Social and Behavioural Sciences for Nursing - Essay Example

? Patient Narrative Introduction This paper seeks to give a narrative of John (not his real , a mentally ill patient diagnosed with schizophrenia that saw him in and out of a psychiatric hospital located in their community. John’s mother who spent considerable time with him at home and in hospital consented to the information she gave on John being given as a narrative in this paper. As such, this paper seeks to narrate the mentally ill patient’s experiences from psychological, sociological and cultural perspectives as shared by the mother. Various appropriate secondary sources will be used to interpret these experiences from social and behavioural science point of view. At age 18, John had been admitted into a psychiatric hospital thrice. Initially, he experienced lack of sleep and was confused holding paranoid beliefs and some grandiose. He saw familiar faces in the faces of strangers causing espionage traits. This made John believe that he was in danger of losing his free and spontaneous thinking ability. According to the mother, John exhibited poor concentration but was high in tension, fear and vigilance which Mueser and Jeste (2008), just as his psychiatrist, attribute to psychosomatic chest pains. Because of the history of psychosis in the family, the psychiatrist easily diagnosed schizophrenia in John. John’s mother recalled how the news was broken to them with the indication that their son would be under medication for the rest of his life traumatising them. These were John’s unique symptoms of a psychological disorder as each patient experiences unique symptoms and as such have unique ways of coping with the same (ed. Steel 2013). In the UK, Weinberger and Harrison (eds. 2011) document between 0.2% and 1% of people experiencing similar problems associated with schizophrenia at any particular time. These people occupy 8% of the hospital beds in Canada. The US has an even higher prevalence of the disorder standing at 1.2% of the total population, with the global data being even higher. Interestingly, one out of a hundred persons would be diagnosed with schizophrenia in their lifetime with diagnosis common in early adulthood at ages 18 to 25 for males and 25 to 30 and again at about 40 for females. The significance of prevalence of this disorder points out at the importance of understanding the perspective of the patient so as to be able to give a more client focussed approach in delivering health care to the community. In this case, John’s life journey informs an appropriate narrative to understand his illness from psychological, sociological and cultural perspectives. Social Perspective John was born into a poor family living in the inner city with the mother having four children each with different unknown fathers. This economic consideration provides a relationship between poverty and schizophrenia because ideally, schizophrenia, just as many other mental illnesses, affects people from poor backgrounds more than those from the more affluent areas. Clinard and Meier (2008) use the isolation theory to explain this phenomenon noting that poverty combined with social isolation would likely trigger psychosis among vulnerable individuals. Supporting this theory is Aneshensel and Phelan (eds. 2006) who postulate that social processes and arrangements form the basis of understanding the causes and consequences of mental illness. In fact, the tag of being mentally ill qualifies as a social transformation in itself. John being a child from a poor family thus explains his condition; an economic condition which was worsened by the expenses that arose from the care that John needed. After spending considerable time in the psychiatric hospital, John was integrated back to the society so as to assist him lead a normal life. This community care policy has benefitted John a great deal as it helped him appreciate himself as any other human. Even so, the community could not really embrace John back normally. Their perspective of the lad had changed, viewing him as an abnormal human being. This points out to social cognition. Social cognition according to Couture and Penn (2013) refers to the manner in which people make sense of others. The exhibition of hallucinations, obsessions, compulsions, depression and withdrawal by mentally ill patients provide a way for people to peg brands on such persons (Clinard & Meier 2008). Since John exhibited traits that defied social order, he was considered as abnormal. He was constantly delusional and hallucinated regularly. He kept a low profile, mostly preferring to be alone, though at times he would burst out, particularly when confronted. These traits scared people away from him and got him nicknames of all sorts based on one’s interpretation of his traits. According to Hinshaw (2007), mental disorders attract social interchange that would most likely shape responses and reactions from people. If such responses and reactions are deemed negative, then the author refers to this as stigma. This faces a majority of mentally ill persons like John, who would be excluded from most of the life’s common roles due to his condition. He would for instance not be allowed to vie for any seat in the community welfare groups as he was deemed to lack leadership skills due to his schizophrenic condition. Even in church, the priest did not allow him to conduct church services or join the choir in spite of his melodious sound. Despite his abilities, the community focussed on his mental condition that caused him to exhibit traits that did not auger well with the society. No one was interested in finding a way of accommodating John with his condition but instead came up with myths as to why he behaved the way he did. Furthermore, coming from a religious community, John faced a lot of discrimination because people considered him as being possessed by evil spirits. Other religious people believed that John and/or his family had committed grievous sins and John’s mental condition was God’s way of punishing their sinfulness. Therefore, the religious members of the community from where John came from distanced themselves from the boy and the family as they considered themselves righteous to be in the company of sinners. In fact, the day his mother made the priest of their church know about her son’s condition, the priest advised that he keeps off any church activities lest God gets angry with the whole church. He further advised that they make sacrifices that would appease God to wholly cleanse the family of their sins and see John get well. He was widely considered to be mad; a postulate which Aneshensel and Phelan (eds. 2006) indicate has been replaced with medical approaches in the modern world which appreciate the condition as a disease and attributes it to the imbalances in the four humours of the body: yellow bile, black bile, phlegm and blood. John could not secure himself any employment as employers feared that he could not meet job demands with a majority particularly fearing that his condition could cause him to mess at work instead of creating value. The only time he would be considered would be when vacancies exist for work that appear nasty to be undertaken by normal human beings. For example, John once met a retired surgeon who wanted to establish a funeral home and approached John to be an undertaker claiming that it was not right for him to stay without a job while he could get him one. His mother recounted how she would be warned of being accompanied by her son for social functions due to the fear of his outbursts. This trend has been edited by Steel (2013) who through the social drift theory argues for development of psychotic experiences among individuals combined with treatment effects as being disadvantageous for employment opportunities and social functioning of the affected persons. Therefore, John, just like other people with psychological challenges, drifted further into lower socio-economic circumstances ending up sharing in the mother’s poor housing with no form of employment. In spite of the direct relationship between schizophrenia diagnosis and poverty, its cause or effect postulate remains unproved (Andresen, Oades & Caputi 2011). Psychological Perspective Psychology suggests mental disorder such as the one John faces as an outcome of particular personality types which would be determined through learning experiences or conditioning. As such, these people exhibit cultural patterns or interpersonal relations that trigger social recognition of such consequences as mental disorders (Clinard & Meier 2008). By the time John was being diagnosed of schizophrenia, he exhibited a myriad of traits that could point out to his mental illness. He exhibited delusions which according to Weinberger and Harrison (eds. 2011) points out to traumatic brain injury in most cases, though for John, this argument did not hold as genetic functioning better explained his experience. He reacted extremely to any form of criticism and regularly experienced insomnia. John would experience reality distortions that impaired him from performing adequately which Haviland et al. (2008) observe would withdraw such persons from the social world and condemn them into their own psychological shell. Indeed, John always preferred living an isolated life. He also experienced hallucinations according to his mother, which Steel (ed. 2013) describes as sensory perceptions of non-existent stimuli. When John’s mother would listen to John taking to himself or at times in his dreams, John thought that the people around him have changed. But according to the family, it is John who had changed and become unable to hold down to his activities or relate to others as he used to. Pierce (2003) appreciates this trait among mentally ill patients referring to this as the prodromal period where the patient feels that their world has changed whereas the other people do not share in this thought. This normally marks the boundary to the acute stage. Even though environmental factors could be attributed to schizophrenic traits, John’s case could have been hereditary, his family having had schizophrenic members before. Haviland et al. (2008) acknowledge the role of biochemical disorder which according to Mueser and Jeste (2008) is an inheritable disposition. Based on the history of the family of John, the community segregated the family considering them as outcasts and perhaps people who should not be allowed to live with others in a normal society. It became almost apparent in the community that bearing the name of the family from which John came from worked to the disadvantage of the subject. Parents warned their children to keep off the family in fear of the safety of their children, a trend that left John lonely. This psychologically influenced John to believe that he was meant to be alone and would find it difficult making friends. Because of this, John exhibited lack of interest in the day-to-day activities and would frequently suffer depression. According to Steel (ed. 2013), there exists convincing evidence of the effectiveness of psychological intervention in reducing the distress and disability caused due to psychotic experiences. The most common of psychological therapies in this context is the Cognitive Behaviour Therapy, CBT which involves the examination of thinking patterns associated with varied behavioural and emotional problems. In applying this approach in John’s case, the psychiatrist established the relationship between feelings, thoughts and actions in an accepting and collaborative environment. It took John 18 sessions that involved the therapist carefully listening to John’s expression of own thoughts and consequently making the appropriate assessment. This helped John greatly improve from the acute stage of his condition to the prodromal stage. To understand the recovery process from schizophrenia by John, this paper borrows from Andresen, Oades and Caputi (2011) who give an indication of two steps to recovery: why me and what now. The ‘why me’ stage refers to the identity confusion stage where one struggles with reconciling pre-illness identity with the emergent identity of the mentally ill person. John considered his schizophrenic condition as the illness was personified in that it was separated from the healthy self. His mother would listen to him wondering aloud why God chose him as a target for the problems he was going through. In the ‘what now’ stage, John was involved in identity reconstruction where he constructed meaning for the illness and carried on to develop a new identity that has a positive sense of self. For John, this stage came with numerous changes in lifestyle and life’s values. He appreciated his condition and started interacting with other family members, taking medication as required without coercion. Cultural Perspective Cultures differ in their consideration of either the normal or the abnormal. According to the Universalist perspective edited by Aneshensel and Phelan (2006), mental disorders exhibit a lot of similarities but expression would differ from one culture to another. This has been further reinforced by the cultural relativist approach which postulates that some disorders would be unique to a specific culture and would thus be understood from the perspective of that culture. Haviland et al. put this into perspective noting that “abnormality involves the development of a delusional system of which culture does not approve” (2008, p. 145). Indeed, by John isolating himself from the other members of the society, he exhibited traits that did not conform to the society’s expectations. Just as most of the other people diagnosed with psychiatric disorders, John was socially excluded. People considered him as being mad and would not therefore wish to associate with him. Hinshaw (2007) acknowledges that some cultures in the US and the UK term psychological disorders such as schizophrenia as madness. Moreover, the community considered John’s mental condition as being contagious. Parents would warn their children against playing or engaging in any way with John fearing that other than endangering their security, he could transmit the disorder to their children. The few who dared interact with him could not share their personal effects with him for fear of contracting the illness. When their distant relatives would visit, they feared sharing a meal or bed with John as they thought this would cost them their normal mental functioning. This left John in a lonely world of his own most of the times. While studying the virus etiology for schizophrenia, Pearce (2003) found no data suggesting active contagiousness of schizophrenia from patients, to an extent where they cause other persons to be mentally ill. To put this into perspective, the scholar appreciates that if there existed any virus that could cause schizophrenia to be contagious, it could either be long gone or fail to be contagious as at the time of psychiatric symptoms arising. Therefore, the society and family treating John as a patient suffering from a contagious condition was a misplaced consideration. Haviland et al. (2008) argue that African Americans seek for treatment when the disease has advanced, often seeking the help of extended family first before moving on to other relationships. The information given by John’s mother gives an indication of this behaviour which John attributes to fear of being perceived as a weakling by the community due to seeking assistance, hence the reason for delaying in informing relevant persons of his condition. John only confided in his mother the fears of his uniqueness from his peers and would occasionally consult his uncle on the same. This follows the argument by Basavanthappa (2008) that information sharing happens easily among people with good relationships. After the depletion of such resources is when such persons consult specialists for treatment. However, John sought medical attention within reasonable time for diagnosis and administration of appropriate treatment. Perhaps this could be the reason for his swift recovery from the condition. Considering his education, John was taken to be different from his normal peers in school; the mother sent him to a special school that handled such students with mental illness. The society feared that schizophrenic students, just as any other mentally ill patients suffer from slow learning. They feared that such students would drag behind the rest of the students in learning thus leading to the whole lot of students performing poorly in school. Lastly, the society considered such students as a safety risk to the rest of the students and even the teachers at large. As such, John’s mother had to enrol her schizophrenic son into a school meant to take care of special needs of such children. In fact, the institution was referred to as a school for children with special needs. This reference not only affected John but also his family who did not appreciate referring to their son as being special based on his health condition. But the cultural stands in the community required such children to be taught in an exclusive environment, provided with special facilities and taught by teachers trained to handle their unique needs. A majority of the students in the school that John attended were non-White according to his mother. The community greatly associated mental illness with African Americans and other minor races. Going by the observation by John’s mother, this statistics then holds. But supporting this observation with scholarly facts, Aneshensel and Phelan (eds. 2006) attributes this to the difference in cultural practices. According to the scholars, Whites seek counselling for every stressor they face no matter how minimal. But the African Americans and indeed the other minor races resort to counselling or similar therapies at advanced stages. Economic misgivings could be a major contributor to this trend coupled by the lifestyle of survival through difficult times. As such, the former tend to be more exposed to mental illness as perceived by the community where John comes from. Conclusion This narrative centres on John, a schizophrenic patient whose life’s journey provides the basis for this paper from a social, psychological and cultural perspective. John’s mother who took care of John at home and when in hospital, gives information that exhibits John’s social exclusion due to society’s cultural beliefs and stigma. Psychologically, John experienced challenges that made him socially withdrawn because he believed that the world has turned against him. With schizophrenia being a psychological condition, CBT provided an appropriate treatment for John who recovered but faced opposition from being wholly integrated into the community due to social cognition that propagates stigma. He was enrolled into a special school which culturally, the society deemed appropriate for John as they feared that he posed safety risk to their children and risked dragging them behind in learning. Therefore, this narrative provides insights into appreciating the behaviours exhibited by schizophrenic patients from the patient’s perspective. This plays an important role in providing an integrated healthcare to such patients. References Andresen, R, Oades, LG & Caputi, P 2011, Psychological recovery: beyond mental illness, John Wily & Sons, West Sussex. Aneshensel, CS & Phelan, JC (eds.) 2006, Handbook of sociology of mental health, Springer, New York, NY. Basavanthappa, BT 2008, Community health nursing, 2nd edn, Jaypee Brothers Medical Publishers, New Delhi. Clinard, MB & Meier, RF 2008, Sociology of deviant behaviour, 13th edn, Thomson Higher Education, Belmont, CA. Couture, SM & Penn, DL 2013, ‘Introduction’, in DL Roberts & DL Penn (eds.), Social cognition in schizophrenia: from evidence to treatment, Oxford University Press, Oxford. Haviland, WA, Prins, HEL, Walrath, D & McBridge, B 2008, A cultural anthropology: the human challenge, 12th edn, Thomson Higher Education, Belmont, CA. Hinshaw, SP 2007, The mark of shame: stigma of mental illness and an agenda for change, Oxford University Press, Oxford. Mueser, KT & Jeste, DV (eds.) 2008, Clinical handbook of schizophrenia, The Guildford Press, New York. Pearce, BD 2003, Can a virus cause schizophrenia?: facts and hypothesis, Kluwer Academic Publishers, Massachusetts. Steel, C (ed.) 2013, CBT for schizophrenia: evidence-based interventions and future directions, John Wiley & Sons, West Sussex. Weinberger, DR & Harrison, P (eds.) 2011, Schizophrenia, 3rd edn, John Wiley & Sons, Hoboken, NJ. Read More