The main goal of this class are to gain an introductory exposure to the nature of the psychiatric disorder known as schizophrenia as revealed by the scientific method. We will discuss a broad range of findings from the scientific investigation of biological and psychological factors related to schizophrenia and its treatment. More specifically we will learn about: (1) key symptomatic features through discussion and enactments of interviews with actors portraying many of the cardinal features of the illness, (2) what brain imaging studies (MRI and fMRI) and neurochemistry have taught us about the neuroscience of the disorder, (3) scientific psychological data and theories concerning cognition, emotion and behavior in schizophrenia, and (4) current, evidence-based somatic and psychosocial approaches to treatment. A brief historical overview of the recent emergence of the psychiatric category of schizophrenia will be presented as well.
The Recovery Movement
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Schizophrenia
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Intervention
In the fifth module we discuss approaches to treatment with a focus on both pharmacologic and psychosocial approaches.
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Matt KurtzProfessor
Psychology and Neuroscience and Behavior
In this section of the course,
we're going to be talking about
psychological and psycho-social treatments
for people with the diagnosis of schizophrenia.
We've already talked a bit about the biological basis of the disorder,
the use of anti-psychotic medications that block dopamine receptors,
and their role in reducing positive symptoms, the disorder.
But what I want to talk about today,
is just how do we address the psycho-social disability,
which is so characteristic of the disorder.
More specifically, there was actually
a study done by the World Health Organization in 2001,
which, in a study of 14 countries around the world,
found that the disability that's associated with psychosis,
is actually ranked as
the third most disabling condition in the world based on the survey of 14 countries.
In fact, the disability,
psycho-social disability associated with schizophrenia,
was higher than both blindness and paraplegia.
Given also, as we've discussed,
that the prevalence rates,
certainly in North America at least,
range from somewhere between half a percent to a percent of the population,
the estimated cost to the society in the U.S. is now
$19 billion in direct costs associated with the psycho-social disability.
When we say direct costs,
we're talking about things like direct medical care.
And there's actually indications that $46 billion is lost every year in indirect costs.
So that would include the loss of lifetime career, lifetime, you know,
access to wages associated with competitive employment that
people with schizophrenia so often have difficulty maintaining.
So, given this huge cost to society,
given the profoundness of the disability that we've talked about,
and given the fact that the anti-psychotic medications,
although often quite effective at reducing the number and intensity of positive symptoms,
strictly delusions and hallucinations,
are really largely or only modestly effective at dealing
with the psycho-social disability that's associated with schizophrenia.
So for these reasons, there's a real need to develop
new treatments to address the psycho-social disabilities that these clients,
who may be taking their medication,
may have reduced their positive symptoms are left with.
These disruptions in social interaction,
disruptions in the ability to sort of maintain competitive employment,
disruptions in the ability to participate in community activities.
All of these different sort of aspects of
psycho-social function which are disrupted in schizophrenia,
we clearly need new treatments to try and address these disabilities.
The good news is that,
in the past 20 years,
there's been really an explosion in
the number and study of new psycho-social interventions,
designed to address these very difficulties in social interaction,
in work, and participating in one's sort of general community.
Work toward psycho-social interventions can be traced
back to the very beginning of the recovery movement.
And when we talk about the recovery movement,
we talk about a movement that is often driven by consumers of mental health services.
And it is a movement that's designed to place the client
who's receiving the services more at the center of psychiatric care.
This movement can be traced back to the writings
of Clifford Beers in the early 20th century.
He wrote a wonderful book called 'A Mind that Found Itself'.
And, in that book which he recounted his life as
a businessman and then his struggles with psychiatric illness,
his hospitalization in several psychiatric hospitals,
and then his subsequent recovery.
Clifford Beer's book had a very large effect, or a large impact,
on the way we think about treatment for people with schizophrenia.
His work, in many ways,
led to what's been called the Mental Health Hygiene Movement,
the 1960s in the 1970s,
where there's a real focus on sort of prevention of psychiatric illness.
And, this recovery model that emerged with this mental hygiene movement
and Clifford Beers and other folk's influence earlier in the 20th century,
the recovery movement is really focused on
self-determination as a key aspect of treatment, right?
That the person receiving the services,
the consumer of these psychiatric services,
play a very important role in sort of determining those services.
The idea is that psychiatric treatment is a collaborative endeavor, right,
in which the individual plays a key role in deciding what the key goals of treatment are.
And, the recovery movement also emphasizes process rather than target,
rather than the idea of necessarily getting that competitive job immediately,
rather focusing on the process towards it, right?
How do we enhance, sort of the experience of moving towards
a goal of independent employment?
It's also targeted at expanding the sense of self that people have,
who received these services,
beyond being simply a consumer model of treatment.
That is to say, developing a sense of self that has purpose,
that takes one out of the role of being a psychiatric client,
and moves them into sort of broader society.
In this model, this recovery model,
the idea is that the onset of
psychiatric illness may be a catastrophe in the person's life.
It often is and often is for the family.
But, the idea of integrating that experience of catastrophe into
sort of a larger life narrative that includes working,
relationships with others, where being the role of
the consumer mental health services just plays a much smaller part of the global,
sort of everyday life,
that the person is engaged with.
This model, this recovery model,
places hope as a very important sort of goal of treatment,
instilling hope, destigmatization, right,
removing the stigma that's so commonly associated
with a particularly severe psychiatric illnesses just like schizophrenia,
and empowering the individual to
really be involved in sort of deciding what their life goals are.
This is very different from the sort of traditional psychiatric model of treatment,
which in the past has,
at times at least,
been characterized by a hierarchical structure in which the physician
is sort of directing the patient as to what
exactly they need to do in generally all cases.
And, it moves away from a model of psychiatric treatment
that is focused on stabilizing the patient only, right?
So just stabilizing the psychiatric symptoms that a client may have and not being
so concerned about what happens with the client
after this stabilization of those symptoms.
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