Understanding and Treating Schizophrenia

Schizophrenia is a devastating, complex disorder that has generated a vast and complicated body of literature. Understanding and Treating Schizophrenia undertakes an explanation of the history of the understanding of schizophrenia, as well as the variety of theories that have attempted to explain what causes it. The author also reviews the literature on various treatments for schizophrenia and provides a discussion of the community needs of individuals with this diagnosis. All of these are presented in a highly balanced, scholarly manner and are clearly filtered through the mind of a clinician with a deep compassion for the severely mentally ill. The combination results in an immediately engaging and deeply absorbing reading experience.

The first section of the book reviews the history of the concept of schizophrenia, including historical changes to the diagnostic criteria and a review of symptom categories, epidemiology, course, and outcome. While much of this material may be familiar to experienced clinicians, Dr. Shean provides a fascinating and thorough account of early attempts to make sense of mental illness and provides a smooth timeline to our present-day understanding of schizophrenia. Of particular interest in the first section of the book is the discussion of language and thought symptoms in Chapter 4, which underlines the widely varying presentations of schizophrenia and provides a particularly insightful and empathic look into the experience of delusions.

In Section II, Dr. Shean presents the diathesis-stress model for vulnerability to schizophrenia and looks at general systems theory. His discussion of the multilayered and interacting determinants that may affect mental illness is an excellent springboard to Sections III, IV, and V, in which he presents a wide-ranging group of perspectives on schizophrenia, including biological, cognitive-behavioral, neurocognitive, psychodynamic, phenomenological, and family-based theories. Beginning with biological views, Dr. Shean provides an even-handed and meticulously documented look at the many theories set forth to explain and prescribe treatment for schizophrenia. Despite the complexity of the subject matter, his accessible and elegant writing style keep the material seamless and readily understandable. The advantages and flaws of each theory are given equal time, and there is no ultimate judgment rendered by the author: this is left to the reader.

The final section of the book is devoted to describing several groundbreaking community programs for individuals with schizophrenia and to discussing the importance of careful community reintegration after hospitalization. Of particular interest is a discussion of international variations in the number of schizophrenic patients who are able to return to work. In some Italian communities, for example, 50 to 60 percent of schizophrenic patients are able to return to at least part-time work, while this number is closer to 15 percent in the United States. Dr. Shean elucidates some of the disincentives for former psychiatric patients to seek work in this country, contrasts the lack of work programs here with several European programs for the mentally ill, and stresses the importance of work in recovery from schizophrenia. For the first time, his balanced tone approaches subtle advocacy, and his carefully constructed arguments are highly persuasive.

Although teeming with information, this well-organized book reins in a daunting subject and makes it accessible to a wide variety of readers. It is an essential one-stop reference for clinicians who work with individuals diagnosed with schizophrenia, and it is an equally excellent introduction to the subject for graduate students or advanced undergraduates. For forensic clinicians and legal practitioners, this volume provides a very manageable look at the enormous and wide-ranging literature on schizophrenia, even if one is approaching the subject seriously for the very first time.

While the book is thorough, well documented, and highly readable, its particular value lies in the equal emphasis it places on the views of the scholar and the practitioner. The author is accomplished in both realms, and the book is steeped in a depth of understanding that is unmatched by other similar undertakings.

• American Academy of Psychiatry and the Law