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APPENDIX A: Characteristics of schizoid thinking

Murray Jackson Karnac Books ePub

I have frequently referred to the writings of Henri Rey, which have been collected in his book Universals of Psychoanalysis in the Treatment of Psychotic and Borderline States (1994). Rey uses the term “universal” in the sense of the primitive mental structures and mechanisms that have their deepest roots in antenatal, perinatal, and postnatal mother-baby relationships and are the substance of the paranoid-schizoid level of development as elaborated by Klein. These universals find expression in different contemporary diagnostic groupings such as borderline, schizoid, or narcissistic personality disorder, and in the psychiatric classification of schizotypal personality disorder. The following is a distillate of Rey’s views on the “schizoid mode of being”, a pure culture of features that are found in varying degrees in individuals who have not reached the level of the depressive position.

•  The schizoid individual finds great difficulty in making contact with others and finds it impossible to maintain any warm and steady relationship. If he actually manages to enter into a relationship, it rapidly becomes intensely dependent and results in disorders of identity.

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CHAPTER FIVE. Catatonia 2: imitation of Christ

Murray Jackson Karnac Books ePub

DAVID

David, a trainee priest, was 25 when the exploratory interview to be described was conducted. He had broken down two years earlier with a schizophrenic illness and was treated with ECT and a maintenance dose of anti-psychotic medication, which his mother supervised. Some months after his discharge from hospital, his mother went away for a fortnight, and David failed to take his medication. As a result, he relapsed into an acute catatonic state. Mute, immobile, refusing food, and demonstrating automatic obedience, maintenance of imposed position of limbs, and the “waxy flexibility” typical of catatonia, he was admitted to his local hospital as an emergency. After observation and intra-gastric feeding, he was again treated with ECT and eventually emerged somewhat from his state of withdrawal. Attempts were then made to encourage him to talk about his experiences, but they were unsuccessful. He showed no emotion apart from smiling in what seemed to be a quite inappropriate way and demonstrated many characteristic symptoms of schizophrenia, including listening to hallucinatory voices. When questioned. he would say he was quite happy, but his train of speech was regularly interrupted by thought-blocking. He disclosed a fear that his thoughts were being broadcast and that they could be heard by others.

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APPENDIX c: The future—-winds of change

Murray Jackson Karnac Books ePub

In the last few years, important collaboration has grown among psycho-analytically informed professionals devoted to developing and integrating the application of psychoanalytic and other psychological methods of research and treatment in the psychoses and other severe mental illness (Johannsen, Larsen, McGlashan, & Vaglum, 2000; Martindale et al., 2000; McGorry, 1996).

An initiative begun several years ago in the United Kingdom, the Association for Psychoanalytic Psychotherapy in the Public Health Sector (APP), has grown dramatically. It has forged links with other European groups to form the European Federation for Psychoanalytic Psychotherapy (EFPP), with an active section devoted to psychosis and a membership of 12,000 in twenty-three countries.

The International Symposium for the Psychotherapy of Schizophrenia (ISPS), founded by Benedetti and Muller in Switzerland in 1954, has become a large and growing international organization. It has recently extended its boundaries to embrace new contemporary perspectives, with a new title, The International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses, while maintaining its acronym (ISPS) and its dedication to preserving its psychoanalytically based origins. Expanding from its original nucleus in Switzerland into the United States, the Scandinavian countries (TIPS), and recently Australia (EPPIC), it has taken root in the United Kingdom and promises to have increasing influence in the coming years. In these organizations, as well as in the International Psychoanalytic Association (IPA), special interest is developing in the relation of psychoanalysis to the psychotherapy of psychoses. An initiative aimed at building bridges between psychoanalysis, neuroscience, cognitive science, and psychology has recently been launched by the Anna Freud Centre, London.

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14. Chronic schizophrenia— catatonic and spatial features: “George”

Murray Jackson Karnac Books ePub

Catatonic schizophrenia was once common among the chronically institutionalized schizophrenic patients of many mental hospitals. In its classical form, it presented as grossly disturbed behaviour and dramatic motor phenomena. Stuporose or semi-stuporose states, often with the assumption of stereotyped postures, sometimes punctuated by sudden outbursts of panicky and at times violent agitation, were characteristic.

However, the advent of anti-psychotic drugs, advances in the practice of psychiatric nursing, and improvements in the organization of traditional mental hospitals have greatly reduced its incidence. Minor forms may still be encountered in which the differentiation from obsessional states may be difficult. In the following case, the psychodynamics and meaning of such symptoms could eventually be understood, and the underlying psychological conflicts resolved.

George

When presented to the seminar, George was 24 years old and had been in twice-weekly psychotherapy in a treatment home for young schizophrenic patients for four years. He had had his first psychotic attack at the age of 16, when long-standing symptoms of depression changed to an acute hallucinatory psychosis with catatonic features. He experienced auditory hallucinations in the form of voices commanding him to kill himself. He said that he was Hitler and the Devil and at other times that he was Jesus Christ. He had a vision, which he thought might have been a dream, of Christ on the cross, which terrified him. He believed that other people had access to his thoughts and could read his mind.

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11. Paranoid psychosis— delusional body image: “Elmer”

Murray Jackson Karnac Books ePub

The establishment of a stable sense of identity, of a view of one’s self existing unchanged over time, is a developmental achievement begun in infancy, and under normal circumstances usually consolidated by early adult life. Adverse factors may impair this process, with the consequence that the sense of self is likely to be fragile and unstable. It may disintegrate under psychological or physical stress, in which case the capacity for normal relationships, in which the self is clearly differentiated from the object (the other person), is impaired or lost, and replaced by a regressive revival of the earlier identifications. Such identifications may change in a kaleidoscopic fashion, leading to confusion or delusion in the subject and bewilderment in the observer. Psychoanalytic concepts can throw light on this disturbance and open the way for psychotherapy aimed at establishing a more mature sense of identity.

Elmer

Elmer, aged 38, suffered his first episode of schizophrenia when he was 20 years old. He was doing unskilled work in a factory when he began to fear that the machinery might come to life while he was away at lunch. He felt obliged to miss his lunch in order to keep the machinery under observation. He soon became extremely violent at home, smashing furniture and threatening his foster-mother with a knife. He accused her of trying to force him to have sexual intercourse with her, and he attacked her and shouted that he was about to kill her. He was restrained by his foster-father and was admitted to a psychiatric ward under a compulsory order.

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