Behavioral therapies and the treatment of schizophrenics.

. . . Mr. C, diagnosed as brain-damaged and schizophrenic . . . gradually became more and more unmanageable . . . continually disrupting ward routine, both by provoking other patients and by directly plaguing the staff with demands. Mr. C's rehabilitation and psychotherapy were retarded because of his direct lack of motivation as well as the staff's unwillingness to have anything to do with him. The problem . . . was to help the staff better manage Mr. C so that he could spend more of his time and energy in therapeutic endeavors—and so that the staff would be less anxious when dealing with him and therefore more willing to work with him. The first step was to get an accurate and specific understanding of just what types of behavior Mr. C was engaging in and to determine how the staff was reacting.. . . Mr. C's most obnoxious behaviors were: urinating and defecating on the floor; shouting; swearing; upsetting other patients and the staff; namecalling; constantly begging cigarettes from patients and staff; demanding other things, like having staff tie his shoes; striking at other patients. It also seemed evident that Mr. C's inappropriate conduct usually was followed by some kind of staff attention Two procedures for eliminating Mr. C's disruptive behavior were discussed with s ta f f . . . . Social attention would no longer be given Mr. C following inappropriate behavior . . . . Social attention and cigarettes . . . can . . . be the consequence of socially acceptable behavior. This would be done by presenting Mr. C with a tangible reward for every fifteen minutes he acted appropriately. . . . a 3"x5" file card, the message upon which communicated that Mr. C has been acting appropriately, that he has not bothered, pestered, or annoyed the staff or other patients, and that two cards could be turned in for two ciga-