Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 285Cognitive therapy, it appears, is also effective for patients in an episode of acutepsychosis, speeding up the resolution of positive symptoms. Patients in inpatienttreatment for acute psychotic illness, in Birmingham, England, were providedwith individual and group cognitive therapy during the hospital stay. Theindividual treatment gently challenged and tested key delusional beliefs. In thegroup therapy, group members offered alternative explanations for the irrationalbeliefs of others, challenged negative beliefs about psychotic illness, and bolsteredone another’s attempts to integrate the concept of illness into their lives and todevelop new coping strategies. Other cognitive procedures were family sessions toenlist family support in the patient’s attempts to manage his or her symptoms, andan activity program aimed at improving interpersonal and self-care skills. Positivesymptoms decreased faster and dropped to a lower level of severity in patientswho received cognitive therapy than in a control group receiving non-specifictherapist support and structured activities. 43 The evidence is getting stronger thatthe treatment of schizophrenia should include cognitive-behavioral therapy andefforts to enhance the self-esteem and coping strategies of the person with theillness.FAMILY THERAPYAlthough family therapy can be as effective in the treatment of schizophrenia asthe antipsychotic drugs, it is often neglected. It must be made clear that familytherapy, here, does not mean efforts to uncover the root cause of the psychosis infamily dynamics. As indicated in Chapter 1, there is little evidence to suggest thatfamily pathology contributes to the development of schizophrenia. The successfulfamily therapy programs, rather, have concentrated on the influence of the familyenvironment on the course of the condition, and have relied heavily upon practicalsupport and education as the essential ingredients.In Chapter 10, the research conducted by Julian Leff and his associates inLondon on the family environment of people with schizophrenia was reviewed insome detail. These researchers have shown that people with schizophrenia whoreturn to a home in which their relatives are critical and over-involved have ahigher relapse rate than those who return to a low-stress home. The greater theproportion of time the patient spends with high-stress relatives, the greater therisk of relapse. Since this early British research was conducted, dozens of similarstudies have been carried out in several countries around the world, nearly all ofthem confirming the original findings. If the results of these studies are pooled sothat hundreds of cases are included we see that the overall rate of relapse in thecritical and over-involved families is more than twice the rate in the familieswithout these features—50 per cent versus 23 per cent at the end of a year. 44Studies of family therapy for people with high-relapse schizophrenia (who aretaking medication), using random assignment of cases to therapy or to a controlgroup, show a marked degree of benefit for family treatment. In the controlgroups relapse rates are as high as might be expected for high-risk cases who are