Need for comprehensive research approach to the treatment of schizophrenia

Schizophrenia treatment and research is hampered by a lack of integration of different conceptions as to the nature of the illness. Researchers have specialized in different fields, and even clinicians too often are restricted to a relatively narrow therapeutic orientation, with little knowledge of other approaches. We should, in my view, recognize the multidimensional nature of our task and aim at the further development of the treatment of schizophrenia; our approach should be integrated, but at the same time differentiated according to the individual case. I therefore consider it necessary to approach my own subject, research on family therapy, from a comprehensive viewpoint. The most important concepts of schizophrenia, and the treatment modes connected with them, are shown simplified in Fig. 1.

There is no need to consider in greater detail here the aetiological theories underlying these orientations. Instead I want to stress that each of these therapeutic approaches can be justified on the basis of research data; it has its own importance as a therapy, and its own limitations as well. Schizophrenic patients form a heterogeneous group in which therapeutic needs are individually weighted in different ways. This must be taken into account in planning the treatment in order to attain the best possible results (Alanen et al., 1982a).

In research work too, more attention should be paid to a multidimensional approach. One weakness which can be seen in many treatment studies is a certain methodological rigidity in the theoretical framework itself. A group of schizophrenics is selected on random grounds, to receive a specific form of treatment; this is administered in a rigidly schematic manner while other similar groups, selected as controls, receive different treatment or none at all. Such a research design does not lead to an adequate view of the possibilities of an individually planned psychotherapeutic treatment approach to schizophrenia (Alanen et al., 1980). It may be more meaningful to study what case-specific clinical, family dynamic and social-background variables should be taken as indications for a certain type of treatment, or for a treatment-mode combination weighted in a certain way. The indications of family-centred treatment modes should also be considered from such a comprehensive point of view, not as a treatment carried out separated from a more global treatment plan.