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"You Can't Feel Your Thoughts": A CLINICAL NOTE ON THE EXPERIENCE OF SCHIZOPHRENIA* Ferdinand van der Veen (This paper was originally published in Voices: The Art And Science of Psychotherapy. Spring, 1974. This is the journal of the American Academy of Psychotherapists. The paper has been slightly revised for this venue.) In this paper I want to present and discuss a verbatim account of a portion of a group therapy session with hospitalized mental patients, during which two patients commented with unusual depth and clarity on their experience of themselves in relation to their illness. The central theme of their comments concerns the cessation of a mental process; a stopping or blocking of the mind that results in an inability to know one's own experience--to feel one's thoughts or think about one's feelings. This process seems relevant to many of the difficulties encountered in psychotherapy especially with schizophrenic persons.
A Therapeutic Problem Psychotherapy with the hospitalized schizophrenic person is commonly accepted as a difficult, problematical undertaking. In contrast to the therapist's experience with non-hospitalized, less disturbed persons-persons more like himself-here he is faced with an unfamiliar and unpromising therapy situation and one that is difficult to understand. The hospital patient may or may not be acutely upset at the time the therapist sees him, but in either case he is often unable to talk about feelings, to engage in self-exploration, to recognize or try to understand his personal problems, to develop trust in the therapist; or, in general, to engage in the kind of activities found to be helpful for less disturbed persons. Also, the patient may often interrupt, misunderstand, or simply not attend to the therapist. The task facing the therapist, to help this person achieve some stable sense of personal integrity and adequacy, is therefore both puzzling and uncertain. One obstacle to this task is the difficulty in accounting for the behavior of the schizophrenic person in terms of his own experience of himself. In part this can be attributed to the inability of the schizophrenic person to communicate his experience. But it also appears to be due to a general lack of knowledge about the inner experiences of the schizophrenic person.* What is it in his experience that makes self-exploration, attending to feelings, and listening to others so difficult and unlikely? What is the schizophrenic person's own sense of what is amiss in his inner world?
The Experience of Two Schizophrenic Patients The purpose of this paper is to provide a partial answer to these questions in the words of two schizophrenic patients, as they talk about their experience during a session of group therapy. The following quarter-hour of a group therapy meeting (the tenth such, with a group of eleven patients) is presented verbatim to give as accurate a picture as possible of the way in which the patients viewed their own experience. One patient, Joe, is in his middle twenties and comes from a rural background and has had little education. Roy, the other patient, is in his middle thirties, and considerably more educated.** Both Joe and Roy have been severely troubled by schizophrenic experiences and episodes for a number of years. The author served as therapist for the group. No attempt is made here to analyze the therapist's statements; they are included to provide the original context for what the patients said. Generally, the tone of the therapist expressions is consistent with an attempt to understand in a tentative fashion the present experience of the patients and to encourage self-exploration and personal identity. The excerpt begins with the therapist asking a question of one of the patients:
The Meaning of Their Experience A central theme in the many ideas and feelings the two patients expressed during this excerpt is the occurrence of what might be termed the loss of the ability to know their experience. Amid much tentativeness, confusion and hesitation, they expressed this loss in a number of ways: Roy said that his mind blocked in response to great turmoil, that he is unable to know whether he is sicker now than before, that he needs to reestablish contact with an essential part of his experience to guard against a recurrence of the turmoil and terrible suffering. Joe expressed much the same uncertainty as Roy about being sicker now than when he was upset, and that his mind stopped when his experience became intolerable. He also said that now it is hard for him to get a thought in his head which he can feel. He almost said it is hard for him to think while remembering feelings. It is as if he can think, but not about or with feelings. The effect of this is that he is not really able to think, or, stated in a more precise way, that while he might be able to think, he cannot feel it, he cannot feel his thoughts. At the end of the excerpt, in response to the therapist’s somewhat impersonal statement, Roy reasserted both the importance of knowing and his own inability to know, by aggressively demanding that the therapist tell him whether he is sicker now than before. Three elements in what Joe and Roy said seem especially difficult to account for in our present understanding of personality and personality change. They are (1) the stopping of one's mind, (2) a profound pervasive uncertainty about oneself, and (3) an inability to feel one's thinking. A possible connection between these elements in the patients’ descriptions may be outlined as follows: 1. Chronically stressful mental conditions lead to a cataclysmic upset in the person’s inner experience involving both thoughts and feelings. 2. This terribly painful upset is halted by the cessation of a fundamental mental process, experienced as a stopping or blocking of the mind, which quiets the upset. 3. As a consequence of this mental cessation a profound connection between the person’s thoughts and feelings is no longer intact. While it is again possible for them to think rationally, they no longer have a direct sense of their inner experience, including the experience of their own thoughts. They cannot think about their feelings nor feel their thoughts. And they can not judge their own state of well-being.*
Implications for the Patients' Lives and for Therapy The loss of the ability to know themselves, to think about their feelings and feel their thoughts, to be in touch with and use their own experience, has a profound effect on many aspects of the lives of the patients. It means that a pervasive uncertainty attends many of the simple day-to-day decisions they need to make regarding their lives; it means that such elementary personal knowledge as whether they felt a particular way, angry for example, is mostly beyond their understanding; it means that the effects of future events are largely unpredictable. These and other consequences of this loss helps us understand their sometimes overwhelming inadequacy in functioning, as well as their adequate and essentially normal behavior in certain impersonal situations where reliance on a knowledge of their own experience is unimportant. The loss of the ability to know themselves may also help to account for a number of the puzzling aspects of the behavior of such patients in therapy. It has many consequences in terms of what they would then not be able to do. It means that they would be unable to communicate their feelings or attitudes accurately, or to explore their own part in their difficulties and problems, or to form a close trusting relationship, or to use their own judgment in evaluating their experiences, or to achieve a sense of their own personal identity. To the degree, therefore, that, as in the case of the patients, intellectual functioning can not be included in an experience, knowledge is not possible.
In addition to the implications for the lives of the patients and for their behavior in therapy, the patients' descriptions are also relevant to the experienced continuity on the part of the therapist between more and less disturbed persons, and between them and the therapist. It has often been said that schizophrenia or psychosis is a matter of degree, not of kind; also, that all persons have experiences similar to those of the schizophrenic, but not to the same extent. This similarity in kind between the various degrees of disturbance is supported by the occurrence of the kinds of problems described above for most therapy relationships, though to a lesser degree.* On the other hand, if we consider the similarity and continuity between degrees of disturbance and between all human experience in the light of the descriptions of the patients, one salient fact emerges. It is that these persons have directly experienced the cessation of a mental process, a stopping of the mind, followed by an inability to know their experience, to judge their own well-being and to feel their thinking. While it is likely that at one time or another most of us have been unable to feel our thoughts or to know how we are, we have probably not directly experienced the actual interruption of the process that makes this possible nor, of course, the cataclysmic pain that appears to lead to such an interruption. We still have a strong sense of the possibility of feeling our thoughts, of being able to come to know about our experience, of, in a word, our potential for personal growth. In schizophrenia, on the other hand, the person may have directly experienced the loss of this potential. It would follow that a central problem in the treatment of schizophrenia concerns the patient’s inner struggle regarding if and how to re-establish this potential for personal, intuitive knowledge. How will it be possible for the schizophrenic person to again know about, make sense of, and attribute meaning to his feelings, so that he may again "feel his thoughts" and "know how he is"?
REFERENCES: 1. Gendlin, E. T. Experiencing and the Creation of Meaning. New York: Glencoe Free Press, 1962. 2. Malone, T. P., Whitaker, G. A., Warkentin, J., & Felder, R. Rational and Nonrational Psychotherapy. A Reply. Amer. J. Psychotherapy, Vol. XV, No. 9., 1961, pp. 212-220. 3. Rogers, C. R. A Tentative Scale for the Measurement of Process in Psychotherapy. In Stein, M. I., (Ed.) Contemporary Psychotherapies. New York: Glencoe Free Press, 1961. 4. Shlien, J. M. A Client-Centered Approach to Schizophrenia: First Approximation. Ch. XI, in Burton, A., (Ed.) Psychotherapy of the Psychoses. New York: Basic Books, 1961. 5. Whitehead, A. N. Process and Reality. New York: MacMillan, 1929. 6. Will, O. A., Jr. Psychotherapy in Reference to the Schizophrenic Reaction. In Stein, M. I., (Ed.) Contemporary Psychotherapies. New York: Glencoe Free Press, 1961. 8/98 ***********Current address:
Ferdinand van der Veen,
Ph.D. Email:
fvdvn@yahoo.com
235 Calle de Sereno
Encinitas, CA 92024 USA
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I believe that
all information on this page is correct but do not accept liability if it is not.
Allan Turner's Person Centred Web Site.
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