Veterans and non-veterans with schizophrenia : a grounded theory comparison of perceptions of self, illness, and treatment

Abstract

This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.