Schizophrenia and the Developmental Moratorium

Jay B. Sisun is a Clinical Research Assistant at Taunton State Hospital. Glen A. Eskedal is the Chair and Professor of Education and Human Services at Suffolk University. Of challenge to developmental psychologists and mental health practitioners is the management of positive and negative symptoms associated with schizophrenia and their effects on mastering psychosocial developmental tasks. The intent of this article is to provide specific information pertinent to understanding this disorder, to understand the age-appropriate struggle for individuation, and to offer recommendations for effective treatment.     

Betrayal And Paranoia: The Psychotherapist's Function as an Intermediary

We present an approach to the problem of structuring a therapeutic alliance with patients presenting paranoid symptoms, using both psychoanalytical and cognitive techniques. Initially, we focused on one of the main aspects of the paranoid worldview: the fear of being betrayed and the tendency to betray. This is a defense maneuver, through which patients deny their passivity, and the impotence in the relationship with their own internal needs and with the significant people in the external world, including the therapist. In our experience to build up a working relationship, both a psychoanalytical interpretation of unconscious conflicts and the cognitive analysis of dysfunctional beliefs are needed. Often, in more serious cases, the role of nonqualified object must be accepted at the beginning, due to the patient's need to be in control of the situation. Only then can a therapeutic phase begin, in most cases, through an integrated approach that includes pharmacological, psychodynamic, and cognitive modalities.     

Creative Activity,Personality, Mental Illness,and Short‐Term Mating Success

It has been argued that creativity evolved, at least in part, through sexual selection to attract mates. Recent research lends support to this view and has also demonstrated a link between certain dimensions of schizotypy, creativity, and short‐term mating. The current study delves deeper into these relationships by focusing on engagement in creative activity and employing an expansive set of personality and mental health measures (Five Factor Model, schizotypy, anxiety, and depression). A general tendency to engage in everyday forms of creative activity was related to number of sexual partners within the past year in males only. Furthermore, schizotypy, anxiety, and Neuroticism were all indirectly related to short‐term mating success, again for males only. The study provides additional support for predictions made by sexual selection theory that men have a higher drive for creative display, and that creativity is linked with higher short‐term mating success. The study also provides support for the contention that certain forms of mental illness may still exist in the gene pool because particular personality traits associated with milder forms of mental illness (i.e., Neuroticism & schizotypy) are also associated directly with creativity and indirectly with short‐term mating success.     

Jung's understanding of schizophrenia: is it still relevant in the ‘era of the brain’?

Jung was highly committed to grasping the meaning of psychotic thinking, and left behind precious insights to treatment scattered through his works written between 1906 and 1958. The tendency of today's psychiatry is to attribute the psychotic process to alteration in the brain's anatomy, biochemistry and electrophysiology, thus exempting the subject, i.e. the afflicted person, from responsibility for attachment to reality and their sanity. Jung understood schizophrenia as an ‘abaissement du niveau mental’, a similar phenomenon to the one encountered in dreams, and caused by a peculiar ‘faiblesse de la volonté’. He contested that complexes in schizophrenia, in contrast with neurotic disorders, are disconnected and can either never reintegrate to the psychic totality or can only join together in remission ‘like a mirror broke into splinters’ (Jung 1939 , para. 507). Accordingly, a person who does not fight for the supremacy of ego consciousness and has let themself be swayed by the intrusion of alien contents arising from the unconscious (even to the point of becoming fascinated by regression) is exposed to the danger of schizophrenia. The contemporary relevance of these notions and their necessity in understanding the psychotic process in the light of modern scientific findings are discussed.     

The sociocultural conceptualisations of schizophrenia and patterns of help seeking in south-east Nigeria

Socioculturally influenced interpretations of mental illness play decisive roles on the time and choice of treatment. These often result in significant delays before patients present at the psychiatric services, with consequent worsening of the prognosis. The aim was to assess the association between sociocultural factors, choice of treatment and treatment delay among patients with schizophrenia. A cross-sectional study of 360 patients with schizophrenia, without previous contact with any statutory psychiatric services, was done. Of this, 75.8% of the participants had visited traditional/faith healers as the first treatment option and have attributed schizophrenia to magico-supernatural causation, despite 70.0% of the participants being educated, while 24.2% of them believed in the natural causation of the illness and presented early to psychiatric hospital. There is a need for community-based psychiatric services that would have mental health education as one of their core mandates; and collaborations with traditional and faith-based healers aimed to reduce delay in their facilities.     

A development of Freudian metapsychology for schizophrenia

The author states that psychoanalysis has much to contribute to schizophrenia. Beginning with a development of Freudian metapsychology, he addresses the in‐depth psychopathological study of a session (the first on the couch) with a schizophrenic patient who hears voices and feels that he is being watched. Since the symptoms appear at the level of the heard word and the visual image – key to Freudian metapsychology – he delineates a circuit for the word and one for the image, describing a blockage in both and the consequences of these. Furthermore, with regard to the patient's progress, he demonstrates first a quantitative improvement in symptoms, and later qualitative changes in his functioning. He shows how, over a time, functioning is improved in a once‐a‐week on‐the‐couch setting after two years of face‐to‐face treatment.     

Patterns of Daily Time Use of Young Adults With or Without First-Episode Psychosis

This study compared patterns of daily activities and satisfaction with time use of young adults with first-episode psychosis and healthy volunteers. Fifty young adults participated in retrospective structured interviews on time use. Young adults with first-episode psychosis spend more time in sleep, passive leisure, and personal care activities, and less in total productive activities and education. No difference appeared for leisure, paid work, and household work, or satisfaction with daily time use. Reasons underlying dissatisfaction with daily time use differed between the groups. Clinical and research implications are discussed.     

Project ABLE

This paper describes a proposed model for the management of Army soldiers rendered ineffective due to inadequate skills in coping with life stress. The history of Army mental health programs is reviewed to establish the rationale for program development. The proposed treatment methods and staffing are discussed. The application of this peacetime treaetment model in the management of combat psychiatric casualties is presented. Emphasis is placed on the role of the Army occupational therapist as a professional skilled in the use of task-directed behavior to enhance daily living skills.