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Kim Hai - Interview 25

Age at interview: 59
Age at diagnosis: 39
Brief Outline: Kim Hai first experienced depression while studying overseas as a young woman, partly due to her experience as a refugee from Vietnam. She has experienced depression at different stages of her life and has found counselling more effective than medication.
Background: Kim Hai works part-time and is married with one son. She came to Australia as a refugee. Ethnic background' Vietnamese.

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Kim Hai was born in Vietnam, the eldest of five children. Her father was a teacher and the family were strongly Catholic. Kim Hai first experienced depression when she was separated from her family and studying science overseas. She had a difficult relationship with her mother, whom she found very domineering. Her relationship with her father was better, but she notes that her father has also experienced depression and a ‘nervous breakdown’. While studying overseas Kim was very angry at being separated from family and Vietnam and engaged in 'self-destructive behaviour’. She thinks that this may in part be a reaction to her mother’s domineering nature and disapproval of her first boyfriend. 
 
Kim Hai reflects that she has experienced depression at different stages in her life, beginning during her time overseas. As well as her separation from her family, the impact of the Vietnam/American war significantly contributed to her depression. Her first boyfriend was killed in the war. Kim Hai says that she often felt sad and numb as well as angry. She did seek counselling while overseas, but was not diagnosed with depression. On reflection she realises she was ‘very depressed’. 
 
She returned to Vietnam, with her then boyfriend who had also been studying overseas, however this meant that she could not complete her Masters degree, despite being an exceptional student. In Vietnam she again experienced depression, and once attempted suicide. Kim Hai escaped Vietnam following the fall of Saigon with her boyfriend in a small boat and in very dangerous circumstances. They lived in a refugee camp in another country for some months and then resettled in Australia. Her father, mother and brothers escaped to America, but Kim Hai was unable to escape with them. Her experiences under the Communist regime, as a refugee and as an interpreter for other refugees, had a profound emotional impact on her, particularly her work with Vietnamese refugees who had been abused or raped by pirates. 
 
In Australia, Kim Hai worked part time. She broke up with her boyfriend, married another person and had a son. In 1991, when her son was a young child, she experienced depression and sought help from her GP. She was prescribed antidepressant medication but found it made her very ill. She received counselling and found this helpful. 
 
More recently she has experienced depression again because of domestic violence in her marriage. Kim Hai first approached her GP, but was not satisfied with her response and sought advice from another GP. She was again prescribed anti-depressant medication but preferred not to take it because it had made her ill the last time she took it. Kim Hai has found counselling very helpful. She says she found it difficult to be assertive with respect to her husband’s anger and violence, and that counselling has assisted her relationships with her husband and son. Counselling has also helped her to understand the network of help available to her and other people with experiences of depression. Kim Hai feels this network would be helpful if she ever experienced serious depression again.
 
She would like to see better access to culturally focused counselling for other Vietnamese people, and is also interested in gaining a more nuanced understanding about the relationship between depression and psychosis. 
 
 

Kim Hai reflected on the diagnostic criteria used to diagnose mental health problems.

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Some people are more resilient than others. Why so I don’t know. It could be half genetic, half you know childhood, upbringing. Ah, it may just be luck. It may be just their supportive network, not just themselves that they are that resilient. 
 
Some people break - very fragile and break very easily. That is a mystery to me too, and there would be a link, you know, ah, between all of us human beings in that kind of relation of various types of emotion. I think we all can become psychotic given enough trauma, though. So I think it is very hard to make list and to tick and categorise people in diagnosing mental health. 
 
So that's, that’s my point anyway. I don't think the diagnosis criteria here now is covering enough, is in-depth enough to detect in a less clinical way either depression or more severe or psychotic tendency. But to give some constructive feedback on those criteria I am not a professional, I cannot do that yet. 
 
 

Kim Hai saw a GP from the same background who was also a friend. This made her reluctant to tell her that her advice had been unhelpful, so instead Kim Hai changed GPs.

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I did go back to her as a patient for some antidepressant for depression because after the interview I thought, oh, how miraculous you know these tablets are. I must try, because I was feeling like quite down at that time, not letting you know my husband and my son know, though. I just said I have to go to see (doctor’s name) for an interview, so I just went, and she was very good. She advised me on how to behave in my marriage to, you know, culturally appropriate way - I tell you about that later; it didn't work for me, though – to save our marriage. 
 
And then I went and took a different antidepressant. 
 
Who gave me that? I try to remember who gave me - I think (another GP) actually gave me some lighter one. I talked to her. I didn't want to go back to (doctor’s name) to say that, because you know she and me we were friends. I didn't want to offend her. But I did talk to her on the phone and said your advice, you know, I try it. It was good for a while but it didn't really work, and she didn't ask me whether I take the drugs or not. If she had asked me I wouldn't have lied, though.
 
 

Kim Hai preferred counselling over antidepressants and discussed why she thought counselling...

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Ah, I could - I'm prone to be depressed again, I would say, with my current situation. I would probably be - never be able to use antidepressant, I don’t know. I would just resort to counselling. In a way, like counselling is not the advice, it's to me like brainstorming so that I can make choices and help myself more or less. I feel supported by counselling. 
 
Ah, I think counselling helped, yes. I firmly believe in my case counselling helped. In Vietnam, like my father had the psychiatrist treating him when he had the episode of nervous breakdown. It was never counselling, it was just a drug treatment and lucky dad got out of it. 
 
Anyway, here I think the mainstream counselling is something very alien to Vietnamese people. It's never in our culture because we don't have psychologists, we just don't have it. And talking to friends and family seem to be the best thing, the closest thing, to counselling in our culture. But talking to friends and family has a drawback as well, because like myself I don't want to burden them. There are some secrets you don't really want them to hear. It could become gossip. They can talk to someone else. There's no confidentiality there. It's not assured. 
 
Ah, friends is better than families or relatives but sometime you just don't have that friend that's close enough to bear your burden or to keep confidential for you. Ah, to me, the counselling here is the best for me, because it has all that you know good thing without all the bad things, as friends and relatives and community. Ah, through my little experience with other Vietnamese people who are depressed, they never want to talk to friends or family. They don't access counselling. 
 
Some of them go on antidepressant. It's a quick fix thing. It is very effective. If they got through and they're compatible with the drugs, many of them have been helped. they don't have much access to counselling because of the language barrier. They don’t get that option in the mainstream. 
 
It's not against the culture, I don't think so. There's an urge to tell someone, to talk with someone. We all agree that it's good that you can talk things out.
 
 

Kim Hai experienced many losses related to living through a war and her experience migrating to Australia as a refugee, which left her with a 'deep sadness'.

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Yeah, so that's probably the first sign of - now that I, on reflection I thought that's probably I went through a period of depression because I was like plucked away from my environment, from my boyfriend, from, from the war, from the suffering of my whole country that I wanted to immerse myself in, to be a part of it, to, maybe to feel like I was doing something, rather than going to (country name), having - you know, I was thinking what was I doing there, having all these meals with a big piece of steak and while my country fellow man, or my father, didn't have that much meat to eat in like a week's time, and my boyfriend was in the war zone and sometime going hungry and fighting the enemy.
 
I didn't feel you know grieving or anything. I was just numb. And I just kept going on with my life, as usual. I never really properly grieved for that loss. But I was always very sad person because in the inside. Now that I think of it, it was probably my inclination to suffer from depression, probably, I don't know. With my knowledge now I'd probably say if I had some help at that time probably you know it would have been good.
 
So I don't know if that's depression or not. You know, that could be. So sadness and depression I think in my case it was very severe sadness, though, compounded with the fact that my environment was changed and I had a lot of angst and anxiety and rebellion you know against the war, against my Mum. I think she was very dominating, domineering woman towards us and my dad as well. 
 
Yeah, so I wasn't in control of my life at that point. So I wanted to be in control of my life by lashing out, doing these outrageous things against every value in our culture and everything. 
 
 

Kim Hai enjoyed the confidentiality and space to talk freely that her psychologist provided.

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In counselling, I found - the first thing I found is like I don't put too much burden on the counsellor, because it's her job. She get paid for it, so I feel a bit less than you know feel obliged and talking to a friend. If I talk to a friend I feel like they have to listen to all my suffering, and ah it's not fair on them. With the counsellor, I know they debriefing sessions and they get paid for it. It's their professions, so I feel more freely to talk to them about traumatic events. 
 
With the counsellor, I feel like it's totally confidential and I like the fact that they don't give too much advice. They will just listen to you but I also like the fact that sometime they challenge my thinking. I think it wouldn't be so useful if they don’t challenge my thinking. So I think all those combined make me feel like I can talk to them more freely and maybe, just for me, by talking it out, I brainstorm myself to find a solution for myself. I brainstorm myself to find a way to heal myself through just like talking, and the other side just listening to it. Sometime asking questions like you're asking me, probing, sometimes just asking me so that I understand my situation more. 
 
I understand like I have choices and responsibilities going with those choices and I feel like I can help myself. I have more belief in myself through brainstorming it out with the counsellor. That, that's how I view my counselling sessions, and I think in my life I will go to counselling again, if I need to. 
 
Yeah, the last bout of counselling, that last 12 months, was all on Medicare and I think that was a great help that the Government gave some funding. If not, I wouldn't have been able to afford the whole 12 sessions without the help of Medicare. 
 
 

Kim Hai was determined to ‘fight’ her depression, but was not sure she would ever fully recover.

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And I feel like in the future, what it holds for me, I might still relax into depression but I know the way out, because I know for me counselling works. I know there are people out there, professionals as well as friends, and government agency like refuge, CAT team who could help me you know to get away from immediate danger, immediate danger from someone or from myself, if I ever feel suicidal. 
 
I am determined not to let the depression get me. That's my determination. But it doesn't mean I am sure like I will not be depressed in the future. In my view, depression is something, like a gradation, it is compounded by specific life circumstances and it is the thing like once you have it with your make-up, genetic make-up, and your life story make up, it will be like a sound wave. It will be up and down and up and down to a certain extent. 
 
It might stabilise but it might never go away. You, I don’t think I'll ever be cured of it but I feel rather safe now because I know what to do if I see the sine wave going to go up and I know how to get it down. Did that make sense?
 
 

Even though Kim Hai experienced periods of feeling better supported by a trusted counsellor, she...

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But now I feel good because I have learned to feel good - that's what I would say - through all these life experiences and counselling sessions, with support from friends and maybe spiritual beings. I have learned to feel good and allow myself to feel good to an extent that I allow myself to, and not feeling so much of the doom and gloom and wanting to go back to the bottom in order to feel safe anymore. It is very abstract, it is you know a bit complicated I think, even to me. 
 
So I don’t think I'm a person who - I'm feeling good but I'm always prepared for disaster. That's what I would say. But not in the traumatic way I used to, like, the oh, good time never last. You know, something's going to happen. This is not going to last. That's what I have always felt. But now I sort of feel good and I, I'm more rational in my feeling good or feeling sad. I still feel sad and I feel like sadness is my refuge. I don't think sadness is bad. 
 
Because I feel like sadness is healing too. If we allow ourselves to feel sad, it might heal us, and we're not afraid of being sad. I'm not afraid of being sad. It's comforting sometimes. 
 
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