Entropy of Mind and Negative Entropy
New perspectives for schizophrenia and its therapy that no psychologist, psychiatrist, or psychotherapist can miss!
Schizophrenia is the main issue in psychiatry as far as clinical, psychopathological, rehabilitative and therapeutic aspects are concerned.
If we consider that the incidence of this disorder affects between 0.5% and 1% of the population, without substantial differences in the various areas of the world, we can easily understand how this pathology afflicts millions of people. When we think too how the whole family is affected by the illness, and consequently we consider the enormous costs which it provokes, it is easy to understand how the therapy of schizophrenia is the most important challenge for present-day psychiatry.
Facing such a complex reality, we must admit that we possess a lack of knowledge concerning the dynamics of this disorder and that there is also currently an unsatisfactory therapeutic approach.
I believe we must put aside the myth that the introduction of neuroleptic drugs substantially modified the prognosis of schizophrenia. An exhaustive meta-analysis of many studies done during this century, both in the USA and in northern Europe, recently carried out by Warner and colleagues, led us to the following:
* Recovery rates have not significantly improved after the introduction of neuroleptic drugs.
* The decrease of hospitalization during this century was already noticeable before the introduction of neuroleptic drugs.
Such data can also be found in some evaluations made by contemporary researchers such as Watt and others, and Wing. They believe that the introduction of neuroleptic drugs has not modified the long-term course of schizophrenia. Two studies done by the World Health Organization, entitled "International Pilot Study of Schizophrenia" and "Determinants of Outcome of Severe Mental Disorders" have proven to be paradoxical.
The prognosis of schizophrenia nowadays is more favourable in developing countries, rather than in industrialized ones. We may explain these unexpected results in the sense that the organization of structured (and expensive) relief organizations, and also pharmacological treatment, are not related to the prognosis of schizophrenia. Lower stress, lower competitiveness, patients' social environment, and the higher possibility (for the patient) of maintaining a positive social role, appear to be the most important variables for the course of schizophrenia. Expressed Emotions studies have also clearly shown the family's role in the outcome of schizophrenia.
The therapeutic approach to schizophrenia is open to ulterior evolution. In fact, the pharmacological treatment can only modify the clinical phenomenology of the disorder, but not its course. Neither systemic, nor the cognitive-behavioural approach are capable, today, of giving controlled data on their efficacy. The general indeterminateness of the therapeutic approach is to be attributed to the lack of satisfactory evidence on the etiopathogenesis of such a severe disorder.
During the past ten years, working at the Department of Psychiatry, Medical School, University of Catania, I developed research concerning psychopathology, therapy and rehabilitation for schizophrenia. As a result of this research I developed a complex model for the etiopathogenesis of schizophrenia as follows:
* Vulnerability.
* Development history.
* Life events and clinical outcome.
* Course of disorder and psychosocial factors.
With these different aspects in mind, over those ten years, I developed an integrated approach to therapy of schizophrenia, characterized by a complex and cognitive inspiration.
From a psychotherapeutic and rehabilitative viewpoint, separable one from the other only in theoretical terms, the results of the research are extremely important. The rationale of intervention must not be a simply tactical one of recovery of specific competences, but also strategic one. The tactical construction, at various stages of the treatment, should stimulate a progressive adjustment to self-reflection, the current situation, coping and problem solving, and communicating in a constructive way. It is also necessary to work with the family in a similar way, in order to replace its role of 'stress-carrier' with a new role of adequate support.
We can arrive at this through cognitive rehabilitative psychotherapy. Besides using the cognitive techniques to train the patient to be capable of self-criticism, coping and problem solving, the psychotherapist must act, more than in any other disorder, as a 'secure base'. It will take time before the schizophrenic patient acquires competency in communication and the ability to discuss. The maintaining of the therapeutic relationship will be determined by trust in the therapist, as well as the security and protection felt by the patient through therapy. He or she must experience the therapeutic relationship as a secure base.
We must stress the important role of competence concerning communication: establishing a correct expression of positive or negative feelings, and improving the capacity to ask questions constructively, or listening in an active participating way.
As I have already said, the psychotherapeutic and rehabilitative treatments are part of the same therapeutic project. We need to work with the patient, and the family separately. Because of the seriousness of the problem, associated to the disability it causes, this therapy must be multi-contextual, since it is carried out in the psychotherapy surgery, the patient's house and in various social situations. The rehabilitation therapist works mainly at the patient's house. The rehabilitation work is also done in all those situations that the therapist and his team believe important for therapy.
The shared experience gained in therapy will allow the patient to face all situations he or she has so far avoided, and it will strengthen the feeling of trust and protection they feel toward the therapist. The latter will act as mediator between the patient and the environment, allowing the patient to overcome the narrow behavioural limits determined by the illness.
From this role of privileged observer, the rehabilitation therapist will be able to evaluate emotional resonance caused by new experiences, and will contribute in training the patient to use cognitive abilities. The patient therefore will become independent and well balanced. Subsequently the role of the rehabilitation therapist will then be of maintaining the therapeutic relationship in a mobile setting that may solve the specific difficulties of schizophrenia.
Entropy of Mind and Negative Entropy describes the more complex aspects of, and actual response to, the challenge of schizophrenia. No psychologist, psychiatrist or psychotherapist can afford to miss this book, which presents an up to date perspective of schizophrenia and its therapy.
Schizophrenia is the main issue in psychiatry as far as clinical, psychopathological, rehabilitative and therapeutic aspects are concerned.
If we consider that the incidence of this disorder affects between 0.5% and 1% of the population, without substantial differences in the various areas of the world, we can easily understand how this pathology afflicts millions of people. When we think too how the whole family is affected by the illness, and consequently we consider the enormous costs which it provokes, it is easy to understand how the therapy of schizophrenia is the most important challenge for present-day psychiatry.
Facing such a complex reality, we must admit that we possess a lack of knowledge concerning the dynamics of this disorder and that there is also currently an unsatisfactory therapeutic approach.
I believe we must put aside the myth that the introduction of neuroleptic drugs substantially modified the prognosis of schizophrenia. An exhaustive meta-analysis of many studies done during this century, both in the USA and in northern Europe, recently carried out by Warner and colleagues, led us to the following:
* Recovery rates have not significantly improved after the introduction of neuroleptic drugs.
* The decrease of hospitalization during this century was already noticeable before the introduction of neuroleptic drugs.
Such data can also be found in some evaluations made by contemporary researchers such as Watt and others, and Wing. They believe that the introduction of neuroleptic drugs has not modified the long-term course of schizophrenia. Two studies done by the World Health Organization, entitled "International Pilot Study of Schizophrenia" and "Determinants of Outcome of Severe Mental Disorders" have proven to be paradoxical.
The prognosis of schizophrenia nowadays is more favourable in developing countries, rather than in industrialized ones. We may explain these unexpected results in the sense that the organization of structured (and expensive) relief organizations, and also pharmacological treatment, are not related to the prognosis of schizophrenia. Lower stress, lower competitiveness, patients' social environment, and the higher possibility (for the patient) of maintaining a positive social role, appear to be the most important variables for the course of schizophrenia. Expressed Emotions studies have also clearly shown the family's role in the outcome of schizophrenia.
The therapeutic approach to schizophrenia is open to ulterior evolution. In fact, the pharmacological treatment can only modify the clinical phenomenology of the disorder, but not its course. Neither systemic, nor the cognitive-behavioural approach are capable, today, of giving controlled data on their efficacy. The general indeterminateness of the therapeutic approach is to be attributed to the lack of satisfactory evidence on the etiopathogenesis of such a severe disorder.
During the past ten years, working at the Department of Psychiatry, Medical School, University of Catania, I developed research concerning psychopathology, therapy and rehabilitation for schizophrenia. As a result of this research I developed a complex model for the etiopathogenesis of schizophrenia as follows:
* Vulnerability.
* Development history.
* Life events and clinical outcome.
* Course of disorder and psychosocial factors.
With these different aspects in mind, over those ten years, I developed an integrated approach to therapy of schizophrenia, characterized by a complex and cognitive inspiration.
From a psychotherapeutic and rehabilitative viewpoint, separable one from the other only in theoretical terms, the results of the research are extremely important. The rationale of intervention must not be a simply tactical one of recovery of specific competences, but also strategic one. The tactical construction, at various stages of the treatment, should stimulate a progressive adjustment to self-reflection, the current situation, coping and problem solving, and communicating in a constructive way. It is also necessary to work with the family in a similar way, in order to replace its role of 'stress-carrier' with a new role of adequate support.
We can arrive at this through cognitive rehabilitative psychotherapy. Besides using the cognitive techniques to train the patient to be capable of self-criticism, coping and problem solving, the psychotherapist must act, more than in any other disorder, as a 'secure base'. It will take time before the schizophrenic patient acquires competency in communication and the ability to discuss. The maintaining of the therapeutic relationship will be determined by trust in the therapist, as well as the security and protection felt by the patient through therapy. He or she must experience the therapeutic relationship as a secure base.
We must stress the important role of competence concerning communication: establishing a correct expression of positive or negative feelings, and improving the capacity to ask questions constructively, or listening in an active participating way.
As I have already said, the psychotherapeutic and rehabilitative treatments are part of the same therapeutic project. We need to work with the patient, and the family separately. Because of the seriousness of the problem, associated to the disability it causes, this therapy must be multi-contextual, since it is carried out in the psychotherapy surgery, the patient's house and in various social situations. The rehabilitation therapist works mainly at the patient's house. The rehabilitation work is also done in all those situations that the therapist and his team believe important for therapy.
The shared experience gained in therapy will allow the patient to face all situations he or she has so far avoided, and it will strengthen the feeling of trust and protection they feel toward the therapist. The latter will act as mediator between the patient and the environment, allowing the patient to overcome the narrow behavioural limits determined by the illness.
From this role of privileged observer, the rehabilitation therapist will be able to evaluate emotional resonance caused by new experiences, and will contribute in training the patient to use cognitive abilities. The patient therefore will become independent and well balanced. Subsequently the role of the rehabilitation therapist will then be of maintaining the therapeutic relationship in a mobile setting that may solve the specific difficulties of schizophrenia.
Entropy of Mind and Negative Entropy describes the more complex aspects of, and actual response to, the challenge of schizophrenia. No psychologist, psychiatrist or psychotherapist can afford to miss this book, which presents an up to date perspective of schizophrenia and its therapy.
