Psychological portrait of a patient with schizophrenia. Schizophrenia Changes in inner self and body schema

Introduction
1. Clinical picture of schizophrenia: brief background
1.1.General clinical characteristics
1.2.Etiology and pathogenesis of schizophrenia
2.0. Psychological portrait of a patient with schizophrenia
2.1. Diagnostics
2.2. Psychological characteristics and symptoms of a patient with schizophrenia
2.2.1. Changing Perception
2.2.2. Inability to separate and interpret external sensations
2.2.3. Delusions and hallucinations
2.2.4. Changing the inner self and body diagram
2.2.5. Changes in emotions
2.2.6. Changes in movement
2.2.7. Changes in behavior
conclusions
Literature

Introduction

Schizophrenia– “a mental illness of unknown etiology, prone to a chronic course, manifested by typical changes in the patient’s personality and other mental disorders varying in severity,” leading, as a rule, to persistent impairments in working capacity and social adaptation. Despite the fact that the term “schizophrenia” appeared only in 1911, when the Swiss psychiatrist E. Bleuler proposed a new term for the name of the disease, the very history of the emergence of schizophrenia (as an endogenous and endogenous-organic disease) causes a lot of controversy among specialists. On the one side, “there are scientists who claim that schizophrenia has always existed, and there are indisputable facts that indicate the antiquity of this disease”. As evidence, Sanskrit sources are often quoted or references are made to biblical characters, for example, the Babylonian king Nebuchadnezzar (eating grass like cattle in grazing), or the prophet Ezekiel (auditory and visual hallucinations). They also insist that people with schizophrenia should be kept at home, and that their illness is from God, and, as a result, it cannot be considered a disease at all in the usual sense of the word. On the other hand, their opponents believe that in most of the examples given from the Bible and Sanskrit sources it is impossible to reliably establish the clinical picture. Moreover, most opponents are of the opinion that in such examples we were talking, for the most part, about people with various brain injuries (birthday, for example), or diseases (epilepsy, viral encephalitis, syphilis), in which psychotic symptoms may occur. As a rule, opponents are not inclined to consider schizophrenia (and any other organic diseases) a disease "from God". As a rule, opponents also deny various theories of schizophrenia in the spirit of the English psychoanalyst R. Laing, ECT, or Dianetics, and rely on strictly scientific methods of studying, diagnosing and treating this disease.

In the last decades of our century, the attention of scientists has been especially acutely drawn to the problems of schizophrenia - its etiology, diagnostic methods and treatment methods. No other disease in related fields of knowledge (psychiatry, neuropsychiatry, clinical psychology, pathopsychology and psychopathology, neurosurgery and many others), despite, of course, the importance of a set of similar measures in the fight against them, is so exciting to scientific thought, so debatable. And given that in recent decades, schizophrenia has become such a widespread disease that it has gone beyond just scientific attention, turning into a social disaster, the topic of early diagnosis of schizophrenic symptoms by persons who are not competent in the closed and frightening field of this knowledge has become especially relevant. The efforts made by mental health services and individual scientists to remove the stigma of a “curse” and “plague” from the disease and help people quickly recognize the early symptoms of schizophrenia are the best evidence of this. Today you will not surprise anyone with popular books about psychiatry, and, in particular, about schizophrenia.

The purpose of this work is the study of portrait features of a schizophrenic patient, the main symptoms of schizophrenia in its various forms and severity.

Main task of the work– give a relatively complete picture of the symptoms of the disease, its clinical manifestations; give examples that reveal some of the behavioral features of patients with schizophrenia.

1. Clinical picture of schizophrenia: brief background

“The large clinical polymorphism of schizophrenia in its modern scope has its historical roots. The main clinical variants of this disease were identified back in the pre-nosological period of the development of psychiatry.”

Schizophrenia as a separate disease was first identified by the German psychiatrist E. Kraepelin (1896). He took groups of patients who had previously been described with diagnoses of hebephrenia (E. Hecker), catatonia (K. Kahlbaum) and paranoids (V. Magnan), and found that in the long term they had a kind of dementia. In this regard, Kraepelin combined these three groups of diseases and called them dementia praecox (dementia praecox). Having identified a separate disease based on its outcome in dementia, Kraepelin at the same time admitted that recovery was possible.

It should be noted that before Kraepelin, the famous Russian psychiatrist V. Kandinsky in 1987 described a similar disease called ideophrenia, and S. Korsakov in 1891 - under the name design. Already at that time, famous Russian psychiatrists noted symptoms in patients that were among the main symptoms of schizophrenia - emotional and volitional disorders, incoherent speech."

The name itself "schizophrenia" was given in 1911 by the famous Swiss psychiatrist E. Bleuler, who described a group of psychoses under this name. Unlike Kraepelin, Bleuler believed that schizophrenia does not necessarily arise in youth, but can develop in adulthood. Bleuler also believed that what is most characteristic of schizophrenia is not the outcome of a kind of dementia, but a special dissociation of the mental processes of the individual, its specific change as a result of the disease process. Bleuler noted that in schizophrenia, lasting improvements and a favorable outcome are possible even without treatment.

If Kraepelin narrowed the scope of schizophrenia, describing only its most malignant forms, then E. Bleuler, on the contrary, overly expanded the boundaries of the disease and classified chronic alcoholic hallucinosis, senile delirium of damage, MDP and even neurotic syndromes as schizophrenia. This was pointed out, in particular, by Gannushkin, saying that “in the large gallery of types of various degenerates and psychopaths, it is not difficult to find examples of such eccentrics who, in their makeup and appearance, are quite consistent with schizophrenics.”

All these studies laid the foundation for the doctrine of schizophrenia, and Bleuler's name has survived to this day, and sometimes schizophrenia is called Bleuler's disease.

1.1.General clinical characteristics

Schizophrenia is included in the group of endogenous and endogenous-limiting mental illnesses. This group includes diseases whose cause has not yet been established, although available data indicate pathology of internal processes in the body, leading to mental disorders. It is also known that schizophrenia (and in general all endogenous diseases) is often observed in individuals with a hereditary burden of the disease. The risk of schizophrenia has even been determined depending on the degree of relationship.

When suffering from schizophrenia, patients become withdrawn, lose social contacts, and experience a depletion of emotional reactions. At the same time, disturbances of sensations, thinking, perception and motor-volitional disorders are observed of varying degrees of severity.

The psychopathological manifestations of schizophrenia are very diverse. According to their characteristics, they are divided into negative and productive. Negative ones reflect loss or distortion of functions, productive ones – identification of specific symptoms, namely: hallucinations, delusions, affective tension and others. Their ratio and representation in the patient’s mental state depend on the severity and form of the disease.

Schizophrenia is most characterized by peculiar disorders that characterize changes in the patient’s personality. These changes concern all mental properties of the individual, and the severity of the changes reflects the malignancy of the disease process. The most typical are intellectual and emotional disorders.

Let us briefly consider each of the typical disorders associated with schizophrenia:

Intellectual disorders. They manifest themselves in various types of thinking disorders: patients complain of an uncontrollable flow of thoughts, their blockage, and others. It is difficult for them to comprehend the meaning of the text they read. There is a tendency to capture special meaning in individual sentences and words, and to create new words. Thinking is often vague; statements seem to slip from one topic to another without a visible logical connection. In a number of patients, the logical sequence takes on the character of speech discontinuity (schizophasia).

Emotional disturbances. They begin with the loss of moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by acute hostility and malice. In some cases, emotional ambivalence is observed, that is, the simultaneous existence of two contradictory feelings. Emotional dissociations occur when, for example, tragic events cause joy. Characterized by emotional dullness - impoverishment of emotional manifestations up to their complete loss.

Behavioral disorders or disorders of volitional activity. Most often they are the result of emotional disorders. Interest in what you love decreases and, over time, disappears altogether. Patients become sloppy and do not observe basic hygienic self-care. The extreme form of such disorders is the so-called abulic-akinetic syndrome, characterized by the absence of any volitional or behavioral impulses and complete immobility.

Perceptual disorders. They manifest themselves predominantly as auditory hallucinations and often various pseudohallucinations of various sense organs: visual, auditory, olfactory.

Highlight three forms of schizophrenia: continuous, periodic and paroxysmal-progressive. Forms of schizophrenia according to Snezhnevsky A.V. - “a taxonomy of forms of schizophrenia, which is based on the fundamentally different nature of their course with the unity of symptomology and trends in the dynamics of the pathological process, the stereotype of the development of the disease. There are continuous, recurrent and paroxysmal-progressive schizophrenia. Each of these forms includes various clinical variants.”

1.2.Etiology and pathogenesis of schizophrenia

“The etiology and pathogenesis of schizophrenia became the subject of special study soon after the disease was identified as a separate nosological unit (nosology is the study of diseases and their classifications - author’s note).”

To date, scientists have obtained a lot of data that allows them to build one or another theory of schizophrenic etiology. Some of these theories have lost their relevance, having failed to withstand empirical testing, or being untenable due to the emergence of new scientific data. Other theories are considered the most promising today. However, as already mentioned, the etiology of schizophrenia is still considered unknown. It is relatively unanimously recognized that the disease belongs to the group of endogenous diseases, that is, those that do not have an exogenous factor that can provoke the development of the disease (trauma, viral infections, etc.). And although there is evidence of the onset of the disease in connection with the influence of some exogenous factor, but, nevertheless, "...after this" does not mean "as a result of this"".

Genetic theory of schizophrenia. According to genetic theory, schizophrenia is a hereditary disease. The most significant evidence in favor of the genetic theory is the numerous facts of schizophrenia in individuals with a genetic burden. “Studies of identical twins indicate that the risk of schizophrenia in the sibling of an already affected twin is approximately 30 percent.”

Neurochemical theory of schizophrenia. The neurochemical theory of schizophrenia dates back to the beginning of our century. In the last two decades, much attention has been focused on dopamine, a neurotransmitter of the catecholamine class. It has been observed that large doses of amphetamines cause an increase in dopamine levels, and the resulting symptoms resemble those of schizophrenia. It has also been observed that the condition of schizophrenic patients worsens if they are given a drug containing dopamine. Scientists have also studied many other neurotransmitters, their interactions and properties (histamine, GABA, glutamic acid, and others).

Theory of developmental defects. A relatively new approach to searching for the causes of schizophrenia. More advanced methods of studying intrauterine development have made it possible to obtain many facts suggesting that the cause of schizophrenia may be intrauterine brain injury or directly at the time of birth of the child. Proponents of this theory argue that the onset of the disease may be caused by exogenous factors, namely postpartum brain injuries, immune system disorders, poisoning at an early stage of development, primary metabolic disorders and some other factors.

Other theories. There are many other theoretical developments attempting to explain the etiology and pathogenesis of schizophrenia. For example, the assertion that dominated the 19th century that masturbation can lead to insanity is considered untenable. Some theories, such as the endocrine theory of schizophrenia, the nutrition theory, or the family theory, still exist, although they are not popular.

2.0. Psychological portrait of a patient with schizophrenia

2.1. Diagnostics

Schizophrenia has a wide range of clinical manifestations, and in some cases its diagnosis is very difficult. The diagnostic criteria are based on so-called negative disorders or peculiar changes in the patient’s personality. These include impoverishment of emotional manifestations, impaired thinking and interpersonal disorders. Schizophrenia is also characterized by a certain set of syndromes.

In diagnosing schizophrenia, it is important to distinguish the clinical picture of schizophrenia from exogenous psychopathologies, affective psychoses (in particular, from MDP), as well as from neuroses and psychopathy. Exogenous psychoses begin in connection with certain hazards (toxic, infectious, and other exogenous factors). With them, special personality changes are observed (of an organic type), psychopathological manifestations occur with a predominance of hallucinatory and visual disorders. In affective psychoses, personality changes characteristic of schizophrenia are not observed. Psychopathological manifestations are limited mainly to affective disorders. In the dynamics of the disease, there is no complication of syndromes, while in schizophrenia there is a tendency to complicate attacks. And in the case of a sluggish, inactive course of the schizophrenic process, a differential diagnosis of schizophrenia with neuroses and psychopathy is necessary. It should be noted that the dynamics of schizophrenia are always different from the dynamics of other nosological units, although sometimes they may be indistinguishable in cases of dishonest or incompetent attitude towards the diagnostic process. Such cases are not uncommon, which contributed to the emergence in science of a special section (or discipline) that studies errors in diagnostic and general clinical practice.

In the legal field of knowledge, there is a so-called “forensic psychiatric assessment”, the main task of which is to identify an accurate clinical picture of the mental state of persons who have committed crimes in a state of passion or mental illness. It should be noted that “in forensic psychiatric practice, approximately half of the subjects declared insane are patients with schizophrenia.”

In schizophrenia, it is not possible to identify a single symptom that would be specific only to this disease. However, there are several symptoms that are most typical of schizophrenia, and also, as already mentioned, the pathogenesis of the disease in dynamics differs from all other mental illnesses, although not always self-evident, and sometimes difficult to distinguish even with a thorough examination.

For example, Bleuler believed that the loss of associative thinking occupies a central place in the symptomatology of the disease. K. Schneider proposed a list of symptoms he named "symptoms of the first rank". The presence of one or more of them in a patient directly indicates schizophrenia.

This list included the following symptoms:

1. Auditory hallucinations, in which “voices” speak the patient’s thoughts out loud,

2. Auditory hallucinations where two “voices” argue with each other,

3. Auditory hallucinations in which “voices” comment on the patient’s actions,

4. Tactile hallucinations, when the patient feels the touch of something foreign,

5. "Removing" thoughts from the patient's head,

6. "Putting" thoughts into the patient's head, carried out by strangers,

7. The belief that the patient's thoughts are transmitted to others (as on a radio), or received by him from others,

8. “Putting” into the patient’s consciousness the feelings of other people,

9. “Insertion” of irresistible impulses into the patient’s consciousness by strangers,

10. The feeling that all the patient’s actions are carried out under someone’s control, automatically,

11. Normal events are systematically given some special, hidden meaning.

American psychiatry took a significant step forward in 1980, adopting a new, significantly revised scheme for diagnosing and systematizing psychiatric diseases, enshrined in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). In 1994, its fourth edition was published ( DSM-IV). According to it, a diagnosis of schizophrenia can only be made if the following conditions are met:

1. Symptoms of the disease appear for at least six months,

2. Compared to the period preceding the disease, there are changes in the ability to perform certain activities (work, communication, personal care),

3. These symptoms are not associated with organic changes in brain tissue or with mental retardation,

4. These symptoms are not associated with manic-depressive psychosis,

5. The symptoms listed in one of points a, b, or c must be present, namely:

A). Any two of the following symptoms must have been present for at least a month: delirium; hallucinations;

disorders of thinking and speech (incoherence or frequent loss of associative connections); Severely disorganized or catatonic behavior, “negative” symptoms (blunted emotions, apathy); b). Strange nonsense, which members of the same subculture with the patient see as groundless;

V). Obvious auditory hallucinations in the form of one or more “voices” commenting on the patient’s actions or arguing with each other.

"Symptom lists like the one above may give the impression that schizophrenia is easy to diagnose. This is true when dealing with an advanced form of the disease, but in the early stages, diagnosing schizophrenia is difficult. Symptoms can occur with varying degrees of frequency, they are mildly expressed, and the patient can skillfully hide some manifestations of his disease.Therefore, it is a widespread practice among specialists when, at the first meetings with the patient, they write down in the medical history: "suspicion of schizophrenia". This means that their diagnosis is in doubt - until the clinical picture becomes clearer."

2.2. Psychological characteristics and symptoms of a patient with schizophrenia

Currently, in psychiatric classifiers (DSM-III, DSM-IV), as well as in the works of individual authors (Sneznensky A.V., Zhablensky A., Sternberg E.Ya. and Molchanova E.K., and many others) there is There are quite a lot of described forms and varieties of schizophrenia. Sometimes these forms are essentially indistinguishable from each other, but have different terminology. For example, asymptomatic schizophrenia (according to V.A. Gilyarovsky) corresponds to Bleuler’s idea of ​​latent schizophrenia.

Many mental illnesses, speaking from the point of view of nosological form, on the contrary, can be nosologically homogeneous, but differ pathogenetically and clinically (for example, alcoholic psychoses, neurosyphilis, and some others). Different countries have national classifications of diseases. All this introduces a certain amount of confusion into research and requires additional and thorough processing and unification of existing data in the field of clinical psychology, psychiatry, neurosurgery, pathopsychology and some other disciplines.

This work will examine all the main symptoms of schizophrenia without taking into account its nosological features. This approach can be useful in pre-medical diagnosis of latent and early forms of schizophrenia by the patient’s relatives and friends. Symptoms of personality disorder will be considered, namely: changes in perception; inability to separate and interpret external sensations; delusions and hallucinations; changes in the inner self and body diagram; changes in emotions; changes in movements and changes in behavior.

2.2.1. Changing Perception

A change in the interpretation of the environment associated with a change in perception is especially noticeable in the initial stages of schizophrenia and, judging by some studies, can be detected in almost two thirds of all patients. These changes can be expressed both in increased perception (which is more common) and in its weakening.

Changes related to visual perception are more common. Colors appear more vibrant and hues appear more saturated. The transformation of familiar objects into something else is also noted:

"Things seem to jump, vibrate, especially everything red; people take on a demonic appearance - with a black silhouette and white shining eyes; all objects - chairs, houses, fences - live their own life, make threatening gestures, come to life."

Changes in perception distort the outlines of objects and make them threatening. The color shades and structure of the material can seem to transform into each other.

Changes in auditory perception are common. Noises and background sounds may seem louder than usual, "It's like someone turned the volume knob on the receiver". Simultaneous strengthening of visual and auditory channels of perception often occurs.

The heightened perception is closely related to the overabundance of incoming signals. The point is not that the senses become more receptive, but that the brain, which usually filters out most of the incoming signals, for some reason does not do this. Such a multitude of external signals bombarding the brain makes it difficult for the patient to concentrate and concentrate. According to some reports, more than half of patients with schizophrenia report disturbances in attention and sense of time.

Changes in perception in schizophrenia affect not only vision and hearing. Many patients, describing their experiences during the period of remission, spoke of extremely strong kinesthetic, olfactory and taste sensations.

Often the change in perception is characterized not by sensory sensitivity, but by the so-called “influx of thoughts” (mentism), “nested thoughts”, described by patients as "the feeling that someone is 'putting' thoughts into their head". One can note the difference in the classification of such symptoms: in the Russian classification, mentism refers to thinking disorders, in the American classification, the symptom is often classified as the so-called "internal irritants".

As a consequence, such changes in perception lead to many and varied changes in the patient's behavior. An unexpected influx of sensory sensations and their aggravation in some patients causes feelings of high spirits, excitement, and exaltation. (This very often leads to erroneous conclusions - for example, the patient’s relatives begin to suspect that he is using drugs. Such exaltation is also characteristic of manic-depressive psychosis, which sometimes also leads to clinical errors). Some patients develop increased religiosity because they believe that they have come into contact with God and the divine. It should be noted that unmotivated increased religiosity, which appeared “suddenly” and does not stem from the characteristics of the subculture of the person displaying it, is one of the fairly reliable symptoms of schizophrenia.

With schizophrenia, perception can not only be sharpened, but also dulled. It should be noted that suppression most often occurs in the later stages of the disease, while the early stages of schizophrenia are characterized by an exacerbation of perception. Suppression is described as "a heavy curtain drawn over the brain; it resembles a heavy thundercloud, obstructing the use of the senses". Your own voice can sound muffled and as if from afar, everything blurs and wavers in your eyes.

2.2.2. Inability to separate and interpret external sensations

A significant group of symptoms in the diagnosis of early schizophrenia are disorders associated with difficulty or inability to interpret incoming signals from the outside world. Auditory, visual and kinesthetic contacts with the environment cease to be understandable to the patient, forcing him to adapt to the surrounding reality in a new way. This can be reflected both in his speech and in his actions.

With such violations, the information received by the patient ceases to be integral for him and very often appears in the form of fragmented, separated elements. For example, when watching television, the patient cannot watch and listen at the same time, and vision and hearing appear to him as two separate entities. The vision of everyday objects and concepts - words, objects, semantic features of what is happening - is disrupted.

“I had to kind of put all the things in order in my head. If I looked at the watch, I saw everything as if separately – the dial, hands, numbers, etc., after which I had to put them together...”

“I tried to sit at home and read; all the words seemed very familiar, like old friends whose faces I know very well, but I can’t remember their names; I read the same paragraph dozens of times, but still didn’t understand anything ", what is it about, and closed the book. I tried to listen to the radio, but the sounds just rang in my head."

Difficulty watching television is very common in schizophrenia. Contrary to popular belief, patients with schizophrenia rarely watch television in clinics. Some may sit in front of a screen and look at it, but very few of them can then tell what they saw. This applies to patients of any level of education and intellectual development. It should also be noted that patients interested in television programs prefer visual programs and cartoons, where it is not necessary to combine auditory and visual signals.

The inability of patients with schizophrenia not only to sort and interpret incoming signals, but also to respond appropriately to them, is one of the main symptoms of this disease. Bleuler, studying schizophrenic patients, was struck by the inadequacy of their behavior. Patients, being unable to adequately perceive the world around them and, as a result, respond adequately and timely to external stimuli, actually lose the possibility of normal communicative relations with the world. Avoidance of social contacts and a tendency to solitude are typical behavior for schizophrenic patients for whom these contacts have become difficult and painful.

The perception of the world, scattered into many heterogeneous and unrelated elements, gives rise to thinking problems, such as confusion of thinking, dissociation of thinking (incorrect associations), concreteness (impaired abstract thinking caused by the disintegration of the world into elements), impaired ability to think logically and see causally - investigative connections. In the latter case, the patient easily combines contradictory statements in his reasoning.

The stage of the disease when the patient, due to his difficulties in contacting the outside world, began to avoid communication, means that the disease is intensively developing and progressing. At the initial stage, noticing obvious violations in speech and the content of what was said (nonsense, neologisms, abracadabra, linguistic absurdities) can very reliably mark the onset of a schizophrenic disease and, as a result, speed up its identification, treatment and further prevention.

2.2.3. Delusions and hallucinations

The strongest impression on others and on the entire culture as a whole, which is expressed even in dozens of works on this topic, is made by the delusions and hallucinations of a patient with schizophrenia. Delusions and hallucinations are the most well-known symptoms of mental illness and, in particular, schizophrenia. Of course, it should be remembered that delusions and hallucinations do not necessarily indicate schizophrenia and schizophrenic nosology. In some cases, these symptoms do not even reflect general psychotic nosology, being a consequence, for example, of acute poisoning, severe alcohol intoxication and some other painful conditions. However, the appearance of hallucinations and delusions in a person “out of nowhere” can accurately indicate the onset (or active phase) of a mental illness.

There are quite developed classifications of delusional and hallucinatory states. Delusional ideas are “erroneous conclusions arising on a painful basis, completely taking over the patient’s consciousness and not amenable to correction”. Every person has errors in judgment and conclusions. However, in a healthy person, logical errors can be corrected by additional facts or arguments, that is, they are correctable. When delirious, the patient is not only unable to change the wrong opinion he has formed, to reconsider his views on this or that phenomenon, but also does not accept criticism from the outside. This is manifested both in the patient’s statements and in his behavior - incorrect, since it is dictated by a point of view that does not correspond to the real situation.

With a more or less gradual development of delirium, one can trace the dynamics of the components that make up its structure. First, a delusional judgment appears, constituting the core of the delusional structure, the catalyst of which is a change in the emotional state - internal tension, anxiety, restlessness, the presence of a feeling of inevitable disaster. The development of such a delusional mood is accompanied by a delusional perception, when everything around becomes dangerous, fraught with a threat, full of some implicit and hidden meaning. Delusional perception is directly related to the formation of a delusional idea, when elements of the past and present are reinterpreted from the point of view of current painful sensations and conditions. Finally, a delusional awareness inevitably arises - an insight, a kind of insight with an intuitive comprehension of the essence of what is happening. From this moment, delusional judgments acquire specific content, which is accompanied by subjective feelings of calm and relief - crystallization of delirium.

“One day I realized that I was being filmed in the leading role of some big film. Everywhere I went in London, there were hidden cameras everywhere, and everything I said and everything I did was filmed and recorded to a tape recorder."

There are delusions of wealth, delusions of invention, delusions of jealousy, delusions of persecution, delusions of jealousy, delusions of self-blame and self-abasement, and many others. These are very common forms with similar symptoms and content in each specific delusional continuum.

One should also distinguish between unsystematized and systematized delirium. In the first case, we are usually talking about such an acute and intense course of the disease that the patient does not even have time to explain to himself what is happening. In the second, it should be remembered that delusion, having the nature of self-evident for the patient, can be disguised for years under some socially controversial theories and communications.

Hallucinations are considered a typical phenomenon in schizophrenia; they close the spectrum of symptoms based on changes in perception. If illusions are erroneous perceptions of something that really exists, then hallucinations are imaginary perceptions, perceptions without an object. The hallucinating person hears voices that do not exist and sees people (objects, phenomena) that do not exist. At the same time, he has complete confidence in the reality of perception.

In schizophrenia, auditory hallucinations are the most common. They are so characteristic of this disease that, based on the fact of their presence, the patient can be given a primary diagnosis of “suspicion of schizophrenia,” which may or may not be confirmed, remaining within the framework of another nosological form.

Hallucinations of the auditory type are quite diverse in their content. The patient may hear individual sounds, some noise, music, a voice or voices. They may be constant or appear only from time to time. “Voices” in different variations and quantities are the most common symptom of schizophrenia. In the overwhelming majority of cases, the “voices” are unpleasant for the patient, very rarely they are pleasant, and in some individual cases they act as advisors, helping the patient do some work or make a certain decision.

The appearance of hallucinations indicates a significant severity of mental disorders. Hallucinations, which are very common in psychoses, never occur in patients with neuroses. By observing the dynamics of hallucinosis, it is possible to more accurately determine whether it belongs to one or another nosological form. For example, with alcoholic hallucinosis, “voices” talk about the patient in the third person, and in schizophrenic hallucinosis, they more often turn to him, comment on his actions or order him to do something.

Visual hallucinations in schizophrenia are much less common and usually occur together with auditory ones. According to numerous clinical observations of various forms of mental illness, it is noted that with exclusively visual hallucinations, the likelihood of schizophrenia is very low. It is also noted that the appearance of olfactory hallucinations in the clinical picture of schizophrenia may indicate the development of a tendency towards an unfavorable course of the disease with resistance to treatment.

It is especially important to pay attention to the fact that the presence of hallucinations can be learned not only from the patient’s stories, but also from his behavior. This may be necessary in cases where the patient hides hallucinations from others. Objective signs of hallucinations, which most often reveal the plot of the hallucination in sufficient detail, can indicate a progressive disease to any inquisitive mind and observant eye.

2.2.4. Changing the inner self and body diagram

Another group of symptoms characteristic of many patients with schizophrenia is closely related to delusions and hallucinations. If a healthy person clearly perceives his body, knows exactly where it begins and where it ends, and is well aware of his “I”, then the typical symptoms of schizophrenia are distortion and irrationality of ideas. These ideas in a patient can fluctuate over a very wide range - from minor somatopsychic disorders of self-perception to the complete inability to distinguish oneself from another person or from some other object in the outside world.

The self-reports of patients with schizophrenia - both in the form of speaking in the process of communication with the outside world, and on the basis of clinical observations - are indeed very diverse. The patient may describe constitutional and morphological changes in the perception of his own body that have no basis - “shifted” parts of the body (sunken eyes, bending of the limbs, shifted nose), changes in the size of parts of the body (shrunken head, shortened or lengthened limbs), defects skin, hair (dry, whitened, yellowed skin, wounds, holes). Some parts of the body may begin to live a “life of their own,” as if they were separated from the body.

"My knees are shaking, and my chest rises like a mountain in front of me. My whole body behaves differently. My arms and legs are separated and at some distance, moving on their own. This happens when I feel like I am a different person, and I imitate his movements or stop and stand like a statue. I have to stop and check whether it is my hand in my pocket or not. I am afraid to move or turn my head. Sometimes I throw my hands and see where they land."

A typical symptom of schizophrenia is a delusional belief in the patient’s pathological defect in his body. For example, a patient may be convinced that he does not have a liver. Or stomach. A frequent case of delusion is the belief in a fatal disease with a description of the “cause” - from the relatively sane (where the delusional sign is their incorrigibility) to the self-evidently symptomatic (worms ate the brain, a belly full of nails, etc.).

Impaired perception of oneself and one’s “I” can lead to the patient no longer distinguishing himself from another person. He may begin to believe that he is, in fact, the opposite sex. And what is happening in the outside world can rhyme for the patient with his bodily functions (rain is his urine, etc.).

2.2.5. Changes in emotions

Changes in emotions are one of the most typical and characteristic changes in schizophrenia. In the early stages of this disease, emotional changes such as depression, guilt, fear, and frequent mood swings may occur. At later stages, a decrease in the emotional background is characteristic, in which it seems that the patient is not able to experience any emotions at all.

In the early stages of schizophrenia, depression is a common symptom. The picture of depression can be very clear, long-lasting and observable, or it can be disguised, implicit, the signs of which are visible only to the eye of a specialist. According to some data, up to 80% of patients with schizophrenia exhibit certain episodes of depression, and in half of the patients depression precedes the onset of delusions and hallucinations. In such cases, early diagnosis of schizophrenia is very important, since after the crystallization of delusional states and judgments, the disease passes into a different form, which is more difficult to treat.

At the onset of the disease, the patient usually experiences a wide range of varied and rapidly changing emotions. Weak or strongly expressed experiences associated with changes in the perception of the external world and one’s own sensory and mental sensations only strengthen this picture. Euphoria, for example, as a marker of schizophrenia, occurs as often as depressive states in later stages, but more often it does not fall into the general clinical picture of symptoms, as it quickly disappears under the pressure of changing circumstances of the external world and futile attempts to adapt to changed conditions. In addition, euphoria often accompanies other psychotic conditions, such as bipolar reactions (MDP in the Russian classification) or severe alcohol intoxication, which can lead to errors in diagnosis and erroneous judgments in general.

The patient experiences many unmotivated emotional experiences: guilt, causeless fear, anxiety.

"I sat in my room, gripped by uncontrollable fear. It just consumed me - I was shaking with fear even at the sight of my cat."

It is believed that the most reliable symptom of schizophrenia is a dulling of the emotional state until the complete disappearance of emotions altogether. Moreover, if in the relatively late stages of a mental illness with a diagnosis of schizophrenia, the patient demonstrates strong emotional reactions, as a rule, this allows one to doubt the diagnosis.

As a rule, at the initial stage of the disease, dulling of emotions may not be very noticeable. Moreover, in neurotic and problematic families, as well as in some subcultures, it may be completely invisible. However, it is possible to trace the symptoms of disruption of the patient’s interaction with other people and empathy, starting from the patient’s everyday picture of the world and his usual behavior, which began to deform in communications and feedback.

2.2.6. Changes in movement

A change in the patient’s general mental picture of the world inevitably leads to a change in his motor activity. Even if the patient carefully hides the pathological symptoms (the presence of hallucinations, visions, delusional experiences, etc.), it is nevertheless possible to detect the appearance of the disease by its changes in movements, when walking, when manipulating objects and in many other cases.

The patient's movement may accelerate or slow down without any apparent reason or more or less clear possibilities to explain this. Feelings of clumsiness and confusion in movements are widespread (often unobservable and, therefore, valuable when the patient himself shares such experiences). The patient may drop things or constantly bump into objects. Sometimes there are short "freezes" while walking or other activity.

Spontaneous movements (signaling hands when walking, gesturing) may increase, but more often they acquire a somewhat unnatural character and are restrained, since the patient seems to be very clumsy, and he tries to minimize these manifestations of his awkwardness and clumsiness. Repetitive movements include tremors, sucking movements of the tongue or lips, tics, and ritualistic movement patterns.

An extreme variant of movement disorders is the catatonic state of a patient with schizophrenia (and other mental disorders), when the patient can maintain the same position for hours or even days, being completely immobilized. The catatonic form occurs, as a rule, in those stages of the disease when it was advanced and the patient did not receive any treatment for one reason or another.

Movement disorders are not the most common symptom in the diagnosis of schizophrenia. If a person develops a movement disorder that persists for some time (about a month according to DSM IV), other signs and symptoms should be looked for. It should also be taken into account that many medications (in particular, antipsychotics) can cause movement disorders: from tics to involuntary muscle spasms of the limbs or trunk.

2.2.7. Changes in behavior

Changes in the patient's behavior are usually secondary symptoms of schizophrenia. That is, changes in the behavior of patients with schizophrenia are usually a reaction to other changes associated with changes in perception, impaired ability to interpret incoming information, hallucinations and delusions, and other symptoms described above. The appearance of such symptoms forces the patient to change the usual patterns and methods of communication, activity, and rest.

The most common changes associated with illness behavior are described in sufficient detail in the psychiatric literature. For example, delusions of persecution force the patient to take a number of actions designed to protect or protect him from imaginary danger: he can install additional locks, doors, bars; on the street, he may constantly look around, or use accessories and clothing that supposedly disguise him. When delirium of jealousy begins, the patient may become exaggeratedly interested in the situation and contacts of the object of jealousy, and visit his place of work under various pretexts; he becomes too demanding when it comes to accurately returning from work or shopping; can secretly inspect clothes or other objects (bags, purses, etc.), and so on.

Schizophrenia is characterized by the so-called “ritual behavior”, when the patient develops a certain sequence of actions that satisfies his obsession and an overvalued attitude towards them. A fairly common delusion of poisoning, for example, pushes the patient to extreme forms of behavior, one way or another related to hygiene and cleanliness: plates are washed many times using very strong chemical cleaning agents, there is a constant struggle with dirt and germs, the patient constantly wipes everything handles of doors and cabinets, washes hands several dozen times a day or more, etc.

“As the dough was ready, a change took place. Individual details began to have their own special meaning. The whole process became a kind of ritual. At some point, the mixing rhythm had to be like the ticking of a clock, at another moment it was necessary to beat the dough, facing the east. "The egg whites had to be beaten from left to right. There was a reason for every action."

It should be borne in mind that the patient, as a rule, has absolute confidence in the correctness of his behavior. Absolutely absurd, from the point of view of a healthy person, actions have a logical explanation and conviction that they are right. And since in a patient with schizophrenia, and, especially, in patients with various forms of delusion, this conviction is not correctable, an outside observer or close people should not try to convince the patient, relying on a system of certain arguments and logical arguments. The patient’s behavior is not a consequence of his incorrect thinking, but a consequence of a mental illness, which today can be quite effectively treated with psychopharmacological drugs and appropriate clinical care.

conclusions

We can say that today the symptoms of schizophrenia have been described quite fully and there is a large amount of clinical data that allows a specialist to make a correct diagnosis with a high degree of probability, on which the further effectiveness and outcome of treatment, the duration of remission, or even the absence of relapses at all depends. . However, it should be assumed that the objective difficulties facing a specialist in making a correct and timely diagnosis are only half the problem, if not a smaller part of it. The main problem in the early diagnosis of schizophrenia is that the preclinical stage of the development of the disease in the vast majority of cases remains invisible to the majority of people living near the patient due to various reasons, one of which is incompetence and a tendency to a subjective and biased interpretation of the patient’s changed behavior .

Help in the early diagnosis of schizophrenia (and other mental illnesses) by those close to the patient and who can detect the onset of the disease at its earliest stages could play an invaluable role in reducing the overall incidence of morbidity and difficulties associated with the treatment of schizophrenia. It is well known that the earlier a disease is detected, the greater the likelihood of its successful treatment. For this, psychiatric science and clinical medicine in general need to make a lot of effort - to disseminate simple and effective knowledge that can raise the level of psychohygienic culture and knowledge among non-specialists an order of magnitude higher, which would contribute to more effective preventive work on the part of the population in alliance with the doctor. psychiatrist and clinician in the prevention of schizophrenia and other mental illnesses.

Literature

1. “Through the eyes of a psychiatrist”, Aleksandrovsky Yu.A., / Moscow, “Soviet Russia”, 1985.

2. “History of Psychiatry”, Y. Kannabikh, / Moscow, TsTR IGP VOS, 1994.

3. “Popular foundations of psychiatry”, D. Enikeeva, / Donetsk, “Stalker”, 1997.

4. “Psychiatry: a textbook”, Zharikov N.M., Ursova L.G., Khritinin D.F., / Moscow, “Medicine”, 1989.

5. “Forensic Psychiatry”, Textbook, /Edited by G.V. Morozova, / Moscow, "Legal Literature", 1990.

6. “Explanatory Dictionary of Psychiatric Terms”, Bleicher V.M., Kruk I.V., / Voronezh, NPO “Modek”, 1995.

7. "Schizophrenia. Clinic and pathogenesis" / Under the general. ed. A.V. Snezhnevsky, / Moscow, 1969.

8. “Schizophrenia: a book to help doctors, patients and members of their families”, E. Fuller Torrey, / St. Petersburg, “Peter”, 1996.

Per. From Polish St. Petersburg, 1998. 294 p.

Those who feel more and understand differently and therefore suffer more, and whom we often call schizophrenics.

PREFACE

Schizophrenia is a common disease; Every hundredth person suffers from this disease. Everyone knows its name. But only a few experts have an idea of ​​​​the nature of this mental illness, the most amazing of all psychoses. Schizophrenia is a mysterious disease called by psychiatrists<дельфийским оракулом>psychiatry, because it concentrates the most important problems of the human psyche. This psychosis - due to the richness of the patients' experiences - is also called the royal disease.

It deserves to be described in the form of a separate monograph, if only because the problems of schizophrenia, although quite hermetic and difficult to understand, should not remain a sphere of knowledge familiar only to a limited circle of specialists. It must be emphasized that deepening the psychopathology of schizophrenia introduces the reader to the main problems of human life.

Despite the richness of schizophrenic symptoms, numerous descriptions of this psychosis, often fragmentary and one-sided, usually suffer from stereotyping. Rare are monographs that describe a colorful and unusual disease in an original and fascinating way, but at the same time with scientific objectivity. Among such works is this book by Professor A. Kempinski, head of the psychiatric clinic of the Medical Academy of Krakow.

From time to time it is necessary to refresh psychiatric topics, make corrections and even break established views, schemes and outdated ways of interpreting psychopathological phenomena. In this regard, Professor Kempinski successfully coped with a very difficult task, because it is technically impossible to write a book containing everything that is known about schizophrenia, and, in addition, this knowledge is difficult to present in an accessible language not only to the general public, but even to specialists.

The author, in his reasoning, follows two paths. First, it takes into account the description of the clinical picture that we find in clinical works on psychopathology. Secondly, relying on his own many years of practical experience, Kempinsky develops his own original concept on a philosophical, psychological and at the same time on a natural scientific basis. He convincingly proves that schizophrenics, although very<другие>, but also people, and not some creatures subject to anathema or excommunication. A. Kempinski shows the richness, originality and even beauty of the thoughts, fantasies and positions of patients with schizophrenia. He went beyond trivial clinical descriptions and touched upon deep-seated problems that usually remain out of sight and poorly understood. Classifying the symptoms of schizophrenia, taking as a basis their theme, structure and color, the author analyzes, among other things, the attitude of patients to other people, the world, their own social role, themselves, sex, etc.

<Метафизика>schizophrenia presented in this monograph is firmly based on specific real observations. Identification of connections and comparisons, for example, between the experiences of patients and impressions from dreams familiar to everyone, brings the picture of this amazing disease closer to the reader. To introduce the reader to the world of experiences of a patient with schizophrenia, the author uses both concepts of everyday language and psychological terms. Concepts from other scientific disciplines are also used when, for example, we are talking about isolation and amplitude of feelings, about the charismatic aspect, about heroism, about the attitude to truth and lies, about the problem of decision-making and power, etc.

Professor Kempinski's book - the reader should know this in advance - does not exhaust all the problems; for example, the author deliberately does not touch on the biochemical aspects of schizophrenia. The fact is that this monograph was written within the framework of a certain philosophical and psychological concept.

Here we encounter not only a transformation of the meanings of well-known terms, but also the proposal of new definitions. These include, for example, the term central to the author’s original concept<информационный метаболизм>. The author believes that the main feature of life is the energy exchange of a living organism with the environment. Not a single atom in the body remains the same. Only the structure remains constant, a certain genetic plan that controls the continuous process of exchange with the environment.

In order for a living organism to carry out energy exchange with its environment, it must navigate it. Therefore, already at the early stages of phylogenesis, along with energy exchange, information exchange appears, or, as the author metaphorically designates this process, information metabolism. In humans, the development of the nervous system creates an exceptional and specific situation for him. In this situation, information metabolism plays an extremely important role and is closely related to energy metabolism.

The author interprets schizophrenia as a disorder of information metabolism. In the premorbid period of life of patients with schizophrenia, dominance of the so-called position<от>environment. Often, from childhood and usually from puberty, future patients feel bad in their environment, run into the world of fantasy, feel different from their peers, and do not participate in games with them, which are important for normal human development. The autistic attitude, according to Professor Kempinski, is essentially based on a weakening of the connection between information metabolism and the outside world.

The safety of a living organism and its individuality are determined by the structure of information and energy metabolism. This structure remains relatively stable thanks to control systems: genetic, endocrine and nervous. There is a close correlation between the intensity of exchange with the external environment (metabolism) and the internal order of the body. A weakened metabolism leads to a disruption of this internal order. For example, before falling asleep, information metabolism weakens and at the same time its certain order is disrupted; thoughts and feelings lose their coherent character.

During sleep, information metabolism decreases almost to zero, and functional structures, closed within the boundaries of the body, form a new order - the dream mechanism. From the position of the author of this book, the two axial symptoms of schizophrenia described at one time by E. Bleuler - autism and splitting - can thus be interpreted as a violation of information metabolism. Professor Kempinski sees this as the key to a better understanding of the experience of a person with schizophrenia.

Another of the many problems discussed in the book is the expression of patients with schizophrenia. This expression often makes it difficult for patients to contact their social environment, but it also happens that it elevates them to the heights of artistic or scientific achievements. It turns out that even with the so-called schizophrenic defect, many of these patients can hardly be considered disabled.

Psychopathological literature has been enriched by a book distinguished by a high scientific level, an original approach and an insightful interpretation of the most complex mental phenomena in normal and pathological conditions.

Professor Dr. E. Brzezicki

CLINICAL PICTURE

HISTORICAL NOTES

Already in ancient literature one can find apt descriptions of schizophrenia. For example, the Holy Scriptures highlight two main symptoms of schizophrenia - autism and splitting:<...встретил Его вышедший из гробов человек, одержимый нечистым духом, он имел жилище в гробах, и никто не мог его связать даже цепями, потому что многократно был он скован оковами и цепями, но разрывал цепи и разбивал оковы, и никто не в силах был укротить его; всегда, ночью и днем, в горах и гробах, кричал он и бился о камни... И спросил его: как тебе имя? И он сказал в ответ: легион имя мне, потому что нас много.>(Gospel of Mark, 5, 3-10).

If epilepsy and depression (melancholy) were already treated as separate diseases in ancient times, then schizophrenia retained the mark of obsession with secret forces for the longest time. The vague and general concept of madness and insanity (vesania) was subjected to attempts at classification only in the second half of the last century: K. Kahlbaum described catatonia and vesania typica, characterized by auditory hallucinations and delusions of persecution, and his student, E. Hecker, described hebephrenia and, finally, , E. Kraepelin brought together various syndromes into a single whole. To define them, he used the concept of dementia praecox - early dullness - proposed in 1860 by B. Morel. The dominant symptom, which allowed him to combine disparate symptoms into a single whole, was the final state of the patient, which was characterized by sensory dullness. Thus, several forms of schizophrenia were simultaneously identified: paranoid, corresponding to K. Kahlbaum’s vesania typica, catatonic, hebephrenic and simple (simplex). This latter corresponds to the case when the picture of the disease characteristic of the final state appears already at the beginning of the disease. The name itself (dullness) indicates that the assessment given to this disease by E. Kraepelin was rather pessimistic. Kraepelin looked at it as if from the end - through the prism of chronic<случаев>, patients staying in the hospital for years.

In 1911, E. Bleuler proposed the concept of schizophrenia from the Greek schizo - split, separate, tear, and fren - heart, mind, will. Unlike E. Kraepelin, he looked at this disease as if from its beginning. He believed that the disease process could be delayed at different stages of development and would not necessarily lead to dullness in every case. The nature of the disease is not always protracted; sometimes it can last only a few days or even hours, leaving behind no noticeable mental changes (so-called schizophrenic defects). As the axial symptoms of schizophrenia, E. Bleuler identified autism, i.e., isolation from the outside world and isolation in one’s own, inner world, far from objective reality, as well as splitting (schizo), or, to use the now fashionable word, disintegration of all mental functions . Also, unlike E. Kraepelin, he did not consider schizophrenia as a single nosological form, but spoke about schizophrenia or forms of schizophrenia, thereby emphasizing the possibility of different etiologies and pathogenesis of the disease process.

Despite the extreme diversity of views on the nature of schizophrenia in modern psychiatry, both of Bleuler’s views presented (the nature of axial symptoms and multifactorial etiology) have not lost their relevance and to this day constitute the main factor integrating conflicting views on schizophrenia.

In recent years there has been a tendency among some psychiatrists to reintroduce the general concept of vesania. By this they strive to emphasize that in psychiatry it is difficult to operate with nosological forms and it is much safer to use isolated syndromes (this is the traditional position of French psychiatry). This position is justified from a therapeutic point of view, and, apparently, its well-known popularity is connected with this. Because treatment methods are selected according to syndromes, and not depending on pathological diagnoses.

Thus, after more than a hundred years, the cycle of development of diagnostic views on schizophrenia has returned to its starting point.

Schizophrenia is often called the royal disease. We are talking not only about the fact that it often affects outstanding and subtle minds, but also about its incredible wealth of symptoms, which makes it possible to see all the features of human nature on a catastrophic scale. Therefore, the description of schizophrenic symptoms turns out to be immeasurably difficult and always the highest and most risky criterion of psychic insight.

We will begin our discussion of the psychology of schizophrenia and the proposal of an existential-analytical interpretation of this disease with some clinical observations. In our work with a large number of schizophrenic patients, a special psychological phenomenon was observed again and again. Patients stated that at times they felt as if they were being filmed by a movie camera. After appropriate research, it turned out, and this is quite remarkable, that this feeling did not have a hallucinatory basis: the patients did not claim that they heard the sound of a working machine or, if they felt that they were being photographed, the clicking of the camera shutter. They claimed that the camera was invisible and the photographer was hiding. There were no paranoid ideas from which the delusion of photography could arise, which in this case would be a secondary delusion - a carrier of the delusion of persecution. There were, of course, cases with a delusional substructure: patients, for example, claimed that they saw themselves in newsreels. Others claimed that their enemies or persecutors were spying on them by secretly taking photographs. But we excluded such cases from the very beginning from our study. Because in these cases, the patients' sensations of being filmed by a movie camera were not directly experienced, but were subsequently constructed and attributed to the past.

Leaving, therefore, these special cases aside, we could designate the rest purely descriptively as “delusion of feeling like an object of filming.” This form of delusion represents a genuine “hallucination of cognition” according to Jaspers; but it can also be classified as "primary delusional feelings" according to Groulet's definition. When the patient was asked why she thought she was being filmed when she saw nothing to confirm this, she characteristically replied: “ I just know it, but I don't know how».

This delirium can take many forms. Some patients believe that they are being recorded on a phonograph. Here we have simply the acoustic analogue of the delirium of a film recording. Still other patients believe they are being eavesdropped. Finally, there are patients who insist that they definitely feel that someone is pursuing them or express the equally irrational belief that someone is thinking about them.

What is common in all these experiences? We can express this as follows: the general thing is that the person experiences himself as an object - an object of influence emanating from the lens of a film or photographic camera, or as an object of the action of a recording device, or an object of eavesdropping on someone, or even of searching and thinking with the side of someone, in short, is the object of various intentional acts on the part of other people. All these patients experience themselves as objects of the psychic activity of other persons, because the various types of apparatus involved are only symbols, mechanical extensions of the psyche of other persons or their intentional acts of seeing and hearing. (It is clear, then, that such mechanical devices represent a kind of mythical intentionality for schizophrenics.)

In these cases of schizophrenia, we are thus dealing with a primary delusional feeling, which may be called the “experience of pure objectivity.” All phenomena that correspond to such designations as “delusion of influence,” “delusion of observation,” or “delusion of persecution” can be interpreted as separate forms of a more general experience of pure objectivity. The schizophrenic experiences himself as an object of observation or persecution intentions from other people.

We see the experience of pure objecthood as an aspect of that central disturbance of the ego that Grule classifies as one of the "primary symptoms" of schizophrenia. We can reduce the various forms of experience of pure objectivity to the general law of schizophrenic experience: the schizophrenic experiences himself as if he, the subject, had been transformed into an object. He experiences mental acts as if they were converted into a passive mood. While a normal person experiences himself as thinking, looking, observing, influencing, listening, eavesdropping, pursuing, seeking and pursuing, photographing or filming with a movie camera, etc., the schizophrenic experiences all these acts and intentions, these mental functions, as if they would be transformed into passive states: “they are watching him,” “they are thinking about him,” etc. In other words, in schizophrenia there is an experience of passivization of mental functions.

We consider this phenomenon as a universal law of the psychology of schizophrenia.

It is interesting to observe how the experienced passivity of such patients, even in speech, leads them to use transitive verbs in the passive mood where active intransitive verbs would be more appropriate. For example, one schizophrenic patient complained that she did not feel awake, but always as if she were being woken up. This passivization tendency explains the well-known avoidance of verbs by schizophrenics and their preference for nouns, since by its very nature the verb presupposes and expresses active experience.

The typical language of autistic schizophrenics, that is, those who are immersed in their own fantasies and therefore “inactive” in relation to the outside world, has another characteristic feature: the predominance of the expressive function compared to the representative one. In this way we can explain and in fact even understand the artificially created languages ​​of many schizophrenics who have ceased to respond to normal language, limiting us to the expressive elements of language, communicating with the patient as if we were “talking” to a dog. Intonation turns out to be more significant than words.

Our interpretation of the schizophrenic way of experiencing as passivization of mental activity is close to Bertz’s theory of schizophrenia. Bertz talks about the lack of mental activity in schizophrenics. He considers the main symptom of schizophrenia to be “hypotonia of consciousness.” If we consider the hypotonia of consciousness in connection with what we have designated as experienced passivization, we arrive at an existential-analytic interpretation of schizophrenia: in schizophrenia, the “ego” is affected both in relation to consciousness and in relation to responsibility. The schizophrenic personality experiences limitations in relation to these two existential factors. The schizophrenic person experiences himself so limited in his full humanity that he can no longer feel himself to really “exist.” These are the features of the schizophrenic experience that prompted Kronfeld to call schizophrenia “anticipated death.”

Bertz makes a clear distinction between process-symptoms and defect-symptoms, and it is precisely on process-symptoms that all phenomenological and psychological interpretations of schizophrenia are based. The existential-analytic interpretation of the schizophrenic way of experiencing also takes process-symptoms as its starting point. In our opinion, similar to the schizophrenic split between process and defect symptoms, there is a split between two ways of experiencing in normal individuals: the experience of falling asleep and dreaming. K. Schneider, in his study of the psychology of schizophrenia, wisely accepted somnolent thinking as its model, rather than dream thinking. The latter was highlighted by C. G. Jung, who interprets the schizophrenic as “a dreamer among the waking.”

How does the normal experience of falling asleep resemble the schizophrenic way of experiencing it? The fact is that a doubtful state also reveals hypotension of consciousness or, using Janet’s expression, “abaissement mentale”. Levy noted “half-finished products of thinking,” and Mayer-Gross speaks of “the empty husk of thinking.” All these phenomena can be found both in normal somnolent and in schizophrenic thinking. In addition, the school of Karl Bühler speaks of “thought patterns” and “free form” thinking. The studies of Levy, Mayer-Gress and Buhler are strikingly consistent in this regard. We can express it this way: from the doubtful state the individual passes into the sleep state through the pure form of thought, instead of filling it out.

Dream thinking differs from dream thinking in that dreams use figurative language. During the process of falling asleep, consciousness decreases to a lower level, designated as hypotension of consciousness. At the moment when this process is completed and, so to speak, the bottom of consciousness is reached, the dream immediately begins. The dream thus unfolds at this lowered level of consciousness. In accordance with the functional changes that occur during the transition from wakefulness to sleep, the sleeper "regresses" to a primitive symbolic dream language.

For a moment, however, let's put aside the fundamental difference between process and defect symptoms of schizophrenia and ask to what extent other symptoms of schizophrenia besides those we have discussed (ego and thought disturbances) are consistent with the theory presented here : extreme passivization of the experience of mental processes. In this regard, we will not discuss to what extent the motor system of a schizophrenic is also subject to such passivization, although our theory, perhaps, could shed light on the catatonic and cataleptic forms of schizophrenia. We will limit our discussion to the psychological problem of auditory hallucinations in schizophrenia. If we start with the phenomenon of “thinking out loud,” the principle of passivization may provide a clue to this puzzle. The thinking of a normal person is accompanied by more or less conscious “inner speech.” These acoustic elements are experienced by the schizophrenic in a passive form; he feels that his thoughts are coming from outside, and as a result he “hears voices,” experiencing his thoughts as if they were percepts. For what is a hallucination if not the experience of something internal and personal, as alien to a given person, as if it were a manifestation of something external?

Unfortunately, there is no way to use this discovery of experienced passivization in practical therapy. But practice provides broad empirical confirmation of the theory. For example, a young man came to us due to severe relationship delusions. The treatment consisted of developing an attitude - not to pay attention to imaginary observers and not to follow those who are supposedly watching him. (The question of whether or not there was any basis for his belief that he was surrounded by spies was excluded from the discussion from the beginning). His sense of being under surveillance disappeared. As soon as he relaxed his careful observation of his surroundings, his constant state of alert desire to detect imaginary observers relaxed, and a miracle happened - the spies disappeared of themselves. As soon as he ceased his own observation, his corresponding passive experience of being observed ceased.

In our opinion, this can only be explained by the assumption that the underlying disturbance caused an inversion of the experience of observation, turning it into a passive mood, the experience of oneself as an object of observation.

Special existential analysis should not at all be limited to cases of severe schizophrenic disorder. Much can be revealed about the schizophrenic experience through the analysis of borderline cases, such as, for example, the above case of a young man with relational delusions. For this reason, we will deal with such forms of schizoid nature, which were previously designated by the term “psychasthenia.” The main feature of this disease is what is usually described as “sentiment vide” (Feeling of emptiness); At the same time, the lack of “sentiment de realite” (Sense of reality) is striking. One of our patients tried to describe his sensations by comparing himself to “a violin without a resonator, completely without resonance”; he felt "as if" he were "only his own shadow." This lack of “resonance” that he complained about produced in him a feeling of depersonalization.

Haug has written an interesting monograph in which he argues that feelings of depersonalization can be caused by exaggerated introspection. We would like to add some comments. Knowledge is never only knowledge about something, but also knowledge about knowledge itself and, in addition, knowledge that knowledge is carried out by the ego. “I know something” means everything at once; “I know something” and “I know something” and at the same time “I know something.” The mental act of cognition or thinking causes, so to speak, a secondary, reflexive act, the object of which is the primary act and the “ego” as the starting point of the primary act. In other words, the act of cognition transforms the subject into an object. The primary act, reflected by the secondary reflexive act, becomes a mental reality and is qualified as a mental act; the experienced quality of the “psychic”, therefore, arises only in reflection and through reflection.

Let's try to consider these relationships using a biological model. Let us assume that the primary mental act corresponds in our biological model to the pseudopodia of an amoeba, which extends from its cell nucleus to some object. Then the secondary, reflexive act will correspond to a second, smaller pseudopodia, which “turns” towards the first elongated pseudopodia. It is not difficult to further imagine that this “reflexive” pseudopodium, being stretched too tightly, can lose its connection with the plasma of the amoeba cell and come off. Something similar occurs as a result of the exaggerated process of introspection that causes depersonalization. Exaggerated introspection means overexertion; the connection with the observing “ego” is severed, and mental functions are left to their own devices. The exaggerated reflective act of introspection can be likened to pulling the strings of intentionality too tightly, so much so that they break and the connection with the primary act and the active ego is no longer felt. From which necessarily follows the loss of feelings of activity and personality; the damaged ego feels depersonalized.

The following happens in the psyche: as a result of accompanying reflection, a mental act becomes a bridge between subject and object and, in addition, the subject becomes the bearer of all mental activity. “Having something,” I have, along with this “something,” this possession itself, as well as “ego” as a self. The "Self" is thus an "ego" that has itself, an "ego" that has become aware of itself. There is also a biological model for this awareness through self-reflection, namely the phylogeny of the proencephalon: the forebrain folds around the brain stem, “bending back,” just as the inhibitory function of consciousness is “reflected” on the instinctive reactions of the diencephalic centers.

We have said that in cases of depersonalization the "strings of intentionality" are pulled so tightly that they are in danger of breaking, and that this may explain why exaggerated introspection causes a splitting of the ego's self-awareness. It is clear, therefore, that hypotension of consciousness in schizophrenia can cause the same kind of ego disorder as hypertension of consciousness in psychasthenia. The difference between schizophrenic ego disorder and psychasthenic depersonalization is only this: in the first case the strings of intentionality are too weak (hypotonia of consciousness), while in the latter they are stretched so tightly that they break (hypotonia of consciousness).

Along with the reduced level of consciousness, to which the personality regresses during sleep, non-pathological hypotension of consciousness develops. We can therefore expect its expression in a decrease in the tendency to reflect. We can assume that in a dream the reflexive processing of a mental act is more or less, so to speak, switched off. The result of this shutdown is that the perceptual elements of "freely emerging images" can weave their hallucinatory patterns without control from the higher faculties.

If, in conclusion, we consider the discoveries of special existential analysis regarding the essential differences between obsessive-neurotic, melancholic and schizophrenic modes of experience, we can summarize as follows. The obsessive neurotic suffers from hyperawareness. A schizophrenic suffers from hypotension of consciousness. The schizophrenic experiences the limitation of the ego both in terms of consciousness and responsibility (the experience of pure objectivity or the principle of passivization). This is the main difference between a schizophrenic and a melancholic person. Because the illness of a melancholic person can be understood in existential-analytical terms only as the formation of a painful process in the human personality, that is, through the mode of humanity. In schizophrenia, however, as existential analysis shows, it is the humanity of the individual that is affected by exposure to the painful process. Nevertheless, even a schizophrenic retains a residual freedom regarding fate and illness, which a person always has, no matter how sick he may be, in all situations and at every moment of life, until the very end.

What methods of treating schizophrenia are used in modern medicine, what happens to the patient’s sense of self, and which of the great composers suffered from this disease.

Actor Russell Crowe as American scientist John Nash in the film A Beautiful Mind (DreamWorks Pictures, Universal Pictures - 2001). John Nash, winner of the Nobel and Abel Prizes, struggled with schizophrenia throughout his life.

Schizophrenia is a mental illness in which the patient loses the unity of mental functions: thinking, emotions, motor skills. The name of the disease comes from the Greek σχίζω (“split”) and φρήν (“mind”) and is associated with the dissociation of mental functions underlying the disease.

Schizophrenia is manifested by neurotic, delusional and hallucinatory disorders, as well as personality changes - decreased mental activity and emotional impoverishment. Schizophrenia was first identified as an independent disease by the German psychiatrist Emil Kraepelin at the beginning of the 20th century.

Manifestations of schizophrenia

This type of disease occurs at puberty, that is, during the period of puberty in young men, and is manifested by a drop in mental activity and fading of emotional reactions. Another continuous form is paranoid schizophrenia, which manifests itself as delusional disorders and hallucinations.

Among continuously ongoing forms, there is also sluggish schizophrenia, in which shallow neurotic disorders and mildly expressed personality changes predominate.

Neurotic disorders in low-grade schizophrenia can manifest themselves as obsessions, depersonalization phenomena in which the patient feels a split in his self, the patient’s doubt about his existence in the real world, or a feeling of loss of feelings for loved ones.

Sometimes schizophrenia occurs in the form of attacks. In some cases, this is favorable recurrent schizophrenia, where, along with mild attacks, remissions occur, during which the patient maintains his social status, does not lose feelings for loved ones and is an almost healthy person.

In other cases, with paroxysmal-progressive schizophrenia, a wide variety of attacks is observed, and personality changes are more pronounced than with a recurrent course.

Modern methods of treating the disease

If in some countries the diagnosis of sluggish schizophrenia is recognized, then in others these cases are regarded as psychopathy or personality accentuation; If some psychiatrists recognize the existence of paroxysmal forms of schizophrenia, others regard them as atypical manic-depressive psychosis, or the third - an endogenous disease.

Due to different views on the boundaries of schizophrenia, there are significantly fewer people suffering from this disease in the United States than in many European countries.

The main method of treating patients with schizophrenia is psychopharmacology. In the 50s of the 20th century, drugs appeared that were effective in treating both psychosis and other manifestations of the disease. One of the first psychopharmacological drugs was the domestic drug “Aminazine”, then the range of drugs expanded, and drugs such as “Stelazine” and “Haloperidol” appeared, and recently “Zyprexa”, “Rispolept”, “Seroquel” have become widespread.

A wide range of antidepressants have also appeared that affect various types of depression - Amitriptyline, Melipramine, Remeron and others. To prevent relapses, so-called maintenance therapy is used, which is necessary in remission to maintain the state that was achieved during hospital treatment. Psychotherapy also has a place in the treatment of schizophrenia. The method of psychocorrection has also become widespread.

Patients with schizophrenia are often afraid to admit that they have some kind of mental disorder. But from a medical point of view, schizophrenia is considered the same as all other diseases that require appropriate treatment.

Rehabilitation in psychiatry is an integral part of treatment and is a long and labor-intensive process, the participants of which, along with the patient, are psychiatrists, psychologists, psychotherapists, social workers, and occupational therapists.

Rehabilitation measures are differentiated depending on the forms of the disease, the degree of safety of the patient, as well as the type of psychiatric care: hospital, semi-inpatient, outpatient.

Reasons for the development of schizophrenia

Most researchers believe that schizophrenia is a disease with a genetic predisposition, which is realized under the influence of unfavorable environmental factors: toxic, infectious, hypoxic, psychogenic.

The disease can be hereditary, but this does not have to be the case. It all depends on the genetic mosaic. But today it is almost impossible to predict whether a child will have schizophrenia or not.

Genetic counseling as it exists today is far from the truth. Sick people often give birth to healthy children, who may differ in some features, but nothing more. Conversely, there are many cases where completely healthy parents give birth to a child with mental characteristics.

When scientists first began to describe this disease, they called it pluriglandular insufficiency and drew attention to the disruption of the endocrine system.

If a patient suffering from schizophrenia begins to gain weight sharply, this is regarded as an unfavorable sign of an effect on the endocrine system. Some patients begin to gain weight, others lose weight. Sexual functions change, when libido disappears or sharply decreases, the menstrual cycle in women is disrupted. In this case, no disturbances in cardiac activity are usually observed.

Psychiatry knows many cases where patients suffering from schizophrenia led normal lives, including professional and creative ones, and sometimes were outstanding people in their field. Suffice it to recall Vsevolod Garshin, Konstantin Batyushkov, Knut Hamsun and many other outstanding writers, artists Edvard Munch, Paul Cezanne, Vincent Van Gogh, composer Robert Schumann, pianist Glenn Gould. As a rule, schizophrenia is not interpreted as a driver of creativity. But scientists believe that this disease often develops in initially talented people.