Unpacking the relationships between psychosis, sense of self, and social identity

: (Alternative Format Thesis)

Abstract

This thesis considers the mental health condition ‘psychosis’ through the lens of social identity theory (SIT). Psychosis is a stigmatising mental health condition. As such, individuals might be expected to resist categorisation of themselves into this social group and find such categorisation wholly negative (a “social curse”). However, it is also well-established that building close connection, or developing a sense of belonging, with similar others, even in a stigmatised group can be protective of health and wellbeing (the rejection identification model) and have health advantages (reflective of a “social cure”). Study 1 is a qualitative investigation of these processes in people with psychosis. Data indicated a positive social identity in relation to psychosis that individuals managed in a nuanced way to maximise wellbeing benefits whilst minimising stigmatising impacts. Study 2 built on this to investigate the relationship between social identification, integration of this identity with other important identities, and wellbeing in people who hear voices. Study 2 also explored possible mechanisms of perceived in-group and out-group empathy. Identity integration emerged as the most powerful predictor of wellbeing (consistent with the cognitive-developmental model of social identity integration). Perceived in-group empathy facilitated strong within group ties and perceived out-group empathy facilitated identity integration and self-coherence. In Study 3, social identity integration processes were elaborated through analysing qualitative interview data from lived experience researchers. Finally, Study 4 demonstrated the acceptability and feasibility of the Groups4Health intervention for loneliness adapted for psychosis and delivered in individual and group formats. Overall, this thesis adds to the literature on the value of social identification and identity integration processes in relation to wellbeing, even within a stigmatising category such as the mental health condition psychosis. The subtlety of how these concepts might apply to this particular group are explored and important theoretical, research and clinical implications discussed.

Date of Award	11 Dec 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	Laura G. E. Smith (Supervisor), Timothy Robert Kurz (Supervisor) & Anthony Morrison (Supervisor)