'Literary thinking' and psychosis

Professor Pat Waugh and Dr Angela Woods, English Literature, Durham University

Professor Waugh and Dr Woods explore how methodologies from literary and cultural theory can provide new models for understanding and narrating the experiences of psychosis patients, especially voice-hearers. Their research has informed clinical policies and the development of training for psychiatric practitioners and clinicians, and has raised awareness both among the public and the medical community about the cultural factors in psychosis and patient narratives.

The research

Together, Professor Waugh and Dr Woods’ research finds a new role for literary and cultural theory in challenging clinical and scientific accounts of human experience and in shaping a novel approach to the way that psychosis is conceptualised, researched and framed within clinical and cultural contexts. This is what they term ‘literary thinking’.

Professor Waugh’s research considers how modernist literature represented and engaged with forms of psychosis, and how this can challenge early twentieth century medical discourses, which relied on solely biological explanations of life and the mind. Her research shows the importance of literature in keeping open interpretative frames that were often closed down by scientific discourses, and in particular, the vital role it can play in reconfiguring discourses and experiences of dissociation which have emerged as key features in the phenomenon of hearing voices.

Dr Woods has taken up Professor Waugh’s insights into these bio-cultural discourses and extended them to analyses of representations of schizophrenia. She explores the relationship between clinical and cultural spheres, both to show the influence of culture in shaping and contesting psychiatric and psychoanalytic accounts of schizophrenia, and to understand how this clinical concept has been used by cultural theorists to explain experiences of the modern and postmodern. Dr Woods has argued for a shift in the way that first-person accounts of psychosis are approached. In clinical settings it is often supposed that written narratives provide ‘direct access’ to people’s lived experience, but she has urged a recognition of the generic, philosophical, political and practical constraints that shape what can and cannot be said in these forms of testimony.

Policy engagement and impact

Their research has led to collaborations and training programmes with clinical practitioners, researchers, and patients at institutions in the UK and the US, and has shaped practice, influenced attitudes of clinicians, and assisted in the professional development of psychosis intervention staff. In February 2012 Dr Woods co-founded – with Charles Fernyhough (Psychology, Durham) and Nurse Consultant Valentina Short – the Joint Special Interest Group for Psychosis (JSIGP), a monthly forum based in the Tees Esk and Wear Valley NHS Trust for clinicians, academic researchers, service-users and family members to exchange ideas, research and best practice. Through the forum and training days and conferences at the Trust, Dr Woods and Professor Waugh have both directly introduced clinicians to ‘literary thinking’, championing humanities-based approaches to psychosis, and have introduced greater rigour to the way in which patient narrative is understood. In particular, they have encouraged clinicians to move from a ‘disease model’ based on diagnostic categorisation to an emphasis on narrative complexity, the patients’ own self-narratives, and the cultural influences which shape how psychosis is understood.

Dr Woods has brought this research further afield, to practitioners in Leeds, and in the US. In partnership with colleagues at Leeds and Sheffield universities, and collaborating with the Andrew Sims Centre (a leading UK provider of training events for mental health workers), she co-facilitated an NHS Continuing Professional Development training course in Leeds for doctors on ‘Clinical Practice and the Value of Narrative: Analysing the Value and Application of Narrative and Stories in Delivering Healthcare’. She also delivered two intensive modules for a new Doctorate in Clinical Social Work at Rutgers University, New Jersey, a programme designed to develop advanced clinical practice skills in theory and practice for mid-career clinicians. Following the success of the modules, Woods will return to Rutgers in 2014.