as WARM are trying to combat the stigma by encouraging people to share

By Han Cheung  /  Staff reporter

Sat, Apr 21, 2018 - Page 13

Whenever Vanessa Wang (王永儀) missed morning classes, she would tell her professor she suffered from chronic vertigo. It was only recently that she mustered up the courage to admit that it was due to her depression and daily panic attacks.

“The first step to defeating [mental illness] is talking about it,” she says.

But it isn’t easy, especially in Taiwan where, although people are becoming more open to seeking professional help, people are still reluctant to talk about their mental health due to deep-rooted social stigma.

Wang says she spent years without support, wondering what was wrong with her before finally seeing a therapist. Last year, she formed WARM (Women Anonymous Reconnecting Mentally), a mental health support group for women, which held its first meeting in Taipei last December.

“We share our stories, our struggles, what we’re going through,” she says. “That encourages people to realize, ‘I should probably do something and it’s okay because she has it too.’ It’s not something to be ashamed of. If we don’t talk, nothing will happen.”

THE STIGMA

According to a survey conducted last year by the John Tung Foundation (董氏基金), 53.2 percent of respondents feel that mental illness is stigmatized in Taiwan. On the other hand, 62 percent “agree or highly agree” that the stigma is unjustified. The same survey shows that 65.3 percent have no clue about available mental health services.

Han Der-yan (韓德彥), assistant professor at Taipei Medical University, says that even in the West, it took many years of educational campaigns before people stopped painting mental issues in a bad light. Taiwan has done well in this field as far as suicide he says, but more work needs to be done as a whole.

“Without proper education, people will revert to the traditional perspectives they were exposed to growing up,” Han says. “This has to do with the Confucian belief that one is responsible for cultivating his or her own mind. If you’re depressed, it’s because you didn’t do something right; you couldn’t control your own emotions.”

Grace Chen (陳芊羽), counseling psychologist at National Taiwan University (NTU), says that the stigma remains stronger among the older generation because they grew up in less favorable circumstances.

“People have to fulfill their basic needs before they can even consider mental health,” she says. “Back then, mental health was only brought up if someone had something serious, which would often result in institutionalization.”

As an authority figure, parents often find it hard to admit that they know nothing about mental health when their child broaches the subject, often lashing out especially because they received no such support when they were young.

“They might say in a dismissive tone, ‘That’s how things are. Do you think you’re the only person in the world who’s suffering?’” she says.

Wang says her parents simply labeled her a troublemaker, and she felt like she was a burden, a mistake — the odd one in the family.

“What they should have done was take me to a psychologist,” she says.

Lily Li (李欣然), a Chinese-Canadian living in Taiwan, says she felt reluctant to speak about her postpartum depression here — until she discovered WARM.

She says that part of her fear is that the media reports on mental health issues only when they are related to shocking crimes.

“I don’t want to be painted in the same picture,” she says. “Even to my friends, I don’t want them to tread carefully around me. I’d like to keep the conversation to people who know what’s going on.”

Han says that if people start to view mental illness as a disease, then it will help destigmatize the issue. He compares it to obesity — if it’s treated as an illness, then people are less likely to make fun of overweight people or trivialize their problems by telling them to eat less or practice self control.

“For example, depression should be treated as ... seriously as schizophrenia,” he says. “Depression also robs people of their functionality and can even lead to death.”

Han adds that if depression was perceived as a physical disease, then people would stop blaming themselves and seek help, just like they do when they come down with the flu.

“If someone has cancer, nobody will tell them to snap out of it,” Wang quips.

SEEKING HELP

Despite the stigma, Chen believes the public is becoming more open minded about mental health issues. He cites NTU’s student counseling center, which is today fully booked compared to when she started less than three years ago. While most Western students had undergone some kind of therapy before they came to her, she noted that most Taiwanese students had no idea what to expect.

“But the fact that [Taiwanese students] often tell me they came at the advice of a friend, indicates that they are talking about it among themselves,” she says.

However, the stigma still runs deep, as she has met students who are either terrified of people finding out, or look for a resolution in only one session.

The university in the past few years has been promoting the counseling center — the available resources are emphasized during freshman orientation and through various workshops and events, and the school has an “NTU Peer” program that teaches students how to persuade their friends to visit the center.

This is all easier to do in a campus setting, especially when the service is included in the tuition. Taiwan’s healthcare does technically cover therapy, but the system does not pay much more for a 40-minute session than a 15-minute one, giving little incentive for hospitals to provide the longer service, something that few in fact provide.

Out-of-pocket therapy typically costs around NT$2,000 (US$68) per hour, which is not a figure many people can afford. That’s why support groups are important, Wang says, but she could not find any in Taipei until she founded her own.

“Fifteen minutes a week is not enough,” she says. “I need someone to remind me every single day that I am supported, that I am not alone.”

Chen affirms that such groups are rare — most support groups in Taiwan focus on specific issues such as divorce or domestic violence.

Li has not been able to attend therapy due to having two young children and living in Tamsui, and she hasn’t been able to attend the weekly WARM meetings. But she says she has found solace through the WARM Facebook group, where she receives prompt responses to her posts.

“Anytime I feel that I need someone to talk me off the ledge, that’s when I’ll go to [WARM’s Facebook page],” she says. “Depression is a very isolating disease. The fact that WARM has created this community for people to feel not alone is more important than anything. For now, that’s enough for me to get by.”

FINDING SOLUTIONS

Besides shelling out for private therapy, there are other resources that are worth trying such as hotlines or seeing an intern therapist.

Han says that people who find themselves feeling down can do an online depression test, as people often chalk up their symptoms to stress, lack of exercise or lack of sleep.

He suggests that if the tests indicate that there’s even a mild problem, people should try calling the available hotlines, such as one provided by the Teacher Chang Foundation (張老師基金會).

If that doesn’t work they should seek professional help.

For family support, Han says the John Tung Foundation has videos and materials that people can show their parents. Bringing up cases of celebrities admitting to mental illness also helps.

“But understanding will not happen in a day or two, or even months,” he says.

Chen says that another issue is the lack of understanding of how therapy works, leading many people to drop out after a few sessions.

“My patients often idealize therapy, thinking that I will give them all the answers,” she says. “Or they will think that they don’t need to say too much and I’ll know what they need.”

With the right expectations, Chen says that patients can make the best out of even a 15-minute session. But he adds that there should be more training for professionals in how to fully communicate to the patients about what they are getting.

In addition to hotlines, Chen says that there are community therapists that charge on a sliding scale, or intern therapists who don’t charge as much.

While WARM is currently only for women — Wang says mixing vulnerable men and women would be “chaos” — it has launched a bimonthly gathering called Bloom Within that is open to all genders.

During these events, a keynote speaker addresses various issues (such as how to tell your boss I’m not mentally healthy) and audience members get on stage to openly share their experiences with mental illness. The next event is today at the French Kiss bistro (吻吧) in Taipei.

Li was the first to share her experience during February’s event.

“It was terrifying,” she says. “I’ve never shaken that hard in my life and I’m a performance major. But I think the fact that saying your story out loud makes [the stigma] go away a little more. I would encourage anybody to do it. If you’re scared, take a few shots.”

Li is not sure if the stigma will go away in her lifetime, as the concept of “saving face” is deeply rooted in Asian culture and identity.

“It’ll start with us. We are the ones who are molding the next generation. And we get it. We may not see a drastic change, but I do hope that in 30 years, 50 years down the road things will get better.”

RESOURCES:

WARM: www.facebook.com/groups/323198761492476

Depression test (English): screening.mentalhealthamerica.net

Depression test (Chinese): phsch.mohw.gov.tw/chinese/UpLoad/Content/1040717003.html

24-hour suicide prevention hotline: 0800-788-995

Teacher Chang hotline (張老師專線): 1980