Theory and Psychopathology

Lines of thought

Identity in the Context of Schizophrenia

This paper examines the idea that context shapes one's sense of who they are.

Note that this author, Dr. Ann Olson, has written a book, entitled: “Illuminating Schizophrenia: Insights into the Uncommon Mind”. It is available for purchase on Amazon.

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Ralph Ellison stated in his novel, The Invisible Man, that if one does not know where he is, then he does not know who he is. Our contexts define us to a great extent, and a lack of context has implications regarding how we do or do not define ourselves. For example, if a man does not know he is part of a circus, then his behavior will not make sense to him or to other people. Although this is a primitive and graphic example of how self-definition impacts one psychologically, it is nevertheless clear that if we do not know our contexts, we do not know ourselves. This reality has particular implications for those who endure schizophrenia.

The contexts of psychotic individuals, whether material or mental, are largely indefinite to them. Psychotic people experience not only nebulous and distorted mental realms, they experience nebulous and distorted material realms due to the impact of their hallucinations and their delusions about reality. The fears that the paranoid schizophrenic experiences may be always mutating, therefore impacting negatively his sense of context, as this context mutates to accommodate new beliefs. Given this, he may inevitably have difficulty in defining who he is.

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While it may be acknowledged that the content of auditory hallucinations in the mind of the schizophrenic may be largely arbitrary in the emergence of its presentation, perhaps even based upon whatever the psychotic individual may believe them to be, the mind is a nebulous arena for the psychotic individual. The mind may become an ever mutating context in which the psychotic individual almost inevitably will struggle to define herself, and no exacting self-definition in this regard will be forthcoming due to the reality of the nature of auditory hallucinations. They are hallucinations. 

Hallucinations may arise from objectification of the mental realm. The mind may become an arena for a subject-object split. This may be perceived by the psychotic individual as a realm occupied the self and the other. Regardless of the cause of the mental fracturing that corresponds with schizophrenia, it is a reality that the schizophrenic, in response to auditory hallucinations, perhaps cannot view the hallucinated “voices in his head” as part of his own thought processes. 

It has been postulated by this writer that the experience of psychotic individuals represents a psychological nudity of the self. We all have reasons, perhaps secret reasons, for shame. If the psychotic individual defines his hallucinations as “extant” and “aware” of his various reasons for shame, he will experience this as a punitive psychological intimacy and nudity. This stance regarding what are hallucinations may reside in the psychotic individual’s definition of her context. Moreover, this stance may reflect the experience of psychological engulfment in the psychotic individual.

The idea of engulfment is reflected in the existential crisis involving confrontation with death. Confrontation with death implicates a lack of context because many people do not know what death constitutes in terms of context. Even in people who view death from a religious or spiritual perspective may find the inevitability of death daunting because they do not know heaven or hell as a context that is understood by them or by anyone else. 

The idea of death to most people may implicate not only a fear of a lack of identifiable context, but a fear of engulfment, as well. The fear of death and the fear of engulfment, when contemplated, represents an existential crisis for all people. This is obvious. Less obvious is the fact that the paranoid schizophrenic may be forced to confront death almost incessantly due to the nature of his delusions. When the inevitability of death represents an ongoing context of a person living with schizophrenia, paradoxically, life may be barely tolerable.

It may be asked: If someone says you are crazy, is it sane to agree with them? A context signified by a label of being mentally ill represents a blanket statement about the identity of the psychotic person, and the psychotic individual may become lost under that blanket. The self-definition of one who is mentally ill in this context is fear-inspiring if only because this context is nebulous and distorted. His response to implicit psychological engulfment is the psychological retreat from both the material and the mental realms, reflected in dissociation or feeling that he himself and his environment are not real, as well as reflecting dissociation in the mental real.

The difficulties inherent in creating an identity as a mentally ill psychotic individual are daunting. Not only are the mental and the material worlds nebulous as a consequence of experienced delusions and hallucinations. The experience of auditory hallucinations is understood by the psychotic individual to be “entities” of some kind who are witnessing his thoughts. He may be said to experience psychological nudity in the mental realm. The paranoid schizophrenic may view his experience as life-threatening, and the confrontation with death, real or imagined, is both nebulous and engulfing.

As the psychotic individual seeks to understand his own identity, he may hold many delusional beliefs about his context, and this may be manifested in a persistent and unending search to resolve his psychosis by seeking a definition of the hallucinations and a firm stance in regarding his delusions. The experience of psychosis is ambiguous, nebulous, and it implicates a lack of an identifiable context. It should be understood that the quest of the schizophrenic may be simply to find an ego-syntonic identity.

 

Ann Olson is a doctor of psychology, a writer of fiction, creative nonfiction and poetry.

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