timistic and high-flying girl, she was diagnosed with severe chronic
depression last summer. “I suddenly felt like I was trapped in a black
hole, and no matter how much I struggled, I couldn’t escape the dark-
ness.” But she hid her agitation from her classmates and family, stick-
ing to her old routine and putting on a smiley face.
When she could keep up the pretense no longer, she sought help
from her school’s therapist. After she was evaluated, the counsellor was
shocked to find she was suffering from severe depression.
It was no surprise to Wang, but her teachers and parents refused to
believe it. They thought she was merely anxious about the upcoming
university entrance examinations, and told her she should relax. She
felt that nobody understood or supported her, and continued inter-
acting with others with her usual smile. But she was surprised to find
how quickly she went downhill. She began to lose control of her body.
Her hands trembled, and she lost her appetite; when she climbed a
single set of stairs her heart would beat unbearably fast.
Ever smaller things would cause her to collapse. Once, she saw her
father fumbling with his lighter, and it caused her to burst into tears.
But most of the time, she tried to hold back from crying and squeeze
out a smile. “I had no choice, because I did not want to worry my
parents,” Wang told ChinaReport in late March.
“I wasn’t surprised that no one noticed, I was very good at covering
it up,” Wang Yiqing says. “I didn’t want to let people know because
I was afraid they would think I was mad or would laugh.” After a
few months, Wang Yiqing went to hospital and was diagnosed with
both anxiety and depression. Today she is mixing group therapy and
medication.
Social Stigma
Because of the stigma attached to depression, there are huge num-
bers of people who cover their mental health problems with a smile.
“Normally, people relate depression with overt sadness, but in real-
ity, some depressed patients can smile well,” Dr Lu Yazhou, a psychia-
trist from Beijing Anding Hospital told ChinaReport: “Some patients
put on a smile as a habitual cover up, even when they are in the dan-
gerous situation of deep depression. But in most cases, there’s sadness
in the smile.” The doctor is often the only person who is aware of how
the patient is feeling on the inside.
Dr Liu Qi, from Beijing No. 6 Hospital, told ChinaReport that there
was another risk. “When they’ve already decided they can’t be helped
and are already planning suicide, they smile.” Typically, people who
suffer with classic, severe depression might have suicidal thoughts, but
not the willpower or energy to act on their feelings. However, those
suffering from smiling depression have the energy to plan and follow
through. This is why smiling depression can be more dangerous than
the classic form of severe depression.
According to Dina Goldstein Silverman, a US psychologist and as-
sistant professor of psychiatry, there’s a troubling connection between
smiling depression and suicide. In contrast with patients who have
little energy to even get out of bed, chronically depressed patients who
are suicidal and report a surge of energy might be more likely to initi-
ate a suicide attempt.Overlooked Problem
Talking about depression is becoming more common in China,
but there’s still many who don’t come forward, especially those who
keep smiling.
Wu Zhe is a licensed psychologist in California, the US. Among his
patients who suffer from smiling depression, most are adolescents. In
her opinion, apart from professional treatment, family participation
is equally important. “In most cases, Chinese-style education empha-
sizes that children should be obedient, and courageous in tackling
obstacles. Children are taught not to bring trouble to the family, thus
the young Chinese feel kind of guilty when talking about their mis-
ery,” Wu Zhe explained to the reporter.
“But talking within the family is helpful in cultivating intimate re-
lationships, and enables children to learn techniques to face outside
pressure.” In the community where Wu works, each school employs
a full-time therapist and teachers are very conscious about students’
mental health. If they see anything wrong, they talk with the student.
“American parents know how important their kids’ mental health is,
and if they see warning signs, they call me to consult.”
The situation is sadly different in China. In 2006, Anding Hospital
in Beijing set up its depression treatment centre, the first of its kind
inside China. Up until now, every day, there are around a couple of
hundred patients seeking treatment in the centre. Doctor Lu from
Anding Hospital believes that in China most people remain ignorant
about the treatment of depression as an illness. “In China, the treat-
ment rate of depression is around 4.3 percent, even in megacities such
as Beijing and Shanghai, the rate is no more than 5.1 percent.”
On March 31, 2017, the China Social Welfare Foundation pub-
lished the 2017 Depression Among Chinese Netizens Research Report.
Only 5 percent of those studied said that they would seek psycho-
therapy or other professional help when they suffer from depression,
and 47 percent said that if they suffered from depression they would
choose to hide it from others.(Wang Yiqing is a pseudonym)