for the first In Sohee Park’s decades of schizophrenia research, she rarely stopped to think about what her subjects’ lives were like. Now a professor of psychology at Vanderbilt University, Parker rose to fame by studying working memory — the fast, scratchpad-like memory that helps us keep track of what we’re doing. By using simple tasks to deconstruct the workings of the brain in schizophrenia, Park hopes to unravel the underlying causes of the disorder’s reality-distorting symptoms — such as delusions, false beliefs that resist conflicting evidence, and hallucinations, which often take the form of imagining the sound of.
“We’ve been doing symptom interviews, where we ask fixed questions about symptoms — these are very standardized, and that’s what we should be doing,” she said. “We never really just talked about life, or their philosophy of life, or their view of their general condition.”
Psychological research on schizophrenia often looks like this: A person diagnosed with schizophrenia or another disorder that causes a psychosis-like condition is tested again and again. Typically, one of these is the PANSS, or “Positive and Negative Syndrome Scale.” Taking the test is often the only time researchers ask their subjects about their actual experience with psychosis—anything the subjects say is distilled into a numerical score ranging from 1 to 7. For PANSS, this is the same grand delusion (“I am the second Jesus”) as the delusion of persecution (“Someone is going to kill me”) and the delusion of reference (“everyone is talking about me”).
Over the past few years, Parker has taken a different approach: She has asked open-ended questions to her research subjects. She hears about things that go far beyond the confines of PANSS, such as out-of-body experiences; imaginary beings; and the deep, day-long fluid states caused by painting. Her research now focuses on how people with schizophrenia experience their bodies.
Park’s focus on personal experiences is unusual in the field of psychiatry. Academic psychologists have long preferred quantitative and neuroscience methods, such as symptom checklists and brain scans, to difficult-to-quantify personal narratives. But despite the analytical challenges they present, these narratives can still be studied.Last month, papers published in widely read journals – one in Lancet Psychiatry another in world psychiatry—Analyzes first-person narratives of delusions and psychosis. To some, this type of research, which involves words and ideas, rather than numbers and mathematical models, may seem unscientific. But Parker, who was not involved in any of the studies, is one of a small group of philosophers, psychologists and neuroscientists who argue that first-person narratives can provide a better understanding of what psychosis looks like and how it works. “In the rush to be embraced by biological and physical scientists,” she said, “what we’re left with is, who is going through these things? Who are the people who are actually experiencing them?”
This neglect begins at diagnosis. In the Diagnostic and Statistical Manual (DSM), the so-called psychiatric diagnosis bible, conditions are defined as a scorecard: You must have X of these Y symptoms within Z months to develop a specific mental illness. The original goal of the system was to facilitate research by providing some objective basis for deciding who has and who does not have a mental illness. But these lists leave little room for the complexities of real life. “In my day-to-day encounters with patients, there is little resonance between what I hear about life experiences – the complexities, the nuances and details and the context, the life context this person describes – and when you make a diagnosis or consider When you’re in therapy, you’re ticking these very reductive boxes,” said Rosa Ritunnano, a psychiatrist and PhD candidate in the University of Birmingham’s Interdisciplinary Mental Health Research and lead author of the paper Lancet Psychiatry.