'I can see it and I can feel it, but I can't put my finger on it': A Foucauldian discourse analysis of experiences of relating on psychiatric inpatient units.

OBJECTIVES: Research has shown interpersonal relationships influence experiences of inpatient psychiatric services. This study explored inpatient staff and service users' talk about relating, and consequences on available/limited social actions. DESIGN: A Foucauldian discourse analysis was used to analyse transcribed semi-structured interviews and focus groups with current inpatient staff members and members of a service-user involvement group. METHOD: Two focus groups (service users n = 10; staff n = 6) and five interviews (service users n = 2; staff n = 3) were held, with participants responding to questions regarding the discursive object of 'experiences of relating on inpatient wards'. RESULTS: A dominant 'medical-technical-legal' discourse was seen, alongside a counter discourse of 'ordinary humane relating'. Through the tensions between these discourses emerged a discourse of 'collaborative exploration'. CONCLUSION: The medical-technical-legal discourse perpetuates notions of mental illness as impenetrable to relating. Staff fear of causing harm and positions of legal accountability generate mistrust which obstructs relating, whilst patients expect to be asked their opinions on their experiences and to be involved in deciding what treatment to accept, and experience frustration and alienation when this is not forthcoming. Ordinary humane relating was described as vital for service users in regaining a sense of self, although not considered enough in itself to promote recovery/wellness. 'Treatment for my problems' was constructed by service users as emerging through the collaborative exploration discourse, where therapeutic relationships can develop, enabling change and a return to safety. PRACTITIONER POINTS: Discourse analysis of how we talk can help us understand the complexities of being, working, and relating on psychiatric inpatient units. Relating as constructed through the medical-technical-legal discourse is seen as the most legitimized but least fulfilling for staff and service users alike. Both staff and service users want purposefully therapeutic, collaborative relationships however, the environment does not currently appear to support these ways of relating emerging with legitimacy. Some simple steps might be taken to begin the shift towards more fulfilling and therapeutic ways of relating being privileged in psychiatric inpatient environments.

Cognition and Social Cognition in non-psychotic siblings of patients with schizophrenia.

INTRODUCTION: Deficits in Social Cognition are common in people with schizophrenia. However, it is not clear if these deficits are a vulnerability marker and whether they are independent to cognitive difficulties. This study investigates these two issues in individuals with a genetic liability to psychosis. METHODS: Twenty-one healthy siblings of patients with schizophrenia were compared with 21 healthy individuals on a range of cognitive and social cognitive measures. Significant differences in cognitive domains were controlled for when comparing the two groups on measures of social cognition. RESULTS: Siblings of people with schizophrenia performed significantly worst on tests of theory of mind and social perception but not on affect recognition. Scores on tests of executive function, processing speed and general IQ were also lower in the sibling group. When controlled for differences in cognitive tests, the two groups still retained significant differences in theory of mind and social perception. However, executive function significantly contributed to theory of mind and processing speed to social perception differences. CONCLUSIONS: These results further suggest that difficulties in some domains of social cognition are associated with a genetic vulnerability for schizophrenia. In these areas, cognitive difficulties account only partially for social cognition problems suggesting that these two domains may represent relatively independent liability factors.

Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia.

A greater understanding of the links between cognitive and social functioning changes is needed to refine cognitive treatments for schizophrenia. To date, studies have been cross-sectional, and few have investigated the impact of cognitive change. This single-blind randomized controlled trial explored the links between changes in executive/memory functions and social behavior, as well as the moderating effect of cognitive remediation therapy (CRT). A total of 85 participants with schizophrenia received 40 sessions of CRT (an individual psychological therapy aiming to improve attention, memory, and problem solving) or treatment-as-usual. At baseline, social functioning was significantly associated with "verbal working memory," "response inhibition," "verbal long-term memory," and "visuo-spatial long-term memory," but not "schema generation," factors. However, only improvement in "schema generation" predicted improved social functioning. This was true whether or not participants had received CRT. These results suggest that cross-sectional associations between cognitive functions and social functioning may not offer the best means for identifying good targets for intervention. Improvement in the ability to generate new schemas has a beneficial impact on social functioning.