How do feelings contribute to the experience of paranoia, in those that are understood to have experienced a first episode of psychosis?

Abstract

There is continued debate amongst service-users and professionals about how psychosis is conceptualised and managed. The medical model typically dominates, although there is no consistent evidence for an underlying biological process. Gaining an understanding of the factors that contribute to experience of psychosis within the first episode of psychosis (FEP) population, could further enhance the interventions and support available and impact on long-term outcomes.Literature review:Shame is associated with poorer outcomes within the broader area of psychosis. However, there are no reviews that consider the role of shame specifically in the FEP population. The aim was to explore the role of shame in a population that is understood to have experienced the first episode of psychosis. The systematic review examined 10 articles identified from five databases. Shame was associated with poorer outcomes and increased distress in the FEP population, particularly related to social anxiety and depression. Therefore, shame needs to be considered when working with this population at a clinical and service level.Research report:With a particular focus on paranoia, the current study aimed to explore an alternative perspective to the dominant model, focussed on understanding how feelings contribute to the experience of paranoia (based on Cromby’s work). Feelings, in this context, are broader than simply emotion and integrally includes relationally, social and material influences. Critical Narrative Analysis was utilised to explore seven people’s experiences of paranoia and the associated feelings, with consideration of their wider social context. The results highlighted that feelings and feeling traps contributed to the experience of paranoia, within the context of social relationships and life experiences. The hermeneutic of suspicion introduced the notion that the current psychological and psychiatric models can leave people feeling disempowered and stuck, fighting to be their ‘normal’ self. Clinical implications are discussed.