Revisiting myths about schizophrenia with implications for treatment.(myth busters)

In 1994, Dr. Courtenay Harding and colleagues published a paper entitled "Empirical correction of seven myths about schizophrenia with implications for treatment" in Acta Psychiatrica Scandinavica. It presented evidence to challenge myths about schizophrenia that persist across mental health disciplines and that stand in the way of effective treatment and recovery. Fifteen years later, CrossCurrents summarizes these myths so you can reflect on what has changed--and what hasn't.

Myth: Once a schizophrenic always a schizophrenic.

Fact: This myth reflects the "clinician's illusion," in which clinicians may repeatedly see the few most severely ill in their caseloads as "typical" when in fact, these individuals represent a small proportion of the actual spectrum. Recent studies have investigated the assumption of downward course and have found wide heterogeneity in the very long-term outcome. These studies have consistently found that half to two-thirds of individuals significantly improved or recovered, including some chronic cases.

Myth: A schizophrenic is a schizophrenic is a schizophrenic.

Fact: There is a lot of variation within the diagnostic category. There is a tendency in the field to lump everyone with the same diagnosis together for treatment and research. In reality, every group of individuals has substantial heterogeneity. In addition to the major impact of gender, there are considerable differences in age, developmental tasks, education levels, job histories, symptom presentation, coping skills, personal strengths and weaknesses, meaning systems, response to stress in general and to stress of particular situations. Schizophrenia is itself heterogeneous, which Swiss psychiatrist Eugene Bleuler recognized in renaming dementia praecox (meaning a premature deterioration of the brain) as "the group of schizophrenias." This heterogeneity requires a comprehensive, biopsychosocial assessment of each client's unique status, the place in his or her own course trajectory and ecological niche. Individual differences require individualized treatment planning, appreciation of developmental achievements and goals and recognition of the "person behind the disorder."

Myth: Rehabilitation can be provided only after stabilization.

Fact: Rehabilitation should begin on day 1. "Real treatment" in today's managed care climate consists of assessment, diagnosis and medication. Anything else, such as rehabilitation, often must wait until stabilization and is often considered an ancillary service. However, stabilization usually leads merely to "maintenance," not rehabilitation. "Real treatment" has been only modestly successful in reducing symptoms, and in helping the client by increasing the levels of functioning in serf-care, work, interpersonal relationships and community reintegration. The burgeoning field of psychiatric rehabilitation combines with medical treatment to significantly improve the client's level of functioning.