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Letter to the Editor   |    
Towards a Comprehensive Therapy for Schizophrenia
Mark R. Munetz, M.D.
Psychiatric Services 1998; doi:
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edited by Hans D. Brenner, Wolfgang Böker, and Ruth Genner; Seattle, Hogrefe & Huber Publishers, 1997, 283 pages, $49

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Towards a Comprehensive Therapy of Schizophrenia presents the written versions of papers from the Fourth International Schizophrenia Symposium held in Bern, Switzerland, in September 1993. As such it has all the strengths and weaknesses of a somewhat dated, multiauthor work. On the strengths side are its array of internationally prominent contributors from Switzerland, Germany, and the United States and its broad biopsychosocial focus. It reviews psychosocial treatment approaches to schizophrenia that are apparently well known in German-speaking countries but are likely to be less familiar to the English-reading audience of this edition. On the weaknesses side is a marked variability in the readability and depth of the different sections and specific chapters.

After an introductory section that includes two chapters relating chaos theory to schizophrenia, the subsequent four sections each focus on a different aspect of intervention related to a stress-vulnerability-coping-competence model for schizophrenia. Sections address biologic vulnerability, cognitive vulnerability, stressors and social supports, and coping strategies aimed at relapse prevention.

The most successful chapters are those that summarize the state of knowledge in a particular area and then raise, and begin to answer, the key research questions remaining to be addressed. Chapters by Green and associates on cognitive remediation, Bellack on social skills training, and Test and associates on Wisconsin's Program of Assertive Community Treatment all do so quite successfully.

Chapters that are less successful describe more narrow areas of research and are either too obscure for the general reader or too limited in scope to be helpful as a state-of-the-art review. Most disappointing along these lines are the two chapters in the biologic-vulnerability section that focus on experience with risperidone.

The final two chapters of the book remind the reader of the humanity of people with schizophrenia. The chapter by John Strauss entitled “Processes of Healing and the Nature of Schizophrenia” is a moving reminder to us all that we are working in a human science. As we move toward a model that emphasizes recovery from serious mental illness, Strauss helps us understand how such improvement may come about. Having spent extensive time with patients who have substantially improved, Strauss notes first that all of these patients talk about, in essence, a “reintegration of the self,” a “sense of finding who one is,” and in some way resolving conflicting goals and values. Second, he observes the importance of relationships in the recovery process. He points out the disturbing reality that patients “testify to how crucial—and how rare—it is to find someone, especially a doctor, who took me seriously.”

Although this is not a book I found easy to read from cover to cover, Strauss' chapter, along with several excellent overviews of effective, complementary psychosocial interventions for schizophrenia, does make it a worthwhile reference for the researcher or clinician interested in a comprehensive approach to the treatment of schizophrenia.

Dr. Munetz is chief clinical officer for the Summit County (Ohio) Alcohol, Drug Addiction, and Mental Health Services Board in Cuyahoga Falls and associate professor of psychiatry at the Northeastern Ohio Universities College of Medicine.




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