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Book Review   |    
Living With Schizophrenia: An Holistic Approach to Understanding, Preventing, and Recovering From "Negative" Symptoms
William H. Wilson, M.D.
Psychiatric Services 1998; doi:
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by John Watkins; Melbourne, Australia, Hill of Content Publishing Company, 1996, 131 pages, $13.95 softcover

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Negative symptoms of schizophrenia—affective flattening, alogia, avolition, and anhedonia—are often disabling and perplexing. These symptoms result from two sources. Primary negative symptoms are due to the neurobiological disorder that underlies schizophrenia. Secondary negative symptoms are caused by medication side effects, primarily drug-induced parkinsonism, or by psychosocial factors such as demoralization and institutionalization.

This short, humane, person-centered book by an Australian mental health counselor explains these facts in lay terms and provides practical suggestions to help individuals with schizophrenia and their families minimize negative symptoms. Unfortunately, the science and therapeutics presented in this book are frequently ten years behind the times, with the result that general readers may be mislead about some important issues.

The book suggests treatment approaches that are now known to be less than optimal and fails to mention some effective approaches. For example, intermittent antipsychotic medication is recommended for maintenance treatment, without noting the greatly increased relapse rates of targeted treatment compared with continuous antipsychotic maintenance treatment. Clozapine and risperidone are mentioned cautiously, but no mention is made of olanzapine or other atypical antipsychotic medications that may treat primary negative symptoms. Psychosocial programs are noted to ameliorate negative symptoms, but current approaches to psychiatric rehabilitation are not discussed.

At times the book is misleading because it does not present the current state of the art. For example, the author expresses skepticism about the brain pathology of schizophrenia based on computed tomography data from the 1980s and without reference to the wealth of more recent, more sophisticated neuroscientific studies that confirm such pathology. The suggested readings at the end of the book include selections from Arieti and Jung, but no current references to psychiatric rehabilitation or to general reviews of schizophrenia for lay readers.

The book's middle section devotes a page or so to each of 21 "practical strategies for preventing and alleviating `negative' symptoms." Here are the first five: understand the nature and cause of negative symptoms, cultivate hope and positive attitudes, create a safe environment, create a safe and supportive family atmosphere, and learn to appreciate silence. If this section were supplemented by current information on psychopharmacology, it would make a fine starting point for group discussions among families and consumers. The book concludes with some speculative thoughts based on Jungian psychology, which will appeal to some readers and not to others.

I hope that the author will revise this book to bring it up to date, as there is much that is worthwhile in his writing. However, for now general readers should be directed to more current resources.

Dr. Wilson is associate professor of psychiatry at Oregon Health Sciences University in Portland.

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