Psychosis Under Discussion

How We Talk About Madness

Michael Farrell

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351975544
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Psychosis Under Discussion: How We Talk About Madness examines the ways in which psychosis is discussed by considering the relationship between language and the perception of mental disorder. A wide range of perspectives is discussed – including historical terms, personal accounts, psychiatric terminology, psychoanalysis and later theoretical analyses, advocacy, anti-psychiatry, slang and humour, and media coverage – and each way of discussing psychosis is revealing. For example, psychiatric terminology and related research, in its efforts to understand and clarify can seem distancing, dispassionate, and too sure of its ground, whereas the language of advocacy, while being supportive and sensitive, can also seem euphemistic and evasive.

In the discourse of mental disorder, both the content of views and the manner in which they are expressed are influential, making it important to take into account both. Psychosis Under Discussion puts these and other important issues under the microscope. International in range, the book's analysis draws on psychiatry, psychology, philosophy, linguistics and history. Written in Michael Farrell's well-known clear and direct style, the book is essential reading for all those interested in understanding mental disorder and the role of language.

1
Introduction

To begin with

Public awareness of mental disorders, coupled with the willingness of people experiencing such disorders to talk about them, seems to be increasing in recent years. For example, in the UK House of Commons in 2016, several members of Parliament spoke of their own disorders, including depression, general anxiety and obsessive-compulsive disorder. However, none to my knowledge revealed that they had experienced psychotic episodes. Even where the ability of people to speak about mental disorders is increasing, the experience of psychosis (and schizophrenia) still often remains in the shadows, although there are signs that this too is changing (Torrey, 2013, p. 335).

‘Psychosis’ is a term that can evoke misunderstanding and sometimes fear, making it a difficult subject to broach. Where it is talked about at all, discussion can be one-sided and misinformed. Groups are formed holding views which they are reluctant to change or even to debate openly. If there is anything positive in these rigid positions, it is that they suggest that people care about the issues involved. Against such a background, this book explores some of the ways in which psychosis is discussed and what this might tell us about the phenomena and the people who articulate various views.

At the outset, the title of the book, Psychosis Under Discussion: How We Talk About Madness, suggests that certain points require clarification. Among these are:

• interactions between language and mental disorders;
• what is meant by ‘psychosis’ and its relation to certain other disorders and to the concept of ‘madness’.

In addition to these matters, other important preliminaries are the book’s aim, its proposed readers and its structure and content.

Language in relation to mental disorders

Some aspects of language

If the book is to concern itself with ‘discussion’ in relation to psychosis and related issues, it will be as well to consider some relevant aspects of language. By ‘language’ in the current context, I mean spoken or written communication using words in a structured way according to certain conventions. The book also looks at other forms of discourse in a broader sense, such as movies.

Permeating the book are general questions about language and its use, for example:

• Why does terminology change over time, and what drives this?
• To what extent does language influence how we interpret experience and how we respond?
• What other factors are involved (e.g. experience, knowledge, attitudes and beliefs), and how do these interact with language?
• How might changes in features such as knowledge, attitudes and beliefs influence changes in language, and is this a two-way street?
• What are the motives for and consequences of using language in different ways?
• Is it possible to determine the functions of types of discourse, such as slang and humour?
• Can we identify aspects of ‘media language’, and do they reflect the views of the public?
• How do groups of people form, and does their language have particular characteristics?

Language and mental disorders

General questions about language and its use can be related to discourse about mental disorders, specifically psychosis and related terms:

• How does language in interaction with factors such as experience, knowledge, attitudes and beliefs affect how we interpret and respond to psychosis?
• How might changes in factors, such as knowledge about psychosis, influence changes in language and vice versa?
• What are the motives for and consequences of discussing psychosis in different ways?
• How are groups, such as psychiatrists, advocacy and support groups, media personnel and anti-psychiatry groups, constituted; does their group language have particular characteristics; and if so, what is its purpose?

In terms of particular chapters, more specific issues arise:

• Why does terminology relating to mental disorders change over time, and what factors influence this?
• What do personal accounts of psychosis contribute to its understanding?
• What are the characteristics of psychiatric discourse, and what are its strengths and weaknesses?
• To what extent do psychoanalysis and subsequent related developments contribute to our understanding of psychosis or schizophrenia?
• What constitutes the language of advocacy and support groups?
• What are the characteristics and motives of anti-psychiatry language?
• How does slang and humour function, and how does it relate to psychosis?
• To what degree does media language about madness reflect the views of members of society?

Psychosis and other disorders

Medical and other perspectives

Psychosis is viewed in different ways. From a medical point of view, psychotic disorders include ‘schizophrenia’, ‘schizotypal personality disorder’, ‘delusional disorder’ and various forms of ‘catatonia’, and are characterised by features such as delusions, hallucinations, disorganised speech and so-called negative symptoms, such as loss of interest in surroundings (American Psychiatric Association, 2013, p. 99, paraphrased). Psychosis may be seen from the vantage point of personal experience. It can be considered in the context of psychoanalytic frameworks, or as part of emancipatory theories that largely see psychosis as a consequence of oppression and lack of understanding on the part of others. These and other viewpoints are examined in the course of this book.

Psychosis and psychopathy

Members of the public and media professionals sometimes confuse psychosis with psychopathy, which is something quite different. In psychiatric terms, psychopathy is a condition in which the individual shows disregard for the rights of others. In fact, the more commonly used psychiatric expression is ‘anti-social personality disorder’ (American Psychiatric Association, 2013, pp. 659–663). Among the diagnostic criteria for this disorder is a ‘pervasive pattern of disregard for and violation of the rights of others’ shown by various features such as ‘lack of remorse’ (Ibid., p. 659). In addition to ‘psychopathy’ and ‘anti-social personality disorder’, the terms ‘sociopathy’ and ‘dyssocial personality disorder’ are also used (Ibid.).

Confusion between psychosis and psychopathy may arise partly because sections of the media are not always careful to make the distinction. Indeed, this is not always easy, as terms change over time. Also, in slang and in some parts of the popular media, the expression ‘psycho’ is used, which does not indicate whether ‘psychosis’ or the term ‘psychopathy’ is intended.

Madness

Some books about ‘psychosis’ also refer to ‘madness’, perhaps using the two terms interchangeably. A distinction can be made however. ‘Psychosis’ refers to the condition as it is seen from a medical perspective, in which there are features like hallucinations, disorganised speech or loss of interest in surroundings. ‘Madness’ tends to refer to the more florid features of psychosis rather than the so-called negative aspects such as lack of interest and motivation. It is this which is reflected in slang expressions, such as ‘mad as a March hare’, in which what is conveyed is excessive, ‘manic’ activity rather than passivity.

Aims of the book

This book examines how people depict and discuss psychosis, and a detailed outline of the content is provided in the ‘Chapter structures’. Here, the focus is on the broad aims, which are several. The first is to explore the way that language is used in various contexts:

• historical terminology;
• personal accounts of psychosis;
• psychiatry and psychology;
• psychoanalysis and later theorising;
• advocacy groups;
• anti-psychiatry;
• informal settings (slang and humour); and
• media coverage.

Issues arise with each of these contexts. For example, it may be accepted that personal accounts of psychosis can be vivid and powerful, providing unique insights into the phenomena. However, such accounts can be problematic because they tend to be given when the individual is not experiencing a psychotic episode. An individual person is recounting in a ‘reasonable’ state experiences which are by definition out of touch with typically experienced reality. However vivid and authentic the language may appear, it remains open to question whether someone in a nonpsychotic state can convey the experience of psychosis. In addition to recognising the content of what is said, this book explores the implications of the way that language is used.

Proposed readers

Who might read this book? I hope that among readers will be individuals who have experienced mental disorders, as well as those who try to help them. Among the latter will be relatives, as well as professionals such as psychiatrists, psychologists, therapists and mental health nurses. Other readers I hope will be members of advocacy and self-support groups. Those with an interest in how language might shape perceptions of mental disorders should find the book informative. Indeed, all individuals with an interest in mental disorder and how it is discussed and perceived should find much to engage them.

Structure and content of the book

The book’s structure reflects the different ways in which psychosis may be considered. A detailed chapter outline is provided separately, while here, I explain the structure of the book. Following this introductory chapter, the main body of the volume discusses different ways in which people talk about psychosis. A concluding chapter draws together some of the threads that have been explored. A bibliography and index complete the book. Remaining chapters cover the following areas.

Historical terminology

Historical changes as reflected in shifts in terminology illuminate the development of understandings of mental disorder, including psychosis and schizophrenia. Amorphous expressions like ‘mad’ and ‘insane’, while still used casually by some, no longer figure in official or clinical debate. ‘Lunatic’ declined in formal use with the demise of the belief that mental disorder was related to moon phases. ‘Maniac’ as a label for an individual is rarely used, as the state of ‘mania’ is presently seen as one aspect of a wider disorder. In the 1800s, the term ‘psychosis’ was variously used to convey the extent to which organic or mental influences were responsible. Efforts to refine classifications of mental disorders led to the development of various terms, including ‘schizophrenia’. Differing views are held about the extent to which ‘schizophrenia’, ‘psychosis’ and other terms may act as negative labels.

Personal accounts of psychosis

This chapter looks briefly at historical and literary accounts where it appears that the individual experienced psychosis, then looks more fully at modern day accounts where the assessment of psychosis tends to be more secure. Sources include letters, diaries and verbal reports of what has been experienced later recounted to others. It is argued that personal accounts may have an authenticity of direct experience, and these (and other features) are used to help with assessments of psychosis. However, there may be limitations in individuals recounting experiences (discordant with reality) in later states of rationality. Similar criticisms were made by French philosopher Jacques Derrida ([various dates and 1967]/1968) in discussing the book History of Madness by Michel Foucault ([1961, 1972 and 1994]/2006).

Psychiatric terminology

Definitions of psychosis, including schizophrenia, are outlined. Identification, diagnostic criteria, prevalence and incidence, causal factors and treatments are considered as indications of a medical and psychiatric perspective. This is also reflected in scientific terminology, categorising and research. Potential benefits of such terminology include bringing clarity and better reliability and validity to assessments and diagnosis. However, scientific language, Latin- and Greek-derived terms, jargon and acronyms can appear impersonal and distancing, conveying greater sureness of what is known and not known than is sometimes justified, which can be interpreted as arrogance. Some perspect...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• Chapter Structures
• Acknowledgements
• Preface
• Author Information
• 1 Introduction
• 2 Historical terminology
• 3 Personal accounts of psychosis
• 4 Psychiatric terminology
• 5 Psychoanalysis and beyond
• 6 Advocacy
• 7 Anti-psychiatry
• 8 Slang and humour
• 9 Media coverage
• 10 Conclusion
• References
• Index