Book Review
Schizophrenia
Personal Therapy for Schizophrenia and Related Disorders. Gerard E Hogarty. New York, London (UK): Guilford Press; 2002. 338 p. US$38.00.
Reviewer rating*: Good to Excellent
Review by: Joel Jeffries, MB, BCh, BAO, MA, FRCPC
Toronto, Ontario
This book’s author has a long- established and well-deserved reputation for research into the social aspects of schizophrenia. In particular, he has made a strong case for the superiority of family and (or) personal therapy combined with pharmacotherapy over pharmacotherapy alone. However, his ideas have not led to the hoped-for outcome that all persons with schizophrenia will receive psychotherapy. There are various reasons for this: such interventions are costly and seemingly endless, as the illness is chronic and remission rates are low, even with ideal care; there are few people practising psychotherapy; schizophrenia patients have low priority for psychotherapists because they are not as interesting as “neurotics” or patients with personality disorders; and their illness limits schizophrenia sufferers’ earning capacity, with the result that, in many settings, treatment is not within their financial grasp. Finally, many other psychological and social methodologies compete with the approach of Hogarty and his Pittsburgh colleagues.
Nevertheless, Hogarty and his collaborators have created a body of knowledge that is unsurpassed by any other group, and he is uniquely qualified to describe the state of the art in psychotherapy for schizophrenia sufferers. Hogarty’s career began when ardent proponents of a psychoanalytic approach could still be found. In this volume, he describes in minute detail a therapeutic intervention—personal therapy (PT)—that he and his colleagues have studied to a degree exceeding that of any earlier or current treatment. He admits that, despite 9 years of research, they have been able to demonstrate “only modestly advancing outcomes beyond those possible with existing interventions”—a statement that raises the question of whether to read on. Also, Hogarty and colleagues studied in total 151 patients, making treatment-group size about 25 patients, on average. In this sample, Hogarty claims that 26% of patients were able to exceed their best premorbid levels of major role adjustment. Conversely, only 54% were able to acquire advanced PT skills, and some patients worsened with PT. In Hogarty and colleagues’ first study, in which the sample comprised patients with families, the PT group showed psychosis relapse rates of only 13% over 3 years. Surprisingly, the relapse rate went up to 35% when family therapy was added to PT—a rate worse than that found with supportive therapy (29%) but better than that found with family therapy alone (42%). When these researchers looked at people who did not live with a family, they found a relapse rate of 44% for PT, which compared most unfavorably with supportive therapy, wherein a mere 14% of patients developed psychosis.
Unfortunately, Dr Hogarty’s explanations for the poor showing of PT are weak and unconvincing. One conclusion offered (without data) is that patients who suffered a relapse had pressing social difficulties, such as homelessness, that needed to be dealt with first. This conclusion has some validity; however, it makes one question a system that funds such research before providing basic necessities of life.
By now, dear reader, I am sure you are eager to know what PT is. For the answer, you must read the book; if it could be succinctly described, the book would be superfluous. Let me help you by explaining that Hogarty and his team have drawn selectively from other writers in the field and include in PT so-called psycho- education, which is really just education about personal or family psychological problems. Social-skills training is also apparent in PT, as are basic social-work activities such as help with benefits, housing, leisure, education, and vocation; stress-reduction techniques such as progressive relaxation; learning to identify prodromal signs; conflict resolution; and optimizing medication.
Dr Hogarty describes the content of PT in great detail, thereby providing a wide-ranging and comprehensive review of available knowledge about schizophrenia. For anyone relatively new to the field, this text is a readable, clear, and relatively unbiased introduction to the necessary basic information. For those who plan to practise psychotherapy, other psychological therapy, or counselling, the book introduces a wide variety of possible interventions and, as do most therapists, readers will choose those that best suit their own style and view of the illness.
That said, the author includes far more information about schizophrenia than is needed to describe PT, and I felt that he was taking the opportunity to share everything he knows, together with additional input from 8 collaborators that include 1 psychiatrist. The book ends with 28 pages titled “A Statistical Primer for Clinicians,” which I doubt many will read and suggests a lack of discrimination about what is relevant. The price is high but similar to other texts. References are many and helpful. Production values are generally very good, although a somewhat pretentious attempt to say that schizophrenia might better be called Pinel-Haslam syndrome is spoiled by incorrectly spelling the latter name Halsam. Aimed at a broad audience, the book’s content is more suitable for social workers and psychologists than for psychiatrists, but there is still much wisdom in its pages.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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