Cover

Half-title

Title

Copyright

Contents

Contributors

Acknowledgements

1 Introduction

Categories and continua

Changing views of the epidemiology of schizophrenia

The aetiology of psychosis

Course and outcome of psychosis

Society and psychosis

Theoretical and conceptual foundations

Social factors and the onset of psychosis

Social factors and outcomes

Models and conclusions

REFERENCES

2 Climate change in psychiatry: periodic fluctuations or terminal trend?

Introduction

Influences on research output

The rise of biological research

Searching for trends in the psychiatric literature (1) Method

Searching for trends in the psychiatric literature (2) Findings

Conclusions

Acknowledgement

REFERENCES

Part I Theoretical and conceptual foundations

3 Social science, psychiatry and psychosis

Introduction

Social science

Historical tensions

The social creation of mental illness

The reality of mental illness

Being mentally ill

Social causation

Structural strain theory

Social stress theory

Social experience and psychosis

Conclusion

REFERENCES

4 Conceptualising the social world

Introduction

History and currency

Processes and conditions

Levels of organisation

Urbanicity and schizophrenia

Migration and psychosis

The ecological and atomistic fallacies

Measurement and analysis

Place and time

New directions

Conclusion

REFERENCES

5 Genes and the social environment

Introduction

History and overview of the field

Definitions of relevant terms and concepts

Recent studies of gene–environment interaction

Methodological issues in gene–environment interactions

Future challenges

REFERENCES

Part II Social factors and the onset of psychosis

6 Society, place and space

Introduction

History

Conceptualising society, place and space

Methodological issues

Urbanisation literature review

Incidence rates in rural and urban areas

Urban birth, upbringing or residence

Possible explanations for the risk-increasing effect of cities

Individual level (1) Biological explanations

Genetic risk

Obstetric complications

Infectious disease and season of birth

Drug use

Individual level (2) Socioenvironmental explanations

Social class

Psychosocial stress

Social isolation

Ecological explanations

Mechanisms

Summary and challenges for future research

Conclusion

REFERENCES

7 Childhood adversity and psychosis

Introduction

Summary of existing literature

Separation from parents or loss of at least one parent

Childhood abuse

Bullying

Parental mental illness

Methodological issues

Defining adversity

Measuring adversity

Validity and retrospective assessment

Sample characteristics

Theoretical models

Biological

Psychological

Behavioural

Integrative theories

Conclusions

REFERENCES

8 Family environment and psychosis

Introduction

History: early studies

Familial communication in schizophrenia

Origins of communication deviance

Expressed emotion

Family interventions

Interplay of genes and the family environment

Adoption studies of schizophrenia

Conclusions and future directions

REFERENCES

9 Adult adversity: do early environment and genotype create lasting vulnerabilities for adult social adversity in psychosis?

Introduction

Adult social risk factors for psychosis

Adult life events

Discrimination and social defeat

Mechanisms (1) Sensitisation to stress

Empirical evidence

Mechanisms (2) Early adversity and behavioural sensitisation

Empirical evidence

Mechanisms (3) Biology and behavioural sensitisation

Mechanisms (4) Gene–environment interactions

Empirical evidence (1) A developmental interactive model of psychosis

Empirical evidence (2) Indirect evidence for gene–environment interaction

Empirical evidence (3) Direct evidence for gene–environment interaction

Conclusion

REFERENCES

10 Migration, ethnicity and psychosis

Introduction

History and overview

Definitions of relevant concepts and terms

Migration

Race, culture and ethnicity

Methodological problems

Measuring migration, ethnicity and culture

Quantifying ethnic groups

Ascertainment bias

Validity testing and the category fallacy

A critical review of the findings

Migration and schizophrenia: a meta-analysis

Psychosis and migration in the UK

Differences in incidence as a window to aetiology?

Genes or environment

Social factors

Interaction of risk factors

Sociodevelopmental model of psychosis

Conclusions

REFERENCES

Part III Social factors and the outcome of psychosis

11 Social factors as a basis for treatment

Introduction

Unemployment

Disincentives to employment

Supported employment

Social firms

Poverty

An economic development approach

Employing consumers in the psychiatric service system

A consumer-oriented pharmacy

Homelessness

Apartments and supervision

Cooperatively-owned housing

Incarceration

A jail diversion programme

Social isolation

The psychosocial clubhouse

Conclusion

REFERENCES

12 Public attitudes, stigma and discrimination against people with mental illness

Introduction

The starting point: stigma

Stigma and physical conditions

Box 12.1 Service user accounts (1)

Degrees of rejection

Understanding stigma

Shortcomings of stigma models

The three core problems

Ignorance: the problem of knowledge

Common myths about disability and mental illness

Prejudice: the problem of negative attitudes

Box 12.2 Service user accounts (2)

Conclusion: discrimination – the problem of rejecting and avoidant behaviour

Box 12.3 Service user accounts (3)

Acknowledgement

REFERENCES

13 Outcomes elsewhere: course of psychosis in ‘other cultures’

Introduction

The epidemiological record

The discursive school: outcome read differently

Conclusion: border crossings

REFERENCES

Part IV Models and conclusions

14 Theories of cognition, emotion and the social world: missing links in psychosis

Introduction

A failed category?

Psychosis as a continuum with normal experience

The boundary problem

Aetiological processes

Analysing single symptoms

Cognitive models of psychosis

Social influences on psychosis

Stressful events and psychosis

Distant trauma and psychosis

Recent research into cognitive processes

Appraisal is central

Stress and cognition

Conclusion

REFERENCES

15 Society and psychosis: future directions and implications

A conceptual framework

Do social factors cause psychosis?

Urbanicity

Migration and ethnicity

Adversity across the life course

Specificity

Causal connections?

Mechanisms

Methodological considerations

Conceptualising and measuring social processes

Distinguishing cause and effect

Outcomes and interventions

Implications

Implications (1) Prevention

Implications (2) Intervention

Conclusion

REFERENCES

Index