(Un)shared realities of psychosis: Intersubjectivity, power, and (mis)recognition in the psychiatrist-patient relationship Restricted; Files Only
Uehling, Melissa (Spring 2025)
Abstract
Delivering effective, compassionate psychiatric care that emphasizes meaningful exploration of patient perspectives remains a challenge for modern psychiatry. Despite the development of certain modalities that seek to improve understanding of patients with psychosis, many individuals experiencing psychosis continue to report feeling misunderstood or misrepresented by psychiatrists. Drawing upon the conceptual areas of subjectivity and intersubjectivity, this work seeks to explore how the perspectives of psychiatrists and patients may align or misalign during psychiatric treatment, and if and how diverging perspectives of patients are explored during treatment. Furthermore, this work seeks to explore if and how shared understandings are created between psychiatrists and patients experiencing psychosis, and what the consequences of these processes are on treatment engagement. This work involved three primary methodologies: First, 25 in-depth, semi-structured interviews with U.S.-based psychiatrists who treat patients with psychosis. Second, 24 in-depth, semi-structured interviews with U.S.-based individuals who experience psychosis and have received psychiatric treatment. Third, 10 months of ethnographic work, specifically involving direct observation of multiple psychiatric treatment settings in which patients with psychosis receive care. Results revealed that many patient participants’ experiences of treatment were characterized by a lack of exploration of their perspective. Interviews and observations revealed multitudes of “hidden speech” that remained unexplored during treatment, which nonetheless had important impacts on treatment engagement and the strength of the doctor-patient relationship. Furthermore, numerous structural factors, such as time constraints, insurance restrictions, and the biomedical emphasis of care led to limitations on the possibilities for shared understanding development during treatment. Overall, this study highlights the complexities of effective care provision and the importance of robust exploration of patient perspectives. This study also highlights the critical need for an exploration of areas of alignment and misalignment between psychiatrist and patient views, and offers reflections on alternatives to treatment provision that may increase engagement and meaningful connection between psychiatrists and patients.
Table of Contents
Table of Contents
CHAPTER ONE: INTRODUCTION 1
1a. A brief history of criticisms of Western psychiatry 2
1b. The development of the modern psychiatric care system 4
1d. Theoretical framework 9
1f. Introduction to theoretical argument 13
1e. Positionality and Dissertation Structure 14
CHAPTER TWO: PSYCHIATRIST PERSPECTIVES 24
INTRODUCTION 27
METHODS 29
RESULTS 31
DISCUSSION 40
CHAPTER THREE: PATIENT PERSPECTIVES 53
INTRODUCTION 56
METHODS 60
RESULTS 62
DISCUSSION 77
CHAPTER FOUR: CLINICAL OBSERVATIONS 89
INTRODUCTION 91
METHODS 96
FINDINGS 98
CONCLUSION 122
CHAPTER FIVE: CONCLUDING REMARKS 128
Tables and Figures
Table 1 52
Table 2 88
Figure 1 129
Figure 2 130
Figure 3 131
About this Dissertation
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File download under embargo until 22 May 2026 | 2025-04-25 17:07:55 -0400 | File download under embargo until 22 May 2026 |
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