- Part one -
Previously, I believed that priority in the education of schizophrenia should certainly be given to the first principle. Now I think the second. Since the patient in this case comes to the denial of his I.
The rejection of spontaneity, following internal direct impulses and desires comes from the fact that in childhood the child learned only to obey the parent and suppress himself, not to trust himself. And only our I (EGO) allows us to test reality and distinguish dreams and hallucinations from objective reality.
The famous Arnhild Lauweng writes about the loss of my self in her book "Tomorrow I have always been a lion." This Norwegian girl has suffered from schizophrenia for 10 years, went through the hell of traditional medical treatment and recovered through her own efforts.
Here is one quote from her confession, describing the origin of the disease: “If 'she' is me, then who writes about 'her'? Is “she” the “me”? But if “she” is “me”, then who then talks about these “I” and “she”?
The chaos grew, and I got more and more entangled in it. One fine evening my hands finally dropped, and I replaced all “I” with an unknown value X. I had the feeling that I no longer exist, that there was nothing left but chaos, and I no longer knew anything - no one I am such, I am nothing, and do I exist at all.
I was no longer there, I ceased to exist as a person with my own identity, which has certain boundaries, a beginning and an end. I dissolved into chaos, turning into a lump of fog, dense as cotton wool, into something indefinite and formless."
Also: … the most distinct alarming signal I had was the disintegration of the sense of identity, the confidence that I am me. I was losing more and more the sense of my real existence, I could no longer say whether I really exist or I am a fictional someone character from the book.
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I could no longer say with certainty who controls my thoughts and actions, whether I do it myself or someone else. What if it's some kind of "author"? I lost confidence in whether I really am, because all that was left was a terrible gray void.
In my diary, I began to replace the word “I” with “she,” and soon, in my mind, I began to think of myself in the third person: “She crossed the road, heading to school. She was terribly sad, and she thought that, probably, she would soon die. And somewhere in the depths, I had a question, who is this “she” - I am or is not me, and the answer was that this cannot be so, because “she” is so sad, and I … I'm not at all. Gray and nothing more."
She describes a certain inner hallucinatory character named Captain who punished her. “From that day on, he often began to punish me and beat me every time I did something wrong, and he often didn’t like how I was doing something. I didn’t have time for anything and was generally a lazy fool. When at work in a cinema kiosk I could not quickly count the change, he took me to the toilet and beat me in the face several times.
He beat me when I forgot my textbook or somehow did my homework. He made me take a stick or twig on the road and beat myself on the thighs if I walked too slowly or rode a bicycle …
I knew perfectly well that I had beaten myself, but I did not have the feeling that it depended on me. The Captain beat me with my hands, I understood and felt how it was happening, but I could not explain, because I had no words for this reality. So I tried to speak as little as possible."
It is obvious that self-denial and even self-destruction of one's Self manifested itself in Arnhild in very clear forms. The reasons that prompted her to give up her ego are not sufficiently discussed in the book. But it is known that her father died early, and at school she felt like an outcast, completely isolated and unworthy of communication as a child. Nothing is known about her mother's actions.
But it is known that her recovery was associated with gaining self-esteem, when she was able, with the help of a social worker, to gain a psychological education, and thereby restore her self.
This case confirms our theory, and I think that there is no need to drink a barrel of wine to feel its taste, I think that other cases will, upon careful study (and not just statistical), confirm the same patterns.
Returning to the principles highlighted earlier. Managing oneself forcibly leads to a mechanical existence, subordination to abstract principles, constant tension and obsessive self-control.
That is why all feelings are "driven" deep into the personality and contact with reality stops. All possibility of obtaining satisfaction from life is lost, since direct experience is not allowed.
The proposal to manage myself somehow differently, more gently, causes misunderstanding or active resistance, such as: "But how can I force myself to do what I do not want?"
During a psychotic attack, nature, as it were, takes its toll, creating a feeling of absolute freedom and irresponsibility. The inexorable inner will, usually suppressing any spontaneity, breaks down, and the flow of insane behavior brings a certain relief, it is a hidden revenge on the abusive parent and allows forbidden impulses and desires to be realized.
In fact, this is the only way to relax, although in another version, psychosis can also manifest itself as super tension - the seizure of the whole being by a cruel will, which serves as a manifestation of the child's boundless stubbornness (or fear) and in this sense also revenge, but of a different kind.
Here is an example taken from the book by D. Hell and M. Fischer-Felten "Schizophrenia": "Dorothea Buck says in her publication:" At the very beginning of the first attack of the disease, with the appearance of still weak internal impulses, I concluded: my will is not in wanting, but in obeying, i.e. I was at one with my psychosis, not rowing upstream. Therefore, psychosis as a feeling of loss of self-control did not cause fear in me."
It is clearly seen from this passage that the "schizophrenic" seeks to submit to psychosis, that his will is directed toward submission, as it was, apparently, in childhood. At the same time, psychosis allows one to get rid of self-control, which is also very desirable for the “patient”.
That is, an attack is both painful submission and protest at the same time. In a conversation with a psychotic youth who showed an amazing ability to think logically. His father, who watched our conversation, was shocked, because he spoke to him like a "complete idiot".
And he could ask me smart questions, lead a discussion. But I asked him some uncomfortable question for him. He did not answer for a long time, I asked again. Then his face suddenly assumed an idiotic expression, his eyes rolled upward under his eyelids, and he clearly began to create an attack.
“You won't fool me,” I said, “I'm not your doctor. I know perfectly well that you hear and understand everything. "Then his eyes went down, focused, he became completely normal and somehow surprised said:" But I really understand everything … ".
He never answered the question. That is, a psychotic attack can be controlled and specially created to solve some problems, maybe to avoid an answer. It is characteristic that this guy declared that he could not talk about himself, he denied his I.
The principle of absolute obedience is realized in fantasies (which acquire the status of reality due to a violation of the reality testing process): about voices that order something to be done and which are very difficult not to obey, about dangerous persecutors, about secret signs given by someone in the strangest forms, about the telepathically perceived will of aliens, God, etc., forcing to do something ridiculous.
In all cases, the "schizophrenic" considers himself a powerless victim of powerful forces (as it was in his childhood) and relieves himself of any responsibility for his condition, as befits a child, for whom everything is decided.
The same principle, manifested in the rejection of spontaneity, sometimes leads to the fact that any movement (even taking a glass of water) turns into a very difficult problem. It is known that the intervention of conscious control in automated skills destroys them, while the "schizophrenic" controls literally every action, sometimes leading to complete paralysis of movements.
Therefore, his body often moves like a wooden doll, and the movements of individual body parts are poorly coordinated with each other. Facial expressions are absent not only because feelings are suppressed, but also because he “does not know” how to express emotions directly or is afraid to express “wrong feelings”.
Therefore, "schizophrenics" themselves note that their face is often pulled into a motionless mask, especially when in contact with other people. Since spontaneity and positive feelings are absent, the schizophrenic becomes insensitive to humor and does not smile, at least sincerely (the laugh of a patient with hebephrenia evokes horror and sympathy in others rather than a feeling of ridicule).
The second principle (rejection of feelings) is connected, on the one hand, with the fact that in the depths of the soul there are the most nightmarish feelings, contact with which is simply terrifying. The need to restrain feelings leads to constant muscle hypertension and alienation from other people.
How can he feel other people's experiences when he does not feel his incredible power of suffering: despair, loneliness, hatred, fear, etc.? The belief that no matter what he does, all this will still lead to suffering or punishment (the theory of "double clamping" may be relevant here), can lead to complete catatonia, which is a manifestation of absolute restraint and absolute despair.
Here is another example from the same book by D. Hell and M. Fischer-Felten: “One patient reported about his experience:“It was as if life were somewhere outside, like dried out.” Another schizophrenic patient said: “It was as if my senses were paralyzed. And then they were created artificially; I feel like a robot."
A psychologist would ask: “Why did you paralyze your senses and then turn yourself into a robot?” But the patient considers himself to be just a victim of the disease, he denies that he is doing this to himself, and the doctor shares his opinion.
Note that many "schizophrenics", completing the task of drawing a human figure, introduce various mechanical parts, gears, for example. The young man, who was clearly in a borderline state, drew a robot with antennas on its head.
"Who is this?" I asked. "Elik, electronic boy," he answered. "And why antennas?" “To catch signals from space.” After a while, I happened to observe his mother, how she talked with the head of our department. I will not give details, but she behaved like a tank, achieving a deliberately inadequate goal.
Self-hatred, which has arisen for one reason or another, makes the "schizophrenic" destroy himself from the inside, in this sense schizophrenia can be defined as the suicide of the soul. But the number of real suicides among them is about 13 times higher than the similar number among healthy people.
Since outwardly they look like emotionally stupid people, doctors do not even suspect what hellish feelings are tearing them apart from the inside, especially since for the most part these feelings are "frozen", and the patient himself does not know about them or hides them.
Patients deny that they hate themselves. Moving problems to the area of delusion helps him to escape from these experiences, although the structure of delusion itself is never accidental, it reflects the patient's deep feelings and attitudes in a transformed and camouflaged form.
It is surprising that there are very interesting studies of the inner world of "schizophrenics", but the authors never get to the point of linking the content of delusions or hallucinations with certain features of the patient's real experiences and relationships. Although similar work was carried out by K. Jung in the clinic of the famous psychiatrist Bleuler.
For example, if a person with schizophrenia is convinced that his thoughts are being eavesdropped, then this may be due to the fact that he was always afraid that his parents would recognize his “bad” thoughts. Or he felt so defenseless that he wanted to withdraw into his thoughts, but even there he did not feel safe.
Maybe the fact is that he really had spiteful and other bad thoughts directed at his parents, and he was very afraid that they would find out about this, etc. But most importantly, he was convinced that his thoughts obey external forces or are available to external forces, which in fact corresponds to the abandonment of his own will, even in the field of thinking.
The young man who drew a robot with antennas on its head as a drawing of a person assured me that there are two centers of power in the world, one is himself, the second is three girls whom he once visited in a hostel … There is a struggle between these centers of power, because of which everyone (!) Now has insomnia. Earlier he told me a story about how these girls laughed at him, which really hurt him, it was clear that he liked these girls. Do I need to clarify the true background of his crazy ideas?
The hatred of the "schizophrenic" towards himself has as its reverse side "frozen" needs for love, understanding and closeness. On the one hand, he gave up the hope of achieving love, understanding and intimacy, on the other hand, this is what he most dreams of.
The schizophrenic still hopes to receive the love of a parent and does not believe that this is impossible. In particular, he tries to earn this love by literally following the parental instructions given to him in childhood.
However, distrust, generated by distorted relationships in childhood, does not allow for rapprochement, openness is frightening. Constant inner disappointment, dissatisfaction and the ban on intimacy give rise to a feeling of emptiness and hopelessness.
In the event that some kind of closeness has arisen, it acquires the meaning of supervalue, and with its loss, the final collapse of the psychic world occurs. The "schizophrenic" constantly asks himself: "Why?.." - and does not find an answer. He never felt good and doesn't know what it is.
You are unlikely to find among the "schizophrenics" such people who at least ever were truly happy, and they project their unhappy past into the future, and therefore their despair has no limit.
Self-hatred results in low self-esteem, and low self-esteem leads to further development of self-denial. Conviction in one's own insignificance can generate, as a protective form, confidence in one's own greatness, excessive pride, and a sense of godliness.
The third principle, which is the constant restraint of feelings, is related to the first and second, since restraint occurs due to the habit of obeying, constantly controlling oneself, and also because the feelings are too strong to be expressed.
In fact, the schizophrenic is deeply convinced that he is not able to release these feelings, since it will simply devastate him. In addition, while maintaining these feelings, he can continue to be offended, hate, accuse someone, expressing them, he takes a step towards forgiveness, but he just does not want this.
The young woman mentioned at the beginning of the article and who was holding back “a cry that could cut mountains like a laser” was by no means going to release this cry. "How can I let him out," she said, "if this scream is my whole life?"
Restraint of feelings leads, as already mentioned, to chronic overstrain of the muscles of the body, as well as to holding the breath. The muscular carapace prevents the free flow of energy through the body and increases the feeling of stiffness. The shell can be so strong that not a single massage therapist is able to relax it, and even in the morning, when the body is relaxed in ordinary people, in these patients the body can be tense "like a board."
The flow of energy corresponds to the image of a river or stream (this image also reflects the relationship with the mother and oral problems). If an individual in his fantasies sees a cloudy, very cold and narrow stream, then this indicates serious psychological problems (Leiner's catatim-imaginative therapy).
What do you say if he sees a narrow stream covered with a crust of ice? At the same time, a whip hits this ice, from which bloody streaks remain on the ice. This is how a sick woman described the image of the energy that "flows" along her spine.
However, "schizophrenics" can both suppress (restrain) and repress their feelings. Therefore, schizophrenics who suppress their feelings develop so-called "positive" symptoms: voiced thoughts, dialogue of voices, withdrawal or insertion of thoughts, imperative voices, etc.
At the same time, for those who displace, “negative” symptoms come to the fore: loss of drives, affective and social isolation, depletion of vocabulary, internal emptiness, etc. The former have to constantly fight with their feelings, the latter expel them outside of their personality, but weaken themselves and devastate.
By the way, this explains why antipsychotic drugs, as the same Fuller Torrey writes, are effective in combating "positive" symptoms and have almost no effect on "negative" symptoms (lack of will, autism, etc.) and reveals what exactly their action consists.
Antipsychotic drugs have essentially only one purpose - to suppress the emotional centers in the patient's brain. By suppressing emotions, antipsychotics help the schizophrenic achieve what he already strives to do, but he does not have the strength to do it.
As a result, his struggle with feelings is facilitated and "positive" symptoms as a means and expression of this struggle are no longer necessary. That is, plus the symptoms are insufficiently suppressed feelings that burst to the surface against the will of the patient.
If the schizophrenic has pushed his feelings out of the intrapersonal psychological space, then the suppression of emotions with the help of drugs does not add anything to this. Emptiness does not disappear, because nothing is already there.
It is necessary first to return these feelings, after which their suppression with drugs could have an effect. Autism and lack of will cannot disappear when emotions are suppressed; rather, they can even intensify, since they reflect the detachment from the emotional world, which is the basis of the individual's mental energy, which has already taken place within the mental world of the individual.
Minus symptoms are the result of repression of feelings, lack of energy. Therefore, antipsychotics are unable to relieve the patient of negative symptoms.
Also from this point of view, it is possible to explain one more "mystery", which is that schizophrenia practically does not occur in patients with rheumatoid arthritis.
Rheumatoid arthritis also refers to "unsolved" diseases, but in fact it is a psychosomatic disease caused by the hatred of an individual for his own body or feelings (in my practice there was such a case).
Schizophrenia, on the other hand, is hatred of one's personality, of oneself as such, and it rarely happens that both variants of hatred occur together. After all, hatred is akin to accusation, and if an individual blames his body for all his troubles, for example, for the fact that it does not correspond to the ideals of his beloved parent, then he will hardly blame himself as a person.
The outward expression of any emotion in a schizophrenic, both in the case of suppression and in the case of repression, is sharply limited and this gives the impression of emotional coldness and alienation.
At the same time, in the inner world of the individual there is an invisible "fight of giants of the senses", none of whom are able to win, and most of the time they are in a state of "clinching" (a term denoting close contact between boxers in which they clamp their hands each other and cannot strike the enemy).
Therefore, the experiences of other people are perceived by the "schizophrenic" as completely insignificant in comparison with his internal problems, he cannot give an emotional reaction to them and gives the impression of being emotionally dull.
The "schizophrenic" does not perceive humor, since humor is the embodiment of spontaneity, an unexpected change in the perception of a situation, joy, and he also does not allow spontaneity and joy.
Some schizoid individuals have confessed to me that they do not find it funny when someone tells anecdotes, they just imitate laughter when it should be. They also usually have tremendous difficulty in having an orgasm and satisfaction from sex.
Therefore, there is almost no joy in their life. They do not live in the present moment, surrendering to feelings, but look at themselves aloof from the outside and assess: "Did I really enjoy it or not?"
However, despite the strongest feelings, they are not aware of them and project them into the outside world, believing that someone is persecuting them, manipulating them against their will, reading their thoughts, etc. This projection helps to not be aware of these feelings and to be alienated from them.
They create fantasies that acquire the status of reality in their minds. But these fantasies always touch on one "fad", in other areas they can reason quite sensibly and give themselves an account of what is happening.
This "fad" actually corresponds to the deepest emotional problems of the individual, it helps them adapt to this life, endure unbearable pain and prove to themselves the unprovable, become free, remaining a "slave", become great, feeling insignificant, rebel against "injustice" life and take revenge on "everyone" by punishing oneself.
Purely statistical research cannot confirm or deny this point of view. There is a need for statistics of deep psychological studies of the inner world of these patients. Superficial data will be deliberately false due to the secrecy of both the patients themselves and their relatives, as well as due to the formality of the questions themselves.
However, psychotherapeutic research in schizophrenia is extremely difficult. Not only because these patients do not want to reveal their inner world to a doctor or psychologist, but also because conducting this research, we unwittingly hurt the strongest experiences of these people, which may have undesirable consequences for their health. Yet such research can be done carefully, for example using directed imagination, projective techniques, dream analysis, etc.
The proposed concept can be considered too simplified, but we desperately need a fairly simple concept that would explain the onset of schizophrenia, and which could explain the origin of certain symptoms of this disease, and would also be potentially testable. There are very complex psychoanalytic theories of schizophrenia, but they are very difficult to state and just as difficult to test.
The ingenious domestic psychotherapist Nazloyan, who uses mask therapy to treat such cases, believes that such a diagnosis is not needed at all. He says that the main violation in the so-called "schizophrenics" is a violation of self-identity, which generally coincides with our opinion.
With the help of a mask, which he sculpts, looking at the patient, he returns to the latter the personality he lost. Therefore, the completion of treatment according to Nazloyan is catharsis, which the "schizophrenic" is experiencing.
He sits down in front of his portrait (a portrait can be created for several months), talks to him, cries or hits the portrait. This lasts for two or three hours, and then recovery comes. These stories support the emotional theory of schizophrenia and the underlying negative self-attitudes underlying the disease.
In this sense, Christian Scharfetter's book "Schizophrenic Personalities" is extremely interesting, which describes in detail the disorders of the self-consciousness in patients with schizophrenia.
The author identifies five main dimensions of self-consciousness, the disorders of which are characteristic of these patients. These are disorders of I-vitality, I-activity, I-coherence, I-delimitation and I-identity.
The book provides a whole range of psychological theories of the origin of this disease, but today there is no convincing evidence of the correctness of one point of view or another. But maybe it is the psychological destruction of the personality control center, which we call I (or Ego), under the influence of an extremely negative self-attitude and leads to diverse manifestations of the schizophrenic symptom complex?
Another circumstantial evidence of the role of negative self-attitudes comes from the infamous "experiments" with lobotomy. Recall that a lobotomy is an operation that cuts off the nerve pathways that connect the frontal lobes of the brain to the rest of the brain.
It is surprisingly simple. Through the eye sockets, "spokes" are inserted into the human brain, with which the surgeon makes movements, approximately like scissors, and thereby cuts the connections of the frontal lobes.
The frontal lobes themselves are not removed, the operation takes literally less than an hour, does not require hospitalization, and the mentally ill person recovers almost instantly. The author of the method was so amazed by the successes that he traveled around the small villages of America and made a lobotomy for everyone right at home. Literally EVERYTHING took place. Including schizophrenia.
No explanation for this phenomenon has been proposed and lobotomy has been prohibited. Because, although the patients recovered, that is, their seizures and seizures disappeared, they became adequate, but they became healthy "vegetables".
That is, they rejoiced in simple joys, they could do simple work, but something higher disappeared from them. They lost creativity, subtle intellectual functions, ambitions, morality suffered. They were losing their most valuable human qualities.
Why? No serious theory has been put forward. Although, from our point of view, the truth lies on the surface. Because the frontal lobes provide the most important human function of self-awareness.
It is not for nothing that the frontal lobes seem to be directed into the brain, they reflect the processes that occur inside the personality itself. That is, the frontal lobes are busy with the processes of self-awareness. Namely, self-awareness ensures both the great achievements of humanity and the suffering of each individual.
It is by comparing oneself to others that a person feels a sense of shame, guilt, or inferiority. It is a sharply negative self-attitude that prompts a person to destroy his Ego. This self-attitude (or I-concept in the terms of K. Rogers) is formed under the influence of “significant Others”, primarily under the influence of parents. Their attitude towards the child later becomes his own self-attitude, and he treats himself as his parents (primarily the mother) treated him.
With a lobotomy, self-attitude disappears, a person ceases to reflect, condemn himself, hate himself, because self-awareness that provides social self-control within the personality cannot be exercised.
A person begins to live in the present moment, not evaluating himself in any way, rejoicing in immediate experiences. Social rejection does not turn into his own selflessness. He does not give up his Self and does not “go crazy” anymore.
However, he also loses the desire to gain some social approval and prestige, to create something for society. Therefore, he loses both ambition and a passionate desire to achieve something in this life. Painful moral searches for the meaning of life, immortality, God disappear from him. Together with the newly acquired normality, he loses something purely human.
It is appropriate here to give an example of a deep study of the feeling of fear in a sick young woman in remission (it should be noted that she was fully aware of the seriousness of her illness, but did not want to be treated with medical means). She told how, as a child, her mother constantly beat her, and she hid, but her mother found and beat her for no reason.
I asked her to imagine what her fear looks like. She replied that fear was like a white, quivering jelly (this image, of course, reflected her own state). Then I asked, who or what is this jelly afraid of?
After thinking, she replied that what caused the fear was a huge gorilla, but this gorilla clearly did nothing against the jelly. This surprised me and I asked her to play the role of a gorilla. She got up from the chair, entered the role of this image, but said that the gorilla did not attack anyone, instead for some reason she wanted to go to the table and knock on it, while she imperatively said several times: "Come out."
"Who's going out?" I asked. "A little child comes out." she replied. "What does a gorilla do?" “Doesn't do anything, but she wants to take this child by the legs and smash his head against the wall,” was her answer.
I would like to leave this episode without comment, it speaks for itself, although of course there are people who can write off this case simply at the expense of the schizophrenic fantasy of this young woman, especially since she herself then began to deny that it was a gorilla - her image mother, that in fact, she was the desired child for the mother, etc.
This was in complete contradiction with what she had said before with many details and details, so it is easy to understand that such a turn in her mind was a way to protect herself from unwanted understanding.
Is it because our science has not yet discovered the essence of schizophrenia, because it also defends itself against unwanted understanding.
I will summarize the main theoretical positions that were expressed in this article:
1. The causes of schizophrenia lie in unbearable emotions directed by a person to destroy his own I, which leads to a violation of the natural processes of testing reality;
2. As a consequence of this, self-deprecation, suppression of the emotional sphere, refusal of spontaneity, overstrain of the muscles of the body, lead to isolation and communication disorders;
3. Hallucinations and delusions are compensatory in nature and are, in fact, waking dreams;
4. Antipsychotics and other antipsychotic drugs suppress the emotional centers of the brain, so they contribute to the disappearance of plus-symptoms, and are powerless to help with minus-symptoms;
5. Lobotomy helped in the treatment of schizophrenia and other mental illnesses because it destroyed the neural substrate of self-awareness, but thereby also destroyed the patient's personality.
Nikolay Linde
- Part one -