Personal versus Medical Meanings in Breakdown, Treatment and Recovery from 'Schizophrenia'

Abstract

This chapter explores some implications of psychotherapy, psychoanalysis and counselling for the treatment of 'schizophrenia'. It is argued that its mainstream treatment is dominated by a medical model, modernist discourse, in which psychiatric and psychological aims have become merged in a psychotherapeutic treatment that is focused on symptom management. These aims have been endorsed by the National Institute for Health and Care Excellence's (NICE) (2014) guidelines for the treatment of 'schizophrenia', despite, by their own measures, yielding a low rate of success. In his heuristic (Moustakas 1990) doctoral research which explored first-hand experiences of 'schizophrenia' and psychotherapy, Cotton (2014) found that personal meaning - both the loss of and the restoration of - was central to the participants' understanding of their 'schizophrenic' breakdown and subsequent recovery. In speaking about what was both helpful and unhelpful about their experiences of treatment, all participants found that psychotherapy that focused on symptom management was an obstacle to restoring personal meaning, and therefore, unwittingly, an obstacle to recovery. The types of psychotherapy that were most likely to adopt this therapy-assymptom- management approach tended to be non-critical and nonreflective, and they emphasised technique and theory over relationship and critical thinking. It is argued that a psychotherapy that can maintain critical qualities may be one way of addressing this gap, and facilitating a way of working more closely with the needs of those with the diagnosis, rather than the needs of those giving the diagnosis.