paradoxes in Schizophrenia

Someday schizophrenia will be understood in terms of its paradoxes. One paradox is that these individuals have a strong yearning for human contact, and particularly, doing things for other people and yet they spend most of their time in the withdrawn state, avoiding human contact and indeed being non-responsive to attempts by the staff to engage them. Here are three examples to illustrate this point:

Case #1: Familiar to our team, this individual believed he wasGod. The following conversation discussion with the therapist illustrates the paradox and how this led to a treatment plan.

Individual: I am God and king of the universe.

Therapist: What is good about being God?

Individual: If you are God, you can move the planets around and control the stars and the sun.

Therapist:What else is good about being God?

Individual:If you are God, you can help millions of people.

Therapist:What do you feel when you think of helping millions of people?

Individual: I feel good. I feel strong. I feel worthwhile. Therapist (after drawing out all of the good feelings about helping people): Now that you have described this great feeling, what can you do right now that will reproduce that same feeling?

Individual:I understand that they just had a hurricane in Texas. I could organize a group and send food and clothing down to Houston.

After dwelling on the meaning and on the affect which was associated with helping people, the individual organized a group of other individuals and staff to collect extra canned foods from supermarkets, and clothing from the salvation army and successfully sent these down to Houston. Pointedly, he no longer talked about being God.

Case #2: This individual spent a good deal of time drinking from the toilet. He stated he had to keep drinking in order to save all the people on the planet. In addition, he reported hearing voices claiming that he was slimy, a piece of junk and worthless. Saving the people of the planet was a manifestation of his need for connection and the drinking from the toilet was a way of cleaning out his dirtiness (which would then make him less likely to be judged by other people if he were more clean) The therapist pointed out to the individual that it was good that he wanted to save so many people but that he was using unusual means to eliminate his sense of dirtiness. The individual then hit upon a separate plan of organizing a group to clean up the rubbish outside the group home. The staff came aboard and took photographs before and after the cleaning up and posted them. The individual responded to the activity and the human support by stopping his bizarre behavior.

Case #3:Another individual struck out at people whenever they entered his room. When the staff tried to restrain him, he would even try harder. His behavior was interpreted as trying to fight against other people. The psychotherapist, however, discovered that it was a yearning to reach out to people that paradoxically took the form of striking at them. The therapeutic approach consisted of finding other physical things he could do when people entered the room such as handing things to them or starting a conversation and fulfilling their need for connection by talking to him about a particular topic that seemed to grab him (for example: “Let’s talk about super heroes in the movies”). Thus, the need for connection with other people was satisfied through more normal methods and the bizarre behavior namely, striking out at people when they entered his room, disappeared.

These cases all illustrate that the delusions can be used as a source of information regarding the individuals’ unfulfilled wants and needs. Additionally, these three cases illuminate the paradox of schizophrenia. On the one hand, the individuals’ behavior: seclusion and fending off other people seem to represent a desire for isolation. On the other hand, when the behavior is understood, it is found to represent a desire to reach out to people. In addition to the yearning for other people, there is a desire to compensate for the negative self-concept by wanting to save people or to help them (in the grandiose case, the idea of being God was a compensation for the worthlessness).

At our next Friday meeting, try to come up with other cases that illustrate this paradox.

Thank You,

ATB