When You No Longer Want to Live- US02

Health & Wellbeing · US02

Health & Wellness · Understanding Yourself

When You No Longer Want to Live

Understanding Yourself in Hard Times, Finding New Hope

Fang Tianliang

L4 English edition · Final · October 2026

This book cannot replace doctors, therapists or crisis services. If you are in danger now, please turn to the next page.

It offers health education and guidance on finding help, not professional assessment or emergency care.

If You Are in Danger Right Now, Please Read This Page First

If you are thinking about ending your life, or you are worried that you might hurt yourself soon, please don't push yourself to keep reading this book.

The most important thing right now is not to work out every problem, or to fix everything that has gone wrong in your life. It is to get yourself somewhere safe, and let someone know you need help.

Please do these three things first:

1.     Don't carry this alone. Contact someone you trust and ask them to come and be with you now. If there is no one suitable, contact emergency or crisis services directly.

2.     Make your surroundings safer. Move away from anything you could use to hurt yourself. If needed, ask someone to look after your medicines for a while. Don't drink alcohol, and don't use alcohol or drugs to numb the pain.

3.     Get professional help straight away. If you feel you might hurt yourself very soon, can't keep yourself safe, or have already hurt yourself, call emergency services or go to A&E now.

If you don't know what to say

You can send these words, exactly as they are, to a family member, a friend or a doctor:

English

I'm having thoughts of ending my life, and I'm worried I might hurt myself. I need you to stay with me now and help me get professional help.

中文

我现在有不想活的念头，担心自己可能会伤害自己。我需要你现在陪着我，帮我联系专业人员。

In the UK

•       Immediate danger: call 999, or go to a hospital emergency department (A&E).

•       You urgently need mental health help, but your life is not in immediate danger: call NHS 111. In England and Scotland, choose the mental health option (in Scotland your call goes to the NHS 24 Mental Health Hub). In Wales, choose Option 2. In Northern Ireland, call Lifeline on 0808 808 8000, free, 24 hours a day.

•       You need someone to listen: Samaritans, 116 123, free, 24 hours a day.

•       If you are under 18: Childline, 0800 1111, free, 24 hours a day, won't show on the phone bill, and you can also chat online. Please also tell an adult you trust, such as a parent or teacher.

•       You can't talk on the phone: text SHOUT to 85258 for 24-hour text support.

If English is not your first language, you can ask for an interpreter. Say "Mandarin, please" or "Cantonese, please" (or the language you need). Don't let language stop you from asking for help.

In mainland China

•       Immediate danger: call 120 for an ambulance, or 110 if someone's safety is at risk.

•       Psychological support: call 12356, the national mental health support line. Hours vary by region; most areas offer at least 18 hours a day. If you can't get through late at night and you are in danger, call 120 or 110.

•       Young people: you can also call the 12355 youth service line.

Elsewhere

Call your local emergency number, or go to the nearest hospital emergency department.

Remember: you don't need to read this whole book now. First get safe, and let one person know what is happening.

When you are safe and someone is with you, we can take our time to understand where this pain comes from, and how life can slowly begin again.

Contents

(If the contents list is empty, right-click here in Word and choose "Update Field".)

 

Preface

Some years ago I began planning a book called When Young People No Longer Want to Live. As I wrote, I realised the title was shutting out a great many people.

Among the letters and messages I received were a teenager at secondary school, a twenty-year-old overseas student and a retired man in his sixties; a young woman who had just become a mother and a middle-aged man who had spent twenty years in a restaurant kitchen. Their lives were very different, yet they had said almost exactly the same words: "I really don't want to live anymore."

Pain has no age limit. So this book has a new title: When You No Longer Want to Live.

The change is about more than a few words. It is about where I stand. Books on this subject often stand outside, analysing why "they" lose hope and telling parents and teachers how to spot the warning signs. That work matters. But this time, I want to stand beside the person who is suffering, and speak to you.

This book belongs to the "Understanding Yourself" section of our Health Garden series. Many people think health means normal blood pressure, healthy blood sugar and no aches and pains. But understanding your own emotions, temperament, pain and inner needs is just as much a part of health. A person can look after their body very well and still carry enormous pain inside, unknown to anyone, sometimes unclear even to themselves. This book is meant to help you understand that part of yourself.

I'm not going to tell you to "look on the bright side", or that "there's no hardship you can't get through". These words are easy to say, and they often leave the listener feeling more alone. What I want to do is look at a few things with you: what these thoughts are, where they come from, whether they will pass, and what you can do today, tomorrow and next month.

How to read this book

If you are in danger right now, please read only two parts: the safety page at the front, and Chapter 8, "What Should I Do First, Today?". You can also turn to the Quick Reference Guide and Danger Signs at the back at any time. The other chapters can wait until you are a little safer and have someone with you.

If you are fairly steady at the moment, you can read from the beginning. The book has five parts:

•       Part One, Understanding Your Pain: what this feeling of "not wanting to live" is.

•       Part Two, How Medicine, Old and New, Understands Suffering: from the Yellow Emperor's Classic of Medicine to modern psychology and psychiatry.

•       Part Three, Six Stories: six different situations, six ways forward.

•       Part Four, When You Already Don't Want to Live: what to do today, how to ask for help, and what Chinese and Western medicine can each offer.

•       Part Five, Understanding Yourself Again, Rebuilding Your Life.

At the end of each chapter there are three short boxes: "A Line from the Classics", "One Thing You Can Do Today" and "Understanding Yourself". They are brief. On days when long passages are too much, reading these few lines is enough.

What this book is not

This book is not a diagnostic tool, and it cannot replace doctors, therapists or crisis services. The parts about Chinese medicine use the theoretical language of a traditional system. That language can help us see how mind and body are connected, but it has not been proven by modern medicine, and it can never replace a suicide risk assessment or emergency care.

The six people and other examples in this book are fictional composites based on common situations. None of them is a real individual.

Finally, I want to say this to you, reading these lines: the fact that you picked up this book means part of you is still looking for a way through. This book is written for that part of you.

Fang Tianliang

 

Part One　Understanding Your Pain

 

Chapter 1　Why Does Life Suddenly Feel Pointless?

1. On the surface, everything is normal

Leo gets up at seven every morning, takes the Tube to work, sits in meetings, answers emails, and picks up a takeaway on the way home. His colleagues think he has become a bit quieter, but his work is fine. At weekends he rings his mother and tells her, "I'm fine, don't worry."

Nobody knows that for weeks now, every night as he lies in bed, he has been thinking: if only I didn't have to wake up tomorrow.

Many people assume that someone who wants to end their life must look desperate, cry all day and be unable to function. In reality, many people still go to work or school, cook, look after children, even joke with others. Looking "normal" is sometimes just a sign that they are used to coping alone, or too afraid of being a burden.

If this sounds like you, please know: the fact that you can still hold things together does not mean you aren't suffering, and it does not mean you don't deserve help.

2. "I don't want to live" can mean many things

The same words, "I don't want to live anymore", can carry different feelings for different people:

•       wanting to sleep and never wake up;

•       feeling like a burden, believing everyone would be better off without you;

•       wanting to disappear, to get away from everyone;

•       feeling that life has no meaning and nothing matters anymore;

•       having endured so much pain for so long that you just want it to stop.

The last of these may be the most common. Many people say, looking back: "I didn't actually want to die. I just couldn't stand hurting like that any longer."

For many people, what they want to stop is unbearable pain, not necessarily life itself. Of course, this can't tell us what any one person truly intends or how much danger they are in. But the distinction matters, because pain can be eased, while once a life has ended there is no chance for anything to change.

3. Four different levels

To understand your current state more clearly, it can help to think in terms of four broad levels. There are no sharp boundaries between them, and not everyone moves through them in order.

Level one: passing low feelings. After a setback, people feel sad and discouraged, and may briefly think "life is exhausting". These thoughts come and go quickly. After a night's sleep or a chat with someone, mood slowly returns.

Level two: lasting hopelessness. Low mood carries on day after day. Nothing seems interesting, the future looks bleak and you feel worthless. You haven't thought specifically about ending your life, but everything has turned grey.

Level three: recurring thoughts of suicide. Thoughts about death come more and more often. They take up a lot of your attention and affect your sleep, eating and contact with others.

Level four: real danger. You have started thinking about how you would do it, or you feel you might lose control and hurt yourself soon.

Whether or not you can tell which level you are at, if you are having thoughts of suicide or are worried about your safety, please don't wait to finish this chapter. Turn to the safety page and Chapter 8 first.

One more thing: not having a specific plan does not mean you are not in danger. If you feel you might hurt yourself soon, that alone is reason enough to get help immediately.

4. Mixed feelings are normal

Many people in pain hear two voices at once. One says, "I'm too tired, let's end it." The other says, "But maybe there's another way."

This conflict can be confusing, even shameful: "I can't even be sure I want to die."

In fact, this ambivalence shows that part of you still has the strength to want to live. You, reading these words right now, are that "maybe there's another way" voice at work.

This book is here to stand with that voice.

5. Thoughts rise and fall, like the tide

Suicidal thoughts are rarely constant. They may be strongest late at night and weaker in the daytime. A message or an argument can bring them flooding in, and a few hours later they may slowly recede.

Crisis workers often use the image of a tide, with high water and low water. The most dangerous time is often when the tide is highest. And at that time, our judgement about the future is at its least reliable.

So when the thoughts are especially strong, you don't need to make any decisions. You only need to find a way to get through that stretch safely: contact someone, leave the place where you are alone, and move away from anything you could use to hurt yourself. When the tide goes out, you will have more strength to think.

6. You are not the only one

One of the most common feelings for people in this kind of pain is: I'm the only one like this, everyone else is fine.

In fact, far more people have had suicidal thoughts than we imagine. They may be your colleagues, classmates, neighbours, even the person you would least expect. But nobody talks about it, so everyone thinks they are the only one.

The reason people stay silent is often shame: a sense that these thoughts mean they are weak, a failure, even "abnormal". In Chinese culture, the phrase for losing hope, xiang bu kai ("unable to think it through"), often carries a note of blame, as if it were the person's own fault.

I'd like you to look at it differently. When a person begins to think they don't want to live, it usually means they are carrying more pain than they can bear right now. It is not a question of character, but a sign that the load is too heavy. When a rope is about to snap, it isn't because the rope is bad; it's because too much is hanging from it.

Admitting that you have had these thoughts is nothing to be ashamed of. It is part of understanding yourself, and the beginning of looking after yourself.

7. What this chapter wants to tell you

This chapter hasn't given you many solutions, because the first step is not solving problems but seeing your state clearly. Let's review:

•       Looking normal does not mean you aren't suffering.

•       For many people, what they want to end is pain, not life.

•       These thoughts come at different levels; having no plan does not mean there is no danger.

•       It is normal to hear both the voice that wants to live and the one that doesn't.

•       The thoughts rise and fall; when they are strongest, don't make decisions, get safe first.

In the next two chapters, we'll look at what pushes people to this point, and why people in pain find it harder and harder to see hope.

A Line from the Classics

"In those who are sorrowful and anxious, the qi is blocked and does not flow." (Lingshu, "The Root of the Spirit")

In plain words: when worry and sorrow last a long time, it is as if the body's energy is jammed. The ancient physicians noticed that long sorrow seems to "stifle" the whole person. In today's language, emotions held inside too long weigh down both body and mind.

One Thing You Can Do Today

In your head or on paper, describe how you feel right now in one sentence: "Right now I feel…". No need to explain why, no need to draw conclusions. Just say it.

Understanding Yourself

At this moment, is it my life I most want to end, or a particular kind of pain? If that pain eased a little, what would be different for me?

 

Chapter 2　What Has Pushed Me Towards Despair?

1. It is rarely just one thing

People often ask, "What on earth happened to make him lose hope?", as if there must be one big enough event to explain someone's despair.

Real life is seldom that simple. More often, pressures pile up layer upon layer: problems at work, poor health, conflict at home, sleepless nights, and nobody to talk to. Then one day something that looks small, a word of criticism or a cold reply, becomes the last straw.

So if you can't explain "why this is happening", there is no need to be confused by that. Despair is often the result of accumulation, not of a single cause.

2. Common heavy blows

Even so, some experiences are especially likely to push people towards the edge:

•       Losing an important relationship: a break-up, divorce, the death of someone close, or a rift with family.

•       Losing work or income: redundancy, a failed business, debts that seem impossible to repay.

•       Blows to health: a serious diagnosis, long-term pain, a chronic illness that keeps flaring up, losing mobility.

•       Losing identity and a sense of worth: retirement, failing exams or a university place, career setbacks, public humiliation.

•       Living with ongoing harm: domestic abuse, bullying, isolation, discrimination.

•       Past trauma: neglect or abuse in childhood, or surviving a serious disaster or act of violence.

What these experiences have in common is that they take away something that used to hold a person up: a person, an income, a healthy body, an identity, or a sense of safety.

3. Why the same event affects people so differently

Two people lose their jobs at the same time. One soon picks himself up and looks for new work; the other sinks into deep despair. That doesn't mean the second person is "weak".

How much an event affects someone depends on many things:

•       Past experience. Someone who was often put down as a child is more likely to think, when they fail, "I knew it, I'm useless."

•       Whether there is support. Having someone to talk to and help think things through is completely different from facing it alone.

•       Your current state of mind and body. Long-term insomnia, physical pain, or another recent blow all make new pressure harder to bear.

•       What the event means to you. For someone whose whole sense of worth comes from work, losing a job is not just losing income; it can feel like losing themselves.

So please don't compare yourself with others: "Other people have been through worse and they're fine, why am I like this?" There is no standard answer to pain. Your feelings are your feelings.

4. Far from home

Many readers of this book live outside the country where they grew up. They face particular pressures that are often overlooked.

Language. In a foreign country, even seeing a doctor or calling a helpline can be stressful. Explaining the pain inside is harder still.

Loneliness. Family and friends are thousands of miles away, and time differences mean even a phone call needs planning. There may be colleagues and classmates around, but nobody to really talk to.

"Share the good news, hide the bad." Before leaving home, the family may have had high hopes or made great sacrifices. So on the phone you only say "everything's fine", and carry the real difficulties alone.

Uncertainty about status and money. Visas, work permits, rent, tuition fees: these pressures hum in the background all the time.

Not knowing where help is. Not knowing what a GP is, not knowing that mental health problems can be taken to a doctor, not knowing there are free helplines.

If this is you, please remember: your difficulties are not because you haven't tried hard enough. They are because you are facing many things that most people never have to face at the same time. All of this can be talked about, and there are people who can help.

5. Don't blame despair on a single cause

People sometimes reduce someone's pain to one thing: "it's just a break-up", "it's just depression", "they just can't let go", "it's just a bad attitude". These explanations sound simple and clear, but they often leave people more isolated.

What is usually true is that life's blows, physical health, patterns of thinking and the support around us are all woven together. Seeing this helps in two ways.

First, you no longer need to blame yourself: "It's all my fault, I'm too fragile."

Second, you will find there is more than one place where change is possible. Perhaps the blow itself can't be undone, but sleep can improve, support can grow, the way you see yourself can slowly shift, and professional treatment can ease symptoms. Each small change can loosen the whole situation a little.

6. Keep a "stress ledger"

Anyone who runs a business knows the value of keeping accounts: what comes in, what goes out, what's left. Our inner strength works a little like a ledger too.

Outgoings are the things that drain you: work pressure, debt, illness, arguments, loneliness, insomnia, old wounds.

Income is whatever replenishes you: someone to talk to, a peaceful meal, a good night's sleep, something that absorbs your attention, a little recognition.

When outgoings exceed income for a long time, the account goes overdrawn. Overdrawn far enough, a person feels "I can't go on."

Seen this way, despair is no longer an unexplained black hole but a ledger that can slowly be sorted out:

•       Which outgoings could be reduced a little? Perhaps handing a task to someone else, turning down an unnecessary commitment, or asking a doctor for help with insomnia.

•       Which sources of income could be increased a little? Perhaps meeting a friend once a week, or getting ten minutes of daylight every day.

•       Which outgoings can't be reduced for now? Those are the ones where you most need others to share the load.

You don't need to balance the books all at once. When you feel a little better, take a sheet of paper and write "what drains me" on the left and "what holds me up" on the right. Just writing it down, many people realise: no wonder I'm so tired, look how much I've been carrying.

A Line from the Classics

"Those once honoured and later brought low may fall ill from within even without external harm; this is called 'loss of nourishment'. Those once wealthy and later poor suffer 'loss of essence'." (Suwen, "On the Five Errors")

In plain words: more than two thousand years ago, physicians already saw that a great fall in a person's circumstances can harm body and mind on its own.

One Thing You Can Do Today

On a piece of paper, write down the things that have been weighing on you lately, large or small, one per line. Once written down, they are no longer just a tangled mess.

Understanding Yourself

Of all these things, which one hurts most? What has it taken from me: a person, a sense of safety, or a certain view of myself?

 

Chapter 3　Why Can I See Less and Less Hope?

1. Tunnel vision

Imagine walking into a long tunnel. The further you go, the darker it gets. You can no longer make out what is around you; you can only see a narrow path ahead.

Psychologists use the term "tunnel vision" for the way people think when they are in extreme pain. Normally, when we face a problem, we can think of several options: talking it through with someone, trying a different approach, waiting a while. But when pain reaches its peak, the mind seems to leave only one road open. Every other possibility disappears.

That is not because you aren't clever, nor because there really is no other way. Pain itself narrows our field of vision. It is a common psychological effect of intense stress.

2. Feelings that pull people deeper

Researchers who study suicide have found that certain feelings are especially likely to push people towards despair. Recognising them can help you tell the difference between your situation and the way your feelings are magnifying it.

Feeling trapped. Believing you are stuck in a situation with no escape, no matter how hard you try.

Helplessness. Believing nothing you do makes any difference.

Feeling like a burden. Believing family and friends would be better off without you. This thought is very common and very deceptive. In fact, it is usually a judgement made in pain, not a true assessment of your worth by others. You deserve support.

Disconnection. Feeling that nobody truly understands you and that you don't belong anywhere.

Rumination. The same thoughts going round and round: "Why am I such a failure?", "If only I had…". The more you think, the deeper you get stuck.

If you recognise yourself in these descriptions, please know: these feelings are real, but they don't necessarily reflect the real world. They are more like a pair of grey-tinted glasses that make everything look hopeless.

3. "I'm useless": the cycle of self-criticism

People in pain are often extremely hard on themselves. One failure becomes "I can't do anything right"; one person's coldness becomes "nobody cares about me"; one relationship ending becomes "I don't deserve to be loved".

Psychologists call these patterns "overgeneralisation" and "catastrophising". They form a cycle: the worse you feel, the more you expect the worst; the more you expect the worst, the worse you feel.

The first step in breaking the cycle is not forcing yourself to "think positive", but learning to notice it: "Ah, I'm turning one thing into everything again." Simply noticing wipes a small clear streak across those grey glasses.

4. The body amplifies despair

People often think of despair purely as a psychological problem and overlook the role of the body.

Long-term insomnia. People who sleep badly find it much harder to manage their emotions. Many feel life becoming more and more unbearable after weeks of poor sleep. Improving sleep can sometimes make a marked difference.

Alcohol. Many people drink to drown their sorrows. Alcohol may numb you briefly, but it deepens low mood and weakens judgement and self-control. For someone already having suicidal thoughts, drinking significantly increases the danger.

Pain and chronic illness. Long-term pain wears down a person's strength until they think, "What's the point of living like this?"

Hormonal change. After childbirth and during the menopause, big hormonal shifts can leave emotions especially fragile.

So looking after your body is no small thing. It can't solve despair on its own, but it can give you a little more strength to face it.

5. Despair is a state, not a prophecy

What this chapter most wants to tell you is this: the hopelessness you feel now is your present state of mind, not an accurate forecast of your future.

In a tunnel, not being able to see the exit doesn't mean there isn't one. Many people who were once deep in despair say, looking back: "At the time I truly believed it was all over. But then, slowly, things changed." The changes weren't necessarily miracles. Sometimes it was finding the right doctor, sometimes a friend appearing at the right moment, sometimes time letting the wound slowly heal over.

I'm not asking you to believe right now that the future will be better. I'm only asking that, before you reach any conclusion, you give yourself some time, and give others a chance to help you.

6. Opening a window in the tunnel

In a tunnel, what you need most is a little light. That light often comes from outside.

From another person. Others can sometimes see a way out that we can't. Not because they are cleverer, but because they are not in your tunnel. A friend's words or a doctor's suggestion may show you options you couldn't see.

From time. Many situations that seem hopeless in the moment look different after a while. Not because the problem has vanished, but because you have more strength and more information. So when pain is at its worst, "not deciding yet" is itself a very important choice.

From the body. Sleeping, eating a meal or going for a walk can sometimes lower the intensity of despair. That isn't to say food and sleep solve the problem, but when the body is a little calmer, the mind has more room to see possibilities.

From professional help. Psychological therapy can help widen a narrowed field of vision bit by bit; for some people, medication can ease the symptoms that drag them into despair. These forms of help are like opening a window in the tunnel wall.

You don't have to grope for the exit alone in the dark. It is absolutely fine to let others help you open a window.

A Line from the Classics

"Excessive brooding knots the qi." (Suwen, "On Pain")

In plain words: going over the same thing again and again leaves body and mind "tied in knots". This has something in common with what modern psychology calls rumination.

One Thing You Can Do Today

When you catch yourself thinking "I'm useless", try adding: "This is how I feel right now. It isn't necessarily a fact."

Understanding Yourself

In the way I judge myself and my future, what is fact, and what might be coming from those "grey glasses"?

 

Part Two　How Medicine, Old and New, Understands Suffering

 

Chapter 4　How Does the Yellow Emperor's Classic Understand Sorrow and Despair?

1. Physicians two thousand years ago cared about the heart and mind too

The Yellow Emperor's Classic of Medicine (Huangdi Neijing) was compiled more than two thousand years ago and is one of the most important texts in Chinese medicine. Many people think it deals only with meridians, organs, acupuncture and herbs, but large parts of it discuss emotions, the mind, and how life circumstances affect health.

Before we begin, I want to be clear: this chapter describes the theoretical language of Chinese medicine. Concepts such as qi, shen (spirit or mind) and the "five organs" are a traditional way of describing the body and life. They do not correspond one-to-one with the organs of modern anatomy, and they have not been proven by modern science. The two theoretical languages deserve mutual respect, but whether a diagnosis is accurate, whether a treatment works and whether it causes harm should all be tested by research.

More importantly: traditional ideas about emotions can help us understand how mind and body are connected, but they cannot replace modern suicide risk assessment and crisis care. If you are in danger now, please seek help first and read this chapter later.

2. "All illness arises from the qi"

The chapter "On Pain" in the Suwen contains a famous passage:

"I know that all illness arises from the qi. Anger makes qi rise; joy makes qi slacken; sorrow makes qi dissipate; fear makes qi sink; cold makes qi contract; heat makes qi leak; fright makes qi chaotic; overwork makes qi drain; brooding makes qi knot."

The idea is that many illnesses are linked to changes in qi. Strong emotions change the state of the whole person. We have all felt this. In deep grief, the body feels weak, as though emptied out, which is just what "sorrow makes qi dissipate" describes. With long-lasting anxiety, the chest feels tight and appetite disappears, as though something is blocking the way, close to the description "brooding makes qi knot".

This observation that emotions affect the body has much in common with modern research into stress, emotion and physical health.

3. Shen: the master of the mind

The chapter "The Root of the Spirit" in the Lingshu discusses mental activity. One passage describes the path from perceiving to reasoning:

"That which takes in things is called the heart-mind; what the heart-mind recalls is called intention; what intention holds onto is called will; reflecting and adjusting on the basis of will is called thought; thought that reaches into the distance is called deliberation; acting on deliberation is called wisdom."

To the ancient physicians, mental activity was a complete process. When emotions became excessive, that process was disrupted. The same chapter says:

"In joy and pleasure, the spirit scatters and is not stored; in sorrow and anxiety, the qi is blocked and does not flow; in great anger, one is confused and cannot govern oneself; in fear and dread, the spirit is shaken and cannot be gathered."

Long sorrow blocks the qi; extreme anger leaves people confused and unable to think straight; deep fear unsettles the mind. These descriptions are somewhat similar to the "tunnel vision" we discussed in Chapter 3: under strong emotion, thinking and judgement are affected.

4. A fall in circumstances can make people ill

The chapter "On the Five Errors" in the Suwen is addressed to physicians and describes five mistakes they commonly make. It specifically reminds them to understand the patient's circumstances:

"Those once honoured and later brought low may fall ill from within even without external harm; this is called 'loss of nourishment'. Those once wealthy and later poor suffer 'loss of essence'."

More than two thousand years ago, this passage pointed to something that still matters today: a person's situation is itself part of their health. Unemployment, bankruptcy and loss of social standing are not just a matter of "failing to let go". They do real harm to body and mind.

The same chapter tells physicians to ask about the patient's diet, daily life, emotional changes and circumstances, not just to look at the pulse and symptoms. This concern with the whole person is still worth learning from.

5. "Keep the spirit within, and where can illness come from?"

The chapter "On the Natural Truth of Ancient Times" in the Suwen contains an often-quoted line:

"Be calm and free of excess desire, and the true qi will follow; keep the spirit within, and where can illness come from?"

This means: when the mind is settled and not troubled by too many desires and distractions, the body's healthy energy flows smoothly; when the spirit is held within rather than scattered, where can illness come from?

The line is often read as an ideal of healthy living. It reminds us that too much striving, too much comparison and too much worry wear down the spirit.

But I want to be very clear: for someone in despair, calm detachment is not something they can achieve on demand. You cannot tell a person in so much pain that they don't want to live to "let go of everything". It will only make them feel they have failed once again.

This line is better seen as a long-term direction. Once the crisis has passed, support is in place and treatment is underway, you can gradually learn ways to settle the mind.

6. Ancient wisdom and today's limits

Reading the Neijing, I often marvel at how carefully the ancients observed. They saw long ago that emotions affect the body, that life circumstances can make people ill, and that physicians must care about the patient's whole life, not just their symptoms.

But we must also be clear about the limits of ancient theory:

•       The ancients had no knowledge of conditions such as depression or bipolar disorder as we understand them today, and no medicines or psychological therapies tested by research.

•       "Pattern differentiation" in Chinese medicine is a traditional way of grouping symptoms. It cannot replace a modern psychiatric assessment, and it certainly cannot be used to judge whether someone is at risk of suicide.

•       Understanding your pain as "stagnant qi" or "an unsettled spirit" can help you see that mind and body are connected. But if that leads you to take only herbal medicine and avoid seeing a doctor, you may miss treatment you need.

The two systems each have their strengths. The best approach is to let each play its part, not to let one replace the other.

A Line from the Classics

"Be calm and free of excess desire, and the true qi will follow; keep the spirit within, and where can illness come from?" (Suwen, "On the Natural Truth of Ancient Times")

In plain words: a settled mind lets the body's healthy energy flow; a spirit held within makes illness less likely. This is a long-term direction, not a demand on someone in crisis.

One Thing You Can Do Today

Notice your body: is there anywhere in your chest, shoulders or stomach that feels tight or heavy right now? You don't need to change anything; just know it is there.

Understanding Yourself

What does my pain look like in my body? Weakness, a heavy chest, sleeplessness, or something else?

 

Chapter 5　How Can Traditional Culture Help Us Face Setbacks?

1. The ancients also reached dead ends

Many of the figures we admire in Chinese history went through times of terrible hardship.

The historian Sima Qian was castrated as punishment. In his Letter to Ren An he wrote of his humiliation and pain, saying he chose to endure and live because his great history, the Records of the Grand Historian, was not yet finished. The poet Su Shi was imprisoned and nearly executed over a few poems, then exiled to Huangzhou in poverty. The poet Du Fu spent his last years wandering, poor and ill.

Their lives show us that pain and despair are not peculiar to modern people, nor only to those who "aren't strong enough". Even the most talented and cultivated people can reach a point where they see no way forward.

But this chapter is not here to say, "Look, people in the past suffered more than you, and they all got through." Comparisons like that mean nothing and can make people blame themselves even more. What I want to do is find some wisdom in tradition that we can borrow, while being honest about its limits.

This chapter looks at how Buddhism, Confucianism and Daoism view life and suffering. These traditions take a clear position on life: it is precious and should not be given up lightly. I will describe their views faithfully, but first I want to say one thing plainly: they can be reasons to treasure your life, but they should never be used to blame you. If you are having thoughts of suicide right now, you are not a "sinful" person, nor someone who has "let your parents down". You are a person carrying enormous pain who needs help.

2. Buddhism: not taking life, and the rarity of human birth

Buddhism places great value on life. The first of the Five Precepts is not to take life. On suicide, the main position of the Buddhist tradition is that ending one's life is not the way to escape suffering. We should not only avoid harming others, but also cherish our own lives. "Not taking life" is both a precept and an expression of respect for life itself.

Why does Buddhism value human life so highly? One important idea is that a human birth is rare and precious.

Buddhist scriptures use the image of the blind turtle and the floating yoke: on a vast ocean floats a piece of wood with a single hole; a blind turtle rises to the surface only now and then, and happens to put its head through the hole. How rare that chance is! The image is not meant to frighten, but to remind us: since we have been given life, we should treasure it.

Buddhism also teaches cause and effect, and rebirth. Within this faith tradition, life's good and bad fortune are linked to many causes and conditions, and ending one's life does not mean that unfinished conditions and responsibilities simply disappear. A human life is also a chance to practise, to do good, to repay kindness and to change oneself. So when life is hard, Buddhism encourages people to face it and treasure their lives, rather than seek release through suicide.

Some people understand life's hardships as a kind of training; others understand their suffering in terms of "repaying debts" or "working off karma". This religious language can carry spiritual meaning for believers, but it cannot prove why a particular person is ill or has suffered a blow, and it certainly cannot be used to conclude that someone who suffers must have done something wrong.

From Buddhism's respect for life, it follows that we should care all the more for people in despair: helping them stay alive, easing their pain, and giving them the chance to go on living and practising.

If you are carrying unbearable pain and have no strength right now to think about karma, practice or the meaning of life, you don't have to force yourself. Reaching out to family, friends and professionals, and getting safety and care, is itself a practical way of treasuring life.

Buddhism speaks of precepts, and it also speaks of compassion. Telling someone in pain that life is precious should never turn into blame or threats. Helping them feel care and hope again matters far more than arguing about whether they have done wrong.

Religious ideas cannot replace a medical assessment, and nobody in crisis should be expected to overcome severe psychological pain through belief alone. Spiritual support and medical help can go together.

What I hope readers take from the Buddhist view of life is this: a human life is rare, and it deserves to be treasured. Even if today is full of difficulty, you can protect yourself first, accept help, and leave room for the future to change.

3. Confucianism: our bodies come from our parents, and caring for ourselves is where filial piety begins

Confucian thought places great weight on relationships: parents and children, spouses, friends, teachers and students, neighbours. A person is not an isolated individual but part of a web of relationships.

On the subject of life, the best-known Confucian words come from the opening chapter of the Classic of Filial Piety (Xiaojing):

"Our body, hair and skin are received from our parents; we dare not harm them. This is where filial piety begins."

The Book of Rites (Liji, "The Meaning of Sacrifices") says something similar: "Our parents gave us life whole; to return it whole may be called filial." Our parents handed us a complete life, and looking after it well is a form of filial love.

For Confucians, caring for your own body is not only a private matter; it is also a way of repaying your parents. A person's life is bound up with parents, children, brothers and sisters, and friends. This has a warm side. When someone feels worthless, thinking of the people who care about them, and of the place they hold in other people's lives, can sometimes bring a little strength.

Confucius said: "Virtue is never alone; it always has neighbours." A person of good character will not be lonely; there will always be like-minded people nearby.

But Confucian ideas can also be turned into pressure. Filial piety can sometimes make people feel: I've let my parents down, I don't deserve to live. Expectations to "bring honour to the family" can make failure feel especially heavy.

So I'd like to read the Xiaojing passage from another angle. "We dare not harm them" is about cherishing and looking after ourselves. Looking after yourself includes eating, sleeping and seeing a doctor. It also includes telling your family when you can't cope, and letting them look after you.

Filial piety does not mean suffering silently alone, nor proving yourself through success. What matters most to your parents is not your exam results or your income, but that you are still here.

A brief note: the line in the Analects, "While your parents are alive, do not travel far; if you must travel, let them know where you are going", is about children letting their parents know where they are. It does not forbid leaving home. For readers living abroad, it can be read in a new way: however far you are from home, let your family know where you are and how you are doing, including when you are not doing well.

4. Daoism: going with change, accepting impermanence

Daoist thought emphasises following nature and accepting change. Laozi said: "Misfortune is what good fortune leans on; good fortune is where misfortune hides." Things are always changing; today's situation is not forever.

The Huainanzi tells a well-known story. An old man living on the frontier lost his horse. When his neighbours came to comfort him, he said it might not be a bad thing. Later the horse returned, bringing a fine horse with it. When the neighbours came to congratulate him, he said it might not be a good thing. This is the origin of the Chinese saying "The old man at the frontier lost his horse", and it reflects the Daoist attitude to change.

This way of thinking reminds us that the despair of the moment is not the final outcome. Circumstances change, moods change, and people change.

However, the Daoist idea of "letting things take their course" is sometimes misread as "do nothing, let it all go". For someone in crisis, that is dangerous. Going with change does not mean giving up on seeking help.

5. Does suffering have meaning? Several different understandings

When we suffer, we often ask: why me? What is the point of this pain?

Different traditions give different answers.

Tradition	Typical understanding of suffering	What it can offer readers today
Buddhism	Suffering, impermanence, causes and conditions, karma and practice	Circumstances change; good actions and choices now can change the future
Confucianism	Self-cultivation, responsibility and self-improvement through adversity	One failure does not cancel a whole life
Daoism	Gain and loss depend on each other; going with change; letting go of attachment	Sometimes the answer is to change the goal, not keep forcing yourself
Christianity	Suffering, faith, hope, bearing one another's burdens	In hard times you can seek support; you don't have to carry it alone
Modern medicine	Biological, psychological and social factors working together	Pain can be assessed and treated, and eased by practical support

These understandings don't necessarily exclude each other. A person can hold a religious faith and also have psychological therapy; can draw strength from Confucian responsibility and still allow themselves rest.

Many Chinese readers know this passage from Mencius ("Gaozi II"):

"When Heaven is about to give a great task to someone, it first makes their heart suffer, wearies their sinews and bones, starves their body, leaves them in want, and frustrates whatever they do, so as to stir their mind, toughen their nature and add to what they could not do before."

These words have encouraged countless people in adversity. Many, looking back, do find that their hardest days made them stronger and more understanding of others.

But I also want to say: not all suffering has a set purpose, and nobody has to prove themselves through endurance. Some hardships don't call for "putting up with it a bit longer", but for changing your situation, seeking protection or getting treatment. Someone living with domestic abuse needs safety; someone with depression needs treatment; someone crushed by debt needs practical help. None of these is a matter of "not being strong enough".

Hardship can help people grow, but growth doesn't have to mean carrying everything alone.

6. Stepping back is not giving up; it leaves more choices open

There is a Chinese saying: "Take one step back, and the sea and sky open wide."

When young, we may take it to mean giving way to others. With more experience, we find a deeper meaning: when one road is blocked, there is no need to stake your whole life on that road.

Many people fall into despair not entirely because life has run out of options, but because, without realising it, they have trapped themselves in a standard that allows only success and never failure:

•       not getting into the university you wanted, and feeling your life is a failure;

•       losing money in business, and feeling you can't face your family;

•       a marriage ending, and feeling you don't deserve to be loved;

•       no longer earning after retirement, and feeling you have lost your worth.

Someone who doesn't get into their chosen university can choose another course, another university or another career. One exam does not decide a whole life.

Someone who has worked hard at a business and lost money will naturally be hurt, and may need a long time to deal with the debts. But a failed business does not mean a worthless person. Protecting your health, getting proper debt advice and rearranging your life may matter more than keeping things at their old scale.

Someone who once earned a high income, and whose income has fallen because of illness, retirement or the economy, need not keep measuring themselves against the old standard.

People have different bodies, abilities, family circumstances and stages of life. A life that suits someone else may not suit you; goals that suited you when you were young may not suit you today.

Chapter 44 of the Daodejing asks:

"Your name or your life: which is dearer? Your life or your wealth: which is worth more?"

Laozi goes on: "Knowing contentment, you avoid disgrace; knowing when to stop, you avoid danger; and so you can endure."

When reputation, wealth and career come into conflict with health, do we have the courage to rethink what matters most?

Sometimes what we need is not to try harder, but to ask less of ourselves. The home can be smaller, life can be simpler, work can be lighter, goals can be lower. Things we once thought we could never give up may, a few years later, seem much less important.

Of course, lowering your expectations cannot instantly remove depression, trauma or severe despair. If you are having suicidal thoughts, you still need to get help promptly. But once you are safe and supported and begin to rebuild your life, learning to adjust your goals to your body, abilities and circumstances is very important. Chapter 12 offers some practical ways to do this.

Stepping back doesn't mean all your past efforts were wasted. Stepping back lets you see other roads that were hidden before.

We can give up a goal, change the way we live, and admit we need help, without giving up on life itself.

7. Su Shi: "a straw cape in the misty rain, my whole life long"

I particularly want to tell you about Su Shi.

In 1079, Su Shi, then in his forties, was falsely accused over a few poems and held in prison for more than a hundred days. At one point he believed he would be executed and wrote farewell poems to his brother. After his release he was banished to Huangzhou as a minor official with no real power, living on a stretch of land on the city's eastern slope. He took the name "Dongpo Jushi", the Recluse of the Eastern Slope.

In Huangzhou he cleared land and farmed, made friends with farmers and fishermen, experimented with cooking, and wrote some of his most famous works, including the Red Cliff rhapsodies and the poem "Calming the Waves" (Ding Feng Bo). In that poem he wrote:

"Looking back at the bleak place I came through, I head home; for me now there is neither wind and rain nor clear sky."

Many readers see Su Shi's broad-mindedness in this poem. But I want to point out that his calm did not arrive on the day he left prison. He went through a long period of low spirits and loneliness in Huangzhou, and he also had letters from friends, acceptance from local farmers and the company of his family. His serenity grew slowly, over time and within relationships.

So if you can't be serene right now, that is completely normal. Serenity is not where you start. It is what you look like after walking a stretch of the road.

8. When traditional wisdom is misused

Traditional culture holds much of value, but some sayings, once simplified and misused, can hurt people who are suffering.

"Just look on the bright side." Usually meant kindly, this ignores the fact that the other person simply can't right now. If they could, they would have already.

"Family shame should not be aired outside." This idea leads many people to keep their pain at home, unwilling to seek outside help or even see a doctor. But mental health problems are not "family shame". Like physical illness, they need professional help.

"A real man doesn't cry easily." Many men are taught from childhood not to show weakness or cry. So the more they hurt, the quieter they become. Research and experience both suggest men are often less likely to seek help. Showing vulnerability is not weakness; admitting you need help takes great courage.

"Self-cultivation will overcome it." Cultivation is valuable, but it cannot replace professional help in a crisis. You cannot ask someone who is drowning to learn to swim first.

"How could you do this to your parents?" People who say this may be trying to remind the other person how precious their life is. But to someone who already feels like a burden, it usually only deepens the guilt. A better thing to say is: "You matter so much to us. We want to be with you through this."

"This is the karma from your past life." Karma is a Buddhist belief, but using it to explain why a particular person is suffering does not fit Buddhism's complex understanding of causes and conditions, and it makes people blame themselves more and seek help less.

"Only by enduring the bitterest hardship can you rise above others." Hardship can sometimes help people grow, but it should never be a reason to refuse rest, treatment or help.

9. How to use traditional wisdom

My suggestion is to treat traditional wisdom as long-term nourishment, not as emergency medicine.

In a crisis, what you need is safety, company and professional help.

After the crisis, on the slow road to recovery, traditional ideas about gain and loss, change, relationships and cultivation can help you understand yourself and your life anew. They might be a line that moves you, a poem read late at night, or a story that makes you think, "So people long ago felt this too."

A Line from the Classics

"Your name or your life: which is dearer? Your life or your wealth: which is worth more? … Knowing contentment, you avoid disgrace; knowing when to stop, you avoid danger; and so you can endure." (Daodejing, Chapter 44)

In plain words: reputation, wealth or life itself, which deserves to be treasured most? Knowing contentment and knowing when to stop is what lets a life endure.

One Thing You Can Do Today

When you are safe and feeling relatively steady, write down the three things you are demanding most of yourself right now. Ask: could any of them be lowered, postponed, or shared with someone else?

Understanding Yourself

If I stopped measuring myself by income, job title, exam results or other people's opinions, what would I still value in myself?

 

Chapter 6　How Does Modern Medicine Explain Despair and Suicidal Thoughts?

1. It is not only bodies that fall ill

If someone breaks a leg, everyone knows they need hospital. If someone has a high fever, everyone knows to see a doctor. But when someone has been low for a long time, can't sleep at night and feels life is pointless, many people don't realise this too may be a health problem that needs treatment.

Modern medicine understands our emotions and thinking as closely linked to how the brain works, the state of the body and our living environment. Suicidal thoughts are often connected with health problems that can be treated. Knowing about these problems is not about labelling yourself. It is about knowing that some pain can be eased considerably with treatment.

2. Health problems that may be involved

Depression. This is one of the conditions most closely linked with suicidal thoughts. It is not just "feeling down", but persistent low mood and loss of interest in things you used to enjoy, often with sleeping too little or too much, changes in appetite, tiredness, difficulty concentrating, feelings of worthlessness and recurring thoughts of death.

Bipolar disorder. Mood swings between lows and unusual highs. During depressive phases people may suffer greatly, and the risk may also rise during transitions between moods.

Anxiety disorders. Long-term tension, worry and panic drain a person's strength, and often occur together with depression.

Post-traumatic stress disorder (PTSD). People who have lived through serious trauma may be repeatedly invaded by painful memories, struggle to sleep and stay constantly on alert.

Alcohol and drug use problems. These deepen depression and weaken judgement and self-control.

Long-term pain and chronic illness. Cancer, chronic pain, neurological conditions and others can leave people exhausted in body and mind.

Sleep disorders. Long-term insomnia in itself has a strong effect on mood.

Emotional problems after childbirth and during the menopause. Hormonal change on top of major life change can trigger serious emotional distress. Postnatal depression is not rare, and it does not mean someone is "a bad mother".

3. Biological, psychological and social factors interweave

Modern medicine often uses a "biopsychosocial" framework to understand these problems.

Biological factors: genetics, changes in brain chemistry and function, hormones, physical illness, and the effects of medicines and alcohol.

Psychological factors: ways of thinking, personality, past experiences and trauma, ways of coping with stress.

Social factors: relationships, finances, work, cultural background, social support, and whether someone faces discrimination or isolation.

These three are not separate; they influence one another. For example, losing a job (social) brings money worries, leading to long-term insomnia (biological). Insomnia makes it easier to fall into negative thinking (psychological), and negative thinking makes the person withdraw and stop seeing friends (social)…

Understanding this interweaving helps us see that treatment and support can also come from several directions.

4. Suicidal thoughts can occur without a diagnosis

It is important to say: not everyone who has suicidal thoughts has a diagnosable mental illness.

Some people, after a sudden heavy blow such as a loved one's unexpected death, huge debts or severe humiliation, may fall into extreme pain within a short time and begin to have suicidal thoughts. They may never have had any mental health problems before.

So we cannot simply say "everyone who is suicidal has depression", nor should anyone think "I don't have depression, so my thoughts don't need attention". With or without a diagnosis, suicidal thoughts always deserve to be taken seriously, and help is always available.

5. Why danger can't be judged by a questionnaire alone

There are many "depression self-tests" and "psychological quizzes" online. They can help people get an initial sense of how they are doing, but they have an important limitation: suicide risk cannot be judged by a single questionnaire or a few questions.

The UK's National Institute for Health and Care Excellence (NICE) also advises that risk assessment tools and scales should not be used on their own to predict who will or won't go on to harm themselves, and that assessment should focus on each person's particular situation and needs (NICE guideline NG225, recommendations 1.6.1–1.6.6).

A person's level of danger can change very quickly. A low score today doesn't mean you will be safe tomorrow. When professionals assess you, they will talk with you in detail about your thoughts, experiences, situation and support, not just look at a score.

For you, the most important test is simple: if you feel you might hurt yourself, you need help. You don't need to wait for a certain score or diagnosis to be entitled to ask.

6. When to seek a professional assessment

Consider seeking a professional assessment soon if:

•       low mood, poor sleep or loss of interest is affecting your work, study or daily life;

•       you keep thinking about death, or have suicidal thoughts;

•       you have come to rely on alcohol or drugs to cope;

•       you have not recovered for a long time after a major blow;

•       your mood has changed markedly after childbirth or during the menopause;

•       people close to you say they are worried about you.

Seek help immediately if you already have a plan or have started preparing, feel you might hurt yourself soon, can't keep yourself safe, or have already hurt yourself. For what to do, see the safety page and Chapter 8.

7. Words that help when talking to a doctor

Many readers grew up with Chinese ways of describing distress, which don't always translate directly. If you, or a parent you are helping, are speaking to a doctor in English, these equivalents may help:

Common Chinese expression	Closest English	Notes
想不开 / 轻生念头 (xiang bu kai)	suicidal thoughts	Doctors use this term directly; there is no need to avoid it
不想活了	I don't want to live anymore	It's fine to say it just like this
伤害自己	self-harm	Deliberately hurting yourself, not necessarily with intent to die
心情不好 / 郁闷	low mood	More everyday than "depression"
抑郁症	depression	A condition that needs diagnosis
神经衰弱 (shenjing shuairuo)	no direct equivalent	Describe the actual symptoms, such as poor sleep, exhaustion, anxiety

When talking to a doctor, it is best to say plainly what you feel and what thoughts you are having. Doctors hear these words every day, and they will not think less of you.

A Line from the Classics

"The five organs transform into five kinds of qi, which give rise to joy, anger, sorrow, worry and fear." (Suwen, "On the Correspondences of Yin and Yang")

In plain words: in their own language, the ancients expressed the observation that emotions and the body are connected. Modern medicine studies the brain, body and emotions in a different language.

One Thing You Can Do Today

Think back over the past two weeks: what has changed in your sleep, appetite, energy and interests? Note it down; it will be useful when you see a doctor.

Understanding Yourself

Have I been treating my pain as a "personality problem" or "not being able to let go", without considering that it may be a treatable health problem?

(To Be Continued)