The nuances of “the social cure” for people who experience psychosis

Abstract

People can derive health benefits from social group memberships. However, joining groups can be difficult for people experiencing psychosis due to the social impacts of the condition and public and internalised stigma. We interviewed a diverse group of 26 people experiencing psychosis and explored through thematic analysis their perceptions of how psychosis influenced social identity processes. Participants confirmed both the impact of psychosis on group processes and the value of group memberships for wellbeing. Empathy, understanding, and lack of judgement were perceived to be critical for group formation. Participants sought social validation in both pre‐existing and new relationships, including from others experiencing psychosis. A novel finding was the compartmentalising of the psychosis identity to facilitate periods of either greater connection or social mobility dependent on current mental state. Thus, this study suggests nuance to the application of the Social Cure for a highly stigmatised, yet fluctuating, condition such as psychosis.

Social identification, identity integration and wellbeing in people who hear voices

“…In conclusion, this study builds on recent qualitative research (Hogg et al, 2022;Sheaves et al, 2021) indicating that social connections are important to psychological wellbeing in people who hear voices. Findings suggest that important interventions to enhance the health and wellbeing of people who hear voices are empathy from others who have similar voice-hearing experiences to develop a strong sense of self as a voice hearer, and empathy from those who do not themselves hear voices to integrate this social identity into a coherent sense of self.…”

“…Empathy includes both this cognitive understanding of another's perspective and affective understanding (Cuff et al, 2016). The current study builds on the work of Livingstone and colleagues, and the qualitative study of Hogg et al (2022) to investigate the association between perceptions of empathy in other voice hearers and a VH social identity on the one hand, and wellbeing on the other. We also examine how perceived empathy, particularly in those who do not themselves hear voices, might relate to the integration of a VH social identity with other important social identities.…”

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems in vulnerable young people

“…This is supported by a recent suggestion that a nuanced application of the social identity approach to health may be needed for diagnoses such as psychosis. 38…”

“…51 However, a sense of connection to others does not always have a beneficial impact on well-being, as it can perpetuate the personal identity as someone who is ‘ill’ with a highly stigmatised condition. 38 The finding that membership continuity was associated with anxiety only through the indirect effect of in-person social connection is less easily explained. Although this broadly aligns with the evidence that in-person social support – and not online social support – is associated with reduced anxiety, 52 it contests the evidence that hopefulness is consistently associated with lower anxiety.…”

“…It is important to address the implications for targeting social group memberships in vulnerable and psychiatric samples, as such populations, in comparison with the general population, can experience significant difficulties with forming and maintaining social groups and are at heightened risk of belonging to groups that can perpetuate a stigmatised identity. 38 As the COVID-19 pandemic forced people to increasingly rely on digital means to communicate and remain connected with social groups, 39 it is therefore also important to investigate the clinical application of the social cure approach within this unique social context.…”