While graduates struggling to find jobs are a serious problem, it's not as bad as it seems, Phillips says."Twenty years ago, only about 2 percent could get into university and anybody else ... took the exam year after year and failed. They ended up seeing their lives as failures," he says.
Phillips says his "gut sense" is that if there were an overall stress meter for all community members in each country, China's stress scores would be down over two decades.
"People in China still think that things are going to be better for their kids than for themselves. That's not true in America now," he says.
While it's not possible to prove any direct, scientific link between lower suicide rates and a community's hopefulness, "there's a whole range of issues in which the level of hope in the community has an indirect relationship to suicide," he says.
More openness about suicide also has helped, Phillips says. "Twenty years ago, it was a taboo. You couldn't write an article on it. You couldn't research it ... Just the fact of making it a legitimate topic of public discourse actually resulted in decreased rates of suicide."
The common use of very toxic pesticides to commit suicide reveals another very surprising fact about suicides in China.
When Phillips and Chinese scientists did a large study on the mental status of individuals before they attempted suicide or completed the act, their findings were met with disbelief from most Western suicide experts.
In that 1999 study, around 60 percent of those who attempted suicide and survived did not have a mental illness at the time, they found. "For those who completed suicide, we found that 30 percent did not have current mental disorders," Phillips says.
The findings were rejected initially because they didn't mesh with the majority of suicide studies - based on the 16 percent of cases worldwide that occur in high-income countries. They uniformly reported that 90 to 95 percent of those who attempt or die from suicide have a mental illness.
Moreover, in high-income countries, those who attempted suicide but were not sure they wanted to die (had a low "intent" to die) are a lot less likely die than in China because they usually used less lethal means.
"In the West, people with a low level of suicidal intent would typically take a couple of Valium, go to the emergency room, be washed out and sent home a couple of hours later," Phillips says.
Role of impulse
"You have people with very low intent (to die) who are using very lethal means. So, as a result, those who make impulsive acts of self-harm are more likely to end up dying," Phillips says.
Those who drink pesticides - unless they vomit or get to a high-level treatment center within two hours - are very likely to die. Treatment centers can't always save them.
Very severe impulsiveness can be a personality disorder. "But the people we see who have made impulsive (suicide) attempts aren't mentally ill," he observes.
Their personality does not seriously interfere with daily social activity. They have kids, go to work and people see them as normal.
White angels in Chongqing South West Hospital
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