Psychotherapeutic Approaches to Schizophrenic Psychoses by Silver Ann-Louise S. de Chavez Manuel Gonzalez Alanen Yrjo O. Martindale Brian

Author:Silver, Ann-Louise S., de Chavez, Manuel Gonzalez, Alanen, Yrjo O., Martindale, Brian
Language: eng
Format: epub
Tags: Behavioral Sciences
Publisher: Taylor & Francis
Published: 2009-05-04T16:00:00+00:00

A focus on Singapore

Singapore is an island state with a total land area of 648 sq km and a multiethnic population of 3.6 million, of which 77 per cent are Chinese, 14 per cent Malays, 8 per cent Indians and the remaining 1 per cent of other races. There is a dual system of health care—the public sector and the private sector. There are 87 psychiatrists with the majority working in the public sector. The Institute of Mental Health and Woodbridge Hospital is the only state psychiatric hospital and it is the principal treatment centre in Singapore for those with severe mental illnesses like schizophrenia.

Primary health care is usually provided by family doctors, doctors in the policlinics, and practitioners of Traditional Chinese Medicine (TCM); there are approximately 1300 registered TCM practitioners in Singapore. Other traditional healers include spiritual healers like the bomohs (Malay traditional medicine men), tang-kis (Chinese temple mediums) and temple priests and religious persons affiliated to churches, mosques and temples. These traditional healers are often the first choice for treatment and the first point of contact for many patients and their family members. The bomoh is popular among the Malays who believe that these traditional healers are well equipped to handle all aspects of mental illness (Razali, 1989). In fact, the bomoh is considered a good psychotherapist who can communicate with the patient more effectively than the medical practitioner (Razali et al., 1996). The Chinese temple medium is often sought to exorcize the evil spirits that have entered to cause disturbances within the body of the patient. Patients sometimes turn to TCM practitioners and also to Ayurvedic medicine and homeopathic healers. Dialogues have been carried out with the TCM practitioners in an attempt to streamline the management of patients with schizophrenia (Chua and Tan, 2004).

Before the 1940s, the treatment of psychiatric patients in Singapore was rather primitive, as documented by Ng (2001). Shortly after World War II ended in Asia, the Mental Disorders and Treatment Ordinance was introduced in Singapore under British rule, but even so the mental hospital was considered an asylum and the approach was still very custodial in nature. About 75 per cent of the patients were suffering from schizophrenia. In 1947, electroconvulsive therapy was introduced, followed by insulin coma treatment and carbon dioxide therapy; prefrontal leucotomy was recommended for chronic cases who were distressed by their symptoms and was performed on three patients in the early 1950s (Colony of Singapore, Department of Health report, 1953). In 1956, occupational therapy, social work and psychological services were started. Psychometric testing was carried out when required and behaviour therapy including the token economy programme was introduced. The psychosocial intervention that resembled psychotherapy seemed more like counselling and was offered to only about 6 per cent of the patient population. Pharmacotherapy became the mainstay in the treatment of mental illness, with atypical antipsychotic medication being included recently. The overall approach in the treatment of schizophrenia today remains very biological in orientation; it was very noticeable that psychotherapy was not emphasized.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.