A student emailed me asking for some help on a school project he was undertaking about catatonic schizophrenia. Here’s my reply:
Okay, first off could you explain exactly what you do, where you do it from, and possibly your history in the business…
I initially trained as a registered general nurse and worked primarily in Accident and Emergency and then Neurology/Neurosurgery. I also work independently as a therapist. For this, I initially trained as a hypnotherapist and then trained in neuro-linguistic programming. I am not registered nor certified as a therapist, nor do I belong to any professional organisations. I work from an office at home, mostly on a one-to-one basis with clients with a variety of problems and difficulties. These range from depression and anxiety through to complex psychiatric problems.
I also do a lot of consultancy and advisory work for people who are trapped within the psychiatric system or undergoing tribunal or professional problems for speaking out about psychiatric practices. My therapeutic work began as I grew increasingly despondent about the quality of practice in psychiatry. I was appalled at how unskilled most of the staff were, who appeared to be more interested in pet theories than actually being able to make people better. As I became more outspoken and increasingly alienated from the establishment, more and more people began to approach me for help. I found that despite the trouble I was regularly in for my views and the negative image portrayed of me, there were a large number of people who felt the same way and wanted help. This was how my private practice began.
Have you dealt with any catatonic schizophrenics? If yes, what have you observed?
One of the most interesting experiences about working with people in a state of schizophrenic catatonia is how “normal” people behave around them. NLP innovator Dr. Richard Bandler comments that it is strange how everyone whispers when there is a catatonic in the room. I have certainly found this to be true.
In one instance, with a young man who not infrequently slipped into catatonia, it was his mother’s behaviour that interested me the most. When he was relatively “normal”, she would fuss around him, constantly checking if he was OK, asking how he was feeling mentally, and so on.
However, when he slipped into a catatonic state, she would behave and talk to him as though he were perfectly normal.
Whilst this might seem strange, it is in fact remarkably common. It is as if the mother (or whoever is dealing with the patient, I see staff behaving this way too) can only relate to the patient when he is ill. When he is well, they do not know how to relate to him.
The nearest analogy I can think of is that of a teacher and a student. In class, they both understand their relationship. One is in charge; the other is not. It is a complementary role with clear boundaries.
But what if that teacher comes to the student’s house, casually dressed, for dinner? It can be very confusing because the dynamics of the relationship have changed. It would be easy if the teacher maintained the role of “teacher”, but what if he behaves as he would when not in that role?
Also strange is that with catatonic schizophrenia, people tend to behave as though the catatonic should not be disturbed. People whisper and speak softly. Catatonic patients often get positioned in wheelchairs in front of windows. Perhaps staff think they will enjoy the view.
What’s the craziest thing you have seen or witnessed in a mental institution?
The staff seem to have a monopoly on the crazy behaviour. Who thinks that plugging someone’s brain into the electricity mains and giving them electroshock is a good idea? They once thought drilling holes in people’s heads was beneficial too. Now they just drug everybody.
The dynamics inside psychiatric institutions are bizarre. You would have to be crazy to be there in the first place. If you weren’t, you would likely become a little unhinged just to survive. Most patient behaviours that seem crazy become intelligible when viewed through the right filters.
For example, I treated a woman who believed she did not have a head. Everyone took this literally. I suspected metaphor. We use metaphor constantly: people lose their minds, get pain in the necks, or suffer heartburn without believing their hearts are on fire.
Laing once referred to a patient who believed he was made of glass. In an institution where everyone sees straight through you, nothing is private. If you feel fragile enough, you might indeed shatter.
What’s a daily routine for someone with catatonic schizophrenia or any type of schizophrenia?
Typically, they are bathed, drugged, and placed in front of a window in a wheelchair. Catheter bags are emptied occasionally, positions adjusted to prevent pressure sores, and sometimes someone tries to coax a response. Occasionally, electroshock is applied to see if it “wakes them up.”
As far as I can tell, very little inside mental institutions is designed to promote recovery. Much of it is drudgery and routine. If a catatonic remains in stupor long enough, it becomes normalised and is no longer noticed as aberrant.
Is there any such treatment for the disease?
It is a mistake to think of catatonia as a disease. Catatonia is a behavioural state with many possible causes, including organic ones such as encephalitis and psychiatric ones. It is less fashionable today, and there are fewer catatonics than fifty years ago.
This is partly due to improved neurological diagnosis and treatment and partly because psychiatric presentations follow cultural fashions. PTSD and teenage depression are fashionable today. Co-dependency has faded, and multiple personality disorder has returned under a new name.
Some conditions once thought psychiatric are now recognised as neurological. Multiple sclerosis was dismissed as psychiatric for years until plaques became visible via brain imaging.
To wake a genuine catatonic person, you must break through the state and reach the person behind it. Whispering will not do. You must raise motivation dramatically, metaphorically strap them into the front of the biggest roller coaster you can imagine.
In your own words, what do you think causes such a condition?
I think it is erroneous to explain human behaviour purely in cause-and-effect terms. Gregory Bateson once remarked that if you kick a ball you know where it will go, but if you kick a dog the outcome is unpredictable.
A better question is, ‘What incentive does the catatonic have to wake up?’ In most psychiatric units I have visited, there is none. Understanding causes merely builds rationalisations around the behaviour rather than changing it.
You might enjoy the Alan Parker film “Birdy”, about a Vietnam veteran in catatonic stupor, starring Nicolas Cage with a soundtrack by Peter Gabriel. It remains one of my favourite films.
Where would someone like me go if I had this condition?
You would likely end up in a psychiatric facility with people whispering to you. Depending on culture, one might be placed in a monastery, prayed over, locked up, drugged, shocked, or subjected to therapy that requires reliving painful memories, none of which is likely to lift one’s spirits.
You might wish to explore Oliver Sacks’ work with post-encephalitic patients from the 1920s epidemic, recorded in his book “Awakenings.” He used L-DOPA to wake patients who had been frozen in catatonia.
L-DOPA raises dopamine levels. This is interesting, since schizophrenia is commonly treated by lowering dopamine. Antipsychotics often cause Parkinsonian symptoms, while Parkinson’s patients treated with L-DOPA may develop hallucinations.
Parkinson’s disease demonstrates alternating states of catatonia and agitation, highlighting the deep interaction between neurology, environment, and experience.
For trivia: an X-Files episode featured catatonic patients revived by an Amanita-based tonic. Some Amanita compounds are chemically related to Parkinson’s medications, though ingestion is extremely dangerous.