There is so much to respond to:
Estaban wrote in response to the phrase "I'm sure there is meaning there":
>I'd rather say: we can _create_ a meaning for a delusional system.
I actually concur with the "create". The issue of whether the client creates
the meaning or the meaning being discursively constructed by the "we" is one
for those thrashing out the personal constructivism versus social
constructionism debated.
Bob wrote:
>Denial can also be understood in grief/loss terms, not simply as
>Denial=non-compliance. I always find it useful to ask people who say
>someone has NO social skills, insight or are dangerous what they mean by the
>terms. Just the other day I was interviewing a relative who spoke of a
>client's violence, they were referring to verbal aggressiveness.
>Elaboration of professionals constructions is a source of great interest to
>me and I believe vital to providing reasoned services.
Asking what they mean is a great idea. In terms of denial not equating simply
ot non compliance I agree. I think the issue of "resistance" is another term
somewhere in this discussion. Fransella suggested we replace resistance with
persitence. That is the person persists, tries to maintain their construct
system to avoid threat.I think the grief denial may be in the persistence
domain.
Returning to delusions- the distinction between utility and validity is of
use. For example, it may be useful for the grieving person to be in denial (to
the point where they may be labelled as "deluded". The belief is however not
viewed as valid. Hopefully those informed more about neo-pragmatism and
viability as criteria for assessing knowledge claims can help with this one.
That is, are we missing the point when we say a belief is not valid and label
it as a delusion?
Chris wrote of insight:
> I guess a distinction can be drawn between 'insightfullness' - as a
learnable >skill - and having the 'right insight' - as an end or goal in
itself. It was >clearly the former which Kelly endorsed.
It strikes me that "delusions" with whatever adjective "fixed", "unshakeable"
or whatever may then be the opposite of insightfulness- they may be the non
testing out that is required for insightfulness.
Regards
Lindsay Oades
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From: pcp@mailbase.ac.uk on Wed, 2 Jul 1997 1:27 PM
Subject: Re: Return response/ Recovering Psych. Patients
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From: "Esteban Laso" <eslaso@ibm.net>
To: <pcp@mailbase.ac.uk>
Subject: Re: Return response/ Recovering Psych. Patients
Date: Tue, 1 Jul 1997 22:00:53 -0500
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Hi everybody
I guess we can start from something like: Voices are real to schizophrenics
-the question is: can we understand why do they need them?
Lindsay Oades wrote
> I really have only been working on a one-to-one basis with these people
for a
> short time (around six mths). This in many ways I feel is an advantage- I
do
> not have the assumptions of chronicity, unshakable delusions etc that
some of
> my colleagues have. Perhaps I am naive but this has the fortunate by
product
> of credulous listening.
C. G. Jung used to say about dream analysis: First, I try to learn all I
can about dreams; then, when approaching a new one, I forget everything
I've learnt and start from a blank page.
> Issues of denial and insight are interesting. Do clients deny suffering
or do
> they deny the label of schizophrenia because of the images and
associations it
> conjures? I heard an interesting use of the word denial lately in a
different
> context- men who have sex with men when married but who don't want to
identify
> as gay- labelled as men in denial. Denial of what exactly? The question
of
> schizophrenia remains. Is denial being used here in the same way as the
phrase
> "without insight"? Is the term also linked to the phrase "non compliant"?
My
> guess from the way the terms are used on the ward is that the answer is
yes to
> both. Interesting personal construct questions may look something like:
> "How do you describe what's happening for you at the moment?"
> "What do you understand by the term schizophrenia?"
> A comparison of these responses would then be of interest.
What kind of denial are we talking about: the client's denial to himself or
to others? The verbal-explicit or nonverbal-implicit one? Schizophrenia is
a handy narrative for both doctors and patients; the later come to think
about themselves as sick persons, the former can refuse to look at the
meaning of delusions by seeing them as byproducts of biological
disfunctions. Denial is a two-sided thing: the shizophrenic denies our
construction of him -and we deny his.
> Currently I am trying to understand a man who used to work at the steel
works.
> He has an elaborate "delusional system" who nobody I think has ever
really
> listened to. Some may consider him thought disordered- he certainly
doesn't
> meet the neater requirements of the cog behavioural ABC approach to
delusions.
> Interestingly though he does use terms consistently- he has meanings for
terms
> such as "pardon", "perfection", "one", "first born creature of the
universe",
> "clear thoughts". These all relate in some way. "Perfection" is related
to a
> steel process. He had difficulties towards the end of his apprenticeship.
He
> talks of the steel works being at war, not receiving a pardon, and the
> psychiatric patients getting side effects because of what the steel works
did.
> I am sure there is meaning in there, and it can't just be meaningless
> epiphenomena of a damaged biology.
I'd rather say: we can _create_ a meaning for a delusional system.
Delusions are very threatening in our cultures -we have no way of
construing them except as _sickness_. Maybe denial is useful if a
schizophrenic learns to keep his delusions for himself -provided they give
him some clues to make his experiences meaningful. Some psychoanalysts say
the best hope for a psychotic is to _structure his delirium_: that is, to
impermeabilizate and tighten it. And, then again, we -the schizo's social
world- must deny his _sickness_ and say: _hey, he's the same man we knew!
He's not sick anymore._
Schizophrenia is a cultural label! And to think about it we must think on
how we use our power as scientists or doctors (in a broad sense).
Hope this helps,
Esteban Laso
eslaso@ibm.net
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