An Important Lesson

Schizophrenia—a bizarre and frightening disorder—was studied intensively throughout the twentieth century. Only since the discovery of antipsychotic drugs, however, have clinicians acquired any practical insight into its causes. As they do with most other psychological disorders, clinical theorists now believe that schizophrenia is probably caused by a combination of factors, though researchers have been far more successful in identifying the biological influences than the psychological and sociocultural ones. While biological investigations have closed in on specific genes, abnormalities in brain biochemistry and structure, and even viral infections, most of the psychological and sociocultural research has been able to cite only general factors, such as the roles of family conflict and diagnostic labeling. Clearly, researchers must identify psychological and sociocultural factors with greater precision if we are to gain a full understanding of schizophrenia.

The treatment picture for schizophrenia and other severe mental disorders has greatly improved in recent decades. After years of frustration and failure, clinicians now have an arsenal of weapons to use against these disorders—medication, institutional programs, psychotherapy, and community programs. It has become clear that antipsychotic medications open the door for recovery, but in most cases other kinds of treatment are also needed to help the recovery process along. The various approaches must be combined in a way that meets each individual’s specific needs.

Working with schizophrenia and other severe disorders has taught therapists an important lesson: no matter how compelling the evidence for biological causation may be, a strictly biological approach to the treatment of psychological disorders is a mistake more often than not. Largely on the basis of pharmacological advances, hundreds of thousands of patients with schizophrenia and other severe mental disorders were released to their communities beginning in the 1960s. Little attention was paid to their psychological and sociocultural needs, and many have been trapped in their pathology ever since. Clinicians must remember this lesson, especially in today’s climate, when managed care and government priorities often promote medication as the sole treatment for psychological problems.

When pioneering clinical researcher Emil Kraepelin described schizophrenia at the end of the nineteenth century, he estimated that only 13 percent of its victims ever improved. Today, even with shortages in community care, many more such people—at least three times as many—show improvement (Pinna et al., 2014). Certainly the clinical field has advanced considerably since Kraepelin’s day, but it still has far to go. Studies suggest that the recovery rates—both partial and full—could be considerably higher (Zipursky, 2014). It is unacceptable that so many people with this and other severe mental disorders receive few or none of the effective community interventions that have been developed, worse still that tens of thousands have become homeless or prison inmates. It is now up to clinicians, along with public officials, to address the needs of all people with schizophrenia and other severe disorders.