The Term Disengagement

As you know, I favor the term “disengagement” in describing our chronic population, even though some are not a withdrawn-for example, the more combative individuals—are disengaged from other people (and in a broader sense from society). The disengagement is characterized by a) a more global loss of interest in the outside world and future goals, and b) a loss of engagement in terms of basic psychological processes, such as attention, recall, and executive function. The central thesis of our approach is: if the individuals have become disengaged, then our goal is to get them re-engaged. It does not seem probable, given the more global aspect of the disengagement that any pill is going to restore these individuals to adaptive functioning. I strongly suspect that these higher level functions, such as interests, goals, and ambitions, and so on, regulate the lower level functions, such as attention, focus, executive function, etc. The idea is that if you can activate the higher level functions, the lower level functions, which implement these, will fall in line. Keith’s work on the predictive value of the Beck Cognitive Insight Scale may support this.