What Maintains Patienthood in chronic schizophrenia?

A crucial question is: when the individuals are no longer immersed in a stimulating activity, they tend to sink back into their previous patient (regressive) mode.

This pattern represents the default mode. This mode takes over whenever the individual leaves the stimulating environment and is maintained until the individual becomes immersed in meaningful activity.

What maintains the regressive mode: As pointed out earlier, the social environment in the hospital or facility unit is organized in such a way as to activate and magnify the patient’s dysfunctional attitudes and beliefs about the self, the outside world, and the future.

A cluster of beliefs and attitudes are imbedded in the patienthood mode. When the individual is not exposed to a stimulating environment, this cluster of beliefs is activated. Consequently, even though the individual is not being regimented, demeaned or criticized, they sink back into this mode.

The view of themselves as worthless, inferior, etc., constitutes the belief about themselves, the outside world, including being diminished, in a variety of ways, the belief about the future including the person’s expectancies, such as “If I try anything, I will only fail at it,” “no sense in being with people it’s not worth the trouble,” “If I try something actively I just won’t enjoy it,” and “I don’t have the energy to do anything.”

The individual, thus, has built up a variety of rules, which squish any positive motivation. The rules are derived from the beliefs, which include: 1) don’t be active, you don’t have the energy, 2) don’t try anything new you’ll only fail, 3) stay away from people they’ll only hurt you.

As indicated, the regressed individual has bought into the negative attitudes of the staff. One point I did not previously mention is that the staff does not regard the individual as automatically entitled to satisfaction. For example, a staff member may say, “this patient is not allowed to go outdoors until he has dressed properly.” The regressed individual assumes this belief in being unentitled and having no rights. This can accentuate their lack of positive motivation.