Social and Family Factors in the Course of Schizophrenia

Abstract

With the current enthusiasm for biological mechanisms in the understanding and treatment of schizophrenia, a bystander may wonder why there is a clamor for psychotherapeutic approaches to this major psychiatric disorder. After all, doesn’t research on genetics, dopamine, and endorphins promise early breakthroughs in deciphering the pathogenesis of schizophrenia? Haven’t the neuroleptic drugs shown that schizophrenia is a biological illness that should be treated with somatic methods? Hasn’t the value of psychotherapy—whether conducted by seasoned analysts, enthusiastic residents, or optimistic social workers—been shown to be limited, at best, for the great proportion of individuals suffering from schizophrenia? Although these questions may seem naive, dead and buried to those who are committed, through training and experience, to a psychotherapeutic approach with schizophrenic patients, they are very much alive in the minds of many rank-and-file psychiatrists, residents-in-training, and health planners, who are the architects of our future national medical insurance programs. Thus, it is important to address the rationale for psychosocial treatment in schizophrenia, and to offer a clear and convincing strategy for its clinical use.

Research Supported by NIMH Grant No. MH 30911 awarded by the Clinical Research Branch. The authors are grateful for the support of NIMH staff: Morris Parloff, Hussain Tuma, Loren Mosher, Samuel Keith, and Joseph Autry III.