FEATURES IN WORKING WITH SCHIZOPHRENIC PATIENTS: MORAL CONSIDERATIONS
Some patients return to their extreme state after only days, saying as one woman said to me, ‘Doctor, it was so beautiful to be on the moon. I was so happy there, why do you torture me by asking me to live in your harsh world? I do not have the strength to bear it here.’ Several hours later she was back in the psychosis once again with a euphoric expression lecturing to all about the moon and other planets. Who is to say that she should be in a different place? She had a choice, made a decision, and kept to it.
I have heard of other cases in which the physician gave a patient drugs, brought him out of his extreme episode only to report the resulting suicide.
An elderly gentleman I treated had been living alone with only his ‘devils’ (auditory hallucinations) for companionship for many years. After carefully adjusting his medication we were able to get rid of the ‘devils,’ at which point he fully realized how lonely and isolated he was and he drowned himself. Given the symptom-caused torment and social isolation which many schizophrenics must endure, in truth I find it surprising that the suicide rate among them is not higher than it is.
What this doctor does not mention is the possibility that the schizophrenic had his ‘devils’ as friends; his extreme state gave life meaning and prevented him from dying. Without the devils, it is fully possible that there was no longer any reason to live. Or, it is possible that one of his devils was no longer friendly to him and helped him to drown! Or, it could also be possible that the medication blocked the auditory channel through altering neurotransmitters so that the devils were no longer located there but took over his movement, whereupon he killed himself. I do not know what happened, but I would like the reader to suffer some of the philosophical uncertainties involved in working with psychotic states. My philosophy is doubt and observe, try to follow the individual process as closely as possible.
*49\227\8*
