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Cultural pathways to psychosis care: Patient and caregiver narratives from Puebla, Mexico
Sylvanna M Vargas1,2, Wilmer A Rivas3,4, Andrew Ryder5
1Department of Psychology, University of Southern California, Los Angeles, CA, USA.
Abstract:
The current study used the McGill Illness Narrative Interview (MINI) to explore patients' (n = 6) and caregivers' (n = 3) narratives about how they identified and sought care for psychosis. Participants were recruited from an outpatient clinic at the Hospital Psiquiátrico Dr. Rafael Serrano, a public psychiatric hospital in Puebla, Mexico. All participants consented to complete semi-structured interviews in Spanish. Thematic analyses were used to inductively identify common themes in participants' narratives. The results indicated that during the initial symptom onset, most participants noticed the presence of hallucinations but did not seek help for this hallmark symptom. Participants described seeking care only when they or their ill relative exhibited escalating aggressive behaviors or physical symptoms that were interpreted as common medical problems. As participants became connected to specialty mental health services, they began to develop a conceptualization of psychosis as a disorder of aggression. For some participants, this conceptualization of psychosis as an illness of aggression contributed to their ambivalence about the diagnosis. These results can be understood using a cultural scripts framework, which suggests that cultural norms are influenced by collective understandings of normalcy and valorization of behaviors. Implications for community campaigns are discussed.
Insights
Patients often delay seeking help for psychosis, initially ignoring hallucinations and only seeking care for aggression or physical symptoms. This perception of psychosis as an aggression disorder impacts diagnosis acceptance.
Area of Science:
- Psychiatry
- Cultural Psychiatry
- Mental Health Services Research
Background:
- Identifying and seeking care for psychosis is complex, influenced by cultural factors and symptom interpretation.
- Understanding patient and caregiver narratives is crucial for improving early intervention in psychosis.
Purpose of the Study:
- To explore patient and caregiver narratives regarding the identification and care-seeking process for psychosis.
- To analyze how cultural scripts influence the conceptualization and treatment of psychosis.
Main Methods:
- Utilized the McGill Illness Narrative Interview (MINI) for semi-structured interviews with patients (n=6) and caregivers (n=3).
- Conducted thematic analysis on interviews conducted in Spanish with participants from a public psychiatric hospital in Puebla, Mexico.
Main Results:
- Participants often delayed seeking help, initially overlooking hallucinations and presenting for care due to aggressive behaviors or physical symptoms.
- Psychosis was frequently conceptualized as a disorder of aggression upon engagement with mental health services.
- This aggression-focused conceptualization contributed to diagnostic ambivalence for some individuals.
Conclusions:
- Cultural scripts shape the understanding and reporting of psychosis symptoms, particularly influencing help-seeking behaviors.
- Early intervention strategies should address the cultural interpretation of psychosis symptoms beyond aggression.
- Community campaigns may need to reframe psychosis to improve early detection and reduce diagnostic hesitancy.
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