Overcoming Fragmentation in the Treatment of Persons With Schizophrenia

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Despite its important clinical implications, Bleuler’s early contention that discrete symptoms such as delusions and hallucinations are secondary to a core fragmentation (splitting) of psychic functions has been largely lost within current models of schizophrenia. This paper offers an integrative approach to the concept of fragmentation as found across a range of theoretical models of schizophrenia, spanning from classic psychiatric accounts to contemporary research. We suggest that revisiting the importance of fragmentation in schizophrenia reveals specific risks in current atomistic trends in contemporary psychopathological and treatment models; namely, increased possibilities for a treatment error we term collusion with fragmentation. Exploration of the implications of colluding with fragmentation highlights the importance of narrative and shared meaning-making processes in the treatment of persons with schizophrenia and presents opportunities to advance and update general integrative treatment approaches toward a more collaborative, hermeneutic approach to assisting persons in recovery.

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