M.Cur. / Schizophrenia is a devastating mental illness and probably the most distressing and disabling mental disorder. It is not the condition of the ill person alone but also of the family which is placed in a crucial and pivotal role and which must take care of the ill relative with schizophrenia. This is so because of the disillusional thinking, altered thought process and distractions of internal stimuli that may interfere with the planning, commitment and rationale for actions, making it difficult for everyone involved. The effects of the illness may be confusing and shocking to families. Parents suffer from great disruptions to their lives and children can struggle with the implications of having a parent suffering from schizophrenia. Siblings of the ill person suffering from chronic schizophrenia are not spared, they even suffer because issues of their own survivorship. The family becomes case managers and primary carers. Family caregivers are vulnerable to emotional manipulation by their mentally ill relative. They are rarely trained/helped to manage difficult circumstances. The family members are called upon for provision of psychological and social therapies, occupational and recreational therapy and attendant care for which they are not trained. The family is also seriously affected and distressed because of the effect schizophrenia has on their relative and the burden of caring. Coping with schizophrenia can especially be difficult for relatives who remember their relative before he or she became ill, giving rise to chronic grieving and sorrow and because of the cyclic nature of schizophrenia giving no definite end point or lengthy respite to complete mourning. The reminders of the "might have been" can be distressing. There is an obvious need for research on the family's experience. It is essential to understand their emotional tones and specific needs in relation to living with a member suffering from chronic schizophrenia as well as to formulate guidelines. The purpose of the study was to explore and describe family member's experiences and to formulate guidelines of care for families living with a member with chronic schizophrenia. The research design was based on qualitative research because of its explorative descriptive and contextual nature. Data were collected by means of indepth phenomenological interviews and naïve sketches. Field notes were written for reflecting upon methods used and the personal notes for the researcher's personal inflections. Literature was used to compare and complement the results. Guba's model on trustworthiness ensured the trustworthiness of the research.

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.

published_or_final_version / Social Work and Social Administration / Master / Master of Social Sciences

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