Although it now seems like a couple of years since I contacted Jack for help and insight into guiding recovery from schizophrenia employing direct confrontation psychotherapy it has only been ten months and it is almost one year to the day since Patrick incurred his last psychotic break.

A lot has transpired since. Patrick continues to experience no delusional or hallucinatory symptoms, he does not hear voices, he continues to take no medication and he is slowly albeit it surely gaining additional confidence in his own ability to live in this world as a healthy and productive contributing member of society.

Jack and I exchanged several emails regarding the importance of assisting the patient not only in his or her psychosocial rehabilitation but more importantly in finding vocational purpose and meaning in life. From our first exchange, Dr. Rosberg highlighted this critical last step in the rehabilitative process.

In Patrick’s case, as my earlier paper “Guiding Recovery from Schizophrenia Employing a Model of Direct Confrontation Psychotherapy” reported Patrick had begun summer employment and had been accepted to return to post secondary studies. Since that report he has successfully worked an entire summer and is currently attending business studies and has an average above 90%. He socializes, at times still with minor difficulty, yet overall freely and without prodding. He plays basketball most days after school and is proud of the fact that he scores frequently and is highly regarded by his team mates.

During late August Patrick withdrew from the disability benefits that he received from the Ontario government. Although he continued to qualify to receive these benefits, with some encouragement from his family, he rejected the ongoing label of being disabled and has accepted that he can live life within the context available to any healthy twenty-two year old young man. He relishes the thought of part time work to earn his own money.

The importance of purpose in one’s life is it provides direction, it aids in defining goals, and when those goals are met there is a feeling of satisfaction and confidence in one’s ability to set forth and succeed and to navigate successfully through life.

One of the most debilitating consequences of a diagnosis by an otherwise well meaning psychiatrist is it confines the individual to a state of chronic hopelessness. Any young man or woman who has a diagnosis of schizophrenia thrown at him or her with the qualification that it is a brain disease of unknown etiology and is chronic with no known cure can’t help but live a life confined to hopelessness and lost opportunity.

In Patrick’s case most all of our recent therapy sessions during the past four months have focused on his omnipresent fear that he will incur yet another psychotic break and that the semblance of a life he is currently constructing will be lost. He analyzes most thoughts and his behavior from the context that these thoughts and behaviors are early indicators that he is destined to regress. There has been no evidence that this is the case. He is consciously, or unconsciously, reminded of earlier experiences that he associated with psychosis while engaged in his day to day activities. The only real help the therapist can offer here is to aid the patient in a critical evaluation of his thoughts and behaviors to identify their potential origin and then to provide reassurance that they are neither signs nor symbols that regression is imminent.

Each of us live our lives within a context. In all cases the contextual beliefs that we have embraced are mere myths yet that context provides meaning and purpose. A psychiatric diagnosis provides a context that the patient is chronically mentally ill and he or she then sets forth to live life within that restrained context. The therapist aims to reshape these limiting beliefs and to aid his patient to enlightenment that one’s context for life is malleable and can be transformed. If we are to live our lives within a context we are well advised to ensure that the context is an empowering one.

In Patrick’s case he is convinced that his earlier use of drugs and alcohol were major contributors to his psychotic breaks. Perhaps they were. Certainly this interpretation aids in constructing a far more empowering context than arguing that his psychosis could have been nothing but schizophrenic in nature.

As Patrick succeeds at the achievement of additional milestones, the next successfully completing his first semester at school, and as he continues to succeed at overcoming the fears borne out of his past experiences and his own mind today, I expect he will gain added confidence and that confidence, within the context of the pursuit of vocational purpose, will ensure he continues to stay well.

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