Introduction. Schizophrenia is often conceptualized as a chronic illness with persisting, relapsing or deteriorating symptoms, and no hope for sustained remission and recovery of functioning (Liberman et al., 2002).Schizophrenia is to psychiatry what cancer to general medicine: a sentence as well as a diagnosis. (Hall et al., 1985) Schizophrenia has been called the
1. Conference on “Promoting Community Mental Health – Issues, Achievements and Visioning into the Future” 15-17 December 2009 Coping with and Recovery from Schizophrenia Dr. Estella Chan
Department of Applied Social Studies
City University of Hong Kong
Email: [email protected]
Tel. No.: 3442 8967
2. Introduction Schizophrenia is often conceptualized as a chronic illness with persisting, relapsing or deteriorating symptoms, and no hope for sustained remission and recovery of functioning (Liberman et al., 2002).
Schizophrenia is to psychiatry what cancer to general medicine: a sentence as well as a diagnosis. (Hall et al., 1985)
Schizophrenia has been called the “cancer of mental illness” because we do not know what causes it or how to prevent it. (Austrian, 2005:90)
Schizophrenia is among the most debilitating of mental illnesses (Walker et al., 2004) and responds to no particular treatment (Bentall, 1990 in Chan, 2004)
3. Introduction Given schizophrenia is regarded as an incurable disease, those who are unfortunately afflicted with it are viewed as passive and hopeless victims of their illness.
However, recovery literature and the findings of my own research reveal that people diagnosed as having schizophrenia are “not simply passive victims of their illness” (Carr, 1988), nor are they passive recipients of expert services (Deegan, 1988; Gagne et al., 2007; Ridgeway, 2001).
4. Introduction People with schizophrenia are “experts by experience” (Roberts & Wolfson, 2004).
They have their own special formula for promoting their recovery (Deegan, 1988).
They “can play an active role in the management of their illness.”
They “make active attempts to master the illness and not have it dominate them” (Carr, 1988).
5. Recovery is possible There is hope for recovery, and full recovery is possible.
There are empirical findings of several long-term studies in different countries showing hope for recovery from schizophrenia.
The recovery rate in these seven long term studies ranged from 46% to 68%.
That is, half to two thirds of people diagnosed with major mental illnesses including schizophrenia were found to show significant or complete recovery over time.
6. Case illustration Name: Dragon (not a real name)
Came to Hong Kong illegally from mainland China when he was 17
Diagnosis: schizophrenia, with grandiose ideas & persecutory delusions
Age at onset: 26 years old
Number of relapses / hospitalization: 3
Married with 2 children, aged 7 and 3 respectively
Lives with wife and children
Works at a sheltered workshop
On medication with sable mental condition
7. What does it mean by “recovery”? Recovery to Dragon does not mean that he is cured.
It does not mean that he has complete absence of symptoms, nor does it mean that he will experience no more episodes of relapse.
Like the experience of most of individuals with schizophrenia, recovery for Dragon is not an end product or result (Deegan, 1996:13).
Instead it is a process involving a transformation of the self wherein Dragon has come to terms with the reality that he has to live with schizophrenia and accepts his limitations (Deegan, 1996:13).
8. What does it mean by “recovery”? Similar to others’ recovery path, Dragon’s recovery journey is not a perfectly linear process, marked by successive accomplishments (Deegan, 1988:16; 1996:13).
There were also setbacks in Dragon’s recovery process that he had twice relapsed into a brief episode of active psychotic symptoms after marriage.
Yet he could manage to go through the episodes at home under the care of his wife.
His mental condition becomes more and more stable after marriage and he has no more psychotic episodes in recent years.
9. What does it mean by “recovery”? Dragon has regained hope for his future and discovered how he can realize his dreams and aspirations.
He has regained meaning and purposes in his life and achieved more and more socially expected and personally valued roles and goals, and is now leading a satisfying and meaningful life.
He has found new meaning and purpose of his life and these motivated him for recovery.
He subjectively found that he has already recovered for 80% to 90% though he has not yet 100% recovered from schizophrenia.
10. Coping & Recovery Dragon believes that “One’s mental illness can really be ‘diluted’ after marriage.” He thus determined to end his mentally ill life and to lead a normalized married life with his children.
Dragon had his logic to “cure” his mental illness by marriage. He explained: “Normal men got wives. Those mental patients who are unmarried will remain dirty and sloppy for the rest of their lives. They do not care about their images and they eat and drink a lot. They are totally living in the dark and in hopelessness.”
11. Coping & Recovery In traditional Chinese societies, marriage was very often arranged in the hope that the joyous occasion would ward off the evils and bring the bridegroom back to health.
Not infrequently in traditional Chinese societies, arranged marriage is used explicitly or implicitly to cure mentally ill youth, based on the belief that sexual frustration is the cause of their illness.
(Lin & Lin, 1981:390)
12. Coping & Recovery Dragon demonstrated capacity to make use of the resources and the strengths of the close ties of Chinese families.
He returned to his home town in Chinese mainland and requested his mother to help arrange his marriage. With the assistance from his mother, a village woman with no history of mental illness willingly married Dragon though she fully understood that Dragon has schizophrenia.
Although Dragon experienced two brief episodes of relapse into a psychotic state after marriage, he managed to stay at home under the care of his wife and did not need to be hospitalized as in the past.
13. Coping & Recovery Dragon attributed his recovery to the effects of his marriage and the help from his family, his wife and children in particular.
Dragon found marriage helped him not only distance himself from the strongly stigmatized psychiatric label of schizophrenia but also contributed to his living a normal family life which he treasured very much.
To enjoy a normal married life, to have his own children and to provide for his wife and children were Dragon’s dreams and life goals.
14. Coping & Recovery Dragon’s wife and children were his greatest support and the most important source of motivation of Dragon to recover, as his family gave his life meaning, provided him with a sense of purpose and value and made his recovery worthwhile.
He revealed that he needed to struggle to get well and he needed to keep his mental and physical health fit for the sake of his children.
He said: “My children give me motivation to get well to earn money. It’s because I need to feed my children. … I survive up till now is totally because of my children. I do not want to abandon my children. I thus never give up struggling for recovery in spite of pain and difficulties.”
15. Coping & Recovery Familial responsibilities indeed rendered Dragon’s life a meaning and thus motivated him to survive.
Just as Dr. Viktor Frankl observed in the Nazi concentration camps:-
“those who knew that there was a task waiting for them to fulfill were most apt to survive.”
“He who has a why to live for can bear almost any how.”
“Once an individual’s search for a meaning is successful, it not only renders him happy but also gives him the capacity to cope with suffering.”
16. Coping & Recovery The responsibility to his family, the meaningful tasks of providing for and nurturing his children were truly the sources of Dragon’s happiness and that fuelled Dragon with the needed willpower and energy to keep on fighting and struggling.
Dragon said: “You can starve yourself but, as a parent, you can’t starve your children. So you got the energy to struggle for recovery.”
At the same time, Dragon found fulfilling familial responsibilities rewarding. He said: “When they [Dragon’s children] call me ‘daddy’, I am lifted up and feel very happy. It’s really very rewarding.”
17. Coping & Recovery Being a caring husband and responsible father, and assuming the duty of providing for the family are socially expected roles and valued activities for adult males among Chinese.
It’s because in Chinese families, traditionally there is a rather clear division of labor between the married couple and there are different gender roles.
That is “the role of the Chinese male is to achieve, provide sustenance, protect the nest and bring prestige to the family. The female role is to be dutiful, to procreate and to bring up the young” (Singer, 1976:48).
18. Coping & Recovery Dragon’s strong sense of responsibility to perform those socially valued roles and activities gave his life a sense of direction and meaning.
These valued social roles also motivated him to keep well and raised Dragon’s self-esteem as well.
Dragon proudly and confidently answered my question how he perceives himself in this way: “I am useful as I have a perfect family.”
Dragon further elaborated: “I am able to have my own children. I am able to provide for my children and can bring up them. All these are incredible accomplishments for a person with a mental illness.”
19. Coping & Recovery As Ridgway (2001:338) points out, “Prior to recovery people were often treated as though they were their diagnoses, felt defined by their disorder, and came to view themselves almost exclusively in terms of their psychiatric problems.”
Dragon’s “no longer viewing himself primarily as a person with a psychiatric disorder” and his “reclaiming a positive sense of self” can be seen as the hallmark of his recovery.
20. Conclusion Dragon maintained a stable mental condition in the recent years. His story showed that a person with schizophrenia is not a helpless victim of the illness.
Rather, he is active in making attempts to not only cope with his mental illness but also to live his life beyond the limitations of his illness.
He has his own personalized coping strategies which are derived from his cultural context.
He is also able to make use of the strong family support of a Chinese family for actualizing his personal dreams and aspirations.
21. References Austrian, S. A. (2005). Mental disorders, medications, and clinical social work (3rd ed., pp.90-111). New York: Columbia University Press.
Carr, V. (1988). Patients’ techniques for coping with schizophrenia: An exploratory study. British Journal of Medical Psychology, 61(4), 339-352.
Chan, Y. K. E. (2004) An exploratory study on the subjective experience of schizophrenia from a non-representative sample of 12 Chinese with schizophrenia in Hong Kong. Unpublished Thesis (PhD): Hong Kong Polytechnic University.
Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11(4), 11-19.
Deegan, P. E. (1996). Recovery and the Conspiracy of Hope. A paper presented at: “There’s a Person In Here”: The Sixth Annual Mental Health Services Conference of Australia and New Zealand. Brisbane, Australia on September 16, 1996. (Retrieved on June 30, 2009, from http://www.patdeegan.com/aboutus_paper.html)
Deegan, P. E. (2001). Recovery as a self-directed process of healing and transformation. Intentional Care. (Retrieved June 14, 2009, from http://www.intentionalcare.org/articles/articles_trans.pdf)
Frankl, V. E. (1984). Man's search for meaning: an introduction to logotherapy (3rd ed.). New York: Simon & Schuster.
22. References Gagne, C., White, W., & Anthony, W. A. (2007). Recovery: A common vision for the fields of mental and addictions. Psychiatric Rehabilitation Journal, 31(1), 32-37.
Hall, W., Andrews, G., & Goldstein, G. (1985). The cost of schizophrenia. Australian and New Zealand Journal of Psychiatry, 19, 3-5.
Liberman, R. P., & Kopelowicz, A. (2002). Recovery from schizophrenia: A challenge for the 21st century. International Review of Psychiatry, 14, 245-255.
Lin, T. Y., & Lin, M. C. (1981). Love, denial and rejection: Responses of Chinese families to mental illness. In A. Kleinman & T. Y. Lin (Eds.), Normal and abnormal behavior in Chinese culture (pp. 387-401). Holland: D. Reidel.
Ridgway, P. (2001). ReStorying psychiatric disability: Learning from first person recovery narratives. Psychiatric Rehabilitation Journal, 24(4), 335-343.
Roberts, G., & Wolfson, P. (2004). The rediscovery of recovery: Open to all. Advances in Psychiatric Treatment, 10, 37-49.
Singer, K. (1976). Cultural and mental health: (II) Childhood and family dynamics (with special reference to Hong Kong). In W. H. Lo, W. Chan, K. S. Ma, A. Wong, & K. K. Yeung (Eds.), Perspectives in mental health Hong Kong (pp. 45-48). Hong Kong: The Mental Health Association of Hong Kong