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Toward a Change of Paradigm in Psychosis: A Contextual Phenomenological Approach

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Psychological Interventions for Psychosis

Abstract

This chapter sets out the increasing evidence that makes it clear that the understanding of psychosis from the biomedical perspective has reached its limits. It is proposed that this depletion has to do with the scientific model on which the research carried out from the biomedical model is based on, a statistical-mechanistic one. Against it, a holistic-contextual science, centered on the person and their circumstances, and based on qualitative methodology and clinical method, is exposed. From a phenomenological-contextual position, psychosis is exposed as an altered way of being in the world and, therefore, its treatment would no longer be a question of reducing the symptoms, but of understanding them in the biographical context of the person and his/her circumstances. Implications of this “turn” are discussed, with a special emphasis on setting up phenomenological differences between different psychotic spectrum disorders, standing out the relevance of a psychotherapy focused on changing the relationship the person has with his/her symptoms, and proposing a holistic-contextual approach as a scientific framework as well as a qualitative methodology for research and clinical practice.

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References

  • Blankenburg, W. (2014). La pérdida de la evidencia natural. Una contribución a la psicopatologia de la esquizofrenia. Ediciones Universidad Diego Portales (Original 1971).

    Google Scholar 

  • Borsboom, D., Cramer, A. O. J., & Kalis, A. (2019). Brain disorders? Not really: Why network structures block reductionism in psychopathology research. Behavioral and Brain Sciences, 42(e2), 1–63. https://doi.org/10.1017/S0140525X17002266

    Article  Google Scholar 

  • Braslow, J. T., Brekke, J. S., & Levenson, J. (2021). Psychiatry’s myopia – Reclaiming the social, cultural, and psychological in the psychiatric gaze. JAMA Psychiatry, 78(4), 349–350. https://doi.org/10.1001/jamapsychiatry.2020.2722

    Article  Google Scholar 

  • Cardella, V. (2020). Rationality in mental disorders: Too little or too much. European Journal of Analytic Philosophy, 16(2), 13–36. https://doi.org/10.31820/ejap.16.2.1

    Article  Google Scholar 

  • Cougle, J. R., Hom, M. A., & Matheny, N. L. (2017). Cognitive behavioral therapy: Empirically supported treatment and the movement to empirically supported practice. In D. McKay, J. S. Abramowitz, & E. A. Storch (Eds.), Treatments for psychological problems and syndromes (pp. 4–14). Wiley Blackwell. https://doi.org/10.1002/9781118877142.ch2

    Chapter  Google Scholar 

  • Díaz Garrido, J. A., Laffite Cabrera, H., & Zúñiga Costa, R. (Eds.). (2021). Terapia de Aceptación y Compromiso en psicosis: Aceptación y Recuperación por niveles (ART). Pirámide.

    Google Scholar 

  • Dumas-Mallet, E., & Gonon, F. (2020). Messaging in biological psychiatry: Misrepresentations, their causes, and potential consequences. Harvard Review of Psychiatry, 28(6), 395–403. https://doi.org/10.1097/HRP.0000000000000276

    Article  PubMed  PubMed Central  Google Scholar 

  • Fava, G. (2020). Psychiatry’s intellectual crisis. Conversations in in critical psychiatry. Psychiatric. Times, 37(9), 38–40.

    Google Scholar 

  • Feyaerts, J., Henriksen, M. G., Vanheule, S., Myin-Germeys, I., & Sass, L. A. (2021a). Delusions beyond beliefs: A critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective. The Lancet Psychiatry, 8(3), 237–249. https://doi.org/10.1016/S2215-0366(20)30460-0

    Article  PubMed  Google Scholar 

  • Feyaerts, J., Kusters, W., Van Duppen, Z., Vanheule, S., Myin-Germeys, I., & Sass, L. (2021b). Uncovering the realities of delusional experience in schizophrenia: A qualitative phenomenological study in Belgium. The Lancet Psychiatry, 8(9), 784–796. https://doi.org/10.1016/S2215-0366(21)00196-6

    Article  PubMed  Google Scholar 

  • Fonseca-Pedrero, E., Ródenas, G., Pérez-Albéniz, A., Al-Halabí, S., Pérez-Álvarez, M., & Muñiz, J. (2022). La hora de la evaluación ambulatoria. Papeles del Psicólogo/Psychologist Papers, xx. https://doi.org/10.23923/pap.psicol.2983

  • Fuchs, T. (2019). The interactive phenomenal field and the life space: A sketch of an ecological concept of psychotherapy. Psychopathology, 52(2), 67–74. https://doi.org/10.1159/000502098

    Article  PubMed  Google Scholar 

  • Galbusera, L., & Kyselo, M. (2019). The importance of dialogue for schizophrenia treatment: Conceptual bridges between the open dialogue approach and enactive cognitive science. HumanaMente, 12, 261–291.

    Google Scholar 

  • Galbusera, L., Fuchs, T., Holm-Hadulla, R. M., & Thoma, S. (2021). Person-centered psychiatry as dialogical psychiatry: The significance of the therapeutic stance. Psychopathology, 1–9. https://doi.org/10.1159/000519501

  • García-Montes, J. M., & Pérez-Álvarez, M. (2001). ACT como tratamiento de síntomas psicóticos. El caso de las alucinaciones auditivas. Análisis y modificación de Conducta, 27, 455–472.

    Google Scholar 

  • García-Montes, J. M., & Pérez-Álvarez, M. (2005). Fundamentación experimental y primeras aplicaciones clínicas de la terapia de aceptación y compromiso en el campo de los síntomas psicóticos. Revista Latinoamericana de Psicología, 37(2), 379–393.

    Google Scholar 

  • García-Montes, J. M., & Pérez-Álvarez, M. (2010). Exposition in existential terms of a case of “negative schizophrenia” approached by means of acceptance and commitment therapy. International Journal of Existential Psychology and Psychotherapy, 3(1), 1–18.

    Google Scholar 

  • García-Montes, J. M., Luciano, C., Hernández, M., & Zaldívar, F. (2004). Aplicación de la terapia de aceptación y compromiso (ACT) a sintomatología delirante: un estudio de caso. Psicothema, 16(1), 117–124.

    Google Scholar 

  • García-Montes, J. M., Pérez-Álvarez, M., López-Ríos, F., Sánchez-Sánchez, L. C., & Vallina-Fernández, O. (2021). Terapia de Aceptación y Compromiso aplicada a síntomas psicóticos positivos. In J. A. Díaz Garrido, H. Laffite Cabrera, & R. Z. Costa (Eds.), Terapia de aceptación y compromiso en psicosis. Aceptación y recuperación por niveles (ART) (pp. 349–375). Pirámide.

    Google Scholar 

  • Gardner, C., & Kleinman, A. (2019). Medicine and the mind – The consequences of psychiatry’s identity crisis. New England Journal of Medicine, 381, 1697–1699.

    Article  PubMed  Google Scholar 

  • Haslam, N. (2016). Concept creep: Psychology’s expanding concepts of harm and pathology. Psychological Inquiry, 27(1), 1–17. https://doi.org/10.1080/1047840X.2016.1082418

    Article  Google Scholar 

  • Ioannidis, J. P. A. (2019). Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders? Behavioral and Brain Sciences, 42, e13. https://doi.org/10.1017/S0140525X1800105X

  • Irarrázaval, L. (2020). A phenomenological paradigm for empirical research in psychiatry and psychology: Open questions. Frontiers in Psychology, 11, 1399. https://doi.org/10.3389/fpsyg.2020.01399

    Article  PubMed  PubMed Central  Google Scholar 

  • Katschnig, H. (2018). Psychiatry’s contribution to the public stereotype of schizophrenia: Historical considerations. Journal of Evaluation in Clinical Practice, 24(5), 1093–1100. https://doi.org/10.1111/jep.13011

    Article  PubMed  PubMed Central  Google Scholar 

  • Kean, C. (2009). Silencing the self: Schizophrenia as a self-disturbance. Schizophrenia Bulletin, 35(6), 1034–1036. https://doi.org/10.1093/schbul/sbp043

    Article  PubMed  PubMed Central  Google Scholar 

  • Klar, P., & Northoff, G. (2021). When the world breaks down: A 3-stage existential model of nihilism in schizophrenia. Psychopathology, 54(4), 169–192. https://doi.org/10.1159/000516814

    Article  PubMed  Google Scholar 

  • Kusters, W. (2014). A philosophy of madness: The experience of psychotic thinking. The MIT Press.

    Google Scholar 

  • Levitt, H., McLeod, J., & Stiles, W. B. (2021). The conceptualization, design, and evaluation of qualitative methods in research on psychotherapy. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 51–86). Wiley.

    Google Scholar 

  • McCarthy-Jones, S. (2012). Hearing voices: The histories, causes and meanings of auditory verbal hallucinations. Cambridge University Press.

    Book  Google Scholar 

  • McLeod, J., Stiles, W. B., & Levitt, H. (2021). Qualitative research: Contributions to psychotherapy practice, theory and policy. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 351–384). Wiley.

    Google Scholar 

  • Minkowski, E. (2001). La esquizofrenia: psicopatología de los esquizoides y los esquizofrénicos. FCE (original de 1927).

    Google Scholar 

  • Moernaut, N., Vanheule, S., & Feyaerts, J. (2018). Content matters, a qualitative analysis of verbal hallucinations. Frontiers in Psychology, 9, 1958. https://doi.org/10.3389/fpsyg.2018.01958

    Article  PubMed  PubMed Central  Google Scholar 

  • Moncrieff, J. (2013). Hablando claro. Una introducción a los fármacos psiquiátricos. Herder.

    Book  Google Scholar 

  • Nelson, B., Torregrossa, L., Thompson, A., Sass, L. A., Park, S., Hartmann, J. A., & Alvarez-Jimenez, M. (2021). Improving treatments for psychotic disorders: Beyond cognitive behaviour therapy for psychosis. Psychosis, 13(1), 78–84.

    Article  PubMed  Google Scholar 

  • Nordgaard, J., Henriksen, M. G., Jansson, L., Handest, P., Møller, P., Rasmussen, A. R., Sandsten, K. E., Nilsson, L. S., Zandersen, M., Zahavi, D., & Parnas, J. (2021). Disordered selfhood in schizophrenia and the examination of anomalous self-experience: Accumulated evidence and experience. Psychopathology, 54, 275–281. https://doi.org/10.1159/000517672

    Article  PubMed  Google Scholar 

  • Paris, J. (2021). El espectro bipolar. ¿Diagnóstico o moda? NED.

    Google Scholar 

  • Parnas, J., & Zandersen, M. (2021). Talking to patients and rediscovering disordered selfhood in schizophrenia. Psychiatric Times, 38(1), 23–25.

    Google Scholar 

  • Parnas, J., Urfer-Parnas, A., & Stephensen, H. (2021). Double bookkeeping and schizophrenia spectrum: Divided unified phenomenal consciousness. European Archives of Psychiatry and Clinical Neuroscience, 271(8), 1513–1523. https://doi.org/10.1007/s00406-020-01185-0

    Article  PubMed  Google Scholar 

  • Pérez-Álvarez, M. (2018). Psychology as a science of subject and comportment, beyond the mind and behavior. Integrative Psychological & Behavioral Science, 52(1), 25–51. https://doi.org/10.1007/s12124-017-9408-4

    Article  Google Scholar 

  • Pérez-Álvarez, M. (2021). Ciencia y pseudociencia en psicología y psiquiatría: más allá de la corriente principal. Alianza Editorial.

    Google Scholar 

  • Pérez-Álvarez, M., & García-Montes, J. M. (2012). From neurochemistry to interpersonal chemistry: Towards a psychotherapy of schizophrenia. In A. J. Lancaster & O. Sharpe (Eds.), Psychotherapy: New research (pp. 1–21). Nova Science Publishers.

    Google Scholar 

  • Pérez-Álvarez, M., & García-Montes, J. M. (2018). Evaluación fenomenológica más allá de los síntomas. In E. Fonseca-Pedrero (Ed.), Evaluación de los trastornos del espectro psicótico (pp. 331–363). Pirámide.

    Google Scholar 

  • Pérez-Álvarez, M., & García-Montes, J. M. (2019). La filosofía de la ciencia aplicada a la psicología clínica: pensando en psicosis. In E. Fonseca-Pedrero (Ed.), Tratamientos psicológicos para la psicosis (pp. 123–144). Pirámide.

    Google Scholar 

  • Pérez-Álvarez, M., García-Montes, J. M., Perona-Garcelán, S., & Vallina-Fernández, O. (2008). Changing relationship with voices: New therapeutic perspectives for treating hallucinations. Clinical Psychology & Psychotherapy, 15(2), 75–85. https://doi.org/10.1002/cpp.563

    Article  Google Scholar 

  • Pérez-Álvarez, M., García Montes, J. M., & Sass, L. (2010). La hora de la fenomenología en la esquizofrenia. Clínica y Salud, 21, 221–233.

    Article  Google Scholar 

  • Pérez-Álvarez, M., García-Montes, J. M., Vallina-Fernández, O., Perona-Garcelán, S., & Cuevas-Yust, C. (2011). New life for schizophrenia psychotherapy in the light of phenomenology. Clinical Psychology & Psychotherapy, 18(3), 187–201. https://doi.org/10.1002/cpp.716

    Article  Google Scholar 

  • Pérez-Álvarez, M., García-Montes, J. M., Vallina-Fernández, O., & Perona-Garcelán, S. (2016). Rethinking schizophrenia in the context of the person and their circumstances: Seven reasons. Frontiers in Psychology, 7, 1650. https://doi.org/10.3389/fpsyg.2016.01650

    Article  PubMed  PubMed Central  Google Scholar 

  • Sacks, E. (2007). The centre cannot hold: A memoir of my schizophrenia. Virago.

    Google Scholar 

  • Salagre, E., & Vieta, E. (2021). Commentary on Kohne and van OS view on precision psychiatry. Psychological Medicine, 51, 1412–1414. https://doi.org/10.1017/S0033291720005309

    Article  PubMed  Google Scholar 

  • Sass, L. A. (1994). Civilized madness: Schizophrenia, self-consciousness and the modern mind. History of the Human Sciences, 7(2), 83–120. https://doi.org/10.1177/095269519400700206

    Article  Google Scholar 

  • Sass, L. (2007). ‘Schizophrenic person’ or ‘person with schizophrenia’?: An essay on illness and the self. Theory & Psychology, 17(3), 395–420. https://doi.org/10.1177/0959354307073152

    Article  Google Scholar 

  • Sass, L. (2014). Delusion and double book-keeping. In T. Fuchs, T. Breyer, & C. Mundt (Eds.), Karl jaspers’ philosophy and psychopathology (pp. 125–147). Springer.

    Chapter  Google Scholar 

  • Sass, L. (2019). Three dangers: Phenomenological reflections on the psychotherapy of psychosis. Psychopathology, 52, 126–134. https://doi.org/10.1159/000500012

    Article  PubMed  Google Scholar 

  • Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29(3), 427–444. https://doi.org/10.1093/oxfordjournals.schbul.a007017

    Article  PubMed  Google Scholar 

  • Sass, L. A., & Parnas, J. (2007). Explaining schizophrenia: The relevance of phenomenology. In M. C. Chung, B. Fulford, & G. Graham (Eds.), Reconceiving schizophrenia (pp. 63–95). Oxford University Press.

    Google Scholar 

  • Sass, L., & Parnas, J. (2017). Thought disorder, subjectivity, and the self. Schizophrenia Bulletin, 43(3), 497–502. https://doi.org/10.1093/schbul/sbx032

    Article  PubMed Central  Google Scholar 

  • Sass, L. A., & Pienkos, E. (2013). Space, time, and atmosphere: A comparative phenomenology of melancholia, mania, and schizophrenia, part II. Journal of Consciousness Studies, 20(7–8), 131–152.

    Google Scholar 

  • Sass, L., & Pienkos, E. (2015). Faces of Intersubjectivity: A phenomenological study of interpersonal experience in melancholia, mania, and schizophrenia. Journal of Phenomenological Psychology, 46(1), 1–32. https://doi.org/10.1163/15691624-12341283

    Article  Google Scholar 

  • Sass, L., & Pienkos, E. (2016). Variedades de la experiencia de sí mismo: una fenomenología comparativa de la melancolía, la manía y la esquizofrenia. Parte I. Revista Colombiana de Filosofía de la Ciencia, 14(28). https://doi.org/10.18270/rcfc.v14i28.1655

  • Sass, L., Pienkos, E., Skodlar, B., Stanghellini, G., Fuchs, T., Parnas, J., & Jones, N. (2017). EAWE: Examination of anomalous world experience. Psychopathology, 50(1), 10–54. https://doi.org/10.1159/000454928

    Article  PubMed  Google Scholar 

  • Sechehaye, M. A. (1947/2003). La realización simbólica y Diario de una esquizofrénica. FCE.

    Google Scholar 

  • Seikkula, J. (2019). Psychosis is not illness but a survival strategy in severe stress: A proposal for an addition to a phenomenological point of view. Psychopathology, 52(2), 143–150. https://doi.org/10.1159/000500162

    Article  PubMed  Google Scholar 

  • Škodlar, B., & Henriksen, M. G. (2019). Toward a phenomenological psychotherapy for schizophrenia. Psychopathology, 52(2), 117–125. https://doi.org/10.1159/000500163

    Article  PubMed  Google Scholar 

  • Standal, K., Solbakken, O. A., Rugkåsa, J., Martinsen, A. R., Halvorsen, M. S., Abbass, A., & Heiervang, K. S. (2021). Why service users choose medication-free psychiatric treatment: A mixed-method study of user accounts. Patient Preference and Adherence, 15, 1647–1660. https://doi.org/10.2147/PPA.S308151

    Article  PubMed  PubMed Central  Google Scholar 

  • Stanghellini, G. (2004). Disembodied spirits and Deanimated bodies: The psychopathology of common sense. Oxford University Press.

    Book  Google Scholar 

  • Stanghellini, G., & Ballerini, M. (2007). Values in persons with schizophrenia. Schizophrenia Bulletin, 33(1), 131–141. https://doi.org/10.1093/schbul/sbl036

    Article  PubMed  Google Scholar 

  • Stanghellini, G., & Lysaker, P. H. (2007). The psychotherapy of schizophrenia through the lens of phenomenology: Intersubjectivity and the search for the recovery of first- and second-person awareness. American Journal of Psychotherapy, 61(2), 163–179.

    Article  PubMed  Google Scholar 

  • Stanghellini, G., & Mancini, M. (2017). The therapeutic interview in mental health: A values-based and person-centered approach. Cambridge University Press.

    Book  Google Scholar 

  • Stanghellini, G., & Rosfort, R. (2015). Disordered selves or persons with schizophrenia? Current Opinion in Psychiatry, 28(3), 256–263.

    Article  PubMed  Google Scholar 

  • Stanghellini, G., & Rossi, R. (2014). Pheno-phenotypes: A holistic approach to the psychopathology of schizophrenia. Current Opinion in Psychiatry, 27(3), 236–241.

    Article  PubMed  Google Scholar 

  • Stupak, R., & Dobroczyński, B. (2021). From mental health industry to humane care. Suggestions for an alternative systemic approach to distress. International Journal of Environmental Research and Public Health, 18(12), 6625. https://doi.org/10.3390/ijerph18126625

    Article  PubMed  PubMed Central  Google Scholar 

  • Swain, G. (2009). Diálogo con el insensato. Asociación Española de Neuropsiquiatría.

    Google Scholar 

  • The Schizophrenia Commission. (2012). The abandoned illness: A report from the schizophrenia commission. Rethink Mental Illness.

    Google Scholar 

  • Vallina-Fernández, Ó., Pérez-Álvarez, M., Fernández-Iglesias, P., Soto-Balbuena, C., Perona-Garcelán, S., & García-Montes, J. M. (2014). Person-based contextual therapy applied to a complex case of schizophrenia. Psicothema, 26(3), 299–307. https://doi.org/10.7334/psicothema2013.247

    Article  PubMed  Google Scholar 

  • van Os, J., & Kohne, A. C. J. (2021). It is not enough to sing its praises: The very foundations of precision psychiatry may be scientifically unsound and require examination. Psychological Medicine, 51, 1415–1417. https://doi.org/10.1017/S0033291721000167

    Article  PubMed  PubMed Central  Google Scholar 

  • Whitaker, R. (2015). Anatomía de una epidemia: medicamentos psiquiátricos andel asombroso aumento de las enfermedades mentales. Capitán Swing.

    Google Scholar 

  • World Health Organization. (2021). Guidance on community mental health services: Promoting person-centred and rights-based approaches. https://www.who.int/publications/i/item/9789240025707

  • Yang, C., Tang, J., Liu, N., Yao, L., Xu, M., Sun, H., Tao, B., Gong, Q., Cao, H., Zhang, W., & Lui, S. (2021). The effects of antipsychotic treatment on the brain of patients with first-episode schizophrenia: A selective review of longitudinal MRI studies. Frontiers in Psychiatry, 12, 593703. https://doi.org/10.3389/fpsyt.2021.593703

    Article  PubMed  PubMed Central  Google Scholar 

  • Yttri, J. E., Urfer-Parnas, A., & Parnas, J. (2020). Auditory verbal hallucinations in schizophrenia: Mode of onset and disclosure. The Journal of Nervous and Mental Disease, 208(9), 689–693. https://doi.org/10.1097/NMD.0000000000001179

    Article  PubMed  PubMed Central  Google Scholar 

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Pérez-Álvarez, M., García-Montes, J.M. (2023). Toward a Change of Paradigm in Psychosis: A Contextual Phenomenological Approach. In: Díaz-Garrido, J.A., Zúñiga, R., Laffite, H., Morris, E. (eds) Psychological Interventions for Psychosis. Springer, Cham. https://doi.org/10.1007/978-3-031-27003-1_1

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