Experiences with early intervention in schizophrenia : an ethnographic study of assertive community treatment in Denmark
The thesis presents a person-centred ethnographic study of individuals' experiences following first-episode psychosis as they received treatment and support from the OPUS early intervention programme in Copenhagen, Denmark. It describes individuals' struggles to come to terms with overwhelming experiences during their psychosis, and their engagement in identity work as they reconstructed individual life projects. Examining individual-society relations, it is a study of health and social policy in practice, from an existential and cultural phenomenological perspective. The researcher took an active membership role - as evaluator - in the programme, and fifteen key informants described their situations and experiences during in-depth interviews and through written narratives. The longitudinal design allowed for individuals' changes in attitudes and life circumstances to be described, and for a dialogical approach. The study explores the community intervention programme from the recipients' perspectives, examining individual processes of transformation in the event of serious psychiatric diagnosis. It describes their social roles in their relationship to treatment staff, their views on medication, and the workings of the therapeutic interventions through psycho-education, multiple-family groups, and social skills training groups. Processes of recovery are analysed as symbolic healing. The OPUS organisation, as well as the general Danish welfare system and the labour market, determined the life choices available to these individuals and their possibilities for social integration. Informants' experiences of mental illness and mental healthcare constituted existential crises in which their senses of ontological security were suspended as their lives were disrupted. -While some informants chose a strategy of 'sealing over' their experiences others 'integrated' them in various ways: either by dogmatically endorsing one particular explanation or by combining different systems of explanation from the cultural repertoire in a creative analytical and theory-building work of bricolage. Re-establishing a sense of biographical continuity - connecting the individual's past, present and future - was crucial to each person's sense of self and experience of recovery.