Re: Grids & schizophrenics
Wed, 25 Nov 1998 23:26:25 EST

In a message dated 11/25/98 7:54:30 AM Central Standard Time, writes:

<< Doesn't this gloss over the fact that their deviant contruals are even more
trouble to themselves? Paranoid thoughts and terrors are no fun, even if,
from within the frame of reference of the sufferer, they may seem
justified; a lot of schizophrenics are very unhappy; a lot commit suicide.

I'm not trying to argue against the idea that a constructivist account of
delusions, in schizophrenics and others, has a lot to offer but there is
now plenty of evidence, e.g. from abnormalities in eye movements, from
brain scans etc. and from genetics, of an underlying neuropathology in
schizophrenia. Therefore, an adequate constructivist account of the lives
and thoughts of these troubled people must encompass the neuropathology
which can distort the inputs to their construing, and perhaps also some of
the processes of construing at all.
I want simply to say that I agree with the above. Medicine has progressed
beyond the old days of sedating people. Counseling does not change or
eliminate the thoughts created by a biochemical imbalance. It is outside the
"range of conveniance" for PCP. This is no different than trying to talk
someone through a heart attack by counseling methods to reduce stress. It can
help but will not likely stop the heart attack.

To this day, I have trouble using the words psychotic or delusions to describe
content of perception in counseing or in diagnostic interviewing. My PCP
background prevents from doing anything but interpreting the context of the
observations of the person. On the other hand, schizophrenia has relevance as
a medical model for me in that it means amongst other things that unpleasant
sights and sounds for a person will be removed for that person by medication
(they are able to respond to medication). The medications used today are
increasingly specific and effective. Once a person takes the medication, I
generally hear the spontaneous reply from the person that the "old person" has
returned. This is then a rich reply with many constructions that will follow
about before and after in counseling. This is the counseling's range of
conveniance. I may have wanted to believe Szaz's point of view earlier, but
cannot when I see the tremendous and rapid change brought about by medication.
Most recently, a formerly homeless person who lived for ten years on the
street cursing at the air living in a 90 gallon garbage can. She now lives at
home pleasantly without syptoms as a result of risperidol. She is glad she
is there. She does not remember how she was. It is hard for others to
believe the change. Therapy did not do this! Now, counseling will help to
place her life experiences in perspective......

John Fallon