Mental Illness and Manifestation of Loneliness: A Nursing Perspective
The word “loneliness” in Oxford Learning Dictionary is defined as, the fact of being without companions (loneliness-definition of loneliness in English l Oxford Dictionaries”, 2016). Similarly in Psychology loneliness can be defined as an aversive emotional experience that occurs when a person’s social network is significantly lacking in either quality or quantity (Perlman & Anne Peplau, 2016).Which was quite evident from my patient’s behavior. During my clinical, I was assigned to the patient who had schizophrenia.
I was supposed to take her history, and do her mental status examination. Patient refused to talk and asked to leave her alone. From her file I came to know that the patient was paranoid schizophrenic and had tried to attempt suicide. Throughout my clinical rotation which was for four weeks, I observed my patient sitting alone, doing nothing but watching television and thinking, not taking part in group activities.
Communication gap was the only hindrance between I and the patient which refrained me from providing the holistic care to the patient, for the patient was paranoid and suspected that everyone is going to hurt her. Building rapport with such patient and involving her in therapeutic conversations and activities was a big challenge I faced as a student nurse.
Loneliness is considered as the one of the manifestations of schizophrenia. Patient with such mental health disorder isolate themselves from people as a result they end up in loneliness. Loneliness is expressed by the schizophrenic patients in their early stage of remission. Patients with schizothymic tendency are more sensitive and are more likely to be hurt than others and have grandiose illusions as well.
However patients with schizothymic temperament find it hard to express their emotions (KUDO, MORI, & GOMIBUCHI, 2016). Likewise, my patient had shown the same behaviors and had persecutory delusions. She had hard time talking and expressing her feelings to me while she was taking the medical therapy for the disorder. According to Nakai mostly “loneliness” is the emotion experienced by patients during their remission from the schizophrenic stage.
According to Eric Erikson a child goes through different psychosocial developmental stages and if any on the stage is interrupted or stopped due to any cause the child ends up in psychological crises. Each stage requires child to resolve the conflict between the two opposite factors such as intimacy vs. isolation at the age of twenty-one to thirty-nine. According to this stage, the person explores his relationships and builds strong relations with others such as a friend or the significant partner. The sixth successfully achieved only if the person has achieved previous stage.
People who achieve the sixth stage successfully than the people who couldn’t do not face problems in the later stages. Otherwise interruption leads to stagnation, the seventh stage of psychosocial development. In the late adulthood the person experiences despair due to unresolved previous stages (“Understanding Erikson’s Stages of Psychosocial Development”, 2016). My patient had conflict in the intimacy vs. isolation stage, where patient lacked social interaction with people and sat all alone either watching television or sleeping and if the patient remained isolated even after the patient is treated for schizophrenia and this may result in the interruption of the following stages and result in despair.
Two factors, predisposing factors such as the person’s personal characteristics, for example shyness and lack of social skills and precipitating factors for example loss of loved one or a change in person’s social life in some significant way make one prone to developing loneliness. For a hospitalized patient, precipitating factors cause a mismatch in patient’s actual social relation and desired social relation. A change in either factor produces loneliness. A patient especially psychiatric patient finds it hard to interact with other patients depending on their mental illness which result in the isolation and loneliness.
Medical Research council, developed a new frame work known as LISTEN (Loneliness intervention using story theory to enhance nursing sensitive outcomes) for loneliness. LISTEN is designed in a sequence of five sessions. LISTEN is a long term intervention for promoting health and avoiding future chances of loneliness (Theeke & Mallow, 2015). For each session concepts from the story theory is used i.e. the nurse comes to know about the complicating problem of patient and understand the patient’s perspective by patient’s own story and uses story theory as a theoretical approach for culturally sensitive nursing practice (Gobble, 2012). In addition to story theory principles of cognitive restructuring is used through changing the maladaptive cognitions and behaviors while reconceptualizing new skills through interaction with others and identifying the meaning in loneliness. After numerous studies and researches on loneliness, the researches have described loneliness in two constructs; an affective component which explains the negative emotional experiences of loneliness and the cognitive component which explains the incongruences between a desired and achieved social interaction by using social and cognitive approaches respectively. These approaches are now being used to understand the affective and the cognitive aspect of loneliness (“loneliness: an integrative approach”, 2016).
Nursing recommendations for lonely patients include; Building a trustworthy relationship with the patient, explain the causes and the consequences of being alone all the time, teach patient the benefits of being with others and learning from them, give patient space to express their feelings, occupational therapies and group activities are recommended to enhance social interaction and learning and cognitive behavioral therapy helps such patients to change their behavior by perceiving their illness in different ways.
In conclusion, loneliness is often expressed by patients in psychiatric settings and patients with schizophrenia receive their treatment which also leads to loneliness in the early remission phase, consequently patient are more likely to overthink and be depressed and their mental status can further deteriorate. As a health care professional it’s a bit challenging to deal with such patients who refuse to talk as was my case and it is indeed important to plan such strategies to involve patient in group even for a short time rather than leaving or avoiding such patients.
KUDO, J., MORI, H., & GOMIBUCHI, T. (2016). Retrieved 22 September 2016, from http://www.med.nagoya-u.ac.jp/medlib/nagoya_j_med_sci/6534/nj6536.pdf
Understanding Erikson’s Stages of Psychosocial Development. (2016). Verywell. Retrieved 22 September 2016, from https://www.verywell.com/erik-eriksons-stages-of-psychosocial-development-2795740
Laurie A. Theeke, J. (2015). The Development of LISTEN: A Novel Intervention for Loneliness. Open Journal Of Nursing, 5(2), 136. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517603/
LONELINESS: AN INTEGRATIVE APPROACH. (2016). Retrieved 23 September 2016, from http://www.jiss.org/documents/volume_3/issue_1/JISS%202013%203(1)%201-29%20Loneliness.pdf
Nursing Management for Social Isolation. (2016). Nanda-books.com. Retrieved 23 September 2016, from http://www.nanda-books.com/2013/05/nursing-management-for-social-isolation.html
perlman, D. &annepeplau, l. (2016). LONELINESS RESEARCH: A SURVEY OF EMPIRICAL FINDINGS. Retrieved 23 September 2016, from http://www.peplaulab.ucla.edu/Peplau_Lab/Publications_files/Perlman%20%26%20Peplau%2084.pdf
Gobble, C. (2012). The Value of Story Theory in Providing Culturally Sensitive Advanced Practice Nursing in Rural Appalachia. Online Journal Of Rural Nursing And Health Care, 9(1), 94-105. Retrieved from http://rnojournal.binghamton.edu/index.php/RNO/article/view/108
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