“You have to be careful who you talk to and what you say …” – on psychosis and making rational choices

Abstract

Background: People who have been diagnosed with schizophrenia are regarded as being no longer capable of making rational choices.

Method: Fifteen users with psychosis diagnosis participated to 10 focus group sessions about different aspects of everyday life. The discussions were tape recorded and the transcript analyzed using a grounded theory inspired methodology. A core category that emerged was making choices in crises situations.

Results: Users have to choose whether or not they want help, to whom to turn for help, and how to describe their problems so as to get the kind of help they seek. The choices were based on past experiences in connection with the choices available. They were constantly making quality judgements of the care workers they came into contact with. Experiencing a sense of comradeship emerged as a vital criterion.

Conclusions: The ability to make rational choices often existed parallel with hallucinations and delusions. This ability could form the basis for a true collaboration between users and professionals. The findings of this study indicate that such collaboration is possible, but that it requires a reassessment of our traditional knowledge base.

Keywords:

• Psychosis
• rational choice
• avolition
• experience-based
• empowerment

Acknowledgments

The study was carried in collaboration with Joëlle Delsart, Xavier Amar, Jonathan, Francisco Camacho, Daniel Berdah, Cyrille Hugony, and Jacques Stojanovic.