Strangely, this manifestation of schizophrenia is not as common as it used to be. Possibly because of improved diagnostics and advances in medical knowledge of diseases of the nervous system, many people previously labelled as “catatonic” 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’ve 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 it’s like you are in a dark room somewhere really far away, you cannot interact with what is going on.
Diane.
According to the bible of psychiatry and insurance companies, the DSM-IV, catatonic schizophrenia is defined as follows:
- Catatonic stupor (marked decrease in reactivity to the environment and/or reduction in spontaneous movement and activity) or mutism.
- Catatonic negativism (an apparently motiveless resistance to all instructions or attempts to be moved).
- Catatonic rigidity (maintenance of a rigid posture against efforts to be moved) or 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 requires careful supervision to prevent harm to themselves or others. Medical care may also be required due to malnutrition, exhaustion, hyperpyrexia, 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 often lower their voices or whisper. I have encountered this behaviour with catatonics nursed on general medical wards, where their postures are changed every two hours and they are hand-fed, watered, and washed by nurses. It is not unusual to find a catatonic patient positioned in front of a television or a window. These patients often have urinary catheters and may soil themselves without complaint. Sometimes intravenous hydration is required once a critical level of dehydration is reached due to refusal or failure to initiate drinking.
Once, I was in Napa State Mental Hospital in California, and a guy had been sitting on a couch in the day room for several years. The only communication he was offering me was through his body position and breathing rate.
His eyes were open, his pupils dilated. I sat nearby at a forty-five-degree angle and matched his posture exactly. I didn’t try to be smooth. I sat there for forty minutes, breathing with him.
At the end of forty minutes, I made small changes to my breathing and he followed, so I knew I had rapport. I could have led him out slowly, but instead I interrupted sharply. I shouted, “Hey! Do you have a cigarette?” He jumped up and said, “God! Don’t do that!”
Frogs Into Princes, p.80.
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 remember one occasion where my sister shook me and said, “Michelle, I am trying to get through. Can you hear me? Can you see me? Are you there?”
Realising this was important, I spoke to her briefly, then immediately went back into that other dimension and forgot about it.
Since starting medication, I only become catatonic during episodes. I am aware of reality but also aware of something I consider more important than reality, the Universe. I might pick up a guitar and become frozen, unable to move, because it feels incredibly important not to move. It is very hard to explain “importance” to someone who does not have schizophrenia.
If you can imagine feeling that you are affecting the fundamental basis of existence, you might come close.
If it is important not to move, then it is important not to move. When my medication is working, I am washed, and then washed again, and again, and once more for luck.
Oh, it goes on and on and on…
An understanding of catatonia from the inside, combined with pacing and leading, can produce profound shifts, as demonstrated decades ago by Laing:
In Chicago, Laing was invited to examine a young girl diagnosed as schizophrenic. She was confined naked in a padded cell and rocked continuously. Laing unexpectedly removed his clothes and joined her, rocking in synchrony. After about twenty minutes, she began speaking for the first time in months.
The doctors were astonished. “Did it never occur to you to do that?” Laing replied…
John Clay, R.D. Laing, The Divided Self.