What we have here, on the whole, is a series of essays and monologues which invite the reader to focus on the success and importance of psychosocial treatments. There are individual chapters on phase-specific treatment, which go some way to addressing whether early needs-adapted treatment can prevent the long-term effects of psychosis. But what is also contained in this interesting and challenging book broadens its scope considerably.
We learn, for example, about the post-Lancanian view, ideas rarely taught in current times except to dismiss them as an old-fashioned blame of the schizophrenogenic mother. In a fascinating chapter Van Eecke argues, among other ideas, for an increased emphasis on the role of the father. This is about as far removed from the neurobiological basis of psychosis as it is possible to be. Yet, if you persevere, there is considerable sense in what is presented here. Most contributors argue for an increase in the psychological and psychodynamic as a way of understanding our patients and enabling clinicians to engage individuals with treatments in addition to medication. Ideas such as ‘the therapeutic work to be undertaken is to help and support the patient’ will receive universal agreement but are not always easy to use in practice when balancing our combined roles of risk managers and treatment providers.
There are further controversial ideas in the final chapter. Most people within the early intervention field will be familiar with the debate on the emphasis and frequency of childhood trauma and abuse as risk factors for psychosis, and the arguments are dissected in detail here. However, on closer reading there is also balance. Read & Hammerley agree that ‘it is not just child sexual abuse’ but also poverty, urbanicity, belonging to a minority ethnic group, etc. that clearly play a causal role in the development of schizophrenia.
So perhaps this text is not as controversial as it is reported to be, but it will provoke thought and debate and I think that is the underlying aim. We should, perhaps, all break away from taught, firmly held views and at times dare to think about schizophrenia from another angle, as a way to balance, hold and integrate ideas as we reach for the prescription pad. The nature v. nurture debate has moved on considerably in recent years but perhaps still has some way to go.
This book challenges the reader to think again about preconceptions of psychotic illness and as such would appeal to those working with such patients. Indeed, the first step in both psychological and biological treatments is to establish a relationship through which effective treatment can be delivered, and ideas presented here can aid this by increasing our understanding.
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