Schizophrenia

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When Ifirst read this manuscript, Iexclaimed to a colleague: "This is the most important and clinically relevant book on schizophrenia since Bleuler!" Time has not altered my initial enthusiastic evaluation. Drs. Strauss and Carpenter are among the most distinguished researchers in the field ofschizophrenia, butthey are also clinicians ofgreat experience, breadth, sensitivity, and flexibility. It is from this expertise, as well as theirwide familiarity with the world literature, thattheyhavebeenable to distill the essence of an exceedingly practical and comprehensive approach to the understanding, evaluation, diagnosis, and treatment of schizophrenia. They begin by unequivocally stating the inadequacy and futility of approaching schizophrenia via a single model. Standingalone, neither a biomedical, a social, nor a psychological model can adequately account for the complexities of this illness with regard to etiology, phenomenol- ogy, course, or optimum treatment. While the advent of psychophar- macologicalinterventionhas made a profound impact on both individual treatment and the responsive support systems, and is an important aspect ofmosttreatmentplans, to view schizophrenia as a phenothiazine deficiency disease is not only bad science but bad therapeutics. Their conceptualization of an "interactive developmental systems model" provides a framework upon which to build a broad medical approach to schizophrenia. This model relates variables drawn from different systems, interactive with one another, and contributing to a pathogenetic process across time. Within this bio-social-psychological matrix, one can then organize information relative to vulnerability, the manifest illness per se, the course of the disorder, and the multiplicity of factors relative to treatment planning.