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Weak Ties and Schizophrenia: Promise and Problems

Dr. Beal and colleagues expand on her earlier elaboration of the “self–authored” communities of schizophrenia patients. The construction of communities by schizophrenia patients is an interesting concept that describes environments that place few interactive demands on the patient but nonetheless contain other human beings, or that represent “virtual relationships” through which an imaginative interaction with TV or radio characters helps to connect the patient to a “wider community.” These opportunities are thought to provide hope to patients for more meaningful and participatory lives beyond their connections with mental health professionals. Indeed, the widely documented reality of schizophrenia is that most patients do have a difficult time making interpersonal connections. Thus, even modest initiatives by patients that serve to engage them with others is a promising foundation on which to build. We worry, however, whether these “weak ties” might come to be viewed by the managers of care (or overworked clinicians) as worthy outcomes in themselves, especially when patients view such relationships as personally meaningful. Will the desired outcome for schizophrenia patients ultimately be defined as personal satisfaction with weak ties and a self–reported decrease in loneliness? We need not look further than the initial enthusiasm for family psychoeducation that quickly became viewed, in some quarters, as an inexpensive form of “family as case manager." Our experience with disorder–relevant psychosocial interventions (Hogarty, 2002) has led us to conclude that most schizophrenia patients are capable of achieving far more than weak ties, provided that they are prepared through an appropriate psychosocial intervention. (Good enough is simply not enough when it comes to tapping patient potential for creating more complex, yet rewarding “self–authored” relationships.) The observational report by Beal and colleagues describes the attempts of only four recently discharged patients to “venture forth and connect." Despite the authors’ interesting commentary on the process and method of “constituting communities," these patients paint a bleak picture of their interpersonal connectedness and quality of life. More often than not, they describe themselves as nonparticipant observers of other human interactions, or at times as being limited to the private world of virtual relationships. In short, they appear to be terribly isolated and not very satisfied with their lives. (As the authors Psychiatry 68(3) Fall 2005 230