Psychotherapies for the Psychoses: Theoretical, Cultural and Clinical Integration

By John F.M. Gleeson; Eóin Killackey et al. | Go to book overview

Chapter 12
Psychosocial interventions in
clinical practice guidelines
for schizophrenia

Eóin Killackey, Helen Krstev and John F. M. Gleeson


Introduction

There have always been treatments for mental illness. Evidence exists of early trepanning efforts, and through the ages other techniques have been used such as blood letting, confinement, dietary interventions, environmental interventions, talking therapies of various modalities, industrial therapies, insulin comas, and ice baths among many others that do not come so easily to mind. Often the means by which a particular treatment came into the canon of therapies was via a distinguished advocate teaching the technique to a group of people who would later propagate it. Alternatively, the view was held that only physicians, due to the serious nature of their work, would make the correct decision regarding treatments. For example in 1879, writing in the American Journal of Insanity (now the American Journal of Psychiatry) one author noted that in relation to treatment, doctors were people of such sober judgement and developed knowledge that ‘all remedies whatever are at the disposal of practitioners to reject or employ them under the sole guidance of their own judgment’ (Bodington, 1879, p. 453).

However well it may have directed selection of appropriate treatments in 1879, the ‘sole guidance of [doctor’s] own judgment’ was ultimately recognized as being one of the restraints on patients receiving access to the best care. The reasons for this are probably many, but two key aspects must have contributed to this change. The first is a cultural shift across the course of the second half of the twentieth century, in which the automatic respect previously given to authority figures diminished. This is as true in medicine as it is in other parts of society. Second, the rise of technology has allowed for the broader and more rapid dissemination of information. For example, now, on the day a journal publishes results of a trial, those results are available to researchers all over the world. This sort of dissemination could not have been dreamt of even in the 1980s.

Although there had been calls for selection of treatments to be more scientifically based for some time (Cochrane, 1972), it was not until the 1990s that large steps were taken to make this a reality. First, in 1992 an article was

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