Schizophrenia, a way of being-in-the-world : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University

Abstract

This phenomenological study describes what it is like to live with a schizophrenic illness and relates the understanding gained from this descripton to implications for nursing practice. The participants in the study were ten adults who have been diagnosed with schizophrenia, who take regular medication and who are living independent lives in the community. Over a period of sixteen months they were interviewed about the effects of the illness on their everyday lives. During this time they explained the challenges and difficulties which have faced them, both during and long after the resolution of acute illness. As they describe it, schizophrenia is a part of who they are. The narrative contained in this thesis presents the participants' stories in aggregated form, setting their experiences alongside ideas from the early work of Martin Heidegger, whose phenomenological writing informed the analysis and interpretation of the data. As the participants explain, schizophrenia has touched every aspect of their lives. Living with schizophrenia is shown to affect their whole Being-in-the-world. It incorporates Being-with-others, living carefully and taking a stand on life. While hoping for a cure, their reality is of living with a chronic illness which has major effects on their lives. At the same time the participants are shown to define themselves not in terms of their illness and treatment, but in respect of their hopes and dreams and the stance each is taking on his or her own life. In this way their existential predicament is highlighted in the study. Participants are on the one hand very much like all other people, while on the other hand they have to contend with very different concerns than do most others. In itself the description of the experience of schizophrenia contained in the thesis is useful for its potential to increase understanding of the illness by nurses and other health professionals. Further than this, however, the study is shown to have implications in terms of nursing practice and the provision of health care. With regard to the seriously mentally ill the data bring into question some of the theoretical positions which have held sway in nursing for many years. The research demonstrates that it is practicable to attend to the subjective experiences of people who suffer from schizophrenia and to understand their needs and desires from the position of fellow human being, without the need for a guiding theory from which to interpret what they are saying or what their words "really mean." It is argued that relationships between nurses and clients which are based on understanding and trust rather than distance hold promise in the care of those with schizophrenia. Heidegger's concept of solicitude as care for others is addressed in this regard, and is shown to be most appropriate as a basis for nursing care in the mental health arena.