Academic journal article East Asian Archives of Psychiatry

Beyond the Clinical Model of Recovery: Recovery of a Chinese Immigrant Woman with Bipolar Disorder

Academic journal article East Asian Archives of Psychiatry

Beyond the Clinical Model of Recovery: Recovery of a Chinese Immigrant Woman with Bipolar Disorder

Article excerpt


Recovery from serious mental illness can be conceptualised in a number of ways, some more helpful to clients than others. This paper aimed to show that the clinical model of recovery, based on symptom relief, return to function, and freedom from hospitalisation, is a limited one and that a holistic approach is needed. The author has chosen to narrate her own story. She is a Chinese immigrant from Hong Kong to Canada suffering from bipolar illness, who was hospitalised several times and, eventually, achieved full recovery. The recovery of the author illustrates the limitations of the clinical model of recovery. Her story demonstrates the importance of the principles of empowerment, as achieved through self-management, social support, meaningful occupation, and spiritual fulfilment. The empowerment model of recovery is recommended for the use of mental health professionals, with special attention to individual client factors such as culture and gender.

Key words: Bipolar disorder; China / ethnology; Emigrants and Immigrants; Personal narratives

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Introduction For most of the 20th century in North America and Europe, people with severe mental illnesses were not expected to recover.1 Until the 1980s and even as late as the beginning of the 21st century, many professionals in North America viewed recovery as meaning adherence to prescribed medications, following the rules as set by one's doctor, establishing control over symptoms, and avoiding re- hospitalisation. Beyond that, not much was expected from clients. The clinical model of recovery is still based on the same criteria: treatment adherence, symptom reduction, restoration of function (sometimes an attempt at cognitive rehabilitation is incorporated into the clinical model), and staying out of hospital. It emphasises the view from the outside, i.e. the clinician's assessment, rather than taking the patient's subjective view into account.2

It was not until 2005, after the report by the 2003 President's New Freedom Commission on Mental Health, that mental health professionals began to consider the necessity of changing their view on recovery.3 In December 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) defined recovery as "A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential."4

In this article, I will be using my own case history, a Chinese female immigrant to Canada, diagnosed with bipolar disorder, to illustrate the process of recovery. I will show the limitations of the clinical model of recovery, and demonstrate the effectiveness of the empowerment model of recovery, thus, reinforcing the SAMHSA definition. Every country has its own mental health system. The procedures differ and mental health legislation may vary. But the experience of illness and recovery that I encountered as an immigrant to Canada are in many ways universal, shared by survivors of different races and cultural backgrounds living in different parts of the world. I hope that my first-person narrative will prove helpful to mental health professionals in treatment of their psychiatric clients.

My Illness

My first episode occurred in 1973 when I was 21 years old, after my return to Hong Kong from studying at the University of Minnesota, and after travelling on my own for 2 months in Europe. I had had a fight with my boyfriend and was upset. A doctor at The University of Hong Kong medical clinic prescribed some pills, and I was able to sleep and concentrate on my studies. However, not knowing much about illness or medication, my mother snatched away the pills and would not let me take them. After that, I could not sleep; I frequently lost my temper and yelled at my parents in English (which they could not understand). My mother called a psychiatrist. Against my will, I was sent to the psychiatric ward of a general hospital and was cared for by private nurses during a 2-week observation period. …

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