Hearing Voices: Qualitative Inquiry in Early Psychosis

Preface

preface Katherine M. Boydell In Canada and internationally, recent years have witnessed an increased growth in qualitative inquiry in the health sciences. Qualitative research exploring the social determinants of health, clinical decision making, interaction between practitioners and patients, patient experiences of illness , health care delivery, and other social aspects of health and health care are regularly featured in medical, nursing, and other health research and professional journals. This text is based on an international symposium featuring such qualitative inquiry in the field of early psychosis, which was held in Toronto in October 2007. Research in the field of early psychosis needs to draw on different perspectives, methodologies, and techniques to generate breadth of knowledge and depth of understanding. Qualitative research is a broad umbrella term for research methodologies that describe and explain individual experiences, behaviours, interactions, and social contexts without the use of statistical procedures or quantification. The aim of most forms of qualitative research is to understand how the world is socially constructed by its participants as well as what meanings those constructions have for the participants. Qualitative methodologies are particularly appropriate for understanding individuals’ and groups’ subjective experiences of health and disease; social, cultural, and political factors in health and disease; and interactions among participants within health care settings. Qualitative research questions focus chiefly on three areas: (1) language as a means to explore processes of communication and patterns of interaction within particular social groups; (2) the description and interpretation of subjective meanings attributed to situations and actions; and (3) theory building through discovering patterns and connections in the data. These methodologies have much to offer in the field of early intervention. This vii viii Preface volume highlights the research that has been conducted internationally and illustrates its’ potential for impact at both the levels of service delivery and mental health policy. The first half of the book is structured around the individual lived experience of psychosis—from the individual, family, and practitioner’s perspectives. The second half moves the reader beyond the micro level towards the macro level, focusing on broader system issues such as medical trainees’ encounters with first episode psychosis (FEP) in the emergency room and the implementation of first episode clinics in the United Kingdom and Australia. Jean Addington begins with an overview of the current state of empirical knowledge on early intervention. She affirms that the clinical and research practice in FEP accomplished to date constitutes a major reform in the treatment of schizophrenia. Tremendous shifts have been made worldwide to identify and treat young people at the very beginning of their illness. Programs have been, and are continuing to be, developed worldwide. The FEP field expects that treatments for people newly diagnosed with a psychotic illness should be available right at the beginning of their illness and that such treatments will need to be of the highest quality and aimed at the best recovery possible. She calls on researchers to further understand the ways in which mental illness interferes with everyday life and how people can learn to manage and minimize the illness so that they can pursue their lives to the best of their ability even in the face of persisting illness. Qualitative methods are uniquely well suited to this task. Katherine Boydell and her colleagues present early findings from their series of case studies focusing on the pathways to mental health care. They highlight a particular case to illustrate the role of illness recognition and (mis)attribution, the experience of symptoms as reality, and the need for education and awareness in the pathway to mental health care. Identification of the various facilitators and roadblocks in accessing services will contribute to our understanding of the duration of untreated psychosis. By taking a comprehensive approach to understanding this journey, the dynamic complexity and interrelatedness of the role of the family, school, treatment system, and broader community are revealed. Katherine Boydell, Siona Jackson, and John Strauss describe a researchbased dance production that aims to provide knowledge about first episode psychosis in an accessible and meaningful way to a wide variety of audiences. The linking of qualitative research to artistic productions is a new and innovative field that has enormous potential to make research more vital, tangible, and relevant. Empirical qualitative data on the subjective , everyday experience of help seeking, as described by ten young people Preface ix between the ages of sixteen and twenty-four, was expressed using movement and music...