The Experience of Psychosis: Fragmentation, Invalidation and Spirituality

Abstract

This study is a qualitative investigation into the subjective experience of psychosis as expressed by clients of a first episode psychosis service in psychotherapy sessions. Fifteen participants, already engaged with the author in his clinical role, were recruited for this study. Recordings were made of psychotherapy sessions where participants subjective experience of psychosis was being discussed as part of the normal course of therapy. Sixty two recordings were made in total, with a mean of 4.1 recordings with each participant. Transcriptions of recordings were made by the author and analysed using Grounded Theory. Commonalities in the data were identified and sorted into categories. Relationships between these categories were explored. Initial analyses yielded 103 distinct categories, which were subsumed under the general headings of Storytelling and Authoring, Causes of Psychosis, Descriptions of Psychotic Experience, Impact of Experience, Responses to and Coping with Experience, Spirituality, and Māori Issues. Subsequent analysis yielded three theoretical constructs which capture the essence of the subjective experience of psychosis: fragmentation integration, invalidation validation, and spirituality. Fragmentation integration relates a sense of a loosening (or, less often, tightening) of connections and associations between aspects of experience, and applies to the personal and interpersonal domains. Validation invalidation refers to the sense of having (or not having) confidence in one s ability to accurately perceive or construe experience and to convey this to self and others. Spirituality refers to an inclination to view the experience of psychosis, or aspects of it, in terms of a broad framework of meaning pertaining to how the individual views his or her relationship with the universe. Findings from this research indicate that those who experience psychosis are eager to explore the meanings of their experience and are competent at reflecting on this experience based on their own subjective experience. Important contributions to our understandings of psychosis can be made by those who have such first-hand acquaintance with psychosis. Theoretical, research, clinical and training implications of this research are discussed.