Mainland Chinese Family Caregiver Narratives in Mental Illness: Disruption and Continuity

Abstract

This study employs a phenomenological hermeneutic approach to analyse narratives written by mainland Chinese people who care for a family member with serious mental illness. Locating culture at the centre of the analysis, the study explicates and explores the salient themes and subthemes in texts that were originally published in a monthly psychoeducational newsletter. Analysis reveals that mental illness constitutes a catastrophic and disruptive event for the caregivers, for the most part women, and their families. Caregivers are driven by intersecting cultural and state-propagated discourses to exert heroic effort and commitment in order to ensure a full “recovery” for the ill family member. In light of the intense stigma surrounding mental illness in Chinese culture, the family member's condition is actively concealed by caregivers. This is to protect healthy family members as much as the ill person. The study concludes that cultural phenomena inform both the sense of disruption experienced by mainland Chinese family caregivers in mental illness and the sense of continuity in their fulfilling of socioculturally prescribed roles.

Keywords:

• China
• mental illness
• family caregiving
• illness narratives
• phenomenological hermeneutics

Notes

1. While in the West caring for people with a serious mental illness is not exclusively a familial activity, in mainland China it is overwhelmingly so. For instance, over 90 per cent of people with chronic schizophrenia in mainland China live at home with their families, considerably higher than the corresponding figure for the United States, where it is only 40 per cent (Phillips, 1993; Ran, Xiang, Simpson and Chan, 2005).

2. Hequembourg and Brallier (2005) claim that women caregivers are also more future-focused than men, a deemed responsibility for the ill person's future life thus potentially adding to a woman caregiver's sense of burden and guilt over any perceived failure to live up to this responsibility.

3. Park and Chesla (2007, p. 304) note that in Confucian-heritage societies women's responsibility to care for ill children “takes precedence over” that to care for their spouse.

4. Face is a cultural phenomenon denoting concern for “how one is evaluated by others” (Hinze, 2002, p. 269). Face lies at the heart of Confucian teachings on social and interpersonal relationships and, as such, maintains a high degree of salience in social behaviour in Confucian-heritage cultures such as mainland China (Wong, 2000).

5. Coping responses to the burden and disruption faced by family caregivers also feature in the narratives under study. These responses are the subject of a separate paper, which is currently being drafted, that examines coping strategies employed by mainland Chinese caregivers.

6. All page numbering refers to Yao (2000). All text examples have been translated by the author.

7. Pearson and Lam (2002, p. 174), however, have found in their mainland Chinese (Guangzhou) study that “[f]amilies were quite speedy in seeking treatment for their relatives after the first onset” of mental illness, “with 31 per cent consulting some kind of psychiatric service within the first month”, rising to 90 per cent within a year of onset. They do note, however, that such a finding “contravenes the commonly held view … that Chinese families delay seeking help beyond the confines of relatives and trusted outsiders for as long as possible, sometimes for years” (p. 174).

8. It should be noted that eugenics also underpins the one-child family planning policy in mainland China and that the Singaporean government appears to have a similar outlook in its family planning policy (anonymous reviewer's pers. comm.).

9. This statement is contained in the author's personal copy of a photocopied English translation of a speech entitled ‘Message of the Vice Premier Li Lanqing to the Symposium on the World Health Day. 7 April 2001’. Higgins et al. (2008) cite the original Chinese speech by Li Lanqing, which is reproduced at http://www.zgxl.net/xlzl/shkf/2001sjws.htm. While “social stability” resonates in the mainland Chinese government's discussion of a range of social and political issues, the author believes its application here to mental illness and mental health is still worthy of note.

10. Phillips, Pearson, Li, Xu and Yang (2002, p. 488) call for greater clinical attention to individual emotional responses and reactions to stigma in mental illness, stating that “the most damaging effect of stigma and discrimination is the subjective internalisation of these negative valuations”.