abpsy l7 05 06

Psychosis, psychology and culture: 

Psychosis, psychology and culture Week seven

Aims: 

Aims To examine criticisms of the medical model To consider the existence of psychotic behaviours in the ‘normal’ population To examine studies focussing on psychotic behaviours, as opposed to studies that ‘begin’ with the assumptions that schizophrenia is a discrete illness To consider the ‘experience near’ perspectives from cultural psychology that question internal and universal models of thought and emotion

Key reading: 

Key reading Read, J. et al (2004) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. London: Brunner-Routledge.

Psychotic traits in general population: personality dimensions: 

Psychotic traits in general population: personality dimensions ‘Normal’ subjects high in schizoptypal or more general psychotic traits have been found to resemble their clinical counterparts in a variety of ways: profiles of psychophysiological response, modes of information processing, and patterns of hemisphere organisation (Claridge, 1993).

BPS psychosis reportBentall, Boyle, Chadwick et al, 2000www.bps.org.uk (pdf file): 

BPS psychosis report Bentall, Boyle, Chadwick et al, 2000 www.bps.org.uk (pdf file) Greater implementation of psychological interventions Variability in ‘symptoms’ (accounting for experience) Cross over between Manic Depression and Schizophrenia Accounting for traumatic experiences and life events Inclusion of service users in clinical decision making Study of individual symptoms, rather than reliance on medical diagnoses Attention to self-esteem, especially low self esteem created via prejudice and stigma

Contemporary theories of psychosis - psychological contributions: 

Contemporary theories of psychosis - psychological contributions Refusing the Biological Zeitgeist and moving towards making sense of symptoms. Began with the work of R.D. Laing and Szaz in 1960s Schizophrenia is a scientific delusion – Mary Boyle. Kraepelin and Bleuler were not describing schizophrenia – encephalitis lethargica. Symptom approaches (Boyle, 1990; Bentall, 1993; 2000; Slade andamp; Cooper, 1998, Frith, 1999). Abandoning diagnostic categories and examining independent behaviours.

Post-Kraepelinian models: 

Post-Kraepelinian models Attack on reliability and validity of schizophrenia diagnosis. Symptom specifics (biological and psychological). DSM IV and Diagnostic Reliability? Relationship between aetiology and diagnosis? Predicting the course and outcome. Lack of consistency in diagnosis.

DSM IV: Construct and predictive Validity?: 

DSM IV: Construct and predictive Validity? Slade andamp; Cooper found psychotic symptoms to be only randomly associated. Cluster analysis: 60% of patients fell into dustbin clusters. No clear border exists between affective disorders and schizophrenia (Kendell et al, 1980). The dividing line between neurotic and psychotic is not clear. Predictive validity is also poor (symptoms cannot predict outcome like other ‘diseases’).

Reviewing the biological evidence – philosophical considerations: 

Reviewing the biological evidence – philosophical considerations The fundamental flaw of ‘dualism’ (Bentall, 2003) Backward circular logic (Jackson, 1986) Tea? We’re mad for it (Rose et al, 1984) Presence of tannine in the urine

Reviewing the biological evidence - genes: 

Reviewing the biological evidence - genes The equal environment assumption Adoption studies Methodological problems Selective Placement (Joseph, 2004)

Reviewing the biological evidence – Bio-chemistry: 

Reviewing the biological evidence – Bio-chemistry Patients are often included in studies when they have been receiving neuroleptic medication (major tranquillisers) Recent studies using drug-free psychotics have found no differences in dopaminergic activity Copolov and Crook, 2000)

Interpreting biology: 

Interpreting biology 'extensive changes in brain structure in neurological illness often lead to little change in behaviour…persistent surgical and biochemical lesions in experimental animals often lead to only temporary changes in behaviour…despite gross recurrent and persistent behavioural changes in psychiatric illness, accompanying disorders of brain function and structure have thus far eluded description.' Wexler, 1980: 289

Psychological and social integrations with biological theories: 

Psychological and social integrations with biological theories 'It is possible that the variability in symptoms between schizophrenics even with the same aetiology is caused not by the primary neurological deficit or information-processing dysfunction, but by the variety of ways in which individuals attempt to compensate or cope with the primary dysfunction. For these and other reasons, consideration of the developmental course of the phenomena of schizophrenia is essential' (Jackson, 1990: 143).

Patient Outcomes as support for symptom approaches: 

Patient Outcomes as support for symptom approaches Bleuler, 1978; Ciompi, 1980; Huber et al, 1984. 1/3 recover completely, 1/3 deteriorate into chronic state, 1/3 experience repeated episodes of psychosis. Patients do not seem to fall into ‘discrete’ types.

Cross-cultural variation: 

Cross-cultural variation There is a 10-55 fold difference between countries (Goldner, 2002) Incidence rates vary widely within countries – urban and rural settings (van Os and McGuffin, 2003) ‘Developing’ countries have much higher rates of recovery

Cultural subjectivities: 

Cultural subjectivities Jenkins (2004) Micro and macro ecologies – 'experience near' theorising – context of everyday life, not the clinic Jenkins andamp; Karno (1992) found enormous variability in EE across cultures – more EE is Euro-American families – no such thing as a natural course of schizophrenia – interpretations of behaviour and others is already cultural – intersubecjtive engagement ‘Self’ is a central analytic in understanding relationship between culture and subjectivity (thinking as bodily process in Iban people in Malaysia) – ‘self’ is absent from DSM-IV Against fundamentalism in human processing – thoughts, selfhood, emotion Self as intersubjective creation – a constellation of interpersonal mechanisms in service of emotional protection against noxious emotional milieu developed through childhood and adolescence Self is not discontinuous with psychotic experiences Intentionality – implicit tending toward and taking up aspect of our world – this world is thoroughly cultured not internal

Gender and psychosis – importance of social engagement: 

Gender and psychosis – importance of social engagement Corin (1990) Men develop 2 coping styles – social distancing (voluntary) and exclusion (involuntary) – men with latter experienced were rehospitalised Women recover much more quickly and have more affective type symptoms (Goldstein et al, 1990) – women with schizophrenia still carry out social duties and household tasks like their ‘normal’ counterparts

Summary: 

Summary Opinion on schizophrenia is divided. Post-Kraepelinian models oppose traditional definitions and dispute research that is based on it. Tension between psychiatric and psychological approaches. Social Cultural factors are important. Shift away from disease models to an exploration of meanings, agency and emotion.