Schizophrenia: Breaking Down the Barriers

This volume was edited by the chairperson (Dr. Ancill) and senior clinical administrative members of the department of psychiatry at St. Vincent's Hospital in Vancouver, British Columbia, but the chapter contributors represent diverse backgrounds: community psychiatry and research psychiatry, physicians and psychologists, and university faculty and pharmaceutical industry researchers, from both sides of the Atlantic. The book is presented as a companion piece to a 1996 conference on this topic, dedicated to the admirable theme of breaking down the barriers that people with schizophrenia describe running into—as noted in the preface, "Therapeutic walls. Economic walls. Walls of ignorance. Walls of prejudice."

The first two of the book's 12 chapters provide a strong start. Dr. John Talbott describes and analyzes the results of a survey he conducted, asking experts, such as clinicians, researchers, patients and their advocates, and family members, what they considered to be the most significant barriers to effective treatment. His discussion constitutes an on-target biopsychosocial prescription for what is needed today in the treatment of persons with schizophrenia in the U.S. and Canada.

Dr. Leona Bachrach follows with a chapter highlighting skillfully chosen excerpts from patient writings. The excerpts address patients' experiences of illness and needs, although the emphasis on program planning suggested by the title is poorly developed.

After this promising and even inspiring beginning, the book's focus is lost. The result is a rather loosely related collection of essays of inconsistent relevance and value, many of which only peripherally address the theme. For example, I expected that "Work and Mental Illness" would be a strong, pertinent piece, but found it merely a description of nonquantified results of informal interviews and observations conducted in the Greater New Haven, Connecticut, area just before a systemic change was introduced. We are told at the end that this chapter represents an early version of a paper published ten years ago. Although the authors are articulate and address important issues, readers could have expected the final version of the paper, or an account of the effects of the administrative changes then taking place in New Haven, or at least some rewriting to address a more current state of affairs.

Another chapter addressing the phenomenology of schizophrenia in a historical context would probably work better as a longer work in a philosophical journal. (I also disagree with the author's contention that patients with schizophrenia can be so feasibly divided diagnostically into those with positive and those with negative symptoms; for too many patients, both kinds of symptoms are prominent.)

The two longest chapters, written by researchers with Zeneca Pharmaceuticals, address preclinical and early clinical data (phase 2 studies) on quetiapine in the technical style one might find in an investigator's brochure for clinical-drug-trial principal investigators. (Zeneca, the manufacturer of quetiapine, supported the publication of this book with an educational grant.) Despite the disappointing unevenness of Schizophrenia: Breaking Down the Barriers, at least several individual chapters are valuable and support the book's stated objective.