by Ann Reitan, PsyD | April 14, 2015
As a doctor of clinical psychology, I address differently the problem of psychosis. I approach psychosis as a result of trauma and mental phenomena as opposed focusing on the brain, the empirical and the medical model of mental illness.
I was very recently reading an article on the subject of new advances in medications to treat disorders that implicate the biochemistry of the brain. This article was entitled “Brain Boom”, and it was written by Mathew Herper. In this article it was stated that, in treating schizophrenia: “Currently, drugs can be effective at treating hallucinations and paranoia, but don’t yet treat cognitive problems and social difficulties caused by the disease.”
There are distinct differences between the experiences of hallucinations and paranoia that may explain why these characteristics are able to be ameliorated by medication while the others are not. It should be noted that hallucinations and emotional problems such as paranoia are visceral experiences, and, for that reason, they may be more implicated in the abnormal brain chemistry from which psychosis emerges. Cognitive and social problems, problems, however, may depend more on experience in the mental and material worlds.
When discussing cognition in a schizophrenic, certain difficulties in schizophrenic thinking are obvious. Loose associations, word salad and poverty of speech are some examples of what signifies cognitive difficulties in these individuals with psychosis. One fact that is seldom considered is that schizophrenics deal with experience that is uncharted — it is novel — and it cannot easily be understood cognitively in that it is difficult to cognitively manipulate the experience of psychosis by the schizophrenic’s own efforts. Why would anyone expect the schizophrenic to be able to think about experience that is uncommon and non-normative? There is no real basis, no real tradition in thought, that would allow the schizophrenic to think productively about psychosis.
While I was in graduate school, I asserted that I wanted to write theory concerning meta-belief systems. Essentially, I wanted to generate belief systems about belief systems — to understand psychosis from a theoretical and essentially cognitive perspective based in cognitive theory. The point that I wish to make is that psychosis, as a thought disorder, should not be encapsulated as a biochemical disorder exclusively. As indicated, it is my belief that the expression of psychosis as psychopathology depends on the mind and the environment as well as biochemical phenomena.
Clearly social deficits in schizophrenics depend on experience in the material world. Given the fact that psychosis tends to emerge in adolescence and young adulthood, there are very important developmental activities that are compromised in terms of maturing socially. This is seen most prominently in Erikson’s stages of social development. When schizophrenia typically emerges, the individual is in the “identity versus role confusion stage” or the “intimacy versus isolation stage”. Psychosis leads to problems with identity formation and interpersonal alienation. This may be attributed to non-normative experience and impoverished social experience.
Essentially, the schizophrenic’s poor cognitive and social skills are impacted by non-normative experience, and hallucinations and paranoia have causal effects on deviant cognition and a lack of social skill. If hallucinations and paranoia can be diminished early in the course schizophrenia, perhaps this non-normative experience would not have this negative impact on cognition and social skill. Clearly, paranoia and hallucinations are implicated in a causal way in terms of their effect on cognition and social skills. Nevertheless, poor cognitive activity and limited social skill depend on non-normative experience in the mental and material worlds.
Overall, poor cognitive and social skills result from a diminished fund of learning. Nevertheless, cognitive skills may be reflected in meta-cognition as it relates to psychosis. Enhancement of cognition about cognition, or cognition about psychosis, may allow for the schizophrenic’s detachment from her psychotic experience. This may prove to be therapeutic. Similarly, the therapeutic benefits of social skills training may be therapeutic. As learning deficits, poor cognitive and social skills have the capacity to respond to learning, and this is a positive correlate to the fact that cognitive and social skills are learned.
Since submitting this article, I have given more thought to the assertion I made regarding the statements within the article Brain Boom. It was stated in Brain Boom, by Matthew Herper, that “currently, drugs can be effective in treating hallucinations and paranoia, but don’t yet treat cognitive problems and social difficulties caused by the disease.”
In terms of cognitive problems in schizophrenics, it may be said that medication improves cognitive organization. While not a replica of intelligence, IQ may be considered to approach cognitive ability based on cognitive organization. There is no doubt that a schizophrenic who is being treated with antipsychotic medication will score higher on an IQ test than that same person might score while taking an equivalent test while taking no antipsychotic meds. This illuminates the effect of medication on cognitive problems in schizophrenics. While not aligned with the quoted statement in the articleBrain Boom, my statements herein support the dramatic and positive effects of antipsychotic medication.
In terms of social skills, I have stated that these are learned, and, correspondingly, these are not learned in schizophrenics due to aspects of poor development in the Eriksonian stages of “identity versus role confusion” and “intimacy versus isolation”. When the Eriksonian stages of development are compromised, the resulting deficits in social skill and ability can be understood. Moreover, treating and diminishing paranoia with antipsychotic medication will have a positive effect on social skills in time. The important part of this last statement is “in time”.
Overall, there exists a synergy between biochemical effects of meds and the realities of cognitive deficits as well as the role of negative emotional states affecting traits. Attempting to separate the material biochemical brain functions treated by antipsychotic meds, from cognitive and social processes that are aligned with schizophrenia is confounded by the synergy between biochemical, cognitive and social aspects of the disease of schizophrenia.
The key to seeing cognitive and social progress in the medicated schizophrenic could be the longevity with which improvement in psychotic process is observed — after the fact of administration of antipsyhcotic medication to the schizophrenic individual.