In the world of psychotherapy, everything is up for debate. When we speak of chronic disease or disease severity there are a million and one opinions.

Take chronicity for example: we tend to think of chronic illness as an affliction that doesn’t go away. A minor cold has a beginning point and an end point. Schizophrenia on the other end doesn’t seem to have either; the DSM speaks of the prodromal phase, a descent into illness that is almost only identifiable retrospectively.

And it never goes away.

Or so it seems.

In Israel and in the United States, those with schizophrenia are considered as disabled for life by Bituach Leumi and the Social Security Administration. However more and more reports of full recovery are emerging. Furthermore, as technology rapidly reshapes society, the definition of disability itself has become a moving target. New occupational opportunities have allowed many formerly disabled people to enter the workplace.

This says nothing of the ideological underpinning of occupational limitation as disability. As a Jew, scarred by the obscenity of Arbeit Macht Frei (‘Labor Makes Freedom’, the sign greeting the Jews and other undesirables as they entered the Nazi death camps) the connection between productivity and human worth is frightening.

This riff however does nothing to clarify the issue I raised in my previous post: how does the cognitive therapist determine the depth of treatment. And that dear reader is where I’ll pick up next.