Psychotherapy Paradigms in Schizophrenia: Persecuted by Love – V

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A patient eventually helped the doctor (read author) to understand that he had felt persecuted by love and that as he had felt love to be dangerous to him—this had something to do with his mother, too, of course—so he felt his own love to be dangerous to others. It was then perhaps that the doctor began to have doubts about the formulation that the essential morbid process in schizophrenia is a narcissistic regression or hypercathexis of the self. Here’s the fifth part of the eight-part serialisation of Prof. Ashoka’s erudite lecture, wherein he deals with a case study, in the weekly column. A Different Truths exclusive.

I once had a patient who told me for many months with a great rage of the father who persecuted him, who hated him, interfered with him, whose eye was always upon him. Everywhere he went, there that eye pursued him with its malevolent, watchful stare. That this conception of his father seemed to bear little resemblance to the worried and seemingly far from frightening an old man who came to visit him in the hospital certainly bothered the patient. I suppose in part this discrepancy between the reality he recognised and the reality he felt led him to conclude, often with considerable despair, how crazy he must be. Fortunately, I did not suffer from the belief that I had good sense, that he did not, that I was in touch with reality, that he was not, or that I had a duty to impart my good sense to him and, therefore, to rub his nose in the discrepancy that already moved him to despair.

During many months many things happened between us and within him. At first, he lived in nightmare most of the time. Then he began to tell me of dreams, which is perhaps to say that gradually there came a time when he slept and dreamt during the night and was awake at least some of the day. He dreamt of going fishing—he and his father had fished together—and gradually the representations of fishing in his dreams changed from sinking boat, churning waves, and sea monsters to voyages in which by his father’s side he took the wheel and steered the boat. That change was a change in his object world—in the object representations and self-representations of inner reality, in a reality symbolically created, in psychic reality, in the reality in which we are all so immersed we only dimly perceive from time to time that it is there and that it is in that reality we live.

Then my patient told me that when he was a boy he had spent many months in bed with a life-endangering illness. Now he remembered vividly how his father, apparently upon a physician’s instructions, restricted his activity, and how his father came often in the night to see him, to check the windows and his covers, to look upon him, to make sure he was all right—and the feelings stirred in him by these experiences. It would have taken a particular act of imagination and some experience, which I did not then have, to be able to hear and see this father and this boy in the raging patient and the image of the persecuting, angry, intruding eye. Yet they were there and a psychotherapist can wait, at least, for months if necessary, until the meaning of a patient’s representations becomes clear.

This patient eventually helped me to understand that he had felt persecuted by love and that as he had felt love to be dangerous to him—this had something to do with his mother, too, of course—so he felt his own love to be dangerous to others. It was then perhaps, although I did not realise it until later, that I began to have doubts about the formulation that the essential morbid process in schizophrenia is a narcissistic regression or hypercathexis of the self. It was also then perhaps that I began to think that a delusion may not be simply the creation of a false reality, substituted for a painful true reality in the interests of gratification, but rather might involve the patient’s use of a particular, and for most of us peculiar, kind of language to represent, think over, and communicate certain conceptions he has of his object world, self, and his past experience.

May those of you who are beginning your work as psychotherapists have the luck I had—to find and be taught by a patient who is willing to teach you and from whom you are willing to learn. There is another way you may set about attempting to alter this unfavorable object world in which the patient finds himself. You may decide to make up for its deficiencies yourself and to provide the patient with opportunities for gratification in the relationship with you. Such strategies of treatment are sometimes rationalized by a belief in corrective emotional experience as the essential therapeutic ingredient of psychotherapy.

I am at a loss as to how to comment on this matter within this short lecture and with the conceptual tools, we have developed so far. Let us dispose immediately of this position when it rests simply upon the failure to recognise that it is inner or symbolically created reality with which we are concerned and that this reality, by the time we come face to face with the patient, is not necessary and not even usually altered simply by the presence of opportunities for gratification.

(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’.