Schizophrenia and the Demands of Emotion




mosaic of young man expressing different emotions

It is clear and obvious that the mind is intentional in terms of its activity. Intentional cognitive activity is seen simply in the ability to solve math problems. It is perhaps more subtle that emotions influence the direction of cognitive activity. Emotional activity is driven less by intention than cognitive activity.

Emotions, which are non-rational, implicate defense mechanisms when they impact thought. Three of the defense mechanisms, developed by Anna Freud, are as follows: denial, sublimation and regression. The defense mechanisms have been modified, construed and categorized by psychiatrist George Eman Vaillant. Vaillant has constructed an extensive theory regarding defense mechanisms based upon Anna Freud’s paradigm. Further comments related to his theory will appear in a latter part of this discussion. In terms of Anna Freud’s definition of certain defense mechanisms, the following is relevant:

  • Denial can be represented by the refusal to accept realities of the mental and material worlds, or actively contending against ideas that provoke in one anxiety. Denial, like other defense mechanisms, relies on “Repression,” a defense mechanism that is understood to underlie all other defense mechanisms.
  • Sublimation represents the alteration or conversion of negative emotions or instincts into positive actions, behaviors, or emotions. This defense mechanism shapes our perspectives by negating the impact of ego gratification, for example, allowing a person to view himself as altruistic, as he denies his unconscious intent to transform negative feelings into ethical and helpful ones. Nevertheless, this defense mechanism is that upon which many good aspects of our society are perpetuated. Individuals who uphold values that are embraced by most people typically use sublimation. The defense mechanism of sublimation allows us ego gains by convincing us of the morality and ethics behind our good deeds.
  • Regressive behavior allows us to retreat to a more comforting and nurturing view of our environments in spite of the fact that this view does not correspond to reality. Regressing into a previous and less mature state of mental and physical development allows one to achieve more psychological and physical comfort than facing a situation without unconsciously distorting it through regression.

As stated by Vaillant, it is also evident, and perhaps more evident, that psychotic thought is skewed by emotion that is the impetus for defense mechanisms. This implicates more psychologically pathological use of defense mechanisms. Through a description of the following three types of delusions, based upon mechanisms of psychological defense, it is possible to discern the emotional motivation for psychotic thinking:

  • Psychotic delusions of persecution represent a category of defense mechanisms. Delusions of persecution may fulfill a need for self-importance, and, moreover, they provide us with a sense of reason, fabricated or not so, for our suffering.
  • Delusions of grandeur, what Vaillant terms as signifying a “superiority complex”, allow for both better self-esteem and the self-perception that one is more powerful in the world than one really is, in spite of the fact these feelings represent pseudo-positive feeling.
  • Erotomanic delusions may reward us sexually, but they may also fulfill desires for intimacy.

These considerations point to the emotional neediness of psychotic individuals. As if the term, “emotional neediness”, is not insulting and deprecating, it is nevertheless relevant. The alienation and the subjugation of the mentally ill are real, and the emotional reasoning behind their defenses are obvious. These facts point to the best answer to the problem of mental illness such as schizophrenia: Fulfill the biopsychosocial needs of the psychotic mentally ill.

In terms of these considerations, medication is effective, and, as science advances, it is becoming increasingly more effective. Relief from alienation is important, and it should be psychotherapeutically approached with as much empathy as possible. Lastly, we should combat the stigma associated with schizophrenia.

As stated, the answers are simple. Enacting them is not. However, if the emotional neediness of schizophrenics is understood compassionately and without judgment, the reality of schizophrenia can be less stigmatizing, it may draw less criticism, and, ultimately, it may be ameliorated. It should be asserted, however, that the problem is not simply the label: “schizophrenic”. The problem may be a matter of assuming the label of “schizophrenia” by the schizophrenic as indicative of personal identity. It is obvious that mental illness of the psychotic mentally ill impacts these individuals possibly more than any other circumstance of their lives ever will. Nevertheless, the realities of these individuals, while perhaps “unreal”, can be viewed with compassion — unless the sane people will not or cannot do so.

References

Vaillant, G. (1986). An Empirically Validated Hierarchy of Defense Mechanisms Archives of General Psychiatry, 43 (8) DOI: 10.1001/archpsyc.1986.01800080072010

Image via Olly / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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