Schizophrenia: Treatment, Process and Outcome, by Thomas H. McGlashan, MD, and Christopher J. Keats, MD. (Arlington, VA: American Psychiatric Press, 1989.)

Book review by Rob Couteau

 

 

 

 

Published in: The Bloomsbury Review, March / April 1990 (CO: Denver)


Intrigued by the often-mysterious causes of remission in the schizophrenic process, the authors of this study turned to an extensive archive of psychoanalytic case histories compiled at the Chestnut Lodge Hospital in Rockville, Maryland. Isolating cases with a particularly positive or negative treatment outcome and then reexamining them with a special focus on the interpersonal processes (particularly those between the patient and the doctor), the researchers hoped to proceed from individual case histories to arrive at a theory of what patterns are likely to emerge in a successful or unsuccessful treatment.

With this purpose in mind, four case histories are presented in a clear, accessible style, with subsequent chapters using narrative material to explore the parameters of the schizophrenic experience. Finally, the authors describe a series of stages, including engagement, attachment, communication, fortification, and integration, each paralleling a stage in the patients' "relationship complexity," "maturation level," and "predicted long-term outcome."

Although the authors acknowledge a bias toward a medical and psychoanalytic orientation, a broader philosophical bias colors this study. For instance, one patient's interest in meditation, which appears to provide a positive, stabilizing influence, is termed "a narcissistic preoccupation." Similarly, the patient's discussion of poetry, reincarnation, and philosophy is characterized as "an effort to rationalize his difficulties." Other value judgments, regarding the manner in which one adjusts to society and assumes various roles, exemplify similar therapeutic biases.

While those working with a medical or psychoanalytic orientation may find this study of interest, one would hope their views would remain adequately open to meet the needs of the schizophrenic patient, who, above all, needs to be heard more and judged and categorized far less.


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