Natasha: (with abrupt unsolicited finality) There’s no monster in this room.
Natasha: No. I looked under the mat (conclusively).
Daddy: How could a monster be under the mat?
She looks at me as though I don’t know anything.
R.D Laing. Conversations With Children.
For NLP Practitioners interested in working with schizophrenia, I suggest familiarization with the following works first:
R.D. Laing: “Knots”; “The Politics of The Family”; “The Politics of Experience and The Bird of Paradise”; “The Divided Self”; “The Facts of Life”; “Sanity, Madness and The Family”; “Self
Gregory Bateson: “Toward a Theory of Schizophrenia” (in “Steps Toward an Ecology of Mind”).
Irvin Goffman: “Asylums”; “Stigma.”
The Oxford Text of Psychiatry.
Peter Breggin “Toxic Psychiatry”.
The information here may appear to be paradoxical given my stance on the existence of schizophrenia as a biological illness, but politics aside, I have listed the information from organic-psychiatry that I believe to be relevant to the NLP Practitioner.
Types of Schizophrenia
The client has predominantly positive symptoms. Disorganised behaviour and speech, delusions, hallucinations and contextually inappropriate emotions.
See for more information about this the pages on Disorganised Schizophrenia.
This is anything but “simple”. It is marked by a slow, gradual onset and withdrawal from society and normal activity. Generally absent are the frank hebephrenic positive symptoms. This type of schizophrenia might be seen as the classic slow psychotic breakdown that affected the room-mate at university. Usually, the person is globally affected and according to current research and practices has the worst prognosis.
Characterised by a severe motor impairment and total withdrawal from the outside world. This condition is marked by gross negative symptoms.
Obvious delusions and hallucinations, usually of a persecutory nature. Often episodic, leaving much of the personality unaffected between episodes.
Saved for those who cannot be classified, but seem a bit unhinged anyway.
How clever has one to be to be stupid?
The others told her she was stupid. So she made
herself stupid in order not to see how stupid
they were to think she was stupid,
because it was bad to think they were stupid.
She preferred to be stupid and good,
rather than bad and clever.
It is bad to be stupid: she needs to be clever
To be so good and stupid.
It is bad to be clever, because this shows
how stupid they were
to tell her how stupid she was.
R.D. Laing. Knots.
Some GeneraLIEsations About Schizophrenics
- often show an inability to form a holistic picture of the world.
- score poorly at reality testing.
- have impaired real world knowledge demonstrate reduced ability to process spatial information even when information is presented directly to the right hemisphere.
- when shown pictures of faces and asked to assign emotions, tend to make errors and misattributions more frequently than normals.
- under-estimate the intensity of expressed negative emotions.
LaRusso demonstrated that paranoid schizophrenics are more accurate in discerning when people are “acting” and are highly sensitive to genuine non-verbal cues that indicate stress. From my own experience, this is true and is also the cause of much problems given the falsities occurring in hospital “care”.
Focal damage to the right hemisphere produces behaviour similar to that seen in schizophrenics:
- Poor understanding/demonstration of social nuances.
- Impaired use of prosody.
- Schizophrenics with negative symptoms demonstrate reduced left ear advantage of non-verbal dichotic tasks.
Schizophrenics often experience their own “willed-actions” as being controlled externally (“I’m being controlled by moonbeams from Sirius”).
In schizophrenics, willed-actions are regulated by the left hemisphere without recursion to the right hemisphere.
The confabulation/delusions of schizophrenics are similar to that of patients receiving neurological insult to the right hemisphere producing “left hemi-neglect”.
Summary of Results of Damage to Right Hemisphere:
- Disturbed Body-Image.
- Spatial Disorientation.
- Misidentification of Events and Faces.
- Deterioration of the “Music Ear” and reduction of creativity such as painting, poetry, music, chess playing, non-trivia math problem solving.
Clumsiness, awkwardness, motor unco-ordination may show sign of right hemispheric dysfunction.
The “intention of movement” is in the right hemisphere. In working with schizophrenics who have the rigidity of movement that is not an effect from the neuroleptic medication, some bodywork, dancing, massage etc, might be a useful start to any session.
As an NLPer, I have no hesitation to begin a session in this way – some people think this pretty odd and prefer to hide behind a desk. Personally, I do not find this acceptable. Do more. Remember, that even people with “phantom limbs” can develop “phantom contractures”, which appears to suggest that the contracture does not originate in the limb – any bodywork that you do is interacting with neurological pathways. You need to know the outcomes that you are going for. Learn where these things are represented on the cortex.
Schizophrenics tend to show a right hemispheric dysfunction, it might not be unreasonable to suggest that activities that activate the right hemisphere will assist general functioning will help you in achieving the intended outcomes for these clients. Working in the “rehab” units I learned a lot about the psychiatric staff and intended outcomes. In one unit, the activity groups would consist of a morning of “art therapy” where the clientele would sit around bored, whilst a well-intentioned nurse would enthusiastically encourage them to put the paintbrush to paper. There would be a music class, where some disinterested schizophrenics would be encouraged to bash tambourines. Then there would be the woodwork class, where the stilted schizophrenics would be encouraged to stick pre-formed wooden models together by another enthusiastic nurse. Meanwhile, one or two individuals would be in the kitchens receiving “cooking therapy” and being told how to cook simple meals.
The entire atmosphere was contrived and blatantly patronizing. I made myself unpopular by repeatedly asking the staff what their intended outcomes were for the groups they were running.
Unfortunately, psychiatric training does not cover this area of outcomes. The staff were merely fulfilling the obligations they had to the “rota” – the paper that is assigned God-like status in institutions, without the flexibility to feedback. If the rota had been fulfilled, then a good days work was performed.