The new findings of this study are the emergence of special coping in patients with mental disorders when violence happens. In the condition of “Helplessness,” many patients tried to explore specific coping in the context of religion. The coping is “submission”. This is revealed in the form of data from many patients: “When I am banded, I am weeping alone, trust only to God,” “Yes, I submit to my mother’s fate, I won’t strive, I am remain quiet alone and pray,” “In my heart, I want to rebel, but I did not, I just obey it, Surrender,” “I am tied on the bed, I want to fight but I am not able to do so, I Surrender,” “I once had thought to fight, but I have no power to do so,” “I choose to be in silent, as I am afraid to be hit again when I am fighting...” A Muslim psychologist [27] explained that the concept, technique, and benefit of submission especially for patients and family with mental health problem were backgrounded with the religion. Most of the patients in mental hospitals of West Java embraced Islamic Religion. Muslims are required to believe in God’s provision called destiny. Everything that has happened was the fate of God. Most patients believed that all the good or bad destiny that has happened with full of wisdom. So, Muslims in certain condition are required to “surrender to God” or in Indonesian terminology it is said as “berserah diri”. In addition, the word of Islam in Arabic means “surrender,” which it reflects, to submit the main tenant to the will of God [28]. With “submission,” after all efforts, the patient hopes that the power of God becomes a “reward” or inspiration to get “the way out” of the problem in life.
In psycho-religious concept, there are three techniques to apply “surrender and submission,” especially for psychiatric patients. First, patients should see that both of pleasure and difficulty are a trial from God, for example, when a patient gets restrained in a mental hospital, this can be a stimulus for the patient to remember his/her God. This is in accordance with the following findings, “In order not to be angry I take a deep breath, while utter astaghfirullah to ask God’s forgiveness, I have to engage in many activities..., I am tied because of my wrong doing, so I did introspection”. Second, patients should feel confident that God will not give a burden beyond of human capability. God has measured every load adjusted to the maximum ability of human. For example, the patient should think that restraint is temporary and impermanent; after that, Allah will give to the patient a reward for struggle and patience. Third, the patient should find the positive side of all difficulties after doing the maximum effort, for example, during the hospitalization the patient should think that it was a form of mercy from God that the patient must break from routine and daily busyness.
Although there are some sceptic scientists who believe that submission in psychiatric patients can be a negative meaning, in which a condition where the patients are forced to change behaviour because there was no other choice, but many psychiatrists agree that submission in relation with religion can be constructive coping and important power to consider. This is supported by [29] who revealed “in navigating the complexities of human health religious commitment is a force to consider, the patient’s spiritual/religious dimension: a forgotten factor in mental health”. In Islamic concepts, the benefits of the submission or Tawakkal to Allah SWT is the guarantee and of ease affair in the world and the Hereafter. Allah SWT said in the Holy Qur’an: “Whoever should believe in Allah and the Last day, and whoever fears Allah He will make for him a way out and will provide for him from where he does not expect. And whoever relies upon Allah, and then He is sufficient for him. Indeed, Allah will accomplish His purpose.” (Ath-thalaq:1-2).
Besides that, submission or Tawakkal could make someone stronger and independent, as Allah said: “Put your trust in the Ever-Living (Allah) who never dies: celebrate His praise, for He Alone is sufficient to be aware of the sins of His servants. (QS. Al-furQan:58)” “But no, by your Lord, they can have no Faith, until they make you (Muhammad, peace be upon him) as a judge in all disputes between them, and find no resistance against your decisions, and accept (the decisions) with full submission.” (QS. An-Nisa: 65). In fact, the patient’s amuck and aggressive behaviors are often leading to inability to control themselves. In contradiction, [30] believe that the restraint in the mental hospital is a punishment for patients to reduce their aggressive behaviors. Other studies concluded that seclusion and restraint were prevented without the increase of violence in wards for men with schizophrenia and violent behavior. Nevertheless, earlier studies were not working through or reporting on submission; however, [31] have published that peacefulness is a special coping of patients with schizophrenia.
This study finds that the patients were able to find constructive coping under anger conditions. The coping includes the following: carry out anything, take a deep breath, ask God’s forgiveness, sing a song alone, and introspect herself (introspection). This finding is particularly important, as it is coming from patients themselves. The problem-solving stemming from the patients is very important, as the patients were doing their own evaluation on the effectiveness of coping in use. Several earlier studies never reported the emergence of positive coping of patient when violence occurs or anger reaches a crest. Sibitz et al. [32], on the other hand, reported that stigma resistance is the extremely important concept of patient coping. As conclusion, the patients themselves are able to find and develop constructive coping appropriate to their experiences. This is consistent with research concluding that coping is an important focus area in schizophrenic clinical interventions [33]. Another study by [34] concluded that patient coping is useful to reduce hearing hallucination (eliminate voices) by focusing attention on a distraction activity such as reading, gardening, singing, or listening to music. Anyhow, patient coping in the form of positive compensation is escape of anger offered by patients themselves.
Study limitations
First, some of our results could be difficult to generalize to other countries. However, we have noticed two features of coping that may relate to other countries. In addition, there are few qualitative researches of violence against patients as victims. As such, our findings may be important for the identification of potential idea and the developing of further research. Second, interviewees were recruited from activity groups in hospital; thus, patients who do not join these groups can have more severe cases. Third, this study did not explore any potential correlation between violence-related coping with age, education, sex, occupation, illness severity, and drugs. Thus, future studies may consider those factors to be explored in order to provide comprehensive understanding regarding how patients with schizophrenia cope with the experienced violence.