Abstract
Through the lenses of critical realism and contextualism, this study is about how psychiatrists perceive schizophrenia and its recovery. Semi-structured interviews with six participants were conducted and analysed using thematic analysis. The findings were organized into four overarching themes: the psychiatrists’ perceptions of schizophrenia; ways of working with individuals with schizophrenia; the relational aspect of working with individuals with schizophrenia; and psychiatrists’ perceptions of recovery. All participants viewed schizophrenia as an illness with biological basis and based their diagnosis largely on clinical experience. Medication was seen as occupying a central role in treatment. Complete recovery was defined as being asymptomatic and being able to function without the use of medication; however, living in the community on medication was also seen as a form of recovery. Only one psychiatrist defined recovery according to the recovery model, viewing individuals as a whole with the potential of living a meaningful life despite having schizophrenia. The study concludes that psychiatrists’ perceptions of schizophrenia and its recovery are influenced by a mental health system which is largely hospital-based and lacks adequate community support and are reflected in the way psychiatrists interact with the patient and the treatment decisions they take on the journey of recovery.
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Notes
- 1.
Through the use of a questionnaire, this quantitative study looked at experienced psychiatrists’ (n = 119) views on aetiology, diagnosis and treatment of schizophrenia. The majority of psychiatrists in this sample rated clinical impression as being more useful for diagnosis than Schneider’s first-rank symptoms, the ICD 9 or the DSM III. With regard to aetiology, the psychiatrists in this study gave the highest ratings to biological factors, followed by life events, which in turn was followed by psychosocial factors. The prescription of medication was significantly higher when compared to other interventions. Interestingly, while those who believed schizophrenia to be the result of biological causes were more likely to choose medication over other forms of interventions, those who believed schizophrenia to be a product of psychosocial factors were found to be more likely to choose psychological treatments.
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Appendix
Appendix
Appendix A: Revised Interview Guide
General Introduction
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1.
How many years of experience do you have working as a psychiatrist?
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2.
During this time, approximately how many cases of schizophrenia have you come across?
Perceptions of Schizophrenia as a Disease and as a Diagnosis, Possible Stigmatising Attitudes, Therapeutic Relationship
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3.
What is schizophrenia?
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4.
If you had to come up with a metaphor to describe schizophrenia, what would it be?
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How would you compare schizophrenia to other mental illnesses?
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5.
What was your impression of schizophrenia when you first started working with individuals with mental health problems? Has this changed over time?
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6.
Have you worked with a patient with schizophrenia in the past week? What was this like for you? How do you relate to a patient with schizophrenia? How does a patient who presents with symptoms of schizophrenia make you feel? What would be going through your mind at that moment? What would your main concerns be? How do you address hallucinations, delusions, and lack of insight?
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7.
Can you take me through your experience of working with a particular patient with schizophrenia? What stuck with you the most with this client?
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8.
What informs you the most when you are making a diagnosis of schizophrenia?
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Do you and if so, how, do you inform patients and their families about the diagnosis? Why or why not? Does this differ from other diagnoses?
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Would you like to share any thoughts on the DSM-5 or the ICD-10?
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Recovery in Schizophrenia
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8.
In your line of work, have you ever observed recovery in schizophrenia?
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9.
Based on your experience, do you think full recovery in schizophrenia is possible?
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If so, how do you define recovery? If not, why not? What would be helpful? What usually serves as a hindrance or a barrier?
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10.
Is there a particular patient that comes to mind when I ask this question? Can you tell me a bit more about this patient? How did the patient recover? Were there any other professionals involved? What treatment was the patient offered? In your opinion, what was particularly helpful for this patient? Were there any obstacles?
Possible Hierarchy
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11.
May I ask what your initial reactions to being asked to take part in a study on schizophrenia were?
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12.
Do you have any other thoughts you would like to share? What was the interview like for you?
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Sargent, J., Abela, A. (2021). Psychiatrists’ Perceptions of Schizophrenia and Its Recovery: A Thematic Analysis. In: Borcsa, M., Willig, C. (eds) Qualitative Research Methods in Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-030-65331-6_2
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