Mental Illness: Is Schizophrenia Rooted in Childhood Symbolisation? – III

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Adult schizophrenic persons are not big children, and my experience with children has not led me to the conclusion that the schizophrenic person has simply returned to a form of symbolisation he knew as a child, or that children symbolise the way schizophrenic persons do,” opines Prof. Ashoka, a renowned Psychiatrist, in the third part of his erudite research, in the weekly column, exclusively in .

Conceptions of a mental illness such as schizophrenia often involve postulation of certain events in early infancy. I myself am somewhat leery of analogies between the symbolisations of adult schizophrenic patients and those of childhood based on the fact that the former appears to us to be in some ways primitive or regressed. By regressed we usually mean not organised according to the usual adult model of waking consciousness. However, as Freud pointed out, regression in this formal sense is not the same as a regression in a temporal sense; that is, regression from one state to another, from one level of organisation to another, is not the same as regression backward in time. It is only because we are so persistently sequential in our thinking, and so preoccupied with an explanation by antecedents or historical origin, that we leap instantly and unreflectingly from formal regression to temporal regression. Adult schizophrenic persons are not big children, and my experience with children has not led me to the conclusion that the schizophrenic person has simply returned to a form of symbolisation he knew as a child, or that children symbolise the way schizophrenic persons do.

However, you, as others do, may wish to contribute to our study of a mental illness such as schizophrenia by making direct observations of children and infants, including, where possible, the sophisticated longitudinal study. I have some cautions before you begin, in addition to those I have already expressed about the observation of behaviour divorced from considerations of its meaning, consideration of meaning being rendered difficult here by the relative sparseness of the child’s resources for communication. Remember that you are inclined to see things in rather simple cause and effect sequences and to impose continuity on your observations, to see one thing leading to another in a series of tiny, hardly separable steps. In this connection, I was recently reminded by one of my (William Pious) of the furor caused by the idea of quantum jumps in physics. Yet it seems possible that there are discontinuous jumps in development (as well as from one psychological state to another), and that what went before bears little resemblance to and cannot be said to be the cause of what came after. The of symbolic thought in infancy is, I believe, such a discontinuity. An infant incapable of symbolization—and I am not, you realise, speaking of recognition of and response to signals—and an infant capable of it, no matter in what rudimentary form, seem worlds apart to me, their behaviour as far different and requiring as much change in the conceptual frame of reference within which it is regarded as the behaviour of the thing-man falling freely through space and that of the animal symbolicum jumping out a window. The reasoning of those who like Susan Isaacs justify extrapolations from the verbal communications of an older child to the meaning of the play of a younger one and from the inferred symbolic meaning of such play to the phantasy life of an infant at the breast replete with symbolisations with different aims— because “must” be conceived in terms of a continuous series—ought, it seems to me, to be subjected to considerable qualification.

Along the same line, something observed at one point in an infant’s or child’s life should not be assumed to be a precursor of something more complicated at a later point, one thing leading inevitably to the other—a type of play, for example, leading to a later defence mechanism, or a kind of verbalization to a later complicated system of symbolisations. Things human being as complicated as they are, almost any event involving symbolisation processes can probably be regarded as no more than a set of multiple potentialities the realisation of which will depend upon other, unknown, unpredictable events, some of which will be non-symbolic in character. As symbol systems increase in and differentiation, new capacities emerge that are not simple extensions of previous ones and these serve new aims. (Heinz Hartmann repeatedly pointed out that the function of a particular psychological formation in the here-and-now cannot be explained or derived simply by referring to its supposed origin. As we have seen, Cassirer made a similar point in a different context). Finally, you may be interested in psychotherapy as a method of generating and testing ideas about mental illness. Psychotherapy is a method for studying symbolisation processes and impairments of symbolisation, and for treating such impairments by symbolic means. Psychotherapy is a method of investigation to the extent that it involves control of the in which the vicissitudes of symbolisation are to be observed and in which aspects of symbolization emerge that under other are not readily observed. There are, of course, forms of psychotherapy in which there is little attempt by the psychotherapist to control in the interest of minimal interference with the emergence of the patient’s symbolisations. There are forms of psychotherapy in which there is in fact little interest in symbolic processes rather an effort to alter what are believed to be the effects of error and ignorance in the patient’s recognition of and response to verbal and other signals.

Psychoanalysis is the most sophisticated form of psychotherapy if the criteria are the extent to which skill is brought to bear to control conditions in the interest of minimal interference with the emergence of many kinds of symbolisation and the extent to which interest is concentrated upon the symbolization function and not upon other aspects of human behaviour. (It follows from this and previous formulations that I am somewhat skeptical that the findings of psychoanalysis or the conceptual framework relevant to its findings are sufficient to construct a general theory of human behaviour. I do believe that in its realm in skillful hands it has no real peer at present as a theory of symbolisation processes or as a method for investigating such processes).

In the conditions maintained by a skilful psychoanalyst, a novel , the transference neurosis, emerges; ideally the patient uses every detail of these carefully controlled conditions—his position vis-à-vis the analyst, the limits of time, fee transactions, the absence of conventional responses or usual cues, the opportunity for free association, the very silence—as media with which to create, shape, reveal symbolic representations of the unique reality in which he lives. The transference neurosis is one of Freud’s greatest scientific discoveries. Here is a that is, to judge by complaints about the behavioural sciences, rare indeed in their realm. It is unexpected. It is of critical theoretical significance. It is replicable, under carefully controlled conditions.

The carefully controlled conditions are comprised by the psychoanalytic situation, which includes a patient capable of prolonged commitment to attempts at the free association and a psychoanalyst whose participation is rigorously disciplined. The patient is willing and able to devote himself to making verbal productions in a situation designed to minimise external excitants, guidance, or interference that might evoke, shape, or obstruct these productions. Furthermore, he agrees himself to try to refrain from preventing in any way—as a result, for example, of deliberate efforts to order, select, or judge material—the utterance in verbal form of whatever comes to his mind. The psychoanalyst’s aims in relation to the patient’s verbal productions are limited to the interpretation of their meaning and the communication of such interpretations in a way that increases the likelihood that they will be meaningful to the patient; all the psychoanalyst’s are exercised to these ends alone. Ideally, the psychoanalyst will not be moved or persuaded to respond to the patient’s verbal productions in any way other than an interpretation of their meaning.

What happens under these circumstances is truly remarkable. Typically, after an initial, apparently relatively uninhibited period of expression, the patient’s symptoms may suddenly disappear, gradually subside in severity, or increasingly cease to concern or preoccupy him. Concomitantly, he finds free association increasingly difficult. Regularly, it is ever more persistent thoughts and intense feelings about the psychoanalyst to which he is reluctant to give verbal expression, despite the injunction to free association.

(To be continued)

Prof. Ashoka Jahnavi Prasad

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Ashoka Jahnavi Prasad is a physician /psychiatrist holding doctorates in pharmacology, history and philosophy plus a higher doctorate. He is also a qualified barrister and geneticist. He is a regular columnist in several newspapers, has published over 100 books and has been described by the Cambridge News as the ‘most educationally qualified in the world’.