Recovery, mental health and inequality. Chinese ethnic minorities as mental health service users

Recovery, Mental Health and Inequality both offers and is much more than a comprehensive and unique view of the realities of Chinese mental health service users in the United Kingdom and their many answers to the questions of ‘what they are recovering from and where they are travelling to’ (9). The author, Lynn Tang, is one of 22 people whose life histories, shared in face-to-face interviews, create the empirical data for this research, thus making her both the researcher and a research subject. This fluidity of roles, typical of what is known as user-controlled or survivor-controlled research in mental health, is what drew me to this book before I discovered many other points of connection, including those relating to my own migration experience. Although I have a different ethnic and cultural background to the research participants and live outside the United Kingdom, this book resonated with me as I believe it will with anyone who has had to deal with immigration authorities and undergo the many bureaucratic and emotional upheavals associated with starting over in another country – either legally or as a so-called undocumented immigrant.

Tang understands ethnicity as a structure and emphasises ‘the interplay of structural factors in constituting socio-economic deprivation and its consequence on health for ethnic minorities’ (17). She therefore gives a vivid picture of the specific life circumstances of Chinese migrants and the ways these contribute to ill health. This includes the harrowing and precarious conditions of Chinese restaurant workers; the predicaments of overseas brides and those in arranged marriages; the burden of overdue debts in the home country; the assumption of informal care work; cultural stereotypes about Chinese people as a ‘non-problematic’ ethnic minority; their under-representation in mental health services; and the specific forms of racism and hate crimes they face in the United Kingdom. At the same time, Tang’s analysis of the interconnectedness of these issues and their cumulative effect on health extends the relevance of her findings far beyond the group at the centre of her research. Her work complements the efforts of many other authors who have been psychiatrised in different contexts around the globe and make their focus ‘reality’ rather than ‘illness’. I am reminded here of the words of the recently deceased Kate Millet:

[l]ife is very difficult: death is hard to endure, bereavement, the death of love, love’s labour lost, hard economic times, lost employment, lost opportunities, the embittering frequency of every form of disappointment in life. This is a reality model, built upon reality. (Millet 2007, 32)

Much of Tang’s book follows the life trajectories of the research participants. Sometimes the argument is hard to follow because the 22 individual stories have been broken into fragments which are scattered throughout the text. The introduction and closing parts of the book, however, are where Tang’s analysis is at its best. Rather than providing any definite answer about the origins of a person’s mental health problems, she shifts the causation debate to socio-economic structures, stating that ‘[c]ausal relationships lie not in events but in generative mechanisms that produce those events’ (25). Powerfully combining capabilities approach, intersectional analyses, critical realist reading and her own insider knowledge, Tang casts aside the biomedical model (in both its western and Chinese versions) and brings social justice to the fore of the mental health debate. Here she begins by situating and problematising the current view of recovery as an individual project and ends by re-framing and revising it as a task for a community. She writes:

a transformative community development approach rather than individualistic intervention, is needed to empower and emancipate service users from the deleterious social inequalities. (145; emphasis added)

This rich study raises other critical issues. To give a mere hint, Tang contests idealised understandings of one’s home country as somewhere one can always go back to; exposes ‘the risk of mistaking stereotypical “culturalist” assumptions for “cultural sensitivity”’ (96); and reflects on medicalisation as an ‘“incomplete” project of colonisation of a lifeworld’ (61).

In a ‘methodological epilogue’, she also makes a case for the advancement of the knowledge of Chinese service users. Tang explains here that the main reason she was not able to adopt ‘a more participatory model of research’ (153) is that this project was undertaken as a PhD study. Despite winning a full scholarship, she faced decisive time and resource constraints. While this is not mentioned, it seems that academic demands and the need to prove the scientific and methodological ‘soundness’ of this research are the invisible restraints on this undertaking. One can only hope that having undoubtedly met these demands, this unique piece of work can now expand to its full potential and begin a life beyond academia. Currently, the project seems to be imprisoned in a book that will not be attainable for most people outside universities. It would be tragic if this important research remained the sole property of the ivory tower and its contribution was reduced to a footnoted perspective on the mental health of ethnic minorities. I hope that this author finds ways and resources to keep jointly producing knowledge with the community whom her work is about and – beyond this – with the always more visible international community of service user/survivor researchers. Without wanting to pin Tang down to any particular research approach or school, I would highlight the relevance of her work for the emerging field of Mad Studies and its contribution to – as she writes – ‘building a collective capability for knowledge development’ (159).

Jasna Russo
College of Health and Life Sciences, Brunel University, London, UK
[email protected]
© 2017 Jasna Russo
https://doi.org/10.1080/09687599.2017.1414303