Without you there is no me: An interpersonal framing of psychosis

Abstract: The general aim of this thesis was to explore experiences of interpersonal relationships of individuals with psychotic disorders and to explore patients’ understanding of their symptoms. The four studies covered different aspects and perspectives relevant to understanding the interpersonal context and its possible associations with psychosis. The aim of Study I was to explore how individuals with psychosis experience their early relationships with caregivers and how they describe themselves as children. The study was based on interviews with 7 men and 5 women (aged 29 to 63 years). Caregivers were portrayed as sexually, physically, and/or emotionally abusive, often in combination with a non-abusive caregiver described as resigned and passive. The childhood strategies such as daydreaming and ‘trying to become invisible’ that emerged resemble recognized childhood signs of psychotic disorders. In Study II, the aim was to explore how individuals with psychosis make sense of the content of their psychotic symptoms. The study was based on the same interviews used in Study I. A consistent theme in the participants’ understanding of the content of their psychotic symptoms was either an absence of interpersonal relationships or relationships described as abusive or intrusive. The aims of Study III were to compare the distribution of attachment styles in patients with psychosis with that in the general population and to investigate the relations between attachment and symptoms in the psychosis group. The study group consisted of 47 individuals (30 males and 17 females) with a mean age of 43.02 years. As expected, the secure attachment style was underrepresented in the study group compared with the general population group, and dismissing and fearful attachment styles were overrepresented in the clinical sample. The results also showed significant positive correlations between preoccupied attachment and severity of symptoms. In Study IV, the aim was to explore mental health professionals’ perceptions of parents of patients with psychosis. Participant observations were conducted during team meetings at a psychiatric care unit specializing in patients with psychosis. In the analysis, a complex and multifaceted image emerged of parents as seen by mental health professionals. Some parents were described as a helpful resource, but others were thought to hinder treatment, or to cause the patient emotional pain. Other parents were described as neglectful or abusive. In sum, this thesis shows that knowledge of interpersonal relationships could be valuable for understanding the early signs and adult symptoms of psychosis. These findings may be important to consider both in individual treatment and in treatment focusing on family interventions.