Psychosis from a psychological perspective

I recently sat in on a presentation about psychological interventions for serious mental illness at an international conference , where the audience was mostly made up of US health professionals working in psychiatric settings.

What was interesting (or to be more accurate, disconcerting) for me were the number of comments from the audience expressing surprise that the problems of a “brain disorder” like schizophrenia could be amenable to psychological therapy. It seemed surprising for some of the audience that engaging a person in discussing the meaning and impact of their psychotic experiences (such as hearing voices or persecutory beliefs) could be of benefit.

Now this wouldn’t have been surprising 15 years ago, but things have certainly moved on, at least in Australia and the United Kingdom (my two frames of reference). It made me think about how your view of the world is structured by assumptions, and how much influence the unhelpful assumptions of an illness model of schizophrenia may have on the care that people receive from mental health services. The worst aspects of the “schizophrenia as brain disorder” explanation lead to invalidating people because they have unusual experiences, encouraging a passive approach to living, and not considering the influence of social and psychological influences upon peoples lives.

Sadly, it appears that the work of British psychologists in developing psychosocial models of psychosis and more effective talking therapies has not yet permeated the healthcare culture in some parts of the US. What gives hope is that despite the diligent work of drug companies it appears that the general public at least remain less convinced by causal biological models of schizophrenia, preferring psychosocial accounts.

There certainly was interest from the audience in understanding psychosis from a psychological perspective, and the presenter spent most of the time discussing normalisation and the dimensional view of symptoms. This was of value, but also a shame, as these things are really the basic assumptions of a cognitive behavioural approach to psychosis and there was not much time to then discuss more detailed therapeutic methods. This information is also more broader than one particular therapeutic model and should be considered part of a working clinician’s understanding of psychosis.

Where can someone start if they want to understand a contemporary psychological view of psychosis? Below are several sources that are worth checking out:

Richard Bentall’s book, “Madness Explained”, is an excellent and comprehensive discussion of the limitations of the diagnostic approach and reductionism in understanding psychosis, and value of psychological models and research to address some of the problems with a strict biological account. There is a summary presentation of the arguments in the book available on the MIND website.

Several years ago the British Psychological Society’s Division of Clinical Psychology produced a useful summary of psychological research, “Recent advances in understanding mental illness and psychotic experiences”, hosted here.

The Schizophrenia Guidelines website, designed to help UK health services implement the NICE Guidance for Schizophrenia, is a good resource for seeing how these psychological perspectives can influence care.

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Filed under CBT, Clinical Psychology, cognitive behavioural therapy, Mental Health, Psychology

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