Case Study: Schizophrenia

Amy is a young woman aged 24 who has been diagnosed with schizophrenia for four years. In that time she has had one really distressing episode that resulted in a serious attempt to take her own life followed by a lengthy hospital admission. She takes antipsychotic medication but is very much ambivalent about its value. She largely complies with taking it because of fearfulness about ‘losing her mind’ and returning to the state she was in when last admitted to hospital. She is worried about all the weight she is putting on and the fact that her life seems to be drifting away from her childhood ambitions. She cannot think about holding down a job or going to college right now, but fears that she may never feel able to. Despite all the talk about recovery, her family and care team seem to be only interested in whether her voices or distressing thoughts are bothering her. To be honest, these have never really gone away but Amy has decided that the best way to stay out of hospital is to tell everyone she is OK.

For Amy, the schizophrenia diagnosis isn’t really helpful – in fact she feels it is stigmatising so never refers to it. A little while ago, Amy met somebody she remembered from hospital while she was out in town. She couldn’t believe the difference in this other person, who had been desperately distressed and dishevelled when Amy knew her on the ward. Now she looked great and was really pleased to see Amy. Over a coffee, she told Amy about a local self-organised service user group she was involved with and invited her along to the next meeting.  Amy wasn’t sure what to expect but was really glad to be asked because her old friends had drifted out of contact and, to be honest, she was feeling lonely and in need of reasons to get out of the house.

At the meeting of the group everyone was quite open and interested in Amy as a new member and a person in her own right. Some people spoke about their own experiences of mental distress but nobody had to. Most of the conversations were about ordinary things and Amy really appreciated that and felt welcome. The group watched a short film of Eleanor Longden talking about her experiences in the mental health system, and the possibility of thinking about psychosis in non-medical ways. This was a revelation to Amy and she found it incredible to realise that people like Eleanor also worked as a psychologist, helping people. For Amy the best part of the film was the plea to ask people ‘what has happened to you?’ rather than ‘what is wrong with you?’  Amy resolved to ask her nurse to get her an appointment with this sort of psychologist.

Imagine you are Amy’s community nurse. What would you do when faced with such a request? What might the challenges be of supporting Amy in her choices? Think about the services you have worked in or had placements in – what resources do they have to offer Amy?

If you are not sure that the services you know are able to deliver this choice. What are the best things they could do pragmatically? Use your imagination to think what an ideal type service could be framed by a ‘what has happened to you?’ philosophy.