The other side of “madness”: frequencies of positive and ambivalent attitudes towards prominent positive symptoms in psychosis

Background: Phenomenological descriptions of psychosis traditionally emphasize the subjective burden that psychosis inflicts on patients. However, a growing body of work suggests that in a subgroup of patients, psychotic symptoms are appraised as positive. The present study set out to explore the frequency of positive, negative and ambivalent attitudes towards positive symptoms. We were also interested in characterizing the phenomenological structure of positive symptoms.

Method: Participants were recruited over the Internet via specialized psychosis forums. Among other questionnaires, participants completed the Community Assessment of Psychic Experiences (CAPE) scale. In addition, we administered a novel scale called Subjective Perception of Positive Symptoms (SUPPOSY) that assesses core positive symptoms along various dimensions (e.g. emotional appraisal, impact on daily life).

Results: For all symptom clusters, the majority of participants expressed ambivalence. Psychotic symptoms were associated with both self-reported positive and negative emotions. Experiencing regret should positive symptoms disappear was associated with prior medication noncompliance.

Discussion: The present study indicates that symptoms are neither regarded as an "emotional hell" nor as a "preferred reality". Thus, for a symptom to become a target of treatment, various aspects of the symptom have to be carefully weighed.