Saving face vs Depression in China

Enoch Li
Enoch Li
Nov 13, 2018 · 5 min read

Cultural constructs sometimes get in the way of mental health. In China, preserving “face” and image of strength exacerbates the stigma and taboos on mental health.

Picture credit: Victor Lau

“You CANNOT go to see doctor. It is shameful. Get better by yourself!”

It was sadly that a young, Chinese female executive recounted the response her parents gave her when she told them she had depression.

It would be a loss of face to the family if the friends and relatives ever knew she had depression. The concept of “saving face” and keeping up appearances is so important in Chinese culture that it sometimes comes at the expense of one’s mental and emotional health.

At least this female executive was able to identify that she wasn’t “well” after months of lethargy, loss of appetite, and loss of interest in anything. Most people here in China would not even know that those are symptoms of depression or other mental health problems. Awareness of mental health is extremely low, if even accepted as something “real” at all.

Another executive shared that his spouse did not support him and dismissed his depression as “attention seeking”, telling him that he should just get on with life, make more money, and support the family.

I sit dumbfounded each time I hear anecdotes like these. Part of me cannot believe the cruel responses, but at the same time, being Chinese myself, I understand them. To make matters worse, many of these executives I work with are only children as a result of the One Child Policy, and the pressure on them to bring glory to the family through their achievements is even more intense. This is but some of the common social stigma surrounding mental health (particularly depression) in China, where I have lived for almost a decade and where I had my most serious depressive episode back in 2010. I, too, was dismissive of depression before I lived through it myself — I saw it as something weak.

China accounts for 30% of the world’s suicides, and while not all of these deaths are linked to depression or mental health, a high percentage are. We hear of these deaths and depression cases occasionally: Chinese students studying overseas who do not know how to face the loneliness and depression and choose to end their lives (recent China Daily article here), examination pressure on students resulting in depression and anxiety (SCMP article here), only children crumpling under the pressure to succeed, people dropping dead at their desks in start-up companies or offices from burnout …

We hear of them only after the fact. We do not hear of them early enough to prevent it.

One main reason is the social stigma around the topic of mental health. Such heavy taboos prevent us from discussing the topic without being self-conscious of it. Even in my work to prevent workplace burnout, I am faced with those challenges — for example, one client asked me to call my workshop “stress management” (which is relatively acceptable here) instead of “mental health” or “mental wellness”. After he requested that I change the title to “How to be happy”, I almost declined to go ahead with the workshop at all, because that was not what it was about! He was so wary of the idea of mental health at work, fearing that everyone would quit their jobs as a result and that he would be responsible for it. It was apparent to me that, like many decision-makers in business, he did not understand that talking about mental health at work and supporting colleagues emotionally made for higher retention rate and more engaged employees.

Suffice to say, much more needs to be done here in China to break taboos, or more lives could be lost, particularly in this culture where it is important to have “face” and to appear “well” in front of others. It’s ingrained here — we’ve even got sayings about it.

Should things take a turn for the worse, it would bring shame not just to the ill person but to the whole family — and all the way down the ancestral line in some cases. The whole village would hear about how the prodigal son broke down. ‘So maybe he wasn’t so talented after all,’ they would muse.

Not all hope is lost. I have seen an increasing trend amongst the larger corporates here in China in taking an interest in staff wellbeing. Diversity and Inclusion initiatives are now branching out into mental health issues. Though, perhaps the first step is to help people understand that depression is real, and that it could happen to anyone — whether they were the top of the class or did not even finish primary school. Education and awareness are essential in helping people to understand that depression and anxiety could become debilitating!

It is not a matter of “face” or “image”. Mental health is part and parcel of health in general, and like the body sometimes gets a cold, the brain does as well.

By Enoch Li

Author of Stress in the City: Playing My Way Out of Depression. Social entrepreneur and Founder of Bearapy, preventing workplace burnout through a dose of playfulness.

Want to see more from Enoch? Read Stress in the City! Here’s a sneak preview …

Having grown up in Hong Kong and Australia and educated in France, Enoch Li always had international aspirations. By her 28th birthday, she had achieved everything she had ever laboured toward. Her mum was speechlessly proud of her financial earnings, she had a supportive and loving romantic partner, and she had lots of friends who adored her. So why did she feel as though something was missing?

One could hardly guess that a strong, successful young woman who travelled the world, lived in multiple cities, had a high paying salary and had rocketed up the corporate ladder, would one day crumble to pieces, so hopeless and devastated that she believed life was no longer worth living.

In Stress in the City, Enoch Li shares her experiences at the top of the corporate game, reflects on the warning signs she refused to see, and documents her journey back from the edge through the rediscovery of her inner child.

Enoch also discusses how companies can help their executives be mentally and emotionally well through her research into the psychology of playfulness, workplace burnout, and company culture.

You might just find that the toys around us may be more meaningful than you think!

Enoch’s penned a few posts for us — check them out here.

Originally published at

Thrive Global

More than living. Thriving.

Enoch Li

Written by

Enoch Li

Founder of Bearapy. Mental Health & Play Consultant. Executive Mental Well-being expert — avoid burnout, depression and anxiety. Finds wisdom in Dr Seuss.

Thrive Global

More than living. Thriving.

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