Time Coding Considerations in Schizophrenia
An interesting feature I have noticed with schizophrenics are the variations that occur in time coding and orientation. When asked to point to their representations most people are able to give its relative location. For example, “to the left, over there, about 3 feet away.”
This is of course once you have overcome the initial hurdle of:
Therapist: “…and where is that picture/representation?”
Client: “In my head.”
When the client isn’t able to understand that you are of course already aware that the
representation is in their head but that you need to know where it is spatially located, this is a good indicator to let you know that you haven’t set things up well enough ahead of time. The more adept practitioner won’t need to ask this question for his own enlightenment of course because with the right calibration and observation skills you will already know where the representation is.
However, asking questions like these can install the necessary observation skills in the client and make him aware of things he otherwise wouldn’t be aware of. Your meta-model questions will directionalise the transderivation of the client in the way you want it to go. I’ve heard lawyers say, “Never ask a question you don’t already know the answer to.” A similar attitude is valuable when working with some clients.
When locating representations, schizophrenic tend to locate them geographically. For example, “Where is that representation?” is often met with, “In my bedroom” or “In Cardiff.” In talking with Intensive Care nurses, a job filled with stress, I have noticed that the majority of staff tend to live a significant distance from their place of work. I wonder if they locate their representations of work by geography as well – as they drive further away from work on their way home, they noticeably feel increasingly relaxed. A generalisation indeed but it makes a point. The kinesthetic state can be anchored by location and physical distance also equals psychological distance.
So what happens when the client is associated into the wrong timeline? When Siebert is asking the girl, “Why did God choose you?” he’s directionalising her transderivation in an interesting way.
Think about it. In order to answer the question, she needs to step outside of her point of reference and see herself from the third position – she has to dissociate from her point of reference in her timeline.
A similar thing occurred when a schizophrenic told me he was dead. The man told me he was “dead, a corpse.” Now think of the options here provided by the meta-model.
“I’m dead, I’m a corpse.” – “How do you know?” Well, he’ll go right ahead and tell you. In that dreadful but mercifully rare neurological disorder of Cotard’s Syndrome***, the patient will often complain about the smell of rotting flesh. With regards to him being dead, asking him “How do you know?” will force the client to search for evidence that he may not have considered before. He may simply answer, “Well, I can feel it, I feel dead.” Further meta-model reduction will chase him down to identifying further evidence for his status as a dead person. Such an approach may not be entirely appropriate as with the headless lady, you may well just successfully reinforce his delusion.
***Whilst the exact neurological mechanism of Cotard’s syndrome is not yet fully understood (and it is neurological and not a psychiatric syndrome par se) Ramachandran reasons that the damage is likely to be in the right temporal lobe. Cotard’s syndrome is nearly always associated with a severe (psychotic) depressive state, which is not surprising if we consider that the
individual appears unable to neurologically create any kinaesthetic response to any input sensory stimulus.
“I’m dead, I’m a corpse” – “So what?” Well, this is possibly Bandler’s new meta-model and quite possibly the most useful response I’ve yet heard used. Ok, so it isn’t exactly sympathetic, it lacks empathy, it’s just not the done thing and your colleagues will think you are a heartless bastard and suggest that you are into S&M behind your back (true story). But think about it. When the man told me he was “dead” this was actually his typical response to any request for him to take any responsibility for his life or control over his environment. So the “So what?” response could be used in the context of, “So what? How exactly does this stop you from doing the washing-up, eh?”
Or you could have, “I’m Jesus.” – “So what? Get a job!”
In the scenario, with my not-so-dead man, my question was aimed at creating a different
transderivation because the man really did seem to think that he was a corpse, even if he did use it as an excuse.
“I’m dead, I’m a corpse.” He said.
“Wow!” the therapist replies, “You are dead!” he says empathically, meeting him at his model of the world – feeling for a pulse he exclaims, “Shit! No pulse”
“See?” Says the dead patient.
“Yes, I do,” the therapist replies. “What on earth happened?” (Thus turning it back into a process).
Now, at this juncture, the dead guy just knows he’s caught.
So he has a choice within this double bind – start backtracking and risk having the therapist hurling pedantry all over his case for the rest of the afternoon, or he can go along with me. He sensibly takes the latter option. It’s less painful. For example, had he said, “Nothing” as an attempt at escape, I’d have chased it with, “What do you mean nothing? You are dead for God’s sake!” and so on and on and on. Instead, he went inside and quickly tried to find the cause of death that would satisfy me. Apparently, a shark ate him so now I’ve definitely got him. As Bandler pointed out – working with hospitalised schizophrenics is easy – they can’t run away or throw you out of their house (unlike agoraphobes – see next chapter).
“When?” I asked pedantically. I want to know details – When? Where? What sort of shark? Who was there? Where is the blood? Where are the scars? (See the subtle implication of the last one?)
Now, pay attention to what is going on here. I am meta-modelling him and chunking down all the way but taking his transderivation away from being associated into being a corpse. It won’t surprise you to learn that I can be pedantic to the point of exasperation. How does he escape? Well, he goes and does the washing up. During one visit to a client who was hospitalised under a mental health section, the silly fool told me that he was there because he was being paid to keep an eye on the staff and not because he was behaving like a loon. He certainly won’t be making that mistake again.
I pursued his reasoning endlessly. Every step and move he made, I checked it out relentlessly. Eventually, he tried to back out and claim that he wasn’t really a secret agent, but I wouldn’t let it go. So, now he was denying it and I was now claiming that he was double bluffing and that he was indeed a secret agent. There was not one single claim or move he could make without me being all over his case. Eventually, he had to invoke his civil rights as a mental health patient in order to get rid of me.