Now I am going to
talk about some types here of schizophrenia
and I will note that these types are no longer supported in the DSM-5.
The DSM-5 is the latest edition of The Diagnostic and Statistical Manual of
Mental Disorders.
These types have been present all the way up until now, or most of these types have
been present up until now .
So historically speaking, they're important,
I think they also provide good examples of the kinds of manifestations you might
see with schizophrenia
because all of these are possibilities. Paranoid type
is dominated by delusions of persecution,
delusions of grandeur, or ideas of reference.
Ideas of reference mean that unrelated events to oneself are seen as being
highly relevant
to oneself. Now grandeur
sounds like it's great like oh, man you are, I am the best. I am the awesomest. Now I have met
Jesus Christ at Broughton State Hospital,
I have met King George at Broughton State Hospital. That's grandeur the way most
people think about it. Now
clearly you're not the second coming of Jesus Christ in Broughton State Hospital.
Nor are you King George from any
era of English History, right. You're a guy
who happens to be a mental hospital because you have schizophrenia
and your delusion is that your this incredibly important figure.
That's grandeur. But there's other kinds of grandeur which is the idea that you
specifically
are, are singled out for some kind of special
or, or ominous treatment by the world.
So persecution, that's common too,
but not always in the way people think about it and ideas of reference. I'll give you a
couple of examples of people that I worked with
that I like. That's something I like to emphasize.
These are people with a disorder,
right. Not monsters, not
other than human. These are human beings
that if you get the chance to know them
are, are oftentimes very wonderful people who are afflicted by very devastating
diseases.
So one guy fits what used to be called paranoid type
and I won't say his name. It doesn't really matter, you wouldn't know who he was.
But you have got to be careful with that. You want to be very careful with confidentiality
and privacy with people, right.
Bu,t anyway, I'll just call him Joe and I'll say
his real given name is Frank. So Joe
believed that he wasn't Frank, right. He is Frank by his documents of birth,
by his social security card, by his family,
everybody that knows him would have called him Frank and that's who he was
to them.
But to him he never was that guy. "I'm Joe.
My real name is Joe. Communists captured my real family
and they're holding them prisoner in Kannapolis because that family lost
their child named Frank
and they have connections with the Communist Party who captured my family
and they say I have to be a substitute for Frank so they want me to act like
I' m their kid." Now this guy's fifty-something years old. "I have to act like I am Frank, but I'm not
Frank. I'm Joe
and I don't know how to get out of this."
So there you have that persecution, right. He's being made to
act like somebody's he is not or bad things will happen to people he loves.
It's also him being singled out, right. Out of all the people in the world that might
be called to play this other person, this other family's son,
it's him, right? So that's kind of that grandeur, right?
He didn't have the idea as a reference so much but he had this delusion
this belief structure that was clearly counter to reality.
We could prove that his family wasn't being held by
communist because there they were. But he just
incorporated that into the delusion. Those aren't my real family. Those are
communist agents. Stuff like that. And he could be funny
but he wasn't trying to be funny but he are a fairly good sense of humor
and he was an interesting guy. He also believed that aliens came down at night
and would take him up into their ship and operate on him
and that he would be fine the next day, and he would tell you stuff. So
regarding Frank I'm like well, I didn't challenge this. I was just a mental health tech.
I'm just, my job is to hang out with the guy and make sure he makes it to his next
appointment in the facility,
et cetera and I'm just hanging out talking to him. He's a nice guy.
He's a funny guy, but he's not trying to be funny, but
he laughs when you laugh in a kind of inappropriate way,
but I say so what happened to the real Frank. If you're not Frank and you are
Joe and he's got all the other patients calling him Joe, it's not his
real name, but he believes it is. He's got all them believing he's
really this other person. I'm like, so whatever happened to the other Frank that you've got
to replace? He went, "Oh, he got bit by a snake."
And I am like he got bit by a snake? He's like, "Yeah!" I said what kind
of snake did he get bit by? He's like, "One of them kinds you can't see too good."
I said all right, because if you had seen it you would have never got bit, and he was like, "Yeah!"
One of them kinds of snakes you can't see too good.
And then he was talking to me one day standing in front of me and he said, "They got
my spine last night," talking about the aliens coming down and operating on him.
And I said really? And he's like, "Yeah." I'm like you know that if they got your spine
you couldn't actually be standing there talking to me
because you need a spine to stand up. And he goes, "Oh, they put it back."
And I went hahaa and he goes hahaa
And I am like I got you. It was odd, but he
believed all of these things in the face of evidence to the contrary. I also worked with
another guy
who believed that he fought the Mafia. He lived in a nursing home
He stayed in the nursing home. The nursing home staff could account for all his
comings and goings, which were none because he stayed there all the time but he
believed he was
out fighting organized crime and that the television gave him instructions.
So when he's in the day room and everybody else is watching the news
he's hearing the news talk to him
about what he's supposed to be doing to fight organized crime. He is getting
coded instructions, ideas of a reference. Something that's
not related to him is being referred directly to him.
So it's a very unusual thing and it makes people uncomfortable. That guy's biggest
complaint
was not he had hallucinations and delusions because they weren't to him
delusions, they were realities. His biggest complaint was that he was lonely.
Nobody would be is friend because it was such an unusual thing to talk to him
about
and I suggested to him and it pissed him off, I was not a therapist at the time. I just
said practically speaking
you seem like a pretty nice guy. You would agree that you're not fighting the mafia
right here while we're talking. And he goes no, of course not, of course not.
I'm like, well I'm not saying you don't. But
I don't know. Maybe there is another plane of reality you exist on. I'm not saying that you
don't.
I'm not going to argue with you because there's no way to argue with this person.
If I argue with him, then what am I? I'm an agent of the Mafia trying to
convince him that he doesn't fight the mafia. So he will just pull me into his delusion,
so I just roll with it. I said but you will agree we don't,
you're not fighting the mafia when you're talking to me and when you're in the day room
talking to other people, you're not fighting it then.
And he is like no, no. And why don't you just not tell people? Why don't you just not tell people that you do that?
And he's like, "But I do, I do!" I said I'm not saying you don't.
I'm saying so why don't you just not tell people that you do until after you get to know them?
Because you seem like a pretty nice guy to me. And then if they got to know you
well then they might be your friend and he got a little agitated.
But a couple months later he is like it works, it works. I've got friends. And I'm
like that's cool man. How you doing? And he goes, "I just don't tell 'em." I'm like
that's awesome! And, and after a while
another, another name for him, Bob, we'll call him Bob,
Bob is just this sweet little old man who thinks he fights the Mafia and
in his world that's
truth and there's no arguing with him. But once you get to know Bob
and then he tells you, it's not so wierd. It's like, Bob's cool. He is just a little weird,
a little different. But he's cool. So he made friends before he started revealing
his delusions and hallucinations, which were not anything critical. It was not going to
hurt anybody if he believed that.
And that's the thing is people get put off by that. I'll give you one more
example on this tip
right here. A guy in Blacksburg who goes around talking like this. He talks really,
really loud and he is a really, really tall guy.
And he gets really intense and he's an older fellow
and he comes up to you in the post office and he says, "Did you see the game, did
you see the game, did you see the game?"
And you say nothing, most people are like this.
You've never seen people get so tight assed as they turn around and they are like this.
They've got their stuff, they are ready in line and the Post Office
staff are ignoring him like he's not even in here.
Now, he's not trespassing. He is on public property. He's not assaulting anybody
he's just trying to have conversations that nobody else wants to have
in a very abrasive manner. Myself not being disaffected by that kinda stuff
I just go, "What game?" And he's like, "The game, the game!!" And he's talking about a game that
occurred in like the 1950s
as if it occurred yesterday. And I have a conversation like, it's very good, it's very good.
And he is talking about a game in Texas and we go on we have a conversation.
No big deal to me, doesn't freak me out, doesn't scare me, doesn't bother me.
And then my turn comes and I go I got to go...and he goes, yeah, yeah, yeah!
So I go up and I transact my business at the counter and I go and I'm like, "Hey man, it's nice
talking to you. I'm going
to take off and leave now. And he is like, "you have a great day,you have a great day!"
No big deal, but believe me if he shows up in the wrong place talking like that
somebody's going to call the cops
because they are uncomfortable with that type of behavior because it
is totally socially inappropriate, right? There's just no,
there's no screen for that. There's no inhabitition of that
and that's what gets him and others like him in trouble most often.
You'll see stories of people in the media
who do dramatically horrible things because they're under delusions and
hallucinations,
right. That's highly dramatized because it's pretty damn dramatic
but it's not common. Its unusual. It could happen, yes.
People who kill their children because they think the Devils going to take them and they
are trying to send their child to heaven -
clearly hallucinations and delusions are involved.
Doesn't excuse the behavior, you still have to hold them accountable for the behavior
but that's very different than just some body saying, "I'm sick of being a parent
and I'm going to kill these little kids."
That's not what's occurring in this case and that kind of thing is
relatively rare.
When you do see it, it is dramatic and gets a lot of play in the media.
I'm not saying it shouldn't. I'm just saying you all know the availability heuristic right
now.
Don't assume that that is some kind of common thing for people who are
suffering from schizophrenia. Catatonic type, and again remember
these categories aren't here anymore, but this was dominated by motor disturbances
ranging from muscular rigidity to relatively
random activity, tic-like movements.
There is this thing called waxy flexibility. I've only seen this
on videotape. I've never seen it in person, but it's pretty,
it's pretty unusual to see it. So waxy flexibility is the idea that a person
might just stop
wherever they are in whatever position there and when they stop
and just stay there for hours and hours and you could come up to him
and maybe raise their arm up like that and it will just stay there.
Something like aren't you trying to get attention or something? Try to do that.
I challenge you to try to hold your arm up for two or three hours.
About five minutes in to it you'll be like, "Hell, man. they are not faking." That's uncomfortable.
It's hard to do that. There is a motor disturbance. This does seem to be very
much related to brain
issues. Neurological condition does seem to be implicated here.
It can be exacerbated by social factors in
environmental factors and stressors and things like that, but that is just not
something you're faking It's very unusual and it is
pretty rare and that's why they got rid of the categories is they say well you know
there doesn't seem to be any research support to keep these distinctions going
because there's so few people in these other types. There's a lot in the paranoid type.
Disorganized type is dominated by severe deterioration of
adaptive behavior. Adaptive behavior is what you and I engage in on a daily
basis so
you get up in the morning, you turn off the alarm, you go brush your teeth,
you get dressed, you have a breakfast or something, you go do your job or you go to
school,
you interact with people and you are adapting all day long
and you are able to function as a result. So here's a lack of functioning because
the person's thought processes
become so skewed. There's this thing called word salad
which is just strange to listen to. It's
as if they're talking to you in sentences and paragraphs
with meaning and content they're just ticulating like it's something
really important
but it doesn't make any sense because it's a random mix of words.
And I have to read to be able to do it, so, "a dominated type
waxy flexibility dominates severe. You know what I'm saying. Severe sounds worse
things
ideas" and it just like,
all these random words. It sounds like they're trying to say something very
emphatically, but none of the words are linking up to
create logical cohesion. And so
you look at that. It's a fairly rare type. I've seen examples of that.
Nowadays you don't need to know this for your test but be aware that nowadays
there is not a good research basis
to support having these individually distinguished types of schizophrenia.
Most of what you saw was paranoid type ideation.
These other symptoms are possible manifestations, but another thing I think
it's important to show with this is this,
these have been around for many, many, many decades
and here they are revising the way they do it based on research.
So, you don't just do stuff to do it. If there's no research support for it,
eventually
they change the way they do it and in that case I say
you can see that we're moving forward as a science slowly because these are
complicated issues.
But we are moving forward and we are using science as our guide.
Given how close we are to the end of this session, let's just wrap it up right now and take
an extra minute off this morning.
You all have a good day and we'll see you on Wednesday.