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Existential Concerns of Individuals Living with Chronic Mental Illness in Guam PDF

297 Pages·2016·1.31 MB·English
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Antioch University AUR - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Teses Dissertations & Teses 2013 Existential Concerns of Individuals Living with Chronic Mental Illness in Guam Christina Maria B. Dela Cruz Antioch University - Seatle Follow this and additional works at: htp://aura.antioch.edu/etds Part of the Clinical Psychology Commons, and the Mental Disorders Commons Recommended Citation Dela Cruz, Christina Maria B., "Existential Concerns of Individuals Living with Chronic Mental Illness in Guam" (2013). Dissertations & Teses. 51. htp://aura.antioch.edu/etds/51 Tis Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Teses at AUR - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Teses by an authorized administrator of AUR - Antioch University Repository and Archive. For more information, please contact EXISTENTIAL CONCERNS OF INDIVIDUALS LIVING WITH CHRONIC MENTAL ILLNESS IN GUAM A Dissertation Presented to the Faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment of the Requirements of the Degree Doctor of Psychology By Cristina Maria B. Dela Cruz June 2013 EXISTENTIAL CONCERNS OF INDIVIDUALS LIVING WITH CHRONIC MENTAL ILLNESS IN GUAM This dissertation, by Cristina Maria B. Dela Cruz, has been approved by the committee members signed below who recommend that it be accepted by the faculty of the Antioch University Seattle at Seattle, WA in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY Dissertation Committee: __________________________ Patricia L. Linn, Ph.D. Chairperson __________________________ Melissa J. Kennedy, Ph.D. __________________________ Ronald J. San Nicolas, Ph.D. __________________________ Date ii © Copyright by Cristina Maria B. Dela Cruz, 2013 All Rights Reserved iii ABSTRACT EXISTENTIAL CONCERNS OF INDIVIDUALS LIVING WITH CHRONIC MENTAL ILLNESS IN GUAM CRISTINA MARIA B. DELA CRUZ Antioch University Seattle Seattle, WA Individuals living with chronic mental illness experience a host of challenges associated with the symptoms of their illness. In an effort to help restore healthy functioning, mental health treatment for individuals with chronic mental illness thus focuses primarily on symptom reduction and management. Recent research exploring the lived experience of individuals with chronic mental illness suggests that apart from their symptoms, these individuals also encounter existential issues related to the self, relationships with others, temporality, making meaning out of the illness experience, and managing life with the illness. At the same time, however, this research has tended to focus on distinct aspects of chronic mental illness rather than the overall experience of day-to-day living with the illness, resulting in a fragmented view of the phenomenon. Moreover, these studies have been conducted primarily in Europe, as well as North America, Australia, and South Africa, but not in Asia or the islands of the Pacific. The goal of this study was twofold: to gain a comprehensive understanding of the lived experience of chronic mental illness in the Pacific Island of Guam, as well as to examine whether the themes found in the extant literature are applicable to individuals from Pacific Islander and Asian cultures living in Guam. Interpretative Phenomenological Analysis was used to guide the research, emphasizing the phenomenological approach to understanding the lived 1 experience of individuals and how they make meaning of their experience. Ten individuals living with chronic mental illness in Guam were interviewed. The interviews were designed to elicit descriptions of the participants’ experience of chronic mental illness and its impact on their daily lives. Results suggest that the participants encountered existential concerns regarding defining and knowing the self, navigating relationships with others, trying to understand the illness, managing the illness, desiring control, and living a meaningful life with the illness, and that the role of the family impacted these concerns. Implications for clinical practice in Guam include both the integration of existential-oriented psychotherapy, as well as interventions that involve the individual’s family to optimize the family’s impact on the individual’s existential well- being. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd 2 Acknowledgements I would like to thank my committee—Pat Linn, Melissa Kennedy, and Ronnie San Nicolas—for their unending support and encouragement, as well as their interest in and commitment to this project. My deepest appreciation goes to the 10 individuals who participated in this study for sharing their life stories and wisdom with me. I would also like to acknowledge the following administrators and staff from Guam’s Department of Mental Health and Substance Abuse for their assistance: Jim Kiffer, Wilfred Aflague, Pat Taimanglo, Lindsey Miller, and all the clinical staff. Many thanks as well to Marci Santos, Laura Post, and Judith Avery for their support. I would also like to extend my heartfelt appreciation to the Antioch psychology faculty, the Antioch staff, as well as my friends and classmates in the Psy.D. program, who made life in Seattle meaningful and memorable. A special “thank you” to Mary Wieneke, Ned Farley, and Diana Chamrad. I am also grateful to the dissertation editor, Jayne Alexander, who worked extremely quickly to help me meet my deadlines. I would like to express my utmost appreciation to my mom and dad, my brother Tony, my sister-in-law Lani, my parents-in-law Sue and Kerr, and my sister-in-law Kathy. Without their patience, understanding, and support, this achievement would not have been possible. Finally, to my husband, Iain, words cannot do justice to how grateful I am for all the ways you have helped me to stay focused and see through the fog. To our dear little boy, Colin, thank you for your beaming smiles and adorable giggles to help lighten each day as I worked on this dissertation, and for giving me perspective as to what is meaningful in life. iv Table of Contents Page Abstract…………………………………………………………………………….... 1 Acknowledgements………………………………………………………………….. iv INTRODUCTION………………………………………………………………….... 1 Objectives of the Study………………………………………………………....... 1 Theoretical Framework………………………………………………………....... 3 Research Question……………………………………………………………....... 4 LITERATURE REVIEW……………………………………………………………. 5 Existential Philosophy and Literature……………………………………………. 5 Søren Kierkegaard……………………………………………………………... 5 The Russian Novelists: Fyodor Dostoevsky and Leo Tolstoy………………... 10 Fyodor Dostoevsky……………………………………………………......... 11 Leo Tolstoy……………………………………………………………......... 15 Jean-Paul Sartre………………………………………………………………... 18 Albert Camus………………………………………………………………...... 26 Summary and Critical Analysis of Existential Philosophy and Literature…..... 30 Existential Psychotherapists……………………………………………………… 33 Rollo May……………………………………………………………………… 34 Viktor Frankl…………………………………………………………………... 41 R. D. Laing…………………………………………………………………...... 48 Irvin D. Yalom……………………………………………………………........ 54 Summary and Critical Analysis of Existential Psychotherapists…………........ 59 Empirical Studies Exploring the Lived Experience of Chronic Mental Illness….. 63 v Psychosis………………………………………………………………………. 63 Long-Term Mental Illness……………………………………………………... 66 Schizophrenia………………………………………………………………...... 72 Bipolar Disorder……………………………………………………………...... 81 Depression……………………………………………………………………... 87 Being Diagnosed………………………………………………………………. 89 Being Misunderstood………………………………………………………...... 92 Being Medicated………………………………………………………………. 96 Being Restrained………………………………………………………………. 106 First-Hand Accounts…………………………………………………………... 108 Summary and Critical Analysis of Empirical Studies………………………..... 112 Rationale for the Proposed Research…………………………………………...... 118 METHOD…………………………………………………………………………..... 121 Participants……………………………………………………………………….. 122 Materials………………………………………………………………………...... 124 Procedure…………………………………………………………………………. 126 Participant Recruitment………………………………………………………... 126 Interviews……………………………………………………………………… 129 Data Analysis…………………………………………………………………….. 131 RESULTS………………………………………………………………………….... 141 Demographic Characteristics of the Participants………………………………… 141 Background Information on the Participants’ Mental Illness……………………. 145 Brief Biographies of the Participants…………………………………………….. 148 vi Research Findings………………………………………………………………... 153 Domain 1: Onset of Illness……………………………………………………. 160 Domain 2: Being Diagnosed………………………………………………….. 171 Domain 3: Being on Medication……………………………………………… 181 Domain 4: Being Hospitalized………………………………………………... 191 Domain 5: Receiving Mental Health Services………………………………... 198 Domain 6: Day-to-Day Living with Chronic Mental Illness………………….. 210 DISCUSSION……………………………………………………………………….. 241 Summary of the Findings………………………………………………………… 241 Findings in Comparison to Literature Review…………………………………… 248 Implications for Clinical Practice………………………………………………… 260 Delimitations and Limitations of the Study…………………………………….... 264 Recommendations for Future Research………………………………………….. 268 Concluding Remarks……………………………………………………………... 270 References………………………………………………………………………….... 272 Appendix A: Interview Protocol……………………………………………………. 277 Appendix B: Participant Recruitment E-mail Correspondence…………………….. 282 Appendix C: Statement of Informed Consent………………………………………. 284 vii

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