Kiely, James; (2023) “There’s my story of you and there’s your story of you”: How clinicians, services, and systems relate to personal meaning making in psychosis. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

There are myriad ways to make sense of psychosis. Throughout history, different individuals and groups have offered a vast range of conceptualisations. This conceptual introduction traces this history of perspectives on psychosis. First, it explores the development of psychiatric, psychological and social understandings mostly dominated by professionals. It then considers contributions from those with lived experience, alongside cultural and spiritual understandings. Next, it considers how these varied frameworks are applied in practice to make sense of psychosis, firstly by service users within mental health services, and secondly by mental health professionals. The concepts of explanatory models and narrative insight are reviewed to capture the active process through which people make sense of their own lives and the world around them. The importance of meaning-making is presented, particularly for those who experience psychosis, with evidence of improvements in self-understanding, identity formation and recovery outcomes. Early Intervention in Psychosis (EIP) services are explored as a key site for meaning-making in psychosis. Limitations in the literature are considered throughout, particularly the limited exploration of how frameworks for understanding psychosis are applied in clinical reality. The lack of research exploring and theorising meaning-making in the clinical encounter is highlighted. Conclusions are drawn in light of these research gaps, with future research questions proposed.

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