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Johansen B Amin, Benjamin Amendolara, Vanessa Girard, Fiza Singh, Recovery-Oriented Principles Provide a Dynamic Reframing of Patient Care in Schizophrenia, Schizophrenia Bulletin, Volume 50, Issue 5, September 2024, Pages 961–962, https://doi.org/10.1093/schbul/sbae127
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Since the mid-20th century, the treatment of schizophrenia has shifted from the institutional setting to the community care setting.1 Older treatment models focused on a chief complaint based on positive or negative psychotic symptoms, with limited consideration for the patient’s goals outside symptom treatment. Patients who suffer from the negative symptoms of schizophrenia have deficiencies in motivation and struggle to create or develop their own goals.2 In acute care settings, when a patient is too ill to engage in meaningful goal planning, a chief complaint, and targeted symptom management makes sense, but this approach has downsides. Beck’s theory of modes describes those subject to this model of care as being in “patient” mode, where the individual assumes they lack agency, reinforcing ideas that they are weak, incapable, or passive characters in their own lives.3,4 The institutional setting and symptom management approach likely exacerbates the amotivation that patients with schizophrenia experience. Oftentimes, the physician determines the goals of treatment, limiting patients’ opportunities to develop their own motivations and choose goals that are relevant to their day-to-day life.
