I do work with schizophrenics who are often forced to take the medication
initially (not in my setting). They have requested that they be given
medication in the future when the medication becomes ineffective. Some sign
contracts to do so. They have said they are miserable when their symptoms
control their lives. They are glad they are and plan to continue to take
their medications despite some miserable side effects and social consequences.
I have also have worked and continue to work with unmedicated schizophrenics
on the street. I strongly advocate for medication if I believe it will be
effective. As a PCP based person, I do listen to content and themes within
the person's systems. I enjoy communicating and discovering their views of
the world and their interpretations and survival methods. I help them to
survive using their construction system and variations collaboratively
developed as long as is possible if this is what they want to do. I agree
that it is ridiculous to ignore the content of their thoughts and delusions.
At times though, their systems fail them in coping or it is apparent that they
are miserable. At times they are hospitalized and medicated often with great
effect.
The question posed to Szaz and to others? As there is only one person....
which person and which construction system should I listen to? Which one is
the real person? Do I discount what has been previously said in the pursuit
of only "the here and now construction system"? Is the here and now
construction system always better? Should I give the alcoholic a drink now
because he currently requests it or remember what he said an hour ago? Do I
listen to the one on medication which requests the meds previously (and who
will later thank me) or the paranoid one refusing it in front of me? I
respect them both. I listen and understand and recognize both construction
systems. If I know the medication is effective for that individual ( and will
likely return that person to whom they were prior to the "illness"), I have
few moral qualms advocating medication despite the presenting construction
system and its beliefs. I also have few moral qualms advocating for
medication for a new person with a cluster of similar symptoms based on my
life experiences working with similar seemingly similar individuals. I do this
based on my anticipation of similar results with others. My results have come
from listening to the construction systems of those people whom have that
group of symptoms referred to as schizophrenia.
I adhere to the belief that the construct has only recently become useful to
the field and do not believe it should be thrown out. I also have not yet
become convinced that we need to relabel it.
John Fallon
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