Kate Whitehead

• Clinical psychologist Ella Tsang struggled with depression and anxiety in her teens and saw a number of therapists

As we mark World Mental Health Day on October 10, clinical psychologist Ella Tsang, who struggled with anxiety and depression in her teens and early 20s, hopes more people will take the time for self-care.

“In Asia we are not used to talking to ourselves in a friendly tone. Maybe we think its cheesy to say ‘I love you’ [to ourselves] and give ourselves support. I hope more people will take a moment to see what it is like to sit with their feelings, because we are indeed our best friend,” says Tsang.

She works with StoryTaler, a Hong Kong social enterprise that promotes mental health awareness and attempts to reduce stigma around mental illness.

Tsang first experienced low mood and poor self-esteem as a 16-year-old. There was no single stressor; it was an accumulation of factors – anxiety about school, family members’ health, daily life and the future. Together, it was overwhelming.

“It affected how I managed myself and I found it hard to go to school,” says Tsang, 30.

Fortunately, her mother was well-informed about mental health and found professional support for her. It wasn’t all smooth sailing, though. Tsang posted on Facebook that she was going to see a counsellor with her mum and was surprised by the negative response.

“I think I was quite naive at first,” says Tsang. “Some people told me to not talk about it because it would affect my future employment status, others said it might spread negativity. I felt uneasy.”

Aged 18, she was diagnosed with depression and anxiety disorder. When she later developed an eating disorder, she says people found that harder to accept.

“To them depression and anxiety is being sad and scared, but an eating disorder they see as another grade of serious; but in reality, it’s not like that. The line between disorder and common experience is more blurred than people perceive,” she says.

Of the six or seven mental health professionals she has seen over the years, she says half have been truly inspiring, the others less so. She had an empowering experience with those who treated her as a person and worked collaboratively with her; those who were problem-focused and treated her as the problem left her feeling disrespected.

In high school, she saw a counsellor in private practice who advised her to manage her expectations about her future, as her depression and anxiety were likely going to be a barrier to having a high-calibre career. Tsang was crushed and took a break from therapy and school for a year.

“Many people in my family are lawyers and engineers. I felt they all had goals and I was the only one who was a failure,” says Tsang.

With the support of family members and her boyfriend, she didn’t let that counsellor’s well-meaning but damaging assessment hold her down.

Her interest in psychology led to a BA in criminology with psychology at Hull University in the United Kingdom, a postgraduate certificate in counselling at City University of Hong Kong, an MA in psychology and then an MSc in clinical psychology at Chinese University of Hong Kong.

“In the beginning [anxiety and depression] was like a roommate I found it hard to live with, but over the past 12 years I’ve learned to live with it and communicate with it like a friend,” she says.

She learned that trying to avoid her emotions, pushing them aside, made the struggle harder, and that there was a reason behind them. Her anxiety was letting her know there are dangers in life and that she needed to protect herself; her depression spoke to the fact that there were people in her life who she loved and cared about.

She learned to appreciate her emotions.

“Now I really observe myself. When things happen in life … and I get stressed and feel anxiety symptoms, I don’t wait for it to develop before I step in to take care of myself.”

Dropping the struggle means she no longer blames herself if symptoms arise, which was her usual response in the past. Today she responds by giving herself some space to listen to herself.

“I talk to myself as if to a friend. Without taking a moment to notice how I feel and what my needs are, I wouldn’t know how to respond to myself,” she says.

It is an ongoing process, but at the heart of her recovery has been self-compassion and learning how to listen to herself and respect her own boundaries.

This has also made her a sensitive and compassionate therapist because she understands how powerful words can be and the importance of truly seeing a person and hearing their story.

The coronavirus pandemic has helped open up conversations for people to talk about their feelings more freely. In the corporate world there is increased support, all of which Tsang sees as encouraging. But there is still room for improvement.

As awareness about mental health issues grows, she still sees regular micro-aggression. For example, people on social media tagging their friends in the comments section when Castle Peak Hospital, Hong Kong’s largest psychiatric hospital, has an open day.

“It might sound harmless, but actually it’s not that funny. Would you joke about the cancer wing of a hospital?” she says.

Such unkind acts affect those struggling with mental health issues, and everyone else. When someone faces an issue in the future, they might resist seeking support for fear of being mocked.

“I hope people in Hong Kong will recognise that having a mental health disorder doesn’t make us any less able. Whether it’s a mental or physical condition, we need to take care of ourselves and our needs. Then we are able to focus and contribute more in our work,” says Tsang.

If we all took a moment to check in with ourselves, to listen to what is going on behind the daily grind of our lives and sit with our feelings – sometimes painful ones – we’d better understand how to look after ourselves.

And if we can acknowledge our own hurts and challenges, we are far more likely to be kind to others and help reduce the stigma around mental health.