A critical narrative analysis of psychiatrists’ engagement with psychosis as a contentious area

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Abstract

Background:

Psychosis, characterised by altered perceptions or interpretations of reality, remains a contested area. Lately, perspectives and conceptualisations of psychosis that have traditionally been more peripheral have gained greater recognition. Both the British Psychological Society and Critical Psychiatry Network have highlighted some contentious areas in recent publications.

Aims:

The aim was to use critical narrative analysis to consider what facilitates and inhibits medical professionals with clinical experience of psychosis to engage with the topic of psychosis as a contentious area.

Method:

Semi-structured interviews were conducted with 12 medical professionals, who were at trainee or qualified level with a minimum of 6 months’ clinical experience within psychiatry, across three Trusts within the United Kingdom. This purposive sample had a diverse range of perspectives regarding psychosis. Critical narrative analysis comprising six distinct stages, informed the analysis.

Results:

Participants positioned themselves broadly within one of three groups: biological psychiatrists, critical psychiatrists and those more conflicted. Narrative analysis was undertaken for each participant before being integrated for this article. The research highlighted several factors which either limit or facilitate opportunities within the psychiatric profession to engage with a plurality of views regarding psychosis. These included the significance of power and hierarchy within the profession, the role of dialogue and the prevalence of reflexivity within the profession.

Conclusion:

A pattern was identified of psychiatrists generally associating with like-minded others and not engaging with wider evidence regarding psychosis, partly as a result of the inherent threats to the power and hierarchy of the profession. This led to new ideas being widely unknown or undervalued, potentially to the disservice of clinical practice.

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Most cited references 18

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The Kraepelinian dichotomy – going, going... but still not gone

Nick Craddock, Michael J Owen (2010)

Recent genetic studies reinforce the view that current approaches to the diagnosis and classification of major psychiatric illness are inadequate. These findings challenge the distinction between schizophrenia and bipolar disorder, and suggest that more attention should be given to the relationship between the functional psychoses and neurodevelopmental disorders such as autism. We are entering a transitional period of several years during which psychiatry will need to move from using traditional descriptive diagnoses to clinical entities (categories and/or dimensions) that relate more closely to the underlying workings of the brain.

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The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change?

Jim J. van Os, Sinan Guloksuz, Thomas Willem Vijn … (2019)

The content and organization of mental health care have been heavily influenced by the view that mental difficulties come as diagnosable disorders that can be treated by specialist practitioners who apply evidence‐based practice (EBP) guidelines of symptom reduction at the group level. However, the EBP symptom‐reduction model is under pressure, as it may be disconnected from what patients need, ignores evidence of the trans‐syndromal nature of mental difficulties, overestimates the contribution of the technical aspects of treatment compared to the relational and ritual components of care, and underestimates the lack of EBP group‐to‐individual generalizability. A growing body of knowledge indicates that mental illnesses are seldom “cured” and are better framed as vulnerabilities. Important gains in well‐being can be achieved when individuals learn to live with mental vulnerabilities through a slow process of strengthening resilience in the social and existential domains. In this paper, we examine what a mental health service would look like if the above factors were taken into account. The mental health service of the 21st century may be best conceived of as a small‐scale healing community fostering connectedness and strengthening resilience in learning to live with mental vulnerability, complemented by a limited number of regional facilities. Peer support, organized at the level of a recovery college, may form the backbone of the community. Treatments should be aimed at trans‐syndromal symptom reduction, tailored to serve the higher‐order process of existential recovery and social participation, and applied by professionals who have been trained to collaborate, embrace idiography and maximize effects mediated by therapeutic relationship and the healing effects of ritualized care interactions. Finally, integration with a public mental health system of e‐communities providing information, peer and citizen support and a range of user‐rated self‐management tools may help bridge the gap between the high prevalence of common mental disorder and the relatively low capacity of any mental health service.

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Postpsychiatry: a new direction for mental health.

Cameron Bracken, J. Thomas (2001)

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Author and article information

Journal

Journal ID (nlm-ta): Int J Soc Psychiatry

Journal ID (iso-abbrev): Int J Soc Psychiatry

Journal ID (publisher-id): ISP

Journal ID (hwp): spisp

Title: The International Journal of Social Psychiatry

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0020-7640

ISSN (Electronic): 1741-2854

Publication date (Electronic): 26 June 2020

Publication date (Print): November 2020

Volume: 66

Issue: 7

Pages: 724-730

Affiliations

[1-0020764020934516]Department of Neuroscience, Psychology and Behaviour, George Davies Centre, University of Leicester, Leicester, UK

Author notes

[*]Jon Crossley, Department of Neuroscience, Psychology and Behaviour, George Davies Centre, University of Leicester, Leicester LE1 7RH, UK. Email: jpc18@ 123456leicester.ac.uk

Author information

Therese O’Donoghue https://orcid.org/0000-0002-3926-1238

Article

Publisher ID: 10.1177_0020764020934516

DOI: 10.1177/0020764020934516

PMC ID: 7430097

PubMed ID: 32588699

SO-VID: f4ee1e37-f54f-4622-91f4-fa2a8d56bd1e

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).