How do people talk decades later about their crisis that we call psychosis? A qualitative study of the personal meaning-making process

Abstract

Psychosis refers to a severe mental state that often significantly affects the individual's life course. However, it remains unclear how people with the lived experiences themselves view these phenomena, as part of their life story. In order to evaluate this personal meaning-making process we conducted in-depth life-story interviews with 20 people who had been diagnosed with non-affective psychosis 10 to 23 years previously in one catchment area. 35% of them were still receiving mental health treatment, and 55% of them were diagnosed with schizophrenia. Only a minority named their experiences as psychosis. On the basis of narrative analysis, two types of stories appeared to encompass how mental health crises and/or related experiences were presented as part of the life story: (i) crisis as a disruptor of the normative course of life (N=9), and (ii) crisis as an expected reaction to life adversities (N=7). In the majority of the stories the mental health crisis was associated with cumulative life adversities in a central life area. Correspondingly, most of the factors that brought relief were narrated as inseparable from social and other real-life environments. We discuss the need for more person-centered and collaborative models of research and treatment.

Research watch: trauma-informed mental health care and avoiding exclusion of people with a psychosis diagnosis from trauma therapies

“…However, they suggest that developmental trauma is only a cause of psychosis in one third of people who receive a psychosis diagnosis. The possibility that it is not a factor in all cases is consistent with the work of Romme et al (2009) and Bergström et al (2019), but these researchers reported that other severe stresses, some in adulthood, could also contribute to psychosis. It may be that a broader definition of trauma is needed to avoid missing important life adversities.…”

Research Watch: inclusion of people’s social networks can help when they experience psychosis

“…In the second study I examine here, Bergström et al (2019) point out the importance of hearing from service users themselves about how they understand their difficulties. They suggest that clinical language can dominate when people are in treatment, making it harder to see how people make sense of their own experiences, and to offer them the kind of support that will be most helpful.…”

“…As explained earlier, the Open Dialogue approach includes the principle of avoiding imposing any specific explanations of people's difficulties (including diagnosis), and enabling service users and their social network members to be more in control. Bergström et al (2019) set out to find out what service users thought about their experiences some years after their initial treatment with the Open Dialogue approach. Bergström et al (2019) suggest that even those close to someone may try to impose their own explanations onto people's difficulties.…”

“…Bergström et al (2019) set out to find out what service users thought about their experiences some years after their initial treatment with the Open Dialogue approach. Bergström et al (2019) suggest that even those close to someone may try to impose their own explanations onto people's difficulties. This may be due to anxiety and the need we all have for answers.…”

“…The people Bergström et al (2019) invited for interview were the same 108 as mentioned in relation to the previous study (Bergström et al (2018)), and all had received Open Dialogue treatment. Bergström et al (2019) wrote to 77 people still living in the Western Lapland area. Effort was made to ensure that the sample included some people who were still in treatment.…”