The Intrapersonal Consequences of Schizophrenia

I have proposed before that schizophrenia represents a biopsyhosocial phenomenon. Essentially, it has been stated that schizophrenia originates from chemical imbalances in the brain in the form of auditory hallucinations. The outward appearance of hearing auditory hallucinations is stigmatizing, and the retreat from stigma by assuming a façade of normalcy alienates the schizophrenic in a psychological sense, driving her further into the self-concealed realities and unrealities of her mind.  In terms of this, the biopsychosocial process is self-reinforcing.

It is important to note that schizophrenia is termed a problem related to “behavioral health”, explicitly. This term may be appropriate in terms of diagnostic considerations using the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM utilizes behavioral criteria for the purpose of diagnosing schizophrenia and other mental illnesses. For example, the psychiatrist will note that the mentally ill client displays “negative affect” as opposed to the statement that she “feels badly”. The schizophrenic client may be stated to “report the experience” of hallucinations, as opposed to simply “experiencing” hallucinations. For the purposes of objectivity, the diagnostic criteria for schizophrenia are stated in behavioral terms.

The term “behavioral health” can be considered to be particularly damaging in that this term can be construed to mean that there is an appropriate and healthy way to behave – that of concealing one’s mental illness.  While it is important to exercise caution in terms of self-revelation of psychotic symptoms, and, in fact, patients are encouraged to reveal to their psychopathological symptoms to their treatment providers, there nevertheless exists an implication that they should behave in a “healthy” way.  This is especially true regarding the mentally ill indvidual’s self-conception.

In terms of the biopsychosocial model of mental illness, assuming an outward appearance of “behavioral health” relates to concealing one’s symptoms as a retreat from stigmatization. This reinforces the tendency to retreat into one’s subjective mind in an effort the avoid stigma, and the consequences of this retreat is further alienation. As indicated, “behavioral health” implies that there is an appropriate façade that should be assumed by schizophrenics in their efforts to appear psychologically healthy. Note that the biopsychosocial model implicates a synergistic cycle of psychopathology, and it is possible to reinforce this cycle at any point in the cycle: biological, intrapersonal and interpersonal.

It is noteworthy that individuals may say that the term “schizophrenic” is stigmatizing. I have heard it suggested that the term “schizophrenic” should be changed to “a person with perceptual differences”. It is much more benign to term an individual “a schizophrenic” than it is to term the fields of psychiatry and psychology those of “behavioral health”.

The term “behavioral health” has emerged from the effects and consequences of behaviorism on the fields of psychiatry and psychology. It is obvious that behaviorism is reductionistic. However, behaviorism continues to dominate the mental or “behavioral” health fields due to its emphasis on predicting and controlling behavior, and behaviorism is valued in that it relies on objective results of psychiatric and psychological treatment.

Behaviorism itself emphasizes outward appearances as opposed to subjective states, and subjective states can be referred to by the term “subjective well-being.” I have noted that most schizophrenics report that they simply want to feel normal most of the time. While one’s behavior may or may not convey subjective well-being, asking the schizophrenic to describe her subjective feelings may be more therapeutic than it is to emphasize her objective characteristics.

While behavioral aspects of mental health treatment, such as hygiene and the observable effects of medication, are important aspects of treatment that emerge from the behavioral perspective, the term “behavioral health” has many negative implications that the lay person or the schizophrenic is unlikely to comprehend. In fact, the schizophrenic may misconstrue the term “behavioral health” to mean that she will be stigmatized if she expresses any symptoms of mental illness.

While stigma is real and impactful, creating a wall between oneself and other people as an assumption or presentation of “behavioral health”, the term “behavioral health” will reinforce the psychopathology referred to as the biopsychosocial cycle of psychotic illness.

Image via wallybird / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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