Research has found that females on the autism spectrum often spend years not understanding why they are different resulting in experienced otherness. My self-directed study written through narrative and poetry-explored the story of a non-traditional graduate student on the autism spectrum at a university. This thesis addresses the question “how is identity shaped through life events”? Looking inside the layers and doorways of self challenged my own long held assumptions of difference and marginalization. Acceptance of self is a lifetime journey. The result showed mentoring is a critical function of academic and personal success. Suggestions are provided to educators to see the person as an individual, look for the twice-gifted student, and attempt to understand the feelings of marginality. These suggestions are presented with the hope of bringing insight and awareness to educators’ understanding of individuals on the wide spectrum called Autism.

The subjective experience of paranoia and persecutory delusions is largely overlooked in the extant literature, especially in first episode psychosis (FEP). This study explored the personal experience and understanding of threatening thoughts in FEP, guided by three over-arching research questions addressing: thought content and emotional distress; the role of life events and context; change in experience over time. Semi-structured interviews were conducted with eight participants. Transcripts were analysed using Interpretative Phenomenological Analysis. Five master themes were identified reflecting recurring characteristics of all participants’ experiences: Exposure of vulnerable self; At the limits of endurance; Elusive sense of agency; The urge to explain it all and FEP as a finite experience? 16 sub-themes indicated elements of master themes that varied among individual narratives. Findings indicated the highly interpersonal nature of threatening thoughts and their role as a key organising factor in people’s lives. Emotional distress was often viewed as consequential to multiple types of thought content, overwhelming pressure, powerlessness and expectation of negative judgement. Difficult life contexts often seemed to contribute to thought manifestation. Reduction of novelty was important to positive change. Several participants framed experiences as terrible but completed, rather than as the beginning of chronic difficulties.

The Mental Health Act 1983, amended in 2007, appears based on the assumption that an undisputed entity of “mental disorder” exists, that people who are designated mentally disordered should be treated, and if necessary, detained by doctors. This study aimed to examine how mental disorder was discursively constructed and how different institutional interventions and practices were justified and legitimised in the House of Commons’ debates regarding the Mental Health Act 2007. Verbatim transcripts from House of Commons debates on the Mental Health Act (conducted between 24th April and 15th May 2007) were studied through a discourse analysis. Seven primary discursive constructions were identified: “The Trusted and Medically Objective Expert,” “The Emergency,” “A Fair Process,” “Supporting Subjects,” “The Decision-Making Impaired and Vulnerably Ill Patient,” “The Lawyer’s Field Day,” and “Societal (Dis)Order.” The study concludes that mental disorder was represented in selective and systemic ways that can help justify and legitimise different interventions and practices, for example, enforced medication, making government legislation and psychiatric practices seem necessary. Consideration was given to how psychiatric practices could be problematic for some service users and how legislation could be based on political and public concerns about social disorder.

Psychosis is suggested to be a leading cause of disability, not only as a direct result of the distressing experiences, but due to the social adversity, increased isolation and subsequent negative impact upon quality of life. While psychological therapies for psychosis show promise in assisting people in recovering from psychosis, relatively little is known about the processes involved, specifically the processes worked through to allow clients to understand and adopt strategic, therapeutic approaches to care. This study aimed to explore how people experiencing psychosis made use of understandings and strategies developed during the joint activity of therapy. Semi-structured interviews were conducted with 11 participants (six psychologist-client pairs) towards the end of, or recently after, finishing therapy for psychosis. Transcribed interviews were analysed using grounded theory. The model constructed presents multi-directional, dynamic interactions between three core categories; ‘Enabling Personal Empowerment’, ‘Navigating a Collaborative Journey’ and ‘Building Belief to generate Trust’. This study explored how processes are derived during therapy, both individually and collaboratively, to help clients better understand and implement the most beneficial strategies introduced through therapy. Through exploring these derived processes, a possible model for the conceptualisation of processes which occur during therapy for psychosis, grounded in client and psychologist accounts of therapy, was generated.

Section A is a review of the literature on cognitive functioning difficulties in psychosis. It focuses on these difficulties as they relate to cognitive models of psychosis. After outlining relevant cognitive models, the literature on cognitive functioning is critically reviewed. The review highlights methodological limitations; gaps in our understanding; and a need for research exploring people's experiences of cognitive functioning difficulties. Section B describes a qualitative study investigating the experience of cognitive difficulties in people with psychosis. Background: An overview of research on cognitive functioning in psychosis reveals limitations in existing understandings, including the absence of a rigorous account of how people with psychosis experience cognitive functioning difficulties. Aims: This study aimed to provide an account of the experience of cognitive functioning difficulties in people with psychosis, including how these difficulties are perceived and understood, how people respond to these difficulties, and what people’s perceptions are of others’ views of these difficulties. Method: A semi-structured interview was carried out with eight participants, focusing on participants’ experience of cognitive difficulties, how they respond to these, how participants perceive others’ understandings, and available support. Interpretative Phenomenological Analysis (Smith, Flowers, & Larkin, 2009) was used. Results: Cognitive impairment was understood in terms of master themes focusing on controlled and reflective thinking; physical experiences; explaining the origins of impairment; identity; and anticipating the future with fear and hope. Conclusions: The findings had significant implications for clinical psychology, including staff and client education about cognitive difficulties, and the importance of cognitive functioning to formulation. New areas for research include interventions stimulating metacognition; managing identity changes in response to cognitive difficulties; and ascertaining staff understanding of cognitive difficulties. Section C is a critical appraisal of the qualitative study 'The experience of cognitive functioning difficulties in people with psychosis: An investigation' described in section B. It provides critical and reflective answers to four questions on the following topic areas: research skills acquired; what one would do differently if repeating the study; clinical consequences of the study; and future research projects.

Section A: A review of literature focused on African Caribbean men with diagnoses of both conduct disorder (as an indicator of antisocial behaviour) and severe mental illness. The review concludes that disorganised infant attachments appear to be predictive of conduct disorder, psychosis and poor engagement with services in a reciprocal 'vicious circle'. Section B: Empirical Paper: This study examined the relationships of African Caribbean men with severe mental illness and a history of conduct disorder, linking this to engagement with services. This was explored qualitatively using attachment theory and Lacanian discourse analysis within a psychosocial methodology. Four interviews were conducted and the texts were analysed. The findings echo the evidence base in showing that, according to this interpretation, all participants showed signs of disorganised attachment. All had had adverse encounters within mental health services although all could also cite discrete experiences which had been helpful and supportive. Each participant held different views about the interaction of ethnicity with care. Section C: A critical reflection on the research process, including: thoughts on learning experiences; retrospective changes to the study; clinical implications; and ideas for future research.

No description available.

The overall aim of the present thesis was three-fold. The first was to study occupational performance in individuals with severe mental disorders and their experiences of occupational therapy, the second to study experienced burden of family caregivers and the third to test the validity and the homogeneity of assessment tools in this area. The samples consisted of individuals with severe mental disorders participating in organised occupations (n= 112), occupational therapy records (n=64), occupational therapists working in mental health care (n=7) and family caregivers of individuals with severe mental disorders (n=256). Data were collected by questionnaires, structured and narrative interviews, observations and occupational therapy records. Individuals with severe mental disorders reported problems related to leisure and work activities and the occupational therapists recorded problems concerning how to organise and structure occupational performance. Individuals functioning on a high cognitive level experienced problems related to work and productive activities. Participation in occupational therapy strengthened their confidence in their own ability. The “Experience of Occupational Performance Questionnaire” (EOPQ) was developed from data on the experiences of women participating in occupational therapy. A principal component analysis gave seven factors with acceptable homogeneity. There is a need for assessment tools to evaluate occupational therapy. The EOPQ represents an attempt to fulfil this need. Family caregivers experienced limitations of daily activities as a burden. The ability to perform daily activities was studied from three perspectives, the individuals’, the occupational therapists’, and the experienced burden of the family caregivers. These perspectives are complementary and thus necessary for planning and implementation of individually adapted occupational therapy as well as for the evaluation of outcomes.

De senaste åren har allt fler människor flytt till Europa. Folk tvingas på flykt på grund av krig, katastrofer och elände. Detta kan knappast vara positivt för deras psykiska hälsa. Allmänsjuksköterskans roll kommer att prövas av detta och det är därför viktigt att sjuksköterskan är medveten om olika tankesätt och omvårdnadsstrategier för att behandla den psykiska ohälsan. Inte minst när det visar att psykisk ohälsa har blivit en ökad trend för sjukskrivning bland den svenska befolkningen. Tio vetenskapliga artiklar och en rapport som behandlade psykisk ohälsa hos människor på flykt analyserades för att ingå i resultatet. Den första delen av resultatet beskriver förekomsten av psykisk ohälsa medan den andra delen redovisar upplevelser i tre teman och sju underteman. Resultatet visar att psykisk ohälsa bland människor på flykt är utbredd, även om det förekommer tydliga skillnader gällande psykiska diagnoser hos dem. Deras upplevelser handlar i stor utsträckning om faktorer som förstärker deras psykiska ohälsa och sätter dem i utanförskap. Det gör att de försöker värna om sig själva genom försvarsmekanismer som inte alltid är till det bättre, samtidigt som de upplever att det finns stöd i deras nya omgivning. Hos människorna själva finns en drivkraft om att kunna acklimatisera sig i det nya samhället även om hinder upplevs, såväl inom dem som runt om kring. Det är därför önskvärt att sjuksköterskan, med hjälp av kunskap om förekomst och upplevelser hos människor på flykt, utför en mellanmänsklig, god och förtroendeingivande vård som behandling för de människor som lider av psykisk ohälsa till följd av flykt. / Background: There has been an increasing prevalence of mental illness among Swedes; in addition a lot more people have fled their home countries due to war and disaster. With them they carried traumatic experiences. What have these effects and occurrences had on their mental status? Aim: This study aims to investigate the prevalence and experience of mental illness among fleeing people. Method: A literature overview was performed to gather and analyse data from both qualitative and quantitative studies. A search for prevalence in quantitative data was used. Prevalence of mental illness is first presented in a compilation and then three themes with seven subthemes describing similarities and differences emerged in the analysis of qualitative and quantitative studies. Results: Prevalence of mental illness was more common among displaced people than the non-displaced with depression, anxiety and posttraumatic stress as the most common diagnosis. Traumatic experiences were also a factor that could hinder the individuals from adopt in the new country. It also showed that there were effects that fortified the mental illness as well as their own defence mechanisms. However, the individuals also experienced support from people with similar experience as well as people in the society they now belong to. They also felt that they wanted to be acclimatized into their new country in order to create a new life. Conclusions: The nurse's role is of importance to create an interpersonal relationship and thus provide safety and trustworthiness to give patients’, persons who have fled, understanding and confidence in health care regarding their mental health.

Background: Studies have shown that patients suffering from mental illness often feel that they are less well treated in health care than patients who do not suffer from a mental illness. What causes this is that patients with mental illness often become subject to stigmatization in healthcare in general. Aim: The aim of this study was to illuminate the experience of stigmatization in the healthcare encounter between nursing staff and patients with a mental illness. Method: Six qualitative and one quantitative article were analyzed to create a literature review. Results: Through the analysis two main-themes and seven sub-themes were identified. The two main-themes were: The feeling of powerlessness and The feeling of deviating. The seven sub-themes were: Not to be taken seriously, Not to be considered to have a real illness, Being malpracticed, Getting a worse response, To live with the fear of being labeled, To be identified with the diagnosis and To repress symptoms. Conclusions: Patients find that they are not taken seriously regarding their mental or physical problems and that they do not receive care on the same terms as patients without a psychiatric diagnosis. Healthcare professionals need better knowledge about experiences of stigmatization, in order to establish a better relationship between patient and nursing staff and to strengthen the patients' self-esteem. / Alla patienter ska få ett lika gott bemötande i mötet med vården oavsett vilken sjukdom de lider av. Idag finns det fortfarande många fördomar och en utbredd brist på kunskap gällande psykisk sjukdom, vilket leder till att patienter många gånger blir föremål för stigmatisering från hälso- och sjukvårdspersonal och genom detta får ett sämre bemötande än patienter som inte lider av psykisk sjukdom. Sjuksköterskan har en viktig roll när det gäller att få patienten att känna sig trygg och utifrån detta kunna skapa en förtroendefull relation med patienten där hen kan känna tillit. Detta för att kunna ge bästa möjliga omvårdnad. När patienten på grund av stigmatisering mister detta förtroende för vården minskar möjligheten för tillfrisknande och till att leva ett, för patienten, optimalt liv med en god upplevelse av hälsa. Syftet med det här examensarbetet var därför att belysa upplevelsen av stigmatisering i mötet med hälso- och sjukvården hos patienter med en psykisk sjukdom. I resultatet har sju vetenskapliga artiklar, sex kvalitativa och en kvantitativ, analyserats. Artiklarna som valdes till resultatet skulle utgå från ett patientperspektiv och därför exkluderades artiklar som belyste närståendes eller vårdpersonals upplevelser. Artiklarna granskades och analyserades med hjälp av Fribergs (2017) analysmetod för litteraturöversikt som syftar till att belysa likheter och skillnader i inkluderade artiklar. Resultatet visar att patienterna ofta känner att de inte blir tagna på allvar och att de inte bemöts på samma villkor som patienter utan en psykiatrisk diagnos. De känner sig även många gånger avvisade när de söker vård genom att de inte blir trodda eller att de upplevs som besvärliga. I tillägg till detta kämpar många patienter med sina egna fördomar kring psykisk sjukdom som får konsekvenser i deras dagliga liv och i mötet med vården. Sjuksköterskor behöver få kunskap om hur de ska bemöta dessa patienter på ett professionellt vis. Stigmatisering, det vill säga olika typer av fördomar kring psykisk sjukdom som får en negativ effekt för dessa patienter, bör lyftas fram och synliggöras inom såväl sjuksköterskeutbildningen som i det kliniska arbetat ute på sjukhus, primärvård och kommunal vård. Det är även viktigt att öka omvårdnadspersonalens kunskaper gällande patienternas upplevelser av stigmatisering, för att kunna arbeta för en bättre relation mellan patient och omvårdnadspersonal samt arbeta för att stärka patientens självkänsla vilket i sin tur kan leda till en bättre återhämtning och livskvalitet.