Conflict within psychosis treatment in the English NHS: investigating the experiences of patients and psychiatrists

The vociferous psychiatric Service User Movement and critical elements within psychiatry form evidence of conflict within the field of psychosis treatment. Psychiatric treatment of psychosis within the English NHS was investigated to understand the conflict-ridden relationships between psychiatrists and patients. The hope was to form a bridge of understanding and dialogue between mainstream psychiatry, its fringes and the Service User Movement. People diagnosed with psychosis who subsequently sought support from the Movement and Consultant Psychiatrists working within the NHS were interviewed, focussing upon their experiences of psychosis treatment. The patients were asked about their experiences of and feelings about their NHS treatment and help received from the Movement and, how and if the experiences had affected their self-understanding. The psychiatrists were asked about their motivations for choosing the speciality, experiences of working with those diagnosed with psychosis and their relationships with patients and other psychiatrists. Interviews were analysed using Framework Analysis, a qualitative method designed to probe individual as well as organisational processes and make policy recommendations. The conflictual dynamic was found to result from a fundamental neglect of existential needs for meaning, hope and relationships in psychiatric training and NHS treatment. The patients felt harmed in treatment because their anxieties about psychic annihilation and need to understand their suffering were ignored. Such harms were found to derive from the lack of focus upon relationships in psychiatric services and training. The psychiatrists suffered low morale and vocational dissatisfaction because their training and work systems left them ill equipped to understand or bear the essential difficulties of the work. Psychoanalytic and other literature is cited to explore unconscious betrayals of human needs in the design of care systems. Ideas are offered to support all involved in the difficult work with psychosis, based upon interventions in psychiatry and other disciplines