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Book Reviews   |    
Understanding and Treating Schizophrenia: Contemporary Research, Theory, and Practice
Reviewed by Ann Hackman, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.8.952
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by Glenn D. Shean, Ph.D.; New York, Haworth Clinical Practice Press, 2004, 336 pages, $44.95 softcover

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Understanding and Treating Schizophrenia: Contemporary Research, Theory, and Practice is described in its first paragraph as an effort to present a balanced critical overview of current research and theoretical perspectives on schizophrenia. In the preface, author Glenn D. Shean, Ph.D., compares the effort to describe schizophrenia by using a single modality of analysis to the attempts of the five proverbial blind men who encounter an elephant. Each man gives a description of only part of the elephant, which is correct but quite different from the description given by the others, and none are comprehensive. Dr. Shean, an extensively published research psychologist and professor of psychology at the College of William and Mary in Williamsburg, Virginia, holds that researchers often look at very different portions of the picture of schizophrenia and may describe only small pieces, sometimes providing information that is simply inaccurate. Dr. Shean goes on to say that this book is an effort to summarize the work and ideas of each group involved in the study and treatment of schizophrenia.

Perhaps the topic is simply too big or the goal too lofty, or perhaps part of the problem is that I as a clinical psychiatrist see a somewhat different part of the picture. However, it seemed to me in reading this text that Dr. Shean has fallen into the very trap he describes in his preface. In my reading of the text I found that large areas were covered inadequately or almost not at all. The most significant of these is the pharmacologic treatment of schizophrenia. In a text of more than 300 pages, a scant dozen pages are devoted to antipsychotic medication and neurochemical theories—compared with more than 30 pages on cognitive and behavioral approaches and therapies. The atypical antipsychotics olanzapine, ziprasidone, and quetiapine are mentioned only in a single sentence, where they are described only as having been approved by the Food and Drug Administration. I saw nothing in the text about adjunctive medications or about issues surrounding medication adherence. Clearly Dr. Shean does not see medication as the primary treatment modality for schizophrenia; for example, he cites literature indicating that medications do not facilitate social recovery among persons with schizophrenia. He also notes repeatedly that there is a great deal more to the treatment of schizophrenia than medication. Although this is certainly a valid point, it still seems that pharmacologic treatment of this illness is a mainstay of our approach to schizophrenia and merits more than cursory mention in a text titled Understanding and Treating Schizophrenia. For example, discussion of the recommendations of the Schizophrenia Patient Outcomes Research Team (PORT) might have been helpful.

Other areas that I felt were somewhat neglected include people with schizophrenia who have dual diagnoses, the consumer movement, and the recovery model. (Recovery is mentioned but not thoroughly discussed.) I thought the chapter called "Schizophrenia and the Family" seemed oddly skewed, with its focus on literature addressing the role of the family in the development of schizophrenia.

Despite these criticisms, there is much to recommend about this book. It is well organized and contains useful summaries of each chapter. The first section, on "The development, evolution, epidemiology, and subsyndromes of schizophrenia," provides a very nice historical overview and an excellent discussion of the changes in diagnostic criteria over time; it also addresses the question of exactly what schizophrenia is and whether we are looking at one disorder or more than one. I found the section on psychodynamic theories to be interesting and informative from a historical perspective. Furthermore, Dr. Shean does a wonderful job of describing some of the nonpharmacologic approaches to schizophrenia, with an especially comprehensive chapter on cognitive-behavioral approaches and therapies.

I recommend the book to mental health care providers of various disciplines who are interested in the history of our thinking on schizophrenia and in nonpharmacologic approaches to treatment of the illness. I would not recommend it for most individuals with schizophrenia or their families.

Dr. Hackman is assistant professor of psychiatry, medical director of assertive community treatment, and associate director of psychiatry residency training at the University of Maryland in Baltimore.

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