Consider the following case example. An individual sits out in the corner, mumbles to himself. When approached by a member of the staff, his speech is minimal, usually one or two words. His speech is also jerky and not fluent. Observe this patient an hour later, while he is participating in a birthday party. He is singing and dancing with the other individuals, converses fluently with them, appears animated, and seems to be having a good time. Shortly thereafter, he sits down to play chess with one of the other individuals and is obviously skilled at the game. What is apparent is that all of his adaptive functions, relative to the specific activity he is engaged in, have been activated.
This example shows us that these individuals have not permanently lost their relevant adaptive functions, and under certain circumstances, are able to function at a relatively normal level.
We have previously utilized the term motivation to explain the individuals’ changes in functioning and observable behavior. It appears that there is a driving force that energizes all of the systems relevant to adaptation to the demand characteristics of the situation. The following systems have been engaged and energized: attentional, memory, executive functions, cognitive processing, linguistic fluency, and problem-solving. These functions are all integrated seamlessly into the specific activity.
What happens when the individual returns to his room and to his favorite corner? The extrinsic incentive or stimuli have been removed, and the various systems (neurocognitive, linguistic, behavioral, affective) have been damped down. It is as though the individual is now in a conservation of energy mode.
We have learned from this that when the individuals are exposed to appropriate incentives/stimuli, they become engaged, and all of the relevant systems become mobilized. Our approach is to form a therapeutic relationship with the therapist/staff/ACT worker, discover meaningful goals and aspirations of the individual, and guide that person along the pathway to recovery.
Addendum: Incentives and stimuli (also called extrinsic motivation) show the importance of the context in evaluating an individual’s behavior. For example, the social or cultural environment might influence the individual’s performance. Investigators have found that individuals performed much better on neurocognitive tests that are conducted in environmentally friendly (recreational) settings, than in a stern medical setting. I have speculated that when individuals are treated as patients, they perform more poorly (patienthood), but when treated as normal individuals (personhood), they perform better. Also, it was found that in India, individuals with schizophrenia do not show neurocognitive deficits. It was inferred that the family serves to support the neurocognitive functions.