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I20

PmCHOLYTIC TREATMENT OF A SCHIZOPHRENIC GIRL

9.30 am.: J is tease; she wants to talk #tous but we insist she be quiet a d : fisten t o the music; she begins to cry arad rub her .hand on her forehead and . m o u t h . She moans and sighs and is distraught-ies, kisses her band and says, "I .want to like myself"-repeats this numerous times. M o n a l l y she bounds : off Ihe much and smashes her fist against the wall. 10.00 am.:J: " I ' m a girL I ' m a girl.' 'Alternately ccies and laughs. Gmw4s and whim, St& a rag into her mouth. Occasionally scmms out " N o ! ' ' When : staff -try to touch her, sbe withdraws and says. "No, leave me done." 10.40 am,: J: "My chest feels like Itm .the Scribble Head Riddle, I'm nat! H e y ,S , I want this .togo away. I don't like it'like this." Sbe then .begins to carry on o m o f her dual c o n d o n s about wards, then stops herself and says: Wo, you're not supposed to -talkl i k e .two ~ ~ r s o nI'm s . not going .to talk roo m u c h . ' ' 10.50 am.: "Fm w e l l now. I feel ~Wereot.I feel like a girL S, please help me." S m o m b her awl taka her band. J responds by trying .to communicate with S . J: 'A girl a d a boy. S, is this Werent o r is it the s a d How come I have b be a girl? W h y do I have to .talk this way? Am l suppased to ad .this way? I'm gonnrr do just what I want when I feel this way. I bave feelings and they're stupid. I guess I couM get out o f bed for awhiae. I'm just not g o m taik two rparsons m y more." J holds S clody and with great affeation, kisses her ocaskmdy. Her speech is siow and soft, not diven and harsh as is usual. J appears to go into a reverie-lib date whuh is characterized by calmaess. 1: "'Iwant to be the mother. Why do I feel t h i s way, S? I ' m goma be a mather. I have a good mouth. I grow h c k into a g i r i now. S. Let me try and do someh o g d i i l m t . Now, love, h t ' s .me and S loving each other. 1 leei sa good. I can't make stant over again." She now becomes very soft and ge.ntle, speaks as though she is spaking gently to hersell-"I could feel this way if I like. I low to get along with peuple. I ' m a girl and a good om. I'm malring the things I'm not supposed .to feel feel this way. Ob, 1 feel like Z'm s u p p a d t o feel! I'm not going -to do what I did last time! 1 feel like I ' m a new baby. T m on h e gas--no, nc-I didn't rnean that {a little agitated). I feel different. I feel good and I can help other people too. Oh, f w i s h I was sick." F asks: "Wbat4s bad?" J: "I feel g d . " F: "Is there such a 4hing aci bad?" J. "No!" (wibb great m p h s k , )She ,then laughs and ask& "Would ii feel good i f I died?" to which S replied, "Yes." 1: "I want .to die." J then Laid down with a deep sigh, dosed her eyes, relaxed and stopped talking. She becarnes extremely peaceful looking and maintains &is stab f o r a b u t twenty minutes. She .then mutters sohly, "Yeah,this is it, &is is it." She strokes 9 s band softly and smiles, and says, "I'm a girl." Her expression is positively b e a t i f i c . She takes S's head in her hands and whispers, "I bve you." There is a remarkabk grace to her hand and body movements. F: "Did you get & I die?" J: "Yes, and I male back dive, see?Ten nrinutes later she said, 'That's the way it's -supposed t o be. I oan be anything I want." She .becoma quiet and rojbeats the word "See?" in a q d o a i n g manner, to .mean "You see, now do you understand."
,

:
:.:

What does that mean'?" J: "To get along with everyone." D: "Whar would

a p if you didn't get along with sommne." J : '*I'd die." Later J says, 'tScribble Head's mother .is dead," and proceeds to go into an autistic discussion :, o f all the wards .in .the hospital. She then becomes agitated, talks iatmitkntly : . aboctt being good or bad and about whether she is a .boy or a girl. She proceeds on .&is .trackand our attempts at intervention are to no avail. E v r J u a r i n ofSession No. 3 In .this session, 3 reached a state of deep accapmce and experienced pro.. found feelings o f love and personal integration. At ~tbe beginnjog o f the sesPion % she was visibly tense a d less ;talkative h o usual. There was an almost grave . aqcct to her feding tone in contrast to her usual loose. uninhibited and instpgro. priate behavior. Soon after taking the drug she tried #toengage us in conversaE c tion but we t & w d them= attempts viewing .thema q a method o f hanging oa to . tbe world she knows and her defensive psychotic -postuJirrg.for two hours, J
. . .h

1
'

q d i y cried and smiled, engaged in famiEar oral activity, expressed anger and l i k e d herself. Then her leering tone changed. She became happy, relaxed and

full of warrnth-she appeared to i x ovenvhehned with feelings o f compassion and love for herself a d for us. J was expressing wonder and delight and her ; voice was relaxed and her words .spokensoftly and slowly as contrasted with her usual rapid tense mode of speech. Her warmth of feeling increased dramtically, and she reacted to these feelings and physically and verbally expresd love for k l f and for S. She has never behaved this way before. We interpret nluch of what sbe said to mean .that s h was. experiencing feelings o f love and acceptaace for the first time and she was quite amazed at this. Her fear had always been that would annihilate herself and o h r s if she expressed her feelings because the primary f d i s .that she knew at some level were her tremendously angry ones. We felt that she had &en able .to achieve a &@cant state af self-acapmce and love during Ibis session. Her whole manner, speech, feeling tone. M y movements and appearance was one of profound self-acceptance and .peace. Tbis was a very dramatic experience to observe and was very si.milar to experiences observed, during psychedelic states, with mature and stable adults.
. 1

Later in the day she became very much involved with good snd bad; and then we asked her to try being bad for a while. She seemed to b m e anxious at &is suggestion and m t e d 4hat she had to get along with everyone and &at she waso'.t so bad. Her anxiety increased and sha ~Eqan a dimusion o f what OIK shoukl or should not do; sbe became increasingly anxious and attempted to define and conk01 her experiences and feelings in -the context of good or &ad.
Aftex the -an, pronounced a n d quite sudden changes oocurrad in her' behavior and perceptions of her world. Her entire deiwional s y s t e m solidified irrto an absolute clear-cut dichotomy of good and bad and their ceqeaive proponents. God and the Devil. Gai was good and stood -for every smially a aHe value 3 b l ever head of. He told her to help the s t a m , to l o v e evaryone, not t o talk gazy aud to do what she was sllpposed to do, which, as far as we could determi% meant doing what everyone tokl he^ to do, .stall as well as every patient. She saw the Devil pretty rnurlr as anevil .temptor who, if she did not resist him. was somehow eble . t o#makeher do bad t&hgs, su& as windows,4ay~w~Bit*ctrildrea,~aadydl,gctmad,mHher haad on thc.btno$andsoon. J w a s m ~ r a t a ~ t o t e l l u s b o she w hated&e Devil, whi& in tmtb was #thestmnpst part of ber. It appeated that in one

1.00 .p.m.: J begins to talk about good and bad wards- a fturry of n a m b ling sped-in .the middle of ehis ashe suddenly stops and says, "I want to die again." She then appears to become a little anxious and says, "I can do anything T want to do. See, I?m a g w d girl." F : "Let's be bad fur awhile." k "Why? I'm a good girl." Appars to be a lit-tleagiiated with tbis suggestion. 3: 'Shall I die? It's fun." D : "What do you want?" J: 'To be a good girl." D:

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124

PSYCHOLYTIC TREATMENT OP A SCHIZOPHRENIC GIRL

DISCUSSION

abtempled # t o nurse on ,the mannikin. Several sessioes earlier d e n the .&mapst had verbaiized bis hate for his mother, J &d hecome terribly c o n m d , rushed over to hlm, p M her hand over his mouth so he couldn't speak and said. "Oh, you must never say tbat." When he also hit the Tnannikjn and screamed, "I bade you, mother," .this also sent J into a panic and she physically . o o the therapist f r m hitting .the manhikin. Now, in Phis session,she was acting out this amhivalence toward m o t h e r , &rough the mamikin, bdb verbally and physically. SSne also continued to hold lthe "good ding6" in her hads aad seemed to & and nu*re on ehese things. She said ,*e was nothing really i n her hands but yet n t k ewere thhp that the liked to have that made her feel goad. She had difficulty w w the nature of .these good !things, but when pressed, mimed a number of dhisgs she liked, including candy, peanut buttar sanb-. members, a boy w e n t she had recently t&em to ascxiating with. atld money. In #thefirst two hours of &is s e s s i o n , J lay quietly aid made no movemmk or verbalizatiann She then sat up and i n a perplexed manner said, "Why do you sometimes get hit by a .$ruck.when you go out on the highway of l i f e ? " After this she lay quietly for a shofi h e and then started to h m e agitatated. She tried to allay this agitation by trying t o express pmitive feelings f6r tbe Ither%@bets but m n t h e ehallowaess of this a t t e m p t .was obvious as she smkd to become aggressive, angry and assaultive. She coded up by saeaming despmkly, "I want to go out on the highway and get killed." She theo would become frightened and yell. "No, no. I don't w a n t ta be killed." Perhaps in some existtiirtial masner, she was dealiog with .the question: ghould I give up my living (psychosis) and.,takemy c h a n m with h e worki of reality? It s e e m s Qhet the m l u t i w of nhe "Riddle" the pmme of positive and negsttiw feelings ( o f good and evil, the Devil imd God) in oneself and the acceptance of .that seeming paradox was b e key to #herentering "t.he highway o f life." In this dilemma, J is not alone and facing such exiskntial questions is of.& the cure work of .the psychedelic wprienee. Whea t r a n d a n c e of &he ego-state is aabiered, the p a d o x is resdved and $he seeming wntradktiao of conditions is expixiend as a uni6ed state. W e feel that J had had glunpses of rthis unified &a&, but as with everyone except she saints, the buman pceptian of opjmition wndiions maintained iW axi c o d k t resulted.
Sessions 14, 15 and 16

The experimental project came to an end at the time when drug laws were drugs: coacted !which n d t a t e d a long and &cult procedure to obtain Consequently, -wewere f a d .to tell J that &e would i m longer be able to have any d o n s .with lthese drugs. The conliemtim tha ensued was as follows: F: "J. beawe of ceatain problms wwe're not going to -be able ,to get any more of tbe drugs we bave beea giving you and so we are going to have to do without W e l l ,yes. &here'sstill than" J: "Isn't there any m e of b s e drugs?" F: " drugs but .web not able to g d -them." J: " M y sot?" F: "Well, it's more of d difficult story but we jwt m ' t going t o .be able to get any a very more." J: "Do you h o w who has any?" F: "Yes." J: " W h o has it?" F: "Well, the man who distributes.it is d e d H A . and he is a representative a the drug oompany a d he lives in San Francisco." J: " W e l l , just.go sthere and tell him that you need same more drugs." F: "That just wonY:t work." J: "Why not?" F: ''He just w0111dn'~tgive .it to us." J: "Well, just hit .him over the head and take tbem." F : "Then !the police would came and get us." J: {In a =riots and determined, yet pleav&) "Well, just go to .the man and ell K i s n that Jeannie D r a k e sa)v that she rreuiIy needs it and can't'sbe pIme have some.."

Oaa question :that k most often asked concerning the results we obiaimed with #thesepsychotic ehikhn is-"But wouldn't you p t the same results without t h e drugs by just giviq the rime and devotion you gave to these children?" Aa can be seen, J evalueted the drugs as Mng an important aspeot of her pychotherapy and 6he wrZter concurs with J's judgment. The writer had spent over two years expuriment;ng with psychotherapeutic techniques wi& tks t y p of child and ithe m d t s were negligible. U one is very fsmihr with the severity .ps~chotic &!dm, one can moe $ of -the problems m m in rea&tidy judge the re.sults of this present work. One extremely important 2 factor which came t o be OF pmamowit importance was t h e constant chaotic and physically seressfui environm~atto which 5bese children were wmtantly subjected. They had to survive on a sterile ward with &ty other acutely distubed and .--out !psychotic children. How anyone could maintain a trace of sanity under these conditions is a mystery. The writer often thought &a4 a m o t i c witirawal would be a healthy readon to having to live in such en . n e

J's mother bad been released from the hospital and came to to her, This apparently was exceedingly stressful for 1 and she .became very disturbed. During lthe 14th session she became totally involved w i t h fear of punishment and reverted back .to :trying to be good. This undoubtedly was related to the d i c r over her rage being aohiwted by havie t o see her ,mother, She became rnanic in her massive denial dun'ng ;this session and it .was felt to be very unpmktive. During the 15th and 16th d o n s , she was excessively quiet, somewhat morose but did have long pwiods where sbe appeared to be in a very tranquil and peaceful state. DLsing .thk #time.she spoke soWy and . m y , only to h x d f , ~ayiq-'~Yts.yes, this is it. It's alright." During dhk period of h e we were prepdug J for ~ ~ n t i n u a t i o afa drug sesians as the project was being amminated. Sbe also knew tbat Lwo of .the staff that she fiad .been closest to were leaving and athis was d i m s i n g to her.

It was obvious &at J k a m e muc& btdtor. She ceased ber isola.ted, autistic behavior b a very large d w no longer sat in a wrmr, twisting p a p s , a d (rrlkiag word-salad. She had chores which she did on the w a d . She ~alked to people miionally and belped with the smaller chiklm. H & comments about other patients, and sometimes st&, were painfully accurate. She t a i d -tolearn but found it almust impossible because of her blhims. She did go t o the Ermpital's rehabf flit ah department and t b music -hslrudmdiscovered, within one bur. &at 3 wuld learn t a play piano "by ear." He .was o ~ h e l m and d entbusisstic d highly rwnmmended she be given this chance 2 to h m do play. Nothing came o f it. She was able ;to carry on very sarisible con- m n versatiom with s M , gave intease and undivided a-ttention to her co-therapist when they m e t between sessions and was able to describe her concorns, reactions and f b d y , her own dynninb. She dmbped a very mPaninafuland iatense rela- Lo t h d i p 16th -!&a m-therapist. 7 % had ~ a totdiy gtatifying experience with each o h , .&e wtherapist describing J as "one o f .the most human, one o f tbe

~~

128

PSYCHOLYTIC TRMTMBNT OF A SCHIZOPHRENIC GIRL

GARY FISHER

129

best people I know." When the therapist and co-therapist left, they had much more diculty in the separation than she md it was quite amazing the depth o f acceptance she had concerning tbe necessity of tamhating the project and her fihtionsbip with both the therapist atad the co-theparia. In fact, sbe was vcsy reassuring and suppoxtive to t h e m and seemed -to exquisitely sense their deep feeof guilk and shame at the ahadonmenr of her and Lhe rest o f the c h i l h . I n short, she carflied on in a rather remarkable fashion and with a maturity that .literallyaus.
FIVE-YEAR FOLLU\V-UP

ing hm U D treatment and suggested a manic-depresfive psychosis diagnosis based on her alternating between hyperactive and withbwai m o o d s .
At the time of her discbarge in June, 1968 she was described as making rocking movements, that she might be having halkacinatory experiences and that often wben eating she would stuff her mouth. She was also noted to @cipate w e l l ia the ward activities, that she did her w a r d chores, that sbe sgoke coherently and well and ihat she was a GO-operative patient. A final note w a s that "Jeannie is an enjoyable pmm"

The pati- was dixhqpd in June, 1968 to her p m t s who had moved .to another state. She bas not beta seen by the writer since May of 1963 and iiw distance mitigated a personal follow-up. The patient's chart at .the state institutioa was made available aad was searcbed for progress notes or that five-y$ar parid. Uafortunately. tbe recurd was scanty but it was possible to glean some idoation of her pychological condition. Tbe 6rst notation in the chart was at the termination of the treatmeat iu June, 1963. The psyc.&trids p r o p s s report read, "Patient is i n good contact with reality; she has k l y good insight; requires no regular medication: cares for all o f her own m e e d s and is M) management prablem: cWiaite improvement." The writer left the institution i n May of 1%3 aid the co-therapist ieft a few weeks later. Witbin three months the majority of the treatment staff bad I&. Consequently, the patient had virtually no one with whom to continue her therapeutic work.
In February, 1944 a notation was made that she asked one of tbe ward workers, "When will my craziness wear out?" She also offered the information that h e must be bappy with her craziness as she didn't want it to leave. I n Aqpst. 1964 a student worker had Jeannie in s group thetapy situation with a number of adolescent girls. mere is no data as to the length of time these sessMns had occufied but a progress evaluation by the student therapist reveals the following information: "Jeannie loves attention and acceptance and is very p M when praised; she is a big help to me when I take the group off the ward. It seema as if she is living another life in her mind. She told me, "I'm out to t m .the world-but how many are there?" Sbe also told me, "Everything is a thousand years old and e v t m n g is getting .better and better." She convases wit& herself a Jot and in these con~rsations she is usually mad at herself and talks of her mother .She shows concern about being sick and dying. As we were walking .the other day, she very intently told me to listen to her talk a d then to a s talking to herself, I went over to answer tbe questions. Ooe day wbm she w her and asked her what she was c o m n e d about. She laugbed and answered, "Oh, don't W e r , I ' m just Calkingl" In May of 1%6 a progrm report indicates that she was not a behavior problem but -that her behavior d l a t e d between hyperactivity and withhawal. A nowion was made &at she verbalized c o n m over fear of drying, of evil, and commented that cleanliness was good. In October of 1967 she was presentad b a consuftaa~t psychiatrist who interv i e d her before a staff. He noted that she was in good psychological cantact "despite her rocking motion." He felt tbat there had beeo improvement ioILow-

Unfortunately. .the follow-up infornution is six& and meager. 'it would appear f r o m these notes that Jeannie generally maintained the progress she had made in her treatment but tbat she Lad not resolved ber essential contlicts. Apparent.ly she was able to live samewhat in .two worlds-the world of her psychotic preoccupation which was dominated by bea impulse of rage toward her mother and the world of external reality. This conclusion is based on her ability to interact appropriately with demands made upon her by ward personnel, her ability to communicate reasoEaably, her participation in activities and work and the fact .that she was seen as not only human. but as an "enjoyable" Buman. While wrestling with her own stated cr:razioess. she was also able to relate a d participate in the dworld. T h i s degree of integration is certainly a far superior one to that which sbe possessed prior to her treatments. The writer feds that it w a s Jeanoie's grrat determination .to know and .to h e more powerful than her "craziness" and that was tbe key facet in her maintaining some degree of sanity. She would actively seek out people and make attempts to understand her cbadic world d bad a belief that she was going to get some answers one way or another. Her attitude towards her unintegmted and wnfused psychic state was OM of tolerance with an unrestrained determination to overcome. The writer ofieo felt, very deeply, that this was one very cowztgeo~~s buman being.
OTHER RESEARCTH UTILIZING PSYCHEDELIC DRUGS W I T H AUTlSTlC SCHlZOPHRENlC CHlLDREN

M a g a r and Aldrich (in press) have recently reviewed the literature on the use of psych&lic drugs with schizopbdc children. Tbey review the work of Bender, Ooldschmidt and Sankar (1962); Bender, F a r m and Cobrinik (1963); F r e e d , Ebin and Wilson (1%2); Peck and Murphy (in Abramson, 1960); Rub. Kriusky, A b m s o n and Goldfarm (1962) aad Simmons, W e n . Loyam, . WatTec and Perlo# (1966). as weil as ware prehthary unpubzished data from our own work. O f -the total of 91 children treated with psychedelics, 55 were treated by Bender. who gave daily dosages over a relatively long .term period (45 to 60 days) but witbout attempting to conduot psycbotherapevtic sessions. The primary p u r p e of the studies by Rolo m nl and S m s er d was explicitly methodological whereas Freedman er a1 were attempting to study the schizo@renic npoess and did not have any therapeutic intent. Our own work was the only one which attempted to create an atmosphere which would ONmize tbe therapeutic prooesr. Magar and Aldkh state: '?ocoaspe~ent dndiogs becomemttcbmore understaodeMe if t b e p g d & & ~ ~ i s v i e w e d nsa dynamic configuration of intimate patkt-therapist-dieu transactioras. In short, the administration of LSD is inex-tricably embedded in a large py&o-

lkipite the diversity along major dimensions known to influence drug response and ueaiment effectiveness, Mogar and Aldrich make the following cordu6ions based on their evalwrion of .the results o f the seven studias a t . viewed. (1) d l , rhildron were refractory to all other form of tracmcwt; (2) only dig& differentid .respasiveness a s a unction o f age. diagnosis, duraUi~r\or severity o fh , (3) most effective results were obtained with at least 100 mcg. doses given daily o r weekly over relatively extended periods of .the; (4) g r a b therapeutic was related to (a) the degree of active therapist involve men^

adults,

(c)

an elevation in positive mood including frequent laughxer, (d) de-

in compulsive ritualistic behavior; (6) although Uerencts in patient mribuw, treatment t&que~, rescad desiga and other non-drug factors seami to e&at . t h efrquencyand srability o f ,hvomble outcomes the types of improveme& found were wsentidy the same in each study. The reviewers conclude that the collective findings argue strongly for more
extensive applications o f psychedelic drugs in .be treatment of this type of child,
ACKNOWLEDGMENT 7l1e writer wishes ta aekmwlcdge, With m t admiration, patisnt's co-tt)erapist, David Dioa, MS.
contribmion of this

REFEREXISCES