It is nothing less than an epidemic rampaging through Taiwan. Some 5.4 million people in Taiwan – equivalent to 31.7 percent, or nearly one-third, of everyone above the age of 20 – show signs of generalized anxiety disorder (GAD), according to a survey by the Taiwan-based Chinese Holistic Health Association.

Those sharing this condition have had at least three of the following chronic symptoms (for six months or more): restlessness or impatience, fatigue, concentration difficulties, frayed emotions, muscle tension and problems falling asleep or sleeping.

Based on a 2009 survey, the Mental Health Foundation estimated that roughly 2 million people in Taiwan felt heavy stress in their daily lives, lacked warm interpersonal interaction, and were depressed to the point of having once considered suicide. The number was considerably higher than three years earlier when, based on the 2006 survey, an estimated 1.42 million people had had thoughts of taking their lives.

Urbanites today can be most accurately depicted as people with bright, even glamorous, exteriors hiding internal anxiety and even depression. Taiwanese native Hong-Chih Kuo, who overcame many obstacles to pitch for the Los Angeles Dodgers and even set a club record with an ERA of 1.27 last year, has been one of those affected by the bug. He was put on the disabled list on May 10 reportedly for an anxiety disorder, and it remains unclear when he will pitch again.

Even superstar singers Chang Hui-mei and Wakin Chau have admitted to fighting bouts of depression and panic attacks.

Psychosomatic Disorders Send Doctor Visits Soaring

The storm has ravaged all sectors of society, leaving people helpless in its wake. From 1998 to 2009, the incidence of doctor visits attributed to psychosomatic disorders (defined as any anxiety-, depression- or stress-triggered neuroses by National Taiwan University Hospital psychiatrist Shih-cheng Liao) rose fourfold, from 1,300 people per 100,000 to 5,300 people per 100,000. (See Table)

Reflecting the trend, mental health and psychiatric clinics have been sprouting up at a rapid rate, from 53 in Taiwan in 2002 to 159 as of the end of February this year.

"As society has developed, and the market has grown, psychiatric departments have also become increasingly popular," says Yang Tsung-tsair, who heads the team that compiles the Mental Health Foundation’s Mental Health Index.

The demand for psychiatric services has grown dramatically in recent years, fueled by the economic meltdown in 2008 and 2009, Yang says. Rising unemployment led to more cases of depression, and employees who were expected to carry the loads of their laid-off colleagues also found themselves under heavy stress.

The recovering economy in 2010 provided little respite for mental health workers. People found themselves busier than ever, stressed to the point that they barely had time to catch their breath, creating a new legion of anxiety sufferers lining up at psychiatrists’ doors.

"At the beginning, most of them had trouble falling asleep or sleeping well. Some had already put up with the condition for a year or two before giving in and coming for treatment," says Wan Fang Hospital psychiatrist Billy Pan. Most of his patients, he says, are in the 20-50 age bracket, but even some junior high and high school students have come to him for help.

The average age of those suffering from sleeping disorders is falling while prescriptions of sedative-hypnotic drugs have risen substantially. According to Department of Health statistics, Taiwan residents last year took 150 million pills with Zopidem, a medication used to treat insomnia, up from 130 million in 2008.

Calling In Sick

Chronic sufferers of anxiety and depression can develop autonomic dysfunction, the new "emerging epidemic" that manifests itself through many symptoms.

Ming-been Lee, a National Taiwan University Hospital psychiatrist and a 30-year veteran of the mental health field, says psychosomatic disorders have become the second most prevalent reason for employees calling in sick, trailing only the common cold.

According to statistics, 75 percent of depression sufferers said they often got headaches for no apparent reason, while 30 percent of anxiety patients said they had ringing in the ears. Respondents also cited a plethora of other symptoms, such as insomnia, dizziness, heart palpitations, chest pains, frequent urination, irregular periods, irritable bowel syndrome, and gastric reflux. All are psychosomatic disorders.

The director of National Taiwan University Hospital’s Health Management Center, Ming-Shiang Wu, found that among patients with gastrointestinal problems whose endoscopies, ultrasounds, or imaging tests all came back clean, a third to a half of their disorders could be traced to anxiety or depression.

The poor physical and mental health of Taiwanese people has begun to affect the country’s overall competitiveness. In the 2011 World Competitiveness Yearbook issued by the International Institute for Management Development (IMD), Taiwan’s overall ranking improved from 8th to 6th. In the "Health & Environment" category, however, it finished 27th among 59 countries evaluated, trailing even Hong Kong (24th), which has the reputation of being a pressure cooker.

The IMD incorporates health and the environment in its criteria primarily because of the impact unhealthy workers can have on their companies. Workers with chronic health problems have trouble reaching their potential, contribute to productivity declines, and drive companies’ costs higher through frequent absences and low efficiency. Poor health can also lead to disabilities that deprive people of their ability to work.

Overwork, Obesity on the Rise

Another way anxiety and depression undermine good health is by contributing to obesity, a condition increasingly prevalent in Taiwan. The Taiwan Medical Association for the Study of Obesity found that excessive stress results in lower serotonin levels. A rapid fall in serotonin can lead to anxiety and restlessness, and the instinctive urge to eat prompted by those conditions has exacerbated the problem of obesity among Taiwanese youth.

Association executive director Hsiao Tun-jen, an obesity specialist, describes the conditions associated with the "overworked obese." Obesity, he says, leads to high blood pressure, high blood fat and high triglycerides, which all may contribute to cardiovascular diseases. Hsiao recalled the case of a young man who went to work for an electronics company after completing his military service. After five years, he had worked his way up to a managerial position but paid a price for it, gaining 25 kilograms and developing metabolic syndrome.

"There is a very high chance you will develop cardiovascular disease in the future. At that point, you could die the moment you face acute stress," is what Hsiao said he told the patient.

The World Health Organization has estimated that by 2020, cardiovascular disease will be the top killer threatening human health, with depression second. The two may seem to be completely different ailments, but in fact they’re closely related.

Stress Not a Disease?

Why have psychosomatic disorders come to be described as an epidemic? Part of the answer can be found in the growing prevalence of stress. NTUH’s Lee believes that the occurrence of anxiety disorders or depression is related to an individual’s physical constitution, genetic makeup and personality, but over 70 percent of the time, it stems from workplace or job stress, and can be compounded by external factors or influenced by sensationalized media reporting.

"When you have this kind of illness, it’s hard. But it’s a hardship others don’t know about," said Lee, who has treated more than 10,000 patients over his career. The cause of their suffering cannot be detected through tests despite the many symptoms they manifest."This is not the type of thing that will get better with just exercise and relaxation," Lee says, stressing that such patients need the help of specialists.

Worth noting, however, is that as in South Korea and Japan, only 20 to 30 percent of people suffering psychosomatic disorders in Taiwan seek treatment, wandering from internists to cardiologists to gastroenterologists without a satisfactory response. Of those who look to doctors for help, only 30 percent seek out psychiatrists.

With stress a burden commonly borne by most people in the modern world, who among us are most vulnerable to developing psychosomatic disorders? According to Cheng Hsin General Hospital psychiatrist Yan Feng-chang, those most at risk are idealists, or people who are highly sensitive or impatient.

In addition, the prevailing values of a particular era also play an important role. "The constant obsession with accomplishing something, being apprehensive and serious" can have a big impact on individuals’ physical and mental health, Yan says, resulting in more ailing people.

Another major factor is the complexity of today’s society, and "the inability to feel warmth" constantly nibbles away at people’s hearts, says psychological counselor Wu Hau-ping. Wu has seen many patients who have sought treatment after developing anxiety or depression because of problematic interpersonal relationships.

"To them, going to work is like going to war," he says of this group of people, who have no friends and receive little support on the job. They are unable to cope with their colleagues or closely interact with them, and, as a consequence, feel isolated and without any sense of security.

Companies Start to Pay Attention

The psychosomatic disorders caused by stress and overwork have clearly emerged as one of modern society’s most terrifying enemies. One top executive of a publishing company describes a manager he worked hard to cultivate, who in his 20 years with the company has seen his weight balloon by 50 kilograms. "He clearly knows he has a problem, but he refuses to seek help from a doctor," says the executive with a trace of anxiety.

To prevent the phenomenon from getting worse, there are an increasing number of companies that have initiated "employee assistance programs" (EAPs) to take care of the mental health of their workers. They hire consulting companies or psychological counseling clinics that specialize in helping enterprises, or provide in-house psychologists, to encourage employees to get help and receive the appropriate psychological guidance

But companies must also think about reinventing their corporate culture, and treating talent as valuable "assets," argues Jui-ping Hung, an assistant professor in Chinese Culture University’s Department of Counseling Psychology. He believes that the use of consultants or psychiatric clinics to help care for employees represents an "external system" that does not address the core issue.

The real key, Hung says, is for employers to show concern for their people and change the corporate spirit and culture or introduce new measures that fit in with the existing culture. One example would be to move away from a "responsibility system," where employees work as long as they need to finish specific tasks, and to set limits on work hours, or even accept the idea of increasing manpower. Only by taking such actions can the company and its people grow together over the long haul.

Wan Fang Hospital’s Pan stresses that corporate cultures must give greater importance to the human side of things rather than invariably emphasizing the pursuit of profit and individual performance.

Patients Must Take Responsibility

Even with changes in corporate cultures, the importance of people’s attitudes toward seeking change remains paramount. The pursuit of treatment for psychosomatic disorders is growing, indicating that the attitude of Taiwanese toward the condition has become more open, and their willingness to seek help is growing. But studies reveal that 70 to 80 percent of people with psychosomatic disorders still believe they can handle the problem themselves.

Specialists in the field are no exception. One doctor said he faced such intense pressure on the job that he has suffered a spate of ailments, from diarrhea to heart palpitations and chest pain, to inflamed and puffy eyes caused by autoimmune disease. Ultimately, though, the doctor shrugged off the problems, figuring all he could do was to think positively and to take some of the issues causing his stress as challenges, seeing them as his way of serving society. "Otherwise, it would get to the point where I could barely breathe," he said.

Everybody Can Be a Gatekeeper

In facing this age of high stress, everybody can serve as a "gatekeeper." The Taiwan Suicide Prevention Center has devised an "emotional state thermometer" for people to evaluate their own mental health (BSRS-5, Brief Symptom Rating Scale) , but the gatekeeper concept is also extremely important, "because some people with psychosomatic disorders will not necessarily seek out help on their own," says NTUH's Lee, who also directs the center. Aside from testing oneself, one should also observe close friends or colleagues and follow an "ask, listen, refer" strategy.

The formula refers to voluntarily caring and listening attentively, offering support without blame, and accompanying one's friend to get medical attention if necessary.

In fact, offering encouragement, caring for others and engaging in conversations can help our own mental health. Clinical psychologist Han Der-yan often tells his patients that having conversations in which they listen to the hardships of others while conveying their own pain creates a sense of sharing each other's burdens, providing a highly effective cushioning effect.

For both the government and the private sector, psychosomatic disorders may be the biggest challenge to growth. According to WHO statistics, North America spends more than US$200 billion a year on stress-related ailments, and in the UK, the Netherlands and other countries, losses associated with stress add up to 10 percent of GDP.

And the long hours Taiwan's workers work on average (2,074 per year compared with 1,911 in the United States) puts Taiwan at even greater risk of having to absorb the hefty costs of stress.

High-energy consuming growth is bound to take a toll on the energy of the people, but to individuals and families, physical and mental health is a core value that cannot be replaced. It's a challenge modern societies, including Taiwan, can no longer ignore.

Translated from the Chinese by Luke Sabatier