Among the most debilitating manifestations of schizophrenia are negative symptoms such as anhedon... more Among the most debilitating manifestations of schizophrenia are negative symptoms such as anhedonia and apathy. Imaging studies have linked these symptoms to morphometric abnormalities in two brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and ventral striatum. Negative symptoms generally are associated with reduced OFC thickness, while apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment, or an underlying phenotypic trait. Here we use multicentre MRI data to investigate orbitofrontal-striatal abnormalities across the schizophrenia-spectrum from healthy populations with schizotypy, to unmedicated and medicated first-episode psychosis patients, and patients with chronic schizophrenia. Striatal volumes and OFC thickness were estimated from T1-weighted images acquired in all three diagnostic groups and controls from four sites (n=337). Results...
Administration and Policy in Mental Health and Mental Health Services Research
Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or pub... more Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient’s home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of al...
Negative symptoms such as anhedonia and apathy are among the most debilitating manifestations of ... more Negative symptoms such as anhedonia and apathy are among the most debilitating manifestations of schizophrenia (SZ). Imaging studies have linked these symptoms to morphometric abnormalities in 2 brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and striatum. Higher negative symptoms are generally associated with reduced OFC thickness, while higher apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment or an underlying phenotypic trait. Here, we use multicentre magnetic resonance imaging data to investigate orbitofrontal-striatal abnormalities across the SZ spectrum from healthy populations with high schizotypy to unmedicated and medicated first-episode psychosis (FEP), and patients with chronic SZ. Putamen, caudate, accumbens volume, and OFC thickness were estimated from T1-weighted images acquired in all 3 diagnostic groups and controls from 4...
Background The treatment in the years following a first-psychosis episode is most crucial as typi... more Background The treatment in the years following a first-psychosis episode is most crucial as typically, the illness onset occurs in a delicate phase of the young adults (Correll, 2018). To address the specialities in the care for this patient population both, the Child and Adolescent, together with the adult department of the Psychiatric University Hospital Zürich implemented the ZEN psychosis first episode program. Members of the specialized team connected in their function as network coaches in a systemic approach all players of the patient’s social and medical network. The better communication on transition points such as to adult department, together with possibilities of low-threshold treatment, aimed to improve treatment adherence and reduce repeated hospitalisations. The study’s main objective was to evaluate the efficacy of the program and with that optimize the treatment process in daily clinical routine. A jurisdictional inquiry has been requested by Swiss Ethics Committee...
Involuntary hospitalization is a frequently discussed intervention physicians must sometimes exec... more Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the p...
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eu... more The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essent...
This chapter situates privacy and confidentiality as central ethical, legal, and anthropological ... more This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering their specific relevance in the context of psychotherapy. In particular, it explores a unique significance that, it is argued, privacy and confidentiality acquire in the therapeutic process to do with the anthropological dimension of privacy, its psychological function, and the specific dynamics of the therapeutic relationship. Based on four case vignettes, potential ethical conflicts about privacy and confidentiality are then discussed. Finally, principles that can guide practitioners in responding to ethical conflicts about privacy and confidentiality in clinical practice are provided.
The conceptual history of schizophrenia is marked by considerable dissent about its nosological s... more The conceptual history of schizophrenia is marked by considerable dissent about its nosological status, and the question of whether it represents a distinct disease entity remains hotly debated. Another recurring feature in the conceptual history of schizophrenia is the reference to concepts of self and person. This paper brings in connection these two debates by interrogating the nosological function of “self” and “person” by means of a fictitious dialogue between Eugen Bleuler, the inventor of schizophrenia, and his contemporary Arthur Kronfeld. Introducing their respective accounts of schizophrenia with a special focus on how concepts of self and person figure therein, our analysis suggests that these concepts are primarily employed in an attempt to guarantee the nosological unity of schizophrenia: mediated by the concept of a core disturbance, alterations of the self or the person thus become the essential core of schizophrenia. Yet, rather than providing an easy solution to the nosological problem of the unity of schizophrenia, the concepts of self and person and their assumed disturbances are themselves fraught with debates about unity. We discuss these conceptual challenges in light of present-day nosological debates and the currently abounding research on the self.
Background
The term ‘difficult’ is pervasively used in relation to medically unexplained symptoms... more Background The term ‘difficult’ is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists ' experiences with and attitudes towards patients suffering from MUS.
Design Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term ‘difficult’. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored.
Setting Three NHS trust secondary care hospitals in North-East England.
Participants 17 senior clinicians from seven medical and two surgical specialities.
Results Unsolicited use of the term ‘difficult’ was common. ‘Difficult’ was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used ‘difficult’ to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of ‘difficult’. Participants also reported experiences that were rewarding and positive.
Conclusions This study shows that blanket statements such as ‘difficult patients’ mask the complexity of doctors ' experiences in the context of MUS. Our nuanced analysis of the use of ‘difficult’ challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars p... more In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how "schizophrenia" is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that "schizophrenia" is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of "schizophrenia" are drawn.
After Eugen Bleuler introduced 'schizophrenia' in 1908, the term was hotly debated but ev... more After Eugen Bleuler introduced 'schizophrenia' in 1908, the term was hotly debated but eventually led to the abandonment of Kraepelin's previous term 'dementia praecox'. Bleuler's contribution has subsequently been interpreted in two main ways. One tradition holds that Bleuler merely renamed 'dementia praecox' while conceptually continuing the Kraepelinian tradition. The other, focusing on Bleuler's characterization of 'dementia praecox' in terms of specific psychological alterations, accredits him with a genuine re-conceptualization. Based on a close reading of 'Die Prognose der Dementia praecox', the paper in which Bleuler first mentioned 'schizophrenia', we suggest a further interpretation of Bleuler's contribution and argue that the main motive for his re-conceptualization is to be found in his rejection of Kraepelinian nosology.
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eu... more The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.
Among the most debilitating manifestations of schizophrenia are negative symptoms such as anhedon... more Among the most debilitating manifestations of schizophrenia are negative symptoms such as anhedonia and apathy. Imaging studies have linked these symptoms to morphometric abnormalities in two brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and ventral striatum. Negative symptoms generally are associated with reduced OFC thickness, while apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment, or an underlying phenotypic trait. Here we use multicentre MRI data to investigate orbitofrontal-striatal abnormalities across the schizophrenia-spectrum from healthy populations with schizotypy, to unmedicated and medicated first-episode psychosis patients, and patients with chronic schizophrenia. Striatal volumes and OFC thickness were estimated from T1-weighted images acquired in all three diagnostic groups and controls from four sites (n=337). Results...
Administration and Policy in Mental Health and Mental Health Services Research
Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or pub... more Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient’s home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of al...
Negative symptoms such as anhedonia and apathy are among the most debilitating manifestations of ... more Negative symptoms such as anhedonia and apathy are among the most debilitating manifestations of schizophrenia (SZ). Imaging studies have linked these symptoms to morphometric abnormalities in 2 brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and striatum. Higher negative symptoms are generally associated with reduced OFC thickness, while higher apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment or an underlying phenotypic trait. Here, we use multicentre magnetic resonance imaging data to investigate orbitofrontal-striatal abnormalities across the SZ spectrum from healthy populations with high schizotypy to unmedicated and medicated first-episode psychosis (FEP), and patients with chronic SZ. Putamen, caudate, accumbens volume, and OFC thickness were estimated from T1-weighted images acquired in all 3 diagnostic groups and controls from 4...
Background The treatment in the years following a first-psychosis episode is most crucial as typi... more Background The treatment in the years following a first-psychosis episode is most crucial as typically, the illness onset occurs in a delicate phase of the young adults (Correll, 2018). To address the specialities in the care for this patient population both, the Child and Adolescent, together with the adult department of the Psychiatric University Hospital Zürich implemented the ZEN psychosis first episode program. Members of the specialized team connected in their function as network coaches in a systemic approach all players of the patient’s social and medical network. The better communication on transition points such as to adult department, together with possibilities of low-threshold treatment, aimed to improve treatment adherence and reduce repeated hospitalisations. The study’s main objective was to evaluate the efficacy of the program and with that optimize the treatment process in daily clinical routine. A jurisdictional inquiry has been requested by Swiss Ethics Committee...
Involuntary hospitalization is a frequently discussed intervention physicians must sometimes exec... more Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the p...
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eu... more The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essent...
This chapter situates privacy and confidentiality as central ethical, legal, and anthropological ... more This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering their specific relevance in the context of psychotherapy. In particular, it explores a unique significance that, it is argued, privacy and confidentiality acquire in the therapeutic process to do with the anthropological dimension of privacy, its psychological function, and the specific dynamics of the therapeutic relationship. Based on four case vignettes, potential ethical conflicts about privacy and confidentiality are then discussed. Finally, principles that can guide practitioners in responding to ethical conflicts about privacy and confidentiality in clinical practice are provided.
The conceptual history of schizophrenia is marked by considerable dissent about its nosological s... more The conceptual history of schizophrenia is marked by considerable dissent about its nosological status, and the question of whether it represents a distinct disease entity remains hotly debated. Another recurring feature in the conceptual history of schizophrenia is the reference to concepts of self and person. This paper brings in connection these two debates by interrogating the nosological function of “self” and “person” by means of a fictitious dialogue between Eugen Bleuler, the inventor of schizophrenia, and his contemporary Arthur Kronfeld. Introducing their respective accounts of schizophrenia with a special focus on how concepts of self and person figure therein, our analysis suggests that these concepts are primarily employed in an attempt to guarantee the nosological unity of schizophrenia: mediated by the concept of a core disturbance, alterations of the self or the person thus become the essential core of schizophrenia. Yet, rather than providing an easy solution to the nosological problem of the unity of schizophrenia, the concepts of self and person and their assumed disturbances are themselves fraught with debates about unity. We discuss these conceptual challenges in light of present-day nosological debates and the currently abounding research on the self.
Background
The term ‘difficult’ is pervasively used in relation to medically unexplained symptoms... more Background The term ‘difficult’ is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists ' experiences with and attitudes towards patients suffering from MUS.
Design Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term ‘difficult’. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored.
Setting Three NHS trust secondary care hospitals in North-East England.
Participants 17 senior clinicians from seven medical and two surgical specialities.
Results Unsolicited use of the term ‘difficult’ was common. ‘Difficult’ was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used ‘difficult’ to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of ‘difficult’. Participants also reported experiences that were rewarding and positive.
Conclusions This study shows that blanket statements such as ‘difficult patients’ mask the complexity of doctors ' experiences in the context of MUS. Our nuanced analysis of the use of ‘difficult’ challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars p... more In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how "schizophrenia" is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that "schizophrenia" is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of "schizophrenia" are drawn.
After Eugen Bleuler introduced 'schizophrenia' in 1908, the term was hotly debated but ev... more After Eugen Bleuler introduced 'schizophrenia' in 1908, the term was hotly debated but eventually led to the abandonment of Kraepelin's previous term 'dementia praecox'. Bleuler's contribution has subsequently been interpreted in two main ways. One tradition holds that Bleuler merely renamed 'dementia praecox' while conceptually continuing the Kraepelinian tradition. The other, focusing on Bleuler's characterization of 'dementia praecox' in terms of specific psychological alterations, accredits him with a genuine re-conceptualization. Based on a close reading of 'Die Prognose der Dementia praecox', the paper in which Bleuler first mentioned 'schizophrenia', we suggest a further interpretation of Bleuler's contribution and argue that the main motive for his re-conceptualization is to be found in his rejection of Kraepelinian nosology.
The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eu... more The introduction of the term and concept schizophrenia earned its inventor, Swiss psychiatrist Eugen Bleuler, worldwide fame. Prompted by the rejection of the main principle of Kraepelinian nosology, namely prognosis, Bleuler's belief in the clinical unity of what Kraepelin had described as dementia praecox required him to search for alternative characterizing features that would allow scientific description and classification. This led him to consider psychological, and to a lesser degree, social factors alongside an assumed underlying neurobiological disease process as constitutive of what he then termed schizophrenia, thus making him an early proponent of a bio-psycho-social understanding of mental illness. Reviewing Bleuler's conception of schizophrenia against the background of his overall clinical and theoretical work, this paper provides a critical overview of Bleuler's key nosological principles and links his work with present-day debates about naturalism, essentialism, and stigma.
Objects of Psychiatrty. Between thing-making, reification & personhood Zurich, June 8 – 11, 2016.... more Objects of Psychiatrty. Between thing-making, reification & personhood Zurich, June 8 – 11, 2016.
International Conference organised by the interdisciplinary research project: “Schizophrenia”: Reception, seman-tic shift, and criticism of a concept in the 20th century. University of Zurich, Psychiatric Hospital Zurich University.
Etwa zwischen 5 und 28 % aller Menschen machen die Erfahrung, dass sie einmal, mehrmals oder auch... more Etwa zwischen 5 und 28 % aller Menschen machen die Erfahrung, dass sie einmal, mehrmals oder auch regelmäßig in Abwesenheit eines äußeren Stimulus eine Stimme hören [1]. Dieser Erfahrung, für manche leidvoll, für andere alltäglich oder gar inspirierend, widmete sich die Ausstellung ‚Hearing Voices: suffering, inspiration and the everyday‘ in Durham (UK). Die Ausstellung entstand im Rahmen des interdisziplinären, vom Wellcome Trust geförderten Forschungsprojekts ‚Hearing the Voice‘ (http://hearingthevoice.org/).
OBJECTS OF PSYCHIATRY takes up current debates within psychiatry namely the debate about the... more OBJECTS OF PSYCHIATRY takes up current debates within psychiatry namely the debate about the reification of psychiatric diagnoses like “schizophrenia”, but also deliberations about autonomy, human rights and participation. At the same time, it considers how the humanities situate psychiatric objects in wider societal contexts and discourses and bring into focus their historical genesis and configuration.
Uploads
Papers by Anke Maatz
The term ‘difficult’ is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists ' experiences with and attitudes towards patients suffering from MUS.
Design
Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term ‘difficult’. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored.
Setting
Three NHS trust secondary care hospitals in North-East England.
Participants
17 senior clinicians from seven medical and two surgical specialities.
Results
Unsolicited use of the term ‘difficult’ was common. ‘Difficult’ was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used ‘difficult’ to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of ‘difficult’. Participants also reported experiences that were rewarding and positive.
Conclusions
This study shows that blanket statements such as ‘difficult patients’ mask the complexity of doctors ' experiences in the context of MUS. Our nuanced analysis of the use of ‘difficult’ challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
The term ‘difficult’ is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists ' experiences with and attitudes towards patients suffering from MUS.
Design
Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term ‘difficult’. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored.
Setting
Three NHS trust secondary care hospitals in North-East England.
Participants
17 senior clinicians from seven medical and two surgical specialities.
Results
Unsolicited use of the term ‘difficult’ was common. ‘Difficult’ was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used ‘difficult’ to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of ‘difficult’. Participants also reported experiences that were rewarding and positive.
Conclusions
This study shows that blanket statements such as ‘difficult patients’ mask the complexity of doctors ' experiences in the context of MUS. Our nuanced analysis of the use of ‘difficult’ challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
International Conference organised by the interdisciplinary research project: “Schizophrenia”: Reception, seman-tic shift, and criticism of a concept in the 20th century. University of Zurich, Psychiatric Hospital Zurich University.