When All Else Fails: Depression from the Inside and What to Do

Recommendations on who to seek help from in Shanghai from someone who's been there.

By Anonymous |

I try to keep my mental illness silent.

It doesn't always cooperate.

There was the time last year when I was looking at pictures of my ex-wife online and the pain overwhelmed me. I didn't know how to stop it but I had a bottle of bourbon and a prescription for diazepam, and that seemed like the best method. I WeChatted a suicide note to a friend in London, who told a friend here in Shanghai, who broke down my door at two in the morning. I fought him, fists and kicking, to a hospital on Yan'an Lu, where some of my friends had gathered. I was oblivious, ranting and raving, shoeless in the winter and convinced I had been kidnapped. For better or worse, the police didn't care and I went home a few hours later. For days after, I could barely remember anything. There was the time when I was younger and I cut my wrists. There was the time I tried to accumulate enough pills to overdose. There was the time last week where I fell into a manic mood and the only thing that made me feel better was cutting lines into my arms with a boxcutter.

I tell these stories not to brag. I am one of thousands, and probably hundreds of thousands or more, if we're talking about the Chinese who are suffering from trauma and mental illness in Shanghai, and every time I see a "community" article about options for help written by a well-adjusted person dipping their toe into the crazy, I want to scream.

I have been here more than a decade. I have seen or heard about some unpleasant things. The expat who hanged himself at a popular apartment complex on Huaihai Road. The acquaintance that started showing signs of paranoid schizophrenia and then left the city. The friend who loses his job every year or two because his depression gets so bad he refuses to go to work or talk to friends or answer his door. The nightlife friends who medicate with drugs and alcohol. The man so violently attacked at a tourist site that his skull was crushed and his brain was exposed and instead of being taken to the hospital, first he had to spend hours at the cop shop, face covered in blood. He now has PTSD and epileptic seizures. We are one community.

Depression has haunted me for twenty years and only recently did I learn that maybe it's PTSD from a bad childhood, and my urge to cut off my friends, withdraw and destroy myself are symptoms and not a cause. I have been on drugs to boost my mood, drugs to moderate my mood, drugs to help me calm down, drugs to help me get out of bed, anti-psychotic drugs (I am not psychotic; it's a new use for them), drugs that left me feeling drunk for two weeks, drugs that have destroyed my sense of taste, and drugs that, I was warned, I was being entrusted with only because the doctor believed I wouldn't take too many and kill myself. (I searched online for how it would work. Complete destruction of your liver and kidneys are more likely than death, and so I keep taking the pills one at a time.) Something inside me keeps the alcohol and powders away. For a while, my doctor recommended electro-shock therapy, which apparently the Chinese are very good and practiced at, but with my new diagnosis, I'd just be zapping away the symptoms. I've been taking these drugs for two decades.

I am not one of Shanghai's most stable residents but I hold down a corporate job and I have friends, and I have happiness once in a while too. I am your neighbor and you'd never know it, unless you saw the scars on my arms and even those are starting to fade. I am not a writer but I need to write this because there are thousands of us out there. There is so much trauma in Shanghai, without touching on the local history, which is overwhelming, but expat mental health is such a small and expensive community that it is often impossible to know where to start.

For all of us who are suffering here in Shanghai, usually many thousands of miles from home (often not a coincidence), I want to tell you where to start and what has helped me.

I have been through multiple bad psychologists, doctors who couldn't remember my name after five minutes (and charged 3,000rmb for the courtesy), doctors who were barred from Shanghai because they didn't have a license for practicing psychology and yet doled out Xanax and Clonazepam to anyone who asked, and a number of charlatans who come with dubious qualifications and 2,000rmb hourly fees. It is hard enough to suffer from mental illness in a foreign country. Doing it in a sometimes crooked environment makes it only worse.

For all of us, I offer this, a short but realistic guide to people who have helped me continue living, and how to do it without spending 25,000rmb per month.

First Thing: Get Insured

Mental health services are expensive in most countries, or at least in the US, where I'm from (thanks shit healthcare system and ongoing stigma). In China, this is doubly so. When a stomachache at Parkway can easily cost 5,000rmb, the first consideration is that you need insurance. Fortunately, Shanghai has some excellent options for this, and the while the initial outlay may be steep, it's often no more expensive than the membership to a yoga studio. In many cases, you can also pay on a monthly basis. There is no better investment than the investment in living.

SmartShanghai has written a guide to insurance in China, some of it relevant here. What you need is a plan that will cover you everywhere outside of your home country, and those are easy to get. This is not a plug but I have used and recommended Pacific Prime for many years. They are a broker and they are excellent at providing spreadsheets that detail what you get for what you pay for. This is key.

If you are in my shoes, it's important to pay attention to details like deductibles (no one wants to pay the first 5,000rmb out of pocket), but even more important to pay attention to details regarding mental health. This is a preexisting condition for most. In my case, I might not have been born crazy, or maybe I was, but the last 30 years have certainly instilled some more in me.

At the risk of sounding like a shill, I have found GeoBlue (also known as HTH) to be a godsend. They cover up to 40 visits with a therapist per year (we'll get to that), and they cover psychologist visits at 75%. If you are going to Parkway, and you should, that means you'll pay 399rmb out of pocket. Dinner at el Willy costs more. There is a catch — you need to contact them ahead of your appointment for a guarantee letter — but then the world of insurance is imperfect, and all things told, if you are struggling with mental illness, this is an excellent plan. There are others but they vary dramatically on how they cover things like psychologist visits and therapy, and these are the most important factors. This is what you need.

Next are the people who have saved my life, literally. They are all intimately important to me and they all serve different functions.

See Someone Who Can Help

The first is Dr John Volokitin, who is a relatively recent addition to the Parkway psychology department (which I believe consists of two people; I saw the other guy for marriage counseling). Volokitin has been in China less than a year but working in this field for decades, and he is, bar none, the most engaged and caring psychiatrist I have met in two decades. He has been the first to listen to my story before prescribing medication, and he is constantly adjusting the specific admixture I use to function. No doubt his is a pharmacological approach but he is well-versed in all approaches, including a type of therapy that involves repeating random words while pressing hard on your eyeballs. If it all sounds crazy, remember the world you are in. Volokitin has saved my life when I was ready to end it, and I know he is doing the same for others in Shanghai. For me, his importance cannot be understated.

Volokitin is also fully aware of the landscape of psychological charlatans operating in Shanghai, and is an excellent resource on how to avoid them. He works in both Puxi and Pudong.

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Thomas Needham is a psychotherapist and organizational psychologist, operating out of a small office, as many psychiatrists in this city do. It's been two years or more since I've seen Needham but I feel his effect every day. He is a fundamentally caring person. He is also unafraid to call you out on your bullshit, which, of course, you have plenty of. Needham was the associate dean for graduate programs in family psychology at the Fuller Graduate School of Psychology in Pasadena, California for nearly a decade, returning to counseling and consulting to help patients directly, instead of being an academic administrator and professor. His style is talk therapy and while he may lead you in a direction, he will never tell you what to do or judge you for what you have done. I know he has personally saved dozens of marriages (including those of friends), and that's to say nothing of people like me, who have come to him in extreme crisis and left feeling soothed and cared for.

Much of Needham's work is in evaluating high-level corporate executives to determine exactly how and where their crazy lies, and I appreciated the part of the initial evolution process that asked me hundreds of questions and gave me a very specific and accurate picture of my personality, warts and all. I have sent multiple friends and romantic partners with serious childhood trauma to Needham. He has received nothing but the highest praise. He charges a fair amount per hour, which is why you need insurance, but this is almost certainly covered (usually at 75%), and for those who are suffering, that's less than a night at a bar. Needham told me there is a move by Western insurers to consolidate practitioners like him in clinics, and so his future with private patients is unclear. His ability, caring and effectiveness are beyond reproach.

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Finally, Gur Schoneberg. Schoneberg is also a trained psychologist and while extremely gifted at talk therapy (she was the one who realized I was suffering from PTSD, after 20 years of being diagnosed with major depression), her practices tend to be more holistic. I, and others, see her specifically for hypnosis, which sounds like a parlor trick to natural skeptics like me, but has proven undeniably effective. I don't pretend to know how the unconscious mind works, other than that it holds a lot trauma and protects children and adults from awful situations (the majority of people, even in combat, do not get PTSD). Hypnotherapy, which often feels like just making up a story, accesses that unconscious mind and can be both soothing and scary, conjuring threatening worlds that wouldn't be out of place in a horror movie. The brain does weird things. It also does wonderful things, like the time I visualized the northern lights, Gur asked me to touch the light, and I suddenly experienced an electrical, drug-like sensation I could feel move down every nerve, from my eyelids to my diaphragm to my calves to my feet. That was a successful session. They are not all successful (Gur disputes this, even for the less obvious happy ones). Nonetheless, I have also come to Gur in extreme crises, when my thoughts were out of control and all I could think about was suicide, and she spent hours helping me past the immediate situation and consulting with my other doctors about the best plan. Like Volokitin, I would say she has saved my life.


My struggles aren't over and these are not the only the effective and caring psychologists in Shanghai. The Shanghai Mental Health Association is another resource for finding help, which I have used in the past to varying degrees, as is the Community Center Shanghai, which helped me with the painful divorce, and there is also Lifeline Shanghai, which is truly the best our expatriate society has to offer: caring people volunteering their time to help other people.

I don't know where I will end up — happiness, I hope — but I don't pretend that I may not find myself in suicidal or crisis situations again. I do know I want to stop pretending life can not be dark, and that, hopefully, the few resources I've listed above can be a light for others in my position. I am not the only one. And neither are you.

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Dr John Volokitin can be reached via Parkway at 6445 5999.

Dr Thomas Needham can be reached through (1) 888-427-3360 or drthom@globalexrs.com.

Gur Schoneberg can be reached through LZ.Shanghai@Ymail.com.

IF you are in acute crisis, there is always Lifeline Shanghai: 6279 8990