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Hune ND, McGovern TF. A Perspective on Neurobiological and Intersubjective Connectedness in Coexisting Schizophrenia and Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2021.1996302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicole D. Hune
- Center for Collegiate Community Recoveries, Texas Tech University, Lubbock, TX, USA
| | - Thomas F. McGovern
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Kovács A, Ladányi B, Farkas N, Stempel L, Kiss D, Bittermann É, Rácz J. The recovery of homicidal people diagnosed with schizophrenia and schizoaffective disorder-An interpretative phenomenological analysis. Front Psychiatry 2022; 13:951678. [PMID: 36741576 PMCID: PMC9892903 DOI: 10.3389/fpsyt.2022.951678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Identity recovery in people diagnosed with schizophrenia who have committed homicide poses several difficulties. Premorbid mental illnesses, the experience of psychosis, and the absence of cohesive ego functions may result in the inability to integrate the homicidal act into self-identity. Problems with integration increase the risk of recidivism and further mental problems. The aim of the present research was to explore how homicidal people diagnosed with schizophrenia make sense of their actions, and how they identify with the homicide. METHOD Six semi-structured interviews were conducted at a long-term psychiatric home with people who had committed homicide and who had been diagnosed with schizophrenia. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA), an idiographic method rooted in phenomenologist traditions that focuses on how participants experience and make sense of events in their lives, and how those events affect their identity and sense of self. RESULTS Three personal experiential themes were established as a result of the analysis: (1) homicide and responsibility; (2) homicide and self; and (3) control over threats to self and self-evaluation. (1) Homicide was often reported to have been committed in a non-conscious, delusional state that may have led to the loss of self-determination. (2) Our interviewees struggled to integrate their acts into their identities. They distanced themselves from the crime or held multiple, parallel interpretations of the act. (3) Recovering patients experienced the constant threat of entering into a delusional reality and losing control. The importance of control was central to their self-evaluation. The patients appeared to distance themselves from the homicidal act and to regard their delusional selves as a threat to their lives. CONCLUSION Therapy aimed at bolstering self-control, supporting the integration of the fragmented self, and raising awareness of the connections between delusional reality and standard, intersubjective reality may be helpful in reducing the instability of the self. Therapy aimed at processing complex grief and loss of family is also needed.
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Affiliation(s)
- Asztrik Kovács
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Bence Ladányi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Criminal Investigation, Hungarian National Police Headquarters, Budapest, Hungary
| | - Noémi Farkas
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Laura Stempel
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Kiss
- Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | | | - József Rácz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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Abstract
Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the social sciences and humanities, and from ethnographic research especially. This paper examines the subjective experience of disruptions in self-identity within a cohort of first episode psychosis (FEP) service users, critically engaging with the SD literature and bringing it into conversation with social sciences and humanities scholarship on self and schizophrenia. Drawing findings from an ongoing ethnographic study of young peoples' experiences with psychosis, we explore meanings of mental distress relating to psychotic episodes and attend to issues of self, identity, and subjectivity. We critique the division between "normal" and "pathological" self-experience that is endorsed within the SD literature, arguing against the notion that fragmentation of self-experience in schizophrenia-spectrum illnesses is indicative of psychopathology. We highlight how experiences categorized as psychosis are also important and complete aspects of one's social world and inner life and explore the ways in which at least some aspects of disruptions of self-identity stem from clinical situations themselves-in particular, from asymmetries of power within the mental health system. Relating our findings to feminist, postcolonial, and disability studies' approaches to the "self," we emphasize the complex interplay between interpersonal, cultural, and structural aspects of self-experience within FEP.
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Affiliation(s)
- Suze G Berkhout
- c/o Post-Graduate Medical Education, Department of Psychiatry, The University of Toronto, 8th Floor, 250 College St., Toronto, ON, M5T 1R8, Canada.
| | - Juveria Zaheer
- Department of Psychiatry, The University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, The University of Toronto, Toronto, Canada
| | - Gary Remington
- Department of Psychiatry, The University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, The University of Toronto, Toronto, Canada
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Pérez-Corrales J, Pérez-de-Heredia-Torres M, Martínez-Piedrola R, Sánchez-Camarero C, Parás-Bravo P, Palacios-Ceña D. 'Being normal' and self-identity: the experience of volunteering in individuals with severe mental disorders-a qualitative study. BMJ Open 2019; 9:e025363. [PMID: 30904862 PMCID: PMC6475362 DOI: 10.1136/bmjopen-2018-025363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/14/2019] [Accepted: 01/30/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study sought to explore the views and experiences of a group of people with severe mental disorders (SMDs) who performed volunteer services. DESIGN A qualitative phenomenological study. SETTING Community public mental health services of the Community of Madrid and the province of Barcelona (Spain). PARTICIPANTS Purposive sampling techniques were used between September 2016 and April 2017. The inclusion criteria were: individuals aged 18-65 years who participated in volunteer activities during the performance of this study, based on the regulations of volunteer services in Spain and the community of Madrid; a diagnosis of non-organic psychotic disorder (F20.x, F21, F22, F24, F25, F28, F29, F31.x, F32.3 and F33) according to the International Classification of Diseases, 10th Revision; an evolution of ≥2 years; and a moderate to severe dysfunction of global functioning with scores ≤70 in the Global Assessment of Functioning Scale. Ultimately, 23 people with SMD participated in the study with a mean age of 47 years (SD 8.23). METHODS Data were collected through in-depth interviews and researcher field notes. A thematic analysis was performed following appropriate guidelines for qualitative research. RESULTS Two main themes emerged to describe the experience of participating in volunteer activities: (1) rebuilding self-identity, based on the participant's experience of volunteering, of acquiring a new role and a new perceived identity that made them feel valued and respected; and (2) being a so-called normal person with a 'normal' life, based on recovering a sense of normality, unmarked by the illness, thanks to daily responsibilities and occupations. CONCLUSIONS Qualitative research offers insight into the way people with SMD experience volunteering and may help to improve understanding of the underlying motivations that drive these individuals. These findings may be applied to improve guidance during their process of recovery and subsequent inclusion into society.
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Affiliation(s)
- Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Marta Pérez-de-Heredia-Torres
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Rosa Martínez-Piedrola
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Carlos Sánchez-Camarero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paula Parás-Bravo
- Department of Nursing, Nursing Group IDIVAL, Faculty of Nursing, University of Cantabria, Santander, Cantabria, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Gold N, Craigie J, Gergel T. Interdisciplinary workshop on "mental disorder and self over time". J Eval Clin Pract 2017; 23:999-1005. [PMID: 28834047 PMCID: PMC5656882 DOI: 10.1111/jep.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie Gold
- Department of Philosophy, King's College London, London, UK
| | - Jillian Craigie
- Centre of Medical Law and Ethics, Dickson Poon School of Law, King's College London, London, UK
| | - Tania Gergel
- Mental Health, Ethics and Law research group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Loughlin M, Bluhm R, Buetow S, Borgerson K, Fuller J. Reasoning, evidence, and clinical decision-making: The great debate moves forward. J Eval Clin Pract 2017; 23:905-914. [PMID: 28960730 DOI: 10.1111/jep.12831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
Abstract
When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life.
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Affiliation(s)
- Michael Loughlin
- Department of Interdisciplinary Studies, MMU Cheshire, Crewe, UK
| | - Robyn Bluhm
- Department of Philosophy, Lyman Briggs College, Michigan State University, East Lancing, Michigan, USA
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | | | - Jonathan Fuller
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa.,Toronto Philosophy of Medicine Network, University of Toronto, Toronto, Canada
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