Depersonalization in psychosis

Depersonalization is a psychological approach that is universally used as a means of dealing with the other when he becomes disturbing, threatening, or tiresome. One no longer allows oneself to be responsive to his feelings and may be prepared to regard him and treat him as though he had no feelings, turning him as if he were a thing, an it. Partial depersonalization of others is extensively practiced in everday life and is regarded as normal if not highly desirable. Everyday life relationship with strangers are based on some partial depersonalizing tendency in so far as one treats the other not in terms of any awareness of who or what he might be in himself but as virtually an android robot playing a role or part in a large machine in which one too may be acting yet another part.

The inner self in the psychotic condition

In the psychotic condition there is a persistent scission, or split, between the self and the body. What the individual regards as his true self is experienced as more or less disembodied, and bodily experience and actions are in turn felt to be part of a false-self system. It is well known that temporary state of dissociation of the self from the body occur in normal people when they are found trapped in a threating situation from which there is no way out; prisoners in concentration camps felt that way. This temporary dissociation is expressed with such thoughts as "this is like a dream"; "this is unreal"; "I can´t believe this is true", or "nothing seems to be touching me". However, in the psychotic condition, this split of self and body (and reality) is constant.

This detachment of the self means that the self is never revealed directly in the individual's expressions and actions, nor does it experience anything spontaneously. The direct and inmediate transactions between the individual, the other, and the world, all come to be meaningless, futile, and false. The psychotic and schizophrenic individual delegates all transactions between himself and the other to a system whithin his being that is not "him". Thus the world is experienced as unreal, and all that belongs to this system is felt to be false and meaningless. The self, therefore, is precluded from having a direct relationship with real thing and real people. When this has happened in patients, one is witness to the struggle which ensues to preserve the self's own sense of its own realness, aliveness, and identity. The frightened and cornered real self relates to the real world of real people through a false self system which he fabricates to put on a front of normality.

What one might call a creative relationship with the other, in which there is mutual enrichment of the self and the other, is impossible, and this interaction is substituted with sterile relationship. The substitution of an interaction with the other results in the individual coming to live in a frightening world in which dread is unmitigated by love. The individual is frightened of the world, afraid that any impingement will be total, will be implosive, penetrative, fragmenting, and engulfing. He is afraid of letting anything of himself go, of coming out of himself, or losing himself in any experience, because he will be depleted, exhausted, emptied, and robbed.

Psychopathy

Individuals who suffer from psychopathy usually show impulsive and antisocial behavior without accompanying anxiety or guilt, and are unable to form lasting and genuine personal relationships. McCord (1964) considered that the distinguishing features of psychopaths were lack of guilt and the inability to love. Buss (1966) listed psychopathic symptoms as the inability to control impulses or delay gratification, the failure to alter punishable behavior, pathological lying, asocial and antisocial behavior, thrill-seeking behavior, poor judgement of behavior, and rejection of authority, discipline and conventions. However, the lack of anxiety does not occur in all psychopaths. Those who lack anxiety have been called, by Karpman in 1941, "primary psychopaths", as distinct from "secondary" psychopaths who show a mixture of symptoms, including neurotic anxiety.

Although psychopaths seem unable to learn to avoid punishment, they do not show learning defect as such, nor do they suffer from memory defect as such. Psychopathic imperviousness to punishment was investigated directly by Painting in 1961. Gough (1948) suggested that psychopaths lack role-playing ability, that is to say, they are unable to regard themselves as part of society or to identify themselves with the viewpoint of other people. This suggestion was supported in a study by Reed and Cuadra who found that student nurses who tended to psychopathy were less able to predict how others would describe them.

Bowlby stressed early maternal deprivation as a source of psychopathy, quoting as evidence the frequency with which psychopaths were found to have been separated from their mother for six months or more in the first five years of their lives. It has also been demonstrated that institutionalized children were retarded socially and intellectually in comparison with fostered children. A psychopath's lack of empathy, his lack of awareness of behavioral cause and effect, and shallow personal relationships, all derive from his early rearing experiences; in particular, from a frequent change of milieu, a loveless environment, or very inconsistent environmental influence.

Psychoanalytic Theory of Schizophrenia

The psychoanalytic theory of schizophrenia usually explains the illness as a regression to the early oral, or adualistic phase of infancy, when the infant's ability to distinguish self and other is considered to be undeveloped. The schizophrenic symptoms of such regression include feelings of depersonalization and loss, phantasies of world dissolution, passivity, and archaic magical thinking.

Sullivan's psychoanalytic theory of schizophrenia was applied by Kantor and Winder in 1959. They elaborated the theory in process-reactive terms; the earlier the developmental stage to which the individual regresses, the more severe the schizophrenia, that is to say, the more it becomes process rather than reactive. In 1962, Goldman subsequently attempted to apply this general theory to specific aspects of regression in schizophrenia, for example, emotional and social behavior. He drew attention to the similarities of infants and schizophrenics in that both express diffuse emotion impulsively and unpredictably, with little stability of any emotional state.

In 1955, Arieti suggested a theory of progressive teleological regression in terms of neurological structure. He considered that when higher nervous centers, that is those developed later in the evolutionary sequence, are paralyzed by anxiety, lower nervous centers would predominate and thus reduce anxiety. The individual's readjustment to this level can not, however, be maintained because it is too deviant from normal functioning, so that further regression and deterioration is often inevitable. Psychoanalysts usually assume that no psychological crisis is ever fully resolved, and that traces of early part-resolved conflicts and partly satisfied needs will always persist into later life.

Symptoms of Schizophrenia

The symptoms of schizophrenia are sometimes subdivided into primary symptoms, which occur in every schizophrenic, and secondary symptoms, which occur only in some schizophrenics and in other kind of patients, too. The primary symptoms of schizophrenia are affective disturbance, such as dull or apathetic emotional reactions, withdrawal or loss of interest in the environment and other people, and thought disturbances. Secondary symptoms include autism or absorption in an inner phantasy world, delusions, hallucinations, and odd behavior such as posturing and grimacing.

Schizophrenic patients often report feelings of depersonalization and perceptual abnormality such as the flatness, remoteness or unreality of their external environment. Depending on the types of schizophrenia, there is good empirical evidence that some schizophrenics experience disturbances of body image. Feelings of depersonalization are not particularly common among schizophrenics, but are common in compulsive depressive patients and in normal individuals under stress. The classification of schizophrenia by symptoms has not been successful, because the symptons overlap and change over time in the life of a patient.

Arieti (1955) distinguished four successive stages in the course of schizophrenia. In the first stage the major symptom is anxiety; in the second, apathy and withdrawal from reality; in the third stage, regressive habits appear and symtoms become blurred; and in the fourth stage, crude primitive habits predominate. However, nowadays modern treatment ensures that few schizophrenic patients pass beyond the second stage.

Types of Schizophrenia

Many investigators divide the schizophrenia into subgroups, which together are referred to as the "schizophrenias. The types of schizophrenia distinguished traditionally are: simple, catatonic, hebephrenic, and paranoid schizophrenia.

Simple schizophrenia is a type of schizophrenia in which the illness usually begins slowly, often in early adolescence. The patient gradually becomes apathetic, less intelligent in his behavior, and is inclined to withdraw from all interaction with his surroundings.

Catatonic schizophrenia has typical phases of stupor, excitement and negativism, and involves a gross deterioration of personal habits, which may degenerate into a near-vegetative form of living.

Hebephrenics show a marked bizarreness and absurdity in their reactions, and, as they deteriorate show increasing disorganization of most psychological functions.

One of the most common types of schizophrenia is paranoid schizophrenia. It typically entails systematic delusions of persecution, and ideas of reference in which the patient reads personal significance into the everyday actions and ordinary speech of others.

These types of schizophrenia are not mutually exclusive, but tend to overlap regarding some symptoms.

Schizophrenia

Schizophrenia is a mental disorder which is characterized by abnormalities in the perception of reality. A schizophrenic patient suffers from distortions in perception, which may affect the senses of sight and hearing, especially causing auditory hallucinations, paranoid delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Schizophrenia derives from Greek and means divided or split mind: "Schizo", divided; "Phrenia", mind. This means that someone who suffers from this mental disease lacks integrity; its mental or cerebral functions and areas are not integrated into one coherent, rational whole.

A schizophrenic person may show auditory hallucinations, delusions, and disorganized and unusual thinking and speech, which range from loss of train of thought and subject flow, with sentences only loosely connected in meaning, to incoherence, known as word salad, in severe cases. Social isolation commonly occurs for a variety of reasons. Impairment in social cognition is associated with schizophrenia, as are symptoms of paranoia from delusions and hallucinations, and apathy or lack of motivation. Whether it is genetic, or caused by a negative early environment, it has been shown that a schizophrenic does not have the frontal lobe fully integrated to the rest of his cerebral cortex. This is caused by two reasons: 1) when blood irrigation in this region of the cerebrum is not effective; 2) when the white matter of the frontal lobe is poorly myelinated and thus inefficient connections between neurons.