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RUSSIAN LAW JOURNAL Volume XI (2023) Issue 12s
INFLUENTIAL EVENTS AND PERSONS IN LIFE OF PATIENTS WITH PARANOID DISORDER; A QUALITATIVE RESEARCH
PARMIDA SOLEIMANI 1, KHADIJEH ABOLMAALI ALHOSSEINI 1
Department of Psychology, Tehran North Branch, Islamic Azad University, Tehran, Iran Corresponding author: Khadijeh Abolmaali ALhosseini, Email: kh.abolmaali@iau-tnb.ac.ir, Co-corresponding author: Parmida Soleimani, Email: parmidasoleimani184@gmail.com
Abstract
Purpose: The purpose of this study was to analyze the narratives of life in patients with paranoid disorder regarding influential events and persons in their life.
Methods and materials: The qualitative research method was used for narrative analysis based on the McAdams review form to analyze the life stories of patients with paranoid disorder. The research population consisted of paranoid patients admitted to Razi psychiatric hospital in Tehran and sampling method was purposive and the interviews eventually saturated with 8 people. The perception and understanding of the patients about identity and disease, values and beliefs, similarity in their narrative, the important individuals and events were studied. Data analysis was carried out using coding at three levels of open, axial, core using MAXQDA version 12.3. Results and conclusion: The significant others in the life of these individuals include the father, mother, sister, brother, spouse, friends and relatives and the opposite sex; Influential events include negative affecting events, positive affecting events, other influential events; traumas; self includes judgments about self, conflicts, humor, individual characteristics, attitudes toward religious issues; attributes include negative external attributions; marriage and sexual matters including marital status and sexual issues which all of this express the experience and dimensions of patients' perception of their lives. The patients know their father and brother as the most important and significant others in their lives and perceived the mother as a person with contradictory behaviors.
Keywords: Narrative analysis, Paranoid disorder, Qualitative research
INTRODUCTION
Paranoid is a psychological and psychiatric term. In this case, the person suffers from a kind of mental disorder or paranoid disorder including pessimism, jealousy and arrogance. It is a form of psychosis. A person seems to be more prone to bad behaviors or bad thoughts such as difficulty thinking, concentrating, or paying attention (1). Paranoid people are as isolated as possible from the rest of society and they try to sit quietly in a corner so that no one notices their presence. Their faces are usually cold and soulless and do not show any emotion (2). Paranoid thoughts are defined as cognitive processes used by individuals to cope with the social environment (3, 4). Stressful life events, especially those that occur during the critical early developmental period, predict the risk of developing psychiatric disorders (5, 6). Paranoid patients also put a lot of effort into avoiding negative themes and maintaining a positive self-image (7, 8). Due to the fact that few studies have been done on qualitative research and narrative analysis in Iran, in this study, the narratives that are the life experiences of patients with paranoid disorders were analyzed and evaluated in order to take an effective step in promoting their health by recognizing areas of their lives.
METHODS AND MATERIALS
In this research, qualitative research method has been used as a purposeful fundamental method of narrative analysis based on McAdams interview form to analyze the life stories of patients with paranoid disorder. Patients with paranoid disorder referred to Razi psychiatric hospital were
RUSSIAN LAW JOURNAL Volume XI (2023) Issue 12s
included. In this study, interviews with individuals were continued until saturation was reached, and finally saturation was obtained with eight subjects. In this study, purposive sampling method has been used in order to gain a deep understanding of the participants and obtain the information required for the research.
The method of interview is individual interview and the participants were explained about the objectives of this study and how to use their information and the researcher's motivation for their selection and the questions and ambiguities were answered while ensuring their anonymity. Subjects were given an informed consent form for written registration. With the consent of the participants, the interviews were recorded for written purposes only. The duration of the interview varied from 31 to 61 minutes, depending on the individual characteristics of the interviewees.
In this study, the form of McAdams semi-structured interview questionnaire was used.
Data analysis in qualitative research was done after the preparation and organization of data (textual data, manuscripts or graphical data), by reducing the data in the form of several themes through the process of theming and summarizing codes, and finally presenting the data in the form of tables and graphics. MAXQDA software version 12.3 was used to facilitate the analysis of qualitative data and increase accuracy. In order to achieve the findings, three levels of open, axial and core coding were used. The five steps for analyzing qualitative data were as following:
• Arranging and preparing data for analysis: The information collected through interviews was organized in the form of manuscripts or computer folders.
• Separating or reducing data: coding or forming classes that were the focus of qualitative analysis. A classification system fills in a detailed description of the formation of themes or codes.
• Data reorganization or pattern search: The process of reorganization can play with data and represent a more abstract concept using objective data transactions.
• Interpretation: Interpretation is a meaningful part of data.
• Conclusions: A conclusion places a set of expressions derived from the findings of a study at a higher conceptual level or a broader set of ideas.
RESULTS
All patients were males ranging from 23-46 years old. The details of all codes extracted from interviews are presented in the table 1.
Table 1: The details of themes and subthemes with relevant quotes
Theme Sub-theme Code Sub-code Quotes
Being influenced Family role The role and position of the Military and political career Membership in SAVAK, Tudeh party, military organizations and other businesses related to violence
by others father The father is extremely isolated and has pessimistic thoughts Strictly prohibiting the wife and children from establishing contact with others and
The role and position of the mother
The role and position of the brother
Very religious father
Fanatical father
Violence and harshness
Contradictory behaviors
Violence and tension
Passive mother against father's behavior
Violence and tension
forcing them to isolate themselves Forcing children to participate in
religious ceremonies and
rites and avoiding taboos Insistence on strict beliefs such as Islamic cover, head
down, no contact with the opposite sex Continuous physical punishment of the child and spouse using tools such as whips and knives A capricious and unstable mother Physical and
mental punishment of
the child, betrayal and abandonment by the mother and long sulking Strong fear of father, hidden support Frequent running away from home due to the fear of being beaten by the brother,
being humiliated, jealousy, the desire to establish a two-year relationship with the
brother, and being ignored by him.
The role and position of the sister Tension with sister Suspicion, cynicism and control towards sisters
The role of the spouse Forced into marriage by family The choice of a spouse by the family has been at an old age and disproportionate to the individual's ideals.
Separation from spouse Separation due to the belief of being abused by the spouse -coldness, lack of sexual attraction
Negative attitude towards spouse Belief in Spouse's unfaithfulness and lack of secrecy - Belief in spouse's secrecy and lying
Argument with spouse Depriving individual freedoms, beating, imprisoning spouse
The role of others around The role of school teachers Punitive teachers Humiliation and ridicule by teachers, physical and psychological punishment by teachers
The influence of family members on the political ideological content of a person A person considers him attitudes, characteristics and spirits derived from living in a
political and militant family
The influence of political figures on the individual Honoring the culture of fighting and trying to identify and attribute oneself to political fighters like Sattar Khan
Communication with colleagues at work Relationships full of tension and conflict Lack of job stability, high absenteeism, beating colleagues
Relationship with the opposite sex The formation of unsuccessful connections Obsessive thoughts and very idealistic standards
Lack of communication with the opposite sex Prohibition of communication by parents, due to inconsistency with the religious beliefs of the family at a younger age, feelings of inferiority and low self-esteem in adolescence.
The effect of communication with friends on a person Lack of friends Belief that the relationship is harmful
Being rejected by friends Belief in not receiving emotional support from friends
Socializing with bad friends Learning illegal activities and drug use, history of arrest and referral to the correctional center
Emotional attachment to same-sex friends Sexual and emotional relationship with the same
sex
Influential events Childhood traumas Pathological violence of father and brother Knifings and constant threats to cut off ears by father and brother - seeing the military dictator father tear open the mother's stomach and remove the baby from it.
Sudden loss of mother and supporting persons in childhood Mother's betrayal and separation
Negative influential events Remarriage of parents Resentment and revenge from mother and father due to betrayal and abandonment of family and remarriage
Fierce fights between parents Violent and heartless relationship between father and mother, child wife and mother's lack of sexual desire, suspicion and cynicism and extreme control by father to wife and daughters.
Bad childhood memories Living in a house with wall to wall torture chamber of SAVAK and seeing the violent scenes of torture of political prisoners and their screams every midnight
and constant fear of the child, witnessing the physical torture of being a mother as a child, memories of being whipped by the father
Bad memories of adolescence and youth Isolation, loneliness, illness and weakness, weed consumption, though rumination, nightmares, firing from university
Bad memories of adulthood Firing from university and workplace due to political activities Dismissed political science student, political reporter, political activist, member of the National part, dismissed secretary of education, member of Tudeh party
Prison violence and torture due to political activities Kidney loss in prison, rape in prison
Committing murder Murder following suspicion
Admission to a mental hospital Hospitalization due to multiple conflicts and disturbing others
Mental and physical injuries after being arrested Harassment by other prisoners and family (jaw and hand bones
for committing a crime broken(
Lack of social support after illness Displacement in the streets, hunger and lack of place
Other influential events 1. Distance from mother in teenage years is considered as emancipation. 2. The focus of peer attention due to violent and antisocial behavior during adolescence 3. Love of music as the only reason to continue living, 4. Interest in philosophical, historical and political science studies that direct one's thoughts. 5. Sexual seduction by adult women during childhood 6. Unconventional sexual relations, such as sex with married women and boys, which forms the basis of a person's anxiety in adulthood (due to strict legal and religious prohibition).
Religious views Compulsion in religious rituals Compulsory going to Friday prayer, Quran class, and delegation forced by the
father has led to blind following without belief in the individual in adulthood
Relying on religion as a way to reduce anxiety Praying to get rid of the horror of hell that a person finds himself trapped in.
DISCUSSION AND CONCLUSION
People with paranoid know their father and brother as the most important and significant others in their lives. Also, the character of the older brother in the lives of these people is usually very controlling, violent and aggressive, which has always cast a shadow of fear on the lives of these people. Trauma in childhood resulted in cognitive distortion. Communication with sisters has also been full of tension and anxiety in these people. According to the narrations of the subjects, these people were exposed to a lot of violence in the childhood. There have been reports of intense fights between parents, mostly over suspicion and pessimism by father. These people generally perceived the mother as a person with contradictory behaviors. Other commonalities between these people were tension with the sister and a negative attitude towards the spouse and constant conflicts with them. The identity style in these people is confused and blocked by sources of power. Paranoid people said that there is a kind of anxiety and guilt. Sometimes paranoid people use religious practices to reduce their anxiety and guilt, and this is a kind of coping strategy in these people. In our study conducted on eight paranoid patients who were admitted to Razi psychiatric hospital; what emerged from the content of the interviews was that these people knew their father and brother as the most important and significant others in their lives, and the narratives they tell of the two were all about the subject and focus of violence. The father's personality in all the subjects was very harsh, had suspicious and pessimistic thoughts and in some cases was very bigoted and dogmatic. Also in most of the subjects the father's job was military or jobs related to violence and dictatorship. Also, the character of the older brother in the lives of these people is usually very controlling and aggressive, which has always cast a shadow of fear on the lives of these people. Regarding the mother's personality, it should be noted that violence, punishment and tension with the mother, and long-lasting violence and hatred and destructiveness of the psyche in childhood were reported.
Communication with sisters has also been full of tension and anxiety in these people. In adolescence, due to the feeling of insecurity and lack of trust in others, which is created in the early years of life, all interpersonal relationships are disrupted in a way that leads them to negative expectations of others, and this puts them in a vicious cycle. It has become a reinforcing event. For example, due to abandonment by the mother, the expectation of abandonment by other women in life is also created in the person, and this has caused a series of anxious behaviors and resorting to force and aggression, which eventually leads to abandonment again and reinforces the abandonment schema. According to research by Szepsenwol & Simpson in 2019, effective internal patterns are activated when individuals feel threatened. Schemas of people with anxious attachment styles make them more aware of the threat, while avoidant people have war-based schemes, especially escapes, and respond more quickly to perceived threats (9,10). Also, due to the guilt that is rooted in the childhood of these people and is mostly created by the source of power, especially the father in their lives, all their adult behaviors are obsessive and full of anxiety and fear. Also, these people usually do not have many friends in life and prefer solitude, but their unfavorable relationship with father and brother sometimes leads to the search for a fatherly
friendship, which unfortunately again due to excessive expectations in friendship and idealization. The person and the inability of the other person to meet their expectations severely devalue them and they again fall into a cycle of suspicion and distrust of others. In some participants, it was seen that due to unfavorable communication with the father and inability to identify with the father, they were drawn to sexual intercourse with a homosexual who in the study sample consisted of men and Due to strong family opposition and social norms, he has suffered from severe fear and anxiety, which has led to the formation of paranoid disorder and harm, and eventually in some people, the decision to eliminate the source of fear. Stressful life events, especially those that occur during the critical period of early development, predict the risk of developing psychiatric disorders (6). Child trauma is associated with epigenetic changes and dysregulation of serotonin function, which is involved in the regulation of emotion (mood), behavior (aggression, impulsivity, and suicide), cognitive and motor function, and the development of the child's brain (11, 12). According to the narrations of the subjects, these people have been exposed to a lot of violence in childhood and have experienced terrible traumas, the perception of which is far beyond the perception of a child, so that the child suffers from a kind of distorted cognition and it has long been confused and confused among a multitude of unanswered questions. The content of the interviews showed that the experience of living in a violent environment in childhood or a suffocating political ideological context are among the factors involved in the formation of disorder and harm during life. Also, other notable similarities in the lives of these people, which are considered as negatively affecting events, are the existence of very intense fights between parents, which have been mostly about the subject of suspicion and pessimism by the father. These fights are sometimes so powerful that the child suffers from a kind of backwardness and a sense of inferiority in life that continues until adulthood and prevents him from relationships with others Gottman, Katz, & Hoovon (1997) have suggested that parents' feelings about their children's specific emotions and the way they interact with them determine children's feelings about their own emotions and attitudes toward them (13, 14). If parents actively acknowledge their children's negative emotions, the basic message is that their emotions are acceptable and worthy of expression and negotiation. If parents discipline their children or prevent them from expressing negative emotions, the basic message is that negative emotions are harmful and should be avoided. In the interpretation of the results, it is better to pay attention to the current situation in the society and common diseases, as the current COVID-19 pandemic apart from the effects on other main organs of the body (15-21), with the remaining effects of the virus that leads to symptoms of long COVID (22), fatigue (23), depression (24) and even psychosis (25, 26), distance from the community and gathering of friends and acquaintances can also help to aggravate the existing situation.
LIMITATION
Considering that the present study has been performed on men with paranoid patients, research can also be performed on women with this disorder and a comparison can be made between the narratives of the two groups. It is suggested that more psychiatric hospitals be included in the research in future research.
CONCLUSION
The significant others include the father, mother, sister, brother, spouse, friends and relatives in the life of the patients with paranoid disorder play important role. Perception of their lives is influenced with influential events such as negative affecting events, positive affecting events, and traumas. The patients know their father and brother as the most important and significant others in their lives and perceived the mother as a person with contradictory behaviors.
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