To try to answer a few of the questions that have been posed and then pose a
few more.
Rob wrote:
>Richard Bell wrote me about a paper he wrote that was
>published in the '92 EPCA volume, that may have some relevance to all of
>this. Has anyone read it?
I have read it- it does have some relevance but is generally a methodological
paper. Worth a look.
Rob wrote further:
>Lindsay, I have looked at portions of the book I think you are
>talking about and was intrigued with the authors' proposal of the "treatment
of >the person" as applied to schizophrenia. I, too, would be interested in
>anything you can share about your methods or results working with your
>patients.
&
Bob wrote:
>What sort of work do you do with the clients of your service?
There are several recent interesting texts from the cognitive therapy
literature including: Haddock & Slade, Chadwick, Birchood & ?, and another
with Kuipers. The focus is on beliefs ofcourse- but at times the emphasis on
personal meaning parallels the personal construct approach.
I really have only been working on a one-to-one basis with these people for a
short time (around six mths). This in many ways I feel is an advantage- I do
not have the assumptions of chronicity, unshakable delusions etc that some of
my colleagues have. Perhaps I am naive but this has the fortunate by product
of credulous listening.
Issues of denial and insight are interesting. Do clients deny suffering or do
they deny the label of schizophrenia because of the images and associations it
conjures? I heard an interesting use of the word denial lately in a different
context- men who have sex with men when married but who don't want to identify
as gay- labelled as men in denial. Denial of what exactly? The question of
schizophrenia remains. Is denial being used here in the same way as the phrase
"without insight"? Is the term also linked to the phrase "non compliant"? My
guess from the way the terms are used on the ward is that the answer is yes to
both. Interesting personal construct questions may look something like:
"How do you describe what's happening for you at the moment?"
"What do you understand by the term schizophrenia?"
A comparison of these responses would then be of interest.
>I would also like to know more about Chris Stevens' work.
Chris is a colleague of mine who will be at the Seattle conference. His work
is not about schizophrenia but rather the idea of "insight" in general. I find
his work interesting in mental health because of the term mentioned above- the
client "without insight". He is on line somewhere so I will let him describe
his own work.
Jon wrote:
>Well said. I concur. Tell me more about your work with "schizophrenics."
Currently I am trying to understand a man who used to work at the steel works.
He has an elaborate "delusional system" who nobody I think has ever really
listened to. Some may consider him thought disordered- he certainly doesn't
meet the neater requirements of the cog behavioural ABC approach to delusions.
Interestingly though he does use terms consistently- he has meanings for terms
such as "pardon", "perfection", "one", "first born creature of the universe",
"clear thoughts". These all relate in some way. "Perfection" is related to a
steel process. He had difficulties towards the end of his apprenticeship. He
talks of the steel works being at war, not receiving a pardon, and the
psychiatric patients getting side effects because of what the steel works did.
I am sure there is meaning in there, and it can't just be meaningless
epiphenomena of a damaged biology. Currently we have a big white board and are
trying to clarify meanings of these terms- as I mentioned they seem to be used
consistently but sometimes bear little resemblance to common usage.
Where is David Vogel? He may have something to say about "delusions"? What
would he think of the cognitive therapists referral to delusions as
"inferential beliefs".
Rob also wrote:
>For myself, I am considering a design comparing differences in the
>content or structure of construct systems of patients rated high vs. low in
>denial of illness.
Rob I think this is really interesting and useful stuff. How do you intend to
define "denial of illness"? Could denial be defined from the person's point of
view in some way? This relates to the questions I posed above.
Bob wrote:
>An offshoot of this work wasunderstanding how people live/cope with voices.
The narrative therapy approach (which can be considered constructivist) is
alos interesting. Narrative therapists (including my partner) work on
"revising the relationship with the problem"- where the problem in this case
is the voice. This has some similarites to reconstruing voices or changing
beliefs about voices. I wonder sometimes though whether the voices are the
construing or the construed?
So much to be done.
Regards
Lindsay Oades
Wollongong
_______________________________________________________________________________
To: pcp@mailbase.ac.uk
From: pcp@mailbase.ac.uk on Tue, 1 Jul 1997 7:41 PM
Subject: Re: Return response/ Recovering Psych. Patients
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From: "Rob Adelman" <radelman@neweracoop.com>
To: <pcp@mailbase.ac.uk>
Subject: Re: Return response/ Recovering Psych. Patients
Date: Mon, 30 Jun 1997 20:57:14 -0500
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Barbara, Lindsay, & Jon -
So, if the concept of denial is a construction that serves a
"protective" function for the mental health worker, and which obscures
rather than reveals the personal worlds of schizophrenics, eliciting the
constructs of schizophrenics may take us beyond the simple dichotomy of
denial/compliance in our viewing of patients. The PCP approach should
enable one to improve the ability to collaborate effectively with these
patients.
In some cases, the goal may be medical compliance. In other cases,
perhaps not, depending on the meaning of one's illness. Or perhaps medical
compliance should be a short term goal for some patients and a long term
goal for others. Richard Bell wrote me about a paper he wrote that was
published in the '92 EPCA volume, that may have some relevance to all of
this. Has anyone read it?
Lindsay, I have looked at portions of the book I think you are
talking
about and was intrigued with the authors' proposal of the "treatment of the
person" as applied to schizophrenia. I, too, would be interested in
anything you can share about your methods or results working with your
patients. I would also like to know more about Chris Stevens' work. Also,
Barbara, I enjoyed your comments, but would like to know more about what
you actually did with your patients.
For myself, I am considering a design comparing differences in the
content or structure of construct systems of patients rated high vs. low in
denial of illness.
Regards,
Rob Adelman
Rusk State Hospital
----------
> From: Lindsay Oades <Lindsay_Oades@uow.edu.au>
> To: pcp@mailbase.ac.uk
> Subject: RE: Return response/ Recovering Psych. Patients
> Date: Friday, June 27, 1997 6:49 PM
>
> Hi Rob & Barbara,
> I have been very interested in your discussion regarding "recovering
> psychiatric clients"- as I currently work in psychiatric rehabilitation.
I no
> longer use the term schizophrenia for two reasons:
> 1) as discussed by Birchwood and his UK colleagues the term holds little
> scientific validity in the way symptoms cluster together -hence terms
such as
> voices, paranoia & delusions are perhaps more appropriate to talk about
(and
> perhaps better match what the clients also talk about (delusions
excepted).
> 2) the term schizophrenia seems to help few people- ie it doesn't really
> inform constructively how clients and heatlh professionals work together-
or
> in Kellyian terms it isn't really an effective transitive diagnosis.
>
> I have of late been asking clients of their personal meanings of voices,
> interesting beliefs (delusions & paranoia etc) and of medication.
Olanzapine
> and Clozapine are very popular where I work- the culture constructs these
as
> the "best and latest treatment" - the clients say yes there are less side
> effects and it seems to stop the voices a little- but as some of the
> cog-behaviourists in the UK are also asking- what of the personal
construals/
> beliefs about voices, how do they relate to client histories etc and (as
you
> have been discussing) how do clients construe adherence and recovery??
>
> Chris Stevens work with insight is also relevant here- is a non compliant
> client one who invalidates the predictions of the worker? Is the client
with
> no insight one who simply invalidates the world view of the worker? I see
> these as serious questions to consider, not to be thrown away as "anti
> psychiatry rhetoric".
>
> Regards
> Lindsay Oades
> Wollongong
>
____________________________________________________________________________
___
> To: pcp@mailbase.ac.uk
> From: pcp@mailbase.ac.uk on Wed, 25 Jun 1997 10:30 AM
> Subject: Re: Return response/ Recovering Psych. Patients
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> From: "Rob Adelman" <radelman@neweracoop.com>
> To: <pcp@mailbase.ac.uk>
> Subject: Re: Return response/ Recovering Psych. Patients
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>
> ----------
> > From: Tooth Barbara Ann <b.tooth@qut.edu.au>
> > To: pcp@mailbase.ac.uk
> > Subject: Re: Request for references on recovering psychiatric patients
> > Date: Monday, June 23, 1997 8:49 PM
> >
> > Dear Rob
> >
> > I am currently completing a research project on recovery from
> > schizophrenia and hence have some information on people's construing of
> > this process. However the part about their prospects of remaining
> > medically compliant raises far to many issues to discuss here. In short
I
> > don't think it is a useful way to look at people's experience of their
> > illness.
> >
> > Regards Barbara
> >
> >Dear Barbara,
>
> I was real glad to hear from you since I had seen your name and
> paper on the program for the conference in Seattle, but didn't know how
to
> contact you. I would
> really appreciate it if you would send me a copy of your paper. I would
be
> glad to reimburse you any costs, or perhaps you could send it
> electronically with your E-Mail. Let me know what would work best for
> you.
> > The problem I am trying to resolve through this research is to find
> some means to deal with the denial issue with psychiatric patients. I
am
> thinking that the way the patients construct their illness may provide
some
> clues as to how to work with them
> in a more collaborative way, so as to enhance their ability to manage
their
> disease.
> I'm curious about your comment about the issue of medication compliance
not
> being
> useful in understanding their experience of their illness. Maybe we are
> coming at this from different directions. Please send more. If it would
> help, I can send a couple of pages of my proposal to you..
>
> Looking forward to your response,
>
> Rob
>
>
>
>
> > On Fri, 20 Jun 1997, Rob Adelman wrote:
> >
> > > Hello out there!
> > >
> > > I am a doctoral candidate at Texas A&M - Commerce and new to the
> mail-list.
> > > I am working with a population of schizophrenic and bipolar
patients
> at
> > > the state hospital. I am interested in applying construct methods to
> > > learning about patient's constructions of their illness, and their
> > > prospects for remaining medically compliant.
> > >
> > > Anyone who has relevant research references or ideas, please write.
> > >
> > > Thanks,
> > >
> > > Rob Adelman
> > > Rusk State Hospital
> > > Rusk, Texas
> > >
> >
>
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