Two Films, Two Ways of Seeing Mental Illness

Inner Senses and Insanity are both films written by Derek Yee, released in Hong Kong cinemas in 2002 and 2015 respectively. Each takes mental health as its subject, and each is built around a psychiatrist and a patient. Thirteen years apart, the two films sketch very different ways of seeing mental health. By comparing them, the author hopes to draw out the shift that has been taking place within the profession in how mental health is understood.

Inner Senses and the Traditional Medical / Rehabilitation Model (Medical / Rehabilitation Model)

The traditional medical or rehabilitation model is centred on returning the patient to their former state. The patient is understood chiefly through the illness itself, with treatment plans built on a pathological and scientific reading of the case. This model therefore places heavy emphasis on the responsibility and role of the professional, while the patient is expected to follow the professional's guidance and instructions on the road to recovery.

In Inner Senses, the way Dr Law (played by Leslie Cheung) assesses and intervenes with the patient Cheung Yan (played by Karena Lam) fits this model closely. First, Dr Law interprets Cheung Yan's condition as an abnormality in the brain. At the same time, by reading the patient's diary, he comes to understand the major traumatic events in her life and her family background (whether this is in keeping with ethical principles is not the focus of this article, and so will not be discussed here). After that, beyond prescribing medication to manage her symptoms, he also invites her parents in, creating an opportunity to guide Cheung Yan in voicing the resentment and hurt she had carried for years over her parents' acrimonious divorce. In the end she is healed, and her symptoms are never mentioned again. Throughout, the process leans heavily on the patient's cooperation and on her following the doctor's instructions, with the entire treatment plan led and devised by the doctor, until at last her symptoms clear.

Insanity and the Recovery Concept (Recovery Concept)

Scholars overseas put forward the recovery concept in the 1990s. They argued that, beyond the help of professionals, a person recovering from mental illness has their own abilities and attitudes, and that the care, encouragement and support of trusted people around them can also do much for their recovery. Although mental illness will impair their functioning to some degree, by restoring meaning to life and rebuilding their abilities they can still re-engage with the community, live a meaningful life, and take on the responsibilities that belong to their own recovery, daily living, self-care and the various roles they hold. Healing is a lifelong process, and it does not simply improve in a straight line; along the way there can be setbacks or periods of standing still, and so relapse is possible — and this is part of the process. Unlike the traditional model, here the professional and the person concerned are partners working together, with treatment and rehabilitation plans led by the person in recovery. In Hong Kong, "recovery-oriented" care was first raised in the Hospital Authority's review of mental health services in 2007, and was gradually rolled out through the mental health service plan of 2010–2015. In the social welfare sector, organisations also began introducing the concept to deliver services from 2010.

In Insanity, Ah Sang (played by Lau Ching-wan) is a patient with schizophrenia who, in the grip of his illness, kills his wife in a delusional state and is ordered by the court to be committed to hospital. Different moments in the film bring parts of the recovery concept to life. After three years of treatment in the psychiatric hospital, his attending physician Dr Cheung Ming-kit (played by Huang Xiaoming) recommends that he be approved for discharge, so that he can re-engage with community life. The film does not detail the course of treatment, but it does detail the doctor's process of assessing him before recommending discharge. During the assessment, beyond understanding the shifts in his inner emotions through the drawings in Ah Sang's notebook and learning about his symptoms in interview, the doctor spends some time understanding his aspirations for life after discharge (even if all he wants is to find a job), and also puts him through a simulated phone-call stress test, to gauge whether — if old matters were brought up to him after discharge — he could cope with the stress. Beyond being a test, it is also a way of restoring Ah Sang's sense of hope.

And after his discharge, were there no symptoms at all? No. When he stopped his medication on his own, hallucinations, voices and delusions would surface from time to time, leaving him distressed — for instance, he would hear his mother-in-law walking up to his home and pounding endlessly on the door, and learn through a hallucination that he had killed not only his wife but also the baby in her womb. This shows that his recovery was bound to rise and fall rather than follow a steady line. Even so, he comes to know how to manage these symptoms, and knows that he needs to return to the hospital for follow-up.

When Ah Sang was discharged, the social worker arranged a hostel for him to live in. But later, when Ah Sang ran into Dr Cheung while working in a restaurant, he revealed that he had chosen to move out and live on his own, hoping for a little freedom and comfort; Dr Cheung responded to his choice with respect and support. This relationship fully shows the respect and trust between the two, and shows that a person in recovery can make choices about their own life and take responsibility for them. By the same token, after Ah Sang later "killed by mistake" a drug user on the rooftop, it was precisely because he had already healed that he was willing to take on legal responsibility for his offence.

Conclusion

From these two films of different periods, we can see the shifting service models within mental health in our city. The two models are not necessarily mutually exclusive. The difference between them lies in whether the gaze is focused on the patient's "illness" and "problems", or on their "humanity" and "abilities". As the profession begins to shift its perspective, the hope is that the public, too, will update theirs — only then can the stigmatisation of people with mental illness be gradually erased.

References

Ling Tsui-man (trans.) (2014). 100 Ways to Support Recovery (2nd ed.). Hong Kong: New Life Psychiatric Rehabilitation Association.

Yeung King-wan (2015). Mental Health Rehabilitation Counselling Work: Theory and Cases. Hong Kong: The Commercial Press.

Ip Kam-shing (2011). Psychiatric Medical Social Work: Beliefs, Theory and Practice. Taipei: Psychological Publishing.

Hospital Authority (2011). Hospital Authority Adult Mental Health Service Plan 2010–2015. Hong Kong: Strategy and Planning Division, Hospital Authority.