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The long, lonely journey back from the darkness
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NANCY Zhang, 26, exemplifies the image of the ideal librarian. She is helpful, diligent and quiet.
But underneath that placid demeanor is the shadow of another self. Zhang was once treated for schizophrenia, though that past isn’t known except by library administrators.
“I like my job here, and I am trying my best to improve my work,” says Zhang. “It is an important step in my recovery to stand on my own two feet.”
Zhang is among the estimated 100 million Chinese mainlanders who suffer some form of mental illness. According to a recent report by the Chinese Center for Disease Control and Prevention, about 16 million were suffering major psychotic problems, such as schizophrenia.
In China, mental illness was and probably still is a taboo subject. Families kept sufferers behind closed doors. In extreme cases, people were sent to mental hospitals, where they often languished for decades.
The issue has now come into focus as a major component of public health.
But for most patients and their families, it’s still a long, hard road toward reintegration with society. Lack of understanding and discrimination still prevail.
In Shanghai, rehabilitation centers have been set up in more than 200 communities to help the mentally ill.
Zhang is one of the very few lucky ones who have successfully taken their first steps back to an ordinary life. As she is quick to admit, it takes a lot of personal effort and courage.
Mental illness encompasses an array of brain dysfunctions that distort consciousness, emotion, thought and behavior, according to Xie Bin, a chief physician at the Shanghai Mental Health Center. There are about 400 types of the disease discovered so far, with most of the causes unclear.
According to a 2009 study on the psychological health of Shanghai residents, about one in eight people reported some form of depression or other mental problems.
Medication and counseling are usually prescribed to treat sufferers in acute phases. Although most of those people are never completely cured, a proportion of them can resume normal social functions with proper treatment, according to Cai Jun, a chief physician at the Shanghai Mental Health Center.
“In stable phases, they can behave just as normally as ordinary people,” says Cai.
Sad case
Deciding what is “normal,” however, can be very subjective.
The case of Xu Wei, 47, who was incarcerated in a mental institution in Shanghai for 12 years, drew a lot of public attention when his lawsuit seeking release from the hospital was rejected recently by the Minhang District People’s Court.
Xu was diagnosed with paranoid schizophrenia in 2003 and sent to Minhang Qingchun Mental Health Hospital. His elder brother, as legal guardian, steadfastly refused to sign discharge papers even after his condition was deemed stable.
Xu thought he found a way out under a new Mental Health Law that supports a patient’s right to willingly accept or reject hospitalization. In the end, his hopes were dashed.
“It is not rare for mental patients to be kept hospitalized even after showing signs of recovery,” says Cai. “Though the average length of hospital stays in Western countries usually is only about 14 days, the length averages up to 50 days in China and 200 days in Shanghai.”
Insufficient community outpatient resources and family resistance keep patients in hospitals.
“Quite a number of the family members see it as a burden to take care of someone with mental illness,” says Cai. “They would rather keep them in the hospitals and leave the responsibility to doctors and nurses. There are patients who have been hospitalized for 40-50 years in some suburban branches.”
Hospitals may be ideal for treating patients with acute problems, but they aren’t so ideal in helping the mentally ill regain social functions like self-management and communication skills.
According to research, the relapse rate for schizophrenia patients taking regular medication for five years is still 60-70 percent, while community-based recovery centers can reduce that to about 30 percent.
“They have to return to the society before they can fully regain normal lives,” says Cai.
Yang Guang Xin Yuan, which translates as Sunshine Heart Garden, set up centers in 200 Shanghai communities beginning in 2009. Their aim is to help stable mentally ill people improve their social functions.
In addition to training classes, the centers operate small commercial businesses, like Sunshine supermarkets and car washes, to provide employment skills to participants.
“Most of the participants are improving gradually at the centers, and some of the best of them are now providing useful skills to other participants,” says Wang Yanfeng, a social worker at the Shanghai Mental Health Center who liaises with the recovery centers.
Still, the number of patients who actually manage to return to normal life with positions such as librarian Zhang are few. It’s hard to convince employers to hire people with past mental problems. And due to thin profit, it’s also difficult to convince online vendors to sell the products produced at the rehabilitation centers.
“Most of the jobs that the recovered sufferers get are still related with the Sunshine Centers,” says Cai. “That should not be the case, yet, unfortunately, it has been.”
Zhang still keeps her past a secret from co-workers. She relies on advice from social workers on how to deflect questions about her past.
“Society is just not yet ready to embrace these people wholeheartedly,” says Cai. “But we will keep trying to change public attitudes.”
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