Subjective experience of diagnosis and treatment in two adolescents with first-episode schizophrenia

The results of a qualitative study on the subjective experience of two adolescents in treatment for first-episode schizophrenia (FESZ) are presented here. We reconstructed the relevant aspects of the diagnosis and treatment processes based on the elaboration of said experience carried out by the participants. We therefore incorporated the perspective of the patients, family members and psychotherapists. The recovery from FESZ, understood as a positive adaptation to the experience of psychosis, is closely connected with the possibility of the adolescent to re-embark on his/her biographical trajectory. In this sense, the concept of recovery from FESZ increasingly emphasizes the subjective dimension of this process. The aim of the study is to understand the subjective experience of diagnosis and treatment processes from the perspective of two patients with FESZ who received comprehensive treatment in the Chilean public health system, their family members and their psychotherapists. The study performed semi-structured interviews and a qualitative content analysis in order to understand and describe, from their perspectives, the subjective experiences associated with the processes of diagnosis and treatment of FESZ. The inclusion of patients, relatives and psychotherapists allowed complementing the perspectives on the phenomenon under study. The results suggest that the central phenomena of appropriation of FESZ and resistance to the appropriation of FESZ are relevant in the accounts of these two cases. The family's emotional climate associated with the experience of FESZ converge in these phenomena, as well as the participation of the adolescent in the processes of diagnosis and treatment, specifically as these processes favor or hinder an appropriation of the psychopathological experience and this enables the reestablishment of the autobiographical continuity. Appropriation of FESZ seems to rely on future prospects that preserve some possibility of performing prior potentialities and expectations, or at least to adapt them in a tolerable way for the adolescents and their environment. Such findings highlight the relevance of developing interventions that encourage more hopeful future perspectives for individuals facing a first psychotic episode and their families

Subjects of Law or Subject to Development? Crime and Juvenile Punishment in Chilean Criminal Justice System

In this paper, we address the condition that, in Chile, the Adolescent Criminal Responsibility Law gives to the young offender. Based on disciplines such as psychology and neuroscience, this law characterizes the young person as a "developing subject" to support his/her special criminal treatment according to their "vulnerable", "risky" and "transgressive" nature. The statistical analysis shows that the law protects, in its differentiated juridical consideration, a reinforced government regime of the youth risk. This regime seeks to resolve the subjection to the law of young people through the extended and dominant idea of their subjection to development

Debo tener esquizofrenia tal vez: experiencia subjetiva y construcción autobiográfica en un adolescente con primer episodio de esquizofrenia

En Chile, desde el año 2000, los trastornos psiquiátricos severos han sido una de las siete prioridades programáticas de las políticas públicas de salud mental. El énfasis fue reforzado en 2005, incluyendo el tratamiento del primer episodio de esquizofrenia en el Régimen de Garantías Explícitas en Salud. Este problema de salud mental, de alta relevancia epidemiológica y clínica, acontece habitualmente durante la adolescencia: tiempo de activos procesos de construcción de identidad e historia subjetiva, a los que se suma la experiencia del primer episodio psicótico y su recuperación. El primer episodio de esquizofrenia, ampliamente investigado por la psicología clínica y las ciencias sociales, ha sido insuficientemente abordado desde la perspectiva de las experiencias subjetivas de pacientes en procesos de tratamiento. El objetivo de este estudio fue analizar las experiencias subjetivas asociadas al diagnóstico y tratamiento de un primer episodio de esquizofrenia, a fin de interpretar sus modos de participación en la construcción de un relato autobiográfico. Se trató de un estudio cualitativo interpretativo de caso único, cuyo participante fue un adolescente de 17 años, egresado de un hospital de día para adolescentes de la Región Metropolitana. Fue entrevistado en profundidad y el corpus resultante fue estudiado desde el análisis de discurso, incorporando aportes de la hermenéutica de Ricur. Los resultados del estudio sugieren que el adolescente que vive un primer episodio psicótico se enfrenta a complejas experiencias subjetivas sobre su diagnóstico y tratamiento, que se elaboran discursivamente en el contexto de los procesos de reconstrucción autobiográfica

Salud mental infanto-juvenil como problemática pública

The present paper the fundamental aspects of Chile's public mental health policies, specifically those addressed to children and adolescents. Based on a critical analysis of the State´s technical regulatory framework on jyperkinetic disorder and shizophrenia, it poses a question about the implicit childhood notion contained in the mental health policy discourse.El presente trabajo expone una revisión sobre los aspectos fundamentales de las políticas públicas de salud mental en Chile, particularmente las dirigidas a los niños y adolescentes. Plantea, a partir del análisis crítico de las normativas técnicas estatales sobre trastornos hipercinéticos y esquizofrenia, una interrogación sobre la noción de infancia implícita en el discurso de la política de salud mental

Chile: Glosario Ilustrado del Malestar

El libro “Chile: Glosario Ilustrado del Malestar” reúne un conjunto de entradas y comentarios, imágenes e ilustraciones, que recorren las distintas inscripciones de la experiencia del malestar contemporáneo en Chile, enmarcadas en las acciones de investigación e intervención cultural interdisciplinarias que ha venido desarrollando el Laboratorio Transdisciplinar de Prácticas Sociales y Subjetividad (LaPSoS) surgido al alero de la Iniciativa Bicentenario Juan Gómez Millas de la Universidad de Chile. Los textos oscilan entre definiciones “técnicas”, micro-ensayos, opiniones; algunas veces con ironía y otras con la seriedad de las apuestas académicas, políticas o culturales. Optar por mantener esta heterogeneidad, a costa de limitar la consistencia de sus contenidos, implica una decisión editorial no exenta de riesgos. Puede entonces provocar en sus lectores alguna incomodidad o directamente una evaluación crítica. Hemos preferido asumir ese riesgo porque las voces implicadas aquí son múltiples y dejamos al lector valorar –o no- que en esta diversidad de voces se produzca un libro que permita la reflexión, la risa, o incluso el malestar

¿Sujetos de derecho o sujetos al desarrollo? Crimen y castigo juvenil en la justicia penal chilena

In this paper, we address the condition that, in Chile, the Adolescent Criminal Responsibility Law gives to the young offender. Based on disciplines such as psychology and neuroscience, this law characterizes the young person as a "developing subject" to support his/her special criminal treatment according to their "vulnerable", "risky" and "transgressive" nature. The statistical analysis shows that the law protects, in its differentiated juridical consideration, a reinforced government regime of the youth risk. This regime seeks to resolve the subjection to the law of young people through the extended and dominant idea of their subjection to development.Abordamos la condición que, en Chile, la Ley de Responsabilidad Penal Adolescente da al joven infractor. Apoyada en la psicología y la neurociencia, ella caracteriza al joven como “sujeto en desarrollo” para respaldar su tratamiento penal especial conforme a su naturaleza “vulnerable”, “riesgosa” y “transgresora”. El examen de registros estadísticos nos permite mostrar que, en su consideración jurídica diferenciada, la ley ampara un régimen reforzado de gobierno del riesgo juvenil. Ello sería resultado del expediente que, contenido en la ley, pretende resolver la sujeción del joven al derecho mediante el imperio de su sujeción al desarrollo.Em Sujeitos de direito ou sujeitos ao desenvolvimento? Crime e castigo juvenil no Sistema de Justiça Criminal chileno, abordamos a condição que, no Chile, a Lei de Responsabilidade Penal do Adolescente dá ao jovem infrator. Fundamentada na psicologia e na neurociência, a lei caracteriza o jovem como um "sujeito em desenvolvimento" para justificar o tratamento criminal especial que ele recebe, em conformidade com sua natureza "vulnerável", "arriscada" e "transgressora". A análise dos registos estatísticos nos mostra que, na sua consideração jurídica diferenciada, a lei protege um regime reforçado de administração do risco juvenil. Esse regime busca, assim, resolver a sujeição do jovem à lei por meio da ideia dominante de sua sujeição a seu próprio desenvolvimento

Psicoterapia desde la perspectiva de pacientes chilenos con esquizofrenia

While the contribution of patients' perspectives regarding their psychotherapeutic experiences has been widely recognized, some have received less attention from research, as is the case of people with schizophrenia. This paper focuses on the subjective experience of psychotherapy in order to go more in-depth into aspects related to the therapeutic success. A study of multiple cases was carried out which included four patients who participated in semi-structured interviews. Data analysis was performed based on the Grounded Theory. Results show that the process of psychotherapeutic change in people with schizophrenia can be understood as a progressive reintegration of the self into the biographical continuity and they contribute to understanding the meaning that psychotherapy can have for people suffering from schizophrenia.Si bien el aporte de la visión de los pacientes sobre sus experiencias psicoterapéuticas ha sido ampliamente reconocido, algunos han recibido menor atención desde la investigación, como es el caso de las personas con esquizofrenia. El presente trabajo se centra en su experiencia subjetiva de la psicoterapia, a fin de profundizar en los aspectos vinculados con el éxito terapéutico. Se realizó un estudio de casos múltiples, que incluyó a cuatro pacientes que participaron de entrevistas semi-estructuradas. El análisis de datos fue realizado a través de la Grounded Theory. Los resultados muestran que el proceso de cambio psicoterapéutico en personas con esquizofrenia puede ser entendido como una progresiva reinserción del self en la continuidad biográfica. En tal sentido, contribuyen a la comprensión de los significados que puede tener la psicoterapia para personas afectadas de esquizofrenia.This study was supported by the Chilean National Commission for Scientific and Technological Research, National Doctoral Fellowship, Folio 21120766; the Chilean Science and Technology Fund (FONDECYT), Project No. 11141179; and the Innovation Fund for Competitiveness (FIC) from the Ministry of Economy, Development and Tourism, by means of the Millennium Science Initiative, Project IS130005

Meeting in difference: revisiting the therapeutic relationship based on patients' and therapists' experiences in several clinical contexts

Despite decades of research on the therapeutic relationship and the therapeutic alliance and their connection with therapeutic outcomes (Horvath, Del Re, Fluckiger, & Symonds, 2011), only a handful of studies have examined how they are experienced by the therapy participants. The aim of the present study is to describe the therapeutic relationship from the subjective perspective of the patients and therapists involved in 3 clinical cases: (a) a 7-year-old child diagnosed with attention deficit hyperactivity disorder, (b) a 29-year old woman diagnosed with a personality disorder, and (c) a 22-year-old man diagnosed with schizophrenia. We conducted semistructured interviews with patients and therapists that were later analyzed following grounded theory coding procedures (Corbin & Strauss, 2008). The results obtained reveal that the constitutive elements of the therapeutic relationship are linked to 2 dimensions of the patient-therapist meeting experience: the technical and role-related dimension, characterized by relational asymmetry, and the affective exchange dimension, characterized by relational symmetry. The article discusses the possible association between the asymmetrical technical dimension, whose roles are defined by the organization of the helping relationship, and the notion of therapeutic alliance as commonly conceptualized and assessed; on the other hand, the experience of the bidirectional and symmetrical patient-therapist affective exchange is linked with concepts such as real relationship and intersubjectivity.National Fund for Scientific and Technological Development (FONDECYT) part of the Ministry of Education, Chilean Government 1141179 Fund for Innovation and Competitiveness (FIC) of the Chilean Ministry of Economy, Development, and Tourism, through the Millennium Scientific Initiative IS13000