"You have to believe in something": Risk of psychosis and psychiatrists' beliefs in the self-fulfilling prophecy

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.

Keywords: France; Medical practices; Prediction; Prognosis; Psychiatry; Psychosis risk; Risk disclosure; Self-fulfilling prophecy.