One of the reasons why I wrote The Imprinted Brain was to allow me to give clinical illustrations of the points I needed to make about mental illnesses such as paranoid schizophrenia. In that particular regard the autobiography of Daniel Paul Schreber was ideal because it included so many symptoms so brilliantly described. As a result, this marvelous work “must be the most written-about document in all psychiatric literature,” as the introduction to a recent paperback edition remarks.
Among the symptoms of psychosis described by Schreber was his visualization of “little men” inhabiting his head and body. I say visualization and not hallucination because Schreber makes it quite clear that his perception of them was in his imagination:
I saw … "little men" innumerable times with my mind’s eye and heard their voices. The remarkable thing about it was that souls or their single nerves could in certain conditions and for particular purposes assume the form of tiny human shapes (… only a few millimeters in size), and as such made mischief on all parts of my body, both inside and on the surface. Those occupied with the opening and closing of the eyes stood above the eyes in the eyebrows and there pulled the eyelids down as they pleased with fine filaments like cobwebs. … When I showed signs of being unwilling to allow my eyelids to be pulled up and down and actually opposed it, the “little men” became annoyed and expressed this by calling me “wretch” … (p.149)
In The Imprinted Brain, I argued that such symptoms as this are explicable in terms of hyper-mentalism understood as a cancer of normal mentalistic thinking—that is, thinking about people as independent agents acting on the basis of mental factors such as intention, belief, emotion, memory and understanding. What is pathological about this particular symptom is that it makes Schreber look at his own mind and body as if they were part of the wider social scene, inhabited by other people with minds, intentions, and activities of their own. Normally we think of our own self as opening or closing our eyes, and if we blink involuntarily, attribute it to a reflex. But Schreber sees his own eyes as if they were part of some external reality, operated by other people beyond his control and intolerant of his interference. This is paradigmatically hyper-mentalistic because, while such mindfulness of others and their independent existence is proper in a social context where other people actually exist, it is out of place in relation to your own body and mind.
The idea of hyper-mentalism was suggested by the now almost universally accepted finding that autism spectrum disorders (ASDs) such as Asperger’s syndrome are symptomatically the opposite and the result of serious deficits in mentalism: hypo-mentalism, if you like. But if so, the cure for psychotic spectrum disorders (PSDs) such as Schreber’s paranoia ought to be to make psychotics autistic, and the therapy for ASD to make autistics psychotic!
In previous posts, I have commented on the former—making psychotics autistic—and on the role that mechanistic skills training can play. But where making autistics psychotic is concerned, I have so far had to content myself with the rather obvious observation that social skills training can help autistics in this respect. And of course, it is true that high-functioning psychotics such as borderline personality disorder patients or those I would describe as psychotic savants have superior or even genius-level social skills.
Nevertheless, you could argue that social skills, while certainly a part of normal mentalism, are hardly the core of psychotic cognition and that the idea of making autistics psychotic in any true sense is too literal a way of putting it. Indeed, until reading Anne Greig and Tommy MacKay’s The Homunculi Approach to Social and Emotional Wellbeing, I would probably have agreed. But having read this remarkable book, I can now point to one striking symptom of classical paranoid cognition that Greig and MacKay show is highly beneficial in cognitive behavioral therapy (CBT) with autistic children: what they call homuncular thinking.
As these authors explain, homunculi is Latin for “little men,” and when used as part of CBT becomes “a fun activity that aims to build social and emotional resilience in children and young people by teaching them how to think. It involves a large, visual interactive activity or game in which five miniature people live inside a Skull poster” (top). They explain that “The Skull and its inhabitants are, therefore, an explicit representation of the inside of the participant’s mind and the actual conflicts, dilemmas or difficulties they experience there. The little Homunculi are created to have specific problem-solving missions and special gadgets to help them, depending on what is happening in the real world outside the participant’s head" (below).
Had Schreber made a cartoon featuring his skull like that above, it would probably have shown that
Other “little men” were assembled almost continuously on my head in great number. They were called “little devils.” In consequence … there appeared in my skull a deep cleft or rent roughly in the middle, which probably was not visible from outside but was visible from inside. The “little devils” stood on both sides of this cleft and compressed my head as though in a vice… (p. 150)
I am deeply indebted to Greig and MacKay: they have demonstrated much better than I ever imagined possible one of the most remarkable possibilities suggested by the diametric model of mental illness. This is that a symptomatic form of psychotic cognition—homuncular thinking—becomes therapeutic when used by autistic children.
[For a later post on the same topic click here.]