HD 3700 1st Edition Lecture 17Outline of Last LectureI. To Be or Not To BeII. Schizophrenia, schizotypes, and endophenotypesIII. First Generation (typical) AntipsychoticsIV. Second Generation AntipsychoticsOutline of Current LectureI. R.D. Laing’s revolutionary approachII. Subtypes of SCZIII. Hamlet’s speech to the playersIV. Prelim Study GuideCurrent LectureI. R.D. Laing’s The Divided Self- Laing’s revolutionary approach—approached the schizophrenic experience with insight and compassion- Psychiatrist, innovator- He felt that the medical model was obscuring us from the mental experience of schizophrenics- Review of medical modelo Hereditary contributions Born with genetic vulnerability to schizophrenia and an outside trigger (stress) causes a schizophrenic breako Medication does not cure the illness but helps to regulate the symptomso Dopamine is in the mesolimbic pathway—unclear what underlying mechanisms cause it We assume that SCZ is a developmental neurological disorder There is a structural problem that comes into effect after puberty—i.e. the brain changeso Women diagnosed with SCZ at a later age – it is much milder for them After menopause it gets much worse Menstruating prevents the intensity of SCZ- The Divided Self – R.D. Laingo Phenomenology Defined as the field of philosophy that focuses on understanding the constituencies of consciousness (How does the mind create? How does the mind develop hypotheses? Etc.) The goal is to reconstruct and try to experience the way that his patients are experiencing him o Therapist: goal is to be quiet, to figure out what it means to the patient to be in their body Patient brings his existence / his state of mind into the therapeuticsession “It is the task of existential phenomenology to articulate what the other’s ‘world’ is and his way of being in it”o Our consciousness is trapped in our bodies We can feel very close / distant from others However, we are still separate physical beings We have an incurrent aloneness that no activity can change We can’t know ourselves without our relationships with others Lonely—to miss being known by someone who is important to you Relationships are affecting your consciousness all the time The relationships that your form are also shaped by boundaries These boundaries determine the experience of our selfhoodo Psychotherapy is an activity in which that aspect of the patient’s being, his relatedness to others, is used for therapeutic ends The therapist acts on the principle that, since relatedness is potentially present in everyone, then he may not be wasting his time in sitting for hours with a silent catatonic who gives every evidence that he does not recognize his existence- Kraepelin’s Patient o 18 years old, strongly built with a pale complexiono Sits with his eyes shut and pays no attention to his surroundingso He does not look up even when he is spoken too The patient is, as Kraepelin noted, “inaccessible”o Although he undoubtedly understood all of the questions he was asked, “he has not given us a single piece of useful information. His talk was—only a series of disconnected sentences having no relation whatsoever to the general situation”o What would Freud say to do? Like a Freudian slip, take the slip (his “inaccessible, useless information”) seriously- So approaching patients as individuals with consciousness…o Laing’s categories of schizophrenic experienceo Engulfment—the world is coming into you and obliterating you Although the episode is not incredibly severe, it still drastically moves you, you are forced to make connections that you wouldn’thave beforeo Implosion—it’s not about the outside world controlling you, its about your own mind Empathize with the implosion Understand what’s happening inside the patient to see how its shaping their external experienceo Petrification and depersonalization- Ontological insecurityo The nature of our critical inquiryo Someone who has a psychotic disorder, cannot depend on anything  Their consciousness can’t make connectionso Consciousness to Lain A sense of security in regard to being in the worldII. Subtypes of SCZ- Four clinical subgroups of SCZo Sensitivity psychosiso Drug related psychosiso Trauma related psychosiso Anxiety psychosiso Each subgroup has its own trigger/stressor and personality type- Sensitivity psychosis o The person slides into the disorder (gradual onset in teens / early 20s)o Relatively minor stress (e.g. leaving home for college, starting work) precipitates episodeso Caregivers usually very involved Encouraging and supportive May be “trying too hard” High expectationso Feels under pressure but at a standstillo Idea / delusions of reference and thought broadcasting especially frequent—particularly when overstimulatedo Prominent “negative” symptoms- Drug related psychosiso Drug induced psychosis at initial presentation (hallucinogens, amphetamines, LSD, cocaine, heavy use of cannibis)o Recurrence or perpetuation of symptoms when drugs not present (on testing)o Initially may be given diagnosis of personality disorder or drug misuse onlyo Hallucinations / paranoia – replay of original psychosis o Onset usually in teens or 20so May have “rebellious” personalityo Frequently from a disrupted familyo Caregiver often very uncertain how to help and may therefore give confused messages to cliento Frequently poor cooperation with services- Trauma related psychosis o If you are already vulnerable to and have the genetic likelihood for SCZ, when you experience this traumatic episode it is a much different psychotic breako Auditory hallucinations Abusive, violent, and/or sexual content Second person (“you’re a [swear word]”) Command (“kill yourself”, “kill your children”)o Experienced as shocking and alieno Repetitive and distressingo Fluctuating insighto Blames selfo Associated with PTSD, especially sexual abuse Depression; suicidal and depressive thoughtso Overlap with borderline personality disorder- Anxiety psychosis o Onset  Acute: it builds up over a few days or weeks Generally later in life: late 20s onwardo Stress-related (e.g. work pressure)o Anxiety relieved by crystallization into a “meaningful” explanation for distressing feelings Delusional perception or delusional conclusion (e.g. “the neighbors are