Disengagement and Low-Functioning

One of the questions we need to confront is what are the internal psychological mechanisms that are involved in the individual’s low-functioning? For the most part, the low-functioning is a direct consequence of the individual’s disengagement from their environment. At a global, the disengagement involves a loss of interest in the types of activities and goals that once served as stimuli to action.

We see the disengagement take a variety of forms a) passive disengagement: the individual, for the most part, remains passive and only reactive to stimuli (specifically, does not initiate action on their own); b) abrasive disengagement: the individual fights against hospital personnel, who are attempting to implement hospital/facility rules such as hygiene, sanitation, and taking pills. The disengagement mode tends to persist probably for the rest of the individual’s life, unless some act of intervention is implemented.

As we have noted before, the disengagement mode involves clusters of negative expectations, beliefs, and rules that lead to avoidance and the tamping down of spontaneous incentives to do things. At a more discrete level, the disengagement involves reduced attention, memory, and executive function. The individual allocates only reduced resources to these specific functions, as well as to the more global investments.

What has been exciting about the results of our recovery-oriented interventions is that it is possible to shift individuals from the disengagement to an engagement mode. Within the engagement mode, the individuals tend to shed many of their negative symptoms, such as alogia and affective blunting. It’s remarkable that some of these individuals who have been withdrawn (often in a hospital or institution for 10 or more years) tendto “wake up.”

Therapeutic Approach: Reengagement

The therapeutic approach is driven by the knowledge that these individuals have retained the capacity for reinvesting their interests and resuming a normal life. The specific task for the mental health professionals and staff is to provide a social environment that will activate positive attitudes about forming relationships with other people, becoming involved in group projects and setting specific, individual goals for themselves. The ultimate goals, promoted by the recovery-orientation, include involvement in independent living, pursuing meaningful goals, and reestablishing relationships with others. Specific factors with individuals involve setting meaningful goals, activating positive expectancies and attitudes, through meaningful activities and at the same time, negating negative attitudes and avoidant tendencies. Since individuals show a strong tendency to relapse into the negativist mode, it is essential to provide an atmosphere that will re-stimulate the adapting, self-fulfilling mode.

Note: Engagement with the therapist and with the group, are powerful forces in themselves; however, especially in the long term disorder, many social skills have fallen into disuse, social skills training, thus become an important bridge to other people, and also, add to the individual’s self-confidence and sense of mastery. So would activating a strength, such as focusing on social skills, as well as nullifying negative expectancies and beliefs.

Therapeutic Approach: Providing a Structure

For inpatients, it is not difficult to get the staff to cooperate in providing opportunities for participation in activities the staff and the individual work together to provide a weekly schedule of activities.

It is more difficult for an individual to follow a schedule of activities when outside the hospital. It is, therefore, important for the therapist and the individual to work out a schedule together. Of course, if the individual obtains employment, this can serve the purpose of providing a structure.