Conclusion

With respect to a person-centered approach to schizophrenia I call for an acknowledgement of the illness. Instead of burdening a person with a psychological diagnosis — a presupposed incongruence between self and experience or an ‘autistic’ way of relating to the world, we would do better to give the person a proper medical diagnosis. Discussion is possible on whether the diagnosis of schizophrenia reflects adequately the disease process it is supposed to describe. But there can be no doubt that there is such a thing as mental illness that influences a person’s functioning much more than can be understood in psychological terms.
  The person-centered approach has been developed in an optimistic era, the ‘high time’ of the ‘so-called humanistic position’ (Schmid, 2003, p. 111). This resulted in a neglect of the conditio humana, ‘the partial lack of freedom, physical illness, transience, suffering and grief’ (Schmid, 2003, p. 111). Only when we are willing to give the illness its proper place in persons with schizophrenia, will we be able to see the interrelatedness between illness and person. We have to leave behind the current metaphor in present-day psychiatry where the person is fighting the disease. In case of severe mental illness the person cannot be separated from the illness.
  A person-centered approach to schizophrenia can learn a lot from the work of Davidson and Strauss (1992, 1995) who regard the person as the crucial factor in the process of recovery. But there is more to learn. Anthropological research into the nature of schizophrenia has resulted in findings that concern the heart of the person-centered approach. The independent, self-reliant person is not synonymous with a healthy human being as once was taught in the humanistic tradition. With respect to vulnerable individuals, which is what persons with a mental illness are, the relational side of persons must be emphasized. In the egocentric settings of Western society ‘even those without significant disability may find themselves isolated, alienated and alone’ (Lin & Kleinman, 1988, p. 561). There is much to be said for the dialogic position that Schmid (2003) regards as essential for the person-centered approach.

  People with schizophrenia are not at odds with the society in which they live, as once was thought. Like any other person in a given society, they try to live a life that embodies the values of the culture in which they are raised. Facing the difficulties persons with schizophrenia have to endure in our society, we can question the evidence of values such as independence, self-reliance and autonomous functioning.
  The long-term course of schizophrenia seems to be influenced favorably in ‘a context of stable and unlimited continuity of care’ (McGlashan, 1988, p. 538). Therefore a personcentered approach to schizophrenia requires a long-term care. ‘The most important element in psychotherapy with schizophrenic patients is the active establishment and maintenance of a reliable interpersonal relationship for an extended period of time’ (Berghofer, 1996, p. 492). Furthermore, this care must take place in a context other than the weekly appointment with the therapist. ‘The therapeutic context is a crucial variable in work with the psychotic client’ (Lambers, 2003, p. 115). Berghofer (1996) made daily visits to the apartments of her patients. There is still little variety in supported housing projects for people with a severe mental disorder. Either clients are forced to live in a group or they are living independently in an isolated context. ‘Unfortunately, in our culture there is little variety of holding environments on offer beyond hospitals’ (Lambers, 2003, p. 115).

Within the contemporary person-centered approach there are openings for the care of people with schizophrenia. I would not prefer a person-centered approach parallel to conventional treatment as Sommerbeck (2003) proposes with her dualistic approach or complementarity principle. Discussion about diagnosis, contact with relatives, the prescription of medicines, hospitalization (involuntary or not), nursing and care in a supportive environment, all are important elements in the treatment of people with schizophrenia. It is not because the patient is prescribed medication or is committed to a hospital involuntarily that the approach cannot be person-centered. I hope to have demonstrated in the foregoing that within regular psychiatry there are enough openings to be found for a person-centered approach. In the person-centered literature there is invariably a mentioning of the ‘medical model’. This might be useful to carry on a controversy with present-day psychiatry but it is not a good starting point to open up a dialogue. The current diverse thinking in psychiatry cannot be reduced to one ‘medical model’.

The person-centered approach can do invaluable work in psychiatry, by establishing a personal relationship with the client, in which the client can find a valued self — not the old self, before the outburst of the illness, but a new self — as a person with a severe mental illness and as a person who can recover from this illness with a new perspective on life.