Toward an integrated treatment of schizophrenia.

Schizophrenia has baffled psychiatrists since its nosological identification by Kraepelin in 1896. In the study of schizophrenia, adherents of biochemical, psychophysiological, and psychological etiologies have vied to exert the primacy of their orientations. Different explanatory levels are not in conflict when a general systems approach is used as suggested by Grinker (I969 and in press). General systems theory may eventually provide the most comprehensive understanding of schizophrenia, but in the meantime, it is necessary to isolate our perspectives and study each of them thoroughly, with integration as our eventual goal. In this report, a psychological perspective will be maintained in deriving treatment principles from schizophrenics who have thus far shown an enduringly good outcome. Although biochemical, neurophysiological, psychophysiological, and other perspectives will not be considered here, their absence does not at all imply that they are less central to understanding the treatment of this grave disorder. In my previous report on a group of 13 young adult schizophrenics (Kayton 1973), good outcome was sustained up to 5.5 years after hospital discharge. "Good outcome" was defined as a decided increase in social and vocational functioning as well as a greatly improved self-appraisal and a marked diminution in the intensity of schizophrenic symptoms. The scale devised by Strauss and Carpenter (1972), which is a measure of social and vocational adjustment as well as frequency of symptoms and rehospitalizations, corroborated the clinical impres-