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BURDEN AND DEFENSE MECHANISMS IN FEMALE SPOUSES OF CHRONIC SCHIZOPHRENIC
PATIENTS
Prof. S.Kumar
Dr. R.Singh and
Dr. S.Mohanty
Institute of
Mental Health and Hospital
Agra
ABSTRACT
In married patients spouses
are expected to experience greater magnitude of burden. To deal with the
situation a number of coping and defensive strategies are adopted. The
index study is an attempt to explore which cluster of defenses is used by
the female spouses of chronic schizophrenic patients. The sample consisted
of 30 female spouses of male chronic schizophrenic patients hospitalized
at Institute
of Mental Health
and Hospital, Agra. Burden Assessment Schedule (Thara et al. 1998)
and Defense Mechanism
Inventory -Female Version (Mrinal and Mrinal, 1984)
were individually
administered on each participant. The results indicated that the
projection is the primary defense mechanism used by the spouses.
KEY WORDS: Spousal Burden,
Defense Mechanisms, Burden Assessment Schedule.
INTRODUCTION
Caregivers of psychiatric patients are exposed
to high levels of burden and distress (Chandrasekhar et al. 2002; Scazufca
& Kuiper, 1996; Pai & Kapur, 1981). The extent and determinants of burden
among the family members as well as spouses of psychiatric patients is
well researched. Both patients and family related factors such as age,
gender, education, psychopathology, coping style, financial condition have
been found to be associated with burden (Moiley et al. 1997; Trivedi et
al. 2003; Chakravorty et al. 1992; Chandrasekharan et al. 2002).
The caregivers of schizophrenic patients use a
number of coping strategies to reduce distress. Studies on coping style
established that different coping strategies used by family members such
as avoidance, denial and resignation are linked to greater burden (Budd et
al. 1998; Scazufca & Kuiper 1999; Sekaran et al. 2001; Hinrichsen &
Liberman 1999). Kumar et al. (2002) observed significantly greater burden
in female spouses of schizophrenic patients living in nuclear family set
up. Ram Mohan et al. (2002) reported that greater use of problem solving
technique is a predictor of well being in family caregivers.
Defense mechanism is essential for softening of
failure, reducing cognitive dissonance, alleviating anxiety and to
maintain self adequacy which is associated with psychopathology and
psychosocial functioning. Unlike coping strategies of caregivers of
psychiatric patients, the use of defense mechanism is not yet reported.
Little knowledge is available regarding the use of defense mechanisms by
the caregivers.
OBJECTIVE:
The
present study attempted to find out if burden is linked with any specific
defense mechanism in female spouses of male chronic schizophrenic
patients.
MATERIAL AND METHOD
The
study was conducted at Institute of Mental Health and Hospital, Agra. 30
female spouses of male chronic schizophrenic patients served as the study
sample. The diagnosis of schizophrenia was made as per ICD-10 Research
Diagnostic Criteria (WHO 1993).
Following tools were individually administered
on spouses.
1.
Defense Mechanism
Inventory – Female Version (DMI) :
The inventory is developed by Mrinal and Mrinal (1984). DMI assesses five
clusters of defense mechanisms:
-
Turning Against Objects
(TAO):
This class of defenses deals with conflict through attacking a real or
presumed external frustrating object.
-
Projection (PRO):
Included here are defenses which justify the expression of aggression
towards an external object through first attributing to it.
-
Principalization (PRN):
This class of defenses deals with conflict through invoking a general
principal that ‘splits off’ affect from content and represses the
former.
-
Turning Against Self
(TAS): In this
class are those defenses that handle conflict through directing
aggressive behavior towards himself.
-
Reversal (REV):
This class includes defenses that deals with conflict by responding in
a positive or neutral fashion to a frustrating object which might be
expected to evoke a negative reaction.
It contains 10 stories. Subject is asked to
respond to four questions corresponding to four types of behaviour evoked
by the situation described in story: (a) proposed actual behaviour (b)
impulsive behaviour (c) thoughts (d) feelings. Five responses are provided
for each question, each responses representing one of the five clusters of
defense mechanism. The scoring is done through templates. The retest
reliability ranges from .80-.92. The construct validity and
inter-relationships are satisfactory.
2.
Burden Assessment
Schedule (BAS): The schedule is
developed by Thara et al (1998). It measures burden in nine areas: (a)
Spouse related (b) Physical and mental health (c) external support (d)
caregiver’s routine (e) support of patient (f) taking responsibility (g)
other relations (h) patients’ behaviour (i) caregivers’ strategy. There
are 40 items rated on three point scale. The reliability is .80. The
validity ranges from .71-.80.
The
sample characteristics are presented in table-1:
|
Table-1:
Sample Characteristics |
|
Patients’ age
(in years) |
38.6±7.97 |
|
Spouses’ age
(in years) |
34,9±8.07 |
|
Education of
spouses |
Literate |
66.7% (20) |
|
Illiterate |
33.3% (10) |
|
Domicile |
Rural |
70% (21) |
|
Urban |
30% (09) |
|
Socio-economic
Status |
Middle |
40% (12) |
|
Low |
60% (18) |
|
Duration of
illness (in years) |
7.46±4.78 |
|
Duration of
exposure to spousal illness |
5.96±4.19 |
RESULTS AND DISCUSSION
The
results of regression analysis are presented in table-2 and figure-1:
|
Table-2:
Regression Analysis: Predictor Variable-BAS |
|
Dependent
Variable |
R |
R square |
Adjusted R
square |
Significance
Level |
|
Turning
Against Objects (TAO) |
.165 |
.027 |
-.008 |
n.s. |
|
Projection
(PRO) |
.364 |
.133 |
.102 |
.05 |
|
Principalization (PRN) |
.080 |
.006 |
-.029 |
n.s. |
|
Turning
Against Self (TAS) |
.210 |
.044 |
.010 |
n.s. |
|
Reversal (REV) |
.176 |
.031 |
-.004 |
n.s. |
The
analysis indicated that spousal burden significantly contributes to
Projection defense mechanisms. The adjusted R square is .102. Projection
includes defenses which justify the expression of aggression towards an
external object (Mrinal & Singhal, 1984; p.4).
Spouses typically report that the patient himself is responsible for
his illness because he thinks himself as correct and refuse to accept
others’ opinion. Moreover, they blame other family members for the
situation. They feel that being female they themselves could not provide
timely and efficient help; and families did not take optimum measures in
early stages of illness rather neglected the patient. They also perceive
treatment cost to be too prohibitive to continue with prescribed treatment
regimen.
These sorts of attribution to the patient, family members and other
aspects of the environment are characteristic expression of projection
defenses which female spouses habitually employ to mitigate their
distress. Srivastava et al. (2005) observed that spouses with external
locus of control perceived higher magnitude of burden. In external locus
of control, a person tends to blame the environment for his condition.
The findings of the present study supplemented the observations that
female spouses primarily express aggression towards external objects.
CONCLUSION
Projection is found
to be the primary defense mechanism associated with spousal burden in
females. The use of projection might be associated with interpersonal
problems within the family and society thereby reducing social support
which need be investigated. Psycho-education should help the spouses to
identify the factors which are responsible for the condition, which may
ultimately pave the way for planning effective strategies to tackle the
confounding factors to the extent possible.
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