Cheat Sheet (Part A)

According to the Oxford English Dictionary, Schizophrenia (interchangeable with Dementia Praecox) has a German etymology of schizophrenie and was first used in literature by Professor E. Bleuler in 1910 in Psychiatrisch-Neurol. Wochenschr. 12, 171. The first appearance of the word in English literature was in a translational text of Professor Bleuler’s articles, titled Lancet 1730(1), that was written between 1910 and 1911. 

The first documented use of the word, however, was through a lecture presented by Professor E. Bleuler on April 24, 1908 . He derived the root concepts of the word from the Greek words schizein and phren; schizein-, being the translation for splitting, and phren-, meaning soul, spirit or mind (changed from a prior meaning) (Ashok 95). Dementia praecox was used before schizophrenia and has a Latin etymology. The root words dementia (a mental illness or insanity affecting thinking and judgement) and praecox (the early fruition or flowering of a fruit) loosely translate into “early flowering madness” (“dementia praecox”).

The medical definition of schizophrenia is “a chronic and severe mental disorder that affects how a person thinks, feels, and behaves” (National Institute of Mental Health). In line with this definition are the symptoms of schizophrenia, which can be divided into three major categories: positive symptoms (additional symptoms that are not seen in normal individuals), negative symptoms (symptoms that retract from the emotions and behaviors of normal individuals), and cognitive symptoms, (symptoms that affect the cognitive and thinking abilities of the patient). Positive symptoms include hallucinations (usually auditory), delusions and awry or dysfunctional speech. Negative symptoms include reduced emotional range, empathy, reduced motivation and drive, and social isolation, whilst cognitive symptoms include deficits in attention, working memory recall, and information analysis. Neuropathological characteristics of schizophrenia include dopaminergic system abnormalities, decreased frontal and temporal lobular volume, enlarged ventricles, and hippocampal structure changes (Frankenburg 2018).

Our group focused mainly on the hallucinogenic and apathetic symptoms that individuals with schizophrenia present. Hallucinations have a major effect on the mental state of a patient suffering from schizophrenia, and we chose to expand on this concept. We also broadened the topic to discuss split personalities and how the delusions and hallucinations that arise from schizophrenia can affect an individual’s life. The second type of symptoms our group focused on were the apathetic and emotional listlessness that patients experience. We chose to  focus on these symptoms because they can be referenced in relation to the social stigma that patients with schizophrenia experience, as well as the isolated conditions that patients place themselves in. With these themes in mind, we decided as a group to present pieces that incorporated these themes from different perspectives. In our group archive we had a clinical view of schizophrenia from a psychological evaluation report (Graeme W), a reflection from the patient’s perspective, present and past (Nia A), another take on a reflection from the patients perspective, but this time, explaining hallucinations (Mathew K), a personal journal entry (Robert McP), and a view of schizophrenia from the diseases’ perspective that targets its progression and motifs (Blake B). In our presentation we showcased Nia, Mathew, and Blake’s works. 

I have chosen to present both a psychological report of the individual and a dialogue between the suffering individual and his hallucinations. I chose the psychological journal 

report because it relates to the narrative types that we have discussed and investigated in class. I also hoped to create a dichotomy in my report between the expected cold, clinical response and analysis that a stereotypical doctor and psychologist would have towards patients, and the actual response that the psychologist would give. The stereotypical response would be a lack of descriptive and emotionally indicative language, with a calculating and clinical analysis of the symptomatic aspects of the patient’s complaints, with little to no emphasis placed on the emotional aspects of the patient related to the disease. I have instead attempted to portray unexpected sympathy and rich descriptive language that is easily understandable to the general public,  a large range of emotions that would be seen as un-stereotypical of medical professionals, and emotional additives that are not common in a stereotypical report. Through this dichotomy, I hope to engage the reader and to prompt them to think about whether the medical professional is being genuine in her empathetic response to Kevin, or if she is putting on a front to improve patient communication. 

In the hallucination dialogue I look to explore the stigma that individuals with schizophrenia experience whilst simultaneously exploring the self-isolation and emotional listlessness that are common symptoms of individuals with schizophrenia. I attempt to create a flat, emotionless dialogue that discusses increasingly morbid and disturbing topics centered around death and societal distancing, and in this way explore, and hopefully expand on, isolation as a general theme as discussed at length in our class, which was  seen particularly in Philoctetes. Through the contrast of the texts, I hope to create a change of perspectives, whereby a medical professional account that should be cold and clinical is descriptive, and a dialogue of isolation that (as seen in Philoctetes) should be incredibly descriptive and rich in textual devices, is flat and emotionless. Through this switch I hope to emphasize the differences in the styles of medical text portrayed from different perspectives. 

Ultimately, through these texts I hope to explore the effect that medical texts have on our perception on both disease, health, life and death, and how they add to our understanding of medicine holistically. Narrative medicine in any form gives us major insights into not only the clinical and pathological effects and characteristics of illness, but also into the human affiliation with the diseases; from this we become aware of how illness and disease change individuals through the suffering they undergo (Charon 1265). We can also gain insight into unmentioned stereotypes that plague the medical field that affect both the health care industry as a whole, as well as the patients that are involved with the industry. Furthermore, through these stories and texts I believe we gain insight on the human condition and on how illness can change an individual’s whole perspective of themself and how others perceive them. Sometimes it also allows individuals to change - hopefully for the better - their views of sick individuals, to create an inclusive atmosphere where there is no discrimination between sick and healthy, as described in Sontag.

Archive (Part B)

Psychological Report of Kevin Miles

For Professional Use Only

Referral Question:

Kevin was referred for a psychological evaluation form his doctor (Jennifer Peters, MD). He is suspected to have schizophrenia, and Dr. Peters has asked for a psychological evaluation for a second opinion and a final diagnosis for Kevin. Kevin has been admitted multiple times previously for hearing voices and seeing people on the side of his vision, with no previous definitive diagnosis on the subject. Kevin’s father dismisses his concern as mere excuses to stop him from being a Division I athlete.

Interviews:

• Kevin:

Kevin enjoys high school but over the past year and half, since his mother’s death, he has been hearing voices. They started off as soft whispers, like rustles in the wind. A faint uttering of words that were just too soft to make audible. As time progressed, the voices became more distinguishable from the surrounding rustlings of nature and the constant chatter of the crowds at school. At first, they were not sinister in nature and merely were a nuisance that caused him to lapse concentration on his school work and baseball practices. Overtime, however, they became more sinister in nature and the words and phrases they uttered into his ear became convoluted and twisted. Dark and accusatory, creating rich tapestries of failure and disappointment, of underperformance and unworthiness all with Kevin as the focal point. The hallucinations were there all the time, when he was writing his exams, they would tell him how little he really knew and how he was going to fail. On the field, they were especially bad. They constantly critiqued his form and technique. The voices became progressively louder as time went by, and Kevin found it more and more difficult to ignore the voices and concentrate on his work. 

His marks have started taking a plummet and what once was a straight A student has been scoring D’s and C‘s on his exams and class quizzes. He says that the voices are worst when he is at home, especially when his father is shouting at him because of grades or a bad practice, or when he is hitting him. He wants to become a professional athlete, but his father is not impressed and wants him to become a lawyer. He claims that writing helps him cope with all the voices in his head. But usually if his father finds him writing for pleasure, he tears the paper up and hits him. His father is averse to him becoming a professional athlete and comes home drunk most nights, when he hits Kevin for no reason a large proportion of the time. He states his father has taken to the bottle ever since his mother lost the battle with ovarian cancer. He wishes for old days, when his mother was happy and his father and him would play baseball in their back yard whilst his mom sat and read a book in the sun close by on her favorite bench. 

Recently (starting about 2 months ago) Kevin has started seeing dark figures at the side of his vision, especially at his games when he is pitching. The figures are obscured, and he can never make out a face, but they are always at the corner of his eye and he constantly hears them talking about him. From the conversations that he can hear, the figures are scouts. They have come to see if he has what it takes to perform and become a DI athlete for college. But their talk is never positive, and they constantly criticize his plays and performance and are never happy. He has also started underperforming because he feels the voices and dark figures are trying to get him to do badly because they want him to get hit by his father. Kevin said he hasn’t been happy or had a day without hearing the voices since his mother died. 

Kevin was unresponsive at first but after a few ice-breaker questions he began to open up, allowing me to get a sense of his personality. He is a very stoic character and feels he has to put up a charade for the people at school, so that he won’t lose his popularity. He has, however, broken up with his girlfriend, making up an excuse about not being ready. When asked to describe himself in a few words, he claims that he is a cantankerous mass, a blight on his families’ name, and a failure at both school and sport. His self-defeat and lack of self-regard are troubling, and he hides scars on his wrists that are characteristic of self-harm. When confronted with the topic of self-harm he quickly dismisses the possibility as trivial and tries to change the topic as soon as possible. Could be a point of further inquiry. 

Kevin also mentions that, apart from his grades taking a dip, his social status has also been put under considerable strain due to the hallucinations. He was an, albeit self-proclaimed, “popular teenager” in the sport group at Spencer High School, with a girlfriend and a close group of friends. After his mother’s death and the onset of his hallucinations, he started becoming more anti-social, and he started separating himself more and more from his friends and girlfriend. He claims that the isolation helped him, although only for a short time, to deal with the voices and try an provide some validity to their claims. His isolation and altered behavior had adverse effects on his popularity and friendships and his girlfriend of 5 month, Amanda, broke up with him 2 months after the onset of his hallucinogenic symptoms. He also claims to have lost his friend circle quickly as his sporting prowess took a dip. Kevin states that he now keeps to himself in the library during lunch breaks and limits social connection. He is afraid of the reaction that others will have when he tells them he sees people. Kevin supplies that most shun him and think that he is faking his hallucinations for attention. 

• Father:

Kevin’s father, Jack, reeks of alcohol upon entering the room and has slurred speech. Is obviously intoxicated and proves to be minimally cooperative and mostly shouts that his son must stop his rubbish and play the f**king game. When prompted to speak about his wife, he withdraws into himself and immediately becomes quiet and mutters inaudible sentences and words to himself. Upon further prompting, he claims that Kevin will never become as good as his other and that he should just give up and become a lawyer. Minimal to negligible support for Kevin’s ambitions evident. 

I was able to glean little information from Jack, the father, due to his incoherent state. 

Major Symptoms Presented: 

• Hallucinations 
• Delusions
• Isolation and anti-social tendencies / behavior 
• Mood and behavioral fluctuations 
• Fatigue 

Final Diagnosis Recommendation and Course of Action:

• Chronic schizophrenia (F20.9)
• Prescribe antipsychotic at a mild dosage but be prepared to change the dosage amount dependent on symptom retention 
• Possible psychological counselling sessions 

Summary:

Kevin’s schizophrenia could possibly have been aggravated by the death of his mother and aggravated by the apparent less than adequate home environment that Kevin currently resides in. Symptomatic treatment would currently be best, and then therapy should be commenced, to hopefully restore Kevin’s self-esteem and self-worth that was jeopardized by his hallucinations, with the ultimate goal to return his life back post-hallucinations. Further consultations needed to see full extent of the disease’s progression and stage.

Hallucination Dialogue 

Location: The Spencer High School baseball pitch during a baseball practice; 

Kevin is on the pitching block sending the ball to a teammate, with their coach correcting his pitch for their game that weekend. In the stands around their practice area Kevin hallucinates a collegiate scout that has come to watch him practice but also to sabotage his practice so that he will not perform well at the game. This is not the first time that Kevin has seen this scout. He can never make out the scout’s face, just merely his figure on the side of his field of vision. 

Coach: Kevin, pitch again. Increase your throw velocity and bend your elbow more, you are throwing too wide. Get it together. Try again and pitch it like you mean it. 

Scout: (Clap…clap…clap) Kevin son, that’s quite a mean throw you got there. Too bad ya can’t hit the target.

Kevin: (grunt)

Scout: What’s the matter? Too focused on your form to listen to me. Or are you realizing that your whole form is off anyway and that I’m right as usual.

Kevin: What do you mean?

Scout: (maniacal grin) Well, you can’t seriously think that any college with a half-decent sport program would take you, do you? I mean look at you…the boy that hears things. How pathetic, do you seriously expect college to take a child like you? You can barely throw a baseball, let alone properly pitch properly. Your mother would be so disappointed. 

Kevin: How do you know what the colleges think?

Scout: Dear boy, I am the colleges. I am the embodiment of all the scouts that come every game, flocking to see the games, to pick out the cream of the crop to fill their roster, all in a bid to make the best team. And you really expect yourself to even be considered? (surprise) you can barely pitch. Look at you, you stand no chance of making it into a Division I college. You’d be better off just quitting. 

Kevin: It’s what I want to do. It’s what my mother would have wanted to me. How could I not make division 1?

Scout: Wow, retrograde physical skills AND mental processing? You really got it bad don’t you son? You won’t make it to Division I. You’ll be lucky to make a community college at the rate you’re going. And your social status is so shaky too, (tisk, tisk). You used to be so popular, the star of the baseball team. Now look at you, spending your time huddled in a corner of the library every break. Rocking yourself back and forth like a child, muttering incomprehensible nonsense to yourself. Have you even seen the looks that the other students give you? They shun you; avoid you like the plague. You have become nothing Kevin. Your dad knows that, why are you still holding out?

Coach: (scream) Kevin, PITCH!

Kevin: It’s easier that way. I can be alone, away from others. 

Scout: (laugh) Oh, my poor child. You are never alone; we are here. We are watching you from the stands on game days when you fail to pitch properly, and we are in the room when your father hits you for being such a disappointment. We were there when you put fake smiles on your face and gave fake love to your girlfriend Amanda. We are always with you Kevin, you are never truly alone…we are part of you. It has been our immense pleasure watching you slowly descend into apathy and lose your emotions. You have become everything you hoped you wouldn’t. An empty husk, floating in the wind with no particular direction…alone in society but never in mind. An outcast navigating the barren wasteland that your life has become with nothing but the voices in your head. (venomous tone) No love, no emotion, just simple emptiness. How does that make you feel?

Kevin: (ponderous) It has been a long time since I’ve felt. I am just so cold… I want to explain to coach how cold and dull I feel inside. He will never understand though. Scout says so.

Coach: (furious) IF YOU ARE GOING TO STAND THERE LIKE AN IDIOT, THEN GET OFF MY FIELD!! You are been wasting my time today. What is going on son? Are you okay? If you are not going to play or seem to care, then get off my field.

Kevin: (stares blankly at the coach. shakes his head and mumbles to self) Leave me alone.  

Coach: (furious) GET OFF MY FIELD BOY 

Scout: (smiling at Kevin) I’ll never leave you alone. I’ll be seeing you soon son.