Understanding the relations between psychosis and urban milieus: an experience-based approach

Requérant: Prof. O. Söderström, Institut de Géographie, Université de Neuchâtel
Co-requérant : Prof. Philippe Conus, Dir. Dépt de Psychiatrie, Université de Lausanne, CHUV.
Collaborations Internationales :
·         Prof. Jim van Os, Dept of Psychiatry and Psychology, Maastricht University.
·         Prof. Chris Philo and Dr. Hester Parr, Dept of Geography, University of Glasgow
Durée : 3 ans dès juin 2014
Budget : 407'000 CHF
Financement : FNS, Commission interdisciplinaire


This research aims to better understand the relationship between the urban milieu and psychosis. There is general agreement among the scientific community that the aetiology of psychotic disorders is multi-factorial, resulting from the interaction between constitutional (genetic, biological, psychological) factors of vulnerability and external stressors. Among the latter, living in an urban milieu has been identified as a potential risk factor since the first half of the 20th century. However, despite recent renewed interest in environmental aspects of psychosis, the mechanisms involved are still very unclear and various facets of the problem have not yet been addressed. In particular, there are no studies in psychiatry analysing how different factors of stress related to an urban milieu combine in patients’ everyday lives. 

Building on work conducted since the 1980’s in human geography on patients' experience of the city, we propose that understanding the mechanisms relating city environments and psychosis requires a change in scale and perspective with regards to classic epidemiological approaches. Thus, the general hypothesis on which this research is based is that an analysis of young patients’ residential biographies and experience of urban space will provide important elements and generate new hypotheses to advance the understanding of how urban milieus influence the emergence of psychosis.
The research aims to provide an answer to the following research question:
How, when and where is a sense of stress or protection occasioned in young psychotic patients’ experience of urban milieus?
The analytical frame of the research is organised around five concepts: 1. identity categorisation; 2. exclusion/inclusion; 3. social norms; 4. built environment and 5. mobility. The first three define social interaction in the city, the last two focus on specific spatial features of the experience of the city. Methodologically, the research uses mixed methods: a survey; narrative and semi-structured interviews; a focus group; and video recordings of urban practices.
Empirically, it is based on a patient cohort and their care workers involved in the Treatment and Early Intervention in Psychosis Program (TIPP), a clinical and research program focusing on the early phase of psychotic disorders at the Department of Psychiatry in Lausanne which has involved 400 patients since 2004.
The interdisciplinary research framework developed in this research, combining psychiatry and human geography, brings about the change of scale and perspective necessary to advance knowledge on the city/psychosis nexus.
In terms of its broader impact, the research will provide new orientations for urban planning, for therapeutic strategies in psychiatry and for the spatial organisation of mental health care.
Keywords: human geography, psychiatry, psychosis, urban milieu, mixed methods, biography