While we live through a variety of circumstances in our daily lives, we find that we shift from one state to another depending upon the context. In adapting to these changing situations, we sit quietly with focused attention while attending a movie or shout and cheer in a ball game. Similarly, individuals with schizophrenia may on infrequent occasions show the same kind of shift from one of passive withdrawal to active engagement in a life situation. For example, an individual who spends almost all of the time sitting in a corner without being responsive to other stimuli, may when properly engaged, play the piano and sing and dance. Other individuals may on occasion show the same type of discrepant behavior. For example, a person who has scored very low on tests of social perception may perform at a very high level when participating in a game of charades.
How do we account for this shift from the regressive or psychotic behavior to normal functioning? To clarify this temporary shift from the psychotic mode to normal behavior, we must turn again to the theory of modes. We propose that the individuals with schizophrenia also have a variety of normal modes in addition to the regressive and psychotic modes. These normal modes may be spontaneously activated only rarely, but they have the same structural characteristics as those in people without schizophrenia. The modes are composed of a variety of schemas including cognitive, affective, motivational, and behavioral schemas. These schemas have a number of features in common. Specifically, both the schemas and modes have their basic properties in common, namely content, density, and charge (level of activation). The content may pertain to the negative view of the individual and the outside world. Furthermore, the content of the schemas is integrated into the content of the mode. Secondly, the schemas and the modes have density which leads to the chronicity of a given schema or mode. The final property is the charge which differs from the density. The density involves the structural characteristics of the schema/mode while the charge simply reflects the degree of energizing of the mode. The greater density sets a limit on the degree and persistence of activation.
The question arises why the activation of the positive adaptive mode does not last even after a strong positive intervention. The answer seems to lie in the fact that the dysfunctional schemas and modes have been reinforced repeatedly over time and thus have acquired sufficient density that the charge cannot overcome for a prolonged period of time. It requires repeated activation of the adaptive mode to surpass the density of the dysfunctional mode. In fact, as the adaptive mode increases in density, there appears to be equivalent atrophy of the dysfunctional mode.
A question has also been raised as to how these individuals can get better given that there is obvious atrophy of the brain on the MRIs. We speculate that the thinning of the brain is actually disuse atrophy of the adaptive schemas. It may be speculated after successful psychotherapy that the brain would return to its normal size. This is an important research question that needs to be addressed by visualizing the brain with MRIs before after the individual has achieved recovery.