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Pao Yue-kong Library, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong http://www.lib.polyu.edu.hk AN EXPLORATORY STUDY OF THE SUBJECTIVE TRAUMATIC SCHOOL BULLYING EXPERIENCES OF ADOLESCENT VICTIMS WHO HAVE LATER DEVELOPED EARLY PSYCHOSIS WONG MEI KWAN ROSETTA Ph.D The Hong Kong Polytechnic University 2016 The Hong Kong Polytechnic University Department of Applied Social Sciences An exploratory study of the subjective traumatic school bullying experiences of adolescent victims who have later developed early psychosis Wong Mei-kwan Rosetta A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy December 2015 CERTIFICATE OF ORIGINALITY I hereby declare that this thesis is my own work and that, to the best of my knowledge and belief, it reproduces no material previously published or written, nor material that has been accepted for the award of any other degree or diploma, except where due acknowledgement has been made in the text. ___________________________ (Signed) WONG MEI KWAN ROSETTA (Name of student) i Abstract This study aims to understand the subjective traumatic school bullying experiences of adolescent victims who have later developed early psychosis. Literature on school bullying, early psychosis and the traumatic impact of bullying is reviewed. It has been reported that a significant proportion of clients with mental problems have suffered from experiences of school bullying, an issue that has been featured in many studies in the international as well as local literature, suggesting the relationship between school bullying and mental problems is closely linked. However, few of these studies pay attention to the subjective experiences of the victims of school bullying who are found to be developing symptoms of psychosis. A narrative inquiry approach is adopted to explore the stories of 8 adolescents with psychosis who have been bullied before the onset. Interviews were conducted, taped, and transcribed. The thematic and structural analysis suggested by Riessman (1993, 2008) has been used to analyze the stories. Using Sullivan’s Interpersonal Theory of Psychiatry (1953) as the conceptual framework, the findings have been separated into 5 main themes and 2 to 4 sub-themes have been developed under each main theme respectively. The first finding is the subjective experience of the being bullied experiences and its traumatic features. The second is the post-bullied complex in which the coping, the unresolved negative feelings and the dynamisms being used are intermingling. The third is the self evaluation and presentation of the participants’ self personification which includes the good-me self, the bad-me self, the poor-me self and the ambivalent-me self. The fourth is the manifestations of the psychotic symptoms and their contents. The fifth is the ii functions of the psychotic symptoms and their resemblance to the contents of being bullied experiences are found. The findings are then thoroughly discussed in the light of the existing literature; both related empirical studies and also Sullivan’s Interpersonal Theory of Psychiatry. The relationship of the themes is then conceptualized in a vicious circle diagram to show the interwoven linkage among them. This study is a pioneer project in exploring the subjective experiences of adolescents with being bullied experiences and psychosis. It discloses the rich details of how the victims were bullied, and how they felt about and struggled with the victimization. The possibility of how the psychosis developed is also explored. This study also contributes to informing further social work practice and educational direction, and focuses on helping this type of client and filling theoretical and methodological gaps in this area of study. iii Acknowledgements There are many people to whom I wish to express my gratitude. Professor Kam- shing Yip has enlightened me as to what the humanistic social work profession really is. He has taught me since my undergraduate studies in social work, and has oriented me toward a knowledge of how to understand people with mental illness. Being my PhD supervisor, Professor Yip has continued to guide me through the perspective of a humanistic and holistic understanding of wounded people. I would like to acknowledge all his teaching with special thanks. I would also like to express my sincere heartfelt thanks to Dr. Carl Cheng. Dr. Cheng has been accompanying me as I went through the hardest times on my PhD journey. He has spent a lot of time reading together with me, giving guidance and comments on my writing, and providing me with emotional support. He is my teacher, a mentor and a friend I will never forget. He is such a sincere and humble person. He has always provided me with encouragement to help me finish this hard job. Dr. Patrick Law, my co-supervisor and a teacher who has helped me at the significant stage of my study, has provided me with scholarly advice as well as emotional support. His rich academic background and experience in research has inspired me greatly. I am thankful for his generosity in teaching me and caring for me. I have received additional learning from others at the Hong Kong Polytechnic University during my PhD study and I need to thank those teachers too. They are Dr. David Ip, Dr. Kwok-leung Ho and Dr. May Tam, and all three of them have enriched my knowledge of different research methodologies. Dr. David Ip has also given me a lot of encouragement and support through other forms of teaching besides formal classroom iv academic lectures. I thank him for his enthusiasm and charisma in helping and leading us. I would also like to thank my external examiners, Professor Richard Hugman and Dr. Shirley Hung for their valuable comments on my thesis. Acknowledgement should also be given to all the adolescent participants, their parents, and the referrers. Due to the need for maintaining confidentiality, I cannot name the adolescents one by one. I am most strongly indebted to them and their parents for their help and I appreciate their toughness while undergoing the hardships in their lives. I sincerely hope that all of them will make a very successful recovery. I also need to express my heartfelt thanks to the social workers and colleagues who have given me a helping hand during the whole process, and especially thank them for case referrals. They are Benson Chan, Petsy Chow, Fanny Law, Florence Pang, Maggie Lau, Wing-kin Lee, Ching-ching Yeung, Carol Leung, Alex Ho and Angela Wong. There are still many other friends who I cannot name one by one, but all of them are kept in my heart. Special thanks should also be given to Dr. Yida Chung for her accompaniment, support and help over the past years. Last but not least, thanks and appreciation must be given to my family. My father, who passed away in 2011, has left me a lot of good memories, and I want to thank him. I must also mention my beloved mother, siblings, nephews, nieces, and also their little children: I want to give them all a big hug one by one. Last of all, I want to express my greatest thanks to the warm and wonderful support I have received from Willis Choy. Thank you very much for all your love and support! v Table of Contents CERTIFICATE OF ORIGINALITY i Abstract ii Acknowledgements iv Table of Contents vi Chapter 1: Introduction 1 1.1 Rising Trend in Adolescence Mental Health Problems 1 1.2 The Linkage between Trauma and Psychosis 3 1.3 The Linkage between Bullying and Psychosis 4 1.4 The Linkage between Bullying and Trauma 6 1.5 Implications for Social Work Research 7 1.6 Structure of this Thesis 8 Chapter 2: Literature Review 10 2.1 School Bullying 10 2.1.1 Definition of School Bullying 10 2.1.2 The Behaviourist Perspective 11 2.1.3 The Victim’s Perspective 13 2.1.4 The Aggressor’s Perspective 15 2.1.5 The Nature Perspective 16 2.1.6 The Psychodynamic Perspective 17 2.1.7 Types of School Bullying 18 2.1.8 Prevalence of School Bullying 20 2.1.9 Consequences of School Bullying 21 vi 2.1.10 Summary of School Bullying Literature 23 2.2 Early Psychosis 25 2.2.1 The Definition and Symptoms of Early Psychosis 25 2.2.2 Early Conceptualizations 28 2.2.3 The Genetics and Neurobiological Perspective 30 2.2.4 The Cognitive Perspective 31 2.2.5 The Psychodynamic Perspective 33 2.2.6 The Phenomenological-Existential Perspective 36 2.2.7 The Interpersonal Theory Perspective 39 2.2.8 The Significance of Understanding Subjective Experiences 41 2.2.9 The Transition from DSM-IV-TR to DSM-5 43 2.2.10 Prevalence of