HKU Bulletin January 2011 (Vol. 12 No. 1)

27 Research Stagnation syndrome, not to be confused with depression, is a unique concept in Traditional Chinese Medicine. Stagnation vs Depression Dr Ng Siu-man with different symptoms. “In the case of stagnation, people are even more conscious of making an effort with their appearance, which is quite different to depression. People with stagnation will feel extremely exhausted, so it may look similar to depression, but the mechanism is totally different, and that will call for different intervention.” According to research, the prevalence of depression is surprisingly low in Hong Kong, running at about two per cent. “This does not mean that the Chinese are free from psychological distress,” says Dr Ng. “It just means that it takes another form. We have a higher prevalence of anxiety disorders and also more so-called functional disorders. “Stagnation is more common than depression among the Chinese people. This is related to our collective bias culture, in which we tend to have some expectations of ourselves to restrain ourselves, to avoid being sick and to endure suffering, and to remain productive for as long as possible – all these will lead to stagnation.” Stagnation syndrome presents itself in three behavioural clusters – body-mind obstruction, over-attachment, and affect- posture inhibition. “We can provide treatment but we can also provide some psychosocial intervention. The initial objective is often symptom relief and this part is relatively easy to deal with,” he says. “The most problematic part is “over-attachment” because that’s not just a cognitive dysfunction, it is something further up in the meaning domain. Fear is strongly associated with over attachment. In contradiction with conventional Traditional Chinese Medicine my data suggests it is fear, not anger, that is the issue. If the anger is repressed it becomes stagnation, and according to the five elements theory fear is generative of anger. Anger rooted in fear is more likely to be repressed than expressed.” The concept of stagnation in Traditional Chinese Medicine (TCM) is proving a useful entry point for the treatment of various psychological disorders, according to one scholar in the Department of Social Work and Social Administration. Assistant Professor, Dr Ng Siu-man, says that because the social stigma relating to stagnation is low, patients are more likely to seek medical help. Although the condition, considered a mind/body syndrome for over 2,000 years in TCM, may present itself as physical symptoms, it will involve psychological issues, such as anxiety. Repressed emotions, especially anger, will lead to liver qi stagnation, according to the five elements theory of TCM. This will affect the liver meridian which, in turn, affects the spleen meridian, triggering digestive problems. “So it seems to be somatic, but it’s related to the emotions, you can’t separate the two. But, because the symptoms are somatic, rather than psychological, a patient is more likely to seek help – that is the beauty of the whole concept. The treatment for stagnation syndrome is to get the qi flowing, through herbal intervention, or acupuncture, or traditional exercise, like tai chi. “So stagnation syndrome is actually a very useful concept for the Chinese people to seek help. It’s quite normal to have stagnation syndrome and do something about it,” says Dr Ng. Quoting prominent psychiatrist, Professor Arthur Kleinman, Dr Ng says cultural factors play a strong part in mental disorders. In the case of the Chinese, the most important characterization is the so-called somatization, or mind/body aspect, and to seek help in the somatic domain.” He disputes the Western translation of stagnation as depression, saying they are two completely different concepts “If you have fear you will “over-attach”, and if you are over-attached to something you will fear losing it. So this is very problematic. From a psychotherapy point of view helping a client work on anger is very easy but fear is quite problematic. My findings show that if you want an ultimate cure you have to work on the fear domain when the patient is ready, otherwise the problem will just recur.” Backed by funding from the RGC General Research Fund, Dr Ng has conducted a study of stagnation syndrome in a random community sample, in Aberdeen, and has found that the prevalence of stagnation syndrome runs at about 6.1 per cent, in adults aged between 18 and 60. Anxiety disorders are even higher, running at over 10 per cent. “The most significant thing is that stagnation syndrome is acceptable to the Chinese,” he says. “They do not feel any shame or stigma in admitting to it, so they will seek help. But when they have depression they may hide the symptoms and feel quite isolated and feel like a failure. So you can consider stagnation syndrome as a functional disorder, meaning it’s a useful channel for seeking help.” The University of Hong Kong Bulletin January 2011