[From Chris Bory
(2009.05.03.1333 EDT)]
I’ve been following
this thread and wanted to share my thoughts:
As a matter of semantics,
I think how we speak of individuals that have internal persistent conflicts
makes a difference in how we conceptualize them. I think, which I believe is in
line with MOL, that there is a difference between saying, “someone who
holds the diagnosis of schizophrenia” and “a
schizophrenic.” The former depathologizes the individual and makes
the social construct of a diagnosis not the person; only something that the ApA
(American Psychiatric Association) labels them with to fit in a specific
category. I think starting with this seemingly small difference can help us
begin to look at, in PCT terms, what goes on for a person that holds a specific
diagnosis.
I remember one of my
professors saying, to elucidate the point about the social construction of our
current diagnostic categories, that someone who is described as having a manic
phase most likely feels (a generality of course) on top of the world and that they feel they can
accomplish anything (and some times they do accomplish many tasks while they are experiencing
what is called mania). So, then, why would anyone want to stop this: getting
things accomplished, feeling extremely elevated, having an increased sense of
self, less need for sleep, and getting more accomplished. Sometimes, these
described phases of mania impact other people (i.e., excessive and
unrestrained spending), which may lead to others wanting to control this
individuals mania (a type of interpersonal arbitrary control). However, this
may only be the case for some individuals. Others may find these so called
manic phases as extremely unpleasant and not consistent with what they
desire, causing internal conflict. So where does this leave us the socially
constructed categories we have developed do not accurately describe an
individuals subjective experience.
I think to follow with
what others have said previously, taking an idiographic approach to
understanding what specifically is causing the conflict for that specific
individual is the only way to try and find the controlled variable and the
conflicted goals. For starters, in looking back at the basic negative feedback
loop, the environmental disturbances that impact an individuals perceptual
input specific to an inpatient state psychiatric center may be so overwhelming
that whatever they try and to do to control their perceptions, the
environmental disturbances are too great. Having some experience working in two
different state psychiatric centers, you see the tremendous limitations placed
on the individuals on a locked unit you are told when to eat, when to
shower, when to socialize, when to be quiet, when to take your medication, when
to go bed (to name a few) - if you do not do what is expected of you by the
experts you are viewed as a being resistant, which could lead to seclusion,
medication sedation, or 4 point restraints if they view you as physically
dangerous. I guess the point Im trying to make is that as a whole, our societys
view and treatment of mental health has a long and difficult history, which is
in conflict with the more recent person centered approaches to understanding
the individuals subjective experience, but I believe this is where PCT and MOL
can help to begin to make a paradigm shift.
Just my thoughts.
Cheers,
Chris
···
On May 3, 2009, at 12:03 PM, Bill Powers wrote:
[From Bill Powers (2009.05.03.08523 MDT)]
Bruce Abbott (2009.05.03.0945 EDT) –
BP: An excellent start on the discussion of PCT and disorders. Let me stir the pot a little more.
BA:
The behavioral manifestations that lead to a diagnosis of schizophrenia are
diverse. These may include hallucinations (typically, hearing voices),BP: This is a problem for other people who worry about the reality of the voices and what that implies, but how is it a problem for the person having the hallucinations? That’s what I would ask about. Is it all right with you to be hearing these voices? If not, why not? If it’s OK, we can move on to something else. I’ve discussed hallucinations with people who had them, and most of them were very bothered by having them. If I’d known about MOL then, we might have got further, but I did explore the hallucinations with them, asking things like whose voices they were, and so on. Maybe just my not being upset by knowing the person heard voices was helpful. They didn’t seem so bothered afterward. The voices didn’t necessarily stop, but people would say, “Oh, there’s Grandma Harriet again.”
BA: delusions (beliefs that are manifestly false to most of us), possibly
including delusions of grandeur and/or persecution (the so-called paranoid
delusions),Again, that is defining the problem that other people have with the person who is deluded (that’s a social problem). What if you simply ask the person what he or she thinks about those ideas? Back when I was about to give up on dianetics, I started doing a lot of MOL-like stuff (unwittingly) with clients because I really didn’t know what else to do. One person I will not name told me he had been making a living in Las Vegas by betting quarters on a roulette wheel which he had learned to time (they let you bet while the ball is still rolling). He won enough to eat but didn’t make larger bets because he knew The Mob would kick him out or kill him if he won too much. He described to me the day he realized that his toothache was being caused by a radar beam coming from the sign he could see on the Silver Dollar Cafe (a big round thing like a radar dish) out his hotel window . He knew this was a delusion but at the same time knew it was true. We just kept exploring this and his other problems. I had no idea what advice to give him, so I didn’t give him any (we didn’t, anyway, in dianetics). Maybe he was already recovering by the time he got to me, but he didn’t think so (his main problem, he felt, was a painful homosexual relationship he was in with someone who mistreated him). But just exploring his delusions and his feelings about them seemed to do the trick. I wouldn’t say he came “back to normal,” because I don’t think he ever was, or ought to be, that, but by the time we finished he felt that his problems had been resolved and he felt much better. That was all I was after.
BA: disorganized speech (rambling discourse that may include
“neologisms” or made-up words), which in severe cases degenerates into “word
salad” that still follows grammatical rules but is meaningless to others,BP: I wouldn’t have the least idea what to do with that. Maybe ask the person what the words or pseudo-sentences mean? Maybe I’d say “I didn’t understand any of that – is that all right with you?” But I would try to determine if there was something about this behavior that was a problem for that person, not just for other people.
BA: distractibility (difficulty maintaining attention), odd repetitive
behaviors, inappropriate emotional outbursts (e.g., suddenly screaming at
someone for no apparent reason), catatonia (remaining immobile in a state of
"waxy flexibility, often for periods lasting hours), apathy and withdrawal
from the social world, and an apparent inability to experience positive
emotions such as happiness, joy, or love.BP: in each of these examples, I’d try to find out, if I could, if the state in question bothered the person demonstrating it. If a person suddenly screamed at me “for no apparent reason”, I’d ask if there were any reasons for that, not say it was “inappropriate.” Or I’d just ask if the person is feeling very angry, or ask what the person would like to happen just then.
The whole theme I’m trying to get across here is the idea of trying to find out what errors the person is trying to correct, or what difficulties there are with correcting them. My own opinions of what is wrong with the person are irrelevant from the PCT point of view. I can’t reorganize the other person (though plugging his brain into a wall socket might do some of that, if not in a very organized way).
BA: I worked as a ward attendant at a large state mental hospital for a short
time while in college and had the opportunity to observe a number of persons
who had been diagnosed with schizophrenia. The dominant impression I had was
that these were people like you and me. With most of them, most of the time,
you could have an ordinary conversation (anti-psychotic medications were
just then coming into use). But I don’t mean to convey that there was
nothing wrong with them. Schizophrenia is no illusion. It is a highly
debilitating disorder – although of course there are degrees, from mild to
severe.BP: Yes. But “debilitating” is in the eye of the beholder – it depends on what someone thinks the person ought to be able to do. If that someone is the person in question, fine, but if it’s someone else, nobody is going to reorganize in any fundamental way just to make someone else feel better.
And somehow I doubt that the same thing was wrong with every one of those “schizophrenics.” That’s just a category, isn’t it?
In high school I sometimes played boogie woogie piano in the mental wards of the VA hospital in Hines, Illinois (my mother was a Gray Lady there). I had the same impression that you got: I wasn’t very different from the guys locked up there. Perhaps I was even a bit less different from them than you were. Even they, however, told me they were different (but that I didn’t need to worry about it, which I learned not to do). But the question I had and still have comes down to this: what did THEY think their problem was, and was anyone trying to help them with that?
BA: From the PCT perspective, it may be easier to state what isn’t wrong than
what is. A person diagnosed as schizophrenic does not appear to have any
problems with lower-level control systems, unless dyskinesias develop as a
side-effect of medication. (Catatonia may be an exception, but see below.)
The person has normal use of skeletal musculature. He or she can walk, talk,
manipulate objects, and so on. Ordinary perception is intact: the person
doesn’t walk into walls or step off a sheer drop. Memory seems to function
normally.BP: Yes, it’s clearly a higher-level problem, though in many cases I think it’s a problem with how to deal with lower-level problems like hallucinations. There isn’t anything abnormal about hearing voices that aren’t really there; sometimes that’s how I remember parts of a conversation. It’s just the imagination connection. The real problems arise in the higher-order interpretations of what the voices say, or of the fact that they are experienced.
BA: On the other hand, the person may be perceiving things that aren’t there,
such as a scolding inner voice. Is this the imagination connection run
amuck?Why “run amuck?” That’s how it’s supposed to work. Maybe the problem is with a higher-order system that keeps the voices turned on all the time, for some reason we might explore.
The voice seems real enough to the person and entering the head from
some external source. The ability to “reality check” is compromised: the
person may hold fast to beliefs that are contrary to fact, logic, or common
sense. The person may have difficulty controlling attention. In the severe
case of “word salad” an entire monologue may consist of sentences whose only
connections are associative.That’s what I would focus on: do the voices sound real, and does the person think they are really real? In the worst cases you describe, naturally we have to suspect some kind of organic problem that can’t be dealt with psychologically, but I’d never assume that to start with. You and I have debugged enough programs to know that a wise analyst never starts out by blaming the hardware.
Catatonia is an interesting case. The person enters a state immobility
characterized by waxy flexibility. You can move the person’s frame around
and he or she will offer no resistance. An arm will stay where you position
it, even if the position is uncomfortable. After the person emerges from
this state, he or she may give you an explanation for it. (One said that he
was saving the world from nuclear holocaust, because one move would upset
the delicate balance between good and evil – a paranoid delusion of
grandeur, by the way.)Yes, I suppose so, but did it seem like a delusion to the person? The other rationalizing phenomenon happens in hypnosis, too (Oh, I just though you might be amused if I tugged on your beard a little). We do like to make sense of our own behavior.
My guess is that that these explanations, like those
all of us give, often are not the actual reasons but are generated post hoc
as a way of justifying what we did. It sounds to me as though something is
wrong with the linkages from higher-level reference signals, although beyond
that I’m not sure how to characterize it. The person doesn’t fall over, so
low-level systems regulating posture and balance are working, but
higher-level systems seem to be in a “don’t care” mode with respect to the
reference settings.That’s just a start at an analysis, but perhaps enough to get the ball
rolling.Good, let’s see what others have to say.
Best,
Bill P.
