Perceptions of Stages of Family Violence and their Perceived Solutions in Persons with Schizophrenia

Abstract

Background: Family violence committed by persons with schizophrenia is a serious problem in the context of the accelerated deinstitutionalization in Japan. Community nurses could play an important role in resolving family violence by persons with schizophrenia. Objective: This study aimed to clarify the reasons for family violence as perceived by adult children with schizophrenia and ways to resolve this problem. Methods: A qualitative descriptive design was employed. Group interviews with 10 participants—five individuals with schizophrenia and five parents of adult children with schizophrenia-were conducted. Transcriptions were segmented according to the following three research questions: “How do parents recognize and cope with violence committed by persons with schizophrenia?,” “How do persons with schizophrenia perceive committing violence toward their parents and how do they change themselves after doing so?” and “How do persons with schizophrenia perceive ways to resolve the issue of violence toward parents?” The data were categorized and subcategorized based on the similarity of codes and organized in chronological order. Categories concerning reasons for violence and the subsequent changes in persons with schizophrenia made up the stages of their experiences. Results: Parents could not understand the reasons for violence committed by persons with schizophrenia. Experiences of committing violence and changes after violence as perceived by persons with schizophrenia involved the following five stages: complicated causes of occurrence, environment conducive to violence, onset of violence, gaining power, and regret and growth. Persons with schizophrenia wanted to be observed from a distance and were desirous of establishing relationships beyond the home. Conclusion: It is necessary for nurses to bridge the gap between patients and their parents by serving as a communication channel between them. In this way, there is hope to promote recovery even if the patient with schizophrenia commits violent acts toward the parent.

Prevalence of violence by people living with severe mental illness against their relatives and its associated impacts: A systematic review

“…Violence was assessed over different time intervals comprising: participants' lifetime 32,38,39,82,83 ; since patient illness onset 29,81 ; and 12 months preceding the study 30,31 . Three studies did not comment on time frame 35,36,44 . Four themes were identified: (i) the nature of violence; (ii) physical impacts; (iii) psychological/emotional impacts; and (iv) impacts on familial relationships (see Table 3).…”

“…Relatives shared challenges in understanding how to prevent or control violent episodes, conveying a sense of powerlessness. Uncontrollability was also echoed in patients' narratives 30,44 …”

“…Often, relatives attributed patient violence to specific illness symptoms, such as delusions and hallucinations, and symptom deterioration 32,35,81,83 . Many studies described relatives' reluctance to seek help, until violence escalated and required intervention from external agencies, including the police 32,36,39,44,81–83 …”

“…Many described a process of (hyper)vigilance whenever the patient was in close proximity; some avoided the patient entirely. Expressions of “walking on eggshells”, 81,82 waiting for something “horrible” to happen, and living in fear of what might happen were common 35,38,39,44,82,83 …”

Family Conflict and Violence by Persons with Serious Mental Illness: How Clinicians Can Intervene During the COVID-19 Pandemic and Beyond

“…However, most extant studies on this topic—all of which have utilized convenience sampling—have found approximately 20% of caregivers and other family members with high levels of contact with persons with SMI to have experienced violence by their relative with SMI in the past year (for a review see Labrum & Solomon, 2017 ). Family violence by persons with SMI has a range of noxious consequences for family members—such as psychological distress, trauma symptoms, and possible injury and death (Ahn et al, 2012 ; Onwumere et al, 2018 )—and for persons with SMI, including involvement in the criminal justice system and deteriorated relationship quality and disconnection from family members (Kageyama et al, 2018 , 2019 ; Labrum & Solomon, 2022 ; Onwumere et al, 2019 ).…”