4.

3 Severe Mental Health in Urban Context: Assignment 2

Cindy Louisa Dikkes - 592354

Lea Zimmermann - 501013
Lydia Mantzourani - 467794
Natacha Henriquez- 491970
Sam ter Haar - 603387
Sophie Scheele - 606193

1. The perception of the psychotic patient as a “confused person” in the process of recovery

a) Interactive Lecture Week 3: In the lecture, the term epistemic injustice was mentioned.
Explain the term epistemic injustice, and give one detailed example of how this could present
itself in a clinical recovery setting (5 points).

Answer key:
• Explanation of term epistemic injustice (2 points): A presented symptom is not always
part of an underlying disease. Unfairness related to knowledge of the mental health
professional. It can cause epistemic injustice when you don’t listen to the patient, and
only think about a symptom of a disease. This is a core problem in psychiatric diagnosis.
• Example clinical setting (3 points), e.g.: An individual comes in with a specific symptom,
such as hearing voices. Diagnosis with a psychotic disorder would be likely as it matches
the DSM criteria. Not examining the context and significance of the symptom is harmful
for the patient. This could hurt recovery.

b) Slade (2009): Name and define the four key domains of personal recovery mentioned by
Slade (2009), and explain how these are important aspects to recovery of mental illness. Mention
specifically one domain as an example of how this domain can influence the perspective of
psychotic patients as “confused persons” (10 points + 1 extra point).

Answer key:
• Explain personal recovery in a few sentences (1 point + 1 extra point)
o At its core, personal recovery looks at the subjective recovery that the patient
experiences, where the judgment of the patient is more important than the current
number of symptoms (1 point)
o Personal recovery is underpinned by a constructivist epistemology, which points
to the changing and negotiated nature of experience. (1 point extra)
• Name and define 4 domains (2 points, 0.5 per domain)
o Hope: A primarily future-oriented expectation of attaining personally valued
goals, relationships or spirituality which lead to meaning and are subjectively
considered possible (0.5 points)
o Identity: Those persistent characteristics which make us unique and by which we
are connected to the rest of the world (0.5 points)
o Meaning: An understanding which makes adequate personal sense of the ‘mental
illness’ experience (0.5 points)
 o Personal responsibility: A constellation of values, cognitions, emotions and
behaviours which lead to full engagement in life (0.5 points)
• How the domains are important to recovery: (4 points, 1 per domain)
o Hope: Mental illness and its devaluing consequences can take away hope for a
good future, thus decreasing motivation and likelihood for change (1 point)
o Identity: Mental illness undermines personal and social identity, which is
necessary for recovery (1 point)
o Meaning: Mental illness is a profound experience, which requires a personally
satisfactory explanation. This explanation can help in the recovery process. (1
point)
o Personal responsibility: The mental illness itself and responses from the person,
mental health services and wider society can all undermine the ability to be
responsible for one’s own life, while this responsibility is actually crucial in the
recovery process. (1 point)
• How one of the domains can influence the perspective of psychotic patients as confused
persons (3 points)
o The domains of the personal recovery framework can integrate a more
empathetic, improved perspective of psychotic patients. (1 point)
o By referring to eg. their identity, the perspective is shifted from their mental
illness to their whole identity. Reflecting on the fact that psychotic patients have a
personal and social identity that makes them unique, the perspective of patients as
“confused persons” might shift to a more understanding perspective where the
whole identity of the person can be perceived. (2 points)

c) Case “confused person”: How are aspects of this framework reflected in Jeroen’s history of
psychosis? Name 3 specific situations and how they relate to the identified domains. (10 points)

Answer key:
• Definition of psychosis (4 points)
o Psychosis can be defined as a mental illness that is characterized by perceptions
that are incongruent with reality. (1 point)
o There are five domains of symptoms, both positive and negative ones (1 point)
o positive: (1 point is at least one is mentioned)
§ delusions
§ hallucinations
§ disorganized thought/ speech
§ disorganized or abnormal motor behavior
o negative: (1 point if at least one is mentioned)
§ restricted emotional expression or affect.
• 3 examples (2 points each, 6 points combined) e.g.
o Hope → Jeroen often felt the need to play the role of the “good” patient when in
clinical facilities, masking the real state of his condition. The facilities focused on
symptom recovery and disregarded the idea of recovery without clearcut symptom
reductions. Internalizing that getting better can only occur when symptoms are
reduced, Jeroen lost hope in real recovery leading him to fake improvements.
 o Identity → When he was asked whether he wanted to go to the hospital with a
small or large ambulance, he was asked for his personal opinion, and therefore
appealed to his identity. This way he felt seen. Alternative example: Asked by
nurse if he wants to eat scrambled eggs once he gets to the hospital.
o Meaning → Indirect meaning: Jeroen’s conversations with different audiences
where he now tries to educate them on psychosis and tries to increase their
understanding (e.g. Ted talk). This helps him integrate his personal meaning of
the psychosis in his personal and social identity.
§ Direct meaning: linking his psychosis with his childhood and
dysfunctional family dynamic justified his condition.
o Personal responsibility → He said that every time there was authority or strong
sense of domination, his symptoms got worse (example with policeman on horse;
handcuffing him). This questioned his own autonomy/ responsibility in the
process, which made him angry and feel like his whole autonomy was taken
away.

References

Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals.
Cambridge University Press.