Schizophrenia and Other Psychoses

By Carol Goh  |  Published on 23 May 2021

What is schizophrenia?

Schizophrenia is a chronic mental disorder characterized by abnormal social behavior, deterioration in intellectual functioning, and a distorted sense of reality.

Schizophrenia can cause a person to be socially withdrawn, as well as displaying strange behaviours, speech, or thoughts. When a person has schizophrenia, they may be able to tell that they are having problems with their thinking which is not right, but they don't know what exactly is wrong.

There are a lot of misconceptions about schizophrenia and its sufferers. Schizophrenia sufferers often wonder if they are indeed crazy, or out of mind. My immediate answer is “No, they are not.” They are just suffering from some symptoms that impede their functioning. However, when it is not under control, schizophrenia is generally considered the most disabling form of psychosis.

Diagnosis of schizophrenia includes the following symptoms:

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (diminished emotional expression or avolition)

Criteria for Dissociative Schizophrenia

There are different forms of schizophrenia. Dissociative schizophrenia is another common form and its symptoms are:

1. Dissociative amnesia

2. Depersonalization

3. The presence of two or more distinct identities or personality states

4. Auditory hallucinations

5. Extensive comorbidity

6. Severe childhood trauma

Dissociative schizophrenia is a type of schizophrenia which satisfies at least three of the above symptoms. Dissociation is a defence mechanism that those suffering from schizophrenia will manifest. Sufferers need this defensive reaction in order to protect them from becoming overwhelmed in the form of psychic pain or fear. When reality becomes too painful and hurting, dissociation serves as a refuge and softens the blow. Hence, there is meaning in the manifestation. If we can decode the meaning, then there is hope for sufferers.

What could cause schizophrenia?

Notwithstanding it could be biological, many studies have found schizophrenia being linked to adverse life events which manifest in the form of post-traumatic stress disorder (PTSD).  With this possible cause in mind, we can then approach this ‘illness’ with intervention targeting at resolving PTSD.

Adverse life events can be traced back to childhood experiences when attachment is so relied on. At this life stage, when a child is abused at the hands of a parent, the child will dissociate in order to maintain the attachment. According to Miller (2016), for those who had experienced three traumas, the increased likelihood of being psychotic was 18 times; for those who had experienced five traumas, that increased likelihood went up to 193 times.

Many studies have found that childhood trauma to be a high-risk factor for schizophrenia (Storvestre, 2020). Childhood trauma encompasses the quality of bonding or attachment with parents which can affect a person’s social cognitive development (Rokita, et al., 2020).

Psychotherapy Intervention for Schizophrenia

If you are suffering from schizophrenia, the treatment usually starts with telling your story from as far back as you can remember. This process is essential even though what has happened in the past could cause pain, fear, and anxiety during the therapy session. This process is what Carl Jung described as working with our shadows – things we deny, repress, or hide. By facing our shadows, we can explore in-depth issues and eventually confront them.

"By facing our shadows, we can explore in-depth issues and eventually confront them."

Inevitably, these past hurts and pain can be inflicted by people in our community. We term this as “peopled wound”. Since it wound us in the community, we must seek healing in the community. It will be helpful in the process of therapy to think of the voices you hear as clues to what the voices are telling you about the nature of the wound. These are authentic experiences and only by listening to the voices, we can uncover the true nature of the inner wounds.

"We term this as “peopled wound”. Since it wound us in the community, we must seek healing in the community."

In the course of intervention, several therapeutic counselling techniques will be employed as the wounds or traumas can be deep seated and complex. The following techniques are often used to handle different types of wounds or traumas:

1. Inner child healing

2. Gestalt

3. Eye Movement Desensitization Reprocessing (EMDR)

4. Schema Therapy

5. Journaling

6. Visualisation

7. Mindfulness

Book Recommendations

1. EMDR Therapy for Schizophrenia and Other Psychoses by Paul William Miller

2. Feeling Unreal by Daphne Simeon

3. Getting Past Your Past by Francine Shapiro

4. The Body Remembers by Babette Rothschild

5. When the Past is Present by David Richo

References

Miller, P. W. (2016). EMDR therapy for schizophrenia and other psychoses. New York: Springer Publishing Company.

Rokita, K.I., Dauvermann, M.R., Mothersill, D., Holleran, L., Holland, J., Costello, L., Cullen, C., Kane, R., McKernan, D., Morris, D., Kelly, J., Gill, M., Corvin, A., Hallahan, B., McDonald, C., & Donohoe, G. (2020). Childhood trauma, parental bonding, and social cognition in patients with schizophrenia and healthy adults. Journal of clinical psychology.

Rokita, K.I., Holleran, L., Dauvermann, M.R., Mothersill, D., Holland, J.F., Costello, L., Kane, R., McKernan, D., Morris, D., Kelly, J., Corvin, A., Hallahan, B., McDonald, C., & Donohoe, G. (2020). Childhood trauma, brain structure and emotion recognition in patients with schizophrenia and healthy participants. Social Cognitive and Affective Neuroscience, 15, 1336 - 1350.

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