Through the Rabbit Hole: Working with Psychosis and Culture

Beavers, Jacqueline (2012) Through the Rabbit Hole: Working with Psychosis and Culture. Doctoral thesis, Meridian University.


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This clinical case study describes an in-depth examination of working with an African American with schizoaffective disorder. Marcus, which is the pseudonym for the client in this clinical case study, is an African American male who was 28 years old when this project began. Marcus was diagnosed with schizoaffective disorder, with his primary symptoms being that of psychosis and depression. Schizoaffective is a complex disorder that necessitated an exploration through multiple lenses. Marcus’ culture, both African American and Rastafarian, were important to understand, as historically African Americans have had a mistrust of mental health providers. Both are addressed through a socio-cultural perspective. I began working with Marcus in 2007 and treatment ended in 2011. He presented as paranoid, delusional, having hallucinations, using alcohol and marijuana heavily, and dealing with extreme medical problems due to fighting. The over arching treatment goal was to develop Marcus’ various subjectivities so that he could explore other parts of himself besides the self that was mental ill. This was largely successful, as Marcus developed subjectivities other than mental illness, including his Rastafarian culture, his vi working subjectivity, and his being a boyfriend in his first romantic relationship. While he was motivated to develop these subjectivities, he became more engaged in treatment and his substance use and symptoms decreased. We also grappled with the differences between us in gender and culture and the power struggles that ensued. As strongly as Marcus engaged in treatment, he also withdrew when tumult within his first relationship arose. The dynamics of our relationship fluctuated as well, as Marcus directed his anger on me and power struggles again resurfaced. By the end of treatment, Marcus was able to articulate his appreciation of our work together. The study’s three main learnings that arose from this process included the importance of considering an individual’s environment, the need to find alternative treatment models to the medical model when working with the African American population, and the need to explore how the societal context determines severity of symptoms in clients with psychosis. A reflection on my own story, my client’s story, stories of others, and myths in relationship to the concepts and principles of Marcus’ treatment are presented as well as interesting research avenues that could show how environment might lessen severity of symptoms through focusing on purpose and developing subjectivities in individuals with psychosis.

Item Type: Thesis (Doctoral)
Subjects: Psychology > Critical Theory
Depositing User: Jackie Beavers
Date Deposited: 17 Jan 2017 21:49
Last Modified: 17 Jan 2017 21:49

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