Re: Grids & schizophrenics

Jonathan D. Raskin (
Tue, 01 Dec 1998 10:12:06 -0500

John (and others following this thread),

You put forward some very interesting ideas. Let me respond simply to your
concerns about which of the sometimes contradictory constructions from the
client one ought to listen to when it comes to medication--those that are
pro or con. Szasz speaks of the "psychiatric will." When one signs a
psychiatric will, it lays out what one wishes to be done (or not done) at a
later time should one be deemed "mentally incompetent." This is one
interesting solution to address your concerns. It seems to me that without
having some formal process through which the client can assert what should
or should not be done to him or her, we run the risk of doing grave harm to
persons by treating them in ways we construe as helpful, but which they may
not. Anyway, let the conversation continue.


At 12:20 AM 12/1/98 EST, you wrote:
>For the purposes of this thread, I will remain on the medical side of the
>argument. I can and have argued on specific cases on either side. I have
>beliefs congruent with either side. I actually only believe in the current
>utility of the term and category of schizophrenic for medicine. I find much
>less utility for the word elsewhere. Discarding it or trying to move to an
>entirely individualistic model does not seem practical or useful to me.
>Medications for this diagnostic category are too specific and effective in
>alleviating symptoms (although there is still a long ways to go). The
>categorization of people by symptoms seems useful in this instance. It also
>helps in explaining to a client that they are not alone in possessing a
>cluster of symptoms. When explained biochemically, a client is often
>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
>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
>are miserable. At times they are hospitalized and medicated often with great
>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
>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
>based on my anticipation of similar results with others. My results have
>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
Jonathan D. Raskin, Ph.D.
Dept. of Psychology-JFT
State University of New York at New Paltz
75 S. Manheim Blvd.
New Paltz, NY 12561-2499
phone: (914) 257-3471 or 3606
fax: (914) 257-3606