Many clinicians in the field of Psychology classify the various types of schizophrenia based on the nature of the symptoms involved and hence sub-classify the disorder as being either positive or negative. Positive forms of schizophrenia might manifest themselves in the person’s behavior as hallucinations, delusions and strange and anomalous behavior. The following is an excerpt from an interview with an individual suffering from schizophrenia and displaying a positive form of the disease:
Interviewer: Have you been nervous or tense lately?This is an example of disorganized speech and would be classified as an example of a positive form of schizophrenia. The patient’s discourse is often unintelligible and difficult, if not impossible, to understand from a logical perspective.
Patient: No, I got a head of lettuce.
Interviewer: You got a head of lettuce? I don’t understand.
Patient: Well, it’s just a head of lettuce.
Interviewer: Tell me about lettuce, what do you mean?
Patient: Well…lettuce is a transformation of a dead cougar that suffered a relapse on the lion’s toe. And he swallowed the lion and something happened. The…see, the…Gloria and Tommy, they’re two heads and they’re not whales. But they escaped with herds of vomit, and things like that. (Neale and Oltmanns, 1980, p. 103-104)
Schizophrenia manifesting itself in negative symptoms often takes the form of behavioral deficits and may be termed “avolition”, “anhedonia” or “alogia.” Each of these terms describes a lack of energy (to the extreme of loss of self-care), loss of speech, and inability to experience pleasure, respectively. The expression “flat affect” is also descriptive of a negative form of the disease as it describes the absence of expression, emotion. Many are familiar with the expression “catatonic” which is indicative of a lack of movement in the schizophrenic which may last for hours or even days at a time. Negative forms of schizophrenia are, simply stated, the absence of certain behaviors, actions, motions that most “normal” people traditionally exhibit.
Although the causes of schizophrenia or unknown at this time, research has revealed a genetic element in the transmission of the disease. For example, if you have a relative who suffers or who has suffered at some time you are more likely to contract the disease yourself. Unfortunately, the exact genetic relationship is unknown at this time and remains somewhat of a mystery to the scientific community. Further research in the field is currently under way and many mental health professionals are waiting with hope and anticipation for more insight into the potential causes and cures.
Although many different varieties of therapy have been researched and found to be effective in mitigating the symptoms of schizophrenia none have yet to be proclaimed as curative or long-lasting. In the 1930’s a man by the name of Sakel found that treating the patient with large doses of insulin did have a palliative effect on the schizophrenic’s symptoms. Unfortunately many of those undergoing this type of treatment lapsed into a coma and died. In 1935 a man by the name of Moniz introduced the pre-frontal lobotomy (made popular by the 1975 film One Flew Over the Cuckoos’ Nest) which in effect destroyed certain neural pathways connecting the frontal lobes of the brain to lower centers associated with speech. This treatment became the primary form of treatment for more than twenty years especially with particularly violent patients. Unfortunately, many patients suffered massive lapses in cognitive ability, became listless and often died precipitously. The introduction of certain drugs eventually took the place of the lobotomy that seemed to effectively reduce the frequency and intensity of some of the more problematic symptoms. 1938 brought the advent of Electro convulsive therapy or ECT whereby electrodes are placed on the patient’s temples and a current is applied for a fraction of a second. The ultimate goal of this treatment was to produce a seizure and then subsequent unconsciousness which seemed to mitigate the schizophrenic’s symptoms, temporarily at least. This method was abandoned as well although it has been revived as a treatment for severe depression. Other more effective treatments followed including the use of anti psychotic drugs although their beneficial properties are celebrated more on the basis of muting the symptoms (especially in positive forms of the disease) rather than curing the disease.
Although drug therapy is still the primary form of treatment for those suffering from schizophrenia, other more creative forms of treatment have been found to be quite effective in reducing the frequency and intensity of certain symptoms. Music therapy is one of these modalities and has been distinguished as a potentially effective treatment for the symptoms of schizophrenia.
A study conducted in 2006 in London found that “music therapy was associated with reductions in general symptoms, such as depression and anxiety, and the negative symptoms of schizophrenia” ( "An exploratory randomized controlled trial of music therapy for inpatients with schizophrenia" British Journal of Psychiatry, 1 November 2006). This particular study utilized an active form of music therapy whereby the patients were given access to musical instruments of their choice and allowed to express themselves. The attending therapist accompanied them initially and tracked their emotional expression in musical terms. She then gave the patients an open opportunity to express themselves freely and without her interaction. Their emotional states were then observed and noted by hospital staff. Although the positive effects of the treatment were temporary, music therapy did help to alleviate some of the symptoms that tend to be more resistant to drug therapies. Another study done in 2002 in China also found similar results to the British where a positive effect was witnessed when music therapy was administered along with standard drug therapies. A third study of note was executed in Japan in 2002 and examined the relationship between the use of group music therapy and alleviation of symptoms associated with schizophrenia including psychosis (a departure from reality). After 34 long-term patients received 15 group music therapy sessions each was measured for levels of psychotic symptoms, quality of life and subjective musical experiences. Significant changes were measured in the group after receiving the music therapy especially in the area of interpersonal relations ( Department of Schizophrenia Research, Tokyo Institute of Psychiatry, Japan. [email protected]) Again, symptom alleviation was temporary in this as well as the Chinese study but further research in the area is underway and many are hopeful that music therapies can be combined with other traditional therapies to help ease some of the more chronic symptoms of schizophrenia.
Schizophrenia is a serious mental infirmity that affects “one person in a hundred at some stage in life “(Scottish Intercollegiate Guidelines Network [SIGN], 1998). Because of its prevalence in our culture and its mysterious and perplexing nature scientists and mental health professionals around the world are actively pursuing treatment modalities that are both effective and enduring, as well as non-invasive to the sufferer. And although a means and method of delivery or a standard of practice has not been established for it, music therapy is one type of intervention that can help to alleviate some of the chronic symptoms associated with schizophrenia without the barbaric horrors of surgery or shock treatment.
Mark Lincoln M.A.