This article represents a modified version of an article originally published on the Brainblogger website. Note, also, that you may purchase Dr. Ann Olson’s book, entitled “Illuminating Schizophrenia: Insights into the Uncommon Mind”, at amazon.com.
Many schizophrenics endure auditory hallucinations that are nearly impossible to understand sensibly, due to the fact that they rely, at least in part, on arbitrary factors. Auditory hallucinations reflect the meanderings of the psychotic individual’s mind, conforming, in a circuitous way, to whatever the psychotic individual imagines them to be.
It has been argued that schizophrenics who experience auditory hallucinations construe their experience in terms of a subject-object split within their minds. Schizophrenic individuals will essentially project recapitulations of early object relations onto their mental realm. Their feelings about these manifestations come from their unconscious conceptualizations of primary figures, such as the mother and the father figures.
The idea that psychosis is a mental split involving object relations is, in theory, similar to the theory of the existence of the unconscious. It is a symbolic representation of mental experience, but it is a theory that is removed from facts regarding brain functioning, involving brain chemistry. It’s a theory which implicates the mind rather than the brain.
Given that the schizophrenic experiences her mind as divided and illusory, spurred on in its presentation by unconscious feelings toward primary, symbolic figures, there exist good reasons for the incomprehensible, chaotic and emotionally punitive nature of psychotic experience. The schizophrenic’s self-perceived psychological nudity of the self in the mind, in the presence of hallucinated “others”, represents punitive experience. This is true even though the schizophrenic is in the private realm of his mind. It is not a matter of reality, but of the psychotic individual’s perception of her mind.
Schizophrenics can also experience paranoia regarding their non-normative experience. This paranoia may result simply from the fear of having an experience of “reality” that differs from that of the majority of the human population. The schizophrenic may cite auditory hallucinations to be aliens or spirits speaking to her, and these types of delusions might provoke fear in anyone who knows that the majority of the human population would disagree with how the schizophrenic construes her experience. The prevalence of schizophrenia in the population is extremely minimal, and the delusions of the schizophrenic render her alone and helpless in confrontation with what she perceives as “others” within her mind, derived from auditory hallucinations.
Delusions may be reinforced by means of chance alone. Isolating experience driven by chance reinforcement of non-normative ideas will clearly be fear provoking, as well as maintaining and reinforcing delusional ideas. In the face of such reinforced beliefs, the reality of fear that many schizophrenics experience is understandable: it is a reaction to ambiguity. The resultant fear of ambiguity that emerges in the schizophrenic, then, creates in her efforts to dissect the ambiguity of her mind and that of the external, material world, as the schizophrenic creates, perhaps unintentionally, increasingly complicated delusions. This is especially true in the paranoid schizophrenic.
The schizophrenic will understand her mental experience to be chaotic and punitive. She will experience an understanding that she cannot make sense of it, even though she may not acknowledge this logically or apply this fact to her situation. She will endure futility in meandering the circuitous path of her mental experience, while simultaneously creating her own mental experience, essentially, her own path. The impossibility of the schizophrenic achieving any objectivity in this is obvious — she has no detachment from her mental experience, albeit she manifests a subject-object split in terms of the functioning of her mind. The mind may represent “process” more than “content”, and the schizophrenic, ultimately, cannot observe her mental experience while she is in the process of creating it.
The schizophrenic’s mind is a single entity, even when it appears to her as not so. Although her self-perceived self-ownership of her mind may be compromised, she will never be able to isolate herself from her hallucinated mental experience. An actual division within her mind is impossible, even when she perceives this division and the perceived division is furthered by her own psychotic process. As she attempts to retreat from her subjective mental experience, she cringes within her own mind. Projection onto the mental realm of primary emotions that were initially directed toward her parents and a recapitulation of such relationships with an abrading sense of intimacy and fear represent the essence of schizophrenic experience.
The basis for paranoia has much to do with the isolation that one feels as a schizophrenic. Isolation culminates from the reality or unreality of non-normative experience. The visceral nature of hallucinations is difficult to negate. Telling the schizophrenic that her hallucinations do not exist is like telling her that she is seeing the color red when she is looking at the color blue. Isolation with regard to this experience is frightening because no one will approach the experience of the schizophrenic with understanding that includes empathy regarding what can be discerned as actual isolation, fear and the visceral nature of hallucinations.
Due to the nature of psychotic experience, renegotiation of early interpersonal relationships is clearly advised in treating psychosis. This may be accomplished by means of psychotherapy aimed at this type of renegotiation. Using Eriksonian theory as a paradigm for treatment, the schizophrenic, often embedded in her sense of mental trauma, may be able to renegotiate the stages of “trust versus mistrust”, “autonomy versus shame and doubt” and “initiative versus guilt” and so on, with the help of her psychotherapist. This type of treatment would be useful in reducing the trauma and suffering associated with the punitive relationships that she has with her auditory hallucinations.
Overwhelmingly, there is a need for the schizophrenic to find relief from the abrading sense of intimacy that she has with her hallucinations, that emerges from the perceived subject-object split within her mind, as she retreats from her own mental experience. This must be the focus of effective psychotherapeutic treatment for schizophrenia. The schizophrenic needs to re-imagine her relationships with her auditory hallucinations, and targeting for change the problematic feelings she directs toward her hallucinations may alleviate some of the subjective pain with which she associates them.