Who are you guys?
“我是 Moreau医生。这位是 Emily。”
I’m Dr. Moreau. This is Emily.
Doctor? Do you have any ID?
We show her our badges. She eyes them suspiciously.
Do you know where you are?
What brought you to hospital?
“没什么 老公昨天晚上回家说我不对劲 他才不对劲 他每天要开三小时的车去公司 回家总是拉了个脸 我觉得我老公有忧郁症 三天前我们吵架 我听我爸爸在说他是耶稣－”
Nothing really my husband came home last night said I was off he’s the one that’s off he has to drive three hours everyday to go to work he’s always _______ at home I think my husband is depressed three days ago we had an argument I hear my dad’s voice saying he is Jesus—
Su’s eyes dart around the walls.
(On entering the nursing station one day I hear Dr. Moreau having a full conversation in Mandarin with Dr. Lam, the only female psychiatrist working there. He labours sentence after sentence when anyone with less patience like myself will have long abandoned the attempt and switched to a more mutually fluent language. Yet it is his persistence that has given him a level of fluency that would be the dream of any kid in Sunday Chinese School, or at least their parents’ dream.)
Is someone listening to us?
_________ is watching me.
Dr. Moreau looks to me. “Organization,” I clarify.
Is the organization after you? Trying to harm you?
She shrugs nonchalantly.
Do you not feel safe here?
She shrugs again.
That’s not it. Maybe the employees here were sent by the organization.
What about us?
I don’t know. It’s possible.
“等会让 Emily 回来再和你谈。等你老公来了， 我们也会和他谈一谈， 好不好？”
Emily will come back in a little while to talk with you some more. Once your husband comes, we’ll also talk to him. Is that ok?”
Su flashes us a cheeky smile as we leave.
I call Su’s husband with the number he’s left us. He tells me he is 10 minutes away from the hospital. While waiting, I talk with Su. Her Chinese is a flood (I silently thank my parents for insisting on Sunday School). She details the gold, blue personality tests they do in her careers counselling class and when redirected, tells me that the purpose of the organization is world peace and somehow, her role is to have a 模范家庭, an exemplary, role-model family. She doesn’t sense any malicious intent but doesn’t know why they are after her. Her father has been dead for over 40 years but now she can hear him. He doesn’t command her to harm herself or anyone, just declares himself Jesus and that Su is Eve and her husband is Adam.
I excuse myself for a moment to speak to her husband Tian who has just arrived on the ward. Dr. Moreau joins us. Tian describes a sudden change within the last week where Su became suspicious of people following them when they were out grocery shopping. Last night, she told him that there were cameras and wire taps in the house. He has never seen her like this. He is bewildered, shaken. Then he asks if he can take his wife home.
Dr. Moreau explains that there will be nurses taking care of Su through the night, and that we will start some medications today to help Su get better. We write out orders for olanzapine and lorazepam.
I bring Tian with me back to Su’s room and update her on what is happening. She isn’t keen on taking any medication but says she’ll listen to the doctor.
It’s an important point of contention: how a patient perceives taking medication for a mental illness, and by extension, recovery. Recovery in mental health is an issue rooted in concepts of illness and in concepts of self.
To depart from individualism to a concept of self that is interdependent and relational, we find something closer to how Su may self-perceive: where the social milieu of people closest to her is not merely backdrop but part of her cognition and decision making. Her family members are part of her self parameters. When a person falls ill, her family members (for is she not also part of them?) will want to take care of her. That may be part of the reason behind Tian’s abrupt request even when clearly he cannot manage alone. This can be maladaptive, another Chinese patient I met around this time divorced her husband to protect him and the children from the demons of her psychosis. The divorce may be a physical attempt to separate herself from the parameters of her family and vice versa. She was determined to be out of their lives though anytime she said she wasn’t needed anymore she would rush into the bathroom to cry unobserved. When it works, the family can be instrumental in the recovery process. They provide the support and social milieu where the patient can function, avoiding hospitalization or homelessness.
Many patients when they describe the psychosis they recovered from will use the metaphor 中邪了, literally, possessed by a demon. Supernatural concepts of mental illness are not uncommon in other parts of the world. This supernatural metaphor punts the disease process outside of patient control. It absolves the patient of the responsibility of the affliction but also responsibility towards recovery. In psychiatric discourse where we ascribe the biological component of mental illness as neurotransmitter imbalances in the brain, the process is localized in the person but still outside of personal control. The concepts of self and illness are at once intracultural and intercultural. It should be part of what we talk about when we talk about recovery in mental health.
When I see Su on the day of her discharge, she is smiling. In exploring her past medical history in the days following her admission, we discovered that Su had suffered from episodes of depression and at least one episode of mania in the past. She was started on lithium, gradually taken off olanzapine. She is to start a daily group CBT program for the two weeks following discharge. There is a follow-up clinic appointment to see Dr. Moreau in 2 weeks. I tell her about community programs and services. When asked about the organization and her father’s voice, she says she doesn’t remember how she came to believe all those things, 好像是中邪了.
In a spasm of indecision, I thought about publishing this series a) after I graduated or b) anonymously. There is something imperative about telling the story now, and that I take responsibility for its telling. Thank you to the colleagues who read and critiqued my drafts. To protect confidentiality I have altered identifying details. All names have been changed, but people are more than their story and any error or misrepresentation is my own.