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

[摘要] 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.

[发布机构] Stellenbosch University