Observation of the frequency with which major decisions on issues affecting psychiatric patients were decided on material elicited from techniques like the Rorschach stimulated the investigation of the applicability of this technique to African patients. The nosological group chosen for this study was the schizophrenic group. Scrutiny into the literature revealed great diversity in conceptions of the etiology of the schizophrenic condition. To handle this material it was necessary to adopt a modification of the framework used in Friedman and Kaplan (1974). Having gone into the models on etiology it was evident that consistency was only possible in the realm of symptoms and diagnosis and the definition of schizophrenia as a group of psychotic disorders characterised by gross distortions of reality : the disorganisation and fragmentation of perception, thought and emotion and withdrawal from social interaction, was adopted. With this preconceived idea of schizophrenia three hypotheses were formulated to test the diagnostic utility of the Rorschach with Nguni schizophrenic female subjects. Summary, p. 104.

The impact of the emotional climate in the home of the schizophrenic on relapse has been researched extensively through the construct of Expressed Emotion (EE). Most often patients from high EE homes have a higher relapse rate than those from low EE homes. This is a robust finding throughout many western and some non-western countries. However, no published research documents EE status and relapse in African countries. This study reports on the EE status and rehospitalisation rates of 29 Zulu-speaking schizophrenic patients in a South African sample. EE was assessed using a translated version of the Level of Expressed Emotion (LEE) scale, a 60 - item, self-report measure developed in Canada (Cole & Kazarian, 1988). A multistage translation procedure, comprising back-translation, the committee approach and decentering was employed. The Zulu SCL-90-R was administered as an indicator of psychological distress. Follow-up data on rehospitalisation was collected nine months after index admission. Results indicated somewhat unsatisfactory internal reliabilities on some of the subscales of the Zulu LEE scale. High scores on the Zulu LEE scale were not significantly predictive of rehospitalisation at follow-up; however, they were significantly predictive of greater previous admissions. The psychometric properties of the Zulu SCL-90-R were found to be satisfactory, indicating the validity of using this instrument for the purpose of screening for psychiatric illness. Zulu schizophrenics were found to have a lower rehospitalisation rate (17% at nine month follow-up) than found in international studies. The course for female schizophrenics was better than that for male schizophrenics. Findings are inconclusive regarding the impact of EE on the course of schizophrenia in a Zulu sample. / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 2000.

This study explored and described the perception of clinical psychologists regarding thebarriers to the provision of psychological services in urban public health settings for people with first-episode schizophrenia. The qualitative research study utilised an explorative, descriptive interpretive research design. Purposive sampling was utilised to gain access to clinical psychologists, who had at least two years of public health experience working with people recently diagnosed with schizophrenia. Data was gathered from 11 participants from the Nelson Mandela Bay Health District of the Eastern Cape by means of in-depth interviews that were conducted in English by the researcher until data saturation had occurred. A computer-assisted qualitative thematic analysis of the collected data was conducted using NVIVO software. The findings have been categorised according to three broad domains: 1)contextual barriers 2)health care system-related barriers and 3)first-episode schizophrenia syndrome-related barriers. Several specific sub-themes were identified for each of these main domains allowing for recommendations and suggestions to be provided for attending to and overcoming these perceived barriers.

精神分裂症（簡稱精分）是一種常見且嚴重的精神疾病，它對患者及其家人的生活有著毀滅性的影響。在西方國家，研究者已經對精分患者子女的經歷研究了許多年，得出的結論在政府以及社會工作者幫助這些家庭時起到重要的參考作用。然而，在中國這個問題被忽視了，目前針對這個群體的、學術規範的研究還沒有在中國大陸展開。鑒於中西巨大的社會和文化差異，我們不可以照搬西方學者的研究成果。為了填補這方面的知識空缺，我們在上海展開了對精神分裂症患者子女經歷的質化研究。 / 本文的資料來自八個家庭的成員對於相關經驗的敘述。我們從三個層面來探究這些青少年的特殊經歷，包括他們對家長的經歷、他們從患病與健康家長處感受到的養育模式、以及他們所經歷的擴展家庭和社會的支持。 / 我們的研究發現包括：1）青少年對家長疾病的適應經歷了三個階段：漠然、焦慮、消極應對。2）患病家長大多對孩子溫暖有餘、管教不足。健康家長對孩子的管教很大程度上取決於家庭經濟情況。當經濟情況惡劣時他們往往忽視孩子的成長需求3）支援系統作用缺失。 / 基於以上發現，本文提煉出三個主題：在惡劣成長環境中掙扎、消極應對、缺乏支持。我們提倡為這些家庭提供社會服務。 / Schizophrenia is a serious and common mental illness which has devastating effects on those affected by schizophrenia, as well as family members including their offspring. In western countries, the topic about the experience of offspring living with a parent diagnosed with schizophrenia has been studied for many years. The outcomes are useful references to the government and social workers in helping these families. However, this topic has been neglected in the Chinese context. A well-designed qualitative study has never been carried out in mainland China. The result from western researcher cannot be used in China due to the vast differences in society and culture. To fill in the gap, a qualitative research was carried out in Shanghai to study children’s experience of parental schizophrenia. / This paper is based on the narratives elicited from eight families, including the parents diagnosed with schizophrenia, the adolescent children, and sometimes other family members. We studied the experience of this special group of adolescents, which contains the experience of their parent’s mental illness, the parenting from both the parent diagnosed with schizophrenia and the healthy parent, as well as the support from extended family and the society. / Our findings include: 1) Adolescents’ attitude towards parental schizophrenia can be divided into three phases: indifference, anxiety, and finally passive coping. The help they can provide for their parents with schizophrenia is very limited in most cases. 2) The parenting they received from the parents with schizophrenia is generally perceived as with high level of warmth and low level of demandingness. The healthy parents may or may not provide enough discipline to the adolescents depending on the families’ economic status. They would fail to focus on the need of the growing children when the economic pressure is high. 3) The supportive network failed to provide enough help to the growing adolescents. / Three themes are proposed based on the findings, namely struggling in poor growing environment, passive coping, and helplessness. We advocate for the development of social work services for these families. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Du, Juan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 264-302). / Abstracts also in Chinese; appendixes in Chinese. / Chapter Chapter 1 --- : Introduction --- p.1 / Chapter 1.1 --- Rationale of the study --- p.1 / Chapter 1.2 --- Research background --- p.3 / Chapter 1.2.1 --- Schizophrenia in China --- p.5 / Chapter 1.2.2 --- Social stigma and discourse on mental illness --- p.6 / Chapter 1.2.3 --- Great challenges for a family with a member with schizophrenia --- p.9 / Chapter 1.2.4 --- Limited mental health service available to these families --- p.11 / Chapter 1.2.5 --- Cultural influences in Chinese society --- p.14 / Chapter 1.3 --- Research objectives and research questions --- p.18 / Chapter 1.3.1 --- Research questions --- p.18 / Chapter 1.3.2 --- Research objectives --- p.19 / Chapter 1.4 --- Significance of the research --- p.20 / Chapter Chapter 2 --- : Literature Review --- p.21 / Chapter 2.1 --- Schizophrenia --- p.21 / Chapter 2.1.1 --- Different perspectives on schizophrenia --- p.21 / Chapter 2.1.2 --- Treatment and Recovery of schizophrenia --- p.33 / Chapter 2.1.3 --- Schizophrenia’s influence on social functioning --- p.37 / Chapter 2.1.4 --- Schizophrenia’s influence on parenting --- p.39 / Chapter 2.2 --- Developing adolescents --- p.46 / Chapter 2.2.1 --- Different perspectives on adolescents --- p.47 / Chapter 2.2.2 --- Offspring with parental psychiatric disorder --- p.53 / Chapter 2.2.3 --- Supportive network of adolescents --- p.60 / Chapter 2.3 --- The roles of social work in mental health facilities --- p.61 / Chapter 2.3.1 --- Condition of mental health social work in Shanghai --- p.62 / Chapter 2.3.2 --- The roles of social workers in other areas --- p.63 / Chapter 2.3.3 --- Social workers serving families with parental schizophrenia --- p.69 / Chapter 2.4 --- Knowledge gap in existed literature --- p.70 / Chapter Chapter 3 --- : Research Methodology --- p.72 / Chapter 3.1 --- Paradigmatic Considerations --- p.72 / Chapter 3.1.1 --- Social constructionism --- p.74 / Chapter 3.1.2 --- Proposed Theoretical Framework --- p.77 / Chapter 3.2 --- Research Design --- p.79 / Chapter 3.2.1 --- Research Site --- p.80 / Chapter 3.2.2 --- Sampling --- p.81 / Chapter 3.2.3 --- Data collection --- p.86 / Chapter 3.2.4 --- Data analysis --- p.89 / Chapter 3.2.5 --- Ethical issues and trustworthiness --- p.91 / Chapter 3.3 --- Strengths and Limitations of this Study --- p.96 / Chapter Chapter 4 --- : Background Information of the Research Participants --- p.98 / Chapter 4.1 --- General Information --- p.98 / Chapter 4.1.1 --- Personal information of adolescents --- p.99 / Chapter 4.1.2 --- Personal Information of parent diagnosed with schizophrenia --- p.101 / Chapter 4.1.3 --- Background Information of participant families --- p.105 / Chapter 4.2 --- Family stories --- p.111 / Chapter 4.3 --- Conditions of the parent with schizophrenia --- p.126 / Chapter 4.3.1 --- Competent youths in the past --- p.126 / Chapter 4.3.2 --- Experience of schizophrenia --- p.127 / Chapter 4.3.3 --- Self-blaming for offspring’s current situation --- p.139 / Chapter 4.4 --- The adolescents --- p.141 / Chapter 4.4.1 --- School Achievement --- p.141 / Chapter 4.4.2 --- Peers --- p.146 / Chapter 4.5 --- Summary --- p.150 / Chapter Chapter 5 --- : Experience of parental schizophrenia --- p.152 / Chapter 5.1 --- Discovery of parental schizophrenia --- p.152 / Chapter 5.2 --- Experience relevant to parental schizophrenia --- p.155 / Chapter 5.2.1 --- Symptoms --- p.155 / Chapter 5.2.2 --- Deterioration of parent’s daily functioning --- p.157 / Chapter 5.2.3 --- Parents’ hospitalization --- p.161 / Chapter 5.2.4 --- Social stigma attached to schizophrenia --- p.166 / Chapter 5.2.5 --- Parent’s concealment of schizophrenia --- p.168 / Chapter 5.3 --- Knowledge of schizophrenia --- p.170 / Chapter 5.4 --- Reaction after knowing parental schizophrenia --- p.174 / Chapter 5.4.1 --- Indifference --- p.174 / Chapter 5.4.2 --- Concern and curiosity --- p.175 / Chapter 5.4.3 --- Passive attitude --- p.179 / Chapter 5.5 --- Coping with parental schizophrenia --- p.182 / Chapter 5.5.1 --- Support and help from the children to the parents with schizophrenia --- p.182 / Chapter 5.5.2 --- Selective concealment of parental schizophrenia --- p.185 / Chapter Chapter 6 --- : Experience of parenting from the parent with schizophrenia --- p.189 / Chapter 6.1 --- Less parental demandingness from the parent with schizophrenia --- p.189 / Chapter 6.1.1 --- Less discipline --- p.190 / Chapter 6.1.2 --- Low pressure on study --- p.191 / Chapter 6.1.3 --- Low expectation for future career --- p.192 / Chapter 6.2 --- More parental warmth from the parent with schizophrenia --- p.195 / Chapter Chapter 7 --- : Supporting Network --- p.197 / Chapter 7.1 --- Interaction between adolescent children with healthy parents --- p.197 / Chapter 7.1.1 --- The condition of the healthy parents --- p.198 / Chapter 7.1.2 --- The parenting style of the healthy parents --- p.203 / Chapter 7.2 --- Support from extended family --- p.207 / Chapter 7.3 --- Support from the society --- p.214 / Chapter 7.3.1 --- Teaching VS. Support --- p.214 / Chapter 7.3.2 --- Little support from school --- p.216 / Chapter Chapter 8 --- : Discussion --- p.219 / Chapter 8.1 --- Parenting style of both parents --- p.219 / Chapter 8.1.1 --- Indulgent parenting of the parent diagnosed with schizophrenia --- p.219 / Chapter 8.1.2 --- The parenting style of the healthy parent --- p.222 / Chapter 8.1.3 --- The influence of the parenting on the developing children --- p.225 / Chapter 8.2 --- Three stages after knowing parental schizophrenia --- p.227 / Chapter 8.3 --- Themes --- p.233 / Chapter 8.3.1 --- Struggle in poor family environment --- p.233 / Chapter 8.3.2 --- Passive coping --- p.239 / Chapter 8.3.3 --- Helplessness --- p.241 / Chapter 8.4 --- Reflection on theoretical framework --- p.244 / Chapter 8.5 --- Implications for practice --- p.247 / Chapter 8.6 --- Implications for theory and research --- p.255 / Chapter 8.6.1 --- Similarities and differences compared with literature --- p.255 / Chapter 8.6.2 --- Directions for future research --- p.257 / List of tables and figures / Chapter Table 1 Length of interviews --- p.89 / Chapter Table 2 Condition of adolescents --- p.99 / Chapter Table 3 Personal information of the parents with schizophrenia --- p.101 / Chapter Table 4 Symptoms and hospitalization --- p.102 / Chapter Table 5 Medication --- p.104 / Chapter Table 6 General family background --- p.105 / Chapter Table 7 Family social economic status --- p.108 / Chapter Table 8 Possible interventions --- p.250 / Chapter Figure 1 Proposed theoretical framework --- p.77 / Chapter Figure 2 Revised theoretical framework --- p.245 / Chapter Appendices --- p.259 / Chapter Appendix 1: Interview Guide (Chinese version) --- p.259 / Chapter Appendix 2: Consent form (Chinese version) --- p.262 / Bibliography --- p.264

Indiana University-Purdue University Indianapolis (IUPUI) / This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.