'Only Connect'( E.M.Forster. )

Historical explanatory ideas of the basic fault.

 

 

 

 

 

 

 

 

 

 

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1.

Karl Jaspers.

Most people can make a judgement about somebody else from what they perceive. They are saying to themselves -'if I was doing that, saying that, then I would be thinking this way'.

Using your own mind you can never achieve an identification with the mental processes that have produced a piece of behaviour from someone who has schizophrenia.

There is a barrier to understanding. The other brain is so altered in the way it makes its connections that a proper engagement does not occur - the 'glass pane' is recent metaphor.


' where there is a will there is a way'

2.

Emil Kraepelin.: - Failure of will .

Whatever it is which wills the gathering in of all the contingencies into a final mental process outcome is lost. Whatever authority in the mind selects, discards, and matches up all the balanced aspects that go to making a decision, aand continuing its directive, is not there. Irrelevant material commands attention and use; significant connections are lost; the driving will which should bring all things together, into the purposive assembly that sustains the progression of behaviour, fails, and the result makes no sense or leads to -nothing relevant, and is not checked out.

Not so much 'will power' but the what it is in the brain of an individual that assembles all the relevant mental process parts and decides on a whole directive.

Kraepelin called the condition Dementia Praecox -a premature dissolution of orientation of the bits of the mind - whilst retaining full consciousness.

Thus, fundamental to the diagnosis were both cross-sectional as well as longitudinal components. Importantly, Kraepelin differentiated the generally deteriorating course of dementia praecox from the more episodic and customarily better outcome seen in manic depressive disorder.

In 1898, however, Kraepelin presented a landmark paper in Heidelburg Germany entitled "The Diagnosis and Prognosis of Dementia Praecox" and indicated that the various psychotic conditions previously grouped but separated - catatonia ( movement and postural imbalance ), hebephrenia ( silly, fractured and facile talk ), dementia paranoids ( fixed delusional ideas )- were actually part of one overall disease entity.

He recognized that, although the course of dementia praecox was variable, repeated relapses and progressive deterioration was the rule.

... "The prognosis, however, is really by no means simple. Whether dementia praecox is susceptible of a complete and permanent recovery...is still very doubtful, if not impossible. But improvements are not at all unusual....It is a more serious matter that in most of these cases the improvement is only temporary, and that such patients are in great danger of relapsing sooner or later, without any particular cause, and then generally suffer more serious injury from their illness."

He noted however that approximately 13% of patients did not exhibit a dementing course.


3.

Eugen Bleuler: - Disconnections ; thought disorder; thinking diverts into associations which have attachments irrelevant to the matter perceived to be in hand, and therefore an individual inner mental world is not matched to the outer one in the usual way - 'autistic thinking'.

Intrusive associations are adopted rather than eliminated and the necessary connections and successive adjustments which make for relationships with others, are lost. Meaning is unchecked; decisions, conclusions, are derived and pursued from these faulty assemblies.

Bleuler labelled the malfunction Schizophrenia - a splitting off of the bits of mental processes which should be able to be 'willed' to come together. The name adopted now - partly because it carries an adjectival ability - 'schizophrenic' - popularised and abused by media people who should no better. It is the brain function that is split within itself , not the personality into multiple personalities.

"If the disease is marked, the personality loses its unity....Often ideas are only partially worked out, and fragments of ideas are connected in an illogical way to constitute a new idea. Concepts lose their completeness, seem to dispense with one or more of their essential components; indeed, in many cases they are only represented by a few truncated notions....Thus, the process of association often works with mere fragments of ideas and concepts. This results in associations which normal individuals will regard as incorrect, bizarre, and utterly unpredictable....Instead of continuing the thought, new ideas crop up which neither the patient nor the observer can bring into any connection with the previous stream of thought....In the severest cases emotional and affective expressions seem to be completely lacking...."

He argued that the schizophrenias had varying underlying causes as well as prognosis. Despite the clinical diversity posited by Bleuler, he asserted that there were four cardinal features almost invariably present in schizophrenic patients.

Remember A4

  • Blunted Affect
  • Loosening of Associations
  • Ambivalence
  • Autism

In 1926, Bleuler described the central clinical characteristics as ...

... "In all forms of schizophrenia, however mild, we find a specific disorder of thought characterized by a loosening of the normal Associations....Many other problems, relating to logic and concepts, can be deduced from this loosening, such as deficiency of judgment, imprecision, the condensation of several concepts into one ...

In the Affective sphere, the emotional responses are uneven; normal in relation to certain events, they may be entirely absent with others...it is out of step with the changes occurring either in the outside world or in the individual himself."

for Ambivalence .... "two opposing feelings may simultaneously color the same mental representation."

In 'Autism' ... "we encounter inadequate contact with the world outside, an inner life turned in on itself."

Other symptoms of schizophrenia include delusions, hallucinations, catatonia, negativism, and stupor. These were thought to be "secondary" symptoms and present in reaction to the individual's intentions, drives, psychotic state, and environmental conditions. Bleuler noted that these latter secondary symptoms were present in schizophrenia (but), as well, in other disorders. He also asserted that despite the secondary nature of these symptoms, they formed the basis of the Kraepelinian classificatory system.


 

 

4.

Kurt Schneider.: - ' passivity '

Things take an immediate importance on their own unchecked against sufficient internal evaluation in external context. A response is then 'forced' ; a conclusion 'made'; seemingly ' felt as though put there' - must be by electricity, by witchcraft, from the television, from the neighbours, from government forces, from people nearby who have extraordinary powers.

[ An example - once at the beginning of an old-fashioned ward round ( new patients were at that time told to rest in and around their bed for the first three days, partly to feel safe and gradually get used to what was going on, partly to support the idea they were patients in a hospital setting, partly to get used to medication side-effects and be observed .
The editor was starting at the first bed end and, trying to be human, introduced himself by saying his name and what he was in the hospital and adding at the end of this introduction a common enough question " what is your name "
The answer - with their name - came from three beds down - the reply was 'forced'.
It could not be withheld until the context was worked out - which would have led to the conclusion - ' the question is not addressed to me but to the person in the first bed -' ( who in fact gave no answer - being negatively withdrawn )

The receptive ' passivity ' led to a forced out response., before the relevant associtions could modify any reaction.

In 1959, Kurt Schneider termed the core features "first-rank" symptoms.

These symptoms included:

  • Hearing one's thoughts spoken aloud - outside oneself
  • Auditory hallucinations - outside commenting on one's own behavior
  • Thought withdrawal, insertion and broadcasting
  • the experience of one's thoughts as being controlled or influenced from the outside
A delusional perception

What is perceived is what all perceive outside, but the inner meaning attached to it in the mind of the sufferer, is given a wrong conviction of an abnormal kind, which is so idiosyncratic, that it cannot be followed by anyone else.The conviction leads to an assembly of subsequent associations that acquire an imperium of their own, dominating subsequent judgements and behaviour. Particularly in circumstances of anxious uncertainty the associations

It is a 'perceptual delusion [ sometimes called 'the primary delusion' ] ; a misbelief - an enduring abnormal connection 'forced' out of an ordinary event that leads to a system of misbelief, more or less, governing abnormal thinking and abnormal judgement, according to whatever is going on in the life. Particularly in circumstances of anxious uncertainty the associations take over and lead behaviour ?

Manifestation of one first-rank symptom - in the absence of altered consciousness with no persistent pervasive mood illness - was sufficient for a diagnosis of schizophrenia.

Second-rank symptoms included other forms of hallucinations, depressive or euphoric mood changes, emotional blunting, perplexity, and sudden delusional ideas. When first-rank symptoms were absent, schizophrenia might still be diagnosed if a sufficient number of second-rank symptoms were present.

Although the schneiderian criteria have been criticized as being nonspecific, they are often in various sub-classifications.


the Cloze explanation ... 5.

the Cloze explanation

The editor finds this helpful. ( Others may not )

Ordinary language is so constrained by the words that come before and after, that if words are cut out, a group of similar citizens will be able to agree on what should be in the gaps, when they fill in the gaps quite separately from each other .

Experimentally a sequence of words in a narrative account { the experimentors gave a starting instruction .... tell us what you did all day yesterday and carry on till we tell you to stop ...... something like that. ] is typed out and every fourth word removed.

People were then asked to fill in the gaps.

In the case of the language of schizophrenia , when this was attempted there were many more odd words which the peer groups were not able to replace. They had got there by the failure of the will, which chooses the initial idea and holding it, moves it forward appropriately - a failure to continue the relevance captured by the initial control. - The loss of the first directive allowed in inner idiosyncratic distracting associations, the odd words, normally eliminated before presentation of the language used in common when relating to another person.

When this 'cloze' testing was originally carried out the errors - the 'faulty' words - were increasingly found when the narrative selected was further and further away from the initial instruction that started the narrative.- further away from the original anchor point which was to be held in mind and govern the range of words chosen.

It was as though the first signal lost its imperium - the will - the further the narrative was away from the first setting out.

When the initial framing instruction was recalled to the narrator - the reminder got for a while, a more normal 'cloze' succession.

The 'cloze'procedure can be done in a 'reverse' mode - by having people with schizophrenia guess at the words removed from a 'normal' narrative. In that case there were more 'odd'words put in than those put in by a 'normal'goup pf participants.

Something like this difficulty explains why many patients cannot read a book - what has been read at the top of the page does not stay to be connected at the bottom. Similarly many cannot follow a televison story - the identification -slipping into another character and the feelings and thoughts - at the same time coming back to your self - is not there.
It explains also the oddities that get into a letter writing, often the clearest sign of schizophrenia. It reads not quite right. Starting off alright with the initial well established habit in correspondence, more and more oddities get in.

The idea behind the 'cloze' failure can be generalised.

People with schizophrenia are not able to rely on the initial mental intention, keeping them on track. Holding to an intention on line, is weakened.

The 'controlling theme' of the day loses its way. Extraneous matters come in, to distract and disorganise, the flow of behaviour.

Or, sometimes, there is just is no driving pilot - no Will - connecting up past experience with what there is to be done. So, there can be a lot of nothingness.

For help, the day has to be structured for them, by an 'anchoring routine to fall back.
The lack of their own 'Will' means they can be taken advantage of - or given help - by someone giving a lead. Often, into street drug misuse.

Critical comment can bring out withdrawal and negativism

What can be done to help is a settled structured week that has within it 'marker' points giving a direction, giving the person a reality referent, one that allows for time, with mentoring in usage, to gain familiarity.

In this way internal representations of what has been done, last week, and therefore what will be going on next week , are rebuilt; long-term aftercare requires a structured programme of activities.

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