DEPRESSED IN PUSAN By Jon Marshall
Living in a foreign culture is an extremely stressful thing to do, made more so by the lack of friends and family. While we can make friends among the Koreans and expats here, they may not become close enough to replace the ones we left behind us. Also, our pool of choices is limited here, and a good match with our needs may not be found. With this as the point of departure, I would like to spend the next few months discussing different aspects of mental health among expats. Depression is an extremely complex set of behaviors and emotions. It can look like many things at different times, especially to the untrained eye, especially if we are desperately trying not to see it. I will try to review what depression is, how to recognize it, and how to respond to it in the Pusan context. Depression can sneak up on you and your friends. Often it is not something that you wake up and find that you are, it something that dawns on you and you look back on your life and think, "I must have been depressed since this time." So, consider the following guideline and take a good long hard look at yourself and your close friends, and you decide. Most of us think of depression as feelings of sadness, emptiness, or hopelessness. Indeed, this is the most important aspect of depression, and to be clinically depressed it must be present for at least two weeks. It may, however, be expressed as no longer taking pleasure in life. These changes may take place so slowly and subtly that you only notice when you look back at them, or after a large change is realized. An irritable mood can be an expression of depression. This may seem like you will be accused of being depressed no matter what, but irritability can be a symptom. The people I�ve known who�ve had this symptom and gone on anti-depressants, report the most profound changes in their outlook. Suddenly, the world is not as painful as they had always thought it had to be. Life, literally, became less painful to experience. Significant changes in weight that are not desired or sought by deliberate diet and exercise changes are an important symptom. Frequently, people eat to compensate for their feelings of despair. This is equally true of men as it is of women, contrary to popular cultural belief. Not eating is done ostensibly because of a lack of motivation, but can be thought of as a punishment. Insomnia, or hypersomnia (sleeping too much) is a frequent symptom of depression. If you have had a week of no sleep, or too much sleep, look for other symptoms of depression you may be experiencing. The average person needs 6 � 10 hours sleep per 24 hour period, so insomnia is a reduction of sleep by somewhere around half of your normal sleeping needs. If you are sleeping more than 10 hours, and this is not normal for you, then you might be experiencing hypersomnia. This may mean that you are only getting up in time to go to work, and going back to bed soon after leaving work. If you are feeling slowed down or edgy, then you might be having another symptom of depression. Lethargy, lack of energy, lack of motivation, or desire to go out and do the things that you normally would enjoy, are all examples of what this might look like. Needing to keep moving, snappishness, or argumentativeness are all examples of how edginess might appear. Feelings of being worn out, and unable to do one more thing are examples of how lethargy might be expressed. It could also be a sense of dragging to the next task, and looking forward to getting home to rest. If this is happening day after day, especially, on non-work days, then you might take another look at depression. Feeling worthless or guilty are symptoms of depression, especially if those are at all obsessive in nature. This is not just a little guilt or angst or low self-esteem, this is feeling low, low, low, and bad, bad, bad. A life long history of low self-esteem may indicate a long term low level depression, and it may be worsened by being exposed to difficult social situations that are faced by expats. If you feel your ability to think clearly or concentrate has been impaired, or that of a friend�s has been, then you may be looking at a depressive symptom. Frequent blocks on memory, making silly, or stupid mistakes often, being indecisive about even little things, feeling easily overwhelmed at the prospect of making a small decision, or not being able to solve even simple puzzles are all ways that this may be expressed. Recurrent thoughts of death or suicide are symptoms of depression. Of course, thinking about killing yourself is a symptom, but also, just thinking about death and suicide often is a symptom. These things frequently slip out during idle conversation. Don�t be afraid to ask someone if they are thinking about suicide, if you become concerned about it. If they aren�t then they may be shocked that you would think that they are. It might cause them to look more closely at what might cause you to think so. If they are, then they might be relieved that you brought it up. You can not put the idea of suicide into someone�s head, because it�s already there. Everyone has already thought of committing suicide at some time or another, and if we want to do it, we will find a way to carry it out. So, don�t worry about asking. What to do if you think you or someone you love here in Pusan is depressed. Call me, I�m an expert at diagnosing these things, and I�ll be happy to talk to anyone who wants to sort through this mess. Consider seeing Dr.Cho Chong Mi who is a psychiatrist with The Foreigners� Clinic. She specializes in depression and alcoholism. I�ve spoken to her over the phone, and her English is good. Dr. Miller, the dentist, is the contact person for The Foreigners� Clinic and can help with communication, if need be. To make an appointment you can call the clinic at 461-3259 or Dr. Cho at 461-3281. They accept insurance, but the costs involved don�t strike me as excessive, probably in the W 50,000 range for appointment and medication. Anti-depressants can be a great blessing when struggling with depression. If you feel some stigma, that�s understandable, but the number of people that I know, who feel like they�ve stepped out of cave into the sunlight, or out of the cold into the penetrating warmth of life, is enormous. They are not a cure all, but in the absence of real therapy, they can make life livable and manageable. Do not be tempted to self -prescribe medication here, anti-depressants are complex and it takes an expert to sort through all of the conflicting indications.