Perceived Social Status Impacts Early Psychosis


Writing in the British Journal of Clinical Psychology, London researchers find that perceptions of lower social rank and inferiority amongst 24 individuals with early psychosis impact on feelings of satisfaction with and feelings of exclusion from peer groups, possibly resulting in lost friendships and on clinical course and recovery.

Abstract → 


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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. The government forcing you into the mental patient role is not a ‘perception’. It’s an objective fact.

    “Individuals with early psychosis viewed themselves as being of lower social rank and inferior in relation to matched controls, and also reported engaging in submissive behaviours more frequently and felt more entrapped by external events.”

    You tend to feel pretty “entrapped by external events” when your government has raped your brain and stolen your human rights. Not to mention smeared you with the stigma of being criminalized in a way, as in the stigma that comes from being forced in to the mental patient role in society’s witch hunt psychiatry rituals.

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  2. I think it’s telling, and speaks to how separate the world of ‘researcher’ and ‘clinician’ are from the world of the people they hold out at arm’s length and examine as if they are specimens, that over 90% of the ‘in the news’ section of brings us articles that can’t even be read by people without an institutional paid subscription to the content.

    The rarefied world of the privilege of even reading about what these so called ‘experts on us’ have to say about ‘us’, is hidden behind expensive paywalls.

    That says a lot about the whole enterprise. It’s an ivory tower quagmire of piece by piece alienation from the real human beings this enterprise claims to be in some giant human scientific endeavor to ‘help’.

    It might be ‘in the news’ for people with institutional subscriptions to academic journals, but it’s certainly not ‘in the news’ for the average internet surfing serf.

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    • Here we have an interesting conundrum, worth exploring:
      Much of what drives the conversation in the scientific and medical communities is what gets published in journals. And mostly that is a handful of “peer”-reviewed journals that are well-regarded. These, of course, are the ones that ask for subscriptions. Individuals can buy them, of course, but it does get expensive.
      I can get access to many of them, but not all, because I am currently a student. I always do when I can, and I try to at least get a sense that the abstract can be supported by the research.
      It may be that if and when this website has some funding and/or cash flow (currently it does not, as should be obvious) we may buy subscriptions to journals; but it would be prohibitive to get subscriptions to all the ones I look at. Currently, most mornings, I look at the “online first” or “early view” or “in press” articles in about 70 journals. I also do a pubmed search that returns about 200 articles on an average morning, which I week through to find articles in journals that aren’t on my list of 70 yet. I do this because many interesting things DON’T make it into the more mainstream journals, precisely because they are “interesting.” Also because sometimes things pop up in journals that are not immediately obvious as ones that would have articles that are of interest to us; journals on obstetrics & gynecology, for instance, which in retrospect would obviously have articles on the issues with psychotropics, but I might not have thought to subscribe to them.
      So this means that it is inevitable that there will be articles from journals that neither we nor readers are likely to have subscriptions to. Does this mean we should not post them?
      I don’t think so. I’m trying to provide a “running banner,” like on the bottom of the screen on CNN, that gives you a taste of what’s being talked about, and how that conversation is going. Sometimes I put things up knowing it will make people angry (or hoping so, because I was) and sometimes I put things up because it just seems interesting and enlightening that someone thought to ask a particular question. Often the articles are things that people would be justified in saying “well, duh” to; things that either SEEM intuitively obvious, or seem like they should just be accepted facts, or that this community (whatever that means) has known for a long time.
      Still, it makes a difference when someone validates something that seems obvious in a hopefully rigorous scientific way. It helps take it out of the realm of folk-wisdom or received wisdom, and makes it justified to say “here’s how we know this is actually true, rather than presumed to be true.”
      So I think there’s some value in pointing out the existence of studies, even if access is not readily available. At least it opens some windows on the ivory tower and the industry; and anybody is free to find a door if they want to. Most of these journals are available in a medical library near you.
      Would it be better not to do this just because some people may not have access, or the access might be difficult? I don’t think so. I think that would be complacent. Whenever anyone tries to argue any of the points made on this website with anyone, especially an academic or a doctor, but really anyone; a journalist, a family member, etc; they are likely to be asked “how do you know that” or “where is the evidence?” I’m trying to provide people with the opportunity to say “it’s in this journal, and it was just published this week, so shut up already.”
      What I cannot provide in access, I try to provide in volume. I like to think that the 400 articles I’ve posted since starting this provide something of an evidence base. Most of the articles in “Mad in America” or “Anatomy of an Epidemic” are similarly unavailable (except through fair-use public services such as the PsychRights website – all praise to Jim Gottstein, as always and forever). I’m trying to continue that into research that is coming out today; I hope the tide of it can become convincing in its own right by-and-by. I think it’s good to know that people are at least looking at non-pharmacologic approaches, and something about what they’re finding, or that they are actually finding contraindications in the pharma research. Often I have found articles that employ twisted logic in the abstracts to gloss over the seemingly obvious finding that the medication did not work. I think it MAY be unconscious when that occurs – a paradigm is a very, very difficult thing to shake loose of – but I’ve been seeing this (what seems like nonsense) for a long time now. When I was working in research a realized at some point that it all looked like word salad and it seemed like article titles were being put together out of refrigerator magnets (in fact I marketed a set of “Diagnostic Refrigerator Magnets” for a while; I have some left, if anyone’s curious.)
      So it pleases me now to be able to find this stuff and put it up somewhere to be seen for what it is, or seems to be, to me. For the most part it’s been very gratifying for me to see the discussions about the articles. I like putting them up for that.
      This is, of course, why it is sometimes disheartening to see the discussion turn sour. I think there are lots of interesting things to talk about about these studies – the “bad” ones as well as the “good” ones – without resorting to derisiveness. Clearly, there is much to be derided – but derision is not new nor particularly enlightening or actually productive. Nor, in the end, is it interesting. It just stops a conversation cold that might otherwise have resulted in people feeling, armed with new ideas, new frameworks, new paradigms, new – well – new knowledge, that they might actually be in a position to make something new happen in the world.
      And that is happening. Monoliths are falling. Change is happening, and it is gathering speed. I think we have an opportunity on this website to coalesce a conversation – the one that started with Bob’s impassioned as well as informed and thoughtful books – into a community that is empowered to be part of making that change happen.
      I think there are lots of corners of this conversation that can truly be part of the solution. The books, and the information from the WHO studies, Harrow studies, Soteria, Gheel, Open Dialogue, etc., all point toward something. What it is waits to be more fully elaborated. Much is known but there always more to know. I personally think that the intersection of mindfulness practice and intentional community – not unlike the sorts of things societies have cultivated for millenia to ensure the safe passage of children into productive adulthood – is the living core of the conversation that springs from all the above-mentioned modalities. But there is lots and lots of conversation to be had in fleshing all this out. And having this conversation is, in fact, perhaps arguably, itself the answer to the problem.
      So while I would love to provide free access to every article I mention, I still think it’s valuable to just point at them and say “here’s what I’m talking about.” I don’t presume to have all the answers, nor even all the information.
      All I can claim to have is my interest, my attention, and the fact that I care; because I’ve seen enough of the things that I don’t want to see happen in the world. I’ve seen enough of people dying, or of being needlessly lost while still alive. That’s why I’m doing this. No one person loses a mind; we all lose it together.
      So there, I’ve gone and explored this conundrum. It’s Friday. I indulged.

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  3. One only needs to use ones common sense to conclude that the people having breakdowns are the ones who are constantly being kicked in the teeth by fate, luck and their fellow human beings, who find it impossible to get jobs who are being judged by luckier folk, etc

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