What makes Chinese adolescents “trapped” in severe mental illness? An interactionist perspective on self and identity

ABSTRACT

The aim of this study was to explore the self and identity perspectives among Chinese adolescents with severe mental illness (SMI), with a focus on their illness experience and subjective meaning of a formal diagnosis. Thirty-one Chinese adolescents were interviewed and the interview data were analysed strictly according to principles suggested by the constructivist grounded theory approach. Five theoretical codes emerged in this study, including changes of personal values and beliefs, accumulated persistent developmental challenges and personal stresses, ineffective coping strategies and development, symptoms and development of mental illness, and changed perceptions and understandings of self. A proposed model of “The dynamic interactions of Chinese adolescents’ identity and mental illness”, was constructed and visualized. The results revealed that adolescents’ identity formation is a fluctuating and non-linear process, but tends to be predominantly negative. The negative self, as informed by long-term ineffective coping with accumulated persistent developmental challenges and stressful events, develops towards a more serious status of negative identity and contributes to relapse symptoms, although this impact occurs variably with perceived personal characteristics. Besides, some participants who had achieved a state of “Buddha-like numbness” made a conscious decision to live a seemingly normal life while coexisting with their illness. The study also highlighted the positive aspects of identity formation that can arise from the experience of illness, including an enhanced sense of realism and increased empathy. Our findings will imply much the need for person-centred treatment plan and services that take into account of individual situations.

KEYWORDS:

• Chinese
• adolescents
• severe mental illness
• self
• identity
• constructivist grounded theory

Acknowledgments

The authors would like to thank all the adolescents for their participation and contribution to this study. Many thanks also to their parents for understanding and agreeing to their children’s participation in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The data and materials that support the findings of this study are available from the authors upon reasonable request.

Authors’ contributions

Yihan Wu devised the research project and the main conceptual ideas. Marcus Yu-Lung Chiu was involved in planning and supervised the research project. Yihan Wu, Weiyun Wu and Sijia Han wrote and revised the manuscript in consultation with Marcus Yu-Lung Chiu and Jing Wang. All authors discussed the results and commented on the manuscript.

Ethical approval

This study was approved by Ethics Committee of Nanjing Normal University and City University of Hong Kong. Informed consent to participate and publish was obtained from all the participating adolescents and their parents.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Social Science Foundation of Jiangsu Province (Grant Number: 23SHC009); the General Project of Philosophy and Social Science Research in Universities in Jiangsu Province (Grant Number: 2023SJYB0243); the Research Starting Foundation for Talented Scholars of Nanjing Normal University (Grant Number: 184080H202A177).

Notes on contributors

Yihan Wu

Yihan Wu is currently an Assistant Professor at the Nanjing Normal University, China. Dr. Wu is interested in child and adolescents social work, health issue and well-beings. Her published works focus on child and adolescents’ emotions and mental health issue, child development, health promotion and public health.

Marcus Yu Lung Chiu

Marcus Yu Lung Chiu is currently a Visiting Professor of School of Health and Wellbeing, University of Bolton, UK and a Research Professor of Caritas Institute of Higher Education, Hong Kong. He lectured in different universities in HK and Singapore, and has been widely known for his advocacy work with family caregivers of people with mental illness in Asia. His research interests include mental health, family caregiving, psychoeducation, programme evaluation, and social inclusion of disability groups. He is the Co-editor of Social Work and Social Sciences Review, and a board member of a number of peer-reviewed journals.

Weiyun Wu

Weiyun Wu, BSocSc in Social Work, is currently a Master of Social Work student at the Nanjing Normal University, China. He is also a registered Assistant Social Worker in China. He researches on school social work and social work education.

Sijia Han

Sijia Han, BSocSc in Social Work, is currently a Master of Social Work student at the Nanjing Normal University, China. She researches on mental health social work and youth issues.

Jing Wang

Jing Wang is currently the Head of Clinical Nurse of the Pediatric Department at Affiliated Jianhu Hospital of Nantong University Xinglin College. She has been engaged in pediatric nursing work for more than ten years, with particular attention paid to psychological nursing and disease rehabilitation guidance for hospitalized children.