Defining the situation: Family members cope with chronic mental illness

Abstract

Chronic mental illness impacts family members who experience burdens as they provide support and assistance to the patient. Family members respond in numerous ways, with some families coping more effectively than others. Little is known about this coping process and the contribution of personal and situational factors to selection of coping strategies. The study's purposes were to identify the process by which family members interpreted personal experiences of mental illness, to describe coping strategies they used and to investigate relationships among coping strategies and selected personal and situational factors. Based upon the stress and coping theory of Lazarus and Folkman and guided by the theoretical perspective of symbolic interactionism, definition of the situation was explored in indepth semi-structured interviews with 15 family members, representing 15 hospitalized psychiatric patients. Subjects also completed The Family Environment Scale, the Ways of Coping Checklist, and the Personal Resources Questionnaire. Interview data were analyzed using the Ethnograph computer program. The qualitative analysis followed interpretive approach based on grounded theory methodology. Quantitative and qualitative data were analyzed for congruence. The qualitative analysis suggested that the situation was defined in terms of two major components: identifying and responding to "patient as person" and using "power relating" to influence the impact and course of the illness. "Patient as person" included assessment of patient losses, and awareness of the essence of the patient that remained in spite of the losses. Specific actions by family members were: changing roles, patterning responses, adjusting attitudes, and making it worse/making it better. Mechanisms were: connectedness, motivation, mobilization and protection. Contexts and conditions that affected the power of relating were: personal values, social support, knowledge, and illness parameters. The components Patient as Person and Power of Relating were related in a conceptual model entitled, "Managing the Interpersonal Environment". The study expanded stress and coping theory as applied to the situation of chronic mental illness. It increased understanding of the process by which family members manage the situation. It provided insights into the importance of managing to family members in a chronic situation. Recommendations for practice and research were identified.