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Iudici A, Alecu G, Quarato M, Neri J. Early Support for People Who Hear Voices: Exploratory Research on Family Medicine Physicians' Clinical Practice and Beliefs. Behav Sci (Basel) 2024; 14:357. [PMID: 38785848 PMCID: PMC11117472 DOI: 10.3390/bs14050357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Nowadays the phenomenon of hearing voices represents a very fertile and discussed field of research. In psychological and psychiatric fields, the phenomenon has been described as a normal phenomenon, but also as a prodromal stage and as a symptom of psychosis. Through a qualitative research methodology, the aim was to explore how family medicine physicians configure the phenomenon and its clinical and interactive implications. The present research involved 35 family medicine physicians as figures of primary importance in the approach toward people who start to hear voices. Semi-structured interviews have been used and they have been analyzed by the method of discourse analysis. The results show a remarkable difficulty in understanding the phenomenon in all its complexity and the tendency to consider it a symptom or a prodromal stage of psychopathology. Increasing the knowledge of doctors on the subject is necessary so that their evaluation and choice of intervention match the needs of each patient. We also discuss the importance of promoting the knowledge of the potential meanings taken on by the voices in the context of the personal and family background of the individual hearer, and of collaboration with other relevant professionals and services.
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Affiliation(s)
- Antonio Iudici
- Department of Philosophy, Education, Sociology and Applied Psychology of Padua (FISPPA), University of Padua, 35139 Padua, Italy;
| | - Giulia Alecu
- Institute of Psychology and Psychotherapy (Scuola Interazionista), 35100 Padua, Italy; (G.A.); (M.Q.)
| | - Maria Quarato
- Institute of Psychology and Psychotherapy (Scuola Interazionista), 35100 Padua, Italy; (G.A.); (M.Q.)
- Ediveria Center, Zentagasse 18 top ¾, 1050 Vienna, Austria
| | - Jessica Neri
- Department of Philosophy, Education, Sociology and Applied Psychology of Padua (FISPPA), University of Padua, 35139 Padua, Italy;
- Institute of Psychology and Psychotherapy (Scuola Interazionista), 35100 Padua, Italy; (G.A.); (M.Q.)
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Hogg LI, Smith LGE, Kurz T, Morrison AP. Social identification, identity integration and wellbeing in people who hear voices. Psychol Psychother 2023. [PMID: 37964710 DOI: 10.1111/papt.12509] [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: 12/21/2022] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Hearing voices is associated with public stigma and this can influence readiness to identify as a voice hearer (VH) and psychological wellbeing. In this study, we investigated the relationships between a VH social identity, the integration of that identity with other important social identities and wellbeing. DESIGN Cross-sectional study, with a subset of longitudinal data across three time points. METHODS People who self-identified as voice hearers completed questionnaires (VH social identity, identity integration, wellbeing and perceptions of in-group and out-group empathy) at three time points, spaced at 3-monthly intervals. The final sample comprised 182 participants at T1, 91 at T2 and 75 at T3. Hierarchical linear multiple regression analyses were used to test all hypotheses. RESULTS The integration of a VH social identity was strongly associated with better psychological wellbeing at T1. Identity integration was also associated with static wellbeing scores at 6 months. Effects on wellbeing were not accounted for by either severity of voice-hearing or paranoia. Whilst perceptions of in-group empathy were associated with VH social identification, perceptions of outgroup empathy were important for identity integration. CONCLUSIONS Integrating a VH social identity with other important identities into a coherent sense of self is important for wellbeing in voice hearers; perceived in-group and outgroup empathy are important in this process.
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Affiliation(s)
- Lorna I Hogg
- Department of Psychology, University of Bath, Bath, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Harris Manchester College, University of Oxford, Oxford, UK
| | | | - Tim Kurz
- Department of Psychology, University of Bath, Bath, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
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Hall B, Terry R, Hayward M. A systematic review and thematic synthesis of qualitative literature on personal recovery and voice hearing. Clin Psychol Psychother 2022. [PMID: 36511369 DOI: 10.1002/cpp.2814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/08/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Personal recovery literature has been influential in the conceptualization of emotional distress and service provision. While personal recovery in psychosis has been well-studied, voice hearing literature has not been reviewed to elucidate recovery processes. METHOD Five databases were systematically searched to identify relevant qualitative recovery literature. Twelve eligible studies were included in this review, and an appraisal tool was applied to assess quality. Thematic synthesis was used to examine the results. RESULTS Three superordinate themes were found relating to 'Recovery Phases', 'Recovery Facilitators' and 'Barriers to Recovery'. Papers included descriptions of finding voices distressing initially yet moving towards integrating and accepting voices. Searching for meaning versus seeking distance from voices were pivotal processes to recovery pathways. Enabling and disrupting recovery experiences are discussed within a proposed model. CONCLUSIONS Recovery in voice hearing is an individual and potentially ongoing process. Future research should seek to examine recovery factors in voice hearing longitudinally and add further evidence to the supportive role services can play in recovery and voice hearing.
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Affiliation(s)
- Bradley Hall
- Salomons Institute for Applied Psychology, Tunbridge Wells, UK
| | - Rachel Terry
- Salomons Institute for Applied Psychology, Tunbridge Wells, UK
| | - Mark Hayward
- Research and Development, Sussex Partnership NHS Foundation Trust, Brighton, UK.,School of Psychology, University of Sussex, Brighton, UK
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Linszen MMJ, de Boer JN, Schutte MJL, Begemann MJH, de Vries J, Koops S, Blom RE, Bohlken MM, Heringa SM, Blom JD, Sommer IEC. Occurrence and phenomenology of hallucinations in the general population: A large online survey. SCHIZOPHRENIA 2022; 8:41. [PMID: 35853871 PMCID: PMC9261095 DOI: 10.1038/s41537-022-00229-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Although epidemiological studies report that hallucinations occur in 6–15% of the general population, little is known about their phenomenology. To overcome this paucity, this study investigates the phenomenological characteristics of hallucinations in the general population, by using a nationally promoted online survey to assess hallucination phenomenology in four sensory modalities, through a self-report version of the Questionnaire for Psychotic Experiences (QPE), in 10,448 participants (aged 14–88 years). The phenomenology of hallucinations was assessed if hallucinations reportedly occurred in the past month. In the past month, auditory hallucinations were reported most frequently (29.5%), followed by visual (21.5%), tactile (19.9%), and olfactory hallucinations (17.3%); hallucinations in two or more modalities were reported by 47.6%. Substantial numbers of participants rated their hallucinations as severe, due to negative content (16.0–31.6%), previous bothersome experiences (14.8–20.2%), ensuing distress (10.5–16.8%), and/or ensuing disfunctioning (12.7–17.3%). Decreased insight was found in 10.2–11.4%. Hypnagogia was reported by 9.0–10.6%, and bereavement hallucinations by 2.8%. Despite a low prevalence of delusions (7.0%), these phenomena were significantly associated with recent hallucinations, observed in up to 13.4% of the participants with hallucinations during the past week (p < 0.001). Our results indicate a wide variety of the phenomenology of hallucinations in the general population and support the existence of a phenomenological continuum.
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A review of functional and structural neuroimaging studies to investigate the inner speech model of auditory verbal hallucinations in schizophrenia. Transl Psychiatry 2021; 11:582. [PMID: 34764242 PMCID: PMC8585980 DOI: 10.1038/s41398-021-01670-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Although the pathophysiology of auditory verbal hallucinations remains uncertain, the inner speech model remains a prominent theory. A systematic review and meta-analyses of both functional and structural neuroimaging studies were performed to investigate the inner speech model. Of the 417 papers retrieved, 26 met the inclusion criteria. Meta-analyses found the left insula to be significantly active during auditory verbal hallucinations and to have a significantly reduced grey matter volume in hallucinators. Dysfunction of the left insula may contribute to the misattribution of inner speech due to its suggested roles in both inner speech production and the salience network. No significant activity was found at Broca's area or Heschl's gyrus during auditory verbal hallucinations. Furthermore, no structural abnormalities were found at these sites or in the arcuate fasciculi. Overall, evidence was found to both support and oppose the inner speech model. Further research should particularly include a systematic review of task-based trait studies with a focus on inner speech production and self-referential processing, and analyses of additional language-related white matter tracts.
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Reddyhough C, Locke V, Badcock JC, Paulik G. Changing Attitudes Towards Voice Hearers: A Literature Review. Community Ment Health J 2021; 57:1032-1044. [PMID: 33068204 DOI: 10.1007/s10597-020-00727-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 10/06/2020] [Indexed: 01/11/2023]
Abstract
Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person's experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings.
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Affiliation(s)
- Caitlin Reddyhough
- Discipline of Psychology, Murdoch University, Building 440, 90 South Street, Murdoch, WA, 6150, Australia.
| | - Vance Locke
- Discipline of Psychology, Murdoch University, Building 440, 90 South Street, Murdoch, WA, 6150, Australia
| | - Johanna C Badcock
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
- Perth Voices Clinic, Murdoch, WA, Australia
| | - Georgie Paulik
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
- Perth Voices Clinic, Murdoch, WA, Australia
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Hearing Voices and Seeing Things: Symptoms of Anxiety Misconstrued as Evidence of Schizophrenia in an Adolescent. J Psychiatr Pract 2021; 27:232-238. [PMID: 33939379 DOI: 10.1097/pra.0000000000000547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A patient's complaint of "hearing voices" or "seeing things" or of similar perceptual abnormalities leaves the clinician with 2 decisions: (1) Is the patient actually experiencing a hallucination, or does the complaint reflect a different mental experience, ranging from outright fabrication to the misinterpretation or mislabeling of vivid thoughts and emotions? (2) How should the experience reported by the patient, whether determined to be a hallucination or not, be understood in the context of the patient's entire history and mental state? We report the case of a 16-year-old whose cartoon-like hallucinations had led to the diagnosis of schizophrenia and had directed attention of the patient, her parents, and her clinicians away from critical issues of anxiety, depression, learning difficulties, and traumatic school experiences. This case illustrates how the diagnosis of schizophrenia can be driven by the prominence and vividness of psychotic-like symptoms reported by a patient, the expectation that patients' chief complaints must be directly and immediately addressed, insufficient attention to collateral information, and the distortions of a "checklist" approach to psychiatric diagnosis driven by the criteria in the Diagnostic and Statistical Manual of Mental Disorders, insurers, and the properties of electronic medical records. Given the consequences of either underdiagnosing or overdiagnosing schizophrenia, and the current lack of validated objective tests to assist with this diagnosis, clinicians are obligated to perform a thorough clinical assessment of such patients, including a probing exploration of the patient's mental state and a systematic collection of collateral information.
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Abstract
Aims and methodSchizophrenia is a psychotic disorder that is stereotypically stigmatised as untreatable and associated with violence. Several authorities have suggested that changing the name, for example to psychosis, would reduce such stigmatisation. We aimed to compare attitudes to schizophrenia and psychosis on Twitter to see if psychosis was associated with less negative attitudes. Tweets containing the terms 'schizophrenia', 'schizophrenic', 'psychosis' or 'psychotic' were collected on www.twitter.com and were captured with NCapture. On NVivo, tweets were coded into categories based on user type, tweet content, attitude and stigma type by two independent raters. We compared the content and attitudes of tweets referring to schizophrenia/schizophrenic and psychosis/psychotic. RESULTS: A total of 1120 tweets referring to schizophrenia/schizophrenic and 1080 referring to psychosis/psychotic were identified over two 7-day periods; 424 original tweets for schizophrenia and 416 original tweets for psychosis were included in the analysis. Psychosis was significantly more commonly included in tweets expressing negative attitudes (n=131, 31.5%) than schizophrenia (n=41, 9.7%) (χ² = 237.03, P < 0.0001). Of the personal opinions or dyadic interactions, 125 (53.4%) in the psychosis data set were stigmatising, compared with 33 (24.6%) of those in the schizophrenia set (χ² = 44.65, P < 0.0001).Clinical implicationsThe terms psychosis/psychotic are associated with a significantly higher number of tweets with negative content than schizophrenia/schizophrenic. Together with other evidence, this suggests that changing the name of schizophrenia to psychosis will not reduce negative attitudes toward the condition.Declaration of interestS.L. has received personal fees from Otsuka and Sunovion, and personal and research fees from Janssen.
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Affiliation(s)
- Giorgianna L Passerello
- Edinburgh Medical School, College of Medicine and Veterinary Medicine,University of Edinburgh,UK
| | - James E Hazelwood
- Edinburgh Medical School, College of Medicine and Veterinary Medicine,University of Edinburgh,UK
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Abstract
The aim of this qualitative study was to describe nursing students' experiences of hearing distressing voices through content analysis of essays regarding changes they encountered during simulation. Data, obtained from undergraduate (n = 237) and graduate (n = 128) students' short self-reflection papers, were analysed using a six-step thematic analysis. The following six themes emerged: (a) experiencing cognitive and perceptual challenges, (b) feeling unpleasant emotions, (c) dealing with functional changes and hardships, (d) experiencing somatic changes, (e) making attempts to cope, and (f) facing lingering impact. The findings suggest that students' experiences of voice-hearing simulation closely resembled the voice-hearers' actual experience. Simulation is an effective teaching modality to introduce nursing students to the world voice-hearers live in and to prepare them for clinical practice enlightened through understanding of what it is like to hear distressing voices.
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Affiliation(s)
- Hyun Jung Kim
- a College of Nursing, Seattle University , Seattle , Washington , USA
| | - Danuta M Wojnar
- a College of Nursing, Seattle University , Seattle , Washington , USA
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de Vries B, van Busschbach JT, van der Stouwe ECD, Aleman A, van Dijk JJM, Lysaker PH, Arends J, Nijman SA, Pijnenborg GHM. Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis. Schizophr Bull 2019; 45:114-126. [PMID: 29547958 PMCID: PMC6293237 DOI: 10.1093/schbul/sby020] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Psychotic disorders often have been linked with violence. However, studies have shown that people with a psychotic disorder are more often victim than perpetrator of violence. The objective of this meta-analysis was to review prevalence rates for different types of victimization and to identify risk factors associated with victimization. Based on a search in MEDLINE, PsycINFO, and Web of Science, 27 studies were found with samples consisting of adults with a psychotic disorder and possible victimization occurring during adulthood and data on "violent victimization," "sexual victimization," "non-violent victimization," and/or "victimization not otherwise specified." The median prevalence rate for violent victimization was 20%, for sexual victimization 20%, nonviolent victimization 19%, and for victimization not otherwise specified 19%. Victimization rates were approximately 4-6 times higher than in the general community. Meta-analyses showed the following significant risk factors: delusion (OR = 1.69), hallucinations (OR = 1.70), manic symptoms (OR = 1.66), drugs (OR = 1.90) or alcohol abuse (OR = 2.05), perpetration of a crime (OR = 4.33), unemployment (OR = 1.31), and homelessness (OR = 2.49). Other risk factors like previous victimization, impaired social functioning, personality disorder, and living in a disadvantaged neighborhood were found only in 1 or 2 studies. Based on the results, we conclude that, depending on the examined time period, 1 in 5 (assessment period ≤3 y) or 1 in 3 (assessment period entire adulthood) people with a psychotic disorder was victim of a crime. Clinical, behavioral, and sociodemographic factors were significantly associated with victimization, as well as previous victimization. Prospective research into risk factors is needed to capture causal trajectories of victimization.
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Affiliation(s)
- Bertine de Vries
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- To whom correspondence should be addressed; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands; tel: 503-637-779, e-mail:
| | - Jooske T van Busschbach
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, the Netherlands
- Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Elisabeth C D van der Stouwe
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, the Netherlands
- Department of Neuroscience, BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - André Aleman
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Neuroscience, BCN Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan J M van Dijk
- International Victimology Institute INTERVICT, Tilburg University, Tilburg, the Netherlands
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
| | - Johan Arends
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
| | - Saskia A Nijman
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, the Netherlands
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
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Linszen MMJ, van Zanten GA, Teunisse RJ, Brouwer RM, Scheltens P, Sommer IE. Auditory hallucinations in adults with hearing impairment: a large prevalence study. Psychol Med 2019; 49:132-139. [PMID: 29554989 DOI: 10.1017/s0033291718000594] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Similar to visual hallucinations in visually impaired patients, auditory hallucinations are often suggested to occur in adults with hearing impairment. However, research on this association is limited. This observational, cross-sectional study tested whether auditory hallucinations are associated with hearing impairment, by assessing their prevalence in an adult population with various degrees of objectified hearing impairment. METHODS Hallucination presence was determined in 1007 subjects aged 18-92, who were referred for audiometric testing to the Department of ENT-Audiology, University Medical Center Utrecht, the Netherlands. The presence and severity of hearing impairment were calculated using mean air conduction thresholds from the most recent pure tone audiometry. RESULTS Out of 829 participants with hearing impairment, 16.2% (n = 134) had experienced auditory hallucinations in the past 4 weeks; significantly more than the non-impaired group [5.8%; n = 10/173; p < 0.001, odds ratio 3.2 (95% confidence interval 1.6-6.2)]. Prevalence of auditory hallucinations significantly increased with categorized severity of impairment, with rates up to 24% in the most profoundly impaired group (p < 0.001). The corrected odds of hallucination presence increased 1.02 times for each dB of impairment in the best ear. Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%). CONCLUSIONS Our findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Although more research on potential confounding factors is necessary, clinicians should be aware of this phenomenon, by inquiring after hallucinations in hearing-impaired patients and, conversely, assessing hearing impairment in patients with auditory hallucinations, since it may be a treatable factor.
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Affiliation(s)
- M M J Linszen
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - G A van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - R J Teunisse
- Department of Geriatric Psychiatry,Dimence, Deventer,The Netherlands
| | - R M Brouwer
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - P Scheltens
- Alzheimer Center and Department of Neurology,Neuroscience Campus Amsterdam,VU University Medical Center,Amsterdam,The Netherlands
| | - I E Sommer
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
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Katschnig H. Psychiatry's contribution to the public stereotype of schizophrenia: Historical considerations. J Eval Clin Pract 2018; 24:1093-1100. [PMID: 30112785 PMCID: PMC6174929 DOI: 10.1111/jep.13011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/11/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
Abstract
The public stereotype of schizophrenia is characterized by craziness, a split personality, unpredictable and dangerous behaviour, and by the idea of a chronic brain disease. It is responsible for delays in help-seeking, encourages social distance and discrimination, and furthers self-stigmatization. This paper discusses the circumstances of the origins of the idea of a chronic brain disease (Emil Kraepelin, 1856-1926), of the split personality concept derived from the term "schizophrenia" (Eugen Bleuler, 1857-1939), and the craziness idea reflected in the "first rank symptoms", which are all hallucinations and delusions (Kurt Schneider, 1887-1967). It shows how Emil Kraepelin's scientific search for homogenous groups of patients with a common aetiology, symptom pattern, and prognosis materialized in the definition of "dementia praecox" as a progressing brain disease; how Eugen Bleuler's life and professional circumstances facilitated an "empathic" approach to his patients and prompted him to put in the foreground incoherence of cognitive and affective functioning, and not the course of the disease; finally, how Kurt Schneider in his didactic attempt to teach general practitioners how to reliably diagnose schizophrenia, neglected what Emil Kraepelin and Eugen Bleuler had emphasized decades earlier and devised his own criteria, consisting exclusively of hallucinations and delusions. In a strange conglomerate, the modern operational diagnostic criteria reflect all three approaches, by claiming to be Neo-Kraepelinean in terms of defining a categorical disease entity with a suggestion of chronicity, by keeping Bleuler's ambiguous term schizophrenia, and by relying heavily on Kurt Schneider's hallucinations and delusions. While interrater reliability may have improved with operational diagnostic criteria, the definition of schizophrenia is still arbitrary and has no empirical validity-but induces stigma.
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Affiliation(s)
- Heinz Katschnig
- Medical University of Vienna, Vienna, Austria.,IMEHPS, Research Institute for Social Psychiatry, Vienna, Austria
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Dias Neto D, Figueiras MJ, Campos S, Tavares P. Impact of economic crisis on the social representation of mental health: Analysis of a decade of newspaper coverage. Int J Soc Psychiatry 2017; 63:736-743. [PMID: 29058959 DOI: 10.1177/0020764017737102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mass media plays a fundamental role in how communities understand mental health and its treatment. However, the effect of major events such as economic crises on the depiction of mental health is still unclear. AIMS This study aimed at analyzing representations of mental health and its treatment and the impact of the 2008 economic crisis. METHODS In total, 1,000 articles were randomly selected from two newspapers from a period before and after the economic crisis. These articles were analyzed with a closed coding system that classified the news as good or bad news according to the presence of themes associated with positive or stigmatizing representations. RESULTS The results show a positive representation of mental health and a negative representation of treatment. Furthermore, the economic crisis had a negative impact on the representation of mental health, but not on treatment. CONCLUSION These findings suggest that the representation of mental health is multifaceted and may be affected differently in its dimensions. There is a need for stigma-reducing interventions that both account for this complexity and are sensitive to context and period.
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Affiliation(s)
- David Dias Neto
- Department of Psychology, Instituto Piaget, Almada, Portugal
| | | | - Sónia Campos
- Department of Psychology, Instituto Piaget, Almada, Portugal
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Abstract
BACKGROUND Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia. AIMS This article explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals' need for clinical care. METHOD A narrative literature review was conducted, using relevant peer-reviewed research published in the English language. RESULTS Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care. CONCLUSION The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
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Howland M, Levin J, Blixen C, Tatsuoka C, Sajatovic M. Mixed-methods analysis of internalized stigma correlates in poorly adherent individuals with bipolar disorder. Compr Psychiatry 2016; 70:174-80. [PMID: 27557395 PMCID: PMC5317182 DOI: 10.1016/j.comppsych.2016.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Internalized stigma, which occurs when stigmatized individuals accept society's assessment and incorporate this assessment into their sense of self, is prevalent in individuals with bipolar disorder (BD). This study explored the correlates of internalized stigma in a research sample of patients with BD who were poorly adherent to their medications. METHODS Both quantitative and qualitative analyses were performed. Scores of 115 individuals with BD on the Internalized Stigma of Mental Illness (ISMI) scale were correlated with scores on the General Self-Efficacy (GSE) Scale, Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS). Regression was run for GSE (dependent variable) and ISMI (independent variable). In-depth qualitative interviews were conducted on a representative subsample (N=21). RESULTS Internalized stigma levels were moderately high. Internalized stigma and self-efficacy correlated, and internalized stigma related to self-efficacy after adjusting for demographic variables (age, gender, years of education), comorbidities, and symptom severity (BPRS and MADRS). Internalized stigma was also associated with the BD symptoms of depression, anxiety, guilt feelings, suspiciousness, and hallucinogenic behaviors. No association was found with mania. CONCLUSIONS Because internalized stigma has strong psychosocial and psychiatric symptom associations, it is recommended that clinicians address both societal stigma and internalized stigma. Strategies such as cognitive-behavioral therapy may help modify BD patients' internalized stigma.
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Affiliation(s)
- Molly Howland
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106.
| | - Jennifer Levin
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106.
| | - Carol Blixen
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106.
| | - Curtis Tatsuoka
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, 44106; Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106.
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106; Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106; Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Ave, Cleveland, OH, 44106.
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Fernyhough C. Listening to the voices. Lancet 2015; 386:2124-5. [PMID: 26638949 DOI: 10.1016/s0140-6736(15)00988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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