[Development of a therapeutic partnership understanding of schizophrenia as a sequela of recent concepts of etiology and changes in psychiatric contemporary theory]

Abstract

Ideas and concepts of the essence and nature of mental diseases have always been rooted in the current zeitgeist that usually regarded the psychotic patient as a helpless victim of demoniacal influences, degenerative processes, organic (endogenous) diseases or the dynamics of familial determinants, all of which seemingly destroyed or paralysed the autonomy of the person who became a schizophrenic. In consequence of these concepts the doctor-patient relationship (active expert-passive object of treatment) has largely been asymetrical, whereas at the same time the doctors' attitude towards the relatives was either indifferent or in the manner of a defence reaction, or of a corrective nature. Recent theories such as the concept of vulnerability and stress-coping stimulated new and fruitful forms of cooperation between doctor, patient and relatives. The schizophrenic patient is now being credited with a greater measure of possibilities to influence the prodromata, the course and the consequences of his psychosis. His relatives can help him in doing so, and in fact they should. Clearly formulated and easily appreciated information on this concept, as well as common attention to and assistance of self-protective and compensatory efforts to cope with psychological basic deficiencies, managing of stressors, early symptoms and handicaps. could promote a "treatment partnership" that is also effective as a preventive measure. The idea of a partnership therapy, too, is linked to current trends in research theory and practice that are characterised by the systemic paradigm while aiming at partially restoring the mental patients' capacity and right to act.