Personal experience of schizophrenia and the role of Danwei: a case study in 1990s Beijing.

Danwei as a cornerstone of Chinese urban society has received great research attention. The relationship between the Danwei and psychiatric patients, however, remains unclear. This article aims to shed light on the subject with an integrated micro-macro approach. It introduces a historical understanding of mental health in urban China under the "economic state in transition" framework. A detailed case study in clinical sociology is provided to reveal the many social factors affecting the experience of a schizophrenic patient and his significant others. A changing role of the Danwei is hypothesized and validated with qualitative data. The Danwei was shown to have changed significantly before the mid-1990s, yet it still played a major role in urban workers' lives, including those of psychiatric patients, and even more so in people's expectations. This lends support to the need for a more responsive public policy to address various social issues brought about by economic reform, with the learning of worldwide experiences including "community care," "social support" and "social rehabilitation." Implications for social research, policymaking and professional practice are discussed.

Understanding the self-care strategies of patients with asthma.

OBJECTIVE: The objective was to understand how adults living with asthma deal with their chronic illness, perceive self-management and develop self-care strategies. METHODS: 24 in-depth, semi-structured interviews were conducted in Montreal, Canada with low- and middle-income adults living with asthma. The interviews were tape-recorded and transcribed for purposes of analysis. The analysis consisted of debriefing sessions, coding and interpretive analysis. RESULTS: We identified 3 types of self-care strategies adopted by the participants in order to deal with asthma: (1) strategy of controlling symptoms leads to patients following the recommendations of their physician; (2) strategy of preventing symptoms involves a holistic approach to treating illness, and leads patients to prefer lay methods and alternative treatments for preventing symptoms instead of relying on medications; (3) strategy of tolerating symptoms leads people to experience aggravated symptoms and to seek emergency care. CONCLUSION: This study reveals that important subjective as well social factors influence the way people deal with a chronic illness like asthma. Future research should: (1) identify the difficulties encountered by vulnerable patients in regard to treatment and care interactions; (2) provide health professionals with the right tools so that they can take into consideration the treatment perceptions and the effects of life conditions on self-management. PRACTICE IMPLICATIONS: Patients with asthma need comprehensive care that addresses social conditions, reluctance to take medication, exploration of lay and alternative treatment and difficulties in accessing preventive care.

Help-seeking behaviors of Chinese patients with schizophrenia admitted to a psychiatric hospital.

PURPOSE: To investigate the help-seeking behaviors and related factors of Chinese psychiatric inpatients with schizophrenia. METHOD: Two hundred and two patients with schizophrenia (ICD-10) were enrolled in this study. A locally-developed, semi-structured questionnaire was used to collect data, including data on illness and help-seeking histories from patients, informants, and medical records. RESULTS: Among 202 inpatients, 120 patients (59.4%) had sought help from at least one type of non-psychiatric facility (NPF), and 82 patients (40.6%) went to a psychiatric hospital directly. Among the NPFs they contacted, 66 patients (32.7%) tried traditional Chinese medicine (TCM) from licensed practitioners (including acupuncturists), 64 (31.7%) chose general hospitals (including 9 who went to emergency departments), and 52 (25.7%) sought help from qigong (breathing exercise) masters or other folk healing methods. The reasons for seeking treatment from NPFs varied; the most common ones included feeling shameful or stigmatized about going to psychiatric hospitals, inaccessibility to or unavailability of psychiatric hospitals, and fear of being incarcerated or receiving electric shock treatment. CONCLUSION: A substantial proportion of psychiatric inpatients in China seek help from non-psychiatric facilities and/or folk healing methods. Feeling shameful or stigmatized, inaccessibility to and/or unavailability of psychiatric services are among the most common barriers to seeking psychiatric treatment. Patients who sought psychiatric help directly are likely to be female, with a chronic onset of illness, a mixed syndrome of positive and negative symptoms, or a better economic status.

A esquizofrenia na China: a experiência de Lu Lu / Schizophrenia in China: Lu Lu's experience

A análise apresentada neste texto adota uma perspectiva da sociologia clínica para investigar um experiência pessoal de esquizofrenia, no contexto da sociedade chinesa em plena transformação, aquela dos anos 1990. Uma das hipóteses de base da sociologia clínica é que a experiência pessoal e a experiência da vida em sociedade são parte de um mesmo fenômeno, não podendo, pois, ser dissociadas. Esta abordagem se baseia igualmente na análise do par experiência-representação. Finalmente, a análise aqui apresentada propõe um olhar que deixa entrever uma prática psiquiátrica inspirada na sociologia clínica. O estudo do caso Lu Lu se inscreve no contexto de uma pesquisa realizada em Beijing, entre 1992 e 1995, junto a 20 pacientes que tinham sido anteriormente hospitalizados no Hospital X e diagnosticados, do ponto de vista médico, como esquizofrênicos (AU)

Social welfare policy: social rehabilitation of psychiatric patients in urban China.

BACKGROUND: The background of this paper is an empirical research on social rehabilitation of psychiatric patients in a large urban city in China during the post-Mao period, the Beijing Psychiatric Rehabilitation Research. Another aspect of this background is an exchange with Chen Sheying, a colleague interested in social services for the elderly in China. The underlying assumption of this paper is the multiple similarities between those two areas. OBJECTIVES: The first objective of this paper is to present a contextual analysis of the development of psychiatric rehabilitation in urban China and a second objective is to stress the similarities between psychiatric rehabilitation and social services to the elderly. MATERIAL: The material presented, while referring mainly to the general context of psychiatry and rehabilitation around that period, includes some data from the Beijing research. There are five analytical dimensions: (1) epistemological choices and research paradigms; (2) rehabilitation as an idea; (3) rehabilitation as a social, political and cultural matter; (4) factors of change in the recent history of China; and, finally, (5) mental illness as a personal experience. DISCUSSION: This presentation leads to a discussion about the multiple similarities between the social welfare of two vulnerable categories of people (i.e. psychiatric patients and the elderly). It also offers, in the specific field of mental illness, a general interpretation of the rapid social changes in urban China. CONCLUSION: The conclusion is that psychiatric and ageing services are both a product of interaction among various cultural and social-political-economic factors. Any social welfare intervention or policy should be based on a thorough understanding of the five dimensions referred to earlier, including the traditional Chinese familism and structural dimensions of the post-Mao 'economic state' orientation.