“To an observer, the bizarre behaviors and speech of a schizophrenic are disturbing. For the schizophrenic, the world is a confusing maze of nightmares from which one cannot wake up. ” (Abramovitz, 2002, p. 8) Schizophrenia is a disease that is not curable. Even though there are many therapies and medicines to help people who have schizophrenia there is no cure. “Schizophrenia is a serious mental disease that affects a person’s thoughts, behavior, moods, and ability to work and relate to others. (Ambramovitz, 2002, p.
) People with schizophrenia usually have a hard time differentiating what is real from what is imagined putting the disease under the term psychosis. When a person is diagnosed as having a psychotic disorder they usually have a hard time comprehending that they are mentally ill because the hallucinations and delusions are so real to the person. There are several types of symptoms for Schizophrenia. Some of the most known are the positive symptoms, which are hallucinations, delusions and inappropriate behavior.
There are also negative symptoms, which are lack of emotions and behaviors otherwise known as blunted emotions. Finally there is a third group of symptoms called disorganized. This group includes disorganized speech, behavior and thinking. For example: “A person with schizophrenia, when asked if he wants a cup of coffee, might reply that there are no cows in New York” (Ambramovitz, 2002, p. 14). “Schizophrenia and the symptoms that characterize it are understandable exaggerations of normal function and not exotic symptoms superimposed on the personality” (Strauss, 1969, p. 585).
There have been problems with diagnosing schizophrenia because people can have schizophrenic symptoms in normal experiences. If a person is going through withdrawal one of the side effects are delusions. And because withdrawal can cause symptoms similar to schizophrenia it takes precedence over schizophrenia. Unless there is a clear physical cause for a psychological symptom, a diagnosis for schizophrenia is not made. There have been other difficulties in diagnosing renia, when asked if he wants a cup of coffee, might reply that there are no cows in New York”re areschizophrenia because of the influence of a persons’ ulture. For instance; in the United Kingdom, there has been controversy with individuals from Afro-Caribbean origin. The reason this could be a problem is because people that are very religious or feel they have a connection to something greater might think they are talking to someone who has passed on and is not with us anymore. Also people that are very intuitive or very in tune with their surroundings may get a feeling or see something that shouldn’t be there and they start question this and start asking people.
In Cognitive-Behavioral Therapy of Schizophrenia by David Kingdon and Douglas Turkington (1994) they describe two types of parapsychological phenomena: 1. Cognitive- for example, clairvoyance, telepath or precognition. Or a person is believed to have acquired knowledge from an unknown source. Creating the term “extrasensory perception (ESP). 2. Physical-“psycho kinesis”, movement of objects or people by parapsychological means. (p. 25) Cox and Cowling (1989) interviewed 60,000 British adults about their beliefs in various unscientific phenomena.
The results were 68% of people believed in God more than 50% believed in thought transference between two people. More than 50%: The possibility of predicting something is going to happen before it actually does. 25% Ghost (the figure rose to 33% among 18-34 year olds), 25% superstitions, 25% Reincarnations, 23% Horoscopes, 21% the devil, 10% “Black Magic” If 68% out of 60,000 British adults believe in God and after life it could pose some problems with diagnosing people with schizophrenia because there isn’t any proof that ghost’s and things in the afterlife don’t exist.
However, there also isn’t scientific proof that ghost’s and whatever else exist. Because there isn’t any evidence whether people can or cannot talk or see the unknown there is another symptom for schizophrenia. As previously stated people that are diagnosed with schizophrenia are usually disorganized, especially with their thinking and speech. “The most prominent symptom is incoherent speech and behavior” (Abramovitz, 2002, p. 20). With this symptom it helps doctors diagnose the disease because it separates the group of people that have hallucinations and delusions.
If a person that has hallucinations but it’s from a “normal” experience they won’t show signs of disorganized speech or thinking. There are many difficulties with diagnosing schizophrenia. There are so many symptoms and sometimes the person might not be in the typical seventeen to twenty-five age range when the symptoms start showing but in the end, most psychiatrists look at the length of time of the symptoms and how severe they are and use the Diagnostic and Statistical Manual of Psychiatry (DSM-IV) for guidance.
According to Silvano Arieti (1995) there are four successive stages in schizophrenia: the initial, the advanced, the preterminal, and the terminal. He states that the initial stage is slow, insidious and passes unnoticed. Some of the symptoms show, hallucinations and delusions, but the person isn’t aware of the disease. The second or advanced stage is when the patient accepts the illness. Anxiety and outbursts decrease and other symptoms seem to rest, “the delusions and hallucinations have lost a great many of their unpleasant qualities” (p. 346). In this stage the persecutory delusions are replaced by delusions of grandeur.
This is when the patient become disorganized or disconnected from their thoughts. The third or preterminal stage is a stage that many psychiatrists have neglected. According to Arieti (1995) many of the patients in this stage are hospitalized and aren’t showing many symptoms from the previous stages. “They have described these patients as approximating more and more a vegetative existence, and a state of “idiocy” (p. 351). Hallucinations and delusions seemed to have disappeared in this phase, which generally occurs 5 to 15 years after the beginning of the illness.
The fourth or terminal stage of schizophrenia is the final stage. It seems the symptoms are no longer psychological but neurological. During this stage there is a huge reduction in motor activity usually bringing about a state of malnutrition and anemia. Arieti (1995) describes it as “schizophrenic withdrawal”. The patient will have a sudden increase in motor activity and will usually start hoarding things such as food and they will also become very depressed. Because there is no cure for schizophrenia most patients go through each cycle numerous times.
Some will never make it to the final stage where some will be stuck between stages three and four. Because of the social toll that schizophrenia takes, for instance no job, lack of friends, not continuing in school, many people with schizophrenics have a problem with drug abuse and approximately 10 to 13 percent of people with the disease end up taking their own lives, because of the depression and the endless cycle of terror (Abramovitz, 2002, p. 11). There are many ways of treatment for schizophrenia. Forms of treatment for schizophrenia are hospitalization, drugs or medicine and therapy. Experts say the most effective treatment plans combine medication with psychotherapy, education, and social rehabilitation programs that address the living skills and emotional needs of the patient” (Ambramovitz, 2002, p. 42). There are several reasons why hospitalization might be necessary, first reason is since schizophrenia symptoms can occur in “normal” experiences the doctor must rule out other possible causes of the persons’ behavior. Second, to find the right medication and dosage the doctor is going to need to do some trial and error and during this time the patient is going to need to be closely observed.
Thirdly, if the patient is in the acute phase they may not be able to take care of themselves and perform basic life skills. Most psychiatric centers are short term programs, which mean the main goal is to have the person healthy and stable and ready to go back out into the world in less than two weeks. They try to move the patient out of the initial stage and recognize what is reality and what is hallucination or delusion. The drugs or medicines that people with schizophrenia take are called Antipsychotics. There are two main categories: conventional and atypical.
Conventional drugs are effective in reducing positive symptoms; however they do not work well on negative symptoms. Atypical drugs, which get there name because of the fact that they do not work on primarily blocking dopamine receptors like conventional drugs, block receptors for serotonin, acetylcholine, and histamine. But how these drugs work are unknown. Medicines work really well with patients because it stabilizes them and gives them the opportunity to build coping skills and relearn life skills however there is a problem.
A lot of the medications whether they are conventional or atypical have very severe side effects. These side effects include restlessness, dry mouth, impotence, blurred vision, constipation, and weight gain, also twitching, slight paralysis, and tremors. Many psychiatrists have tried different combinations and dosages of the medicines but the outcome is usually unpleasant. This causes a problem because many people with schizophrenia aren’t mentally disabled and notice the side effects which make them not want to take the medication.
Many patients once stable and not seeing hallucinations will stop taking the medications which will make them relapse because the disease is not cured; the medicine just makes it dormant. But thankfully there are treatments beyond drugs. There are many types of therapies for patients with schizophrenia from psychotherapy to physical therapies (shock treatment) (Arieti, 1995, p. 435). Psychotherapy aims at an atmosphere devoted to acceptance, trust, and an effort to “reach” him, increase in the ability to communicate, and for the patient to gain self-esteem (Arieti, 1995, p. 436).
The other type of therapy shock therapy or electroconvulsive therapy (ECT) is a therapy that was created when psychiatrist began looking for a less unpleasant way of causing convulsion. Convulsion therapy was a treatment that became popular in the 1930s and it’s when doctors would inject camphor, which caused seizures, because: “Patients with epilepsy had fewer seizures if they developed schizophrenia. Psychiatrists hoped that causing seizures in people with schizophrenia who did not have schizophrenia might somehow help them recover from their mental illness” (Abramovitz, 2002, p. 47).
The injections did eliminate symptoms but the camphor created unpleasant side effects. So doctors started looking for a different type of treatment. ECT is a very dangerous procedure because the doctor is literally erasing the patients memory and some people think that too much of this can’t be good so in 1970 the federal government passed a law restricting the use and now it’s really only used unless the patient gives consent or medicine does not help them. There is one more group of therapies and that is rehabilitation therapy. Rehabilitation therapies consist of social workers, art therapists, recreational therapists, and music therapists.
The aim of this therapy is to help patients learn the skills they need to interact with others, get a job, and live independently. During the sessions you can have an individual setting or a group setting. “Attempts to modify the activity of human beings by music have interested psychologists for many years” (Skelly & Haslerud, 1952). Music therapy has been around for centuries. But it really didn’t get acknowledgement until the 1900s. With psychiatric patients music therapists aim to work on basic life skills, appropriate behavior, coping skills, and positive thinking.
Group Improvisation Therapy: The Experience of One Man with Schizophrenia by Hellen Odell Miller is about a man who attends a day clinic for people with psychiatric problems associated with long-term mental illness and his change from a person with schizophrenia who was always angry and closed off to a man that was adventurous and expressive towards others. In this clinic there are several psychotherapies including music therapy. During this day clinic there is a weekly one hour music therapy session, anyone in the clinic can join but they first must meet with the music therapist to be assessed.
There are five people in the group including the man, both female and male ranging from 29-57 years old. The main subject in the case study, Brian, came from a family where the father was diagnosed with schizophrenia and already had three admissions to a psychiatric hospital. The reason why Brian was referred to this day clinic was because he seemed unable to make long term plans for his life. The referral stated “his mental state seems to make him inaccessible to rational planning for the future. Brian was already attending the music therapy group for two years and the two year period can be divided into three main phases.
Phase one which was a six month period was about Brian testing and establishing himself. In the beginning Brian was always criticizing the group, he was often monosyllabic and seemed confused and his thoughts seemed disordered. During the group sessions the therapist would play accompaniment and have the group members improvise whether it be rhythmically or harmonically. In the beginning the group needed a lot of support but towards the end the therapist could improvise with the group. The therapist realized the only way to really connect with Brian was through his behavior.
In a structured manner the therapist would egg Brian on, push some of his buttons to see how far she could go with him. Then once she saw Brian was really angry she said act as if you are disinterested with Dorothy (another member of the group). Now the therapist knows from previous sessions that Dorothy and Brian connected so to make him do this caused some conflict between his behavior towards the therapist and his behavior towards Dorothy. Brian ended up having an exchange with Dorothy about their families which became the turning point in Brian’s therapy. Phase two is bout trusting or not. This phase was about Brian deciding whether he wanted to be close with others or not. During this phase Brian explored his relationships with others, he was also admitted to the hospital which the therapist said didn’t seem necessary but it did help him a lot. His relationship with the therapist grew stronger and he asked her several times to help him be discharged. The therapist agreed she would. She helped him look for a new community home and after the six month phase as he was settling in the therapist could see Brian becoming more adventurous and expressive.
Phase three is all about Brian’s hard work. During this one-year phase Brian’s music became more complex and he became really involved with the group but not in a positive way. His anger got the best of him and he actually made a member leave the group. The therapist thinks that Brian has been hurt in the past and still needs exploring but she never got to go deep enough to explore this. In the entire two years Brian would constantly insult people week after week and sometimes said that he was forced to go to the group but he and the therapist know that it’s his choice and he could leave at any time.
However, Brian’s only motivation to relate to others was through the group and he began to trust and enjoy the freedom of improvising with others. Brian still attends the group and it has helped him maintain his quality of life. There are many different types of music therapy techniques that can work with the different goals of schizophrenia. One is improvisation like in the case study, which works on helping the patient with freedom. There is sing along and call and response where you can work on a patient’s attention span and positive thinking.
And there is lyric analysis where you break down the lyrics of a song and ask the patient what it means to them. For instance in my music therapy session last week I played I Won’t Give Up by Jason Mraz and after I played I asked the patients in my group session how did the lyrics make them feel. One client Maureen, who was just admitted to the hospital with schizophrenia, broke down and said the song was so beautiful and lyrics were so meaningful that it helped organize her thoughts and think positively that she shouldn’t give up and she can move on from this time in her life.
Music therapy is really beneficial for patients with schizophrenia because you can have that therapist-client relationship without making the client feel uncomfortable by always asking them questions. You can use music to have a conversation with a client and it’s less stressful for the client. Schizophrenia is an incurable disease that uses many therapies and drugs to help patients with this disease. Hopefully one day there will be a cure but for now just trying to understand what the patients are going through and trying to keep them thinking positively is the best medicine.
Abramovitz, M. (2002). Schizophrenia. San Diego, Calif: Lucent Books Arieti, S. (1974). Interpretation of schizophrenia. New York: Basic Books. Bruscia, K. E. (1991). Case studies in music therapy. Phoenixville, PA: Barcelona Publishers Cox, D. , & Cowling P. (1989) Are you normal? London: Tower Press. Kingdon, D. G. , & Turkington, D. (1994). Cognitive-behavioral therapy of schizophrenia. New York: Guiford Press. Skelly, C. G. , & Haslerud, G. M. (1952). Music and the general activity of apathetic schizophrenics. University of New Hampshire. Strauss, J. S. (1969). Hallucinations and delusions as points on continua function. Archives of General Psychiatry, 21, 581-586.
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Schizophrenia: Psychiatry and New York. (2017, Jan 24). Retrieved from https://graduateway.com/schizophrenia-psychiatry-and-new-york/