Re: Return response/ Recovering Psych. Patients

Esteban Laso (
Tue, 1 Jul 1997 22:00:53 -0500

Hi everybody

I guess we can start from something like: Voices are real to schizophrenics
-the question is: can we understand why do they need them?

Lindsay Oades wrote
> I really have only been working on a one-to-one basis with these people
for a
> short time (around six mths). This in many ways I feel is an advantage- I
> not have the assumptions of chronicity, unshakable delusions etc that
some of
> my colleagues have. Perhaps I am naive but this has the fortunate by
> of credulous listening.

C. G. Jung used to say about dream analysis: First, I try to learn all I
can about dreams; then, when approaching a new one, I forget everything
I've learnt and start from a blank page.

> Issues of denial and insight are interesting. Do clients deny suffering
or do
> they deny the label of schizophrenia because of the images and
associations it
> conjures? I heard an interesting use of the word denial lately in a
> context- men who have sex with men when married but who don't want to
> as gay- labelled as men in denial. Denial of what exactly? The question
> schizophrenia remains. Is denial being used here in the same way as the
> "without insight"? Is the term also linked to the phrase "non compliant"?
> guess from the way the terms are used on the ward is that the answer is
yes to
> both. Interesting personal construct questions may look something like:
> "How do you describe what's happening for you at the moment?"
> "What do you understand by the term schizophrenia?"
> A comparison of these responses would then be of interest.

What kind of denial are we talking about: the client's denial to himself or
to others? The verbal-explicit or nonverbal-implicit one? Schizophrenia is
a handy narrative for both doctors and patients; the later come to think
about themselves as sick persons, the former can refuse to look at the
meaning of delusions by seeing them as byproducts of biological
disfunctions. Denial is a two-sided thing: the shizophrenic denies our
construction of him -and we deny his.

> Currently I am trying to understand a man who used to work at the steel
> He has an elaborate "delusional system" who nobody I think has ever
> listened to. Some may consider him thought disordered- he certainly
> meet the neater requirements of the cog behavioural ABC approach to
> Interestingly though he does use terms consistently- he has meanings for
> such as "pardon", "perfection", "one", "first born creature of the
> "clear thoughts". These all relate in some way. "Perfection" is related
to a
> steel process. He had difficulties towards the end of his apprenticeship.
> talks of the steel works being at war, not receiving a pardon, and the
> psychiatric patients getting side effects because of what the steel works
> I am sure there is meaning in there, and it can't just be meaningless
> epiphenomena of a damaged biology.

I'd rather say: we can _create_ a meaning for a delusional system.
Delusions are very threatening in our cultures -we have no way of
construing them except as _sickness_. Maybe denial is useful if a
schizophrenic learns to keep his delusions for himself -provided they give
him some clues to make his experiences meaningful. Some psychoanalysts say
the best hope for a psychotic is to _structure his delirium_: that is, to
impermeabilizate and tighten it. And, then again, we -the schizo's social
world- must deny his _sickness_ and say: _hey, he's the same man we knew!
He's not sick anymore._
Schizophrenia is a cultural label! And to think about it we must think on
how we use our power as scientists or doctors (in a broad sense).
Hope this helps,

Esteban Laso