Excerpts from Book: "Diaries of My Older Sister: Depression and Suicide in Korea, Asia and America"


(Partial Excerpt below. Full 180 page version will be Available on Amazon Kindle, Apple iBooks Dec 2019. Paperbooks by Mid-2020) 


Preface


My sister Katie committed suicide in her college dorm room a few months before her 21st birthday.
When she was alive, Katie was deemed the model eldest Asian daughter, the quintessential example of the “model minority.” She was an overachieving straight-A student pursuing her double-major STEM degree at a top university on full scholarship. Because of her maturity, intelligence and caring personality, Katie was a great role model for not just me but also for many friends who knew her. She loved singing acapella, writing poetry, drawing and plant collecting. Nobody could tell from looking at Katie that she had been secretly suffering from crippling depression, bulimia and low self-esteem for most of her young adult life.
Prior to her suicide, Katie had been seeing a campus psychiatrist for several months after a romantic breakup. Her friends on campus had been quite worried about her visibly changed, thin appearance and mood changes. Her diaries indicate that she was forcing herself on an extreme diet only eating one apple a day and then filling herself up with water. On one particular afternoon, she received a C- on her biochemistry midterm exam.  Katie was the type of person who could not stand anything less than perfection from herself and always tried to meet the high expectations of being the model Asian daughter. She might have been in a particularly vulnerable mental state that day, with her relationship issues and eating disorders compounded on top of this incident. According to Katie’s friend who had talked to her earlier that afternoon, this exam score might have felt devastating for her and pushed her over the edge,
By the time Katie’s roommate discovered her in her room with a plastic bag over her head, she had been without oxygen for way too long. I still clearly remember the night when my mother and I received a call from the school hospital telling us that Katie had tried to hang herself. Katie was taken to the ICU where she fell into a deep coma and diagnosed with severe, irreversible brain damage. She spent her last weeks in the hospital hooked up to a life support machine while my mother, a few close family friends and I prayed for a miracle. After months of no noticeable improvement, we were forced to agree with the doctors to turn off her life support. 

The rest of the world seemed to move on after Katie’s death, but it wasn’t easy for me or my mother. After her death, her campus psychiatrist sat us down and said, “Katie suffered from severe depression due to her oversensitive personality. Medications did not seem to help her. We are sorry.” I remember angrily thinking, “That’s it? That’s the best explanation you could come up with?” I could not believe that was the extent of their knowledge. My sister’s death definitely deserved a better explanation than that.
Katie and I had been very close and were almost inseparable when we were little, spending all of our childhood years together. Over the last 15 years, as her younger brother who loved her deeply, I have tried to unravel the truth behind why Katie might have been so compelled to commit suicide. It just didn’t make any sense to me—a person as intelligent as her deciding to throw away her own life at such a young age. I studied the nature of depression and reviewed Katie’s handwritten diaries that she had kept since she was 12 years old. I analyzed her writings carefully, hoping to gain more insight into the inner workings of her mind, thoughts and emotions while she was alive.



Me and Katie growing up in South Korea and Japan

And what I started to realize, 15 years after her death, is that no single person or event might have been to blame. I strongly believe that Katie’s suicide was not just an isolated event based only on her specific circumstances, but the result of a very noticeable general pattern related to depression and suicide worldwide. This may be a trend that has particularly impacted demographics such as South Koreans, Asian-Americans and young adults in the U.S.
Research in psychology shows that there is a strong connection between our mental narrative and depression. “Mental narrative” in this context means the stories you tell yourself in your own mind and the way you talk to yourself, commonly referred to as your internal dialogue or self-talk. According to a study published in Social Cognitive and Affective Neuroscience in 2016, “maladaptive rumination” or the act of repetitively thinking negative and distressing thoughts about one’s life is one of the most common tell-tale causes of depression.[1] Certain personality traits such as perfectionism, neuroticism and excessive focus on relational status (how you compare to others) all contribute to this harmful mental habit and are most commonly found in chronic depressive patients.[2] Katie had clearly expressed similar thought patterns in her own diaries and in her interactions with others when she was alive. Katie used to think of herself as fat, ugly, broken and stupid, when in fact, she was talented, beautiful and intelligent.

Left: One of Katie’s last diary notebooks she kept until her death
Right: A page from her diary. In the right column, Katie lists out the reasons she dislikes herself, “stupid, weak, fat, unlikable and not cute.” In the left column, she lists her positive qualities such as having a loving family and good grades in school. It shows her final attempts to remain positive despite her frequent, self-loathing rumination

One of Katie’s diary entries in Korean. Translation: “I will try to be a little stronger person today. I want to live every day and every moment the best I can. There are people who value me, I am not alone; the reason I feel lonely is because I’m too stupid to realize that. I need to stop thinking painful thoughts. I will live today as best as I can because today is precious and will not come back.”

The insights I gathered from Katie’s diaries led me to ask if others suffer from similar thought patterns. The answer was a resounding yes. A 2009 research study published by the University of Maryland School of Public Health found a pattern of strong mental stress among Asian-American young adults in terms of “pressure to meet parental expectations of high academic achievement”, “living up to the model minority stereotype”, “difficulty of balancing two different cultures and communicating with parents”,  and “discrimination or isolation due to racial or cultural background.”[3] The Anxiety and Depression Association of America also reports that Asian-Americans are three times less likely than their non-Asian counterparts to seek treatment for their mental health concerns because “doing so would admit the existence of a mental health disorder, and in turn would bring shame to their family's name by appearing weak or imperfect.”[4]
Traditional Asian cultures have long indoctrinated their people to value academic performance, high social status and professional advancement as top priorities in life. But our community has not been successful in prioritizing the importance of mental health awareness, emotional intelligence or helping younger generations develop a strong sense of self-love or self-identity first. This might have been the case with Katie as well. She never learned that caring about her own mental health and changing the way she thought about herself were just as important as getting good grades in school or achieving “success” in the eyes of others. She silently pursued the Asian vision of “success,” suffered quietly by herself like a mature older Asian daughter and then died quietly in her dorm room.
We are also not the only South Korean or American family that has directly or indirectly experienced the effects of depression and suicide. It’s been reported that South Korea has the highest suicide rate among the OECD (Organization for Economic Cooperation and Development) member countries of the world. Many high-profile South Korean celebrities, musicians and even a former president have committed suicide over the recent years, citing reasons such as shame, guilt, self-loathing and social pressure. In the United States, suicide rates among teens and young adults regardless of race have reached their highest point in nearly two decades with an annual increase of 10% between 2014 to 2017 according to the U.S. News & World Report in 2019.[5] Also, a 2018 report from the Blue Cross Blue Shield Association found that diagnoses of major depression among its patient members swelled by 33% between 2013 to 2016 for all adults, 63% for teens and 47% for millennials.[6] “We are concerned that depression rates are continuing to accelerate, and we need to do more work to identify the underlying cause,” says Dr. Trent Haywood, MD, a former Senior VP and Chief Medical Officer for the Blue Cross Blue Shield Association.

 I wrote this book to remind everyone that our understanding of clinical depression as well as our cultural definition of “success” must evolve to create a healthier and more balanced mental narrative for people all over the world. The Asian-American and South Korean communities in particular are great examples of the damage that can stem from a distorted mental narrative on a societal scale. In a culture that considers lagging behind your peers in academic, professional or personal achievements a cause for great shame and disappointment, there is bound to be mental turmoil among its people, especially young adults who are emotionally sensitive and susceptible to external influence.
The first section of this book covers the different types of harmful mental habits that people vulnerable to depression are likely to engage in and how they manifest in the form of automatic, repetitive thoughts in your mind. These thoughts then may cause people to suffer from a stressful mental activity called “rumination” which is well-documented in psychology as a precursor to major depression. The second section covers the possible origins behind how and why our mind creates these stories. We will cover the impact of childhood experiences, parental upbringing, cultural influences, social media, peer pressure, neurochemistry and more. The last section discusses the possible strategies we can employ to change our mindset going forward as individuals and also collectively as a society.

I don’t claim to be a certified expert on mental illnesses. I definitely do not have all the answers myself.  I think of myself more as a messenger of the already existing, complex knowledge out there regarding these topics, and this book is my attempt at distilling that body of knowledge and current findings for you so that the general public can elevate their level of understanding. I do consider myself a committed student and a first-hand observer of the nature of depression because of how dramatically it has impacted me and my family. But I also encourage you to think objectively about the ideas in these pages, challenge them if necessary and verify the truth for yourself. If this book can guide a few of you into having a better understanding of depression and of how you can help yourself and others, it will have achieved its purpose. I look forward to sharing this story with you. We thank you wholeheartedly for reading our book.



Table of Contents



Copyright and Disclaimer 2

Table of Contents 3

Preface 4

I: Observing Our Mind’s Stories 13

Chapter 1: “I am not good enough” 14

Chapter 2: “I am so ugly and unattractive” 18

Chapter 3: “I am so behind compared to others” 21

Chapter 4: “I should have, I would have, I could have” 25

Chapter 5: “I must always be perfect” 28

Chapter 6: “I am a total failure” 31

II: What Creates Our Mind’s Stories 35

Chapter 7: Our Brain (Part I) 35

Chapter 8: Our Brain (Part II) 41

Chapter 9: Culture 45

Chapter 10: People Around You 53

Chapter 11: Childhood Conditioning 58

Chapter 12: Your Self-Identity 67

III: Taking Control of Our Mind’s Stories 70

Chapter 13: The Current State of Depression Treatment and Understanding 71

Chapter 14: Awareness and Presence 79

Chapter 15: Downward Spiral, Upward Spiral 83

Chapter 16: The Power of Appreciation 87

Chapter 17: Top-Down, Bottom-Up 93

Chapter 18: "An Idle Mind is the Devil's Workshop" 97

Chapter 19: Faith, Spirituality and My Testimony 100

Dear Asian Parents 107

Epilogue 111

Acknowledgements 116

A Letter to Korean Readers 117

About the Author 120



References 121

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