SCHIZOPHRENIA

Schizophrenia

Schizophrenia

Introduction

Schizophrenia is presented as a biopsychological model that goes beyond current biological etiology and considers psychosocial stressors that exacerbate this condition. High dopamine levels thought to contribute to schizophrenia are viewed as a biological reflection of loosened thought incited by psychological stress contributing to the mind-body interaction and, at times, creative processes. Psychotherapeutic interventions are considered indispensable to the treatment of schizophrenia. (Berkow, 1992)

Discussion

Clinicians working with clients who have schizophrenia may sense that, like Janus, the two-faced Roman god of portals and exits, these individuals peer simultaneously inward and outward, with significant focus on a mysterious inner world. More than 70 years ago, Kraeplin (1919/1971) observed in the countenance of those who have schizophrenia what he described as the eerie "glass wall" of affect. The flat affect, glazed eyes, and agitation from unseen stimuli characteristic of the person with schizophrenia are at once symptoms of their reality and symbols of a private psychological experience more magnetic and absorbing than the questions of the clinical interviewer attempting to unravel the meaning of the visions and voices reported by these clients.

Although it is not physically painful for the patient (Albee, 1982), the continuous mental activity of schizophrenia is nevertheless a source of anguish. At unexpected moments, the logic of the person with schizophrenia becomes scrambled into multiple voices, images, and sensations, which often reflect unconscious or present conflicts. Bleuler (1936) coined the term schizophrenia, which literally means "split mind." Yet what is split is not the totality of the mind as if creating two separate personalities but the relationship the person with schizophrenia has with him- or herself, resulting in a "division" between psychological processes that are normally experienced as integrated: thought and the thinker, mind and body, good self and bad self, time and logical sequence. In this fragmentation of the personality, the person with schizophrenia loses the most essential of human attributes. Among these attributes are the ability to see and think clearly, to experience inner tranquility, to relate to others meaningfully, to approach the world with trust, and to love others without deluding the true nature of their character (Laing, 1969).

The phenomenology of schizophrenia may be compared to living within the imagery of Salvador Dali's surrealistic painting, The Persistence of Memory, where unimaginable spectacles, as bizarre as timepieces melting from trees, intrude into consciousness. In the mind of someone with schizophrenia, all reality becomes distorted, threatening, and unexpected, and even the flow of time loses its assured and consistent pace. Sullivan (1953) noted that schizophrenia creates in the mind the condition of "attempting to orient oneself on awakening in the midst of a vivid nightmare" (p. 243).

Case Study

Robert is a 28 year old man diagnosed with schizophrenia. He has been referred to Top Quality Rehabilitation (TQP) to provide supported employment services. Robert graduated from high school and got a job working in a video store. After working for about 6 months Robert began to hear voices that told him he was no ...