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Margaret believed that because she had never been in love with Ray, she had committed a mortal sin by marrying him and bringing children into the world. Now, as punishment, God had made her and her children immortal, so that they would have to suffer in their unhappy home life forever. She had come to this realization one evening while she was washing the dishes. Looking down into the sink, she saw a fork lying across a knife in the shape of a cross; suddenly she knew that she had become immortal. (Mayer &# 038; Osborne, 1987, p. 164) Margarets beliefs of immortality may seem outlandish or crazy to most of us, but the truth is that those visions are part of her very complex world. It is a world controlled by things other than herself, often characterized by loud voices, disturbing hallucinations, and, as we have seen above, elaborate stories that delegate her life.
She is so absorbed in her world that she cannot carry out normal, every day functions such as taking care of her children, and she often drags them into her delusions. Margaret, like one percent of the United States population (over two million people) has been diagnosed with schizophrenia (Carson, Buchner, &# 038; Mineka, 2000). Although the disease itself has been around since the origins of psychology, schizophrenia as a diagnosis has only been recognized for a little over one hundred years. Beginning with Emil Kraepelins research, a group of seemingly causeless symptoms began to emerge that would form the modern diagnosis. Dementia paradox was the name given to these symptoms.
It included dementia paradox, catatonia, and dementia paranoids (Neale &# 038; Oltmanns, 1980). Today these symptoms and others form the basis for diagnosing schizophrenia. Schizophrenia itself has been perplexing psychologists ever since its recognition as a disorder. Constant research and countless studies have been done over the years with few concrete results. We still are very unsure of the origins of the disorder, and are even more unsure of how to treat it. In this paper I plan to describe the symptoms associated with the disorder, discuss the etiology of the disorder, and describe some methods psychologists use to treat the disorder using the case study I received in class.
Schizophrenia is a term that is used to describe an extremely broad list of behaviors and symptoms. Before we get into the diagnostic criteria (as specified in the DSM-IV) it is important to note that there are two general symptom patterns in Schizophrenia, positive and negative. Positive symptom patterns are characterized by behaviors that have been added to a persons normal functions such as increased agitation, hallucinations, or abnormal behavior. In contrast, negative symptom patters represent a general absence of all normal, expected behaviors. Negative symptoms can include a general lack of emotion, poor speech, or lowered mental capacity (Carson, Buchner, &# 038; Mineka, 2000). Patients that predominantly display elements of the positive symptom patterns generally have a good chance of recovery and are termed Type I schizophrenics, while patients that display elements of the negative symptom patterns have a lowered chance of recovery and are termed Type II schizophrenics (Carson, Buchner, &# 038; Mineka, 2000).
Type I and Type II Schizophrenia are not official diagnosis, however. The DSM-IV has a complex criterion that must be met in order to diagnose someone as schizophrenic. At the top of this list are the characteristic symptoms. The characteristic symptoms are probably the most representative of the disorder. There are five main categories of these. The first is delusions.
Delusions can represent many things in the patient. They can be in the form of irrational beliefs not shared by others (Neale &# 038; Oltmanns, 1980) such as Margarets belief that as punishment, God had made her? immortal. (Meyer &# 038; Osborne, 1987, p. 162) They can also be delusions related to the patients sense of self (Carson, Buchner, &# 038; Mineka, 2000). Some examples are assumption of a new identity such as George Washington, or identifying oneself as some form or part of a greater force or being, such as God or the force in Star Wars. Patients with delusions sometimes even have difficultly with recognizing their own gender (Carson, Buchner, &# 038; Mineka, 2000). The second characteristic symptom for schizophrenia listed in the DSM is hallucinations.
Over 50 % of all patients with schizophrenia experience them. Hallucinations are perceptions that are made without any external stimulation (Neale &# 038; Oltmanns, 1980). They can be purely verbal, such as a voice in someones head, or can be visual, such as seeing distorted views of the setting or seeing a snake slither across the floor. Hallucinations can also be perceptual; the patient may feel a hand on their shoulder or feel bugs crawling on their bodies (Carson, Buchner, &# 038; Mineka, 2000). Disorganized speech is the third symptom. This is a prime indicator of schizophrenia.
The patient fails to make sense when talking, often linking together phrases that do not make sense or straying dramatically from the subject-derailment (Carson, Buchner, &# 038; Mineka, 2000). Here is an example of disorganized speech exhibited in my case study. Psychiatrist: When you realized that you were immortal, were you afraid? Margaret: No. You see, the sun to me is the sun to people, but its God to me. When I look up to the sun, its God, not the sun anymore.
See what I mean? God took over my life because I didnt deserve to live it myself. Ive go to get out of here so that I can be closer to him. (Meyer &# 038; Osborne, 1987, p. 162) A large array of symptoms is displayed in the fourth criterion, grossly disorganized or catatonic behavior. Behavior for diagnosed schizophrenics is erratic at best.
There is a steep decline of goal-oriented activity such as bathing or changing clothes, and many times these activities must be undertaken by nurses. Ritualistic behavior such as saluting several times before entering a doorway is often observed (Neale &# 038; Oltmanns, 1980). Many patients are easily irritated due to heightened senses and low information processing; this may lead to outbursts and violence (Carson, Buchner, &# 038; Mineka, 2000). Also, many schizophrenics display catatonic behavior.
They may contort their bodies into uncomfortable postures for long periods of time, or may erupt into manic-type behaviors. Other erratic behavior may include mutism, involuntary protrusions of the tongue, lip smacking, and bizarre facial expressions (Neale &# 038; Oltmanns, 1980). Finally, we have the appearance of negative symptoms. This includes affective flattening, which can be observed in Margaret, my case study (Carson, Buchner, &# 038; Mineka, 2000). Throughout the interview, Margarets face remained blank and expressionless.
She spoke in a dull monotone? (Meyer &# 038; Osborne, 1987, p. 162) Also in some cases there is very little speech and an absence of the will (Carson, Buchner, &# 038; Mineka, 2000). In addition to the characteristic symptoms listed above, there are several other criterion that must be met for a diagnosis. There must be a drop in social or occupational functioning for a significant amount of time since the onset of symptoms. There must be an absence of Schizoaffective and mood disorders, of substance abuse, and of a general medical condition. Finally, the symptoms must persist for at least six months (Carson, Buchner, &# 038; Mineka, 2000). Once a patient is diagnosed with schizophrenia, they may be diagnosed in a specific subtype of the disorder.
There are four of these subtypes: catatonic type, disorganized type, paranoid type, and undifferentiated type (Carson, Buchner, &# 038; Mineka, 2000). Catatonic type is characterized by alternating periods of extreme hyperactivity that is sometimes violent, and periods of withdrawal (Neale &# 038; Oltmanns, 1980). The periods of withdrawal in this subtype are particularly interesting. They are characterized by stupor, muteness, obedience negativism in which a patient rejects all outside suggestion or instruction, and a state of waxy flexibility. The latter is a phenomenon in which the body may be placed in a particular position, be it comfortable or not, and held there for long periods of time (Neale &# 038; Oltmanns, 1980).
Catatonic patients do not control their bowel movements, or urination. They may drool, and are not affected by painful stimuli (Carson, Buchner, &# 038; Mineka, 2000). Paranoid subtypes are characterized by elaborate delusions marked with suspicion and hostility. Many believe that they are being watched or followed, and some are extremely religious (Carson, Buchner, &# 038; Mineka, 2000). Their actions stem from these behaviors, therefore, patients with paranoid subtype may be very paranoid and hostile towards family and friends.
Also, paranoid subtypes often have grand illusions such as being a powerful god. They have auditory and visual hallucinations, and may act on these making them somewhat dangerous (Carson, Buchner, &# 038; Mineka, 2000). My case study shows many signs of paranoid subtype: she is extremely religious, God has punished her (Meyer &# 038; Osborne, 1987, p. 161) therefore making her persecuted, and her actions reflect her belief in this delusion. Also, she has poor interpersonal relationships especially with her husband whom, she states, she has never been in love with. (Meyer &# 038; Osborne, 1987, p, 161) Disorganized subtype has an earlier onset. The patient typically is an odd, eccentric person, and is often preoccupied with religion. This subtype is more severe in regression than the other three, often leading to childlike behavior.
Inappropriate laughter, giggling, silliness, and shallowness are common symptoms, as are bizarre behavior, and weird mannerisms (Neale &# 038; Oltmanns, 1980). Hallucinations are also very common (Carson, Buchner, &# 038; Mineka, 2000). Lastly, there is undifferentiated subtype. This is kind of a catchall subtype.
It contains people that are diagnosed schizophrenics but have no distinctive behaviors. Often an undifferentiated diagnosis is made at the onset of schizophrenia or when a patient is moving from one subtype to another (Carson, Buchner, &# 038; Mineka, 2000). Now that I have described the disorder, lets take a look at the causation of the disorder. Unfortunately, the cause of Schizophrenia has remained somewhat elusive over the years.
One of the reasons for this is the fact that Schizophrenia spans many aspects of science. Not only are there psychological causes for the disorder, there are also biological, neurological, and chemical causes as well (Neale &# 038; Oltmanns, 1980). It is hard to differentiate one cause from another. Suspected causes range from seasonal differences in the births of schizophrenics to excessive trans methylation in catecholamine synapses (West &# 038; Flinn, 1976). We know that there are biological factors due to the high prevalence rate amongst parents and children and monozygotic twins (between 15 - 38 %) (West &# 038; Flinn, 1976). However, we also know that this cannot be the only reason because that rate is not 100 %, so many factors must come into play.
One these factors is the family. There are several similarities in family environment that has been observed in studies of schizophrenic patients. The mothers were almost always highly unstable often very strange and usually were either extremely overbearing or extremely uncaring and unconcerned. The fathers are very much like the mothers, highly unstable, aggressive, paranoid, passive, or extremely competitive or hostile towards the child (West &# 038; Flinn, 1976). The marriage between the two was in turmoil or the parenting was done essentially by one parent while the other took a passive position. In some situations the parent took on immature, child-like behavior, or tried to make the child an emotional replacement for the spouse.
Essentially the child did not have a good example from which to learn behavior and this lead to the child avoiding relationships, and distrust of others (West &# 038; Flinn, 1976). Lets now look at the parallels between the causal factors listed above, and my personal case study. Margaret came from a rich family in New York. Her father was a lawyer and worked long hours and her mother was an actress who was often described as high-strung, nervous, and eccentric.
She had been diagnosed with an emotionally unstable personality by her long time psychoanalyst and is known to have had at least one psychotic episode that lead to a hospitalization. Neither of Margarets parents had time for their children, who sent her and her older siblings off to boarding school as soon as they reached the third grade. At this point, we begin to see signs of slipping on Margarets side. Her grades drop, and she becomes socially withdrawn and isolated. The only time spent at home was at holidays, which were uneventful other than the irritability and emotional outbursts of the mother. These outbursts were usually directed at the father (Meyer &# 038; Osborne, 1987).
You can see the parallels between the observed cases and my case study: emotionally unstable mother who was absent in raising the child, a father that also took a passive approach to parenting, the feuding marriage. Finally, the sending of the children off to boarding school at such a young age demonstrates the parents lack of concern for the children. These factors, combined with the genetic contribution of the mothers unstable personality, hold ample causation for the development of schizophrenia. Now that we know the case history of Margaret, and possible causes for her disorder, we can begin to develop a treatment to fit her. Since Margaret displays mostly positive symptoms (excluding her emotional flatness), and is responsive to medications, we shall classify her as a Type I schizophrenic.
Now that she is receiving steady medication to combat her hallucinations and delusions, we can concentrate on helping her with her social and occupational impairment, and her emotional flatness. After reviewing several treatments, I have chosen one that was outlined in one of my library books. In this treatment, five major issues are important: security, contact, psychological insight, collaboration, and establishing expectations (Strauss &# 038; Carpenter, 1981). The first major issue is developing a sense of security for the patient. Most schizophrenics are intimidated at the idea of strange behavior that they cannot control (Strauss &# 038; Carpenter, 1981).
Having a close relative on hand, ridding the room of dangerous objects, or leaving the door open are good ways to start making the patient more comfortable. Make your conversations more informal so as to be less intimidating as a clinician. Also, clear up any questions that the patient may have, this may reduce his or her anxiety (Strauss &# 038; Carpenter, 1981). Establishing non-intrusive, personal contact is also very crucial. Schizophrenics are often very isolated people.
This is due to several things. They have experienced a lot of personal experiences that are bizarre, and this makes them feel different than others who have not had similar problems, also, prior reactions to their odd behavior from other people may reinforce this belief. Patients usually have a problem socializing with others, and they are often removed from their environment and put in unfamiliar places, such as hospitals (Strauss &# 038; Carpenter, 1981). The clinician must avoid any dehumanizing actions (restraints, etc. ), intrusiveness, impatience, and doctor-like behavior. Initial interviews must focus on data pertaining to the problem, history, social context, and the diagnostic axes (Strauss &# 038; Carpenter, 1981).
Explore the patients point of view, and be sure to respect the patients self-set boundaries. In other words, if they dont want to talk about something, dont make them. You and your client may make more progress if you listen to the patient and follow their lead (Strauss &# 038; Carpenter, 1981). Psychological insight is the next major issue. Schizophrenia is a very traumatic event for all those diagnosed with it, but it is not an event that cant be learned from. Some patients may be open to this, and with the clinicians help, may learn to explore their experiences, which may help them with future problems.
Some patients, however, will not be as responsive, but will at least gain enough insight into their illness to cooperate in future treatment and recognize some warning signs of upcoming psychotic episodes (Strauss &# 038; Carpenter, 1981). The collaborative orientation to treatment states that the patient and the clinician work together to achieve some type of therapeutic success (Strauss &# 038; Carpenter, 1981). This requires that the clinician continuously involves the patient in the information that leads to the therapy used, that the patient understands this information, and the patient is informed of the reason an action is taken that may be against the patients wishes (Strauss &# 038; Carpenter, 1981). The patient will not always understand all actions taken, but they must be informed of them. Lastly, expectations need to be set towards the beginning of treatment. Expectations that are too high may leave the patient vulnerable to an episode, while expectations that are too low may lead the patient to constrict their life even more (Strauss &# 038; Carpenter, 1981).
It is important when working with the patient to find appropriate expectations so that they are informed of their treatment, have some control over the client / therapist relationship, exercise some control of their behavior, and can identify areas of personal vulnerability that they would like to work on (Strauss &# 038; Carpenter, 1981). Later on in the treatment the patient and clinician can discuss more specific goals such as whether or not work is an option, to what level personal relationships can exist in their life, and other situations that the patient may encounter in the future (Strauss &# 038; Carpenter, 1981). Stressing these important issues in treatment will give the patient a stable environment in which symptoms can be treated, and in which the course of the disorder can be combated. They also pave the way for learning necessary skills such as preparing the patient for the possible impact of things like personal losses, illness, or family conflict. The patients negative view of social relationships such as Margarets negative relationship with her husband may be combated with social skills training, and vocational rehabilitation is used to prepare the patient to reenter the work force (Strauss &# 038; Carpenter, 1981). This treatment can have very positive results when it has been carried out in the proper manner, and I think that it would be very beneficial to Margarets personal case study.
I have demonstrated to you characteristics of schizophrenia, ideas of the origin of the disorder, and presented you with a model treatment. I hope that you have learned a lot regarding schizophrenia, and, although we still do not know very much about it, I hope that you learned that it is not a lost cause, that, with the right methods and training, great progress may be made. References Carson, R. C. , Buchner, J. N. , &# 038; Mineka, Susan. (2000). Abnormal Psychology and Modern Life.
Boston: Allyn and Bacon. Dawson, D. F. &# 038; Blum, H. M. (1983). Schizophrenia in Focus: Guidelines for Treatment and Rehabilitation. New York: Human Sciences Press, Inc.
Dawson, J. G. &# 038; Stone, H. K. (1961). Psychotherapy with Schizophrenics. Baton Rouge: Louisiana State University Press. Gelman, Sheldon. (1999).
Medicating Schizophrenia. New Brunswick: Rutgers University Press. Johnstone, E. C. , &# 038; Humphreys, M. S. (1999). Schizophrenia: Concepts and Clinical Management.
Cambridge: Cambridge University Press. Like, Theodore. (1973). The Origin and Treatment of Schizophrenic Disorders. New York: Basic Books, Inc. , Publishers.
May, P. R. (1968). Treatment of Schizophrenia. New York: Science House, Inc. Meyer, R. G. , &# 038; Osborne, Y.
H. (1987). Case Studies in Abnormal Behavior. Boston, MA: Allyn and Bacon Neale, J. M. , &# 038; Oltmanns, T. F. (1980). Schizophrenia.
New York: John Wiley &# 038; Sons. Strauss, J. S. , &# 038; Carpenter, W. T. (1981). Schizophrenia. New York: Plenum Medical Book Company.
West, L. J. &# 038; Flinn, D. E. (1976). Treatment of Schizophrenia: Progress and Prospects. New York: Ground &# 038; Stratton Inc Bibliography on bottom of paper
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