Abstract
Background:Psychosis, characterised by altered perceptions or interpretations of reality, remains a contested area. Lately, perspectives and conceptualisations of psychosis that have traditionally been more peripheral have gained greater recognition. Both the British Psychological Society and Critical Psychiatry Network have highlighted some contentious areas in recent publications.Aims:The aim was to use critical narrative analysis to consider what facilitates and inhibits medical professionals with clinical experience of psychosis to engage with the topic of psychosis as a contentious area.Method:Semi-structured interviews were conducted with 12 medical professionals, who were at trainee or qualified level with a minimum of 6 months’ clinical experience within psychiatry, across three Trusts within the United Kingdom. This purposive sample had a diverse range of perspectives regarding psychosis. Critical narrative analysis comprising six distinct stages, informed the analysis.Results:Participants positioned themselves broadly within one of three groups: biological psychiatrists, critical psychiatrists and those more conflicted. Narrative analysis was undertaken for each participant before being integrated for this article. The research highlighted several factors which either limit or facilitate opportunities within the psychiatric profession to engage with a plurality of views regarding psychosis. These included the significance of power and hierarchy within the profession, the role of dialogue and the prevalence of reflexivity within the profession.Conclusion:A pattern was identified of psychiatrists generally associating with like-minded others and not engaging with wider evidence regarding psychosis, partly as a result of the inherent threats to the power and hierarchy of the profession. This led to new ideas being widely unknown or undervalued, potentially to the disservice of clinical practice.
Highlights
The conceptualisation of psychosis is inevitably influenced by theories of etiology
There is a diversity of explanatory approaches to understanding psychosis, including social realist, behavioural, social constructionist, spiritual, cognitive and psychodynamic models, a biological understanding is the most strongly endorsed (Harlan et al, 2009)
Approval was granted by three National Health Service (NHS) Trusts in England, which fell within a Royal College of Psychiatry Deanery, to contact prospective participants
Summary
The conceptualisation of psychosis is inevitably influenced by theories of etiology. Within psychiatry, there is a diversity of explanatory approaches to understanding psychosis, including social realist, behavioural, social constructionist, spiritual, cognitive and psychodynamic models, a biological understanding is the most strongly endorsed (Harlan et al, 2009). Perspectives and conceptualisations of psychosis that have traditionally been more peripheral have gained greater recognition Both the British Psychological Society and Critical Psychiatry Network have highlighted some contentious areas in recent publications. Method: Semi-structured interviews were conducted with 12 medical professionals, who were at trainee or qualified level with a minimum of 6 months’ clinical experience within psychiatry, across three Trusts within the United Kingdom This purposive sample had a diverse range of perspectives regarding psychosis. Conclusion: A pattern was identified of psychiatrists generally associating with like-minded others and not engaging with wider evidence regarding psychosis, partly as a result of the inherent threats to the power and hierarchy of the profession This led to new ideas being widely unknown or undervalued, potentially to the disservice of clinical practice
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