Psychodynamic Understanding of Schizophrenia

Freud believed that schizophrenia is characterized by decathexis of objects, which refers to the withdrawal of psychological energy previously invested in internal mental structures or object representations. The individual’s emotional or libidinal engagement withdraws or disengages from internal mental object representations and withdraws from relationships with real others in reality.

Freud believed that schizophrenia is a regressive state in response to intense frustration and intense conflict with others. The regression from the psychological stage of relating to others to the individuation stage of development is accompanied by a withdrawal of emotional investment from object representations and external persons.

In Freud’s later theories, his understanding of psychosis evolved to view psychosis as a conflict between the self and the external world. Psychosis involves the denial of reality and the transformation of reality that follows denial.

Federn believes that the outstanding feature of schizophrenia patients is that there is no barrier between the internal world and the external world because their psychological energy is not continuously invested in the boundaries of the self (this is fundamentally different from neurotic patients). I think this may be the reason why people with schizophrenia lack normal reality testing functions.

Olin and Mednick identified several risk factors that may lead an individual to develop psychosis, which can be broadly divided into two categories:

• 1) Etiological factors in early life. These include perinatal complications, family history of schizophrenia, exposure to influenza during pregnancy, neurobehavioral deficits, early separation from parents, impaired family functioning, and institutional care.
• 2) Premonitory manifestations of mental illness in behavioral and social aspects identified by clinical workers and teachers, as well as personality variables revealed by interviews and scales.

Taken together, it is the interaction of genetic susceptibility to disease, environmental conditions, personal characteristics, and life events that lead to the occurrence of mental illness.

Psychotic symptoms have meaning.

For example, grandiose delusions or hallucinations are often caused by an attack on the self-esteem of people with schizophrenia. Patients develop exaggerated thoughts or perceptions to offset narcissistic impairment.

For example, people with schizophrenia have relationships filled with fear. Fear involves how to maintain the integrity of self-boundaries in relationships, fear of merging with others or being swallowed up by relationships. Such fear directly leads to interpersonal isolation in patients with schizophrenia. Even a therapeutic relationship can therefore be extremely challenging for patients, who fear that connecting with others will have disastrous consequences.

Treatment for Schizophrenia

Medical treatement

Schizophrenia requires medication recommendations. And you should see a psychiatrist regularly to adjust your medications. When drugs control and alleviate psychotic symptoms, schizophrenia patients may begin or restore intimate relationships, social relationships, and even work and study functions. Of course, this will also be accompanied by great anxiety.

Some patients may even experience a feeling similar to an existential crisis because they begin to think about the purpose of life and the meaning of existence after they are no longer troubled by symptoms. Others experience grief and are forced to feel a need to reassess their worth after realizing that their previous lives were deprived of the opportunity to live well because of their illness.

Those patients who return to society and start working may face pressure to integrate the meaning of work into their life goals and identity because they have been unable to work for many years.

Individual psychotherapy

Different treatment methods need to be selected according to the patient’s specific situation and different stages of the disease, including but not limited to supportive psychotherapy, expressive psychotherapy, and inward exploratory psychotherapy.

The basic therapeutic principle is that after a safe, trusting, and solid therapeutic alliance is established between the patient and the therapist, the therapist identifies, points out, and discusses the patient’s unique factors affecting recurrence and addresses the patient’s deficits and functional impairments. In terms of aspects, the patient’s external life status is stable, the family environment is supportive or there are other social support resources. After all the above conditions are met, the therapist may start to try expressive treatment methods with introspection or interpretation as the core.

Group psychotherapy

On the premise that positive symptoms are well controlled, inpatient group psychotherapy can greatly support patients in completing the reintegration process. Group psychotherapy in long-stay ward conditions is more effective, helping patients build a sense of trust, gain support in group interpersonal interactions, discuss their worries and fears in the group, and learn how to deal with the stigma of mental illness.

Family intervention

It is more practical to provide necessary mental health education to family members of schizophrenia patients and teach them some basic strategies to cope with the patient’s symptoms, and it can also transform the family into an environment that can support the patient.

For example, family members should be educated to first control their emotions when facing a patient’s positive symptoms and prevent them from pointing too strongly and stressfully at the patient. For example, family members should avoid being strongly over-involved and over-blaming the patient. These two aspects may be sensitive factors leading to patient relapse. That is, family intervention needs to intervene in the interaction pattern between family members and patients.

Psychosocial skills training

Utilize the patient’s own strength and existing abilities to rekindle the patient’s hope, maximize the patient’s career potential, encourage the patient to actively participate in his or her own treatment, and help the patient acquire or develop social skills.

Hospitalization

The structure of inpatient treatment – the model of psychiatrist + psychotherapist + nurse + social worker – determines that inpatient treatment can provide a haven for patients to the greatest extent possible.

Medication, nurses, and therapists during hospitalization can to a large extent provide patients with auxiliary self-functions and help patients recover better. In the residential treatment environment, the patient’s sense of omnipotence is challenged by the need to meet the needs of others, and the patient’s needs and wishes are inevitably frustrated by reality. This benign setback can promote the recovery of the patient’s reality testing function, as well as the recovery of other self-functions.

Conclusion

The pathological characteristics of the patient, the treatment methods and methods used, the hospitalization environment (including the framework setting of the treatment (the personnel involved, the combination of drug treatment combined with psychotherapy, social psychological skills learning, and intervention for the patient’s family), the patient’s and The dynamic atmosphere formed between staff and patients) provides patients with a supportive and promoting living space. If patients can receive hospitalization for a long enough time according to their own conditions, they can recover to the greatest extent.