VOL. 7, NO. 2, 1981
Schizophrenia and Ego
Psychology
199
by William J. Annitto
At Issue
fatigue, or "seek out a separate reality." This latter decision is made
even more ominous, as this "alterThe psychology of hallucinations
native may lead to profound perhas been viewed as an "etiosonality disintegration." Thus, the
pathogenetic" tool for the diagschizophrenic is blamed for his
nosis of schizophrenia (Schizodisease, while the drug abuser
phrenia Bulletin, Vol. 5, No. 4,
simply has made another poor
1979). This phenomenological
choice. Finally, she implies that
misrepresentation is criticized as
the "animation" type of hallucinapossibly damaging for both the
tion signifies schizophrenia. She
schizophrenic and the drug
psychologizes again by noting: "it
abuser. The need to accept the
may be seen as serving a purpose
often chronic course of schizofor the faltering ego." The schizophrenia as an organic disease is
phrenic "causes" animations to atdiscussed.
tain "wished-for warmth."
Thus, Marsh perpetuates two
In Vol. 5, No. 4 of the Schizophrenia
misconceptions
about schizoBulletin, Anna Marsh (1979) dephrenia.
Firstly,
by attending only
scribed the case of a 26-year-old
to the quality of the hallucination,
graduate student, who apparently
she fails to see the patient. Babegan hallucinating after LSD insically, the affective and formal
gestion. Marsh then discusses the
thought disorders inherent in
three types of hallucinations,
schizophrenia are totally ignored.
briefly reviewing the literature on
That
schizophrenics and abusers of
hallucinations in both schizohallucinogens
both hallucinate is
phrenics and users of psychedelic
indubitable. However, clinically,
drugs. The issue raised—the difthe exogenous hallucinator should
ferential diagnostic significance of
demonstrate a more normal, if too
hallucinations—is of extreme imeasily irritated, affective tone.
portance for the researcher, the
Schizophrenics, sadly, lose their
clinician, and, most importantly,
affective
tone. They do not choose
the patient.
this to salve a "faltering ego." It is
The diagnostic pitfalls in Ameritragically part of the disorder, not
can psychiatry are so numerous
a vagary of choice. Secondly,
that they need not be catalogued
Marsh uses ego psychology to exhere. However, to use the varying
plain the organic phenomena of
forms of visual hallucinations as
this terrible disorder. As I have
one of the major criteria for diagnoted above, according to her
nosis, as Marsh does, neither adschema, schizophrenics can choose
vances the scientific study of
to ignore symptoms or be disintephenomenology nor benefits the
grated. They are, once again,
patient. It belies, even further, the
blamed, as it were, for their probproblems of nosology and
lem: If only we could talk them
therapeutics.
into better choices.
Marsh states that the types of
hallucinations are on a continuum.
Then she "psychologizes" this
Reprint requests should be sent to
continuum by pointing out that
Dr. W.J. Annitto at Fair Oaks Hospihallucinating patients have
tal, 19 Prospect St., Summit, NJ
choices: either ignore them, blame
07901.
Abstract
SCHIZOPHRENIA BULLETIN
200
I am advocating that schizophrenics be viewed like any patient with severe illness. The renal
failure patient is not taunted for
needing dialysis. Their elevated
BUN and creatinine levels are not
explained as by-products of the
failing kidneys' need for comfort
and solace. The obstreperous
dialysand may choose to drink too
much water and the negativistic
schizophrenic may choose to be
mute. Neither has chosen to be
symptomatic.
The schizophrenic, then, if confronted within an ethos based in
ego psychology, will be found
wanting in areas of the human
makeup which are questioned in
no other medical illness. This obsequious attitude dehumanizes
both the patient and the doctor. It
serves to protect the practitioner,
whose "ego" will usually remain
"intact," from any responsibility in
terms of treatment or understanding. Sadly, it provides no hope for
the patient who must try to avoid
this "separate reality" with a personality that is unable to choose
reality over animated constructs of
metaphysics. It is the ultimate
double bind: You are not well because you choose not to be; to be
so, you cannot choose well.
Alternatively, if the patient's
disorder is appreciated as an organic process without voluntary
sanctions, he is offered the opportunity to confront his harsh destiny. Simultaneously, the physician can view the schizophrenic as
a suffering patient, not a defective
creation of abstruse, mystical,
psychic-body parts.
Schizophrenia is certainly not to
be taken blithely. Its outcome is
generally unpleasant for victim
and family. Not unlike malignancy, this disease causes pain
and torment that go far beyond the
understanding of even the most
righteous reasonable man. It has
no redeeming aspects; it
strengthens no weak character by
developing fortitude or persever-
ance. It is bleak, painful, and often
debilitating.
Therapeutic goals, then, must be
to alleviate the acute symptoms,
foster self-esteem, and encourage
whatever socioeconomic independence may be possible. Most
importantly, the therapist should
recognize that with positive clinical response to somatic therapy
will come terrifying insight. Not
unlike Kubler-Ross's patients, the
schizophrenic needs help to arrive
at "acceptance" of the illness at
this point.
The Author
William J. Annitto, M.D., is Associate Director, Adult Services,
Fair Oaks Hospital, Summit, NJ.
He is also Clinical Assistant Professor of Psychiatry, College of
Medicine and Dentistry of New
Jersey, New Jersey Medical School,
Newark, NJ.