Since its founding, American Orthopsychiatric Association (AOA) has been at the forefront of working at the intersection of mental health and social justice. In Mental Health and Social Change: 50 Years of Orthopsychiatry (Shore & Mannino, 1975), former organization president and journal editor Milton Shore and Fortune Mannino wrote that the association had consistently held a philosophy that included (a) a commitment to an interdisciplinary approach in the study of mental health problems and the development of mental health programs; (b) an emphasis on prevention as well as treatment; (c) the integration of the clinical and the social; (d) a major focus on the social scene and its interweaving with mental health problems in individuals within society; and (e) an avoidance of dilettantism, superficiality, and well-meaning generalizations through a commitment to high-quality research, thoughtful analysis of mental health issues, and high professional standards of practice in all areas of mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evidence-based approaches and modalities for targeting and treating the cognitive impairments of schizophrenia have proliferated over the past 15 years. The impairments targeted are distributed across the cognitive spectrum, from elemental perception, attention, and memory, to complex executive and social-cognitive functioning. Cognitive treatment is most beneficial when embedded in comprehensive programs of psychiatric rehabilitation. To personalize comprehensive treatment and rehabilitation of schizophrenia spectrum disorders, practitioners and participants must select from a rapidly expanding array of particular modalities and apply them in the broad context of the participant's overall recovery. At present, no particular treatment, cognitive or otherwise, can be considered more important or primary than the context in which it is applied. Persistent difficulty in dissemination of new technology for severe and disabling mental illness compounds the significance of the context created by a full treatment array. In this article, a case-study of a mental health service system is described, showing the broad-ranging effects of degrading the rehabilitative context of treatments, obviating the benefits of cognitive treatment and other modalities. To realize the promise of cognitive treatment, the problems that prevent dissemination and maintenance of complete psychiatric rehabilitation programs have to be addressed.

This year’s volume celebrates developments of recent years in our understanding of severe mental illness, in terms of how the brain works, at the biochemical, cellular and systemic levels. The contributors all have in common a concern for the molar, systemic implications of the more molecular processes at the core of their research. This concern reflects an important conceptual trend in our national mental health research agenda, toward identification of brain subsystems, neural circuits and information processing mechanisms whose dysfunction produces the cognitive and behavioral consequences that we recognize as the schizophrenia spectrum. Increasingly, psychopathologists expect that understanding these brain subsystems will revolutionize not just our diagnostic taxonomy, but also our basic understanding of the nature of severe mental illness.

In his 2010 book Being Human: Human Being, Rue Cromwell developed some key ideas for reforming psychology. These include resolving the conundrum of subject, object, and consciousness in science; sorting through the tangles of meaning in superficially similar but fundamentally different epistemologies; and reversing conflation of cultural, social, and economic values with those of science. This discussion applies those ideas to some particulars of clinical psychology, psychopathology and the treatment and rehabilitation of severe and disabling mental illness.

This article reviews progress in the development of effective cognitive remediation therapy (CRT) and its translational process. There is now enough evidence that cognitive difficulties experienced by people with schizophrenia can change and that the agenda for the next generation of studies is to increase these effects systematically through cognitive remediation. We examine the necessary steps and challenges of moving CRT to treatment dissemination. Theories which have been designed to explain the effects of cognitive remediation, are important but we conclude that they are not essential for dissemination which could progress in an empirical fashion. One apparent barrier is that cognitive remediation therapies look different on the surface. However, they still tend to use many of the same training procedures. The only important marker for outcome identified in the current studies seems to be the training emphasis. Some therapies concentrate on massed practice of cognitive functions, whereas others also use direct training of strategies. These may produce differing effects as noted in the most recent meta-analyses. We recommend attention to several critical issues in the next generation of empirical studies. These include developing more complex models of the therapy effects that take into account participant characteristics, specific and broad cognitive outcomes, the study design, as well as the specific and nonspecific effects of treatment, which have rarely been investigated in this empirical programme.

The Means-Ends Problem Solving task (MEPS) was used to assess the effect of instructional set on means-ends thinking. Half of the vignettes were presented from the perspective of a hypothetical individual and half from the subjects’ own personal perspective. Results showed that subjects instructed to respond from the perspective of the hypothetical other produced less socially appropriate responses when their own perspective was presented first. When the order of instructed perspective was reversed (i.e., hypothetical other first), no differences in response quality or quantity were found. This finding supports the use of the MEPS in its traditional form. Results from a second task (alternative solution generation), designed to assess the effect of priming across different social problem solving-tasks, revealed a facilitative priming effect. Individuals generated more solutions to a problem situation when the previous MEPS vignettes had been in the instructed perspective order of Other-Self. Implications of the study’s findings for a two-stage model of problem solving and clinical assessment are discussed.