Schizophrenia is one of the most misunderstood disorders of the mind; it presents differently for most people, and there are a number of different symptoms outside of the most commonly known delusions and hallucinations. Due to this misunderstanding, a number of treatment methods are bypassed to subdue the client, or “quiet” the symptoms. Although medication can be helpful to many, both atypical and typical antipsychotics have a number of severe side effects that may cause more damage than help (Leucht et al., 2009/Stroup & Marder, 2013/McKim, 2007). Of course, the best approach to any mental illness is the incorporation of both medication and therapy, but sadly, this is not always the case. Typical psychotherapy is sometimes regarded as fruitless in regards to treating schizophrenia, possibly because there are a significant amount of symptoms that could “get in the way” of a therapy session. However, R.D. Laing was very successful in treating individuals with schizophrenia through therapy (Laing, 1960), and by implementing a very humanistic approach, through his use of compassion for the client. I believe that this approach should be revisited, and when dealing with hallucinations and delusions in particular, we should be asking the client and ourselves “what are the voices saying?”
Typically, the response to a delusional thought or hallucination is to either 1.) get rid of it or 2.) play into it. Neither is the proper response. If we do not know where this delusion is coming from, how will we be able to properly treat it? We won’t be doing anything other than taking a shot in the dark. By asking the client what the voice is saying, we get a closer look into their psyche, and a closer look into the root of the problem. Understandably parents wish to separate themselves from their child’s mental illness; they do not wish to be blamed for it. Freud was, however, correct in identifying the impact parents have (genetically and environmentally) on the child’s development (Freud, 1918/1923/1949). Early childhood experiences are undeniably, a contributing factor to any mental illness and we should not be ignoring this impact.
How we were treated in our childhood (by parents, peers, other adults), has a significant impact on how we view ourselves, and by extension how we behave. For an individual with schizophrenia, these memories and experiences are quite possibly repressed, and just now, manifesting in negative, neurotic ways. For instance, a client who is hearing a persecutory voice telling them they are worthless, ugly, or that they do everything wrong/can’t do anything right, is a client who quite likely has heard these phrases prior to the onset of symptoms. I have discussed in a previous article the impact a disintegrated self has on the psyche, so too has Laing (Laing, 1960). This inability to integrate certain aspects into the self (memories, experiences, aspects of personality), will present themselves later in the form of symptoms. For those with schizophrenia, this typically manifests in hallucinations and delusions.
By way of simply knowing what the voices are saying, we are able to perform psychoanalysis successfully. Instead of shying away from treating schizophrenia with therapy, we should be approaching it the same as any other mental disorder. Let me give an example.
A young woman, aged 26, has been experiencing delusions for the past year and a half. She is hearing voices telling her that she will “never amount to anything” and “without me you’re worthless.” These voices are of course, very distressing to her, and cause a significant amount of anxiety and worry, which leads to depressive feelings. She begins to believe these voices, and her lifestyle changes significantly from “normal” functioning prior to the onset of symptoms, to a disorganized, chaotic, and dysfunctional lifestyle. She finds it difficult to get out of bed, to eat properly, to get dressed –all of which are simple, everyday tasks most of us are able to perform without thinking consciously about it. This is because she is focused on the voices, combating them, and struggling so hard to repress them.
If we were to ask her “what are the voices saying?” we could discover the source. These thoughts have been repressed for some time, and perhaps, they originate from previous feelings of self-worth (or lack thereof). If we analyze and assess the clients’ history (childhood and beyond), we may get a better understanding of where these thoughts are coming from. It is normal for each of us, from time to time, to have negative thoughts about the self – but do we not also understand, with a little introspection, to some degree where they are coming from?
Say for instance, we were to discover, through our analysis, that all throughout her childhood her parents verbally and physically abused her. When she went into school it was difficult for her to make friends, and she was teased and bullied all throughout middle and high school. She tried her best to ignore this negativity, in an attempt to “survive” her years in school until graduation. This is of course, a very extreme case, however, by ignoring and repressing these negative thoughts and behaviours, they resurface later.
In order to combat these thoughts and experiences properly, we should be counseling, and employing cognitive behavioral therapy (CBT) (Beck, 1967). By counseling, I am referring particularly to counseling parent-child relationships (should this be found to be one of the main sources of negativity). By communicating our feelings, and working through the negativity instead of keeping it inside and ruminating about it, we are more likely to deal effectively with the source. This should not be the only resource we rely on for combating these delusions. We should also be employing CBT – challenging thoughts and behaviours.
By getting to the root of the problem, that is, the source of these thoughts and voices, we can address them directly. We can ask the source (parent, friend, teacher etcetera), why. We may also be able to determine that this is not a fundamental aspect of the clients’ personality. They are in fact not worthless, or ugly, and whatever else the voices may be saying. The first step is of course to confront the source, and the next step is to combat the continuing voices. Just because we have addressed the source does not mean the voices will dissipate. We must change the way in which we think, because this thought pattern, although separate from our selves, has become somewhat integrated into the self. We are able to combat these thoughts and change them, through CBT – by using exercises and homework. These must be taken seriously in order to experience change, because we are trying to alter negative thought patterns that have been with the client since childhood or beyond. As we know, it is very difficult to break a habit, so too is it difficult to break a thought cycle.
Therefore, we must confront those with schizophrenia not as helpless and beyond cure. Instead, we should confront these clients with compassion and new ways of understanding their illness. For many, these thoughts will represent something very real to them. These thoughts should be regarded as a manifestation of repressed thoughts, experiences and memories. As Freud has taught us, when we understand the impact a memory has on an individual, we are able to treat it effectively (Freud, 1895). Even just speaking of the source is cathartic. Instead of ignoring the voices, and repressing them even more, we should be asking what are they saying, and what does this mean?
Beck, A.T. (1967). The diagnosis and management of depression. Philadelphia, PA: University of Pennsylvania Press. ISBN 0-8122-7674-4
Freud, Sigmund., & Breuer, Josef. (1955). Studies on Hysteria. (James Strachey, Trans.). London: Hogarth press. (Original work published 1895).
Freud, Sigmund. (1918). “From the History of an Infantile Neurosis”, reprinted in Peter Gay, The Freud Reader (London: Vintage, 1995).
Freud, Sigmund. (1927). The Ego and the Id. (Joan Riviere, Trans.). London: Hogarth Press (original work published 1923).
Freud, Sigmund.(1989). An Outline of Psycho-Analysis. (James Strachey, Trans.). New York: Norton & Company. (Original work published 1949).
Laing, R.D. (1960).The Divided Self: An Existential Study in Sanity and Madness. Harmondsworth: Penguin
Leucht, S., Corves, C., Arbter, D., Engel, R.R., Li,C., & Davis, J.M. (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet, 373 (9657): 31-41. doi: 10.1016/S0140-6736(08)61764-X.
McKim, W. (2007). Psychomotor Stimulants. Drugs and behaviour: An Introduction to behaviour pharmacology. Pearson Prentice Hall.
Stroup TS, and Marder S. (2013). Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. Retrieved from http://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-acute-and-maintenance-phase-treatment