Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.     

Expressed Emotion In The Narrative Context of Family Photographs

This study aims to elucidate cognitive and contextual aspects of the EE (Expressed Emotion) concept. The EE levels of both parents of two first admission psychotic patients were rated from the Five Minute Speech Sample (FMSS), and the emotional responses were further analyzed in narratives of family photographs. The attribution model was found to provide an explanatory framework for understanding relatives' expressed emotions (EE) toward a family member suffering from psychotic disturbances. Four case reports indicated that family photographs induced parents to create narratives in which emotions, attributions, and strategies for coping with stressful aspects of the illness came forward as intertwined phenomena. The method can offer more comprehensive data for intervention strategies aiming to alter the prevailing atmosphere and interaction patterns within the high EE family.     

The Experience of Time in Acute Psychosis and Schizophrenia

From the narrative point of view the plot of a story configures time. In psychosis, when experiences remain unnarrated, experience being-in-time is also missing. Once experiences are given narrative form, they can be left behind as a part of individual's personal history, thus enabling present experiences to be narrated. Unnarrated experiences do not accumulate. Narrative history contains, however, enough redundancy to invite you to restory your past in a new way if you need to. Hence, from the narrative point of view, early, family- and network-centered intervention is of special value in cases of acute psychosis.     

When More is Better than Less; Three Theories of Psychosis—Projection, Double Bind, and Possession

Three psychological theories of psychosis are described, each of which has standing in psychiatry. Defined by the terms projection, double bind, and possession, they initially appear to have little or nothing in common to explain psychosis, but converge at four points: (1) A high degree of anxiety precipitated by a dilemma or conflict perceived to be unsolvable by the person; (2) the anxiety triggers a shift from one thought or motive in the direction of its opposite, because the original was believed too antagonistic to the wishes of significant others; (3) the opposite, in order to remain opposite, requires that the original thought or motive be forgotten, (4) a singular means to produce and reinforce forgetting is the interposition of psychiatric symptoms. In psychiatry today treatment would fit more consistently with the three theories taken as a whole rather than any one, and a rationale for this viewpoint is elaborated.     

Psychosis,symbol, affectivity 1: etiopathogenesis and treatment through analytical psychology

This is the first of two papers concerning our study into an integrated approach to psychotic disorders, conducted at the University of Palermo’s Psychiatry Unit Polyclinic over approximately 15 years. Here we will explore and reflect upon the acute psychotic condition mainly from a theoretical and conceptual perspective, while in the second paper we will explore the clinical perspective. From the point of view of psychopathology, and in the light of C.G. Jung’s conceptualization of analytical psychology, as well as calling on contributions from other authors from the systemic-relational and post-psychoanalytic field, we will clarify the ideas developed over these last few years by our team. From a more speculative perspective we will advance new interpretive hypotheses in an attempt to thoroughly understand the nature of the psychotic condition, both on a psychodynamic relational and a neuroscientific level. The paper describes how we revised our understanding of psychosis from a brain disease to a process aimed at the rearrangement of psychic functioning, as anticipated by John Weir Perry nearly 40 years ago.     

Antenatal caregiving representations and perinatal behavior in mothers with severe lifetime psychopathology

Psychopathology poses a risk for optimal parenting. The current study explored antenatal caregiving representations as markers for later risk of nonoptimal maternal behavior among mothers with severe mental illness. Sixty-five mothers diagnosed with psychosis, bipolar disorder, depression (psychopathology group), and nonclinical controls participated in a longitudinal study from pregnancy to 16 weeks after birth. Mental health diagnoses and caregiving representations were assessed during pregnancy. Maternal behavior was assessed during the 5-min recovery phase of the still-face paradigm at 16 weeks. Mothers with psychopathology reported significantly higher levels of “heightened” caregiving representations (i.e., separation anxiety from the child) than did controls. The only significant diagnostic group difference in perinatal maternal behavior was that mothers diagnosed with depression exhibited more overriding-intrusive behavior than did nonclinical control mothers. Regression modeling results showed that antenatal caregiving representations of “role reversal” predicted significantly lower levels of sensitivity and higher levels of overriding-intrusive behavior independent of the effect of psychopathology. The findings can be interpreted in the context of representational transformation to motherhood during pregnancy. The results provide preliminary evidence for the potential of a new questionnaire measure of caregiving representations as a screening instrument for antenatal representational risk.     

Stigma towards psychosis: Cross‐cultural differences in prejudice,stereotypes, and discrimination in White British and South Asians

Public stigma towards people with mental health problems has been demonstrated in Western societies. Little is known about non‐Western cultures and whether cultures differ in their perceptions of people with mental health problems. Aim of this study was to examine cultural differences in prejudice, stereotypes, and discrimination towards people with psychosis. Participants were from White British and South Asian backgrounds (N = 128, aged 16–20 years) recruited from two schools and colleges in the United Kingdom. They completed a cross‐sectional survey on affective, cognitive, and behavioural dimensions of stigma. Results revealed significant cultural differences on all three stigma dimensions. South Asians attributed higher anger (prejudice) and dangerousness (stereotypes) to people with psychosis than White British. They also reported lower willingness to help, greater avoidance, and higher endorsement of segregation (discrimination). The effects of ethnic group on helping intentions, avoidance, and segregation endorsement were mediated by anger and by dangerousness. Understanding cultural differences in stigma towards psychosis will be important for designing stigma interventions as well as treatments for people with different cultural backgrounds.     

Jung's understanding of schizophrenia: is it still relevant in the ‘era of the brain’?

Jung was highly committed to grasping the meaning of psychotic thinking, and left behind precious insights to treatment scattered through his works written between 1906 and 1958. The tendency of today's psychiatry is to attribute the psychotic process to alteration in the brain's anatomy, biochemistry and electrophysiology, thus exempting the subject, i.e. the afflicted person, from responsibility for attachment to reality and their sanity. Jung understood schizophrenia as an ‘abaissement du niveau mental’, a similar phenomenon to the one encountered in dreams, and caused by a peculiar ‘faiblesse de la volonté’. He contested that complexes in schizophrenia, in contrast with neurotic disorders, are disconnected and can either never reintegrate to the psychic totality or can only join together in remission ‘like a mirror broke into splinters’ (Jung 1939 , para. 507). Accordingly, a person who does not fight for the supremacy of ego consciousness and has let themself be swayed by the intrusion of alien contents arising from the unconscious (even to the point of becoming fascinated by regression) is exposed to the danger of schizophrenia. The contemporary relevance of these notions and their necessity in understanding the psychotic process in the light of modern scientific findings are discussed.