Coping With
Psychosis: Some Thoughts From a Psychologist With Paranoid Schizophrenia
by Frederick J. Frese III, Ph.D.
In the early spring of 1966, I was hospitalized and
diagnosed with
paranoid schizophrenia. Over the course of the following decades, I
recovered sufficiently to become a psychologist and devote virtually all of my
professional life to caring and advocating for others whose disabilities are
similar to my own. Although accounts of my adventures with relapse and
recommended coping strategies have been published elsewhere (Frese, in press;
Frese, 1997; Frese, 1994; Schwartz et al., 1997), this article focuses
specifically on the mental process accompanying schizophrenia, which is
traditionally termed disorganized thinking or formal thought disorder.
Due to the cognitive processes that are involved in disorganized thinking,
those of us with schizophrenia may exhibit a tendency toward circumstantiality,
meaning that in conversations we wander from the topic at hand, but we are
generally able to return to the topic after our diversionary side-trips. As
this mechanism progresses, however, we increasingly become unable to return to
the topic, slipping off the track, exhibiting derailment, loose associations
and tangentiality. If this phenomenon further exacerbates, we may find
ourselves in states of linguistic disorganization, incoherence, or in the
production of "word salad." This disorganized thinking has been
argued by some to be "the single most important feature of
schizophrenia" (American Psychiatric Association, 2000).
My experience suggests that a model based on the thinking of the philosopher
Edmund Husserl, as described by Schwartz et al. (1997) and Spitzer (1997), can
be particularly helpful in rendering an increased understanding and
appreciation of this process. According to these authors, the disorganized
thinking of schizophrenia can be conceptualized as a cognitive process of
over-inclusion, or "an expansion of the horizon of meaning" (Schwartz
et al., 1997). From time to time, often as a function of stress or excitement,
our neurotransmitting mechanisms become increasingly active.
During these times, we begin to conceptually broaden, or overemphasize, the
connectedness of words, as well as of other sounds and sights, in a non-linear,
quasi-poetic, manner. Our thinking becomes dominated by metaphors. We have a
heightened awareness of similarities in the sounds of words. We become
particularly aware of rhyming, alliterations and other phonological
relationships among words. Words and phrases are likely to engender thoughts of
music and lines from songs. We are more likely to perceive amusing
relationships among words, and between words and other stimuli. In more poetic
terms, our mental processes become increasingly influenced by the muses. As a
part of this phenomenon, we may also begin to perceive certain mystical or
spiritual aspects of everyday situations. Sometimes these experiences can be
quite moving, frightening and even life-altering.
If one's mental horizons are allowed to expand too far, there will be
serious consequences. If not contained, this cognitive process can become quite
disabling. Fortunately, modern medicines and other forms of treatment enable
increasing numbers of us to avoid the worst of these consequences. The mind's
tendency to expand its horizon of meaning can be kept in check. Our sensitivity
to semantic and phonological relationships does not have to become so acute
that we can no longer focus on the problems of everyday life.
The DSM-IV-TR states that "less severe disorganized thinking or speech
may occur during the prodromal or residual periods of schizophrenia"
(American Psychiatric Association, 2000). However the DSM-IV-TR does not make
it clear that, even in recovery, our thought processes tend to be colored by
the same mechanisms which, when intensified, can become disabling. Even with
treatment, the cognitive processes of those of us with schizophrenia continue
to be affected to some degree. Even when we are in a relatively normal state,
our minds often continue to be subject to perceiving relationships of which
others are unaware, relationships that affect our sense of reality and truth.
Because we have this tendency to "listen to a different drummer," we
often experience difficulties in communicating with our more "normal"
friends. Sometimes others perceive what we say and do as strange or bizarre.
Even while in recovery, we may still meet one or more of the DSM-IV-TR criteria
for the three schizophrenia-spectrum personality disorders-paranoid, schizoid
or schizotypal.
In conclusion, there has recently begun to appear in the literature a call
for reconsideration concerning the disorganized thinking aspect of
schizophrenia. Recognizing this process as a function of an expanded horizon of
meaning may provide an improved vehicle for a better appreciation of the
phenomenological world of people with schizophrenia. Such improved
understanding could be valuable in assisting those of us with this condition to
more easily integrate our social and vocational efforts into the activities of
the everyday world.
Dr. Frese served as director of psychology at Western Reserve Psychiatric
Hospital from 1980 to 1995. He is currently coordinator of the Summit County,
Ohio, Recovery Project, and is First Vice President of the National Alliance
for the Mentally Ill.
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References
References American Psychiatric Association (2000), Diagnostic and
Statistical Manual of Mental Disorders, 4th ed., Text Revision. Washington,
D.C.: American Psychiatric Association.
Frese FJ (in press), Psychology practitioners and schizophrenia: a view from
both sides. J Clin Psychology/In Session.
Frese FJ (1997), Twelve aspects of coping for persons with serious mental
illness. In: Psychological and Social Aspects of Psychiatric Disability,
Spaniol L, Gagne C, Koehler M, eds. Boston: Center for Psychiatric
Rehabilitation, Boston University, pp145-155.
Frese FJ (1994), A calling. Second Opinion 19(3):11-25.
Schwartz MA, Wiggins OP, Spitzer M (1997), Psychotic experience and disordered
thinking: a reappraisal from new perspectives. J Nerv Ment Dis
185(3):176-187.
Spitzer M (1997), A cognitive neuroscience view of schizophrenic thought
disorder. Schizophr Bull 23(1):29-50.
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