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| Negative Symptoms or Psychological Sequelae? |
Negative Symptoms or Psychological Sequelae?
Contributing to the pessimistic attitude towards schizophrenia is the apparent lack of motivation in some people with the illness. This is often seen as a symptom of the illness. Lack of motivation, or ‘avolition’, is one of the negative symptoms of schizophrenia. However, a number of factors that are not essential to the illness can contribute towards this loss of motivation. Harding (1987) summarized possible causes of chronicity in schizophrenia other than the symptoms of the illness. These were:
. the effects of institutionalization;
. adoption of the patient role;
. lack of rehabilitation;
. social and economic status;
Contributing to the pessimistic attitude towards schizophrenia is the apparent lack of motivation in some people with the illness. This is often seen as a symptom of the illness. Lack of motivation, or ‘avolition’, is one of the negative symptoms of schizophrenia. However, a number of factors that are not essential to the illness can contribute towards this loss of motivation. Harding (1987) summarized possible causes of chronicity in schizophrenia other than the symptoms of the illness. These were:
. the effects of institutionalization;
. adoption of the patient role;
. lack of rehabilitation;
. social and economic status;
. medication effects;
. staff expectations; and
. self-fulfilling prophecies.
Today, medications have improved, long-term hospitalization is no longer the norm (Warner, 2004) and policies promote rehabilitation and recovery. However, consumers continue to report the iatrogenic effects of medication, poor community care, the pessimistic attitude of mental health workers, stigma, adoption of the patient role and loss of hope as contributing to their apparent lack of motivation (e.g. Bassman, 2000; Bjorklund, 1998; Fekete, 2004; Frese, 2000; Henderson, 2004; Lally, 1989; Mead and Copeland, 2000). Strauss et al. (1989) described several psychological and environmental sources of negative symptoms, including:
. fear that involvement in enjoyable activities could lead to a relapse into positive symptoms;
. problems with losing the structure provided by the sick role to develop a ‘nonpatient’ identity;
. self-protective withdrawal in the face of overwhelming conditions; . institutionalization; and
. stigma leading to the acceptance of the role of mental patient.
These socially-induced negative symptoms can then affect the course of the disorder (Strauss et al., 1989). It is clear that these factors may be present for people with serious mental illnesses other than schizophrenia. In this chapter, we examine how each of the component processes of recovery is absent in the Moratorium stage, and how this contributes to withdrawal, helplessness and the apparent lack of motivation.
. staff expectations; and
. self-fulfilling prophecies.
Today, medications have improved, long-term hospitalization is no longer the norm (Warner, 2004) and policies promote rehabilitation and recovery. However, consumers continue to report the iatrogenic effects of medication, poor community care, the pessimistic attitude of mental health workers, stigma, adoption of the patient role and loss of hope as contributing to their apparent lack of motivation (e.g. Bassman, 2000; Bjorklund, 1998; Fekete, 2004; Frese, 2000; Henderson, 2004; Lally, 1989; Mead and Copeland, 2000). Strauss et al. (1989) described several psychological and environmental sources of negative symptoms, including:
. fear that involvement in enjoyable activities could lead to a relapse into positive symptoms;
. problems with losing the structure provided by the sick role to develop a ‘nonpatient’ identity;
. self-protective withdrawal in the face of overwhelming conditions; . institutionalization; and
. stigma leading to the acceptance of the role of mental patient.
These socially-induced negative symptoms can then affect the course of the disorder (Strauss et al., 1989). It is clear that these factors may be present for people with serious mental illnesses other than schizophrenia. In this chapter, we examine how each of the component processes of recovery is absent in the Moratorium stage, and how this contributes to withdrawal, helplessness and the apparent lack of motivation.
