Schizophrenia is a disease that primarily affects the social aspects of a person’s life. it is manifested by an increase in isolation, self- doubt, fear of the surrounding reality and inability to adequately assess it, loss of emotional contacts, social skills. In the end, all this leads to the loss of these people from society, which further contributes to the progression of the disease. In addition to the fact that the sick person himself is most often unable to maintain social ties, relatives can also contribute to the isolation of the patient, on the one hand, overly obsessively insisting on “socialization”. In this case, the personality characteristics of such patients are not taken into account. On the one hand, this leads to protest reactions, and on the other, delaying the visit to the doctor in order to avoid publicity of the painful condition.
The main line that modern doctors adhere to is the perception of the patient as a full-fledged person, having his own characteristics and interests, rights and responsibilities, capable of being a full-fledged member of society. Many studies have proven that it is this approach that contributes to the most successful healing of patients with schizophrenia. Important factors leading to disability are the lack of initiative and inactivity of patients, indulging in symptoms of the disease, overprotection of the patient and his excessive dependence on relatives and doctors.
The task of the doctor in the treatment of schizophrenic patients is not only to relieve the symptoms of the disease, but also to return a person to the social environment, and since schizophrenia is chronic, the main emphasis is on learning to live in new conditions, coexistence with the disease. This part of the treatment is called psychosocial rehabilitation – the restoration or formation of the emotional, motivational resources of the individual lost as a result of the disease, training in interaction, restoration of the ability to solve problems, integration into society. The goal of this treatment is to achieve social competence and patient autonomy.
To date, special methods have been developed for the rehabilitation of patients, which include both individual and group forms of work. To These include: training of social skills, communication, self-esteem, self-assured behavior, independent living, learning to cope with residual symptoms of psychosis, family therapy. Experience shows that the earlier the rehabilitation work is started, the more successfully the patient regains social skills, which means, the less damage the disease causes. As a rule, the elements of rehabilitation begin immediately after the patient leaves the acute state, when he again becomes able to more or less adequately perceive the environment.
Social training for schizophrenia
An episode of psychosis, especially the first time that has arisen , is always a shock for the patient in the first place, because he does not understand what happened to him, why and how to continue to live with it. Therefore, usually patients are immediately included in the work of the psychoeducational group, where the essence of the disease, the features of its course, symptoms and ways of identifying them , is formed, motivation for long-term drug treatment is formed, and the ability to cope with psychopathological disorders is taught . In this case, an active role is assigned not only to the doctor, but also to the patient, because one of the tasks is to motivate the patient for active internal work to combat the disease.
During social trainings, the patient learns the skills of controlling his behavior, thoughts, sensations, learns to make rational decisions, develops an attitude towards illness, treatment, and life in new conditions. At the same time, family therapy is carried out , in which the relatives of the patient or even several families in which there is a mentally ill person are involved , depending on the tactics of therapy, such groups can be carried out with the participation of the patients themselves or without him.
During therapy sessions, explanatory work is carried out with relatives, training them to identify the symptoms of the disease and how to deal with them, so that relatives can act as co – therapists, helping the doctor. Also, training is carried out for interaction within the family, tactics of an even and benevolent attitude are developed, since a tense atmosphere in the family, an excessive level of emotional expressiveness can cause exacerbations of the disease.
An important stage in rehabilitation is the training of social skills. It is aimed at increasing the resilience of patients to stressful influences (the demands of society, family conflicts) and its goal is to develop skills of interaction with various government agencies, the distribution of the household budget, housekeeping, shopping, spending free time and skills of interpersonal relationships (conversation skills, friendship and family relations).
During psychosocial training, the problems that patients face in daily life are identified . Together with the patients, training goals are set, then a rehearsal of behavior in the form of role-playing games is carried out , which imitate real situations of everyday life, later there is practice in real life – the application of the acquired skills outside the artificial learning environment, but at the same time the therapist’s control is maintained, and, finally, independent application by the patient of the acquired skills in daily life.
Employment after schizophrenia
Another stage of rehabilitation is employment. At the same time, an individual approach is important, taking into account the severity of the disease, the degree of loss of existing labor skills, the wishes of the patient, an analysis of the currently available opportunities.
In Depending on the form of the disease the patient can either continue their education or career. At the same time, it remains possible to discuss emerging difficulties with the therapist and , if necessary, conduct trainings with the development of rational models of behavior. In case of loss of labor skills by patients, special trainings are conducted, which can be carried out in a hospital, at special courses or at the workplace. At the same time, attention is paid to such things as arriving on time for work, neatness, structuring working hours, choosing the sequence of tasks, interacting with colleagues and management. At first, the so-called protected employment is possible, when the patient works under the supervision of a therapist and social worker, while working conditions are sparing with a decrease in the length of the working day, simplification of production tasks.
The next stage is “transitional” employment, when patients work in regular enterprises, but under the supervision of occupational rehabilitation specialists , who help resolve emerging problems. And, finally, it is employment on a general basis. Recently, preference has been given to employment on a general basis without stages of preliminary training, with on-the- job training , with support from social workers and doctors, and after reaching a stable state of independent work. According to statistics, about half of patients with schizophrenia do not have disabilities and work in ordinary enterprises. Disabled people of group II can work in medical and labor workshops at dispensaries, and disabled people III – in specially created conditions.
During rehabilitation, it is important that the patient, on the one hand, feels his autonomy and responsibility, and on the other hand, can count on support from the family, doctors and social services in case of difficulties or exacerbations of the disease. Ideally, the result of this work is the development of a patient’s lifestyle that is as close as possible to a full-fledged healthy lifestyle with family, work, social circle, hobbies. This helps to preserve the person’s “I” destroyed by the disease, thanks to the stimulating expectation of his environment and the stimuli that are given by the awareness of his own responsibility, the desire for recognition and self-esteem.