Comment on the Stage Theory of Schizophrenia

Yes, it is an excellent presentation that emphasizes Stage Phase of “Illness” and need for  conceptualizing “treatment-interventions,” differently, with less emphasis on  the importance of targeting the so called  “positive  symptoms” of schizophrenia and psychosis,  and the importance of having  more emphasis on use of positive psychology, appropriate medication intervention to ensure stabilization of “vegetative functioning,” (without implying life-long dependency),  supportive therapeutic milieu that includes significant-others in client’s life, , including provision for productive day routine and vocational employment support,  and more importantly, a  belief in client’s inner capacity for adaptation, along with ensuring  prevention of  development of life long identification with the “illness-dependent- persona” with the goal of maximizing functional outcome in person’s life stage.  Current medication and psychotherapy models of treatments, in my view, often unwittingly work counter to the latter point expressed here. This is a view we have expressed in my collaboratively written book with Charles Boisvert: Mind Stimulation Therapy: Cognitive Intervention for Persons with Schizophrenia, Routledge, 2013, and in my blog on mind stimulation therapy.


Thanks for sharing your deep and reflective and as usual erudite thoughts and perspective on the issue of Mind-body Brain-Behavior (and Soul, I may add) that have been in the minds of people of all ages and cultures. Some of which I believe fall in the realm of Unknown and Unknowable, or tied to one’s deep seated beliefs and faiths of religious and spiritual nature, or tied to one’s personal or collective search for “existential meanings” of life, not necessarily amenable to a collective rational discourse.  


Comment on Recovery and Role of Positive Mental Health

I have taken a position in my individual and collaborative writings the need to highlight and focus on innate resiliency and capacity for adaptation to different life circumstances that we all face. It is a part of our biological and psycho-social-spiritual evolutionary process to make the best of our present reality of our existence, whatever they may be. Circumstances, situations, individual, and collective approaches may vary and social change and culture and our evolving knowledge base that is available. Adverse life experiences or “Dukkha,” as Buddha would say, is part of our human, or organism’s life experiences, and reflected in our knowledge of nature along with intense awareness of Uncertainty that confront our conscious living existence. No matter how “disabled” a person may present, he or she has the innate capacity for optimal adaptation that is present, and individual and social therapeutic approaches may need to focus how to promote that capacity, with compensatory support services, which may involve a variety of interventions involving biological, psychological, and social approaches of different degree based on client’s own and significant other people’s (involved with client) perceived needs of benefits. No one formula will fit all and needs to be individualized, that is where the challenge for a clinical service provider in engaging in mutually agreed upon strategy with the consumer-client.   

Iatrogenic effects or negative side effect issue are not only associated with a given intervention, biological or psychological, there is also potential for counter-recovery by fostering identification with the “illness dependent persona” that any ongoing “treatment process” entails, as it may take away client’s inner search for his or her best adaptation and sense of “wellbeing.” Too much focus on “what is wrong,” or “what negative experiences that may or may not have happened in one’s past history, may outlast the benefit beyond a point of, promoting one’s perpetual “obsession” with the past neglecting the use of positive redirection and capacity to make the best of one’s present life circumstances.  After all, from a Reality Perspective, the present moment or reality of living experience that we all face, where past is gone, and future is partially can be predicted, but mostly Unknown. I do acknowledge the importance of advocacy for social policy change with emerging new knowledge base for mental health or for any other social situation, as well as need to address personal grievances for what has been done “wrong,” and ensure societal responsibility to protect future “wrong doings,” but it may be important for a practicing clinician to compartmentalize these processes, and focus on what one can do best to promote recovery within one’s discipline identified professional role, whatever they may be. How to promote capacity and engagement in various “positive redirection” activities, some of which are referred by Brian, and build in “compensatory support” (including therapeutic prompt) in the individual’s personal and social life and the “milieu environment” and collaboration with significant others in client’s life will no doubt involve thoughtful reflection and challenge to service clinicians. Approaching one’s role in some defined ways in terms of what is “possible” and what is not, given one’s unique roles and functions, may help to navigate the process to a mutual understanding and satisfaction for client and client service providers. Peer support roles for both clients and clinicians are important component to this process.


To balance the perspective, it would be helpful to cite any studies that may also show positive changes in genetic expressions and epigenetic effects across generations demonstrating “positive” effects of psycho-social and environmental factors, so research can identify what positive psycho-social factors that one should value and foster.  

 The other issue would be demonstration of reversibility of negative effects through psycho-social interventions, as that is also an important focus of interest to many members of ISPS types of organization, who engage in using and advocating for the psycho-social perspective, while “reversibility” research on biological and genetic interventions will be most appealing to people who have identifications with that discipline perspective. 

My sense is that biological and genetic research in some ways mirror physics and astronomy, where knowledge will always be expanding, but will always be limited by the fact that much will remain Unknown and Unknowable, a simile to the assumption that approximately only 4% of known matter in the Universe is knowable, 96% of all in the Universe consists of Dark Matter and Dark Energy and remain invisible to the human mind, and possibly knowable to some extent by limited indirect evidence.  

Nevertheless, it is exciting for the human mind to continuously explore and expand our knowledge base, and our associated conscious ever expanding experience in the process of discovering new intricacies of interrelated connections among physical, biological, psycho-social, and existential-spiritual Realities. 


On Multifaceted Reality: Need to acknowledge subjectivity in experiencing Reality

The Reality is that anything we do or undertake a study has multidimensional reality components, whereby, an event or a behavior can be viewed or studied from various perspectives involving biological, psychological, psycho-social, environmental, spiritual, or any other infinite dimensional factors that one can think of, at both micro or macro levels. (From an existential-spiritual and astronomy perspective, we are all manifestations of One Whole.)  As such, schizophrenia or any other mental illness or “normal or abnormal behavior” have many dimensional perspectives, and use of a given perspective is a function of evolving and changing social and cultural perspectives, often influenced by changing “knowledge base” and public perception of what works and benefits a given person (from both person’s perspective as well as from the care giver or professional helpers’ perspectives). One pursuing psycho-social dimension, as ISPS is dedicated to promote, does not necessarily involve negating other perspectives, or promoting or substituting one “authoritarian-reductionist” model for another.  What is important if one wants to pursue a particular model perspective, is to demonstrate to consumers and public at large, how the specific intervention is helpful, while mindful of potential for any adverse effects or consideration that new information or research may negate any positive effect of an intervention or that a better intervention strategy may evolve to replace or modify the one in existence. Knowledge is multidimensional and fluid, as such, no one discipline or perspective has the monopoly of the “truth.” In spite of all the outward differences, we are all trying to promote what makes the best sense in terms of a clinical intervention, and in this case, as in others, the jury will always be out there to judge the efficacy of an intervention, the perspective of which will also be subject to change with time. 

Advocacy for social policy change and clinical intervention and practice research may operate in parallel processes to provide clarity to one’s current functions and roles in a specific situation, as well as any discussion as to what are considered facts and what are considered opinions. Keeping these perspectives separate, and more importantly acknowledging and respecting differences expressed are important.





Conflicting views on various perspectives from disciplines or advocacies for social change in mental health service

I will make only a series of brief statements to highlight my perspectives:

1. As living beings, we are always influenced by biological, psycho-social and environmental factors, although they may be considered as separate entities in the context of discussion and in highlighting specific influences, but discussing or advocating for one, does not imply negation of existence the value of the others. 

2. Service exchange (providing goods and services, including health care) is a part of human society, whereby people do make “living” that includes “profits” that contributes to one’s living existence.  All of us are actual potential customers to each other’s as long as we live, even when we die (e.g., burial service).

3. In the context of marketing and profit making, services may be provided that may or may not be beneficial, and that goes for all service providers, medical or psycho-social included. Marketing is universal to the process, but it can be “abused.” Research and advocacy are important to counter balance the process.

4. In the context of professional discipline identification of various services, each discipline knowledge based interventions is going through evolutionary process of change with increased knowledge of the efficacy of specific interventions that are also consistent with evolving cultural and social values and expectations.

5. “Idealized perfect societies” do not exist, where all levels of “disabilities” are fully compensated through idealized social structure and bio-medical and environmental interventions, and where we all have the capacity to experience “happy-spiritual bliss” as living human beings (although many believe in such a reality after death).  We all live with “imperfections” and that goes with our current status of “mental health treatment and recovery,” which does not mean we need to be satisfied with it, but work to improve in our individual capacities, while doing what our given roles as service providers are. (And that goes with any vocation that people purse in different fields in life.)  In this context neither medical or psycho-social interventions are all “good ” or “bad,” their efficacy and value are determined by individual choices and socio-cultural perspectives based on existing knowledge but subject to evolving change process.

6. Advocacy of a given perspective is a legitimate pursuit -to make a case on behalf of a given perspective, but when it takes a dogmatic authoritarian stance, it may convince some, but may not have a larger acceptance of audience, and may vitiate its own cause or may promote other “negative effects.” 

7. All kinds of research studies on efficacy, cost-benefit analysis, negative effects of a given intervention are important in our continued enhancement of knowledge and improving our quality of life, and improving particular discipline service provisions. (All the links provided in this Forum is useful to many of us, depending our own interest.)   

8. To advocate and promote a particular discipline perspective, biological or psycho-social perspectives in mental health, one does not need to build its case of efficacy by investing time and effort to tear down and point out deficiencies in other discipline perspectives that are involved in providing services.  

9. Granted the dynamics of evolving knowledge base of any discipline or any human service exchange of information or service goods, we all in our own ways review what we know best, what skills we can use to provide services to others to make a living, and what we do not know, which probably is the larger domain for any discipline or service provider knowledge domain. Yes, our knowledge base and practice of skills will need always in a dynamic mode of change with the emergence of “new information.”  

10. We are all in some ways involved in exchange of services, either as providers or receivers, or both, our practice of doing reflects whatever roles we are assuming at a given time, and often advocacy role for change for one’s discipline service or social perspective or larger social -cultural change- all which are relevant pursuits, need to be dealt separately, and is probably in practice done this way by all. Mixing the two will be problematic in the actual context of clinical or service provider roles that one may be employed in.   

These are just my personal reflections and thought as I was following the discussion thread, and they may be considered vague statements of platitudes, but for whatever their merits, i am taking the liberty to share them.