|Alan Sroufe Attachment Theory Mary Jo Barrett Diets Mindfulness Couples David Schnarch Brain Science Challenging Cases Ethics Attachment William Doherty Gender Issues Great Attachment Debate Men in Therapy Anxiety Linda Bacon The Future of Psychotherapy Trauma Future of Psychotherapy Mind/Body Community of Excellence Wendy Behary Clinical Excellence Narcissistic Clients Clinical Mastery Etienne Wenger Couples Therapy Symposium 2012 CE Comments|
|Clinicians Digest July/Aug 2008 - Page 4|
We've pretty much accepted the notion that the only kind of useful psychotherapy for schizophrenia involves med management, basic social-skills training, psychoeducation for family members to help reduce the stress on the person, and perhaps some cognitive-behavioral therapy to help schizophrenic patients keep a realistic perspective on their hallucinations. But a remarkable new memoir, The Center Cannot Hold: My Journey Through Madness, by Elyn Saks, associate dean and professor of law, psychology, and behavioral science at the University of Southern California law school—who's actively schizophrenic—challenges our ideas about limited psychotherapy and limited prognoses for people with schizophrenia. Saks insists that without old-fashioned, long-term, intensive psychoanalytic therapy, she'd be one of the thousands of minimally functioning individuals with schizophrenia.
As a law student, Saks was convinced that her brain would overheat, blow out of her head, and spatter the classroom walls. Over the years, she's been psychiatrically hospitalized several times, and now, decades later, she still has frequent, powerful delusions. Unlike mathematician John Nash (A Beautiful Mind), Saks's schizophrenia isn't in remission: she remains on the antipsychotic Clozapine, and even then, she sometimes has to retreat to a safe place to manage her delusions. On the morning of her wedding, long after her last hospitalization, she needed reassurance that aliens wouldn't be attending.
Saks's memoir is a testimony to the power of the intimate therapeutic relationship for people with schizophrenia. The psychotic symptoms, bizarre behavior, and emotional outbursts characteristic of schizophrenia drive even friends away and create an isolation chamber that amplifies symptoms. Saks believes that her therapist's acceptance, understanding, and occasional interpretations allow her to both acknowledge her emotions and test reality.
When her violent, uncontrollable thoughts began to unhinge her, for example, her therapist explained that the thoughts were an expression of her fear, not of violent impulses. That perspective helped Saks manage them. Her therapist allows her to share her psychotic thoughts without fear of abandonment, ridicule, or being locked up "One of the worst aspects of schizophrenia," Saks writes, "is the profound isolation, the constant awareness that you're different . . . not really human."