Ann Reitan, PsyD – Brain Blogger Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 All You Need Is Love? Mon, 06 Jul 2015 14:00:18 +0000 Freud stated that one component of happiness is love. Correspondingly, one aspect of wellbeing is appropriate emotional attachment. Relationships, especially when they reflect the needs of the mentally ill individual, can counteract the problems of alienation and a lack of relational success, which typify mental illness, to a significant extent.

Essential to success in the arena of love and attachment depends on the appropriate “fit” of relational activity with respect to the unique needs, abilities, and skills of that individual. The need for practical success in relational spheres is paramount to the wellbeing of all people, but this need is seen most poignantly in the mentally ill.

Often, relational activity is compromised in the mentally ill. This is true of various psychological and psychiatric disorders that include psychotic disorders and borderline personality disorder (BPD).

These symptoms can include sporadic and spontaneous anxiety, ongoing subjective distress, impulsivity, mood fluctuations, flat affect and dissociation or emotional withdrawal, and symptoms of paranoia. Note that these disorders have components of anxiety and disrupted social relationships, especially in terms of the realities of distorted interpersonal boundaries. Note, also, that emotional attachment and detachment signified by very weak and insecure boundaries, such as seen in BPD, and the very strong and isolative boundaries associated with psychotic disorders, will profoundly affect negatively these individuals’ ability to negotiate relationships.

Mental illness may evolve or mutate most prominently with the circumstances of changing interpersonal activity. It is important to have a significant other in one’s life, such an individual may be characterized by a caretaker, a friend who accepts the truthful realities of one’s mental illness, or a spouse who understands the extremes of one’s illness.

The benefits of group intervention

Moreover, the mental or the behavioral health system often conducts groups for even severely mentally ill individuals. Group and individual psychotherapy with these people is paramount in treating the emotional and the relational components of these disorders.

One aspect of group intervention with psychotic clients, who often have trouble connecting with caregivers and therapists, may be the cultivation of an atmosphere in the group that allows for the honest expression of an
individual’s hallucinations and delusions, allowing for an explanation of how these thoughts and feelings are construed by that individual.

The actual intervention in this scenario would be to ask the peers of the divulging client to express how he or she thinks it feels to hold the beliefs of that individual. This is an example of how to treat psychotic disorders, and a lessening of paranoia may emerge in the psychotic client.

Impulsivity and subjective distress, in addition to disrupted and diffuse boundaries, characterize borderline personality disorder. Linehan’s Dialectical Behavioral Therapy (DBT) has been shown to be effective in treating this disorder. The curative essence of this theory and therapy seems to be the cultivation of an accepting relationship with the client and the treatment of the client’s stated needs and concerns with respect. By asking the client what she needs “right now”, the client is much more likely to conceptualize her issues as surmountable, at least in terms of the immediacy in meeting her needs.

This juxtaposition of ”process” and “content´ represents the dialectical component of this therapy. It contains the practice of treating the client with implacable goodwill, and this component of DBT is both innovative and illuminating.

The links between psychopathology and interpersonal relationships

It is interesting and it may be the case that psychotic disorders and personality disorders may reside on a continuum of more or less psychopathology and functional relational connectedness. While both types of disorders are severe, they entail differences in terms of relational closeness with others: friends, significant others, family members and caregivers, clinicians, psychologists and psychiatrists.

Essentially, the individual with BPD may have insecure attachments with other people, who may be perceived as significant or not so in the life of the individual, by that individual, consciously or unconsciously. It is the perception of the client with BPD that his relationships are unreliable and untrustworthy. Treatment for BPD should be enacted with implacable good will, and, while the BPD client may founder in distress and distrust of her clinician, eventually, perhaps, that client will begin to stabilize in valuing and devaluing the clinician in a balanced way.

Implications for therapy and treatment

In terms of psychotic disorders, the individuals manifesting them are much less treatable by means of traditional individual psychotherapy. It should be noted that the emotions in those with psychotic disorders may be dormant, unconscious and trampled into oblivion by the realities of punitive symptoms culminating in learned helplessness.

Their thought processes also may be compromised by limited frontal lobe activity, either as a direct causal element in the presentation of psychotic disorders, or emerging from the psychotic individual’s inability to
think logically about his non-normative experience.

However, while they may be much less able to express their feelings than those individuals with BPD, there are ways to elicit expression of their feelings. Creative self-expression may be at least a partial means of allowing the psychotic individual to find a recapitulation of her internal feelings. By means of visual art and creative writing, the psychotic client may be able to express dormant feelings that allow her to project onto her artwork a reflection of her internal state.

As is known, projection of one’s internal state in terms of self-reflection is crucial to effective psychotherapy. Art therapy serves this need as well.

Overall, relationship and interpersonal connectedness are essential to psychological wellbeing. Freud stated that love is an aspect of happiness. While many interpersonal relationships do not equate with love, more or less, relationships with others signify an important treatment concern, and this concern should be translated into action by establishing endeavors to reach the client in terms of his core – sometimes utilizing creative methods.

Image via William Perugini / Shutterstock.

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Stigma Towards Mental Health Stigma Impacts Vocation Sat, 04 Jul 2015 14:00:29 +0000 Freud stated that the components of happiness are love and work. Yet, it’s interesting that people in our society tend to accept, almost unconsciously, the idea that mentally ill people are not suitable for either of these activities.

This idea seems to pervade, especially in the minds of people who adhere to conventional modes of thought. It is severe stigmatization that allows those who are not mentally ill to placidly ignore the difficulties of those who are, as these non-mentally ill people proceed without any kind of empathy for those much less fortunate.

The functioning of mentally ill individuals in vocational spheres implicates labelling theory. Mentally ill people judged to be less competent, and they become this by means of self-fulfilling prophecy. The mentally ill are labelled and viewed as dysfunctional due to stigma, they then internalize negative self-evaluations, they react with less confidence, and they understand that they are not “normal”, they become agonizingly doubtful about their ability to achieve normal lives, they tend to become less competent than other “normal” people, they focus on their inadequacies and undermine their potentials for success, especially in the realms of love and work.

Nevertheless, there do exist types of employment are seen as appropriate for mentally ill individuals, including jobs at fast food restaurants, dishwashing in restaurants, serving in convenience stores, stocking products in stores, and as peer support specialists in mental health clinics and facilities. As an unspoken precedent, there seems a normative view that the more simple and menial the proposed jobs is, the more likely the mentally ill individual will be able to perform the functions of the job.

This normative view is not blatantly unsupported. However, it is herein contended that, except in the case of highly specialized, complicated professions that require extensive experience, training and advanced degrees, what type of job really suits the mentally individual in terms of a niche may be counterintuitive.

The right “niche” is a powerful idea. A person’s niche may have little to do with education, IQ, cognitive ability, or aspiration. The right niche may have to do with the stress of a job, uniquely perceived by the individual and the mentally ill individual in particular. The right niche may also involve the atmosphere of a workplace or the idiosyncratic relationships that one forms with one’s boss or one’s co-workers.

Acceptance in the workplace is to be sought after by the mentally ill individual. This can mean hiding one of the most important aspects of one’s identity: one’s mental illness, (and it should be noted that, however we try to circumvent the issue, one’s mental illness is a large aspect of the mentally ill individual’s identity.) The choice for the mentally ill seems to be honesty about their mental illness, entailing a lack of acceptance associated with stigma that causes one to denigrate oneself and one’s ability, or concealing their mental illness, which is accompanied by anxiety, shame and a feeling of lacking integrity. This situation, for the mentally ill individual, amounts to the emergence of neuroticism, in addition to the mania or depression or psychotic symptoms that this individual may display.

The psychological pain of stigma is perceived subjectively by the mentally ill individual, although all mentally ill individuals know, consciously or unconsciously, what stigma means in terms of the psychological ramifications. Overall, the solution to this conundrum would seem to be efforts to lessen the stigma associated with mental illness. Acceptance of the mentally ill by larger society is imperative. How this may take place is an even greater conundrum.

Image via Dmitry Kalinovsky / Shutterstock.

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The Black “Whole” of Paranoid Schizophrenia Fri, 12 Jun 2015 14:00:07 +0000 It has been stated that paranoid schizophrenics are more cognitively able than those manifesting other forms of schizophrenia.  While this assertion may be somewhat dubious, there exists a reality that paranoid schizophrenics do think about their circumstances, instead of simply being overwhelmed and confused by their symptoms, albeit some delusional symptoms.  Given the basic delusional assumptions that paranoid schizophrenics may hold, paranoia is perhaps an understandable reaction to their symptoms.


The paranoia that certain schizophrenics display or perhaps conceal reflects a reaction to the attrbutions that form the premises of what paranoid schizophrenics believe.  It may or may not be obvious that paranoia exists as a result of a belief that something or someone perhaps incomprehensible holds power over one’s life, one’s self, one’s emotions and even one’s thoughts.  When the schizophrenic attributes intentionality to who or whatever is causing her symptoms, paranoia is an understandable reaction.


Thinking about one’s symptoms, (for example, one’s auditory hallucinations), is likely to lead to a compounding delusional system in the paranoid schizophrenic.  It is not a comforting situation to be alone with one’s non-normative experience, to hold ideas and beliefs that seemingly no one else supports, and to be afraid.  Schizophrenics feel compelled to make sense of themselves to nonpsychotic individuals.  They seek a reflection of their internal states, and, given that interpersonal behavior, implicating shared feeling, is comforting, it becomes evident that paranoid schizophrenics have little solace with regard to their existence.


This writer has asserted in the past that psychotic delusions can be combatted by the schizophrenic’s refusal to make a judgement about his hallucinations.  Consideration of the statement and postulation that “the whole if more than the sum of the parts”, reflects the reason behind a refusal to make a judgment:  a judgment about “the whole”, and it can be “a black hole”, allows for a refusal to enact gravitation toward the “reality” of what might become the paramount and constructed delusional system of the paranoid schizophrenic.  Note that, in many paranoid schizophrenics, this type of judgment about the whole may entail suicide.


I once read a quotation that essentially stated that “we are happy if, for everything inside us, there is an equal and opposite reflection of us in the outside world.”  This applies to one’s mental health, and it represents a basis for Humanistic theory and therapy.

Accurate reflection of the self is what is at the heart of the conundrum inherent in the delusional systems of schizophrenics.  If the schizophrenic makes a seemingly all-encompassing judgment about his condition of mental illness, his view of the self in the wake of such an affirmation of hallucinations and delusions may, again, form a basis for suicide.


Even relative comprehension of this article might provide some basis for psychotherapeutic reflection of the paranoid schizophrenic.  Nevertheless, this assertion would amount to contesting that psychoeducation is curative, and it is only marginally so. However, accurate reflection of schizophrenics’ internal state is what is lacking in psychotherapy with these individuals.


It should be noted that this article represents a kind of meta-theory, or theory about theory based essentially on the delusional theories of schizophrenics, paranoid or not so.  In terms of this, what is written here does not have the immediacy or the visceral quality of sensory experience or, for that matter, the pseudo-sensory experience of hallucinations.


Ultimately and as stated, accurate reflection of schizophrenics’ internal states is lacking in psychotherapy with these individuals.  It may be easier to empathize with these individuals—without validating their delusional systems-than is realized

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Psychosis and Resistance to Taking Meds Wed, 10 Jun 2015 14:00:19 +0000 It is known that psychotropic medication can be quite efficacious in treating the mentally ill. It’s also known that psychotic individuals may discontinue taking their medication. This is a serious treatment consideration. The tendency in some schizophrenics to stop taking their meds bears scrutiny.

The scientific bases for treatment with antipsychotics may be compelling to scientists, and cognitive understanding behind the use of this type of medication is convincing. While it is obvious that antipsychotic medication, to a great extent, alleviates psychopathology, this fact may be less obvious to the schizophrenic.
Medication for treatment of psychotic disorders is not entirely effective. It does not completely resolve mental illness. The complete diminishment of symptoms of psychosis has not been entirely forthcoming, in spite of rigorous research and significant advances in the science of psychiatry. As stated clearly, the “cure” for schizophrenia has not been established, and this reality allows psychotic individuals to speculate about the remaining ineffectiveness of psychotropic medication.

This ineffectiveness of antipsychotic meds allows psychotic thought to compound psychotic thought. Essentially, psychotic symptoms reinforce psychotic symptoms. It is the nature of delusions to provide a basis for further delusions, and one of these delusions in psychotic individuals may be the idea that medication causes mental illness. This is an idea represents a reality to schizophrenics, perhaps reinforced by chance alone.

Another aspect of psychotic thought is that it is quite simplistic, such as the idea that medication causes psychotic symptoms. This delusion may be actualized by psychotic individuals’ perception regarding the correspondence between taking medication and having psychotic symptoms. While correlation does not imply causation, this concept may be difficult for schizophrenics to grasp.

Schizophrenics may believe that, if they do not take their meds, they will cease to be psychotic. The rebound of psychotic symptoms that accompany discontinuation of antipsychotic meds proves that this discontinuation will not entail the lessening of psychotic symptoms. The implacability of delusional material allows for logical thought to be compromised in a manner that confirms delusional material. Clearly, delusion strengthens delusion in a cyclic way, and the psychotic symptoms that remain event in the wake of taking meds will continue to manifest themselves, in spite of taking meds.

Although behaviorism applies to behavior, the “covert” behavior of cognition is reinforced by the schizophrenic’s palatable belief that their symptoms can be explained in a way that is understandable to themselves and others, in a congruent way. This leads to simplistic affirmation of delusional material by the schizophrenic, and it is perhaps the seeming remote quality of the scientific method that will not convince the schizophrenic to relinquish delusion. Relinquishing delusional material may not be possible, as delusion compounds delusion, and the basis for psychotic ideation appears to be psychosis.  Delusional material relies on interval-ratio reinforcement even though it is related to the covert behavior of cognition that is reinforced by chance alone.

What is seen as rewarding to the schizophrenic is the cultivation of comprehensible beliefs that will not be viewed as stigmatizing by others.

While the situation of delusion compounding delusion in the schizophrenic is dire, comprehension of how the schizophrenic views her situation may allow for a deeper understanding of the emotions of the schizophrenic, and these emotions may be asserted to be valid given the subjective, albeit delusional, perspective that the schizophrenic painfully embraces.

Image via Jeng Niamwhan / Shutterstock.

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Dissociation and Psychosis Thu, 21 May 2015 12:00:59 +0000 Dissociation represents a condition of disconnection from events and states that are usually integrated. These include many conditions of consciousness, such as memory, identity and perception. For the purposes of this article, there is a focus on depersonalization and derealization.

Depersonalization is a sense of existence in which one inhabits a consciousness that allows for the feeling that one is not in her own body. In this feeling-state, the individual’s body is perceived as disconnected from one’s sense of self. This state typically results from physical or sexual abuse or other types of trauma.

Derealization comprises a state in which the world and the environment “feel” unreal to the individual residing in this state. Both depersonalization and derealization are aspects of dissociation represented by subjective states that usually result from trauma.

Both of these aspects of dissociation, specifically, depersonalization and derealization, can be considered psychological mechanisms of defense. Nevertheless, living in a dissociative state is not ideal: it represents an emotional withdrawal from one’s healthy sense of self and the world. However, dissociation can protect the individual in that state from future trauma, such as physical abuse that results in psychological abuse.

Dissociation in the forms of depersonalization and derealization provide a thin, albeit very thin, emotional buffer against physical or psychological harm.

The science of psychiatry treats psychotic disorders through the application of medication to the problems of hallucinations and delusions. The reality or unreality of hallucinations, which may be considered a semantic onslaught, can cause one to withdraw into the self and experience dissociation, such as depersonalization and derealization. While meds might culminate in the elimination of hallucinations (which is a great achievement), psychotic states whose symptoms are represented by auditory hallucinations, are experienced by the psychotic individual as torture amounting to trauma. Delusions compound this suffering.

Trauma can result in regression through emotional withdrawal of the self from the material self and the material world. While it might seem sentimental to procure the phrase, “a return to the womb”, this may be exactly what dissociation represents.

While perhaps not understood to be a salient precursor to Eriksons’s stages of development, this “return to the womb” may be considered to be an internal state of those who have experienced trauma, including the subjective experience of psychosis.

Regressive psychotherapy based upon the Eriksonian stages, proceeding with a a focus on “trust versus mistrust” and on to psychological dichotomies at the psychotic person’s natural level of development, such as “intimacy versus isolation”, may prove to be effective. This psychotherapy might be created utilizing appropriate interventions, such as Rogerian therapy as an initial stage focusing on trust, moving toward the cultivation of feelings of autonomy using Adlerian therapy, reinforcing acts of initiative and industrious accomplishment using behaviorism, engendering identity using cognitive therapy that addresses the emergence of abstract thought.

Overall, the dissociative person is a fragile shell of a person as a result of trauma. Nurturing this budding human being through appropriate psychotherapy might ameliorate the trauma associated with the expression of depersonalization and derealization.

Image via Anna Tamila / Shutterstock.

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Learning Skills and Psychosis Tue, 14 Apr 2015 12:00:05 +0000 As a doctor of clinical psychology, I address differently the problem of psychosis. I approach psychosis as a result of trauma and mental phenomena as opposed focusing on the brain, the empirical and the medical model of mental illness.

I was very recently reading an article on the subject of new advances in medications to treat disorders that implicate the biochemistry of the brain. This article was entitled “Brain Boom”, and it was written by Mathew Herper. In this article it was stated that, in treating schizophrenia: “Currently, drugs can be effective at treating hallucinations and paranoia, but don’t yet treat cognitive problems and social difficulties caused by the disease.”

There are distinct differences between the experiences of hallucinations and paranoia that may explain why these characteristics are able to be ameliorated by medication while the others are not. It should be noted that hallucinations and emotional problems such as paranoia are visceral experiences, and, for that reason, they may be more implicated in the abnormal brain chemistry from which psychosis emerges. Cognitive and social problems, problems, however, may depend more on experience in the mental and material worlds.

When discussing cognition in a schizophrenic, certain difficulties in schizophrenic thinking are obvious. Loose associations, word salad and poverty of speech are some examples of what signifies cognitive difficulties in these individuals with psychosis. One fact that is seldom considered is that schizophrenics deal with experience that is uncharted — it is novel — and it cannot easily be understood cognitively in that it is difficult to cognitively manipulate the experience of psychosis by the schizophrenic’s own efforts. Why would anyone expect the schizophrenic to be able to think about experience that is uncommon and non-normative? There is no real basis, no real tradition in thought, that would allow the schizophrenic to think productively about psychosis.

While I was in graduate school, I asserted that I wanted to write theory concerning meta-belief systems. Essentially, I wanted to generate belief systems about belief systems — to understand psychosis from a theoretical and essentially cognitive perspective based in cognitive theory. The point that I wish to make is that psychosis, as a thought disorder, should not be encapsulated as a biochemical disorder exclusively. As indicated, it is my belief that the expression of psychosis as psychopathology depends on the mind and the environment as well as biochemical phenomena.

Clearly social deficits in schizophrenics depend on experience in the material world. Given the fact that psychosis tends to emerge in adolescence and young adulthood, there are very important developmental activities that are compromised in terms of maturing socially. This is seen most prominently in Erikson’s stages of social development. When schizophrenia typically emerges, the individual is in the “identity versus role confusion stage” or the “intimacy versus isolation stage”. Psychosis leads to problems with identity formation and interpersonal alienation. This may be attributed to non-normative experience and impoverished social experience.

Essentially, the schizophrenic’s poor cognitive and social skills are impacted by non-normative experience, and hallucinations and paranoia have causal effects on deviant cognition and a lack of social skill. If hallucinations and paranoia can be diminished early in the course schizophrenia, perhaps this non-normative experience would not have this negative impact on cognition and social skill. Clearly, paranoia and hallucinations are implicated in a causal way in terms of their effect on cognition and social skills. Nevertheless, poor cognitive activity and limited social skill depend on non-normative experience in the mental and material worlds.

Overall, poor cognitive and social skills result from a diminished fund of learning. Nevertheless, cognitive skills may be reflected in meta-cognition as it relates to psychosis. Enhancement of cognition about cognition, or cognition about psychosis, may allow for the schizophrenic’s detachment from her psychotic experience. This may prove to be therapeutic. Similarly, the therapeutic benefits of social skills training may be therapeutic. As learning deficits, poor cognitive and social skills have the capacity to respond to learning, and this is a positive correlate to the fact that cognitive and social skills are learned.


Since submitting this article, I have given more thought to the assertion I made regarding the statements within the article Brain Boom. It was stated in Brain Boom, by Matthew Herper, that “currently, drugs can be effective in treating hallucinations and paranoia, but don’t yet treat cognitive problems and social difficulties caused by the disease.”

In terms of cognitive problems in schizophrenics, it may be said that medication improves cognitive organization. While not a replica of intelligence, IQ may be considered to approach cognitive ability based on cognitive organization. There is no doubt that a schizophrenic who is being treated with antipsychotic medication will score higher on an IQ test than that same person might score while taking an equivalent test while taking no antipsychotic meds. This illuminates the effect of medication on cognitive problems in schizophrenics. While not aligned with the quoted statement in the article Brain Boom, my statements herein support the dramatic and positive effects of antipsychotic medication.

In terms of social skills, I have stated that these are learned, and, correspondingly, these are not learned in schizophrenics due to aspects of poor development in the Eriksonian stages of “identity versus role confusion” and “intimacy versus isolation”. When the Eriksonian stages of development are compromised, the resulting deficits in social skill and ability can be understood. Moreover, treating and diminishing paranoia with antipsychotic medication will have a positive effect on social skills in time. The important part of this last statement is “in time”.

Overall, there exists a synergy between biochemical effects of meds and the realities of cognitive deficits as well as the role of negative emotional states affecting traits. Attempting to separate the material biochemical brain functions treated by antipsychotic meds, from cognitive and social processes that are aligned with schizophrenia is confounded by the synergy between biochemical, cognitive and social aspects of the disease of schizophrenia.

The key to seeing cognitive and social progress in the medicated schizophrenic could be the longevity with which improvement in psychotic process is observed — after the fact of administration of antipsyhcotic medication to the schizophrenic individual.

Image via Volt Collection / Shutterstock.

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Proactive Intervention for the Emergence of Psychosis Fri, 20 Mar 2015 11:00:08 +0000 It is known that mental illness – and serious psychotic disorders in particular – tend to afflict young adults who are socially, vocationally and academically disadvantaged individuals. While this is not always the case, it is true that those people who emerge with psychotic disorders tend to be isolative individuals who have social difficulties in the arenas of junior high and high school.

It is much less likely that young people who are fully integrated academically, vocationally and socially with their primary peers groups will emerge with schizophrenia and other psychotic disorders generally. Intuitively congruent with this is the assertion that young adults and adolescents who engage in academic and social activities in junior high and high school may be able to ward off the expression of mental illness and psychotic disorders themselves. In fact, social involvement, whether this is constituted by belonging to the Latin Club or the Soccer Team, may provide a buffer against the emergence of mental illness, in spite of  individuals  having a genetic predisposition to psychosis.

It has been asserted that diagnoses of schizophrenia in identical twin studies demonstrate an approximately 50% concordance rate. This means that environmental factors are as much complicit in the emergence or lack of it of schizophrenia as biological factors and genetic factors in particular.  It is obvious that there exists a synergy between the mind, the brain and the environment.  Attributions about one’s experience of the material world alters how the environment is perceived by the individual.  Mental experience is unique to the individual, whether that individual is an identical twin or not so.  Based upon these facts, identical twins will differ to some extent in whether psychosis will emerge.

This fact bodes well for the potential of all persons who may or may not emerge with schizophrenia in spite of genetic predispositions. It is obvious that an adolescent’s academic and social involvement activities with peers in young adulthood will impact social his skills as a mature adult.

This does not mean that, if psychotic disorders do emerge, there is no reason to expect that the adult with a psychotic disorder will not be able to pursue and achieve social, academic and vocational success. Most if not all individuals have resources and avenues to success.  However, positive academic, vocational and extracurricular involvement with peers in junior high and high school will provide the individual who genetically predisposed to schizophrenia with a foundation for success in later life, regardless of whether that individual emerges with schizophrenia.

It has been stated by one of my mentors that, if a child has one adult in his life who supports him in ways that may approach unconditional validation, that child will emerge as resilient. Unconditional love and support may, however, be a myth.

Nevertheless, a good enough role model may be able to guide and and support the psychotic individual and work with his strengths in all or even one area. This might make a considerable difference in individual’s ability to cope with schizophrenia and emerge as successful in areas of love and work in spite of it.

Image via Antonio Diaz / Shutterstock.

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Schizophrenia and the Demands of Emotion Thu, 08 Jan 2015 12:00:22 +0000 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.


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

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Mental Context – A Delicate Subject Wed, 10 Dec 2014 12:00:43 +0000 Differentiating psychotic experience from religious experience is a delicate matter. The discussion that follows is not intended to validate psychotic experience or denigrate religious experience. Rather, it is meant to address the questions of whether hallucinations and delusions can be distinguished from religious experience.

M. Pierre, a noted researcher, wrote an article entitled “Faith or delusion? At the crossroads of religion and psychosis”. In this article, he evaluates clinical psychiatric or psychological practice concluding that, “in clinical practice, no clear guidelines exist to distinguish between ‘normal’ religious beliefs and ‘pathological’ religious delusions.” Clearly, differentiating psychotic experience and religious experience represents a difficult conundrum.

It should be noted that both psychotic experience and religious experience largely rely on events in the mental realm. Scientists who attempt to empirically evaluate and validate religious experience often overlook the fact that facts emerge from and in the material world, and religious faith is generated from mental experience perhaps in synchronicity with material experience. As such, religious experience is subjective instead of being objective. However, this does not mean that it is invalid.

Synchronicity is a concept that can explain religious experience. Synchronicity is defined as the simultaneous appearance of events which appear significantly related but have no discernable causal connection. Religious experience relies on the reality that there are no discernable causal connections regarding the synchronicity of parallel events in the material and the mental realms. Synchronicity may be characteristic of religious experience, and it is the lack of a causal connection that forms a basis for individuals to understand this experience as miraculous. Causal realities are thought to rely on chance events. When experience appears to be meaningful but strongly improbable, it is thought not to be based upon chance events.

The psychotic individual may experience synchronicity of chance events, but in terms of this experience, synchronicity generates delusions instead of faith in religious ideas, including miracles.

Psychotic ideation and religion may be differentiated, and the key to this differentiation may be based on the context in which they occur. Religious ideas usually occur in the context of benevolence, perhaps that of God, as well as a positive view of the world in terms of non-normative experience. Psychotic ideation occurs in the context of a punitive and deceptive state of mind and the world. Religious experience is sought in the mental and the material worlds, while psychotic hallucinations and delusions result in the psychotic individual cringing in both the mental and the material worlds. It should be noted, however, that what is defined by religious experience can be negative, as well. However, it may be meaningful to the individual whether it is positive or negative, while psychosis tends to be dismissed by the non-psychotic as not meaningful.

I’ve suggested in previous articles that the mind is whatever we imagine it to be. This is a simple and perhaps dubious statement, but it is not entirely dissimilar to and incompatible with the idea that the mind is Skinner’s “black box”. The appearance of what constitutes experience outside of what can be considered causally explicated may be understood as relying on the mental context of this experience.

While religious individuals may welcome “miracles” nonjudgmentally, paranoid psychotic individuals go to extremes of thought in order to make sense of them or avoid them. The psychotic individual may not be able to make sense of “religious experience” because, to them, the only rational and logical ways of understanding psychosis rely on metacognition instead of faith. If psychotic individuals could exercise faith that hallucinations are just that – hallucinations – then they would function in a more positive way.

It is the case that psychosis is ego-dystonic, incompatible with the self-conception and the- definition of the psychotic individual. This may be the result of stigma that accompanies the self-denigration by the psychotic individual or the possible insidious, but relentless, auditory hallucinations that may clamor within the mental experience of the psychotic individual. What clinicians treating the mentally do not seem to realize is that, while the psychotic should accept psychosis, psychosis may be unacceptable.

Overall, it seems to be the context of religious and psychotic experience that differentiates them. The specific religious context of this perceived experience may determine whether this experience is positive or negative. Even though religious experience can have positive or negative connotations, it is still regarded as more meaningful than psychotic experience, and it is responded to with faith. Faith implicates a tendency on the part of the religious person to accept with little evaluation the perceived meaning of experience. Faith, like self-confidence, may elicit faith or trust in religious experience as defined by the individual, and this faith or trust may frame experience in a way that is compatible with a perceived unification with God. If the mind is whatever we each imagine it to be in terms of projection onto the mental realm, then religious experience will have an appearance of validity simply because this validity is expected.

Psychotic experience remains more problematic to the individual dealing with hallucinations and delusions. Often, psychotic individuals imagine their minds to be punitive arenas that present as deceptive. Because they imagine their experience to be irrational, as is told to them by clinicians, their experience of their minds and even their material environments are confusing and painful.

While a perceived experience of God or the identification as experience emanating from God within the mental realms of the religious person, one is forgiven, loved and trusting. God is represented as faithful in doing what is best for the individual, even when the experience of what seems to be God’s will can be painful. When the imagined mental context represents God as trustworthy, good thoughts and feelings will emanate from this experience. Conversely, the experience of the psychotic mind is painful. Due to the difference in the way mental experience is framed in terms of religion and psychosis, the subjective realities of the mind’s presentation will conform to divergent representations of reality in both the mental and the material realms.

This discussion is not meant to imply that religious experience is invalid or that psychotic experience should be considered valid. The essential idea that is proposed in this article is that the mind is whatever it is imagined to be by the individual experiencing it. Although this idea may be identified as a weak explanation of the mind, this understanding of the mind implicates projection onto the mental world of what the mind is believed to be by the individual. What the mind is believed to be then generates a context of the mental realm, and the appearance of psychosis and religious views of the mind rely on context.


Pierre JM (2001). Faith or delusion? At the crossroads of religion and psychosis. Journal of psychiatric practice, 7 (3), 163-72 PMID: 15990520

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Stigma and Schizophrenia – A Predetermination of Failure Fri, 28 Nov 2014 12:00:26 +0000 Stigma surrounding schizophrenia is a circumstance of mental illness that the newly diagnosed schizophrenic may not initially perceive or anticipate. To my knowledge, many schizophrenics initially speak of their mental illnesses publicly to strangers, not really expecting that this will cause others to view them as extremely peculiar or exactly what they are: mentally ill.

Newly diagnosed schizophrenics may seek reflection of their internal states, attempting to understand themselves as mentally ill. It is then that they encounter stigmatization.

As a matter of course, stigma tends to exacerbate the condition of schizophrenia because it leads to interpersonal alienation and a withdrawal into the mental realm. This culminates in greater involvement in psychotic ideation and perhaps greater interaction with one’s hallucinations, as this is understood by the schizophrenic. Stigmatization is damaging to the schizophrenic. It leads to engulfment in mental illness, given that stigma, in a cyclic way, culminates in deeper psychopathology, and deeper psychopathology leads to increased stigmatization by others.

There was a person of my acquaintance, diagnosed with schizophrenia and early in the process of her mental illness, but newly aware of stigmatization. She asked her clinician how she would be able to combat stigma. The clinician replied: “Get a job.” This was good advice.

Vocational activity in the form of employment or scholastic endeavor can help to ameliorate stigma. Such activity may normalize the self-concept of the schizophrenic individual, and it will lead to a greater sense of self-worth. If a schizophrenic can obtain vocational activity prior to the emergence of damage to her sense of self as a result of stigma, she may have more success in vocational spheres. She may gain self-confidence in spite of her mental illness.  

The fact that the newly diagnosed schizophrenic may be particularly responsive to intervention at the initial stage of dealing with her illness stems from the reality she has not really accepted stigma as an aspect of her self-definition. Healthy and normative activity can be enacted by this individual at this stage specifically prior to assumption of the damaging effects of stigma in terms of her self-concept. Stretching the newly diagnosed person’s belief in terms of what she is capable of in the vocational and educational realms will benefit that schizophrenic individual.

One clinician, a psychotherapist, engaged in treatment with a schizophrenic individual of my acquaintance. The schizophrenic individual expressed her desire to attend graduate school. The clinician stated: “You will never go to graduate school. Look at the statistics on people like you.” This therapist’s statement was contraindicated by the facts regarding appropriate treatment for mental illness. The psychotherapist stigmatized the client. The client, however, did not accept the stigmatization that the clinician projected onto her. The client went on to achieve a doctorate in psychology.

This client was an anomaly. Most schizophrenics may have believed the therapist’s statement, whether it did or did not accurately reflect their level of ability. There is no way of estimating how many schizophrenics’ life goals have been destroyed by the way others have stigmatized them. Perhaps the mental illness, schizophrenia, is only partially the culprit in the failure of people with schizophrenia to achieve vocational and educational success.

Clearly, another culprit may be the damaging and stigmatizing ways that others view schizophrenics. These views, communicated to the schizophrenic, become prophetic specifically because the schizophrenic believes them, incorporates them into his self-definition, and lives by them.

Early in the course of the illness of an individual diagnosed with schizophrenia represents the ideal time to intervene and even halt the progress and the process of emerging psychopathology. The fact that the newly diagnosed schizophrenic does not readily perceive the stigma associated with mental illness can actually benefit her. If the newly diagnosed schizophrenic is assisted in engaging in activities that will strengthen her self-concept, she may be better equipped to cope with stigma and its implications.

Encouraging vocational and educational activity is an important aspect of treatment for schizophrenia. However, stigmatization may be a substantial reason for failure in these areas. As a result, the schizophrenic individual may reside in secrecy regarding her mental illness, as a way of deflecting the effects of stigmatization. Note, as well, that alienation is one effect of stigma, and alienation bolsters mental illness. Failure, alienation and a sense of personal diminishment and defeat accompany stigma. It is essential that schizophrenics are reached early in their illnesses, before the effects of stigma have virtually predetermined failure.

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Is It Sane To Agree That You’re Crazy? Thu, 30 Oct 2014 11:00:18 +0000 Therapeutic reflection – the act of re-stating the client’s ideas using different words – represents an avenue towards mirroring the client’s internal state through therapeutic verbal interaction and the therapeutic stance of the person-centered therapist.

Carl Rogers developed person-centered and humanistic theory and psychotherapy as a way to ameliorate psychological problems. He advocated unconditional positive regard, genuineness and accurate empathy on the part of the therapist as having curative qualities when received by the individual in psychotherapy. He also asserted that therapeutic reflection was psychologically curative.

Humanistic psychotherapy allows the client to lead the verbal interaction, fostering a self-actualizing tendency or a growth potential in the client. The goal of this therapy – as perceived by the client – is the meeting of his real self and his ideal self. Therapy culminates in psychological health when the real self and the ideal self are in synchronicity. While this type of therapy may represent an outstandingly effective paradigm for treatment of psychological problems, and it does, it may be viewed as useless when applied to the schizophrenic.

So, if you are mentally ill, and another person says you are crazy, is it sane to agree with them?

This paradox represents the dilemma for people with schizophrenia, and it is inherent in the contradictory nature of this statement. Whether the psychotic individual agrees or disagrees with the attribution and the label of mental illness, he cannot comprehend himself in a psychologically healthy way. As self-comprehension is an avenue toward healing of psychological problems, a comprehension that may be at the core of any type of psychotherapy, gaining insight into the self may be essential in ameliorating psychological problems.

It might be said that we are sane if the reality of what we are and our own understanding of these are accurately reflected by those in our environment. As indicated, Carl Rogers advocated accurate empathy as having the power of psychological healing. The question that pertains to this is one of whether accurate empathy, enacted by the “other” or the psychotherapist in relation to the “self” of the psychotic individual, as perceived by the “self” of that individual, is even possible.

The problem for the psychotic individual may be, in part, the problem of whether anyone can accurately empathize with her perspective. The thoughts and attributions of the psychotic individual that equate with, essentially, her delusional system, may be completely outside the realm of what the humanistic psychotherapist, or any other kind of psychotherapist, would even consider. This bodes poorly for the possibility of accurate empathy on the part of the psychotherapist, and, even if the psychotherapist is able to accurately mirror the internal state of the psychotic individual, there exists that concern on the therapist’s part that validating the psychotic individual’s perspective may simply affirm the delusional system of that individual, thus rendering such a course anti-therapeutic.

Carl Rogers made the statement: “Only when I accept myself as I am, can I then change.” This idea may be the basis for the effectiveness of accurate empathy and mirroring or reflection of the client’s internal state. In terms of treating the schizophrenic, the issue seems to be one of how to enact accurate empathy toward the psychotic client without affirming her delusional system.

There seems to be an overwhelming stress in the field of mental health to refuse to affirm as credible even the slightest amount of delusional material. It is known that psychotic individuals have over-valued ideas. The act of affirming these ideas as credible is counterintuitive. However, it should be noted that these ideas on the part of the schizophrenic may be over-valued by her simply because therapists refuse to give credence to them. In this sense, over-valued ideas may be a reaction to a lack of affirmation regarding her ideas.

Paranoid schizophrenics, for example, not only have over-valued ideas; they have visceral fear that accompanies their visceral hallucinations and their delusions. The need for the psychotic individual to communicate this fear to her therapist is intense. The psychotherapist’s dismissal of this fear as simply unfounded does not make the delusional individual feel safer, and, in fact, it renders her less safe, even if only due to the fact that she believes she has reason to fear, she is alienated with it, and no one will take her seriously. This amounts to subjective psychological suffering.  

There might exist the possibility for addressing the paranoid psychotic individual’s delusional system by simply by explaining the situation to them. For example, the psychotherapist may say: “I acknowledge that you are afraid of being alone with this fear. Part of your illness resides in the fact that no one will take your concerns as seriously as you take them. If I thought and believed the things that you think and believe, I would be afraid, too. Sometimes talking about one’s fears diminishes them. Can you agree tell me all about your situation? Can we work together to gradually challenge your fears by talking about the information you may be afraid of disclosing, so that we can together prove to you that nothing bad will happen if you do so? I will stay with you through this process. I will listen. And I will comfort you as best I can. I will be able to help you feel safe.”

Self-acceptance may be both a precursor to therapeutic change as well as a result of such change. Perhaps change that is both a cause and a result of self-acceptance that may occur simultaneously. The first step toward dealing effectively with one’s mental illness is admitting that one has a mental illness.

However, if you have a mental illness and someone says that you are crazy, is it sane to agree with them? For the mentally ill person, agreeing with this statement amounts to anarchy on the level of the self. However, by disagreeing with this statement, the mentally ill client may endure a different anarchy that may isolate that individual with his fears, his hallucinations and his delusions.

Humanistic psychotherapy has a potential to be applied effectively to the psychotic individual by an insightful and empathic person-centered therapist who is willing to imagine what her client is dealing with.

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Psychotherapy for Paranoid Schizophrenia Mon, 27 Oct 2014 11:00:04 +0000 Often psychotherapy is not considered to be effective with individuals dealing with schizophrenia spectrum disorders. But a cognitive-relational psychotherapy approach helps form a warm, trusting and detached relationship, conveys an understanding and concern for one’s client, and involves the therapist telling that individual their own empathic views about what that individual is dealing with.

Often clinicians assume that psychotherapy does not work well with persons manifesting what are called “thought disorders” – conceived to be irrational, unrealistic and factually inaccurate. Again, clinicians fail to understand, empathically, the circumstances of the psychotic individual. It should be noted that schizophrenics deal with non-normative experience that, in terms of hallucinations, is visceral in nature. This experience entrenches them in delusions based on hallucinations that are highly convincing.

One idea that may help schizophrenics is reflected in this line from a poem I wrote: “May you walk beyond the empty sudden blindness of existence.” To schizophrenics in crisis and even those not in crisis, the future may seem to be extremely uncertain and perhaps treacherous. They may perceive both the mental and the material worlds as incredibly dangerous. And in many ways, they are dangerous, due to the amount of suffering experienced by the paranoid schizophrenic that seems to her to be inflicted on her by these worlds.

No knowledge about knowledge

A non-epistemological stance regarding no knowledge about knowledge may help a schizophrenic replace her delusions. Essentially, the non-epistemological view represents deconstruction of knowledge with an assertion that relies on the fact that all “knowledge” is subjective. While schizophrenics have subjective views regarding their own knowledge, and although this may be communicated to them, they may be able to understand, in a similar sense, that nobody really has any kind of certain knowledge.

In terms of non-epistemology, it may not be possible to live in the world on these terms. Moreover, it may not be possible to tolerate an awareness that anything may happen to us at any time that will catapult us into crisis. The sudden death of a loved one may be an example of this.

Typically, we reside in faith that things will go normally and as planned, and they generally do so. However, the schizophrenic lacks such faith. If the therapist can communicate to the schizophrenic that she should try to get as comfortable as possible with simply “not knowing,” this may help the schizophrenic. There is a basis for “not knowing” that corresponds to everyone’s subjective experiences of the world, and this is reflected in all individuals’ perspectives on the mental and the material worlds. Realistically, it might be more threatening to the schizophrenic to “not know”, as opposed to clasping her delusional beliefs.

In terms of addressing the idea of “not knowing” with the paranoid schizophrenic, the psychotherapist may say the following: “Nobody knows what the future may bring. If you buy a lottery ticket, even if the chances are small, you may win the lottery. If you have sex, even with birth control, you may become a parent. Most events in are life happen by chance. You don’t really know what will happen, even if you fear with certainty that bad things will happen to you. Your condition of schizophrenia really causes you to suffer mostly because of your fear of bad things happening to you, rather than these things actually happening to you. Maybe the thing you should fear in your life is the fear itself. By realizing that you do not know what the future will bring, you may feel safer.”

Context matters?

Another aspect of dealing with schizophrenia is encompassed in the idea, stated by Ralph Ellison in The Invisible Man: “If you don’t know where you are, you don’t know who you are.”

This statement implies that one needs to know her context in order to know her self and her identity. Often schizophrenics fail to know their contexts. They have confused and distorted ideas about context, based on the fact that their contexts, in their minds as well as in the material world, may reflect delusions and hallucinations. This leads to ambiguity as perceived by the schizophrenic in her mental and material environments as threatening, simply because the schizophrenic may be dealing with non-normative experience.

The clinician may convey to the schizophrenic the idea of not knowing her context by stating: “It’s hard to know what you think of yourself when you don’t really know what you are dealing with in the world. This may be what causes you to be afraid of the world. And this means that you are afraid of both your voices in your mind, (for example), and the people outside in the world.”

The schizophrenic may adhere to her delusional beliefs due to the fact that she, as well as virtually everyone else in the world, thinks that knowing one’s context allows them to be safer than they would be if they did not “know what they know”, even when “knowing what they know” may be delusional. Again, the assertion that the client does not really know what her worlds signify can replace delusional ideas.

One way of communicating this idea to a paranoid schizophrenic would be constituted by saying: “You might think that being a schizophrenic makes people prejudiced towards you, and it may, but also the world we live in makes you into a schizophrenic. Your context in the world – and how the world views you – may be determined by the situation that you are in. You may believe that this is false, that you really know more than other people about the world, but you still do not know what you are in the world, perhaps because believing you are schizophrenic may be unacceptable and may not make sense to you. Nevertheless, you do not know for certain what the world is. That is why it is scary. And you don’t know who and what you really are, because you may believe one thing and others believe differently.”

Treating life as normal

Another idea for dealing with hallucinations and delusions stems from a novel by Carrie Fisher, Postcards from the Edge, which states the idea that: “Perhaps if we treat life as normal, a sense of normalcy will follow.”

This idea is highly salient to dealing with one’s hallucinations and delusions. The schizophrenic may be perhaps traumatized by her experience, but treating life as normal may lead to a gradually acquired feeling of safety.

The idea embedded in this statement from Fisher reflects the advantages of the act of challenging the delusions of a schizophrenic by the schizophrenic. Living one’s life normally in terms of habits and faith in the normative view of reality may allow the schizophrenic to experience the decay of her fears, her paranoia and her delusions. Not obsessing about one’s hallucinations and delusions, by trusting life to proceed normally, combats the punitive experience of schizophrenia and paranoid schizophrenia, in particular.

It should be noted that the ideas contained within this article represent an intellectualized framework of how the clinician or the psychotherapist may approach therapy with a paranoid schizophrenic. They may also be applicable to those who are high functioning, but may be suffering to an extreme extent.

A belief in the scientific bases for the effectiveness of psychiatric medications may be a belief that can be cultivated or even spontaneously adhered to by the schizophrenic. Nevertheless, non-normative experience may lead to non-normative thought, and the deep communication by an empathic therapist who is able to accurately imagine and recapitulate to the schizophrenic what she is dealing with may be in some sense curative.

I have applied these ideas to psychotherapy with paranoid schizophrenics with some success. One client, a paranoid schizophrenic, was struck by the idea that “if you don’t know where you are, you don’t know who you are.” She asked for a restatement of that idea based upon the connection she had established with it. Another schizophrenic stated humorously that he wanted to write a book entitled, The Fallacy of Truth.” He was able to understand a non-epistemological stance. Lastly, one client tried diligently to treat her life as normal and routine even though she was hyper-vigilant and paranoid. The trauma that she experienced precluded her from entirely benefiting from this perspective, but she became extremely high functioning.

Overall, these ideas for psychotherapy, from a cognitive relational perspective, may be of some help to some people, especially paranoid schizophrenics. However, it should be noted that the different types of schizophrenia may correspond with different interventions and treatment.

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Poor Social Judgment – An Aspect of Schizophrenia Sun, 12 Oct 2014 11:00:40 +0000 There are three components that generally typify an individual emerging with schizophrenia: alienation, introversion and divergent thinking. Together, these characteristics diminish the schizophrenic individual’s capacity for exercising good judgment in social situations.


People with emerging schizophrenia are generally socially impaired and isolated. As stated by Burns (2006), “premorbid developmental and social impairments have been well documented in adult schizophrenia.” People with schizophrenia tend to be unpopular and uninvolved in primary and secondary school, and they may also be more introverted than their peers.

The mentally ill are possibly the most alienated members of our society. Research suggests that social isolation (i.e. limited social interaction with other children) and poor or disrupted interpersonal relations during childhood, teen and early adult years appear to increase an individual’s risk for future development of schizophrenia-spectrum disorders. It is quite possible that social isolation is causally implicated in the presentation of schizophrenia, instead of simply being correlated with psychosis as a separate characteristic. It is obvious that social isolation is a consequence of schizophrenia.


Introversion may also accompany psychosis, and it too may be inexorably intertwined with alienation and psychosis. Divergent thinking has been noted to be descriptive of individuals that may be more self-involved, at least in terms of their thinking processes. Jung noted that introverts solve their problems in their own minds, as opposed to extroverts who rely on the external world and interaction with other people in solving problems.

As stated by Rugu (2013), “one is predominantly introverted if his interest and attention generally turn inward, toward his own thoughts and feelings; if his interest and attention are generally directed outward, toward other people and external stimuli, he is predominantly extroverted.” Clearly, however, there exists a continuum between introversion and extraversion, with most individuals falling between the two extremes. Nevertheless, most schizophrenics are probably more introverted than they are extroverted, and the social isolation that may accompany their introversion may be extreme.

Divergent thinking

In previous articles, I’ve suggested that schizophrenic individuals tend to be divergent thinkers. Divergent thinking has been noted to rely on perceiving more details in the in the mental and the material worlds than what might emerge from what may be called dogmatic thinking, and it should be understood that there exists worlds that are constituted by the material and the non-material.

While people with schizophrenia may be more imaginative than non-mentally ill individuals, the creativity implicit in their thought processes may not be productive in a positive sense, specifically because they may lack the quality of convergent thinking, involving analytic reasoning and logic. Schizophrenics may have more details at their disposal with which to construct their world-views, but they may not be able to construct their world-views in a meaningful way. Divergent thinking characterizes perhaps all forms of schizophrenia. It may be most obvious in the paranoid schizophrenic, but the results of this type of thinking, when convergent thinking is lacking in the individual, can be seen disorganized schizophrenic individuals.

Divergent thinking accompanies social isolation due to the fact that this type of thinking leads to unique ideas, whether these are good ideas or bad ideas, and whether these ideas are practically applicable to problems in the material and mental worlds. Because divergent thinking is a quality that characterizes schizophrenic individuals as well, it might be said, again, that divergent thinking is a correlate of schizophrenia and it may result in alienation. Alienation, divergent thinking, and introversion all may be amalgamated as causes of the psychotic presentation. In combination, these characteristics allow for the synergy between isolation and introversion, compounded by the influence of divergent thinking, perhaps without the convergent thinking which would permit solutions to problems related to social interaction.

The synergy between alienation, introversion and divergent thinking may all equally form part of the personality of the schizophrenic individual. This personality will be dysfunctional in meeting the interpersonal needs of the schizophrenic individual, due to the nature of intrapersonal self-involvement reflected in alienation, introversion and divergent thinking.

Social judgment

Ultimately, it is social judgment that is compromised by these three characteristics. The schizophrenic’s essential and paramount battle may be to ameliorate the effects of stigma, a consequence of implicit societal attitudes that are a reaction to the schizophrenic’s hapless and unintended nonconformity.

Without social judgment, the schizophrenic may have no means of negotiating social relationships, she may be unable to understand how others view her, and she may lose contact with others in the material world. This loss of real world social contact, then, exacerbates the condition of schizophrenia.

Schizophrenia can be viewed as a vicious cycle caused by alienation, introversion and divergent thinking. Social skills training would be an intervention that might serve to assist schizophrenics in dealing with stigma. This type of training might allow them to approach new acquaintances with knowledge of appropriate disclosure of their condition – disclosure that may demonstrate a social awareness of how their illness is viewed by others. Equipped with an understanding, however limited, of the role of stigma in terms of their interactions with others, people with schizophrenia may be better able to interact in the material world.


Burns J (2006). The social brain hypothesis of schizophrenia. World psychiatry : official journal of the World Psychiatric Association (WPA), 5 (2), 77-81 PMID: 16946939

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Treating Children and Teens Diagnosed with Schizophrenia Wed, 24 Sep 2014 11:00:11 +0000 In this article, I will focus on treatment considerations regarding the diagnosis of schizophrenia in children and adolescents. This article on assessment of schizophrenia concerns the nature of psychological tests that evaluate the prevalence of schizophrenic symptoms in an individual child or adolescent. These specific tests, which rely on interview and self-report, are described as potentially useful in formulating a diagnosis of schizophrenia by a qualified clinician.

There are several treatment strategies for helping one’s child or adolescent cope with a diagnosis of schizophrenia. These avenues to treatment may include psychiatric medication, individual therapy, behavioral intervention, such as a token economy, and family therapy.

Medications for psychotic illnesses have revolutionized the treatment for schizophrenia and psychotic disorders of all types. While some parents may be reluctant to medicate their child for very good reasons, medication nevertheless may be an extremely important piece of a configuration of treatment strategies. The fact is that medication has evolved since the times when medication was viewed by some as “psychiatric straight jacket”. 

While past antipsychotics have been termed “major sedatives”, newer, atypical antipsychotics increase cognitive organization, and, in conjunction with other medications, such as appropriately prescribed antidepressant and mood stabilizing medication, these medications may help the child or adolescent. For this reason, the use of medication should be considered as treatment for children and adolescents who manifest schizophrenic symptoms. It might make them feel better, and it might increase their subjective well-being.

While medication seems to be the treatment of choice for psychotic disorders, other interventions bear scrutiny. Sometimes clinicians underestimate the value of psychotherapy in treating schizophrenia. The reality exists that even the most well-intended parents will have difficulty dealing with their schizophrenic child. However, if a child therapist treats a child, she may have more success in diminishing the overt symptoms of schizophrenia in a child, precisely because she is not one of the child’s parents.

A therapist can be warm and detached, simultaneously. While these two characteristics may seem dichotomous, they can be combined by a therapist so that she does not forfeit her objectivity, but nevertheless nurtures the child. The element of emotional detachment in a therapist is crucial for both parties. One can see that parents and their youths may lack detachment from each other to an extent that creates negative feelings in both the parents and their children. This is why bringing the child in for individual therapy may be crucial to the child’s or the adolescent’s well-being. If nothing else, the therapist might serve as a trusted and caring adult or role model. This type of relationship clearly will benefit the child or adolescent who becomes involved in individual therapy. It should be noted that therapy of any modality, relational, behavioral or eco-systemic, will likely benefit the child or adolescent.

One intervention that relies on the principles of behaviorism is the token economy. A token economy can be described as a system of positive and negative reinforcement by which a child may earn and lose privileges as a result of his behavior. This means that the child essentially enters into a contract with the facilitator of the token economy, who would likely be his parent. The contract between the child and his parent would specify what the child may gain or lose privileges, contingent on whether he did his chores or his homework, as examples. As such, the child may earn one hour of playing video games, as an example, in return for completing his homework.

If the rewards are meaningful to the child, and the system of the token economy seems fair to the child, the token economy will work to change maladaptive behavior. Note, also, that the rules of the token economy may be determined before it is implemented, and the child’s or adolescent’s feelings, as well as his parents’ feelings, should not enter into what and when rewards will be forthcoming. This allows for some detachment, on the part of both the child and the parent, which will assist the process entailed by the token economy, overall.

Family therapy is efficacious in treating the schizophrenic child or adolescent for several reasons. Clearly, by means of family therapy, the schizophrenic child or adolescent will feel supported by her parents in terms of the concern that they demonstrate in gathering together in an effort to help the client, who is the identified patient. Moreover, the family can be guided and monitored by the therapist in such a way that the family members can express their feelings about the issues surrounding the impact of the diagnosis on the family without angering other family members. Lastly, the therapist will be able to normalize the experience of family members, thus clarifying their expectations about living with the diagnosis of the child or adolescent.

Overwhelmingly, however, it is the support of the schizophrenic individual by her family members as evidenced by the choice to engage in family therapy that will have the greatest positive therapeutic effect on that individual. He will know that his family cares about him.

The diagnosis of schizophrenia regarding a child or adolescent is incredibly difficult for the entire family to endure. However, this may be the case largely because the parents do not know how to negotiate the process of beginning with observation of odd behavior in their child, then seeking an assessment for a schizophrenic diagnosis, and culminating in treatment for all family members to help them deal with the situation.

No one expects to have a schizophrenic child. The anger, sadness and grief associated with this diagnosis are extreme. However, parents should note that their child may feel this anger and sadness and grief more poignantly than they do. The odd, confusing and inappropriate behavior of their child or adolescent may be compounded simply because he has received this diagnosis, and he is likely to be treated differently by family members as a result of this diagnosis.

The appropriate behavior of the schizophrenic individual’s family members is crucial to dealing well with this diagnosis. Perhaps the discussion by this writer has in some way illuminated the path for the families of schizophrenic children and adolescents so that they will be able to cope effectively with this diagnosis that need not equate with tragedy.

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The Intrapersonal Consequences of Schizophrenia Fri, 05 Sep 2014 11:00:35 +0000 I have proposed before that schizophrenia represents a biopsyhosocial phenomenon. Essentially, it has been stated that schizophrenia originates from chemical imbalances in the brain in the form of auditory hallucinations. The outward appearance of hearing auditory hallucinations is stigmatizing, and the retreat from stigma by assuming a façade of normalcy alienates the schizophrenic in a psychological sense, driving her further into the self-concealed realities and unrealities of her mind.  In terms of this, the biopsychosocial process is self-reinforcing.

It is important to note that schizophrenia is termed a problem related to “behavioral health”, explicitly. This term may be appropriate in terms of diagnostic considerations using the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM utilizes behavioral criteria for the purpose of diagnosing schizophrenia and other mental illnesses. For example, the psychiatrist will note that the mentally ill client displays “negative affect” as opposed to the statement that she “feels badly”. The schizophrenic client may be stated to “report the experience” of hallucinations, as opposed to simply “experiencing” hallucinations. For the purposes of objectivity, the diagnostic criteria for schizophrenia are stated in behavioral terms.

The term “behavioral health” can be considered to be particularly damaging in that this term can be construed to mean that there is an appropriate and healthy way to behave – that of concealing one’s mental illness.  While it is important to exercise caution in terms of self-revelation of psychotic symptoms, and, in fact, patients are encouraged to reveal to their psychopathological symptoms to their treatment providers, there nevertheless exists an implication that they should behave in a “healthy” way.  This is especially true regarding the mentally ill indvidual’s self-conception.

In terms of the biopsychosocial model of mental illness, assuming an outward appearance of “behavioral health” relates to concealing one’s symptoms as a retreat from stigmatization. This reinforces the tendency to retreat into one’s subjective mind in an effort the avoid stigma, and the consequences of this retreat is further alienation. As indicated, “behavioral health” implies that there is an appropriate façade that should be assumed by schizophrenics in their efforts to appear psychologically healthy. Note that the biopsychosocial model implicates a synergistic cycle of psychopathology, and it is possible to reinforce this cycle at any point in the cycle: biological, intrapersonal and interpersonal.

It is noteworthy that individuals may say that the term “schizophrenic” is stigmatizing. I have heard it suggested that the term “schizophrenic” should be changed to “a person with perceptual differences”. It is much more benign to term an individual “a schizophrenic” than it is to term the fields of psychiatry and psychology those of “behavioral health”.

The term “behavioral health” has emerged from the effects and consequences of behaviorism on the fields of psychiatry and psychology. It is obvious that behaviorism is reductionistic. However, behaviorism continues to dominate the mental or “behavioral” health fields due to its emphasis on predicting and controlling behavior, and behaviorism is valued in that it relies on objective results of psychiatric and psychological treatment.

Behaviorism itself emphasizes outward appearances as opposed to subjective states, and subjective states can be referred to by the term “subjective well-being.” I have noted that most schizophrenics report that they simply want to feel normal most of the time. While one’s behavior may or may not convey subjective well-being, asking the schizophrenic to describe her subjective feelings may be more therapeutic than it is to emphasize her objective characteristics.

While behavioral aspects of mental health treatment, such as hygiene and the observable effects of medication, are important aspects of treatment that emerge from the behavioral perspective, the term “behavioral health” has many negative implications that the lay person or the schizophrenic is unlikely to comprehend. In fact, the schizophrenic may misconstrue the term “behavioral health” to mean that she will be stigmatized if she expresses any symptoms of mental illness.

While stigma is real and impactful, creating a wall between oneself and other people as an assumption or presentation of “behavioral health”, the term “behavioral health” will reinforce the psychopathology referred to as the biopsychosocial cycle of psychotic illness.

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