Existential Concerns of Individuals Living with Chronic Mental Illness in Guam

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Antioch University
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Dissertations & Teses
2013
Existential Concerns of Individuals Living with
Chronic Mental Illness in Guam
Christina Maria B. Dela Cruz
Antioch University - Seatle
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Dela Cruz, Christina Maria B., "Existential Concerns of Individuals Living with Chronic Mental Illness in Guam" (2013). Dissertations
& Teses. 51.
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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
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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
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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

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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.
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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

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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

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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

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