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IN focusing principally on interesting new developments in the psychosocial treatment of schizophrenia, this paper may prove a rather stressful experience for the reader & stressful because it involves change, and change is never easy to tolerate.
I should like to begin by considering the magnitude of the schizophrenic problem. In 1968, there were approximately 320,000 single episodes of this disorder treated in some public facility (including general hospitals and outpatient clinics). If we consider that the number of schizophrenic patients resident in State hospitals across the country has declined by about 30 percent in the last 15 years, this statistic may not seem alarming. At first glance, it might even appear that we are doing quite a good job in treating schizophrenic patients. But if we look at schizophrenic patients who have been discharged from a psychiatric facility after one psychotic episode, we must also ask what their chances are of returning to the hospital within two years. Unfortunately, at present, their chances are about 50-50; that is, about half of them will return to the hospital within two years of initial discharge. This trend, often called “the revolving door policy,” is an unhappy comment on our present-day treatment of schizophrenia. Not only are we at a loss to explain the high relapse rate among apparently “recovered” schizohprenics but what has made possible their leaving the hospital in the first place is also quite unclear. In a study done by Philip May1 in a State hospital, 92 percent of patients receiving drugs plus psychotherapy (delivered by residents) were discharged within a year of their admission, whereas only 60 percent of those who received milieu therapy but no drugs left the hospital within the same period. (It is interesting to note that both these figures are substantially higher than the “spontaneous remission” rate of roughly 33 percent.) Clearly, May's study leaves many questions unanswered and, moreover, the subject