| Separation and correct understanding are the | | | | what you experience to be real today." |
| cornerstones of successful treatment and recovery | | | | As treatment progresses and the patient comes to |
| from serious emotional disorders. But there are | | | | recognize the shifting realities, he can begin to |
| additional factors and modalities, of course, including | | | | recognize where the other realities come from. One |
| the judicious use of medications, the occasional | | | | recovering schizophrenic woman complained that |
| administration of ECT, the cross referencing of adult | | | | when she returned from shopping she would put the |
| and infant realities, the immediate identification of | | | | groceries on the floor instead of in the refrigerator. |
| relapses each time there is a contact with a family | | | | She did this even though she knew the food would |
| member, the use of day programs, of work, school | | | | spoil. She, therefore, wondered why she did it. It was |
| and community services, the therapeutic alliance and | | | | easy to point out that the baby plays on the floor, |
| the personal interaction with the patient. | | | | puts everything on the floor and never puts anything |
| CROSS REFERENCING THE REALITIES | | | | away. |
| The therapist must become an anchor in adult reality, | | | | In a similar fashion, each symptom that is a replay of |
| a person with whom the patient can relate at such a | | | | the reality/ behavior of the infant can be interpreted. |
| firm adult to adult level that contact with the | | | | When the patient lists countless reasons why he |
| therapist immediately brings the patient back to the | | | | cannot move away from his parents' home, this is |
| adult reality. One catatonic, in the excitement phase, | | | | the infant mind speaking. The adult will find just as |
| was thrashing about uncontrollably as four police | | | | many ways to make the separation possible. Every |
| officers tried to restrain him. When the first author | | | | thought, word, action, and feeling can be identified as |
| appeared, the patient continued to struggle in violent | | | | to its source. Eventually the patient learns to cross |
| thrashing motions resembling the thrust of the infant | | | | reference his thoughts and learns to recognize which |
| in the birth process. While he could not stop the | | | | part of his mind they are coming from. |
| thrusting motion of the body, the rational part of the | | | | Treating the Patient |
| mind responded to the sight of his therapist and he | | | | What is real to the person depends on the reality the |
| explained in lucid fashion everything that happened to | | | | person is experiencing at the time. Only with special |
| him that day that led up to the loss of control. Just | | | | attention to cross referencing various realities can the |
| as his family represented his anchor in the infantile | | | | patient begin to recognize "I've been here before." |
| mind/brain, his therapist represented his anchor in the | | | | One of the best times to do the cross referencing is |
| adult. | | | | when the patient is coming out of the delusional |
| The identification and cross referencing of realities is | | | | system and the realities are changing on a daily basis. |
| a very important aspect of treating schizophrenia, | | | | This is also a good time to identify how the particular |
| and especially the paranoid. Wil Menninger (personal | | | | reality or behavior relates to that of an earlier age |
| communication) once cautioned "always start with | | | | during infancy. |
| the reality the patient is experiencing." This is sound | | | | One schizophrenic high school student whose mother |
| advice. One approach is to say "I absolutely believe, | | | | just left home, partially returned to age 18 months |
| 100%, that what you are telling me is exactly what | | | | when she left him at that time. His means of getting |
| you experience to be so." "You are experiencing that | | | | her to pick him up during infancy was to have a |
| people on television are talking about you," etc. | | | | smelly diaper. His later symptoms were the same. He |
| Once this is fully acknowledged, it may be possible to | | | | did not become overtly delusional, but his affect was |
| move on to: "The way we experience things varies | | | | flat and the stench from unclean underwear was so |
| somewhat from time to time and from person to | | | | strong that no one could sit next to him. (Note: this |
| person. If ten people witness the same event, they | | | | first symptom was regarded by the first author as |
| experience it ten different ways. If one person | | | | "schizophrenia until proven otherwise," and an |
| experiences something at ten different ages, he | | | | aggressive treatment approach prevented |
| experiences it ten different ways. If you are asleep | | | | development of the full disorder.) |
| and dreaming and a bear is chasing you, it is real until | | | | Each symptom such as this needs correct |
| you wake up. If you are hypnotized and told you are | | | | interpretation until the patient has good understanding |
| a rooster, that is real until you are no longer under | | | | and comprehension of his illness. With schizophrenia |
| hypnotic suggestion. Likewise, when persons shift to | | | | of very early origin, interpretation can be more |
| earlier ages, they may be experiencing what is real to | | | | difficult since rigidity, concrete thinking and inflexibility |
| them at an earlier time. | | | | are greater at earlier ages. More of the |
| "What you experienced to be real yesterday is not | | | | interpretations have to be made when the person is |
| what you experience to be real today" (this | | | | not in the acute state. To achieve positive results |
| interpretation is vitally important as the patient's | | | | with the more disturbed, the total separation from |
| delusional system begins to change with the advent | | | | family is absolutely essential otherwise there will not |
| of hospitalization, separation from family and the | | | | be sufficient return to the adult brain to allow for |
| administration of neuroleptic medication). "Perhaps | | | | insight and recovery. |
| what you experience tomorrow will be different from | | | | |