- Email: [email protected]
Understanding the adaptive struggles of schizophrenic patients. A methodological study
4"76
A .~I 1:;141(L t X I'.S.'Y(71l f J ' l i k ' l ' l l f l l X ) ( ; l ( "AL ,~lgS()Clh'l'lO.\"
A P s y e h o d ) ' n a n i i e V i e w of P s e u d o n e u .relic S c h i z o p h r e n i a Ja.',~i::s
p.
M . I ) . , ()oh*..t!'.M
(:A'l-rv:l.i.,
(.:nit:~,r,vilt/ l l o e h ct al. tiave d e s c r i b e d otir COlic e p t +it: iii]lereltt d~'tici~-ltc'v ~lf ilitegr;itixt~ capat'ilv ill tlit~ p ~ l t e l i l i a l l v ps('lldOlll--llroll{: s c i i i z o p i l r e l i i t " p¢,rsoil. T h i s defteielicv, i i l t e r a e t i i ~ w i t h d i s t o r t e d e~lvirolm~mital o p p o r t u l i i t y , c a n | m m a n i f e s t e d as prirriar.v d i l l | C a ] s)'r~lptonas of tills svli(.|l't)llll[.~: disorders of t h i t i k i l i g , ~3' " " t'ill~)tiOilal l'e~ l],itlOil ~ilid ,~;elisotilllOtOl'a lltolltitilli(- fltliCtil)liillg. As ilit(,I'llliI i l l ] d ('x tel'li;i ! s i i l I l t i i a t/i)ll ])ec()llle 11ll)l'e {.'f)! t1})1 (£,x, t]ie i r i d i v i d l i a l al'l'iVC'S ;t{ distorted eciliC:fc~pts ()f" s e l f a l i d w o r l d .... l e a d i n g lo ; l b l i O t ' l l i i t l patteriis (if t ) e h a \ ' i o r . These, in tl.irll, elicit r e a c t | o i l s fl'¢/lll the C,liVil'Oltlllellt t h a i f l l r l h e r ] i n | i t opt)err u i l i t)'. These l'everlieratilig i n t e r a c t i o n s lead tO elllergellC't2 o f s e e o l l d a r v e i i r i i e a ] s y n / p t o l l l a t i ):i o .~<,. v pali-ailXii,lv,., p:t11-11eiir~)sis a l l d c h a o t i c sexllaiiitv, C ] i l i i e a ] i l l u s t r a t i ~ ) n s w i l l illso a l h i d e to t r e a t a b i l i t y .
Schizol)hrenie Cognition SILvANo AItIETI,
M.D.,
New
}.'ork
3lerdical College S c h i z o p h r e n i a h a s r e c e n t l y b e e n int e r p r e t e d as it r e s u l t of ; l b n o r m a I i n t r a f m n i l v t~syehodvilamic:s. E v e n t h e c o g u i t i r e d i s o r d e r s of t h e s e l ; i z o p h r e n i c h a v e b e e n i n l e r p r e t e d as t h e r e s u l t of a b n o r lrtal COlilUlilllicalioii ( B a t e s o n ) or as direct t r a n s m i s s i o n of i r r a t i o n a l i t y f r o m t h e parerits ( L i d z , V~.'ynne, e t c . ) . A l t h o u g h i n t e r p e r s o n a l factors u n d o u l l t e d l ) , play,, an i m p o r t a n t role in e l | c i t i n g t h e a n x i e t y w h i c h m a y read to s c h i z o p h r e n i a a n d ill d e p r i v i n g t h e p a t i e n t of a n t i s e h i z o p h r e n ic defenses, the present m i t h o r feels t h a t tills a p p r o a c h is onl)" it p a r t i a l one ill the understarldilag o f the s c h i z o p h r e n i c svlidl'f)lllt~ arid e s p e c i a l l y of s c h i z o p h r e n i c cognition. S c h i z o p h r e n i c c o g n i t i o n is v i e w e d as t h e r e e m e r g e n c e , in p a r l i c u l a r d i s t r e s s f u l
situatioi~s. ,ff c ~ g n i t i v e m o d e s of o r g a n / z a l i o n w h i c i i exist ii~ e v e r y h u m a n b~*iiJg i~ a state {~f p o t e n t i a l | l ) . Ttlis i n : m a t u r e c'oKliitive olr~r;iliiZ;.ttiOll i l l s its m v n laws. iill(] c'}larac,teristic's a i i d reI)r~>duc'es tqir]v st ~i~'s. wltic'ti tic:('| i r ilt C'v t-l-V not'ilia| t/l~>ligllt o r i ) O r t ' e p t u a ] proet,ss. ",vitliolil I)t, ill~ a c c ' l ) l i i p a l l i e d |)\' :F%VaIl't'l leSS. Ill tilt'st" stag¢.s ]):lrl-l)cwC'el)tioti illld a p p r t ' il~'llSiOti o f FJ;il'tia] (l~l" p r e d i c a t i v e ) s i n t i i zii'ilv l e a d t
of view.
S o m e Q u a l i t i e s o f t h e Visu.'tl l l a l l u e i n a tions of S c l a i z o p h r e n i a
l ) a v l D A. lqutcsKl-:, M . I ) . arid \\"ILLIAM P. \\;~l.sox, ~1.I)., 13ttkc" Urii-
co'ratty St,vcra] fiivestigators }rove prese,~ted t h e artistic r e e r e a t i o i l of tile /uilhieiliatiolis of a f e w s e l , i z o p l i r c n i e s . T h e g e o i n e t r v auld o t h e r c h a r a c t e r i s t i c s of false p e r c e p t i o n s h a v e b e e n n e g l e c t e d in tim lil(.'ratllre. T h e r e f o r e t h e visual h a l l u e i n a lions ~t: fifty, p a t i e n t s w i t h a c u t e a n d ehronic, sc'hizop/trenia w e r e s t u d i e d for t h e f o l l o w i n g factors: c h m l t i o n , t i m e of occurrence, rehlih~ to o l h e r types, colors. (lllalities of o b j e c t s , m o v e m e n t . sI)atial r e l a t i o n s h i p s , a n d o t h e r faetors. O n e - i l a l f or o v e r o c c u r r e d d u r i n g t | l e d a y a n d n i g h t . Nlost w e r e ill cMor, t h r e e d i m e n s i o l m l , n o r m a | in size, n n d s e e m e d to b e real a n d c o m p l e t e . Sixty p e r c e n t w e r e signifieattt a n d f r i g h t e n i n g alid were mobile. Understanding the Adaptive Struggles of Schizophrenic Patients. A ~[ethodologiell Study SAN'DOll I~.,%DO, NI.[)., School of Psych iatry
Note:
York
T o g r a s p - t h e rmtln-e of s c h i z o p h r e n i a . t h e i n v e s t i g a t o r n-Itlst f i r s t l e a r n to u n d e r -
i.'~ll-,i]ll(
staild lhc iidaptivc l )ll ri',~iit stltiilt~
pal I i¢.'litS,
tiolii
slri:iggli's of schizolht~
tlicir
i n a d a q 1l;~ic-ies l't~-
disordered
.life per-
t'Oi'lll~!iit'('. Sllt'ti iliidl:,rstaildiilg is /illailialll/" oii]v t]Irltugii Ill+<.-"nleiila], ill p a r t i c l i lily t h e l l l o l i v a t i O l i a ] itpl)l-Oa(.li. V¢iil'killg
willt
llte illvcsti~ative nlethod o| COllltlllllliCatcd dccp inlrospectioii. This n i c t h o d s u p p l i e s at p r e s e n t t h e p r i m a r y ]):iSiS ft)r diagn~tsis aiid gives the besl C]II(I'N t() prol>icnls w]lich t ' i i l l ])e s(li%'l'd olllx b\" ilisl>ecti.nal (]~h.vsiological a n d Gt'n~'lic) i l . l ~ i r v . E v e n i | all the physiological t)rol~lei~ls of scllizophrtmia had ])('('li sliCC'eSSflliiv w~lrked olll. tor t'f)rlt,liilillU, this k l , l w ] e d g e
tile llee(| w i t h
capiible. "l'llo
nit_'t}todological
diiced by adaptational
scht'llle
illtro-
psvehodvnaniics
f~n" sllidies oil st'tiizophrcilia is t'olilpose.d (1 1 collc'clion ;tlid psx'chlih~gical o r d e r i n g of iiltr<~sI)ectional inforlnatioll: (:2) c~>llection alnd p h y s i c a l ~r(tering
F'H] I ) A Y A t r T E I I N ( ) ( ) N .
47"7
s c ] l i z o p h r c l t i c d~.sorders. T h e first ~mtlille of all a d a p t a t i o l l a d t l l c . r v s~, c ~ m s t r u c t e d has b c c n c a l h ' d "'schizotyt>al ~rgaliizati~m auid tim d e v e l o p m e n t a l .st'i-cs..~ . t~t" schiz,~tx]):t] l)eliavior.'" In tlic ])resellt s c i c n t i f c situ:ttion, rt~co g n i t i ( m of this adal)taticmal lll(-~n-v is r , ' t a r d c d by thr¢,: o b s t a c h ' s : t l} Ill(: hlvcstigatOl'S; traditi~n,ll a v o i d a n c e ~f t}le izJin~t-l~o¢lv g~,p. 0mrebv. Itiissi~lg t h e b r i d g e ~t a m o d u s ol,cratldi litilized ~lnd e r the a d a l ) t a t i o n a l the~wv.; ( 2 ) a v o i d a n t e c~t l h e p s y c l m a n a l y t i c irtvcs~ti~:ltivc m e t I , M , w h i c h alolm c a n raise t]l,+ lnolivati<~iia] appr+lac'h to the staHls of :i fti]lttedgcd br;ill(rll ()f ltlllli:lll l>it>lola): (3) lltist;,ikillg thtf ; l d m i t t e d l v nl}tho]ogica] illld a-l)iolo~ical speculalliolls
".29: 0 0 P..k I., l'~l).~B H U A I~ Y 2 8 , 1 9 6 4
,~essi
Chairntan: H o w A m ~ 11t'XT. P h . D . Recorder: Llssv J..~i~\uK, M . D . A lrunctional Systemic op'hrenia
Analysis of Schiz-
OcDr:x It. LLXt)SLlZY, P h 3 ) . , Itarvard
University A m e t h o d of a n a l y z i n g s c h i z o p h r e n i a b y l a b o r a t o r y r e c o r d i n g of t h e s i m u l t a n e ous i n t e r a c t i o n b e t w e e n s y m p t o m a t : i c a n d l m n s ) ' m p t o n m t i c reflex s y s t e m s is prcse,~te, d, ' C o n c e p t s e v o l v e d f r o m arm, I v z i n g s i m u l t a n e o u s r e c o r d s .of v o c a l a n d motor symptoms and operant responding, c o l l e c t e d d a i l y on t h e s a m e c h r o n i c
s c h i z o p h r e n i c p a t i e n t s s i r m e 1957. T a r g e t s y m p t o r n s a r e Iiot d e f i n e d t o p o g r a p h i c , ally (i.e_., " ' h a l l u c i n a t i n g " or "'paeillg'} b u t a r e f u n c t i o i m l l y d e f i n e d b y t h e deg r e e to w h i c h tliev, i n t e r f e r e w i t h l l o n n a l .djustive behavior. E x e m p l a r y s c h i z o p h r e n i c reflex system. i~lteractioris a n d s e i n e effects of wellk n o w n d n l g s on t h e s e i n t e r a c t i o n s are p r e s e r i t e d : I m p l i c a t i o n s for t h e o r y , res e a r c h , d i a g n o s i s , a n d t h e r a p y of schizop h r e n i c t ) e h a v i o r arc. d i s c u s s e d .
A .~I 1:;141(L t X I'.S.'Y(71l f J ' l i k ' l ' l l f l l X ) ( ; l ( "AL ,~lgS()Clh'l'lO.\"
A P s y e h o d ) ' n a n i i e V i e w of P s e u d o n e u .relic S c h i z o p h r e n i a Ja.',~i::s
p.
M . I ) . , ()oh*..t!'.M
(:A'l-rv:l.i.,
(.:nit:~,r,vilt/ l l o e h ct al. tiave d e s c r i b e d otir COlic e p t +it: iii]lereltt d~'tici~-ltc'v ~lf ilitegr;itixt~ capat'ilv ill tlit~ p ~ l t e l i l i a l l v ps('lldOlll--llroll{: s c i i i z o p i l r e l i i t " p¢,rsoil. T h i s defteielicv, i i l t e r a e t i i ~ w i t h d i s t o r t e d e~lvirolm~mital o p p o r t u l i i t y , c a n | m m a n i f e s t e d as prirriar.v d i l l | C a ] s)'r~lptonas of tills svli(.|l't)llll[.~: disorders of t h i t i k i l i g , ~3' " " t'ill~)tiOilal l'e~ l],itlOil ~ilid ,~;elisotilllOtOl'a lltolltitilli(- fltliCtil)liillg. As ilit(,I'llliI i l l ] d ('x tel'li;i ! s i i l I l t i i a t/i)ll ])ec()llle 11ll)l'e {.'f)! t1})1 (£,x, t]ie i r i d i v i d l i a l al'l'iVC'S ;t{ distorted eciliC:fc~pts ()f" s e l f a l i d w o r l d .... l e a d i n g lo ; l b l i O t ' l l i i t l patteriis (if t ) e h a \ ' i o r . These, in tl.irll, elicit r e a c t | o i l s fl'¢/lll the C,liVil'Oltlllellt t h a i f l l r l h e r ] i n | i t opt)err u i l i t)'. These l'everlieratilig i n t e r a c t i o n s lead tO elllergellC't2 o f s e e o l l d a r v e i i r i i e a ] s y n / p t o l l l a t i ):i o .~<,. v pali-ailXii,lv,., p:t11-11eiir~)sis a l l d c h a o t i c sexllaiiitv, C ] i l i i e a ] i l l u s t r a t i ~ ) n s w i l l illso a l h i d e to t r e a t a b i l i t y .
Schizol)hrenie Cognition SILvANo AItIETI,
M.D.,
New
}.'ork
3lerdical College S c h i z o p h r e n i a h a s r e c e n t l y b e e n int e r p r e t e d as it r e s u l t of ; l b n o r m a I i n t r a f m n i l v t~syehodvilamic:s. E v e n t h e c o g u i t i r e d i s o r d e r s of t h e s e l ; i z o p h r e n i c h a v e b e e n i n l e r p r e t e d as t h e r e s u l t of a b n o r lrtal COlilUlilllicalioii ( B a t e s o n ) or as direct t r a n s m i s s i o n of i r r a t i o n a l i t y f r o m t h e parerits ( L i d z , V~.'ynne, e t c . ) . A l t h o u g h i n t e r p e r s o n a l factors u n d o u l l t e d l ) , play,, an i m p o r t a n t role in e l | c i t i n g t h e a n x i e t y w h i c h m a y read to s c h i z o p h r e n i a a n d ill d e p r i v i n g t h e p a t i e n t of a n t i s e h i z o p h r e n ic defenses, the present m i t h o r feels t h a t tills a p p r o a c h is onl)" it p a r t i a l one ill the understarldilag o f the s c h i z o p h r e n i c svlidl'f)lllt~ arid e s p e c i a l l y of s c h i z o p h r e n i c cognition. S c h i z o p h r e n i c c o g n i t i o n is v i e w e d as t h e r e e m e r g e n c e , in p a r l i c u l a r d i s t r e s s f u l
situatioi~s. ,ff c ~ g n i t i v e m o d e s of o r g a n / z a l i o n w h i c i i exist ii~ e v e r y h u m a n b~*iiJg i~ a state {~f p o t e n t i a l | l ) . Ttlis i n : m a t u r e c'oKliitive olr~r;iliiZ;.ttiOll i l l s its m v n laws. iill(] c'}larac,teristic's a i i d reI)r~>duc'es tqir]v st ~i~'s. wltic'ti tic:('| i r ilt C'v t-l-V not'ilia| t/l~>ligllt o r i ) O r t ' e p t u a ] proet,ss. ",vitliolil I)t, ill~ a c c ' l ) l i i p a l l i e d |)\' :F%VaIl't'l leSS. Ill tilt'st" stag¢.s ]):lrl-l)cwC'el)tioti illld a p p r t ' il~'llSiOti o f FJ;il'tia] (l~l" p r e d i c a t i v e ) s i n t i i zii'ilv l e a d t
of view.
S o m e Q u a l i t i e s o f t h e Visu.'tl l l a l l u e i n a tions of S c l a i z o p h r e n i a
l ) a v l D A. lqutcsKl-:, M . I ) . arid \\"ILLIAM P. \\;~l.sox, ~1.I)., 13ttkc" Urii-
co'ratty St,vcra] fiivestigators }rove prese,~ted t h e artistic r e e r e a t i o i l of tile /uilhieiliatiolis of a f e w s e l , i z o p l i r c n i e s . T h e g e o i n e t r v auld o t h e r c h a r a c t e r i s t i c s of false p e r c e p t i o n s h a v e b e e n n e g l e c t e d in tim lil(.'ratllre. T h e r e f o r e t h e visual h a l l u e i n a lions ~t: fifty, p a t i e n t s w i t h a c u t e a n d ehronic, sc'hizop/trenia w e r e s t u d i e d for t h e f o l l o w i n g factors: c h m l t i o n , t i m e of occurrence, rehlih~ to o l h e r types, colors. (lllalities of o b j e c t s , m o v e m e n t . sI)atial r e l a t i o n s h i p s , a n d o t h e r faetors. O n e - i l a l f or o v e r o c c u r r e d d u r i n g t | l e d a y a n d n i g h t . Nlost w e r e ill cMor, t h r e e d i m e n s i o l m l , n o r m a | in size, n n d s e e m e d to b e real a n d c o m p l e t e . Sixty p e r c e n t w e r e signifieattt a n d f r i g h t e n i n g alid were mobile. Understanding the Adaptive Struggles of Schizophrenic Patients. A ~[ethodologiell Study SAN'DOll I~.,%DO, NI.[)., School of Psych iatry
Note:
York
T o g r a s p - t h e rmtln-e of s c h i z o p h r e n i a . t h e i n v e s t i g a t o r n-Itlst f i r s t l e a r n to u n d e r -
i.'~ll-,i]ll(
staild lhc iidaptivc l )ll ri',~iit stltiilt~
pal I i¢.'litS,
tiolii
slri:iggli's of schizolht~
tlicir
i n a d a q 1l;~ic-ies l't~-
disordered
.life per-
t'Oi'lll~!iit'('. Sllt'ti iliidl:,rstaildiilg is /illailialll/" oii]v t]Irltugii Ill+<.-"nleiila], ill p a r t i c l i lily t h e l l l o l i v a t i O l i a ] itpl)l-Oa(.li. V¢iil'killg
willt
llte illvcsti~ative nlethod o| COllltlllllliCatcd dccp inlrospectioii. This n i c t h o d s u p p l i e s at p r e s e n t t h e p r i m a r y ]):iSiS ft)r diagn~tsis aiid gives the besl C]II(I'N t() prol>icnls w]lich t ' i i l l ])e s(li%'l'd olllx b\" ilisl>ecti.nal (]~h.vsiological a n d Gt'n~'lic) i l . l ~ i r v . E v e n i | all the physiological t)rol~lei~ls of scllizophrtmia had ])('('li sliCC'eSSflliiv w~lrked olll. tor t'f)rlt,liilillU, this k l , l w ] e d g e
tile llee(| w i t h
capiible. "l'llo
nit_'t}todological
diiced by adaptational
scht'llle
illtro-
psvehodvnaniics
f~n" sllidies oil st'tiizophrcilia is t'olilpose.d (1 1 collc'clion ;tlid psx'chlih~gical o r d e r i n g of iiltr<~sI)ectional inforlnatioll: (:2) c~>llection alnd p h y s i c a l ~r(tering
F'H] I ) A Y A t r T E I I N ( ) ( ) N .
47"7
s c ] l i z o p h r c l t i c d~.sorders. T h e first ~mtlille of all a d a p t a t i o l l a d t l l c . r v s~, c ~ m s t r u c t e d has b c c n c a l h ' d "'schizotyt>al ~rgaliizati~m auid tim d e v e l o p m e n t a l .st'i-cs..~ . t~t" schiz,~tx]):t] l)eliavior.'" In tlic ])resellt s c i c n t i f c situ:ttion, rt~co g n i t i ( m of this adal)taticmal lll(-~n-v is r , ' t a r d c d by thr¢,: o b s t a c h ' s : t l} Ill(: hlvcstigatOl'S; traditi~n,ll a v o i d a n c e ~f t}le izJin~t-l~o¢lv g~,p. 0mrebv. Itiissi~lg t h e b r i d g e ~t a m o d u s ol,cratldi litilized ~lnd e r the a d a l ) t a t i o n a l the~wv.; ( 2 ) a v o i d a n t e c~t l h e p s y c l m a n a l y t i c irtvcs~ti~:ltivc m e t I , M , w h i c h alolm c a n raise t]l,+ lnolivati<~iia] appr+lac'h to the staHls of :i fti]lttedgcd br;ill(rll ()f ltlllli:lll l>it>lola): (3) lltist;,ikillg thtf ; l d m i t t e d l v nl}tho]ogica] illld a-l)iolo~ical speculalliolls
".29: 0 0 P..k I., l'~l).~B H U A I~ Y 2 8 , 1 9 6 4
,~essi
Chairntan: H o w A m ~ 11t'XT. P h . D . Recorder: Llssv J..~i~\uK, M . D . A lrunctional Systemic op'hrenia
Analysis of Schiz-
OcDr:x It. LLXt)SLlZY, P h 3 ) . , Itarvard
University A m e t h o d of a n a l y z i n g s c h i z o p h r e n i a b y l a b o r a t o r y r e c o r d i n g of t h e s i m u l t a n e ous i n t e r a c t i o n b e t w e e n s y m p t o m a t : i c a n d l m n s ) ' m p t o n m t i c reflex s y s t e m s is prcse,~te, d, ' C o n c e p t s e v o l v e d f r o m arm, I v z i n g s i m u l t a n e o u s r e c o r d s .of v o c a l a n d motor symptoms and operant responding, c o l l e c t e d d a i l y on t h e s a m e c h r o n i c
s c h i z o p h r e n i c p a t i e n t s s i r m e 1957. T a r g e t s y m p t o r n s a r e Iiot d e f i n e d t o p o g r a p h i c , ally (i.e_., " ' h a l l u c i n a t i n g " or "'paeillg'} b u t a r e f u n c t i o i m l l y d e f i n e d b y t h e deg r e e to w h i c h tliev, i n t e r f e r e w i t h l l o n n a l .djustive behavior. E x e m p l a r y s c h i z o p h r e n i c reflex system. i~lteractioris a n d s e i n e effects of wellk n o w n d n l g s on t h e s e i n t e r a c t i o n s are p r e s e r i t e d : I m p l i c a t i o n s for t h e o r y , res e a r c h , d i a g n o s i s , a n d t h e r a p y of schizop h r e n i c t ) e h a v i o r arc. d i s c u s s e d .