Experiences of Schizophrenia : An Integration of the Personal, Scientific, and Therapeutic book cover
1st Edition

Experiences of Schizophrenia
An Integration of the Personal, Scientific, and Therapeutic

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ISBN 9780898629972
Published August 24, 1993 by Guilford Press
511 Pages

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Book Description

In this important new volume, Michael Robbins presents an exploration of schizophrenia unique in both its breadth and depth. His work renders this mysterious condition much more comprehensible, and offers both theoreticians and clinicians of different scientific orientations new possibilities for treatment and interdisciplinary collaboration. The book interweaves an explication of the nature and treatment of schizophrenia, drawn from interlocking perspectives including organic, psychological, interpersonal, familial, and socio-cultural, with five of the most detailed case reports of treatment to be found in the literature.

Part I introduces the work by covering basic definitions of schizophrenia, the hierarchical systems model for mental illness, issues concerning the data presented in the book, and the methodology used to gather information. Representing the extremes in outcome, Part II comprises two extensive case studies: One is the story of an unusually successful treatment; the other is a case that proved to be a multisystem failure. Chapters in Part III synthesize what is known about the disorder from the perspectives of neuroscience, psychology and psychoanalysis, family systems, and society and culture, incorporating Dr. Robbins' original ideas in these areas. The contributions of such factors as constitutional vulnerability are also explored.

Chapters on treatment issues in Part IV cover evaluation and treatment planning from a systems perspective, and review studies of the efficacy of a psychological approach. Technique, process, and the stages of psychotherapy are discussed in detail, as are issues of hospital treatment, pharmacologic and somatic modalities, and family treatment. Part V consists of three complete case studies that are illuminating reading for professionals and students alike. Covering the cases from inception to termination, and spanning the gamut of clinical experience, they include one case that had a positive outcome, one in which the patient seemed to choose to remain ill, and one successful treatment of a chronic schizophrenic. Rounding out the volume is a chapter that summarizes the work and points the way for future research.

This thought-provoking book is basic reading for all human science professionals interested in the study and treatment of mental illness, in philosophical and practical questions about the relationships among the scientific disciplines, or in broad questions about the connections among the individual, the family, and social structure.

Table of Contents

The Groundwork. Introduction. What is Schizophrenia? A Hierarchical Systems Model for Mental Illness. Data and Methodology. Part II: Cases I. The Extremes of Outcome. Case I: Emily: An Unusually Successful Treatment. Case 2: Edward: A Multi-System Failure. Part III: Viewpoints on Schizophrenia: A Pluralistic Model. The Perspective of Neuroscience. Constitutional Vulnerability and an Epigenetic Model. Introduction to a Psychoanalytic Systems Perspective. The Psychology System. The Family System. Society and Culture. Part IV: The Treatment of Schizophrenia. Evaluation and Treatment Planning from a Systems Perspective. Studies of the Efficacy of Psychological Treatment. Psychotherapeutic Technique and Process. The Psychological Perspective: Stages of Therapy. Treatment in the Mental Hospital. Illustrations of Crises in Hospital Treatment and Considerations of Family Treatment. Treatment of the Organism Under Stress. Part V: Cases II. The Middle Range of Outcome. Case 4: Joanna: A Positive Outcome. Case 3: Rachel: The Choice to Remain Ill. Case 5: Celia: Treatment of a Chronic Schizophrenic. Part VI: Conclusion. Systems and Interventions in Schizophrenia: A Reprise. References.

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Michael D. Robbins, M.D., is Assistant Clinical Professor of Psychiatry at Harvard Medical School, and is a psychoanalyst affiliated with the Boston Psychoanalytic Society. He has applied his psychoanalytic knowledge to the understanding and treatment of seriously disturbed persons, both in an office setting and at McLean Hospital, Belmont, MA, where he is currently an Attending Psychiatrist. There he has also been in charge of treatment wards, was Director of Admissions, and has done much teaching and consulting. Dr. Robbins has published extensively in the psychoanalytic literature on the theory and treatment of seriously disturbed persons and on related issues of infant and child development. In 1983, he was awarded the Felix and Helene Deutsch Prize by the Boston Psychoanalytic Society for his paper, "Toward a New Mind Model for the Primitive Personalities."


"In a psychiatric era in which biological reductionism runs rampant, this impressive new volume by Michael Robbins demands attention. With erudition, grace, and sophistication, he reminds us that persons with schizophrenia live out their lives in an internal psychological world that cries out for understanding. Although a psychoanalyst, the author avoids the trap of privileging psychology over biology. With an extraordinary command of the literature and superb scholarship, he compellingly demonstrates the importance of thinking pluralistically about the treatment of schizophrenia. Robbins is one of a handful of clinicians who has devoted his professional career to the intensive psychotherapeutic treatment of severely disturbed patients. This book, the crowning achievement of his life's work, should be read and re-read by all clinicians who work with psychotically disturbed patients." --Glen O. Gabbard, M.D., Medical Director, C. F. Menninger Memorial Hospital

"In this very important and timely work, Michael Robbins offers us the harvest of a long, dedicated, and unusual career in the psychoanalytic treatment of schizophrenic patients. He candidly offers his failures and credibly presents his successes and shows his unusual gift for integrating a psychoanalytic model of understanding and treatment with neurobiological, social, and psychological perspectives. His work constitutes a clarion call to revive interest in an all but lost focus of treatment, and he offers his long, hard-won experience to support his message." --James Grotstein, M.D.

"Dr. Robbins documents his extraordinary experience in this therapeutic realm with engrossing narrative, gripping candor, and eloquent scholarly perspective. The data is timeless and provides an uncommon text for personal or group study in the assessment of psychotherapy's role in the long-term treatment of schizophrenia." --Sheldon Roth, M.D., Harvard Medical School

"At long last, we have a book integrating the perspectives of every relevant discipline about the conundrum of schizophrenia! Michael Robbins writes with passion and clarity; EXPERIENCES OF SCHIZOPHRENIA is destined to be the standard reference of this decade for clinicians ready to do reparative work with patients who suffer from this syndrome. In addition to splendid case reports illustrating a variety of outcomes, Robbins offers a persuasive clinical theory explicating the pathogenesis of schizophrenia, including biological, psychological, and familial determinants. This is essential reading for those of us concerned with developing a comprehensive theory of mental functions." --John E. Gedo, M.D.
...simply the best and most important book on the subject to come to print in decades.
--American Journal of Psychoanalysis, 8/1/1993ƒƒ
...this is a must book for anyone involved in or interested in the treatment of severely ill psychotic patients....For psychiatric residents and psychologists training in a hospital setting, I cannot imagine a better and more thoughtful and informative guide to understanding the complexity of their therapeutic task. For other interested readers, they can anticipate a profound and informative introduction to the world and experience of the schizophrenic.
--Psychoanalytic Books, 8/1/1993ƒƒ
The author does an excellent job describing the complex psychological issues involved in treatment through the use of detailed, insightful accounts of long-term psychotherapies of five persons...I would recommend this book to all mental health providers working with persons with schizophrenia.
--Bulletin of the Menninger Clinic, 8/1/1993