On these two days, the report "Hangzhou Daily" pushed "Hangzhou man calls from the funeral home: can you write about our genius son" on major social media. This is a readme article. The narrator is Jin Sex Yong, his child Jin Xiaoyu was blinded in one eye due to an accident in childhood, suddenly dropped out of high school when he was in high school, and then had a mental condition, was diagnosed with manic depression, and later retired from college and dropped out of school. Jin Xiaoyu is ill-fated. After the death of his mother, Jin Shengyong, as a father, called the media, "Can you write the story of my son?" My son is a genius, he's in a mental hospital now, and his mom just left today. "Jin Xiaoyu's experience and parents' care have thus become a moving and legendary news story.
Now, more and more people know About Kim, a translator born in 1972. He has translated more than 20 works, both in English and Japanese, spanning novels, art and philosophy. His latest translation of Benjamin's Epistles also added thousands of "want to read" annotations to Douban overnight.
Jin Xiaoyu has translated and published some of his books in recent years, "Andrey Tarkovsky: Elements of Cinema" (2018), "Flying Souls" (2019) and "The Diary of Andy Warhol" (2019).
According to his father, Jin Sexyong, the reason why Jin Xiaoyu embarked on the road of translation was because his wife went to NTU to participate in a classmate association in 2010. At that time, a classmate who stayed in school to teach asked to be a translator after learning that "my child has no job due to illness." For more than a decade, Jin Xiaoyu worked as a translator, and his serious attitude towards words made him popular and loved by the editors of the publishing house. It is conceivable that even if we do not consider more effort than ordinary people have made, Jin Xiaoyu is also a very remarkable translator in terms of translation work and quality.
However, without my father's self-report, there might not have been such a legend, and without this legend, so many people might not suddenly know "translator Jin Xiaoyu". However, we would like to ask another question here: If Jin Xiaoyu was born into an ordinary family, his parents did not have a college professor, and did not become a translator, what kind of work could he do after recovery? For most people, this is an idea that requires courage and imagination, because people with mental illness, even when they recover, are often far from the crowd and out of the radar. Like this time, we only occasionally see a single instance of them through some legendary story or extreme news. They either become legends or stigmatized and discriminated against in invisible places.
Stills from the movie Rain Man (1988).
Removing the social network that not every parent has, what remains may be the more common situation of people with mental illness or recovery. The simplest expression of this situation is the ubiquity of discrimination and stigma when applying for a job, and they themselves may be forced to "self-stigmatize". The following author works in the Department of Social Work of South China Normal University, engaged in sociology and social work research, and has handled casework related to mental health. The case in which he intervened at the time was a woman with a bachelor's degree and foreign language expertise, more than thirty years old, with several years of experience in foreign trade business, but the job application was rejected, on the grounds that "we do not invite mentally ill patients", and finally found only a manual job with a monthly salary of no more than 500 yuan. After repeated failures, she was hospitalized again. The author also met her here.
Written by | Li Qiaoming
01
MS S: Another case
The legendary story of Jin Xiaoyu, the protagonist of "Genius Son", reminds me of the experience of doing fieldwork a few years ago.
The woman I came into contact with, Ms. S, who also had excellent foreign language skills, was repeatedly discriminated against in employment. Her father was bedridden in old age, and her brother who lived in a different place refused her to leave the door, thus repeatedly falling into the "hospital-discharge" cycle, and had to work in a low-wage manual work that was mismatched with her ability in the community disability shelter employment factory. Compared with Ms. S, Jin Xiaoyu is undoubtedly lucky. Parents and families have the capacity and resources to provide a shelter from the wind and rain for their recovery and employment.
Stills from the movie One Flew Over the Cuckoo's Nest (1975).
The focus on this topic stems from my social work experience, which has handled casework related to mental health. In retrospect, the process of handling these cases focused on restoring the "order of life" of the parties and the people involved. That is to say, it is treated as an "incident", and the problems of mental disorder patients in individual cases seem to be "solved" with the end of the incident, but the substantive problems faced by mentally disabled people such as family acceptance, employment and return to normal life have not been solved. Based on reflections on past work experience, I prefer to discuss the challenges faced by people with mental disabilities/recoveries based on the position of a social work researcher.
At that time, I was invited by the head of a local social service federation to visit Ms. S at a certain hospital. The person in charge told me that she had been hospitalized for more than a year because of discrimination in her job search, which led to a recurrence of mental illness. The hospital is a large local psychiatric treatment and rehabilitation hospital, located on the outskirts of the city far from human habitation, and treats most of the city's mental patients. The visiting team consisted of the head of the federation, the counselor, the head of the shelter workshop and me.
After entering the hospital inpatient treatment area, a faint odor stimulated my nerves. I tried my best to hide my physiological aversion to the smell. The smell wafted from the inpatient area, mixed with the smell of detergent and excrement, not strong enough, but uncomfortable enough. Treatment and inpatient areas are separated by an iron fence, and the closer you get to the fence, the heavier the smell. Several inpatients leaned against the fence, curious about our arrival. The doctor let us into a conference room of tens of square meters. The conference room was opposite the door of the doctor's treatment room, no different from the ordinary conference room, with a large conference table in the middle, surrounded by a dozen black leather chairs. My past professional experience made me think that the doctor would take us to a more relaxing counseling room, but it didn't.
During the ward visit, we consulted with the hospital's medical social worker and psychiatrist before communicating with Ms. S in a conference room.
Ms. S, dressed in a uniform blue-and-white hospital gown, looked clean and fresh, albeit with a somewhat nervous expression. If she doesn't wear a patient's outfit, I think it's hard to recognize at a glance that she has a mental problem. All parties have provided their own views from their own working positions. I learned about the standards for the rehabilitation of mental disorders, the employment policy for those who have recovered from mental disorders, the cooperation between doctors and medical social workers, and the connection between hospital treatment for mental rehabilitation and the community rehabilitation system. During the interview, it was learned that doctors focus on the physical performance and physiological rehabilitation standards of mental rehabilitation, while social service providers focus on the social functions and problems of mentally rehabilitated people, such as social stigma, employability and employment opportunities. However, these different medical, service and research focuses have gaps in the articulation system, and the problems that arise cannot be solved during the patient's rehabilitation.
02
"Stigma" vs. "Self-Stigma"
If we look at mental illness from a historical perspective, we will find that mental illness itself is a dynamically developing social construction process. In Madness and Civilization, Foucault uses an "archaeological" way to show how "madness" is separated from "reason" in Western historical practice, and is shaped by power as a natural enemy of "reason" and "social order". Foucault believed that mental illness itself was the process and result of social construction and power shaping. During the Renaissance in the 16th century, "madness" was understood only as an individual problem, as one with reason, as a "mysterious revelation." In the 17th century, in the era of scientism, "madness" became a sin; and in modern times, "madness" was completely stripped of society and became a "disease".
Madness and Civilization (Revised Translation), by Michel Foucault, translated by Liu Beicheng and Yang Yuanbao, Life, Reading, and Xinzhi Triptych Bookstore, July 2019.
In The Invention of Madness, Emily Baum combed in detail how the medical concept of "madness" gradually entered China from the West and became deeply rooted in the "invention" process. Before the fall of the late Qing Dynasty, madness was generally understood by Chinese medicine as a problem of physical function and emotion, and was not attributed to nerve or brain problems. Therefore, "madness" is generally regarded as a practice in the private sphere, and it is handled by the people themselves. With the strengthening of the state's social control over madness, madness has gradually become a "social problem". Especially after modern medicine entered China, the governance function of madness gradually shifted to hospitals and health departments.
It can be seen that whether in the West or China, the formation and acceptance of the concept of mental illness is a process of entanglement and dynamic development with the socio-political context. The diagnosis, treatment and rehabilitation of mental illness are unlikely to be solved by the medical system alone, divorced from their social attributes.
Ms. S's employment experience requires us to pay more attention to the problem of social stigma and stigmatization suffered by mentally rehabilitated people when they are employed. In existing research, stigma is generally understood on two levels. The first level is the behavioral cognitive level. Corrigan argues that the "normal group" of society has "stereotypes" about the existence of mentally rehabilitated people, which in turn creates cognitive and emotional prejudices against them, which in turn leads to discrimination and exclusion of them in behavior. The second level is to understand it from a sociological point of view. This orientation understands the issue of stigma from the perspective of power. Stigmatization refers to the labeling and cognitive stereotyping of vulnerable groups by powerful groups, which in turn separates vulnerable groups from the mainstream social power structure, loses social status, and suffers discrimination. Link and Phelan emphasize that all of this happens in specific power situations. Further, we need to identify and remove stigma through context.
Stills from the movie Ocean Paradise (2010).
Based on the above understanding, some studies have tried to integrate the theoretical gaps between the psychological level and social perspective from the perspective of integration. Corrigan and Watson point out that the integrated perspective of social stigma and exclusion leads some people with mental disorders to internalize external cognition and rejection behavior, which in turn generates "self-stigma" psychological cognition and behavior. Rüsch et al. and Link argue that the damage caused by this stigma internalization is most obvious when the rehabilitated person identifies with social stigma and self-depreciates, resulting in a state of low self-esteem, self-exclusion, and self-control. These studies go some way to explaining why mentally rehabilitated people encounter setbacks and difficulties in their daily lives, such as seeking medical care, employment, housing, and family relationships. On the other hand, in order to resist social stigma and self-stigma, people with mental disorders may use self-empowerment to fight against unfavorable factors in the environment, such as avoiding medical treatment, refusing to take medicine, and ignoring social relations.
The problem of employment discrimination of mentally rehabilitated persons can be said to be the biggest obstacle to their return to society and the "normalization" of their lives. Research by Szeto and several scholars, including Dobson, Scheid, and Hipes, shows that people with mental recovery have little access to fair employment. Even if they are employed, they are jobs that degrade their vocational ability. Scheid's research in the United States shows that socio-economic policies have a limited effect on the institutional protection of fair employment for the recovered, and the system has not significantly changed the discriminatory attitudes of employers, or even strengthened this stigma and discrimination. In the context of domestic rehabilitation, such mentally rehabilitated persons are in a similar situation.
03
From individuals, families to communities:
The dilemma of rehabilitation support systems
Ms. S is in her thirties, has a bachelor's degree, outstanding foreign language ability, and has several years of experience in foreign trade business. In the process of communicating with us, the thinking is quick and the cognition is clear. Doctors believe she is in recovery.
Despite this, she did not successfully obtain employment opportunities before, but was blatantly discriminated against by the interviewing unit on the spot as "we do not invite mentally ill patients" at the job fair. After being stimulated, Ms. S suffered a mental "secondary injury" and was soon re-admitted to the hospital for treatment. This discrimination makes it likely that after she is discharged from the hospital, she will continue to do simple manual work in sheltered workshops that do not match her professional abilities. According to the person in charge of the shelter workshop, the income of manual work is 300-500 yuan per month, which is far from the woman's professional ability and career expectations. The person in charge and the medical social worker also revealed that although the tax law, that is, the relevant tax policies, have preferential tax relief for enterprises that accept the employment of disabled people, this preferential treatment is not enough for enterprises to voluntarily accept employment of disabled groups. Some enterprises even ostensibly accept people with disabilities, but use the "empty pay" method, that is, nominally provide jobs and pay wages, but require the disabled to be "absent". This is more common in people with physical disabilities, who in contrast to those who recover from mental disorders have more difficulty in obtaining employment opportunities.
In addition to workplace barriers, the lack of alternative residency rights is also an obstacle to the return of recovered persons to the community. During the visit, it was learned that Ms. S's family only had an 80-year-old father who was in poor health, and it was difficult to "take care" of her. Even if she is discharged from the hospital, she may be considered a person who has lost the ability to live independently and needs to be cared for by others. Is it possible to find other suitable accommodation in the community besides the family? According to the head of the FEDERATION, the existing disability care system in Mainland D lacks a "midway dormitory" set up in the community similar to that in Hong Kong. This is mainly for those who have left the hospital and have difficulty immediately returning to their families and reintegrating into social life. This buffer setting, coupled with appropriate vocational training, is more conducive to the return of the recovered into society. The hospital adopts a closed treatment that is completely isolated from society, and patients only have one half-day opportunity to "let go" outside the "ward" outside the "ward" and in the designated open space of the campus. Research in the Lancet journal shows that diseases such as mental health are difficult to improve further through biomedical treatment alone. This long-term isolation from society is likely to cause serious degradation of the social functions of mentally rehabilitated persons and is not conducive to their return to social life.
However, perhaps the biggest obstacle to community recovery comes from residents' stigma and prejudice against mental illness. It is often difficult for them to fully accept people with mental disabilities/recoveries living in the same community. Even families of people with mental disorders (mostly autistic) who live in government-provided public rental housing will be protested by owners who claim to be worried about the "public safety" of the community. Admittedly, there are many studies showing that certain types of mental illness, such as schizophrenia, are strongly associated with violent/aggressive behavior. But this does not mean that all types of people with mental disorders are aggressive, such as people with autism who do not have violence most of the time. Scientific cognition helps to dispel residents' fears based on prejudice. It also shows that social education on mental illness has a long way to go.
Theoretically, biomedical care plus community rehabilitation is an ideal system of psychiatric rehabilitation support. In practice, "biomedicine" is often compressed into "drug treatment" due to the lack of medical resources.
I learned from the psychiatrist that in addition to treating more than 40 people with mental disorders, her job required her to work daily and receive new patients. This also means that doctors do not have much time to visit the ward every morning, and it is difficult to implement one-on-one psychological counseling to supplement it except for drug treatment. At the level of community rehabilitation, there is also a shortage of manpower in the community mental rehabilitation system. Although doctors in community health service centers have "nominal" rehabilitation medical functions for mentally rehabilitated persons, such as the timely distribution of free rehabilitation drugs and assistance to the families of the recovered. Unfortunately, because the doctor position in the health center itself is a general practice setting, mental rehabilitation only accounts for a small proportion of its work content, so it is difficult for community doctors to have enough energy to devote themselves to the community rehabilitation of the rehabilitated people.
Another problem with community rehabilitation support systems is that community social workers do not necessarily take the initiative to serve people with mental disorders/rehabilitated persons as their job responsibilities, unless such services fall within the scope of "hard indicators". Furthermore, family support for the recovered is the most important but often overlooked part. Family members are subjected to multiple psychological, social and economic pressures of external stigmatization and the care of the recovered. As a result of these pressures, many families of rehabilitated people have also had to send mentally rehabilitated people to hospitals for long-term care. In the more mature community rehabilitation support system, social rehabilitation doctors, social workers, nursing staff and other social professional service providers can provide "respite services" to the family caregivers of the recovered, which can alleviate the pressure of the caregivers to a certain extent, so that they can provide sustainable family care for the mentally rehabilitated people.
04
The road to "decontamination"
Combining the above, we will find that the dilemmas and challenges faced by mentally rehabilitated people in the environment of social stigmatization are both individual and group discrimination factors and structural factors. So, how can we (especially social workers who provide professional services) "decontaminate" and improve their living conditions? Foreign studies have found that there are three main decontamination strategies, the first is "protest", that is, through various innovative social movements to appeal for and advocate the realization of the legitimate rights and interests of mental rehabilitation; the second is "contact", that is, to create opportunities for social people to face contact with mental rehabilitation, to enhance their awareness, tolerance and acceptance of mental illness; the third is "education", that is, to carry out various types of mental illness course education, science and mental health common sense, in order to reduce social panic. Rüsch et al. found that although these three approaches have not yet been supported by consistent empirical studies on their effectiveness, it does not mean that these "decontamination" strategies are completely ineffective.
In this regard, the aura of genius smeared by celebrities such as Jin Xiaoyu and Hemingway by the media is a benign and romantic illusion with us for people with bipolar disorder, which belongs to the statistical sense of "survivor bias" phenomenon. It may be that Ms. S is a true typical sample of the social life of people with mental disorders and recovered people.
Therefore, we can also see how fragile the path to social return of the mentally rehabilitated person who relies on the individual and the family system is. The reason is as Ma Zhiying, an anthropologist at the University of Chicago, pointed out in the article "Intimate Life Politics: Family Rights and Responsibilities and Mental Health Legislation":
"The Mental Health Law, which came into effect in May 2013, establishes the family as the subject of authority and responsibility for the treatment, care and supervision of patients with mental disorders. This practice continues the dependence of Chinese psychiatric practice on patients' families since the 1980s, but avoids other possibilities of public-private relations in psychiatry, such as discourse about family oppression within psychiatry and pro bono legal circles' calls to prevent family misuse of medicine. The establishment of the status of the main body of power and responsibility in China stems from the introduction of psychiatry into Confucian family culture with a new theory of knowledge, and also from the privatization of public care responsibilities in the market economy. This choice reflects legislators' consideration of preventing abuses of public power and of preventing humanitarian tragedies resulting from extreme personalization. However, by placing too much emphasis on family responsibilities, the complexity of family relations in the transition period is ignored, and the need for the state's health responsibilities and the prudent use of public power is also diluted. ”
At the very least, this suggests that the state welfare system and the community care system should not completely withdraw from the path of social return of the mentally rehabilitated.
Stills from the movie I Am Sam (I Am Sam 2001).
From the perspective of social work, although the employment support system for the recovered is not perfect, we can improve the well-being of the mentally rehabilitated in at least four aspects.
First of all, medical social workers can connect with organizations such as home clinics, social work service stations, and shelter workshops to prevent the emergence of a "vacuum" of social services after the discharge of mentally recovered people. Second, when the rights and interests of the rehabilitated person are damaged in the process of returning to society, the social worker can cooperate with lawyers and the media to protect the legitimate rights and interests of the rehabilitated person.
Third, community social workers can try to liaise with potential employers of rehabilitated persons to minimize possible employment discrimination; finally, use social advocacy strategies to carry out community education to reduce the stigma of mental illness and promote the government to establish a system conducive to the development of the recovered. For example, with reference to Hong Kong's practice of providing "halfway dormitories" for mentally rehabilitated persons, a vocational training system for step-by-step rehabilitation has been established to provide rehabilitation with the institutional guarantee of equal employment opportunities of "making the best use of their talents", rather than just providing sheltered workshops for simple manual work without discrimination.
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Link,B.G.,Struening,E.L.,Todd,S.N.,Asmussen,S.,Phelan.J. (2001) Stigma as a Barrier to Recovery:The Consequences of Stigma for the Self-Esteem of People With Mental Illnesses.PSYCHIATRIC SERVICES,52,1621-1626.
Rüsch, N.,Angermeyer,M.C.,Corrigan,P.W.(2005). Mental illness stigma:
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Szeto,A. C.H.,Dobson,K.S.(2010). Reducing the stigma of mental disorders at work: A review of current workplace anti-stigma intervention programs. Applied and Preventive Psychology,14,41–56.
Author| Li Qiaoming;
Editor| Nozon; Walk Away;
Proofreading | Liu Jun.