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The Subjective Experience of Individuals Diagnosed with Schizophrenia in the Western Cape, South Africa

Hamman, Colette (2017-12)

Thesis (MSc)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: Epidemiological research highlights the severity of the symptoms and outcomes associated with a diagnosis of schizophrenia; the burden of which is increasing substantially in many developing countries such as South Africa. Numerous scholars have been critical of the existing research on schizophrenia. It seems that, although the biological underpinnings of schizophrenia are commonly acknowledged, a psychological and subjective perspective on the pathogenesis of schizophrenia has not adequately been incorporated into research of this diagnosis in developing countries. Against this background, this study aimed to achieve a deeper and richer understanding of the subjective experience of a diagnosis of schizophrenia in South Africa. This aim was achieved by exploring how a group of individuals from the Western Cape, South Africa, experience and understand the diagnosis of schizophrenia and its associated symptoms. Informed by a social constructionist theoretical perspective, this study employed a multiple case study design to yield qualitative data. In-depth, open-ended, semi-structured interviews were conducted with twelve people diagnosed with schizophrenia. The transcribed interviews were analysed by implementing social constructionist grounded theory, with interpretations informed by relational psychoanalysis and discursive psychology. Interviews with people carrying this diagnosis uncovered traumatic histories of abuse and submission, highlighting the need to take individual histories seriously, even in people with a diagnosis of schizophrenia. While all of the participants clearly had psychotic experiences, they also experienced rich and diverse emotional worlds often in reaction to disturbed and disturbing intersubjective fields. A complex and vicious cycle of fear, anxiety, and paranoia; shame, anger, and aggression; loneliness and isolation; sadness and even more shame, emerges - not necessarily captured by the diagnosis of schizophrenia. Despite their traumatic experiences and in contrast to their complex experiences of emotional distress, participants, when discussing their diagnosis, quite explicitly and implicitly adhered to a medical discourse of schizophrenia. Informed by this medical model, they constructed themselves as abnormal and as having a dysfunctional brain, which needs to be medically treated. Lastly, caring for others and being cared for by others seemed to be very important for restoring a sense of humanity. This care was mainly provided by families, rather than in the context of the medical model. I argue that, despite the fact that the diagnosis of schizophrenia is helpful and facilitates the medical treatment of the person, it can also obscure some of the very complex emotional experiences of some very traumatised, scared, ashamed, angry, lonely, and sad individuals who carry this diagnosis. This often entails that these people are not dealt with as complex human beings who have been hurt and also leads to them not defining themselves as such. Integrated models are suggested to recognise the suffering behind this diagnosis; these models include subjective and psychological perspectives on the pathogenesis of schizophrenia that promise a caring and humanising approach in a clinical setting.

AFRIKAANS OPSOMMING: Epidemiologiese navorsing beklemtoon die erns van die simptome en uitkomstes wat met 'n diagnose van skisofrenie geassosieër word, waarvan die las aansienlik toeneem in vele ontwikkelende lande soos Suid-Afrika. Vele skoliere is krities oor die huidige navorsing op skisofrenie. Dit blyk dat die biologiese meganismes van skisofrenie algemeen erken word. Nuwe konsepsualiserings van die diagnose wat 'n sielkundige en subjektiewe perspektief op die patogenese van skisofrenie beklemtoon, word egter nie voldoende in navorsing in ontwikkelende lande geïnkorporeer nie. Teen hierdie agtergrond, het die huidige studie beoog om 'n dieper en ryker begrip van die subjektiewe ervaring van 'n diagnose van skisofrenie in Suid-Afrika, te verkry. Hierdie doel is behaal deur te ondersoek hoe 'n groep individue van die Wes-Kaap, Suid-Afrika, die diagnose van skisofrenie en simptome wat geassosieër word met die diagnose, subjektief ervaar en verstaan. Hierdie studie is vanuit 'n sosiaal-konstruksionistiese perspektief (social constructionist perspective), tesame met 'n veelvuldige gevallestudie ontwerp (multiple case study design), uitgevoer, om kwalitatiewe data te lewer. In-diepte, semi-gestruktureerde, oop-einde onderhoude is met twaalf mense wat gediagnoseer is met skisofrenie, uitgevoer. Daarna is die getranskribeerde onderhoude deur middel van sosiaal-konstruksionistiese gegronde teorie (social constructionist grounded theory) geanaliseer, met afleidings wat deur relasionele psigoanalise (relational psychoanalysis) en diskursiewe sielkunde (discursive psychology) verryk is. Die onderhoude het traumatiese geskiedenisse van mishandeling en onderdanigheid getoon. Dit beklemtoon die nodigheid om 'n individu se geskiedenis ernstig op te neem, selfs in mense wat met skisofrenie gediagnoseer is. Die onderhoude het verder getoon dat, terwyl al die deelnemers duidelik psigotiese ervarings gehad het, hulle ook ryk en diverse emosionele wêrelde ervaar wat dikwels in reaksie tot versteurde en vreesaanjaande intersubjektiewe velde plaasgevind het. 'n Komplekse en bose kringloop van vrees, angstigheid en paranoia, skaamte, woede en aggressie, eensaamheid en isolasie, hartseer, en nog meer skaamte, verskyn - wat nie noodwendig deur die diagnose van skisofrenie beskryf word nie. Dit het ook voorgekom asof, tenspyte van hul traumatiese ervarings en in teenstelling met hul komplekse emosionele ervarings, pasiënte se besprekings van hul diagnose, implisiet en eksplisiet aan die mediese diskoers van skisofrenie voldoen het. Volgens hierdie mediese model, konstrueer deelnemers hulself as abnormaal en in besit van 'n disfunksionele brein wat medies behandel moet word. Laastens, blyk dit of sorg vir ander en om versorg te word deur ander, baie belangrik is om 'n sin van menslikheid te herstel. Hierdie sorg was hoofsaaklik deur families, eerder as in die konteks van die mediese model, voorsien. Ek argumenteer dat, tenspyte van die feit dat die diagnose hulpvaardig is en dit die mediese behandeling van die persoon fasiliteer, dit ook sommige van die komplekse emosionele ervarings van getraumatiseerde, bang, skaam, kwaad, eensaam en hartseer individue wie die diagnose dra, kan versteek. Dit behels dan dikwels dat hierdie persone nie behandel word as komplekse mense wie seergekry het nie en ook nie hulself as dit ervaar nie. Geïntegreerde modelle word voorgestel wat die lyding wat met 'n diagnose van skisofrenie gepaardgaan, erken. Dit sluit subjektiewe en sielkundige perspektiewe op die patogenese van skisofrenie in en beloof 'n versorgende en menslike benadering in 'n kliniese omgewing.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102965
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