A “trigger”, a cause or obscured? How trauma and adversity are constructed in psychiatric stress-vulnerability accounts of “psychosis”

Abstract

How do mental health professionals link adverse life experiences with the kinds of beliefs and experiences which attract a diagnosis of psychosis and what implications does this have for women with these diagnoses? Drawing on a broadly critical realist framework, we present data from two studies relevant to these questions. First, we analyse the discursive practices engaged in during a staff-only discussion of a female in-patient with a psychosis diagnosis who had been raped some years previously. Staff oriented to the irrationality and factuality of her ostensibly delusional statements about rape and pregnancy in the present and formulated adverse experience as a “stress factor” triggering a manic episode, thereby precluding alternative contextualising interpretations. In a second, interview-based, study, psychiatrists drew on a range of discursive resources which differentiated “psychosis” from other forms of distress, constructed trauma as a stressor which could trigger psychosis because of a genetic predisposition, and constructed medication as the primary intervention whilst trauma was de-emphasised. We discuss the implications of these findings for the kinds of explanations and forms of help offered and suggest ways in which distress might be contextualised as well as possible future directions for feminist research and practice.

Feminine sexuality, religiousness and psychotic distress: Tracing a pattern

“…Many of the childhood adversities linked to later development of psychotic experiences were mentioned in the accounts of the participants in these studies, including negative family relations, abuse and victimization, as well as experiences of undermining and rejection (Harper et al, 2021; Tseris, 2019). The common element binding all the participants’ accounts, however, was upbringing in a conservative religious family, pointing to the role of family culture, in conjunction with broader cultural environments, in the development and form of psychotic experiences.…”

Systemic vulnerability: Towards a theoretical framework for identifying institutional failures that violate rights

“…Considering the background information presented in the previous sections, it is of particular interest for elaborating our theoretical framework, a critical and feminist perspective on the processes of individualization, pathologization, and the medicalization of trauma. In this respect, Harper et al (2021) have researched how staff working with psychiatric patients disqualify alternative interpretations which might contextualize their statements about rape and pregnancy. Likewise, Tseris (2015, p. 34) argues that we must always locate women's stories “within broader social and relational context” as an approach that might resist the inflexibilities of diagnostic classification.…”

Editorial introduction: The politics of psychological suffering

“…Two of the articles in this special issue provide sobering illustrations of ways in which diagnostic framings of people’s distress can compromise the possibilities for good care. Harper, O’Donnell, and Platts (2021, this issue) present a pair of studies carried out in London that examine how mental health personnel talk about psychosis. The authors show how this talk is premised on the assumption that adverse experiences—no matter how severe—have little clinical import.…”

“…This notion is now accepted as fact by the public at large and also by primary care physicians, who write most of the prescriptions for antidepressants and anti-anxiety drugs. As Harper, O’Donnell, and Platts (2021, this issue) and Thompson (2021, this issue) point out, biologized versions of psychological suffering now define psychiatric care in much of the world.…”