Hearing Voices: Qualitative Inquiry in Early Psychosis

5. Hearing Echoes: Image Identification and the Clinicians’ (Learning) Experience with Early Intervention

5 Hearing echoes: image identification and the clinicians’ (learning) experience with early intervention Joan McIlwrick What knowledge and mystery are present in our patients and in our encounters, and are we able to learn from them? (Killackey, Yung, and McGorry, 2007) Introduction What can we learn about a person in the early stages of a psychotic illness if we see the experience from the perspective of the clinicians that care for these patients? What do clinicians learn about themselves when they work alongside a person with a developing psychotic disorder? Are these questions worth exploring, and, if so, how do we explore them? Moreover, how can these stories be told? These were the ideas I was considering in October 2007 during the inaugural meeting of the International Early Psychosis Qualitative Research Consortium in Toronto, where I was seated at the same table as several veteran early interventionists. Hearing the passionate opinions, stories, and occasional debates from this international group of researchers and clinicians made me reflect upon the types of experiences that shape our professional lives. Of particular interest to me was, and is, the impact that people experiencing the early stages of psychosis have upon the clinicians they encounter. My interest in the clinician experience has developed over the past ten years. My professional path has led me to meet two people with early stage psychosis at pivotal moments in my training, and the impact of these encounters has clearly influenced the work I continue to do. When I was a third-year medical student, seriously considering quitting medical school, 73 74 Joan McilwricK it was because a young woman with a psychotic disorder volunteered her time and personal story with my group of clinical skills students that I became interested in a career in psychiatry. Although there were many reasons why I became a psychiatrist, it was ultimately because Mary shared her story with a group of medical students that I started down this road. If Mary was the start of my work in psychiatry, then Ray is the reason I believe in early intervention. Ray was a man I met midway through my residency, while he was in what I now understand to be the psychosis prodrome. For various reasons, he never received early intervention, and I encountered him over several years of my residency, usually when he appeared in the emergency room when I was on call. His condition deteriorated to the point of homelessness over those years, and he will always be a reminder to me of the importance of early intervention for young people with mental illness. Neither Mary nor Ray ever knew the impact they had on my development as a clinician, primarily because it took years before I understood the extent of the impact for myself. In an era of “Code Burgundy” (the term used to define too many patients and not enough hospital beds), overcrowding in the emergency room (Canadian Association of Emergency Physicians (CAEP), 2007), overcapacity on the units, long wait-lists in the clinics, and other demands on the time and attention of clinicians, there is little time for self-reflection on what we learn from our patients, both about their experiences and about our own. The purpose of this chapter is to provide you with the opportunity to experience reflections from residents , psychiatrists, and nurses on their work alongside people with early stage psychosis. How Does This Chapter Fit into the Current Early Psychosis Landscape? Early intervention for psychotic disorders is said to date back 200-300 years, starting in the 1700s when “lunatics” were relabelled as “patients.” Over time, people with psychotic illnesses were moved from “asylum cells” to “curable” wards where they received treatment and were no longer on display as entertainment to the fee-paying public (Reame, 2002). Generally , early intervention in psychosis refers to the movement, started in the early 1990s, that includes researchers, patients, clinicians, caregivers, and policy makers, who were all focused on the early identification and treatment of people with psychotic disorders. A recent summary of the early psychosis field comprises key issues such as focusing primarily on matters related to the duration of untreated illness as well as the economics, timing , and ethics of early intervention (Killackey, Yung, and McGorry, 2007). Understandably, the focus of early intervention work to date has used hearing echoes 75 quantitative methods and focused primarily on topics related to psychosis as a biological...