Laelia Benoit1, Thomas Russo2, Caroline Barry2, Bruno Falissard2, Nicolas Henckes3. 1. Maison de Solenn, Maison des Adolescents, Cochin Hospital, Hôpitaux de Paris (APHP), France; Center for Research and Epidemiology and Population Health (CESP), French National Institute of Health and Medical Research (Inserm), School of Public Health (EDSP) U1018, University of Paris Saclay, France. Electronic address: laelia.benoit@inserm.fr. 2. Center for Research and Epidemiology and Population Health (CESP), French National Institute of Health and Medical Research (Inserm), School of Public Health (EDSP) U1018, University of Paris Saclay, France. 3. Center for Research in Medicine, Science, Health, Mental Health, and Society (Cermes3), Centre National de La Recherche Scientifique (CNRS), France.
Abstract
BACKGROUND: Psychiatric care is a fruitful setting for exploring the rise of surveillance medicine, which shapes gray zones of uncertainty between health and illness. Predicting psychosis has become a priority in the international mental health field, but French psychiatrists appear reluctant to refer their young patients for standardized assessments or disclose their risks to them. AIM: This research addressed French psychiatrists' attitudes towards risk disclosure about psychosis to adolescents presenting symptoms that might reflect either typical teenager unease or the first signs of psychosis onset. METHODS: A mixed-method design included 12 in-depth qualitative interviews followed by an online survey with responses from 487 psychiatrists. RESULTS: French psychiatrists' reluctance to engage in risk disclosure emerges from a professional norm: a belief in the self-fulfilling prophecy. They - especially those with a background in social science and psychology - believe in the optimistic self-fulfilling prophecy. They fear the consequences of pessimistic predictions, struggle to maintain functional optimism, favor long-term inconspicuous medical watchfulness, and systematically understand favorable outcomes as a consequence of medical care, independent of the accuracy of risk detection.
BACKGROUND:Psychiatric care is a fruitful setting for exploring the rise of surveillance medicine, which shapes gray zones of uncertainty between health and illness. Predicting psychosis has become a priority in the international mental health field, but French psychiatrists appear reluctant to refer their young patients for standardized assessments or disclose their risks to them. AIM: This research addressed French psychiatrists' attitudes towards risk disclosure about psychosis to adolescents presenting symptoms that might reflect either typical teenager unease or the first signs of psychosis onset. METHODS: A mixed-method design included 12 in-depth qualitative interviews followed by an online survey with responses from 487 psychiatrists. RESULTS: French psychiatrists' reluctance to engage in risk disclosure emerges from a professional norm: a belief in the self-fulfilling prophecy. They - especially those with a background in social science and psychology - believe in the optimistic self-fulfilling prophecy. They fear the consequences of pessimistic predictions, struggle to maintain functional optimism, favor long-term inconspicuous medical watchfulness, and systematically understand favorable outcomes as a consequence of medical care, independent of the accuracy of risk detection.