Formulation of Symptoms of Negative Syndrome

1. In thinking of the description and treatment (and course) of the negative syndrome, consider the following: John H. has been hospitalized for over four years. When introduced to his therapist, he is slouched in an armchair in the corner, staring vacantly into space, and apparently detached from the immediate environment. When questioned, by the therapist, he mumbles a few words. Also, he shows minimal facial expressions. John H.’s generalized behavior appears to fit the criteria of the negative syndrome of schizophrenia, very well. He seems to show the typical signs and symptoms, as described in the literature: avolition, alogia, anergia, asociality, anhedonia (in response to questioning, he says he does not get pleasure out of anything), apathy, blunted affect, and diminished activity.

2. Many of this individual’s presentation can be fitted into the negative syndrome, including the following: staring vacantly into space=apathy; from his inactivity, one infers anergia and amotivation; his lack of participation with other individuals=asociality; unquestioning he responds that he does not enjoy anything= anhedonia; his psychical inactivity= lack of activity; and diminished facial expression= blunted affect.

3. Now observe the individual 6 months after successful treatment. He actively participates in activities on the unit (he has formed a cooking club), obviously socializes with other people, states that he gets enjoyment out of what he is doing, shows animated faces, and is obviously interested in his environment.

4. This reversal of the syndrome indicates that each of the characteristics of the negative syndrome is on a dimension. Each of these characteristics represents a degree of intensity, the negative syndrome, consisting of low-intensity anchors of the characteristics.

5. There is something missing from the description of the negative syndrome. The missing element has to do with the individual’s beliefs and attitudes, which help to shape his motivation and free-up the energy to carry it out. These attitudes and beliefs cover a wide range of positive processes, including negative self-evaluations, defeatist attitudes, low-performance expectancies, negative expectancies regarding social connections, and beliefs about the meaning of the significance and value of specific interactions.

6. We can arrange the various “symptoms” of the negative syndrome into a casual sequence: a) negative attitudes and beliefs-> b) diminished goals and the drive (energy) to complete the goals-> c) diminished engagement (apathy, reduced activity interactions, diminished pleasure and affect).

7. The negativity was obviously reversed six months later. We assume that the specific elements of the interventions and social environment were the stimuli that changed the beliefs from negative to positive and, consequently, activated the motivation and access to energy, which has activated the other characteristics.

8. Please note the continuum from normal behavior to the negative syndrome. One can experience all of the “symptoms” of the negative syndrome but at a much lower level of intensity: observe somebody in acute distress after the breakup of an intimate relationship or an unexpected failure.