School for Social Work
Schizophrenia-Etiology, Schizophrenia-Treatment, Psychoses-Etiology, Psychoses-Treatment, Open Dialogue, Hearing Voices, Hearing Voices Network, Interpersonal, Dialogic, Power relations, Mastricht approach, Delusions, C/S/X, Phenomenological psychiatry, Subjectivity, Trauma, Racism, Disproportionate diagnosis, Iatrogenic effects, Critique of the medical model, Countertransference, Postmodernism, Hallucinations, Rationalism, Intersubjectivity, Spirituality, Cultural countertransference, Capitalism, Neuroleptcs, Sullivan, Harry Stack, 1892-1949, Fromm-Reichmann, Frieda, Karon, Bertram P., Romme, M. A. J., Lysaker, Paul H., Finland, Seikkula, Jaakko, Sheppard-Pratt Hospital, Chestnut Lodge (Psychiatric Hospital : Rockville, Md.), Pharmaceutical industry
The dominant discourse of schizophrenia as an incurable and biologically determined disease was interrogated through the lenses of race, culture, postmodern philosophy as well as quantitative and qualitative data suggesting a causal relationship between trauma and psychosis (Ensink, 1992; Read, J., van Os, J., Morrison, A.P. and Ross, C. A., 2005; Romme and Escher, 1989, 1996, 2000). The superior outcomes of those treatment models that privileged psychosocial support over pharmaceutical interventions also called into question the primacy of the medical model, as did the longitudinal studies of the World Health Organization (WHO) and over-representation in diagnosis among African Americans (Osiezagha, in press). According to the WHO, individuals diagnosed with schizophrenia in non-industrialized countries had better outcomes than those in industrialized countries (Whitaker, 2010). Practitioners of Open Dialogue found that with increased social support 70% of those being treated for psychosis were able to recover without the use of neuroleptics, and that there was a negative correlation between use of neuroleptics and remission of symptoms (Seikkula and Arnkil, 2006). Forces that perpetuate the primacy of the medical model were explored including: individual and cultural countertransference; the financial interests of the pharmaceutical industry; and Western culture's privileging of rationalism, individualism and scientific thinking. The following meaning-making approaches to psychosis, all of which emphasize subjective experience, were examined: the Hearing Voices Movement; individual psychotherapy as informed by the interpersonalists (Sullivan, Fromm-Reichmann, Karon), intersubjectivists (Lysaker, Daroyanni, Orange, Atwood, Stolorow) and the phenomenological psychiatrists (Stanghellini); and the approach of Open Dialogue (Seikkula) developed in province of Western Lapland, Finland. Points of overlap and points of disjunction in the way these three approaches conceptualize psychosis, healing and treatment was explored with focus on power dynamics, interpersonal healing, medication, hospitalization, and the course and frequency of treatment. Case material was utilized to highlight the concepts discussed in this research that concluded with implications for current practice in the contemporary context of the United States.
Alpern, Sarah K., "Dismantling the dominant narrative of the irreversibility of schizophrenia : three meaning making approaches to psychosis" (2013). Theses, Dissertations, and Projects. 594.