harmful concept of Schizophrenia, The

Mental Health Nursing, Mar 2007 by Romme, Marius, Morris, Mervyn

Of course, we do not expect an individual professional in mental health care will be able to change the system, neither do we think that collectively nurses should necessarily start a protest against the concept of schizophrenia, though supporting the CASL initiative is important. Rather, we are hopeful that because of the time and relationship nurses have with people who have psychotic experiences, you each will play a critical role in letting go of the ideas that keep the schizophrenia concept alive.

Professionals nurses are not powerless in daily practice. When you are with people who are 'psychotic', start listening to their experiences and ask them to explain to you what they experience. Then help the person unpick the different kinds of experiences they have, like hearing voices, ideas of reference, delusions, the expressions of their 'negative symptoms', taking no initiative or isolating themselves. Then ask what is their difficulty in coping with these experiences, so that you are informed about their anxiety, depressiveness and feelings of powerlessness. It is then possible to explore how these experiences developed over time and possibly interrelate with each other.

Accepting that these experiences are their reality, we would go on to ask what has happened in their life that could possibly relate to these mental health problems, and start with the complaint they started with. If people are confused about that, it is helpful to go over their life story, asking what has happened to them, identifying eventful experiences; illnesses, loss of someone close or a loved one; problems in relationships with others like friends, family, parents, brothers and sisters; problems with work, housing and finances. Also, it is important to explore problems with emotions like aggression, physical abuse, or having been belittled, or having been aggressive themselves, or having had problems with sexuality, sexual identity, or sexual abuse. If a person describes such events, or experiences, a simple question is to ask if it could have anything to do with their voices, paranoia or personal convictions, and discuss this, accepting their thinking and their emotions about it.

We have learnt from our course at UCE in Birmingham over the last seven years that this approach takes time to develop. In the meantime, you may well have relevant skills that for example help reduce people's anxiety about voices and CBT training, which is widely available, can also be adapted to this way of working. We thoroughly recommend Recovery an alien concept by Ron Coleman (1999), or you can read Making Sense of Voices (Romme and Escher, 2000) and find practical possibilities there.

Reference

Romme R, Morrison M (2007) The harmful concept of schizophrenia. Mental Health Nursing 27(2): 7-11.

References

APA (American psychiatric association) (1994) Diagnostic and statistical Manual of Mental Disorders (4th version), Washington DC: American psychiatric Press.

Bentall RP (1990) Reconstructing Schizophrenia. London: Routledge.