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Understanding ‘Psychosis’

Written by Philip Houghton on . Posted in Clinical Psychology Bite-Size

Understanding ‘Psychosis’

Issue 01 – April 2008

Author: Philip Houghton (philip.houghton@nottshc.nhs.uk)

Key points
  • The “illness” model of ‘psychosis’ is just one amongst many ways of understanding ‘psychosis’
  • Social, economic, cultural, historical and psychological factors all influence the development and maintenance of psychotic experiences
Implications for practice
  • The way we understand ‘psychosis’ will profoundly influence what we think will be helpful in reducing distress
  • We should be aiming to develop with clients a rich understanding of where things have come from and what is likely to be of help
The experience of ‘psychosis’, when a person’s reality is not shared by people around them, can be terrifying, confusing, highly distressing, or at times magical and uplifting for the individual experiencing it. For those of us working with people experiencing ‘psychosis’ it can be difficult to understand what they are going through. But what causes and maintains psychotic experiences? And what impact does this have on how we work with people experiencing ‘psychosis’? Whilst we are all aware of the theory that ‘psychosis’ is caused by a biochemical imbalance, there remains no physical test for ‘psychosis’ or any other form of mental health difficulty. Whilst biochemical explanations are widely subscribed to and often assumed to be true, we need to remember that they remain as theories rather than facts, and that there are many other alternative possibilities as to why people become psychotic. So if it isn’t all about biochemistry, what other things might influence the development of ‘psychosis’?

Life experiences.

Put under enough stress research suggests that the majority of us would become psychotic, and it is thought that around 70% of voice hearers developed the experience following a traumatic or emotional event1. It is vital to consider the role of stress as people are likely to have experienced a greater number of stressful events in the 6 months before an episode of ‘psychosis’2, and one doesn’t need to work within mental health services for long to see that increased stress often increases peoples distressing psychotic experiences. But it is not just current stressful events that are influential. Studies also show a high rate of childhood sexual abuse or other early traumatic events in individuals experiencing ‘psychosis’3.

The social environment.

Within the industrial world, if you are part of the urban lower classes in a large city then you are more likely to get a diagnosis of schizophrenia and the prevailing economic conditions are also influential as there is evidence that outcomes are worse during times of economic recession4. How one is treated by society is also important, as exposure to racial tension, and being part of a marginalised immigrant group can lead to higher levels of ‘psychosis’ (see Bentall, 20045). This suggests that the social environment, the material resources and social roles people have play a part in the development and maintenance of psychotic experiences.

Where does this leave us?

It is highly likely that each person’s difficulties have come from, and are maintained by a unique combination of cultural, environmental, psychological and biological influences. ‘Psychosis’ in this way is no different from any other form of mental distress. Put another way, the likelihood of experiencing ongoing mental health difficulties substantially increases the more traumatic someone’s life history is, the more difficult their socio-economic environment was or continues to be, the more stressful their current circumstances are and the fewer resources (e.g. social support, intelligence, looks, money) they have to cope with or influence stressful circumstances.

Why is our understanding of ‘psychosis’ important?

How we understand ‘psychosis’ directly links to what we think will be helpful. Throughout history particular views of ‘psychosis’ have led to some appalling “treatments” including: insulin comas (where people were brought to a state close to death, revived and then the process repeated); prefrontal leucotomy (where an ice pick like instrument was inserted above the eye and into the brain); and extermination (see Bentall, 20045). Whilst these examples may be extreme, for all of us our view of what leads to ‘psychosis’ will influence what we are interested in, what we ask about and what we consider important when devising care plans. As an example, following a very pure bio- medical view may lead to a failure to consider a person’s historical context and the particular meaning they give to their experiences. More helpful in my view is to try to consider the range of factors known to be influential, so to try to arrive at a formulation of the person’s difficulties. In other words, we should be aiming to develop with clients a story that tells us where things have come from and what is likely to be of help. This story will never be limited to biology or genetics, but will encompass the whole range of cultural, environmental, and psychological influences.

References

  1. Romme, M. & Escher, S. (1993). Accepting voices. London: Mind Publications
  2. British Psychological Society. (2000). Recent advances in understanding mental illness and psychotic experiences. A report by the British Psychological Society Division of Clinical Psychology. Leicester: British Psychological Society. Free download: www.understandingpsychosis.com
  3. Morrison, A., Frame, L. & Larkin, W. (2003). Relationships between trauma and psychosis: A review and integration. British Journal of Clinical Psychology, 42, 331-353
  4. Warner, R. (2004) Recovery from schizophrenia: Psychiatry and political economy. London: Brunner-Routledge
  5. Bentall, R. (2004) Madness explained: Psychosis and human nature. London: Penguin
 

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