Positive withdrawal and the quest for meaning: the reconstruction of experience among schizophrenics

Psychosocial rehabilitation often remains entrapped within a restrictive definition. It is characterized by a normative orientation, which predetermines the objectives to achieve, and by an approach from outside of the person, which emphasizes the functional aspects of rehabilitation. In this context, marks of withdrawal, lack of involvement, or inactivity are interpreted as signs of passivity or as residual or negative symptoms, which are often associated with a negative prognosis. In parallel, as data regarding the heterogeneity of evolution of schizophrenia begin to accumulate, some authors have defended the idea that studies have to concentrate on the course of the disorder and on the associated processes (Harding et al. 1987; Strauss 1986). They propose going beyond an objective evaluation of signs and behaviors in order to situate them within a larger life-frame. This draws attention to the potential polysemy of symptoms, including the so-called negative symptoms, which can reflect a diversity of influences and therefore possess various psychiatric meanings (Strauss 1989). Yet, the systematic study of "meaning" in psychiatry is still in its infancy and lacks clear conceptual and methodological points of reference (Strauss and Estroff 1989). On another hand, implications for rehabilitation of a meaning-centered approach to psychiatric symptoms have not been fully elaborated. An intensive study conducted in Montreal with patients diagnosed as schizophrenics sought to describe the factors and processes associated with different types of insertion in the community, and particularly to understand the rehabilitative strategies and the specific forms of being-in-the-world associated with an ability to remain in the community. Data collected through open-ended interviews were both quantitatively analyzed and subjected to content and qualitative analysis. The conceptual reference frame was derived from anthropology and from the European school of psychiatric phenomenology. Data indicate that non-rehospitalization is associated with a stance of "positive withdrawal" (Corin 1990); it is characterized by a position at a distance from social roles and social relationships, combined with various strategies for keeping more tenuous links with the social environment. The case study presented here illustrates the complex organization of these various elements in a given life-frame. It also demonstrates the role played by symbols and meanings in developing a new articulation of personal experience.