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Few potential suicides seek help, study shows

Last week, Wang Hsiao-fen (王小芬), an actress in the Special Report VCD, attempted suicide. The next day, a 20-year-old female jumped from the ninth floor of a Taichung county building. Several other suicide attempts followed. Reports about people attempting to take their own life have become a fixture in the news and made "suicide" and "depression" common household terms familiar even to young children.

However, although the term "depression" is widely used these days, polls show that few people actually know where to draw the line between just feeling down and being clinically depressed. This is understandable, given the lack of consensus even amongst experts in the field.

While 52.5 percent of those polled by the John Tung Foundation's mental health department stated that they were able to differentiate between despondency and clinical depression, other studies indicate that many people suffering from depression never seek professional help.

According to Liao Shih-chen (廖士程), a psychiatrist at the National Taiwan University hospital, research by Academia Sinica professor Cheng Tai-an (鄭泰安) indicated that 97 percent of people attempting suicide suffer from some psychiatric disorder, and 89 percent have severe depression.

The survey found that only 4.1 percent of those who feel depressed ever seek professional help and that 7.6 percent visit a general physician.

The figures show that, although depression is an accepted medical condition, society is not very eager to write off depression as just a clinical condition.

Wu Yin-chang (吳英璋), professor of clinical psychology at the National Taiwan University, emphasized that declaring depression an illness precludes some forms of treatment.

"The social role of the patient in our society is to rest. However, a depressed individual cannot just hand the problem to doctors, becoming a victim. We shouldn't quickly categorize depression as a disease or illness," Wu stated.

Wu stressed understanding one's own evaluation of environmental factors as the crux of treatment.

"It is important to ask yourself what your emotions mean to you. What does your environment mean to you? For example, if a friend's death causes you grief, ask yourself why. Was it a case of dependence? What did your friend mean to you?" Wu said.

However, other experts point out the limitations of self-reflection and the need for professional help in certain cases.

Vivian Y.H. Yeh (葉雅馨), mental health section chief at the John Tung Foundation, said her research indicated that 42.2 percent of the survey participants tried to deal with feelings of depression by sleeping or resting, while 34.2 percent engage in exercise or leisure activities and 33.8 percent talk to friends.

However, Yeh said that medical treatment was necessary in certain circumstances.

"If you don't manage the symptoms of depression, the depressed individual could be driven to suicide. When symptoms are uncontrollable, medication is an option. Just talking is not always enough," Yeh said.

"At the same time, medication should be supported by psychological counseling," she said.

Liao agreed with her, saying drugs often only suppress the symptoms.

"Medicine can control one's symptoms, but if a person's thoughts do not change, the likelihood of suicide actually increases after medication is taken," Liao said.

Liao described depression as the result of psychological, biological and societal forces. "All three can trigger depression. In most cases, treatment changes a person's thoughts last, after all three have changed," Liao said.

Liao's description of depression as the result of psychological, biological and societal influences redefines the traditional understanding of illness as a strictly biological condition to be treated with drugs and medical procedures. Experts point out that illnesses do not occur in a vacuum but rather in the context of society.

"In actuality, all illnesses, not just depression, can be understood in light of these three influences. It's just a question of which dimension needs more attention or support in each case," said Tom Yang (楊聰財), executive secretary of the Taiwanese Society of Psychiatry.

Yeh said that disorders such as diabetes and high blood pressure probably also had societal triggers.

At the same time, a person's psychological health will have physical manifestations. According to Liao, about 50 percent of those who commit suicide visit a general physician about one month before the suicide attempt, while 30 percent visit a physician one week before.

Yang said spiritual convictions also play an important role in a patient's recovery.

"Spiritual convictions will have an influence on one's health by shaping one's understanding of illness. Perhaps it is something that is out of your hands," Yang said.

"According to World Health Organization research, those who have religious beliefs are less likely to attempt suicide. In particular, those of the Islamic faith were found to have the lowest suicide rate," Liao said.

"Ultimately, the goal of treatment is to restore the patient to his or her social role," said Yeh, concluding that the different dimensions of treatment played complimentary roles in recovery.
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