Selected Strategies

Implications for treatment and training 65

most profitable base for developing better models about the nature of the schizophrenias.

The central thesis of this report has implications also for those whose primary involvement is training psychiatrists and other professionals. What has been said about the complexity of the schizophrenias underscores the importance of teaching a way of thinking about the etiologies of these disorders that reflects the role of multiple domains and many variables. Therefore, students need to be introduced to the complexity of these syndromes without either oversimplification or focus on a single domain. Present gaps in our knowledge need to be presented with equal clarity. Competing theoretical models of the schizophrenias should be presented; they stimulate thought and study.

The schizophrenias often have an unclear onset and a long course, which makes it helpful to the trainee to have a clear understanding of the basic concepts of child and adolescent development as well as clinical experience with intensive, long-term treatment modalities of individuals with these syndromes by which to observe the interactions between life events, relationships, and fluctuations in symptoms.

Many training programs are located in institutions or departments in which there is a major emphasis upon biology, psychology, or sociology. Trainees in such institutions or departments, in particular, need to be introduced to a broadly based understanding of the biopsychosocial factors involved in the etiologies of the schizophrenias. In a parallel manner, trainees need to become comfortable with using a wide variety of treatment modalities. Biologic, psychologic, and social treatments are each useful and necessary in the treatment of many patients with Schizophrenic Disorders. Reliance on a single treatment modality is usually inadequate.

Finally, it should be emphasized to trainees that there is no incompatibility between the development of clinical skills and the ability to conceptualize research hypotheses. The curiosity of clinicians dealing with patients with such disor-