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The Art of Conversation - Part 2

By John McManamy

My previous article talked about Bob, a person whose illness isolated him from human contact at a fairly early age, and thereby deprived him of the opportunity to learn and refine the vital social skills he needs to function in the real world. I witnessed Bob - on his big night out - make the social gaffe (at least in musician circles) of telling a sax player that he plays four saxophones.


Poor Bob. The conversation was over before he even started.


Bob has probably been diagnosed with schizophrenia, a label that strongly implies, "Abandon all hope." Should we?


No! Robert Liberman MD emphatically responds. Dr Liberman, a pioneer in the field of psychiatric rehabilitation, is director of the UCLA Center for Research on Treatment and Rehabilitation of Psychosis. In an article published in the July 2001 Directions in Psychiatry, "Recovery from Schizophrenia," Dr Liberman contends that "there is nothing inevitable in the course of schizophrenia."


Rather: "There is growing body of empirically-based clinical research showing that rates of recovery from schizophrenia can be multiplied many-fold over traditional estimates."


Dr Liberman and his colleagues at UCLA have devised a step-by-step program for teaching social and independent living skills, including how to have a conversation, what to expect in the workplace, and dealing with intimate relationships. In his article, Dr Liberman cited the example of Bernard, who - to boost confidence for initiating conversations with women - was instructed make regular visits to the mall and practice speaking to female store clerks.


Dr Liberman reports that five years following his last psychotic episode, Bernard is working and has been successfully dating.


But Dr Liberman does acknowledge that good outcomes have a lot to do with "higher premorbid levels of vocational and social adjustment."


In other words, individuals with mental illness have a much better chance of recovery if their illness hits them later in life, after they have experienced some taste of success in the real world, after they have had ample opportunity to hone their social and work skills.

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