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THE
SCHIZOCOCCUS: AN INTERPERSONAL PERSPECTIVE
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Phil
Salmon |
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Birkbeck College, University
of London, UK
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Forty years
ago, Don Bannister’s
ground-breaking research on schizophrenic thought disorder suggested
that the
problem should be understood as a loosening of individual construing.
Thought
disordered schizophrenics were seen as loose construers when making
sense of
other people, and this, it was proposed, was the result of serial
invalidation.
Although Don derided medical accounts as a search for the
‘schizococcus’, his
own understanding was still couched in intrapsychic terms. In this
article, it
is argued that we might usefully think of this and other problems not
as
residing within people, but between them.
Keywords: schizophrenia, thought disorder,
intersubjectivity, personal construct psychology
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SCHIZOPHRENIC THOUGHT DISORDER AND
INDIVIDUAL CONSTRUCTION
In this paper, I want to consider the
substance of Don Bannister’s ground-breaking research on schizophrenic
thought
disorder, and then go on to suggest how the insights he offered might
relate to
more recent developments in constructionist understandings. In
particular, I
will argue that we should think of construing not as something that is
the
property of separate individuals. Rather, it is a process that occupies
the
space between them.
Forty years ago Don Bannister embarked
on a
research programme to investigate schizophrenic thought disorder. Using
grids
that used either people or objects as elements, he showed that thought
disordered
schizophrenics had characteristically loosened constructions of people,
while
retaining relatively tight constructions of objects. He theorised that
this
lack of an effective theory about other people was brought about
through a
process of serial invalidation, in which the person had been unable to
develop
a way of making sense of others.
With this elegant series of
well-designed experiments
underpinning each stage in his ongoing argument, Don succeeded in
outlining a
comprehensive theory of schizophrenic thought disorder. This has led to
recent
work that has resulted in support for this explanation (Cipolletta
&
Roserro, 2003). So far from being a generalised brain malfunction
causing a
lack of conceptual structure – the schizococcus, as he dubbed it -
thought disorder
evidently applied in a highly specific way, affecting only
psychological
spheres, and leaving intact understandings of the physical world. Nor
did this
condition arise inexplicably, out of the blue, but was apparently the
outcome
of successive experiences of invalidation.
In contrast with the conceptual ragbag
of
bio-medical explanations, Don’s understanding cogently embraced within
a single
universe of discourse aetiology, symptomatology, and - potentially at
least –
psychotherapeutic treatment. The scope and power of this work is of
course, characteristic
of all Don’s thinking. But I’d like to add a personal note, and say
that,
beyond this, there were special reasons why this particular sphere
engaged him
so deeply. In being apparently meaningless, thought disorder presented
the
greatest possible challenge to understanding, to the power of thought
itself,
in which Don was always passionately invested. And in addition, he
carried with
him a profound grief over an intimate friend who had come to develop
thought-disordered schizophrenia.
In Don’s vision, thought-disordered
schizophrenics
made fine physicists, but hopeless psychologists. The accuracy of this
portrayal became vividly clear to me, during this research, in my
year-long
daily meetings with a man called Percy. Try as I would, I could not
elicit from
Percy a single reference to any aspect of human personality or
interpersonal
relationships. Asked about psychological qualities, he could only
resort to a physicalistic
vocabulary: how big, how much hair, and so on. But to enquiries about
places in England, Percy, who had worked as a post office clerk, could
respond with a
fully detailed and highly accurate account.
Within Kelly’s theoretical formulation,
it
is the commonality and the sociality corollaries that are most
obviously
entailed in the predicament of schizophrenic thought disorder. The
condition evidently
involves at least partial commonality with others, insofar as the whole
physical world is seen in a similar way. This is of course quite
obvious from
the fact that even the most apparently disturbed schizophrenics can
find their
way about, dress themselves, use knives and forks for eating and so on.
The
lack of commonality with others applies only within the sphere of
psychological
understanding – the sense we make of ourselves and others, our
behaviour and
experience, our social and interpersonal relationships.
And here, the argument brings in
schizophrenics
who are not thought-disordered. An incidental finding in this work, as
I
indicated earlier, was the fact that in the people grid - the
psychological
grid - this group demonstrated somewhat idiosyncratic relationships.
Don
speculated that non-thought-disordered schizophrenia might be a bus
stop on the
way to thought disorder. Whether it progressed in this way would depend
on
whether or not the eccentricity applied within an area of vital social
concern.
If you believe your neighbour is sending death rays through the wall,
leading
you to take drastic action against him, then you are likely to meet
strongly
invalidating responses – social sanctions of one kind or another. But
if you
merely hold the conviction that you are descended from George the
Third, you
will probably be generally tolerated as a deluded but harmless
eccentric.
SCHIZOPHRENIC
THOUGHT DISORDER AND
INTERSUBJECTIVITY
However, total lack of commonality in
psychological
understanding is surely a very different matter. Some degree of common
ground
with others must be the prerequisite for sociality. We make sense of
other
people by drawing on our own conceptual repertoire. If we do not
necessarily see
the human world in the same way as another person – may, indeed, view
it in
diametrically opposite ways – nevertheless, we can still imagine
something of
that person’s point of view, enough to be able to anticipate and react
in socially
appropriate terms. We possess within our construct system the raw
material for
representing, positioning, and responding to other human beings.
In every area of human existence,
sociality
is crucial. This is true of even superficial encounters. Life itself
depends
upon the accurate reading of the intentions of other drivers in the
road.
Longer-term and personally significant relationships are built upon a
mutual
appreciation of each other’s point of view, and become unviable if this
is
lost. In interaction with strangers, we regularly assume at least some
reciprocal understanding. You’re standing in a crowded tube train which
has
stopped in a tunnel for 10 minutes. A voice makes an announcement which
is completely
inaudible. You risk a smile, a resigned shake of the head to the woman
standing
beside you; in return she raises her eyebrows with a comic grimace.
But suppose instead of the expected
reciprocity
she tells you, as did one of Don’s patients, ‘I’m time up and straight
myself.’
How would we respond to such a conversational overture? The general
reaction to
thought disorder is one of bewilderment and dismay. Goffman (1963),
described
the deeply felt necessity, in any kind of interpersonal encounter, to
maintain
the social fabric – the smooth running, the spontaneous flow, of
conversational
negotiations. We make huge efforts, he believes, to avoid social
embarrassment.
If the social fabric becomes ruptured, action must be taken, urgently,
to
repair it.
For most people, the utterances of
thought-disordered schizophrenics produce extreme social embarrassment,
by
seeming bafflingly strange. But the socially reparative work Goffman
(1963) describes
appears impossible, because there seems no mutuality – no shared sense
of how
the encounter should proceed. As Barham and Haywood (1995) suggest,
writing of
long-term schizophrenics now living in the community, in talking of
their own
experience such people seem incomprehensible because they cannot
account for
their lives as socially intelligible projects. And short-term
encounters typically
move quickly from tension and constraint into mistrust, avoidance, even
hostility.
In relating thought disordered
schizophrenia to spheres of common and mutual understanding, Don’s work
locates
it as essentially something between people, an inter-subjective state,
rather
than a thing within the individual. And in contrast with the static
condition
depicted by bio-medical definitions, Don’s portrayal makes it a stage –
a late,
often, alas, a final stage - within a process. That process is of
course exactly
the same process of relating to one another in which we are all
engaged.
On this logic, to understand the
development of thought-disordered schizophrenia, we have to look to
relational
rather than individualistic matters. If this condition is the outcome
of a prolonged
experience of invalidation, we need to focus closely on the
transactions and
negotiations in which those concerned have been embroiled. In examining
these,
two particular directions in recent thinking seem potentially helpful:
the work
of John Shotter (1989) on the one hand, and that of Trevor Butt, Vivien
Burr
and Richard Bell (1997) on the other.
John Shotter (1989) argued that, in
establishing a sense of personal identity, the pronoun You is prior to
that of
I. As he put it,
The thou is older than the I in the sense
that the capacity to be addressed as a ‘you’ by others is a preliminary
to
being able to say ‘I’ of oneself, of being able to understand the
uniqueness of
one’s own ‘position’ in relation to others, and to take responsibility
for
one’s actions.
In childhood, Shotter suggested, the use
of
You is ontologically formative; ‘When small children are addressed as
You they
are being instructed how TO BE.’ Since we can act only in to the
opportunities
offered us, such early communications must be vital in governing the
sense, or
the lack of a sense, of one’s own personhood.
This vision offers a different, and I
think
potentially fruitful perspective on the many well-documented clinical
studies
of schizophrenics. Among those who have closely researched the
development of
schizophrenia, its genesis in early relationships is generally agreed.
As perhaps
most vividly illustrated in the early work of R. D. Laing (1959), the
symptoms of
young schizophrenic men and women can be seen as meaningful responses
to
complex and contradictory family communications. Their ontological
insecurity,
Laing argued, is the outcome of parental refusal to allow them a
separate
identity. This picture is broadly endorsed by more recent research.
Here is
Lucy Johnstone, writing in 1989:
Parents, due to psychological problems
that
may date back several generations, are unable to facilitate their
infant’s very
early development of a sense of identity and separateness. Problems
come to the
fore when separation becomes an issue in adolescence or early
adulthood.
Because of the crucial role that the child has come to play in the
parents’
fragile psychological adjustment, any moves that he or she makes
towards independence
are very threatening. However, since these difficulties are largely out
of
awareness and are in conflict with the parents’ genuine love and
concern, they
can only emerge in the form of confused and contradictory
communications.
In the terms John Shotter offers, the
You
with which these parents address their young sons and daughters is
highly
problematic. Because You is never clearly separate from I, there is a
fundamental
ambiguity in formative messages as to how to be – how to act out a
particular
personhood. Within the emotional intensity and intrusiveness of
virtually
symbiotic relationships, young people cannot clearly differentiate
themselves
from their parents. They lack the opportunities which would allow them
to act
as independent persons. They cannot achieve the sense of being both
uniquely
positioned and socially accountable, which characterises personhood.
It is essentially the lack of
personhood,
in this vision, which defines thought-disordered schizophrenia. And in
thinking
about personhood, a further recent line of thought, one developed by
Trevor
Butt and his colleagues, seems potentially enlightening. In a social
self grid,
followed by an interview, subjects were invited to consider themselves
in a
series of different relationships. While construing themselves as
dispersed
through these relationships – as having a plurality of selves - people
also
experienced a sense of ‘being themselves’ within relationships which
allowed
spontaneous, pre-reflective functioning. The sense of self, it seems,
is not
identified by fixed positions on a number of particular constructs, but
is anchored
in some perhaps unarticulated yet deeply felt superordinate. In
particular
relationships, it seems, the other person is felt to recognise this
deep self;
and it is this sense of security in personal recognition – the
awareness that
one’s identity is safely lodged with the other - which allows
interaction to
flow, to be spontaneous.
To take the logic of this approach one
step
further, the same superordinate, hard-to-articulate yet confident sense
of the
other must apply within relationships which allow spontaneity. Such
situations
must surely involve a reciprocal recognition of each others’ unique
personhood.
This is perhaps why it is impossible to describe, to portray in words,
an
intimately known and loved person. For in the freedom, the generosity
of deep
personal recognition, we do not stick to a familiar script, but play,
go off at
tangents, become inconsequential, wayward, capricious. And we delight
in the
other’s unexpected turns, their whimsicality, perversity even. In the
moment-to-moment fluidity of encounters like these, there is plenty of
room in
how, as Shotter puts it, we go on together.
But clearly, the relational
circumstances
in which schizophrenics grow up do not allow this kind of freedom, its
largeness
of space, its trustful openness to unforeseen directions. In the
claustrophobic,
suffocating closeness of parent-child relations, young people are
subject to constant
anxious monitoring, to moment-to-moment personal constraints on how
they are
expected to be. Spontaneity becomes impossible, since it carries risks
of
departure from the family script. And because the young person’s
identity is essentially
merged with that of a parent, there can be no sense of a truly
self-other
relation through which, for all of us, our personhood becomes
constituted.
When those whose development of
personhood
has been impeded in this way enter the psychiatric world, their
problems are
likely to be at best, crystallised, and at worst, seriously worsened.
The
non-person status of diagnosed schizophrenics is itself heavily
endorsed within
conventional psychiatric treatment. Hospitalisation means being subject
to a
regime which blocks and disregards the subjective intentions and agency
of patients,
and denies their capacity for responsibility and accountability to
others. For
Rufus May (2002), the self-dubbed mad psychologist, this last aspect
was
particularly damaging. He contrasts his treatment by medical and
nursing staff,
who did not listen to him, with the profound help offered by a
fellow-patient:
I was challenged
respectfully about my bizarre
or emotive behaviour by a fellow-patient, and that had a memorable
impact in
getting me to become more accountable for my actions and take more
responsibility
for my behaviour. (2002, p.224)
This seems important. Being challenged,
being asked to account for ones behaviour, to be responsible to others:
surely
this is what constitutes moral character. And I think it is the
implicit denial
of moral character that is the most damaging feature of the label
schizophrenic.
Once a schizophrenic, always a
schizophrenic.
That was Peter Barham’s sad conclusion, following years of painstaking
research. This was not the consequence of the condition itself, but
rather the
outcome of social exclusion. Must this always be true? Don himself did
not
think so. He saw his work as leading to therapeutic endeavour. In the
logic of
his findings about its genesis, the last phase of his research was
geared
towards reversing thought disorder. Working within each patient’s
construct
system, islands of stable construct relationships were to form the
focus of
consistent validational evidence. That way, he hoped, larger spheres of
meaning, within the world of people and their inter-relations, could be
gradually built up. But this venture ran into the sand; it proved too
difficult, even within an institutional environment, to exercise
sufficient
control over the validational fortunes of patients living there.
Don’s therapeutic focus, within the
logic
of his approach, was the inner world, the construing, of
thought-disordered
schizophrenics. But perhaps it is not to the cognitive sphere that we
should be
looking, rather the discursive sphere within which personhood becomes
established and sustained. Certainly the few reportedly successful
therapeutic
endeavours have entailed a central concern with relationships – with
deeply
personal relationships. In the Californian Soteria project, for
instance, and
those that have evolved in Scandinavia, therapeutic efforts have abjured the illness model in
favour of
that of the person, and that person’s relationships with others.
Typically, the
staff in such projects have been non-medical and non-professional, and
the goal
has been to establish respectful, non-intrusive yet empathic relations
with people
labelled schizophrenic.
Relationships like these aim to allow
clients to express their own subjectivity, to speak of their own
experience as
it actually is. To quote Rufus May again, talking about the damaging
character
of his hospital stay:
There was a big
mismatch between my experiences
and how they were being made sense of by the professionals. They
weren’t trying
to engage with us as patients, and they weren’t listening to us. (2002,
p.224)
Being able to speak about personal
experiences, however strange these may seem to the listener, means
being heard
as Other. And the recognition of difference, otherness, is surely
essential in
truly I-thou relationships. It is the refusal to allow children their
otherness
in over-intrusive, symbiotic early relationships which evidently
forestalls the
development of personhood. By the same token, an openness, on the part
of
another, to listen, to affirm, to engage personally with the subjective
world
of a disturbed person, seems to offer that person the possibility of
recognising themselves, and being recognised, as a unique human being.
But of course this is a very far from
easy
task. It is disturbing, even frightening, to open oneself to talk which
is
humanly strange, perhaps barely intelligible. Entering into alien
experiences
can threaten one’s own personal identity; it takes a special kind of
courage to
do so. Nor is close and empathic attention to the other enough. What is
needed
is a mutual, a reciprocal inter-relationship. Both sides of the
encounter must
be vitally present, be mutually recognised. We all come to know
ourselves, to
be constituted as persons, through the inter-relational process of
human converse.
For schizophrenics, as for anyone else, two-way responsiveness is
crucial. The
relationship demands the acknowledgment of an I, as well as a thou.
Exclusive
attention to a disturbed person, however sensitive, is not in itself
sufficient.
The responses, the ongoing experience of his or her partner in converse
must
also be brought into focus, be acknowledged, be thought about. It is
the
relation itself, the interaction, the to and fro, the between, which is
crucial.
Surely the most skilled and courageous
practitioner of this kind of process, and its most eloquent narrator,
is the neurologist
Oliver Sacks. Sacks (1985, 1991, 1995) enables his readers to enter
into
vividly rendered worlds of great human strangeness. He achieves this,
as he describes,
through a prolonged, intense and intimate concentration on his lived
encounters
with those who are ‘other’. This means attending to, and deeply
dwelling in,
his own sensed feelings, and his tentative ideas about the expressive
meaning
of his subject’s speech and actions. Through his delicate awareness of
how he
himself feels, moment-to-moment, in his ongoing relation to the other,
Sacks
becomes able, eventually, to enter, and to convey, that person’s inner
subjectivity. So it is that we, as readers, are enabled to
imaginatively
inhabit the strange world of Leonard, the post-encephalitic patient who
is the
subject of Awakenings:
At the end of my first meeting with
Leonard,
I said to him: What’s it like being the way you are? What would you
compare it
to? He spelt out the following answer: ‘Caged, deprived, like Rilke’s
tiger’….Again
and again, with his penetrating descriptions, his imaginative
metaphors, or his
great stock of poetic images. Leonard would try to evoke the nature of
his own
being and experience. ‘There’s an awful presence’, he once tapped out,
‘And an
awful absence. The presence is a mixture of nagging and pushing and
pressure,
with being held back and constrained and stopped – I often call it the
goad and
the halter. The absence is a terrible isolation and coldness and
shrinking – a
bottomless darkness and unreality.
There can be few practitioners as
delicate,
or as daringly imaginative, as Oliver Sacks. But his unique
explorations,
described so vividly in his writings, seem to show what it can mean to
work
towards personhood in those who have previously been denied it.
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REFERENCES
Bannister D. (1963). The genesis of
schizophrenic thought disorder: a serial invalidation hypothesis. Br. J. Psychiat.
109. 680-686
Barham P. & Hayward R. (1995). Relocating
madness: from the mental patient to the person. London:
Free Association
Press.
Butt T., Burr V. & Bell R. (1997).
Fragmentation and the sense of self. Constructivism
in the Human Sciences 2, 12-29
Cipolletta, S., & Racerro, G.
(2003).
Testing the serial invalidation hypothesis in the genesis of
schizophrenic
thought disorder: a research with repertory grids. In G. Chiari and
M.L.Nuzzo
(Eds), Psychological constructivism
and the social world (pp. 353-368) Milano:
Franco Angeli.
Goffman, E. (1963). Stigma. Harmondsworth: Penguin
Johnstone, L. (1989). Users and abusers
of
psychiatry. London: Routledge
Laing, R. D. (1959). The divided self.
Harmondsworth: Penguin
May R. (2002) The experience of madness.
J.
Critical Psychology, Counselling and Psychotherapy. 2. 220-227
Shotter, J. (1989). Social
accountability
and the social construction of ‘You’. In J. Shotter & K. Gergen
(Eds). Texts
of identity London: Sage.
Sacks, O. (1973) Awakenings London:
Picador
Sacks, O. (1985). The man who mistook his
wife for a hat. London: Picador
Sacks, O. (1995). An anthropologist on Mars. London:
Picador |
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ABOUT THE
AUTHOR
Phillida
Salmon, PhD, worked for eleven
years as a Clinical Psychologist before holding various teaching posts.
She
currently works for the Open University and for Birkbeck Continuing
Education,
where she offers courses on Narrative and Identity. She also works as a
psychotherapist at the Medical Foundation for the Victims of Torture.
Her most
recent publication is 'Using multiple voices in autobiographical
writing', in
Horrocks et al, eds. (2002) Narrative, Memory and Life Transitions.
E-mail:
P.Salmon@ioe.ac.uk |
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REFERENCE
Salmon, P.
(2004). The schizococcus: an interpersonal
perspective. Personal Construct
Theory & Practice, 1, 76-81
(Retrieved from http://www.pcp-net.org/journal/pctp04/salmon04.html)
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Received: 12 Jan 2004 -
Accepted: 9 August 2004 -
Published: 30 Dec 2004
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