Re: Schizophrenia

Tim A. Connor (
Sun, 29 Nov 1998 22:30:07 -0800 (PST)

In working with "schizophrenics" (Kelly always put that in scare quotes,
so I'll follow him), I've struggled to understand and find ways to help
them with their difficulties that are consistent with constructivist
principles. A few things stand out:

1) It seems to me that the core of "schizophrenia" is not the content of
their constructions, but their inability to do what most of us do
routinely--to check our constructions against social consensus and modify
them accordingly (or not modify them, but to effectively construe others'
constructions of our constructions, and temper our social behavior
accordingly). In other words, an impairment of sociality and commonality.
There are lots of people who have unusual, even seriously annoying, belief
systems and yet manage to avoid getting diagnosed. They must be able to
do something that "schizophrenics" can't.

2) Even if, as I think we must, we concede that "schizophrenia" (or at
least some "schizophrenias") has its roots in some dysfunction of the
brain chemistry, we still need to take into account the effect on
personality development of having such a condition. Not only the
difficulty of construing and anticipating our own experiences, but the
constant invalidation of our constructions by others. ( I have worked,
I'm sorry to say, in places where clients were all but forbidden to talk
about their "delusions" or "hallucinations" and staff were told to simply
change the subject if the client tried to talk about his or her bizarre
experiences or fears. I can't think of many situations less conducive to
mental health than being unable to communicate one's experience to
anyone.) Normalizing the brain chemistry does not "cure" "schizophrenia,"
though it may be a necessary precondition for such a "cure."

3) To have a relationship with someone, I need to construe his/her
constructions, including constructions of self, but I don't need to take
them at face value. I don't assume that either I or the client
necessarily have the "correct" construction of the situation, but that we
can benefit from each others' perspectives. So I have no hesitation about
saying, "I know that you believe you are not ill, and that (elaborate
system involving the US Govt., the Marines, almost all psychiatrists, and
a special research project dealing with ESP) is true; well it doesn't make
sense to me, and frankly I think it's a symptom of your problem and that
you might well change your mind if you agreed to take the recommended dose
of Zyprexa. But that's your choice to make...what are you willing to
experiment with to make your life a little better today?" The "credulous
approach" doesn't mean I have to share the client's world view, only to
assume that it makes sense to him/her and try to understand how.

I think the constructivist/biological dichotomy is a rather unproductive
one (on both sides), hopefully one to be transcended someday. I do find
that the more we learn about neurobiology, the more support there is for
constructivist psychology, but most of the people on the biomedical side
don't seem to have noticed yet.


Tim Connor, M.S. "Psychotherapy is not
Pacific University an applied science, it
School of Professional Psychology is a basic science in
2004 Pacific Avenue which the scientists
Forest Grove, OR 97116 USA are the client and his
<> therapist"
--George Kelly