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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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2
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Wurtz HM, Hernandez M, Baird M. Thriving Despite the Odds: Digital Capital and Reimagined Life Projects Among Mexican College Students During COVID-19. Cult Med Psychiatry 2024; 48:23-44. [PMID: 37962769 DOI: 10.1007/s11013-023-09839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
During the pandemic, Mexico experienced one of the longest periods of school closures in Latin America. After the first year of COVID-19, thousands of college students dropped out of school, which has been partially attributed to difficulties in adapting to online learning. This study examines how some college students in Mexico coped with and overcame these challenges. Our research draws on journals of and in-depth interviews with Mexican college students who participated in the Pandemic Journaling Project-a combined online journaling platform and research study. Participant accounts describe challenges students experienced navigating the rapid roll-out of online education. However, over time, many of the students in our study cultivated a renewed sense of purpose in their educational activities. They attributed this shift in perspective to their ability to carve out new approaches to social support, the development of professional capacities, and insight into the potential for technology to promote a more inclusive society. Our work shows how students' ability to integrate digital competencies into their broader life projects and aspirations for the future played an important role in college perseverance and reducing mental health distress. Findings have important implications for the potential role of increased access to technological resources in mitigating social inequity and improving mental health outcomes among young adults.
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Affiliation(s)
- Heather M Wurtz
- Department of Anthropology, University of Connecticut, Storrs, CT, USA.
- Research Program on Global Health & Human Rights, Human Rights Institute, University of Connecticut, Storrs, CT, USA.
- Population Studies and Training Center, Brown University, Providence, RI, USA.
| | - Maria Hernandez
- El Instituto: Institute of Latina/o, Caribbean and Latin America Studies of College of Liberal Arts and Science, University of Connecticut, Storrs, CT, USA
| | - Madeline Baird
- Department of Anthropology, University of Connecticut, Storrs, CT, USA
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3
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Myers NL. Collaborative Journaling in the Social Sciences: Guidelines and Applications. Cult Med Psychiatry 2024; 48:1-3. [PMID: 38526671 DOI: 10.1007/s11013-024-09854-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Neely Laurenzo Myers
- Department of Anthropology, Southern Methodist University, PO Box 750336, Dallas, TX, 75275-0336, USA.
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Wurtz HM, Mason KA, Willen SS. Introduction: Student Experiences of COVID-19 Around the Globe: Insights from the Pandemic Journaling Project. Cult Med Psychiatry 2024; 48:4-22. [PMID: 38460059 DOI: 10.1007/s11013-024-09848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 03/11/2024]
Abstract
The COVID-19 crisis has taken a significant toll on the mental health of many students around the globe. In addition to the traumatic effects of loss of life and livelihood within students' families, students have faced other challenges, including disruptions to learning and work; decreased access to health care services; emotional struggles associated with loneliness and social isolation; and difficulties exercising essential rights, such as rights to civic engagement, housing, and protection from violence. Such disruptions negatively impact students' developmental, emotional, and behavioral health and wellbeing and also become overlaid upon existing inequities to generate intersectional effects. With these findings in mind, this special issue investigates how COVID-19 has affected the mental health and wellbeing of high school and college students in diverse locations around the world, including the United States, Mexico, Brazil, China, and South Africa. The contributions collected here analyze data collected through the Pandemic Journaling Project, a combined research study and online journaling platform that ran on a weekly basis from May 2020 through May 2022, along with complementary projects and using additional research methods, such as semi-structured interviews and autobiographical writing by students. The collection offers a nuanced, comparative window onto the diverse struggles that students and educators experienced at the height of the pandemic and considers potential solutions for addressing the long-term impacts of COVID-19. It also suggests a potential role for journaling in promoting mental wellbeing among youth, particularly in the Global South.
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Affiliation(s)
- Heather M Wurtz
- Research Program on Global Health and Human Rights, Human Rights Institute, University of Connecticut, 405 Babbidge Road, U-1205, Storrs, CT, 06269, USA.
- Department of Anthropology, University of Connecticut, 354 Mansfield Road, Unit 1176, Storrs, CT, 06226, USA.
- Population Studies and Training Center, Brown University, 68 Waterman Street, Providence, RI, 02912, USA.
| | - Katherine A Mason
- Population Studies and Training Center, Brown University, 68 Waterman Street, Providence, RI, 02912, USA
- Department of Anthropology, Brown University, 128 Hope Street, Providence, RI, 02912, USA
| | - Sarah S Willen
- Research Program on Global Health and Human Rights, Human Rights Institute, University of Connecticut, 405 Babbidge Road, U-1205, Storrs, CT, 06269, USA
- Department of Anthropology, University of Connecticut, 354 Mansfield Road, Unit 1176, Storrs, CT, 06226, USA
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Lebovitz JG, Luhrmann TM, AhnAllen CG. The Experience of Psychosis in Psychiatric Inpatients During the COVID-19 Pandemic Among Unhoused Individuals. Cult Med Psychiatry 2024; 48:158-176. [PMID: 37246170 PMCID: PMC10225167 DOI: 10.1007/s11013-023-09826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
This research investigates the impact of Coronavirus-2019 on individuals without housing and experiencing psychosis using semi-structured qualitative interviews and a case study format. We found that for our participants, life in the pandemic was generally more difficult and filled with violence. Further, the pandemic seemed to impact the content of psychosis directly, such that in some cases voices referred to politics around the virus. Being unhoused during the pandemic may increase the sense of powerlessness, social defeat, and the sense of failure in social interactions. Despite national and local measures to mitigate virus spread in unhoused communities, the pandemic seemed to be particularly hard on those who were unhoused. This research should support our efforts to see access to secure housing as a human rights issue.
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Affiliation(s)
- Julia G Lebovitz
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Psychiatry, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Jamaica Plain, Boston, MA, 02130, USA
| | - Tanya M Luhrmann
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Anthropology, Stanford University, Stanford, CA, USA
| | - Christopher G AhnAllen
- Department of Psychiatry, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Jamaica Plain, Boston, MA, 02130, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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van Sambeek N, Franssen G, van Geelen S, Scheepers F. Making meaning of trauma in psychosis. Front Psychiatry 2023; 14:1272683. [PMID: 38025479 PMCID: PMC10656619 DOI: 10.3389/fpsyt.2023.1272683] [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: 08/04/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Finding new meaning and identity in the aftermath of trauma has been identified as a key process of mental health recovery. However, research indicates that this meaning-making process is compromised in people with psychosis. Considering the high prevalence, yet under-treatment of trauma in people with psychosis, it is urgent to gain insight into how their meaning-making process can be supported. Aim To gain insight into how people with psychosis make meaning of trauma and identify barriers and facilitators in their meaning-making process. Methods Qualitative inquiry of N = 21 interviews transcripts from the Dutch Psychiatry Storybank. We included interviews of people who (a) lived through multiple psychotic episodes, and (b) spontaneously addressed traumatic experiences in a low-structured interview. Storyline analysis was performed to gain insight into the meaning-making of trauma within their self-stories. Psychosocial conceptualizations of narrative identity were used to inform the analysis. A data-validation session with four experts-by-experience was organized to check and improve the quality of our analysis. Results We identified four different story types: (1) Psychiatry as the wrong setting to find meaning; (2) The ongoing struggle to get trauma-therapy; (3) Exposure to trauma as a threat to a stable life, and (4) Disclosure as the key to resolving alienation. Each story type comprises a different plot, meaning of trauma withing the self-story, (lack of) integration and barriers and facilitators in the meaning-making process. Overall, barriers in the meaning-making process were mostly situated within mental healthcare and stigma-related. People felt particularly hindered by pessimistic ideas on their capacity to develop self-insight and cope with distress, resulting in limited treatment options. Their process of adaptive meaning-making often started with supportive, non-judgmental relationships with individuals or communities that offered them the safety to disclose trauma and motivated them to engage in a process of self-inquiry and growth. Conclusion The outcomes illuminate the social context of the meaning-making challenges that people with psychosis face and illustrate the devastating influence of stigma. Our outcomes offer guidance to remove barriers to adaptive meaning-making in people with psychosis, and can help clinicians to attune to differences in the meaning-making of trauma.
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Affiliation(s)
- Nienke van Sambeek
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gaston Franssen
- Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands
| | | | - Floortje Scheepers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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Aggarwal NK, Chen D, Lewis-Fernández R, Guarnaccia P. Patient identity narratives through the cultural formulation interview in a New York City outpatient clinic. Med Anthropol Q 2023; 37:280-295. [PMID: 37335932 PMCID: PMC10644257 DOI: 10.1111/maq.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/21/2023] [Indexed: 06/21/2023]
Abstract
Anthropologists have critiqued cultural competence programs in medical settings while introducing mental health clinicians to social theories on culture for practice. We explore how patients articulated narratives about themselves and how clinicians responded to such narratives through an intervention known as the Cultural Formulation Interview that anthropologists have helped develop. We conducted over 500 hours of fieldwork from 2014 to 2019 at an outpatient clinic in New York, analyzing multiple data (participant observation, medical records, patient-clinician sessions, and individual debriefing interviews) in a trial joining clinical and ethnographic methods. Our study enrolled 45 patients and six clinicians, yielding 117 patient-clinician appointments and 98 debriefing interviews. Most patients differed in how they presented their identities through demographic forms and discussed them in sessions with their clinicians. Two-thirds of the patients drew connections between their personal identities and experiences of mental illness. These results reveal why cultural identities should not be taken for granted in clinical settings.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University Department of Psychiatry; New York State Psychiatric Institute; New York, NY, USA
| | - Daniel Chen
- Department of Psychiatry, Flushing Hospital Medical Center; Flushing, NY, USA
| | - Roberto Lewis-Fernández
- Columbia University Department of Psychiatry; New York State Psychiatric Institute; New York, NY, USA
| | - Peter Guarnaccia
- Department of Human Ecology, Rutgers University; New Brunswick, NJ, USA
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Parson NC, Wurtz HM, Lowrey M, Santos C. “Life will go on with the beauty of the roses”: The moral dimensions of coping with distress through autobiographical writing during Covid-19. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Abstract
This paper attends to the sociality available in the clozapine clinic regimen and suggests that the social dimensions of clozapine treatment may be as important as the biochemical efficacy of clozapine. The clozapine clinic is where people diagnosed with chronic schizophrenia who take the antipsychotic clozapine go for routine monitoring of clozapine side effects, particularly haematological effects. Psychopharmaceutical treatments are often criticized for being reductionistic and dehumanizing, but clozapine clinics offer increased clinical contact in the age of deinstitutionalization. The inadvertent social benefits of biomedically reductive treatments have not previously been ethnographically attended to in the clozapine-only context. Drawing on 18 months of ethnographic fieldwork with 43 clozapine clients and 16 clinical caregivers in two clozapine clinics in the United Kingdom in Australia, I argue that routine clinical attachments in the clozapine clinic can serve a therapeutic role in terms of providing opportunities for clients' health agency, social competence and accountability. This socio-therapeutic quality appeared to be available because the clinical emphasis was not on psychotic illness. It depended, however, on reliable and familiar social exchanges inside the clinic and on the predictability of clinical activity. The importance of unemotional but unfailing relationships and rhythms in the clozapine clinic context echoes cross-cultural findings about how schizophrenia is managed more productively in environments that invite more neutral and equal social exchanges.
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Fumanti M. 'A German Whore and no Money at that': Insanity and the Moral and Political Economies of German South West Africa. Cult Med Psychiatry 2020; 44:382-403. [PMID: 31741190 PMCID: PMC7343752 DOI: 10.1007/s11013-019-09663-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
While the links between colonial psychiatry and racism figure prominently in histories of the diagnosis, treatment and institutionalisation of the mentally ill in Africa, there is an absence of patient-centred accounts, in the analysis of the efforts of the colonial-era subjects themselves to be pro-active not merely as the mentally ill, by clinical or court definition, but as persons embedded in social relationships with their kin and significant others. Moreover, despite an emerging scholarship, little is known of the experience of European settlers. In this respect there is a need for a more balanced representation, one that shows the ambivalence of colonial psychiatry and its reach into the lives of colonial subjects, Africans and Europeans alike. In this paper I focus on the narratives of a settler in German South West Africa and her efforts to escape diagnosis and institutionalisation. In building on a feminist approach to illness narratives, in particular on the idea of bearing empathic witness, I will explore the ways in which illness narratives can reveal the complex moral and political economies of the colonial world.
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Affiliation(s)
- Mattia Fumanti
- Department of Social Anthropology, The University of St Andrews, 71 North Street, KY16 9AL, St Andrews, Fife, UK.
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11
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Abstract
Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the social sciences and humanities, and from ethnographic research especially. This paper examines the subjective experience of disruptions in self-identity within a cohort of first episode psychosis (FEP) service users, critically engaging with the SD literature and bringing it into conversation with social sciences and humanities scholarship on self and schizophrenia. Drawing findings from an ongoing ethnographic study of young peoples' experiences with psychosis, we explore meanings of mental distress relating to psychotic episodes and attend to issues of self, identity, and subjectivity. We critique the division between "normal" and "pathological" self-experience that is endorsed within the SD literature, arguing against the notion that fragmentation of self-experience in schizophrenia-spectrum illnesses is indicative of psychopathology. We highlight how experiences categorized as psychosis are also important and complete aspects of one's social world and inner life and explore the ways in which at least some aspects of disruptions of self-identity stem from clinical situations themselves-in particular, from asymmetries of power within the mental health system. Relating our findings to feminist, postcolonial, and disability studies' approaches to the "self," we emphasize the complex interplay between interpersonal, cultural, and structural aspects of self-experience within FEP.
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Affiliation(s)
- Suze G Berkhout
- c/o Post-Graduate Medical Education, Department of Psychiatry, The University of Toronto, 8th Floor, 250 College St., Toronto, ON, M5T 1R8, Canada.
| | - Juveria Zaheer
- Department of Psychiatry, The University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, The University of Toronto, Toronto, Canada
| | - Gary Remington
- Department of Psychiatry, The University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, The University of Toronto, Toronto, Canada
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Rabeyron T. Clinique des expériences d’abduction : trauma, clivage et logiques de l’originaire. EVOLUTION PSYCHIATRIQUE 2018. [DOI: 10.1016/j.evopsy.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Actively Negotiating the Mind-Body Divide: How Clozapine-Treated Schizophrenia Patients Make Health for Themselves. Cult Med Psychiatry 2017; 41:368-381. [PMID: 28074346 DOI: 10.1007/s11013-016-9517-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It is well recognised that antipsychotic treatments impact the whole body, not just the target area of the brain. For people with refractory schizophrenia on clozapine, the gold standard antipsychotic treatment in England and Australia, the separation of mental and physical regimes of health is particularly pronounced, resulting in multiple, compartmentalised treatment registers. Clinicians often focus on the mental health aspects of clozapine use, using physical indicators to determine whether treatment can continue. Our observations of 59 participants in England and Australia over 18 months revealed that patients did not observe this hierarchisation of mental treatments and physical outcomes. Patients often actively engaged in the management of their bodily symptoms, leading us to advance the figure of the active, rather than passive, patient. In our paper, we do not take the position that the facility for active management is a special one utilised only by these patients. We seek instead to draw attention to what is currently overlooked as an ordinary capacity to enact some sort of control over life, even under ostensibly confined and confining circumstances. We argue that clozapine-treated schizophrenia patients utilise the clinical dichotomy between mental and physical domains of health to rework what health means to them. This permits patients to actively manage their own phenomenological 'life projects' (Rapport, I am Dynamite: an Alternative Anthropology of Power, Routledge, London 2003), and forces us to reconsider the notion of clinical giveness of what health means. This making of one's own meanings of health may be critical to the maintenance of a sense of self.
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Rosen C, Jones N, Longden E, Chase KA, Shattell M, Melbourne JK, Keedy SK, Sharma RP. Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis. Front Psychiatry 2017; 8:57. [PMID: 28469582 PMCID: PMC5395710 DOI: 10.3389/fpsyt.2017.00057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/29/2017] [Indexed: 01/27/2023] Open
Abstract
Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that "Happened," demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that "Happened" and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious-spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Nev Jones
- Felton Institute, San Francisco, CA, USA
| | - Eleanor Longden
- Greater Manchester West Mental Health NHS Foundation Trust, Psychosis Research Unit, Manchester, UK
| | - Kayla A Chase
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mona Shattell
- Department of Community, Systems, and Mental Health Nursing, Rush University, Chicago, IL, USA
| | | | - Sarah K Keedy
- Department of Psychiatry, University of Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychiatry, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
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