The original thread had some discussion of doing a postmortem for every case of psychosis in the community, and a comparison with death—we know people sometimes die at random, and we know some things increase risk of death, but we haven’t stopped there and have developed a much, much more gears-y model of what causes death and made a lot of progress on preventing it.
One major difference is that when people die, they are dead—i.e. won’t be around for the postmortem. And for many causes of death there is little-to-no moralizing to be done—it’s not the person’s fault they died, it just happened.
I don’t know how the community could have a public or semi-public postmortem on a case of psychosis without this constituting a deep dive into that person’s whole deal, with commentary from all over the community (including the least empathetic among us) on whether they made reasonable choices leading up to the psychosis, whether they have some inherent shortcoming (“rip to that person but I’m built different” sort of attitudes), etc. I can’t imagine this being a good and healthy experience for anyone, perhaps least of all someone just coming out of a psychotic episode.
(Also, the attached stigma can be materially damaging—I know of people who now have a difficult time getting grants or positions in orgs, after having one episode years ago and being very stable ever since. I’m not going to make claims about whether this is a reasonable Bayesian choice by the employers and grant funders, but one can certainly see why the person who had the episode would want to avoid it, and how they might get stuck in that position with no way out no matter how reasonable and stable they become.)
This does seem unfortunate—I’d prefer it if it were possible to disseminate the information without these effects. But given the very nature of psychosis I don’t think it’s possible to divorce dissecting the information from dissecting the person.
The original thread had some discussion of doing a postmortem for every case of psychosis in the community, and a comparison with death—we know people sometimes die at random, and we know some things increase risk of death, but we haven’t stopped there and have developed a much, much more gears-y model of what causes death and made a lot of progress on preventing it.
One major difference is that when people die, they are dead—i.e. won’t be around for the postmortem. And for many causes of death there is little-to-no moralizing to be done—it’s not the person’s fault they died, it just happened.
I don’t know how the community could have a public or semi-public postmortem on a case of psychosis without this constituting a deep dive into that person’s whole deal, with commentary from all over the community (including the least empathetic among us) on whether they made reasonable choices leading up to the psychosis, whether they have some inherent shortcoming (“rip to that person but I’m built different” sort of attitudes), etc. I can’t imagine this being a good and healthy experience for anyone, perhaps least of all someone just coming out of a psychotic episode.
(Also, the attached stigma can be materially damaging—I know of people who now have a difficult time getting grants or positions in orgs, after having one episode years ago and being very stable ever since. I’m not going to make claims about whether this is a reasonable Bayesian choice by the employers and grant funders, but one can certainly see why the person who had the episode would want to avoid it, and how they might get stuck in that position with no way out no matter how reasonable and stable they become.)
This does seem unfortunate—I’d prefer it if it were possible to disseminate the information without these effects. But given the very nature of psychosis I don’t think it’s possible to divorce dissecting the information from dissecting the person.