Introduction to Mini-Series on Schizophrenia

Extract

It is fitting that the first mini-series issue of Behaviour Change should be devoted to an exposition of current cognitive-behavioural treatments for various aspects of schizophrenia. The disorder has a surprisingly high incidence in the population. Approximately 1 in 100 people will develop schizophrenia during the course of their life-time (Cancro, 1980). Arieti (1981) observes that more hospital beds are occupied by individuals suffering from schizophrenia than from any other psychiatric or medical problem, including cancer or cardiovascular disease.

The introduction of the phenothiazines in the 1950s resulted in dramatic increases in hospital discharges for schizophrenic patients but did little to change the “revolving-door” phenomenon. This chronic relapsing population is characterized as “the patient's having been admitted to an inpatient mental health facility several times and/or having been hospitalized for a period of at least a year on a single admission,” as well as possessing “a number of deficits in adaptive behavior” (Matson, 1980, p. 169). Indeed, whilst the schizophrenic individual's most florid symptoms e.g. delusions, hallucinations and thought disorder, may be well controlled on even minimal dosages of the neuroleptics (generally leading to that person's discharge from hospital), other social and self-care deficits may remain prominent reminders of the patient's difficulties in everyday living.

The chronic schizophrenic patient's deficits are characterized by an ambivalent relationship with the outside world. On the one hand he displays a lack of willingness or ability to interact appropriately with other people, and on the other hand, he depends on significant others such as a parent, other relative, or even a health professional. Despite this, he has a poor social network. He has reduced expectations of himself, is unable to effectively problem-solve, and his lifestyle reflects a desire to have an uneventful existence, free from harrassment. He becomes alienated from society, and may be unable to seek and gain employment, live independently, or manage routine responsibilities, e.g. financial budgeting.