Love in a time of crisis: Intimate relationships, sexuality and desire in early psychosis and recovery

This PhD research project explores how younger adults (18–35) experience intimate relationships, romance, sexuality, love, and desire during crisis and recovery in early psychosis.

Background

Psychosis often includes an experience of ‘crisis’, sometimes involving an inpatient stay, interactions with police or housing issues. In the UK, people experiencing a first episode of psychosis are referred to Early Intervention Services (EIS), which offer interventions drawing primarily on biological and psychological models. The social context of psychosis and recovery is less well understood, despite a promising evidence base (Stafford et al., 2013).

Relationships are essential to wellbeing (Baumeister and Leary, 1995), however they are also implicated in the creation and maintenance of mental health problems (Pilgrim et al., 2009, p235). People experiencing psychosis may have specific difficulties maintaining interpersonal relationships, exacerbated by histories of relational trauma (Mackrell and Lavender, 2004). Crises can disrupt friendships (Brand, Harrop and Ellett, 2011) and family relationships (Cocoran et al., 2007), but young people with psychosis value interpersonal opportunities that help them feel better understood, less stigmatised, and more ‘normal’ (Newton et al., 2007).

Romantic relationships in early adulthood support identity development, independence and autonomy (e.g. Erikson, 1968), provide a sense of meaningfulness (Argyle, 1987) and are one of the most important concerns for young people (Furman, Brown and Feiring, 1999), yet there is a lack of policy, clinical praxis, and academic literature available to inform approaches to intimate relationships in the context of mental health, and many services see intimate relationships as primarily risky.

Sexuality and intimacy are essential to the human condition (Tiwana et al., 2016), yet people with psychosis have unmet needs in this area (Jager and McCann, 2017). Two reviews on psychosis and sexuality noted a strong biomedical focus in the research literature (Jager and McCann, 2017), with studies focusing on perceived (clinical) risk factors (eg unwanted pregnancy; STIs) or on managing sexual dysfunction arising from antipsychotic use (McCann, 2003). Less is known about the subjective and intersubjective experiences inherent in intimate relationships and sexual desire in the context of psychosis. There is little in-depth empirical research, but small-scale studies indicate that romantic relationships are perceived as both normalising and risky (Redmond, Larkin and Harrop, 2010) and can offer an important source of reciprocal care (Boden, Larkin and Harrop, in prep.).

This PhD research project is an opportunity to ask:

How do younger adults who have had a crisis in the context of psychosis experience intimacy, sexuality and romance?
What role do intimate relationships play in recovery from mental health crises?
What role do (diverse) sexual identities and relationship expectations have in crisis and recovery?
How do service-users experience the impact of mental health interventions and services on their sexuality and intimacy at times of crisis and recovery?
This project will take a qualitative approach primarily utilising hermeneutic phenomenological approaches to understand subjective and intersubjective experience, alongside creative data collection methods. The project is interdisciplinary, drawing on psychological and sociological thinking.