Interpretation of Schizophrenia

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Interpretation of Schizophrenia (first edition, 1955) is a book by Italy-born American psychiatrist Silvano Arieti in which the author sets forth demonstrative evidence of a psychological etiology for schizophrenia.

Arieti expanded the book vastly in 1974 (ISBN 0-465-03429-2) and that edition won the U.S. National Book Award in the Science category.[1]

Interpretation of schizophrenia is a 756-page book divided in 45 chapters. Arieti begins his book stating that it is difficult to define schizophrenia. He asks if schizophrenia is an illness and answers in the negative, since the disorder is not understood in classic Virchowian criterion of cellular pathology. Though those searching for a biological basis of schizophrenia far outnumber those undertaking psychological approaches, Arieti supports the minority view. He believes schizophrenia is an unrealistic way to represent both the self and the world and praises psychiatrist Adolf Meyer for stressing the importance of psychological factors in the etiology of schizophrenia. Arieti also mentions that Freud felt that in schizophrenia the patient's relationship with people is handicapped (an observation that resembles what presently is called autism).

Family as a cause[edit]

Arieti then describes the psychogenic factors that lead to the disorder. The family environment and psychodynamics in the etiology of psychosis comes under scrutiny. Arieti describes the building of neurotic and psychotic defense mechanisms; the emerging schizoid personality, and fully developed schizophrenia understood as an injury to the inner self. Arieti believes that a state of extreme anxiety originating in early childhood produces vulnerability for the whole life of the individual.

A characteristic of Homo sapiens is a prolonged childhood with a consequently extended dependency on adults. This, according to Arieti, "is the basis of the psychodynamics of schizophrenia", a claim that also appears in later writers on child abuse such as Alice Miller and Colin Ross. Arieti reviews the paper by Frieda Fromm-Reichmann about the "schizophrenogenic" mother and reaches the tentative conclusion that only 25 percent of the mothers of people with schizophrenia in his clinical experience fit that image. However, he adds that only in a minority of schizophrenia cases "the child is able to retain the good maternal image". Arieti also mentions the work of Theodore Lidz, another trauma model author of schizophrenia. Like Lidz, Arieti emphasizes the weakness of the father of the patient with schizophrenia in the paternal role. In Arieti's own words:

In the first edition of this book I have described one family constellation [...] when a domineering, nagging and hostile mother, who gives the child no chance to assert himself, is married to a dependent, weak man, who is too weak to help the child [...]. In these families the weak parent [...] becomes antagonistic and hostile toward the children because [...] he displaces his anger from the spouse to the children, as the spouse is too strong to be a suitable target.

The roles can be reversed when the domineering spouse is the father. Arieti is convinced that each schizophrenia case is representative of those human situations in which something went extremely wrong. "If we ignore it, we become deaf to a profound message that the patient may try to convey". For example, Arieti states about one of his patients that "his adolescence was a crescendo of frustration, anxiety and injury to self-esteem". Arieti also mentions a catatonic patient who, after introjecting the mother's engulfing behavior, believed that by moving he could produce havoc. The patient's feelings, according to Arieti, became reminiscent of cosmic powers that may cause the destruction of the universe, so the patient chose immobility. For Arieti, the selectivity of certain motor actions is proof that catatonia is not a biological disease or illness, but rather a disorder of the will.

Inner world of the schizophrenic[edit]

In Part three of Interpretation of schizophrenia Arieti describes how in spite of its efforts to stay in reality, the patient's defenses finally succumb. When the patient "cannot change the unbearable situation of himself any longer, he has to change reality". Arieti examines the inner world of the person with schizophrenia.

When a patient states he is Jesus he is compensating a feeling of extreme humiliation at home. The paranoid schizophrenic, Arieti explains, resorts to "teleologic causality" or animism to understand the world. He writes that whatever occurs to the patient is interpreted as willed by the parental alters of the patient. In deterministic or teleologic causality, if Nature's happenings were not willed they simply would not occur. In paranoid projection the schizophrenic takes out from him/herself a disagreeable part of the self onto the world. In Interpretation of schizophrenia Arieti illustrates all of the above theoretical constructions with concrete cases of his clinical experience as a psychiatrist.

Arieti maintains that in every case of schizophrenia that he studied serious family disturbance was found. When the patient idealizes the parent the idealized image of the parent is maintained in the patient's mind at the expense of an unbearable self-image. He speculates that psychosis starts only when the malevolent image of the parent is transformed "into a distressing other". The parent or parents alters enter the mind accusing the patient of "bad child" or other equivalent accusations in voices that the adult patient hears.

Since the 1980s, and into the beginnings of 21st century, biological psychiatric models of schizophrenia almost completely took over the psychiatric profession. Current research into the disorder focuses on neurobiology. Psychological approaches to schizophrenia like Arieti's are a rarity in the profession, although this structurally created circumstance neglects the obvious connection between psychological phenomena and neurotransmitter levels, which can be changed through certain practices, like Yoga, meditation, hyperventilation, sensory deprivation, sleep deprivation, among others.

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