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Schizophrenia is possibly the most misunderstood of mental illnesses. If you recall, it was not too long ago that people everywhere thought schizophrenia meant multiple personalities. Multiple personality disorder is actually a dissociative identity disorder. Of course, a trained professional would know the difference, right? Well, unfortunately, that is not always the case.
Diagnosis can pose real problems due to the possibility of the existence of overlapping features, as well as there being symptoms that can change over time. Hence, a person's diagnosis may change many times over in their lifetime. For the caregiver, it can be extremely disappointing to go without an official diagnosis, because without it--a revelation quickly arises that the "expert" help needed might not exist. Diagnostically speaking, it is rare that a person fits neatly into one category.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), schizophrenia is characterized by having psychotic symptoms as a defining feature. In schizophrenia, the term psychotic refers to delusions or prominent hallucinations, disorganized speech, and disorganized or catatonic behavior. With psychosis, there is often a loss of ego boundaries or a gross impairment of reality testing, as well as social/occupational dysfunction. The hallucinations can present in any or all of the senses; in fact, it is not uncommon for a schizophrenic to hear voices in their head.
From a professional standpoint, one must be cautious not to misinterpret what a client is communicating. For example, the loss of ego boundaries can present as a flow of unconscious and subconscious communication, loosely connected or irrational ideas, and dream-like imagery. This might be a symptom of psychosis, or it might be a symptom of--let's say--a religious or spiritual problem (DSM-IV, v62.89). "The spiritual psychologies would certainly agree that reasoning is a valuable skill, but many would disagree that it is the highest skill. Some would call intuition the greatest skill...; others would call the ability to love the highest skill" (Tart, 1992, p.88). The importance of these differences is often considered a cultural issue.
The author, Daniel Hanson is a communications professor at Augsburg College in Minneapolis. In this book, Hanson chronicles his journal entries, along with some from his wife and children--including his son J. who was diagnosed schizophrenic at age 20. Given this, readers are provided with an honest depiction of Hanson's experience living with a child diagnosed with schizophrenia.
In J's case, he believes he is God, and there is the added complication of his being too functional to be labeled disabled, and not functional enough to be considered normal. For the most part it is clear that J does not agree with the values laden in the consensual reality many of us share in western culture. The state of J's mentality raises many issues. These issues provide reason to question the intelligence of our culture, including our policies on how we treat those who stand outside the ideal states of being with which we prefer to identify. And of course, there is reason to question our consensus on reality.
In reading J's contribution to the book, one might ask, "If I put it to a rhythm and made it rhyme would it make more sense to everybody?" After all, J brings up some valid points, such as "ignorance being the opposite of love," and so forth. It's something to ponder. And, if we strip away that layer of ourselves that allows us to be seen as separate from one another, aren't we all God? Some people hold that perspective as true. One might question, if J. received less med's and more therapy would he find his place in our consensual reality the way Forrest Gump did? Or, could J be another Rumi?
It is with disappointment, fear, and many questions that the Hansons suffer through the stages of grief and the guilt associated with, not wanting to, but being lead to, having their son labeled mentally ill and ultimately schizophrenic. Hanson talks poignantly about the stigma and feelings of isolation that encroach on family life, his son's loss of trust, as well as the difficulty they have accepting J's condition. With diagnosis, medical management, and custodial arrangements to be considered, with the answers to each of these concerns requiring participation in a process of trial and error, the stages leading to acceptance are often repeated many times over. Given this, the reader should remember that this book is a compilation of journal entries, and there are redundancies in the writing that reflect the repetition of suffering through the process.
In review, the book would make a valuable addition to a curriculum in the health careers, and psychological studies in particular. As stated earlier, the book raises many issues to encourage lively class discussion. Therapists can gain some insight into the diagnostic category of schizophrenia. Family members and caregivers alike can find solace in the fact that they are not alone. In addition, they may benefit from the experience Hanson offers as to what helps him and his family continue to cope in their on-going process of finding "Room for J."
American Psychiatric Association (1994). Diagnostic and Statistical Manual, Fourth
Edition. Washington, DC.: American Psychiatric Association.
Tart, C. (1992). Transpersonal Psychologies. San Francisco, CA: Harper & Row.
© 2007 Rosemary Cook
Rosemary Cook is a Therapeutic Counselor in private practice living on Long Island, NY.