A New Way of Looking at Schizophrenia

  1. Prevailing View: The individual has irrational beliefs and inappropriate or bizarre behavior.  These features are viewed as encrusted into the individual and affect the way he believes, behaves, and feels.
  2. Low-Functioning individuals with the negative symptoms are similarly seen as stuck at this level of functioning and, therefore, not amenable to very much change.
  3. A new look specifies that the positive and negative symptoms tend to camouflage the “healthy,” normal component of the personality.  While this normal aspect of the personality is not generally obvious, especially when the individual is interviewed, it has not been extinguished but is still present in a latent stage.
  4. When the individuals are totally engaged in a meaningful, rewarding activity, such as participating in a birthday party, athletic game, or a fashion show, they are animated, active, etc., and no longer show symptoms of schizophrenia.  In fact, they become indistinguishable from the staff.
  5. The way we understand this behavior is as follows: personality, in general, is composed of a variety of modes.  Depending on the circumstances, we can fluctuate from an angry to a loving, to a passive mode.  For example, individuals with schizophrenia have psychotic and regressive modes, in addition to the normal mode.
  6. If these individuals are in an environment that impacts their symptomatology, they will express their hallucinations, delusions, and disorganized speech, when the individuals are subjected to a “mental status examination,” or when the environment in the unit is representative of a medical institution.  When the environment is changed to one similar to that of everyday life, then the individuals are likely to behave more normally—that is, the “normal mode” is activated.
  7. The goal is to enable the individual to become engaged in normal life, particularly in activity that is meaningful to the individual, such as participating in a birthday party, games, etc.
  8. Using the delusions, hallucinations, and inappropriate/bizarre behavior may be a source of information to uncover the individual’s needs and protective strategies.
  9. As I have noted previously, grandiose delusions serve to fulfill, in a much exaggerated form, the individual’s needs to feel important, accepted, respected, etc.  They also symbolically fulfill a defensive strategy: if one is God, a billionaire, or the president, then other people will not devalue, ignore, or reject the individual.  
  10. Paranoid fears, such as being poisoned also serve a protective function.  The individual has the usual fears of being rejected, depreciated, etc.  These fears are transformed into fears of physical assault, and thus, take the form of beliefs in being poised, being spied upon, etc.  The individual is therefore vigilant and on guard, of course, what they are really vigilant for is rejection, etc., but they express these fears in physical terms.  

Why do Individuals Cling to their Hallucinations and Delusions?

The delusions and hallucinations serve a very important function in the individual’s adjustment to their perceived environment.  As indicated before, the grandiose delusions serve the purpose of warding off the possibility of being devalued or disrespected.  The paranoid fears often serve a safety function: the individual is vigilant against psychosocial attacks, which take the form of physical attacks.  The need to protect oneself against psychosocial threats is so strong that the delusions are held with a high degree of certainty.