“I Believe I Know Better Even than the Psychiatrists What Caused It”: Exploring the Development of Causal Beliefs in People Experiencing Psychosis

Abstract

This study aimed to describe the causal beliefs of individuals experiencing psychosis, specifically exploring how they are developed and maintained. Individuals with experience of psychosis were recruited from mental health services for in-depth interviews. A thematic analysis was used to analyse transcripts and key themes were identified. Fifteen interviews were conducted. Individuals were engaged in the process of exploring explanations for their experiences and reported sophisticated models of causation. Participants described a change in their beliefs, with the cause of their experiences not immediately clear. Individuals generated their models via external (family, professionals) and internal (evaluative, positive affect) processes and reported differing levels of conviction in relation to their beliefs. Clinicians should take the opportunity to explore the causal beliefs of their service-users, as they are able to provide intelligent and thoughtful explanatory models. In particular, clinicians should be aware of the emotional impact of different aetiological models and their personal role in the development of a client’s beliefs.

Causal Beliefs About and Perceptions of Illness in Persons Experiencing Schizophrenia and in Close Relatives of Such Individuals: An Exploratory Study

“…Although these percentages seem in the same range as reported in the global meta-analyses mentioned above,46,47 differences in size and methodology among the studies preclude any conclusion about a French specificity (or absence of specificity) in the matter. The low rate of causal attributions in favor of substance abuse in our PES sample could, however, be explained by a reluctance to attribute first cause to substance abuse, which has been described in qualitative studies 36,38. Even if they acknowledge the potential for an exacerbation of symptoms, individuals with schizophrenia often believe that drug-use would not by itself provoke the illness, and they sometimes consider that the positive effects of drug use (especially of cannabis), when controlled, prevail over the disadvantages 36…”

“…35,36 The general French population more easily attributes biogenetic causes to schizophrenia than to other mental illnesses. 37 The results in our PES sample may reflect this literacy or the integration of professionals' views, 38,39 thanks to formal or informal therapeutic education. Users of psychiatric services are also increasingly accessing information about causes through the Internet and social networks.…”

“…The low rate of causal attributions in favor of substance abuse in our PES sample could, however, be explained by a reluctance to attribute first cause to substance abuse, which has been described in qualitative studies. 36,38 Even if they acknowledge the potential for an exacerbation of symptoms, individuals with schizophrenia often believe that drug-use would not by itself provoke the illness, and they sometimes consider that the positive effects of drug use (especially of cannabis), when controlled, prevail over the disadvantages. 36 In the CR group, causal attribution to substance abuse was strongly associated with participation in family psychoeducation, which offers access to current scientific knowledge.…”

Mindsets of mental illness: What are the implications for stigma?

“…Importantly, these narratives stand in stark contrast to one another. For example, after decades in which it was commonly assumed that mental illness was the result of personal factors such as a “weakness of character” (Brockington et al, 1993; Corrigan et al, 1999, 2000; Corrigan & Watson, 2002; Link et al, 1999), clinicians, media sources, and individuals with and without mental illness today tend to point to factors largely outside personal control as the primary cause of mental illness (Carter et al, 2018; Deacon, 2013; Harrington, 2019; Lebowitz & Appelbaum, 2019; Luderer & Böcker, 1993; Pescosolido et al, 2010; Read et al, 2015; Schroder et al, 2020). Indeed, participants in the current work identified biological factors such as a chemical imbalance in the brain, psychosocial factors such as a past traumatic experience or stressful life events (e.g., toxic work environment), or some combination of the two.…”

The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors

“…Patients generally identify a number of factors contributing to the development of their experiences. 8 A few studies are exceptions in that they have been theoretically guided. For example, Bechdolf and colleagues 9 in a study of 27 patients with schizophrenia found that all recollected experiencing ‘basic symptoms’ (typically subtle changes in thought and perception) before relapse.…”