Carley Cain, N480, Visual Report: The Byers Family and Psychosis

The Byers Family and Psychosis

(“Stanger Things”, (2016).

Introduction: Description of the condition Brief psychotic disorder is described as the, “sudden onset of psychotic symptoms” (Townsend, 2015, p. 108). The symptoms endure one day to one month, and there is a full recovery after the episode is over (Townsend, 2015, p. 108). This condition may be triggered by an extreme psychosocial stressor (Townsend, 2015, p. 108). In Joyce’s case, the death of her son, Will, triggered a brief psychotic break. Psychosis is a break from reality, the reality is that Will passed away recently when he was riding his bike home from a friend’s house at night. He was riding past the quarry, when the land under him gave way and he fell in and drowned.

The symptoms of psychotic disorders can be organized into 4 categories: positive symptoms, negative symptoms, cognitive symptoms, and affective symptoms (Churchill et al., 2013, p. 119). Joyce is exhibiting positive and cognitive symptoms. The cognitive symptoms include: hallucinations, delusions, and bizarre behavior (Churchill et al., 2013, p.

119). She believes that the government has monsters from another dimension that have escaped and captured Will, and now the government has covered it up by saying that Will is dead (Ditcher et al., 2016). This is an example of delusional thinking, which is defined as, “false fixed beliefs that cannot be corrected by reasoning and are usually bizarre” (Churchill et al., 2013, p. 119). She also claims so have seen the monster, can hear Will talking to her, and that he can talk to her “through the lights” (Ditcher et al., 2016). These are visual, and auditory hallucinations respectfully.

Hallucinations are defined as, “false sensory perceptions not associated with real external stimuli” (Townsend, 2015, p. 114). Because of these delusions and hallucinations, she sets up Christmas lights around the house, and spends her time sitting in the house and asking Will to talk to her (Ditcher et al., 2016). This is an example of another positive symptom: bizarre behavior (Churchill et al., 2013, p. 119). Some cognitive symptoms that Joyce is exhibiting include: poor problem-solving ability, emotional turmoil, and confusion (Townsend, 2015, p. 108). She is unable to face the stress of planning a funeral, because of her poor problem-solving ability.

She exhibits emotional turmoil throughout her grieving process, which is normal after a loss of a family member, but is exaggerated in Joyce’s case.

She is also experiencing extreme confusion, and is unable to answer simple questions or keep facts, or dates straight (Ditcher et al., 2016).

Meet the Byers:

Jonathan Byers:

Joyce Byers:

(“Jonathan”, n.d.)

• The Patient

(“Joyce”, n.d.)

• Age: 37 • Occupation: Works at a small general store.

• Living Conditions: Lives in Hawkins, Indiana. It is a small town where everybody knows everybody, and it’s hard to live down a bad reputation (Ditcher et al., 2016). Her house is small and located on the not-as-nice side of town. It is right off of a small road, so she has no immediate neighbors (Ditcher et al., 2016).

The interior of the house is not up to the latest fashion trends, but is uncluttered and clean. She lives there with her two sons Jonathan, and Will (Ditcher et al., 2016).

• Meaningful relationships: Joyce loves her two sons (Ditcher et al., 2016). Friends from her job and the community supported her when Will died by bringing her food and trying to comfort her (Ditcher et al., 2016). Joyce’s biggest form of support comes from Jonathan, who always steps up when anything needs to be done, from making breakfast to planning the funeral (Ditcher et al., 2016). She also spends time with Chief Hopper, the Hawkins Police Chief. They have been friends for many years, she trusts him, and he has her best interest in mind (Ditcher et al., 2016). Lonnie, her ex-husband, and her do not speak often (Ditcher et al., 2016).

• Patterns of living: Joyce’s world revolves around her kids. When she is not working hard trying to make enough money to support them, she is at home spending time with them. She liked to play with Will and was very supportive of whatever he was interested in (Ditcher et al., 2016).

• Relation to Patient: Son • Age: 16 • Occupation: Is a full-time high school student at Hawkins High (Ditcher et al., 2016). Works at a local restaurant to help his mom pay the bills (Ditcher et al., 2016).

• Living Conditions: Lives with his mom and brother in Hawkins (Ditcher et al., 2016). He hates his father for leaving the family, and not caring for or supporting them (Ditcher et al., 2016).

• Meaningful relationships: Jonathan has close and loving relationships with his mom and brother. He is considered a “loner” at school, and does not have many friends (Ditcher et al., 2016). His one friend, Nancy, has been a support to him after Will’s death (Ditcher et al., 2016).

• Patterns of living: Jonathan assumes many of the responsibilities around the house (such as making breakfast, and helping will in the morning) (Ditcher et al., 2016). When Will died and his mom was sick, he assumed even more responsibilities, like taking care of his mom, and planning the funeral (Ditcher et al., 2016). Most of his time is spend at school or work.

When he does have leisure time he enjoys photography (Ditcher et al., 2016).

Will Byers (deceased):

Lonnie Byers:

(“Will”, 2016)

• Relation to Patient: Son • Age: 12 • Occupation: Was a student at Hawkins middle school (Ditcher et al., 2016).

• Living Conditions: Lived with his mom and brother in Hawkins (Ditcher et al., 2016).

• Meaningful relationships: Will loved his mom and brother. He also had a group of close friends: Mike, Lucas, and Dustin (Ditcher et al., 2016). He was sad that his father was not around, and was often disappointed by his father’s multiple broken promises.

• Patterns of living: Will would spend the majority of his time at school, or with his friends because his mom was often busy working. He was a good student, liked the game Dungeons and Dragons, and music (Ditcher et al., 2016). He would use his bike to get to school, and around town.

• Will passed away recently when he was riding his bike home from Mike’s house at night. He was riding past the quarry, when the land under him gave way and he fell in and drowned.

(“Lonnie”, n.d.)

• Relation to Patient: Ex-husband • Age: 40 • Occupation: Works as a mechanic.

• Living Conditions: Lives in the city, a few hours away from Hawkins. He lives in a small, unkept house.

• Meaningful relationships: He lives with his girlfriend Cynthia, who is much younger, 25. He no longer initiates conversations or relationships with Joyce, Jonathan, or Will. He does not keep his word.

• After Will died and Joyce was grieving, she asked Lonnie to come to town for a while. He encouraged her to drink alcohol, which upset Jonathan, because that was not good for her (Ditcher et al., 2016). Lonnie was not sad about Will’s death, instead he told Joyce that she should sue, so that he could get money out of the situation (Ditcher et al., 2016).

Description of Family Structure • Joyce (37) is a single-mother of Jonathan (16), and Will (12).

• According to Duvall’s family stages, this family falls into “Stage 5.

Teenage children” (Brand et al., 2012, p. 2). The Byers fit into stage 5 because Jonathan is 16 years old. Before Will passed away they would have also fit into “Stage 4. School-aged children” because Will was 12, and in middle school (Brand et al., 2012, p. 2).

• “Family members assume different roles for the work of caring and nurturing with or without the presence of illness” (Denham, Eggenberger, Krumwiede, & Young, 2016, p. 120). The dynamics, roles, and functions of the family have recently shifted because of their recent loss. Before Will’s death Joyce was primarily responsible for working to financially support Jonathan and Will.

She would also serve as emotional support, and encouragement to both of them. Because Joyce was working so much Jonathan was responsible for chores around the house, and daily meal preparation. He also worked to financially support the family. Will was responsible for going to school, and staying out of trouble, which was not a problem for him. He was helpful around the house, but did not have specific responsibilities. Joyce and Jonathan both tried to make sure Will had a loving, stress-free home environment. After Will’s death, Joyce began showing symptoms of psychosis. As a result, she could no longer preform her family roles and responsibilities. Jonathan had to further step up in order to take care of his mother, and the responsibilities she could no longer preform, such as providing financially. On top of that he had to make decisions regarding Will’s funeral arrangements by himself, and protect Joyce from Lonnie’s selfish intentions.

CULTURE/ RELIGION TRADITIONS: • The Byers are a Christian family, the celebrate Christmas and promote Christian values such as love and forgiveness (Ditcher et al., 2016). They are also emerged in the small-town culture of Hawkins, Indiana.

That means that everyone in town knows their family situation and struggles.

COMMUNICATION: • Communication between Joyce and Jonathan is strained. Jonathan sometimes gets stressed from his increased responsibilities, and that his mother is not helping him. This results in him raising his voice at her on a few occasions (Ditcher et al., 2016). Joyce is open with Jonathan about her delusions and hallucination, only after Jonathan asks her questions about her behavior. So, in that way communication can be improved.

(“Lights”, 2016)

(“Once for yes twice for no”, 2016)

STRENGHTS & CHALLENGES: • Strengths: The small-town culture means that many people are willing to offer support to the Byer’s family (Ditcher et al., 2016). The family fosters community and support through eating meals together (Ditcher et al., 2016). Jonathan is extremely mature for his age, and is willing to help his mother.

• Challenges: The small-town culture makes having privacy difficult (Ditcher et al., 2016).

The Byers are a single-parent household, so Jonathan and Will don’t have a supportive father figure. They are also struggling to make ends meet, so Jonathan works extra hours, and the family experiences increased stress.

The Family Assessment and Intervention Model APPLICATION OF FAM THEORY: The Family Assessment and Intervention Model views the family as a dynamic system that is open to the effects of its environment (Kaakinen, Coehle, Steele, Tabacco, & Hanson, 2015, p. 91). The family creates different levels of protection, to protect their core family unit from stressors (Kaakinen et al., 2015, 91). This model describes the family’s levels of protection as a “flexible line of defense”, “normal line of defense”, and “lines of resistance” (Kaakinen et al., 2015, 92). The model also depicts three areas of influence on the family. Area 1 involves the family’s response to health promotion activities (Kaakinen et al., 2015, 92). Area 2 involves their response to instability at their lines of defense and resistance (Kaakinen et al., 2015, 92). Area 3 has to do with the family restoring themselves to stable family functions (Kaakinen et al., 2015, 92). Area 3 does not deal with lines of resistance or defense, instead it involves primary, secondary, and tertiary levels of prevention and intervention (Kaakinen et al., 2015, p. 92). This model demonstrates how, “unexpected/unwanted health status changes can affect the basic family unit or core” (Kaakinen et al., 2015, 91). This model explains that families react to stressors differently (Kaakinen et al., 2015, 91). Also, The family’s ability to cope depends on how deeply the stressor penetrates the family’s lines of defense and resistance (Kaakinen et al., 2015, 91). The family’s ability to cope is also effected by how, “capable or experienced the family is in adapting to maintain its stability” (Kaakinen et al., 2015, 91). In order to help the family return to a state of family stability, the nurse can utilize The Family Assessment and Intervention Model to identify what is causing a family stress, and how the family is reacting to stress (Kaakinen et al., 2015, 92). The nurse then uses the model to help the family identify problem-solving strategies, and utilizes the family’s strengths to implement interventions to promote family stability (Kaakinen et al., 2015, 92).

The Problem: In this case the problem that the Byers family is currently facing is Joyce’s brief psychotic disorder. The family is reacting to the stress by Joyce being mentally incapacitated by her illness, and unable to help herself. So, Jonathan is trying to help her by taking over responsibilities. In regards to area 1, Jonathan recognized that this was not part of the normal grieving process when Joyce told him about her hallucinations and delusions. In assessing area 2, it is noted that Jonathan is trying to protect what is left of his basic family structure by first taking over responsibilities (flexible line of defense) and then taking Joyce to the doctor’s office (normal line of defense). The nurse should utilize area 3 in The Family Assessment and Intervention Model to help the family restore stability.

Interventions & Outcomes 1. Intervention: The nurse should encourage family members to talk about, “ways of relating and individual experiences of psychosis” (Rapsey, Burbach,& Reibstein, 2015, p. 518) • Rational: This enables the family to develop new, shared understandings of the illness (Rapsey, Burbach,& Reibstein, 2015, p. 518).

• Outcome: Jonathan and Joyce will talk about Joyce’s experience with psychosis by the end of the day.

2. Intervention: The nurse will assess the caregiver’s (Jonathan’s) needs (Roddy, Onwumere, & Kuipers, 2015, p. 539).

• Rational: Caregivers showed higher levels of satisfaction of professional care providers when their needs were addressed (Roddy, Onwumere, & Kuipers, 2015, p. 539). When the caregiver is supported, the patient is inadvertently supported as well, and the nurse is providing familycentered care.

• Outcome: The nurse will assess and encourage Jonathan as a caregiver for his mother by the end of their appointment (Roddy, Onwumere, & Kuipers, 2015, p. 539).

3. Intervention: Explain and encourage Jonathan and Joyce to see a family therapist (Allen, Burbach, & Reibstein, 2013, p. 217) • Rational: Families with a family member with psychosis, who attended family therapy described it as providing a therapeutic space (Allen, Burbach, & Reibstein, 2013, p. 217). This therapeutic space fosters healing and connection of the family.

• Outcome: Jonathan and Joyce will set up an initial family therapy session.

(“Jonathan and Joyce”, n.d.)

References Allen, J., Burbach, F., & Reibstein, J. (2013). 'A Different World' Individuals' experience of an integrated family intervention for psychosis and its contribution to recovery. Psychology & Psychotherapy: Theory, Research & Practice, 86(2), 212-228. doi:10.1111/j.20448341.2011.02057.x Brand, G., Burson, M., DeFrain, J. D., Fenton, A. M., Friesen, J. L., Hanna, J. S., . . . Werth, L. A. (2012). Getting connected, staying connected: The normal, to-be-expected, satisfactions and challenges couples and families experience. University of Nebraska Lincoln.

Retrieved March 7, 2017, from http://extensionpublications.unl.edu/assets/pdf/g2124.pdf Churchill, L., Henry, N. J., Johnson, J., McMichael, M. G., Redding, S. R., Roberts, K., & Sommer, S. (2013). RN mental health nursing: review module (9th ed.). Assessment Technologies Institute.

Denham, S. A., Eggenberger, S., Krumwiede, N., & Young, P. K. (2016). Family-focused nursing care. Philadelphia, PA: F.A. Davis Company.

Ditcher, P., Duffer, M., Duffer, R., & Nickson-Lopez, J. (Writers), Campbell, M. B., Denault, R., Duffer, M., Duffer, R., Levy, S., & Peterson, K. M. (Directors), Doble, J., Geiger, R., Mecklenburg, J., Morris, E., & Tatlock, A. (Producers). (2016, July 15). Stranger Things [Television series]. Los Gatos, California: Netflix. Retrieved from https://www.netflix.com/watch/80077369?trackId=14170286&tctx=1%2C0%2C67f3eea0-44e9-4c4b-be0f-8753c8a47acf-56567601 Jonathan and Joyce. (n.d.). Retrieved March 12, 2017, from http://dorkshelf.com/wordpress/wp-content/uploads/2016/07/StrangerThings-Chapter-2-B.jpg Jonathan. (n.d.). Retrieved March 12, 2017, from https://s-media-cacheak0.pinimg.com/originals/7e/4b/66/7e4b664313901b6b99d4784112045dc5.jpg Joyce. (n.d.). Retrieved March 12, 2017, from http://strangerthings.wikia.com/wiki/Joyce_Byers Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family health care nursing: Theory, practice, and research (5th ed.). Philadelphia, PA: F. A. Davis Company.

Lights. (2016, August 9). Retrieved March 12, 2017, from http://www.avclub.com/article/make-your-own-stranger-things-christmas-lightmess-240856 Lonnie. (n.d.). Retrieved March 12, 2017, from http://vignette1.wikia.nocookie.net/strangerthings8338/images/9/9e/Lonnie_001.png/revision/latest?cb=20160727041819 Once for yes twice for no. (2016, August). Retrieved March 12, 2017, from http://strangerthingsnetflix.tumblr.com/post/149421052976/once-for-yes-twice-for-no Rapsey, E. S., Burbach, F. R., & Reibstein, J. (2015). Exploring the process of family interventions for psychosis in relation to attachment, attributions and problem-maintaining cycles: an IPA study. Journal Of Family Therapy, 37(4), 509-528. doi:10.1111/1467-6427.12085 Roddy, S., Onwumere, J., & Kuipers, E. (2015). A pilot investigation of a brief, needs-led caregiver focused intervention in psychosis.

Journal Of Family Therapy, 37(4), 529-545. doi:10.1111/1467-6427.12054 Stranger Things. (2016, July 20). Retrieved March 12, 2017, from http://www.patheos.com/blogs/sickpilgrim/2016/07/sick-pilgrim-chatsjonathan-and-jess-bingewatch-stranger-things/ Townsend, M. C. (2015). Psychiatric nursing: Assessment, care plans, and medications (9th ed.). Philadelphia: F.A. Davis Company.

Will. (2016, July 26). Retrieved March 12, 2017, from https://www.buzzfeed.com/keelyflaherty/heres-what-the-stranger-things-cast-lookslike-out-of-costum?utm_term=.haomM3mVB#.predjKdwe