Strangely, this manifestation of schizophrenia is not as common as it used to be. Possibly because of improved diagnostics and advances in the medical knowledge of diseases of the nervous system, many "catatonics" may now receive a differential diagnosis.
"Catatonia is not a voluntary thing. You aren't purposely not moving because you think something bad is going to happen. It happens against your volition, you just get stuck. Sometimes you are not aware of anything. I've lost hours and have not understood how time could actually pass. I could be reaching for a glass and by the time my hand comes down with the glass I lost two hours. Sometimes you are vaguely aware of things, like nothing gets through but every once in a while you can hear someone calling your name-but there is no way to answer.
Sometimes it is like your eyes are a video camera and your consciousness is watching what is being recorded but its like you are in a dark room somewhere really far away--you cannot interact with what is going on."
According to that bible of psychiatry and insurance companies, The DSMiv, catatonic schizophrenia is defined as follows:
- Catatonic stupor (marked decrease in reactivity to the environment and/or reduction in spontaneous movements and activity) or mutism.
- Catatonic negativism (an apparent motiveless resistance to all instructions or attempts to be moved).
- Catatonic rigidity (maintenance of a rigid posture against efforts to be moved).
- Catatonic excitement (excited motor activity, apparently purposeless and not influenced by external stimuli).
- Catatonic posturing (voluntary assumption of inappropriate or bizarre postures).
…During catatonic stupor or excitement, the person needs careful supervision to avoid hurting himself or herself or others. Medical care may also be needed because of malnutrition, exhaustion, hyper pyrexia, or self inflicted injury.
Although Catatonic Schizophrenia was very common several decades ago, it is now rare in Europe and North America.
Bandler reports the strange behaviour of people around catatonics - strange in that people have a tendency to whisper. I have encountered this behaviour with catatonics being nursed on general medical hospital wards, where their postures are changed every two hours, they are hand fed and watered and washed by the nurses. It is not unusual to find the catatonic positioned in front of a television or looking out the window. These patients will often have a urinary catheter and will soil themselves without complaint. Sometimes they will have intravenous hydration when they have reached a critical point of dehydration via refusal of/failure to initiate drinking.
Once I was in Napa State Mental Hospital in California, and a guy had been sitting there for several years on the couch in the day room. The only communication he was offering me were his body position and his breathing rate. His eyes were open, pupils dilated. So I sat facing away from him at about a forty-five degree angle in a chair nearby, and I put myself in exactly the same body position. I didn't even bother to be smooth. I put myself in the same body position and I sat there for forty minutes breathing with him. At the end of forty minutes I had tried little variations in my breathing, and he would follow, so I knew I had rapport at that point. I could have changed my breathing slowly over a period of time and brought him out that way. Instead I interrupted it and shocked him. I shouted "Hey! Do you have a cigarette?" He jumped up off the couch and said "God! Don't do that!"
Frogs Into Princes. p80.
One eloquent description of the catatonic experience is given by "Michelle":
I was not "aware" of reality at all. I was completely in my head, initially. I do remember one occasion, where my sister took hold of me and shook me and shook me "Michelle, I am TRYING to get through, can you HEAR me? Can you SEE me? Michelle, Michelle. Are you there?"
Realizing this was in some way important I do recall talking to her for a few minutes, but immediately went back to that other dimension and forgot about it.
Since the start of drugs though I have only become catatonic during an "episode" or "break". I am fully aware of reality, but am also aware of something that I consider to be more important than reality. The Universe. I could pick up a guitar and then not be able to move, be frozen in that position, sometimes not knowing or understanding why, just that it was or is so INCREDIBLY important that I don't move. It is so hard to explain "IMPORTANCE" to someone that does not have schizophrenia.
If you can think of the fundamental basis of existence and feel that you can affect it you might come close.
If it is important not to move, then it is important not to move. I don't know if I am a typical example. In normal life when my drugs are trucking along happily an
washed a bit more, and then a bit more, and then a bit for luck and then a bit extra.
Oh it goes on and on and on .....................
An understanding of catatonia from the inside and a basic understanding of pacing and leading can work wonders with these states, as demonstrated decades ago by Laing:
In Chicago, Laing was invited by some doctors to examine a young girl diagnosed as schizophrenic. The girl was locked into a padded cell in a special hospital and sat there naked. She usually spent the whole day rocking to and fro. The doctors asked Laing for his opinion… Unexpectedly, Laing stripped off naked himself and entered her cell. There he sat with her, rocking in time to her rhythm. After about 20 minutes she started speaking, something she had not done for several months. The doctors were amazed. "Did it never occur to you to do that?" Laing commented…
John Clay. R.D. Laing - A Divided Self.