Psychotherapy Paradigms in Schizophrenia: Understanding the Symbolisation Process of the Patient – VII

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The object world may fail to encourage, support, or reward the effort to achieve or sustain higher levels of functioning. Since symbolisation processes are significantly future-oriented, persistent disappointment or the thwarting of expectations may lead to the conviction that it is futile to expend effort in achieving higher levels of symbolisation. Here’s the seventh and the penultimate part of the eight-part serialisation of Prof. Ashoka’s lecture, wherein he deals with the practical aspects of psychotherapy, in the weekly column, exclusively for Different Truths.

Symbolisation may be disrupted by drastic, abrupt, confusing, distracting, or excessive intrusions. Demands for higher level symbolisation may exceed the innate and acquired capacities of the schizophrenic person or may exceed the effort that is available for higher level symbolisation, or that can be allocated to it, given the variety or magnitude of demands upon him. (If this be your conception of the patient’s state of affairs, you would not necessarily want to lure or urge your already overtaxed patient to engage in interpersonal relations as though you believed that the main difficulty is that he has turned from interpersonal relations to an excessive preoccupation with himself.)

The object world may fail to encourage, support, or reward the effort to achieve or sustain higher levels of functioning. Since symbolisation processes are significantly future-oriented, persistent disappointment or the thwarting of expectations may lead to the conviction that it is futile to expend effort in achieving higher levels of symbolisation. (We may remember here that three of the subsystems of personality—the symbolic processes of which are differentiated from id- processes by just this characteristic—require some conception of, orientation to, and attitude toward the future: ego-ideal processes function to recreate the past in the future; ego processes function to create the present for the sake of the future, and superego processes function to create the future out of the possibilities of the present.)

You will, I think, be impressed by your patient’s sense of futility. He may describe this as depression, but it is important for you to realise that he means he is without hope. (Incidentally, if one of you is interested in carrying out a simple investigation, I suggest you examine the use of the future tense by schizophrenic patients. Presumably, it may make a difference to thought if the reference to the future is altered or absent from the thinker’s frame of reference. In this connection, it is suggestive that Whorf, for example, holds that the Hopis’ worldview is different from ours since their language refers to the validity or the grounds for assertion when our language refers to time or temporal sequence.)

For most of us, rational thought, which is concerned with the relation of means to ends, presupposes a hopeful orientation to the future that we care about ends we want and expect to attain. Such hopes and expectations have usually been persistently disappointed in the life of the schizophrenic person. If this is so, it follows that the restoration of hope in a relationship with the psychotherapist, for example, should result in an apparent improvement in the ability to think logically; I believe I have seen something like that. It also follows that disappointment in the relationship with the psychotherapist may result in an apparent impairment or perhaps lack of interest in the ability to think logically; I believe I have seen that too.

Another way of looking at this matter is that the schizophrenic person is not primarily concerned in his thought and symbolisation with the relation of means to ends, but rather with an attempt to create or discover meaningful ends. He may be seeking in his symbolisation to establish some sense of solidarity with the object world, to feel himself related to it in meaningful ways so that he can imagine gratifying end states of affairs he might seek to bring into being and maintain. A different level of symbolisation from that involved in rational thought or logical discourse may be functional for the attempt to endow ends with cathexis or value—more like the symbolisation in myth, art, or religion.

You may miss the point if you hear a patient’s communication primarily in terms of its rationality. Rationality may be beside the point; the patient is up to something else in his communications—perhaps an attempt to establish some kind of union or continuity with you or a bond between you and him.

Finally, the object world may be of such a nature that symbolisation processes are not valued. Nothing about the object world directs attention to them or invests them with value. Federn has pointed out that focusing the schizophrenic patient’s attention upon his ego states and ego functions, upon symbolisation processes and when and how these occur, in painstaking detail, tends to improve ego functioning or, as we might say, raise the level of functioning at which symbolisation occurs. One must be interested in the details of how the patient sees and feels himself and the world, and how, under what circumstances and in what sequence exactly, changes in such states and conceptions occur. As you show such interest, the patient may become interested; as he becomes interested, he begins to symbolise at a higher level.

The degree of impact of such an object world depends upon the extent to which it impinges upon an already relatively unstable system of symbolic processes, including always both object-representations and self-representations.

(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’.