An exploratory study on the traumatic experience of Chinese people with schizophrenia in Hong Kong

Abstract

This study aimed to understand the inter-relationship between traumatic experience and the presenting psychotic symptoms of people with schizophrenia. Literature shows that there are three possible ways in which trauma can affect psychosis: (1) by influencing developmental trauma; (2) by being diagnosed with psychosis and the subsequent invasive treatment and the reinforcement between trauma and psychosis; and (3) trauma experienced as a result of increased vulnerability to victimization (Walsh et al., 2003). Other literature indicates that the content or themes of traumatic experience and the presenting psychotic symptoms of people with schizophrenia are related. (Dvir, Denietolis & Frazier, 2013; Hardy et al., 2005; Read, van Os, Morrison & Ross, 2005). However, limited studies exploring the traumatic experiences of people with schizophrenia are found in the local context. Therefore, in-depth qualitative interviews and inductive analysis were conducted for this study. Using purposive sampling, participants were recruited from either halfway houses or the NGO Integrated Community Centre for Mental Wellness (ICCMW). All participants were found to suffer from traumatic experience before the onset of schizophrenia such as physical abuse, sexual abuse, bullying and loss of significant others. Most suffered from trauma since childhood or young adulthood. The content of their psychotic symptoms, such as delusions and hallucinations, were somewhat related to the themes of their traumatic experiences. Association between their unmet needs and unexpressed emotions, such as longing for love and a sense of inferiority and the manifestation of psychotic symptoms were also identified. The treatment process, such as the side effects of antipsychotic drugs and hospitalization, also induced secondary trauma for some participants. In addition, negative influences due to suffering from schizophrenia, including stigmatization and victimization, were also found in this study. A proposed three-level: individual, family and society intervention model was applied. This should be a long-term process to understand the life experiences of an individual, their internal needs and repressed emotions. These three levels of intervention are mutually inclusive and thus interact with each other. There is no priority as to which level should be applied first as it depends on the specific needs of the person with schizophrenia. In order to achieve the proposed comprehensive intervention strategy, it should not rely on the efforts of mental health service units alone but should also include collaboration with other resources such as the Government, mass media and other stakeholders in the community. Medical, psychosocial and strength-based approaches have been applied in mental health service in recent years. However, it was found that the medical history and mental states of participants were the main focus in their case files, whereas their developmental history was not widely known. This reflects that the medical model is still influential in mental health services in social work practice. This study did not aim to reject the medical model but rather to offer alternative views for professional social workers to understand people with schizophrenia. In doing so, it also suggests that social workers should provide services in a more humanistic manner to help service users during their recovery journeys.