Casework applications to the treatment of the schizophrenic patient: an analytical review of current concepts and clinical practice

Schizophrenia, the most common of the psychoses, is a challenging subject for the beginning social worker in a psychiatric setting. The purpose of this study, after reviewing the nature and cause of schizophrenia and indicating how it is currently treated in mental hospitals and clinics, is to assess (a) whether casework is an appropriate treatment method for this disorder; and (b) if so, what modification of casework is necessary to meet the schizophrenic person's needs. Schizophrenia is no longer regarded as a purely psychiatric concern. Current treatment aims at reduction of symptoms and improvement in social adjustment of the schizophrenic patient, not "cure" of the underlying pathology. According to modern psychiatry, the central problem in schizophrenia is the social malfunctioning of the patient, and social workers in the community as well as in clinical settings are being called upon with increasing frequency to aid in the treatment of this disorder. As foundation for this study, the orthopsychiatric literature available over the past decade on the psychopathology and treatment of the schizophrenic has been critically reviewed. From this material and from the personal experience of the writer in casework service to hospitalized schizophrenic patients, current concepts on the nature and cause of schizophrenia are defined, and present treatment measures evaluated. Casework as a method for treating schizophrenia is analyzed, and the phases of study, social diagnosis, planning and implementing treatment is applied to the schizophrenic patient's central problems, defense mechanisms, and impaired ego-functioning. "Ego breakdown" in schizophrenia is assessed, and contrasted with the ego-functioning of the normal, neurotic and sociopathic personality types. The conclusions of this study can only be applicable to schizophrenia in general, not to specific cases. Schizophrenia is psychogenic in origin, originating in early childhood when extreme anxiety and insecurity in the child are caused by faulty relationships with the parents, and in particular with the mother. The treatment of choice for schizophrenia is psychotherapy, with adjunctive physical therapies used to reduce symptoms and increase accessibility to personal contact. The supportive treatment method of casework and most of its techniques are eminently suited to treating the schizophrenic patient: the modifying treatment method, clarification, catharsis and interpretation of underlying conflicts, are not. The casework approach to the schizophrenic differs decidedly from that used with clients possessing stronger egos, who can tolerate the anxiety aroused by self-examination. The goals of casework with the schizophrenic patient are support of the constructive parts of the patient's personality, strengthening of his ego-functioning, and maintenance of his psychotic defenses until more constructive defenses are rebuilt. The schizophrenic patient's central problems are his withdrawal from reality due to fear, and his basic mistrust of people. A reality-oriented approach, directed to helping the patient cope more effectively with everyday problems, is used to overcome the schizophrenic patient's distrust and to renew his contact with the real world.Arts, Faculty ofSocial Work, School ofGraduat