The Self-Concept of Shizoprenia

Purpose:

 According Self-concept theory, “Self “was divided “I” and “Me” (James.W1890).“I”is the self who recognized “Me”, “Me”is the self who is recognized. When we think about and image ourselves, “I” and “Me” are distinguished. Therefore, we can be conscious ourselves objectively. Self-concept is said that basic concept structure which supports self- consciousness tacitly (Kajita 1988). It is thought that self-concept is basis of the relationship between “I” and “Me”. Self-concept is developed in childhood, and established from adolescence to adulthood (David 1992). Especially, a number of life events occur, people change individual role from adolescence to adulthood. Each time change of social role, people conscious to self objectively. As a result, self-concept would be more complex. Self-worth and self-development are increasing (David 1992). In case of patients with Schizophrenia, their self-monitoring is poor because of cognitive deficit. Therefore, it is hard to they have objective view to themselves. In addition, they have hospitalization experience, stigma, and loss of the social role (McCay 1998). Also, Schizophrenia often develops in a prime of life from youth where numbers of life events occur. So, their self-concept has influence since they were diagnosed with Schizophrenia. It suggests that their self-concept might be ambiguous. In review, Kajita(1988) said that the patients with psychiatric disorder, who have incorrect self-concept like “I an emperor”are difficult to adapt social life. Not adaption in social life leads to their low self-worth and self-esteem. There are a lot of reports about self-concept, but most report were academic self-concept which means  self-evaluation. And the research that focuses on the self concept of patients with schizophrenia is not found. That why we focus on the self concept of patients with schizophrenia and explore nursing approach for patients with schizophrenia in this study. The Purpose of this study was to elucidate the self concept of patients with schizophrenia

Methods:

Subject: Our study’s Subjects were patients with schizophrenia in three psychiatry hospitals and out-patients in a community workshop.

Procedure: First, we recruited subjects that their doctors and nurses decided patient’s condition could stand our study. Because there are not doctors and nurses in community workshop, subjects were recruited by staff.  Then, we ask to consent with each subject. After we adjusted convenient time with subject, we conducted semi-structured interviews with participants 1 time or 2 times. Considering their condition, interviews was set less than 30 minutes each time. And also, we investigated Demographic information from medical record (age, sex, disease duration, chlorpromazine equivalent) in hospitals. In case of out-patients, we investigated Demographic information by asking them.

Analysis: About the transcription of all interviews, we used QCA to analyze our material. We focus on self-concept that Kajita (1988) proposed, categories were added in a concept-driven procedure. Self-concept that Kajita proposed is consist of Present cognition and definition to the self, Feeling and evaluation to the self, The self that is seen from others, Past self-image, The self-image about possibility and future, What should do and ideal about the self (1988).To assess content validity, expert who is familiar with self-concept check coding frame.

 Ethical considerations: Our study obtained organization of the Ethics Committee’s proposal. We explained the purpose and method of this study, the participation is free, keeping anonymous in document. Participants Signed on Consent form. 

Results:

39 patients with schizophrenia participated in our study. We excluded four partisepants of those, because they have thought disorder.That why we analysed interview contents from 35 partisepants. Among 35 partisepants, 14 partisepants admitted the recording of interview contents and other partisepants admitted that a researcher wrote down interview contents in a memo. We interviewed partisepants 1-2 times.The interview time of the average was 25 minutes earch time. Participants were 21men and14 female, the average age was 46.7 years old.

 Following a concept-driven procedure in QCA, first we treated six component (Present cognition and definition to the self, Feeling and evaluation to the self, The self that is seen from others, Past self-image, The self-image about possibility and future, What should do and ideal about the self)of the self-concept Kajita proposed as main categories. All labes of transcription divied to subcategories by considering related maincategories.

1) Present cognition and definition to the self

Present cognition and definition to the selfis consisited of three subcategories(State of the self, Emotional intention and attutide of the self, self-difinition). The labels which means their feeling sense of incongruity,like “A voice order and advice me in various ways”“I feel heavy at a body because of the sleep shortage”were integrated into the self who feels sense of incongruity. And the labels which means state of the self in delusion, like“I am God of the religion” were integrated into. The self who feels sense of incongruity and the self that changed by a disease were integrated into State of the self. In Emotional intention and attutide of the self,exression about like or dislike as“I like walking”“I don't like to cook” were integrated. In self-difinition,attributes of the self like “I am schizophrenia” “I have family”were integrated.

2) Feeling and evaluation to the self

 Feeling and evaluation to the self is consisited of three subcategories (Self-confidence and pride, Sense of superiority and inferiority complex, Self-acceptanece). In Self-confidence and pride, the confidence that understands an illness than anyone else like “I know my illness than psysician” , Resistance to stigma like “I don’t have metal illness”,pride to the self like, “I have worked for the major company”were integrated. In Sense of superiority and inferiority complex,“I envy healthly person”“I have a power of the telepathy” were integrated. The labels which means feeling about the self who is under medical treatment like“I hate having to take medicin”, evaluation about change of the state of the self like“I feel getting better from my illness”evaluation of modified the self to the self like“I do not understand effect of the medicine clearly, but the medicine may work”acceptance of the patient role like “There is me who cannot beat the self who have illness” were integrated into Self-acceptanece.

3) The self that is seen from others

The self that is seen from othersis consisited of two subcategories (image and difinition from others, Feeling and evaluation from others). In image and difinition from others , difinition of schizophrenia by others were integrated In Feeling and evaluation from others,evaluation about the self who have illness like“I am seen strange mentally by others” were integrated.

4) Past self-image

 Past self-image is consisited of three subcategories(Past experience, image and difinition to past self, Feeling to past self ). Interpretation to Past self , a sense of guilt to Past self and so on were integrated into this category.

5) The self-image about possibility and future

 The self-image about possibility and futureis consisited of four subcategories (Possibilty of prediction and conviction, Image for plane for future, Image for will and intention, Desire to the self).Self-image for state, action and will when I became ill badly, were integrated into this category.

6) What should do and ideal about the self

 This main categories is consisited of two subcategories (What should do and ideal about the self). the labels which means What should “I”do , ideal and dream were integrated into this category.

Conclusion:

In our study, shizoprenia were consious to themselves objectivly like“A voice order and advice me in various ways” “There is me who cannot beat the self who have illness” but some label means the self that changed by a disease like “I am God of the religion”. According old review in Japan, when shizoprenia want to talk about experience of delusion, they already couldn’t make“me”objective,and they feels something enter into “me” (Kimura1978).Therefore our study suggested that shizoprenia have two sides of the self.One side was the self and other side was the self that was influenced by illness.It thought that this result is charactristic of schizophrenia