What's wrong with schizophrenics? (was: Control system description)

[From Bill Powers (2009.05.04.0232 MDT)]

forwarding this from Tim Carey with permission..

Bill P.

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From: "Tim.Carey" <Tim.Carey@canberra.edu.au>

To: "Bill Powers" <powers_w@frontier.net>,
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Hi Bill,

Sorry for my delay in responding. I'm just catching up with these now.
Yep, good question "What is wrong with someone who has schizophrenia?"
Knowing someone has schizophrenia really tells us nothing about what is
wrong with them - from their perspective. I guess that's the theme of
your email and one I try to reflect in my clinical practice. I think
it's crucial to find out what the problem is with any apparent symptom a
person is reporting. Invariably, "what the problem is" boils down to
them not being able to do some of the things they'd like to do.

There's an ongoing debate about how much we know when we know a person
fits a diagnostic category. For me, it's not much at all. Interestingly,
even the authors of the DSM-IV-TR (Diagnostic and Statistical Manual of
Mental Disorders, 4th edition, text revision, 2000) don't place much
weight on the boundaries of diagnostic categories. On page xxxi of the
introduction they write: "In DSM-IV, there is no assumption that each
category of mental disorder is a completely discrete entity with
absolute boundaries dividing it from other mental disorders or from no
mental disorder." How about that?

The area of psychological distress is in bad need of an organising
framework and a way of understanding psychological symptoms. For me,
that organising framework is PCT (I bet that came as a surprise!). The
focus is on understanding what the problem is with any particular
symptom the client reports. Asking something as simple as "Does it
bother you to ... (hear voices, feel depressed, think about what other
people are thinking of you, etc)" can be illuminating and a good place
to begin helping people explore the areas of their life that aren't the
way they want them to be.

That seems to be pretty much what you're talking about Bill.

Thanks for including me in this.

Tim

Tim Carey, PhD, MAPS
Associate Professor
Course Convenor - Master of Clinical Psychology, PhD (Clin Psych)

Centre for Applied Psychology
Faculty of Health
University of Canberra ACT 2601

Phone: +61 (0)2 6201 2950
Fax: +61 (0)2 6201 5753
Email: Tim.Carey@canberra.edu.au

Australian Government Higher Education (CRICOS)
Registered Provider number: #00212K

[From Bill Powers (2009.05.04.1134 MDT)]

More from Tim Carey ---

Bill P.

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Hi Bill and Bruce,

Interesting stuff. I think the field of mental health would benefit
hugely by this sort of detailed analysis of the problem. One of the
problems with the problem, though, is that we don't know really what the
problem is! That's why Bill's idea of finding out what the problem is is
so important.

Another factor to throw into the mix is that people who attract a
diagnosis of schizophrenia or bipolar disorder almost never (in my
experience) voluntarily enter treatment. It's been a few years now where
I worked in depth with people who get these sort of labels but,
invariably, their symptoms are much more of a problem for their carers
than they are for them. I think that adds a very different perspective
to the situation.

For every symptom listed in the DSM-IV-TR it's almost always to find so
called "normal" people in the population who report that symptom but
aren't bothered by it at all. Some people produces amazing creative
works by hearing voices or having hallucinations. What's the difference
between debilitation and admired creativity?

That brings me to the last proviso I think is important when discussing
these kinds of problems. We don't know if someone experiences delusions.
All we know is that someone reports experiencing delusions. I think
these could be very different things. It used to puzzle me no-end why
people would continue to tell their psychiatrist that they were hearing
voices or believing weird things when they knew telling the psychiatrist
that would keep them locked up. I don't know that they all know that but
I did ask a couple of people on the ward and they at least knew it - or
could say they knew it.

Asking "why is this person hearing voices?" is an interesting question
but not nearly so interesting, for me, as asking "why is this person
telling me they're hearing voices?"

Tim

Tim Carey, PhD, MAPS
Associate Professor
Course Convenor - Master of Clinical Psychology, PhD (Clin Psych)

Centre for Applied Psychology
Faculty of Health
University of Canberra ACT 2601

Phone: +61 (0)2 6201 2950
Fax: +61 (0)2 6201 5753
Email: Tim.Carey@canberra.edu.au

Australian Government Higher Education (CRICOS)
Registered Provider number: #00212K