Schizophrenia Treatment Diary - Those Days as a Psychotherapist

I came into contact with psychology in 2010 and started to study Zhengerba Jing. It has been spent on and off for 5 years. I am considered a senior enthusiast. I am confident that my basic skills in this area are better than my major (mechanical design). Much more solid. Most people are interested in psychology for two reasons: one is to peep into other people's inner worlds, and the other is that they have had psychological disorders themselves. Unfortunately, I belong to the latter group. I had three years of mild depression in adolescence, six years of difficulty falling asleep (neurasthenia caused by study pressure), more than three years of obsessive-compulsive behavior, and a five-month period of job hunting in 2014 when I resigned. Anxiety disorder. The saying that a long-term illness makes a doctor can't be more appropriate to describe my situation.

In modern society, new things are emerging in an explosive manner. The world is changing with each passing day and the changes are too fast. Tempting factors have suddenly increased, giving people many undesirable desires and creating a lot of pressure. Therefore, our generation is more likely to have psychological problems than our parents and grandparents, so we must pay more attention to prevention and self-monitoring at all times.

If you study psychology too deeply and get into acting, looking at people is somewhat like an occupational disease, but this is also a special perspective. For example, when people talk about a person who is difficult to get along with, they will directly say that that person has "character problems", "immorality", and "lack of education". As a psychology enthusiast, I cannot give such an irresponsible evaluation casually. Most people with interpersonal barriers have psychological barriers of one kind or another. After all, there are only a very small number of people who are truly morally corrupt. For example, the tenants we share are a couple, plus their sister and brother-in-law. There are a total of four people crowded into a room all day long. They rarely go out and refuse to communicate with everyone. They never say hello to anyone but use other people's things. , and also took some public facilities as their own. When meeting such a "weird" group of people, everyone can't help but mention character issues. But I observed what was behind it: paranoia, vulnerability, social anxiety and family environment.

But what we are talking about today is not small problems such as paranoid personality disorder, depression, and obsessive-compulsive disorder, but schizophrenia, which is known as the most serious psychological problem (no one). The protagonist of the story He is my childhood playmate, let’s call him Mr. A (Article 14 of the "Professional Code of Ethics for Psychological Counselors", "Psychological counselors should strictly abide by the principle of confidentiality and have the responsibility to explain to visitors the confidentiality of psychological counselors) Principle, and the limitations when applying this principle” (forgive me for not revealing Mr. A’s name). During the two months I spent closely with Mr. A, life was like a suspense movie, with ups and downs in the plot. Those who have not experienced it cannot imagine it out of thin air. Those who have experienced it will never forget it.

1. We haven’t seen each other for many years, so you are like this (October 2nd? Sunny? My hometown in Yangzhou)

Although I have learned about Mr. A’s condition from my parents in advance, I just I was still surprised to see his condition when I got home - he was sitting still, his eyes were blank, his face was blank, he looked in pain, and he had no intention of saying hello to me. I had a phone call with A in early 2014. Although we didn’t talk about the specific content of life, the negative energy coming from the other end of the phone made me feel like I was talking to a black hole in the universe. All the passion in my body was sucked away and I was left in a state of despair. After I hung up the phone, the sensitivity of a psychology enthusiast made me realize that A’s situation was not optimistic. He was likely to suffer from psychological problems when he graduated in 2015. But what I didn't expect was that his questions would come so promptly and fiercely. In addition, from the second half of 2014 to the first half of 2015, I myself was entangled in various major life events, and I couldn't get away from caring about him.

Until September this year, my family told me that A had a big problem - he heard someone talking in his ear all day long, revealing his privacy. He couldn't get rid of it, couldn't find it, and felt trapped. An unknown person followed and teased him, and he firmly believed that his parents and the unknown person conspired to persecute him. Moreover, he failed to obtain a diploma because he missed more than half of the courses, and his relationship with his classmates and roommates was in a mess. The most exaggerated thing was to go to the public security bureau to report that he was being persecuted. After his family took him to the hospital for psychiatric treatment, he still refused treatment and medication, insisting that there was nothing wrong with him.

Although I have not seen the hospital’s diagnosis and treatment results, through his performance and his family’s description, I am absolutely sure that Mr. A has paranoid schizophrenia (the most common type of schizophrenia). If you don’t know about this disease, you can read about the protagonist of the biographical movie "A Beautiful Mind" - Nobel Prize winner John Nash, who made outstanding contributions to game theory. He has exactly the same symptoms.

Regarding this meeting with Mr. A for so many years, I have to sigh, I haven’t seen you for so many years, why are you like this?

2. Relax a little and take you to climb the mountain (October 10, sunny, Dayang Mountain, Suzhou)

Question A is really too tricky, it really doesn’t take two days. It can be solved - firstly, he is facing difficulties in finding a job because he does not have a diploma, and the serious inertia caused by mental problems has destroyed his will to learn, resulting in a serious lack of professional skills; secondly, because of his personality , A's emotional numbness and indifference, his long-term solitary life, his extreme fear of social interaction, and his difficulty in integrating even if he found a job. This is also the most important factor that caused his illness; third, he fiercely resisted taking medicine, refused to admit his illness, and refused to cooperate with treatment. This is also the biggest problem that seriously hinders recovery. Because of these points, after discussing with A’s family, we decided to bring A to Suzhou after the National Day holiday for personal treatment and ability training.

A firmly believes that everyone around him wants to harm him (delusion of persecution). Although he is only willing to listen to my words, he cannot fully trust me because he has not seen me for many years. Therefore, treatment and ability training are Nothing can be rushed. So I decided to take A out for the time being. Firstly, it can release his extreme depression. Secondly, it can provide him with the friendship he has been missing most in these years. Thirdly, it can enhance mutual trust and lay a good foundation for subsequent treatment and training plans. .

After preparing enough dry food and drinking water, A and I embarked on a one-day trip to Dayang Mountain. The weather is very good and the air in Dayang Mountain is very fresh. Mountaineering is a very healthy sport and consumes a lot of energy. Due to living at home for many years and taking medication recently, A's physical fitness was somewhat unable to keep up, and he wanted to give up several times during the process. This fear of difficulties and extremely poor willpower are also highly consistent with the symptoms of schizophrenia, so I had to take the trouble to do it once Encourage him for the first time. Although A is not happy, he is more cooperative. On the way, I tried to chat with A many times, but A was not very willing to talk and took little initiative, making the atmosphere a bit awkward. During the water break, I told a dirty joke, and A couldn't help but laugh. This was the first time in so many days that I saw a second expression appear on A's numb face, and the atmosphere gradually became more harmonious. .

At the end of the evening journey, I intentionally or unintentionally talked about some of the psychological problems I had encountered before (self-disclosure), and also talked about some topics that people are usually ashamed to talk about (such as love, masturbation, etc. etc.), gradually removing A's carefully prepared psychological defense. A was also willing to take the initiative to mention his own problems. He talked about how he was severely isolated by his classmates and roommates because he was not good at communicating with others. He also talked about how in his sophomore year, he suddenly heard someone talking in his ear and walked away. He followed him wherever he went, and by the time he was in his junior and senior years, he could hear it almost all day long, even when he was sleeping. And no matter what he was thinking about, "that person" knew it and exposed it, and he felt that it was not an illusion at all. Although I have learned most of them in advance, through A’s own statement, it is of absolute significance in psychotherapy, because most of the problems that can be expressed are not hopeless problems.

3. Look, this is how society is (October 17th, cloudy, Qingfeng Decoration Company, Suzhou Convention Center Hotel, Taihu Park?)

"Psychological problems, research Most of the causes are not in the medical field, but are often related to social relationship problems." This is the insight I gained when I encountered a bottleneck in studying psychology last year and switched to studying sociology. Later, I discovered that I had the same relationship with the giant Alfred a hundred years ago. ·The remarks of Adler (along with Freud and Jung, known as the "Three Giants of Psychoanalysis") coincide with each other.

Having laid the foundation for mutual trust, I would like to start with Mr. A’s main root cause (social phobia and social withdrawal).

Due to living in isolation for many years, A's social skills are seriously lacking. What's more serious is that he seems to have no intention to change the status quo. This is tricky because I can't whip him into communicating with people. So with the idea of ??giving it a try, I took A to Qingfeng Decoration Company and Suzhou Convention Center, and found two interior designers to discuss decoration cooperation. A watched the whole process, hoping that my words and deeds would be contagious. To him, it can alleviate his fear of social interaction, which is also an essential skill for the job interview he is about to face.

I went to Taihu Park in the afternoon, walked around the water, and continued chatting with A for a long time. A was a little more relaxed than the first time we went out, and was a little more willing to take the initiative to talk to me. Initiating some topics can be regarded as further enhancing trust.

4. I feel how heavy your heart is (October 21, rain, residence)

I have been living with A for some time, and I discovered that A’s My living habits are indeed very different from ordinary people: I have a serious tendency to procrastinate, and it takes a long time to finish a simple and clear task; getting up every day is like facing a long march, and I have to be urged three times and six times before I can get up; there is no one bit Willingness to take the initiative to do things. If he is not given tasks, he will only watch TV or be in a daze. Even if tasks are given, he will always carry out discounts. His face is expressionless most of the time, as if he is suffering from depression (actually not, patients with depression will take the initiative to seek medical treatment. But he will never); severely lacks self-confidence, overestimates his own abilities, and cannot do many small things (such as online shopping, Baidu search for required information, making resumes, submitting resumes to find jobs...), which is most often said. One sentence is "I can't do it, I really can't do it."

His behavior, in the eyes of most people (including his family), is considered laziness. In fact, the disease has destroyed his willpower, so that he procrastinates again and again, sits still, and even The small matter of getting up has become a huge project for him, which is why he didn't even have the willpower to get up to go to class during college, resulting in missing so many courses and failing exams - this is simply hopeless in the eyes of others. .

Because he does not have a diploma, A refuses to learn drawing software, accept my induction training, or even submit a resume. I have no choice but to think that all this is in vain. The only option was to think of some unconventional methods - to help A fake a graduation certificate online, which was exactly the same as the real one. Although it was useless because the authenticity could be checked online, with this encouragement, A finally took action.

Within a week, at my urging, A applied for online banking and local phone cards, bought a useful mobile phone, registered an email, applied for a QQ number, and installed mapping software Creo and Auto?CAD, I made a very unsatisfactory resume - this was simply unimaginable to Mr. A in the past. Finally there was some substantial breakthrough.

5. Shout out, there is nothing to be shy about (October 31, cloudy to sunny, Mudu Ancient Town, Lingyan Mountain, Tianping Mountain, Baima Stream)

Let’s come to Suzhou together It's been almost a month, and A's drawing skills have already gained a certain foundation, and his basic living abilities have also improved. Judging from his last trip to Dayang Mountain, A really needs physical exercise. On this day, I want to take him out to relax and go hiking and training in Mudu Ancient Street and Lingyan Mountain.

In the morning, we traveled 35 kilometers to the old streets of Mudu Ancient Town, where we took him to experience the real old Suzhou and its small bridges and flowing water, and had some snacks. In the afternoon, we climbed nearby Lingyan Mountain, visited Lingyan Temple on the top of the mountain, and tasted the vegetarian noodles known as "the most delicious noodles in Suzhou" in the temple. Later, I followed the back mountain road all the way down the mountain, and climbed Tianping Mountain and Baima Stream unplanned.

Especially halfway up Tianping Mountain, facing the rolling mountains, I couldn't help but roar "Ahhhhhhhhhhhhhhhhhhhhhhhhh", and I felt so happy. Then I patted Mr. A on the back and motioned for him to try too. What surprised me was that this time Mr. A didn’t hesitate and yelled several times without any scruple - how could such a repressed person like him do this? Such a move! Maybe it was the long-distance exercise that opened up A’s long-hidden nature, maybe it was my demonstration effect, maybe it was because A had really been suppressed for too long and needed to be released.

But no matter what, we can see two points - first, A is no longer guarded against me; second, exercise is indeed important to A.

After returning home, I felt that our mutual trust had a certain foundation, so I safely introduced the knowledge about schizophrenia to A, convinced A that he had schizophrenia, and gave him I have done several authoritative psychological tests including the "Minnesota Personality Questionnaire", and the test results have proven my point of view. A's reaction seems to be very compliant. I feel that the day is not far away when I let him take the initiative to take medicine and cooperate with treatment.

After that, I took him to long-distance running every few days. Although he didn’t like pure exercise, A still participated with me, and the situation seemed to be getting better day by day.

6. Don’t be afraid, I am your backing (November 9, Xiaoyu, residence)

Sleepwalking is very mysterious and seems to be something you only see in movies. , but the following plot will reveal the mystery of sleepwalking.

After submitting resumes for a while, A received interview notices from several companies. Due to his innate social phobia, lack of any previous interview experience, and the fact that he failed to graduate, A was a little worried. So I must continue to encourage him about this matter, but due to A’s suspicious and weird personality (typical characteristics of schizophrenia: suspiciousness and difficulty trusting other people’s words), too much encouragement made him feel that I was deliberately comforting him. , but it made him even less confident, which made me dumbfounded.

He had no choice but to let him experience the scene he feared. After interviewing with two companies, the situation was indeed not ideal. In fact, I didn't expect him to be successful at the beginning of the interview, so I wasn't very anxious about it. But the thing that makes me anxious is that although I am not satisfied with my performance and ability, and I am a little anxious, A is still able to escape from reality. I will not continue studying when I come back. I am not even too lazy to submit my resume again and just continue to watch TV. ,daze.

I asked him: "If you still can't find a job after a while and the next fresh graduates come out, what will you do?"

His answer was surprising. I was very annoyed: "The worst case scenario is that I'll go back home and look for you in my hometown." Then I continued to watch TV in a daze.

I am usually quite restrained, but this time I got really angry and said in a stern tone: "Stop fucking fooling yourself and others! If you can find her in your hometown, why don't you follow me?" Is it so far away? Think about how much stronger the industrial base is in Suzhou. Wouldn’t it be better for you to go back to your hometown? ”

This time A’s numb nerves were finally touched. Maybe he was good at my unexpected anger, maybe he had to admit that he had deceived himself, but no matter what, A started to move again. After practicing drawing seriously for a period of time, A got a little "out of control". One night, he sat up inexplicably. The black shadow stared at me and asked: "How on earth do you draw this?" I was sleeping relatively lightly, and I was surprised: "What did you say?" Then there was no reply from A, and he lay down to sleep again. He didn't know anything about it when he woke up the next day.

Sleepwalking occurs in deep sleep, so it is not a dream. 15% of children will sleepwalk, which is normal, but the probability of adults is less than 1%. Generally, it is likely to be caused by schizophrenia. Through Freud’s research on dreams and my own actual speculation, we can at least read the following points from A’s dream interpretation: A is still not confident in his drawing skills and still has a certain desire for work, but At the same time, he also developed a serious dependence on me (this can be regarded as a side effect of trust).

His luck seemed to be better this time. Within a few days, several companies sent interview notices, and A was also very proactive in preparing. Because he has participated in more interviews, A has become more or less experienced and is no longer so worried about interviews.

But the result was still not ideal. Later, none of these companies were involved. Maybe his fake certificate was found, or maybe it was for other reasons. Don't talk about him this time, even I was hit and a little discouraged.

But I can’t accept giving up after working hard for so long. Besides, if I give up, who else around A can help him? There was no way, with the mentality of treating a dead horse as a living horse doctor, I no longer let A invest online, but personally took him and his graduation certificate to the job market to try his luck. Fortunately, A still listened to me in this aspect. words.

His luck was indeed not in vain. After two days of investing, two companies at the job market said they could interview him even though he did not have a diploma. So A participated in two more interviews. , and all successfully passed the preliminary examination.

7. How many secrets do you hide in your heart? (November 15th, cloudy, Yangcheng Lake Peninsula)

Later, one of the two companies hired A and asked A to go for a physical examination. This time, A made a move that I didn’t understand very much. He needed me. Accompany him to the physical examination, otherwise he will be very lonely. This left me speechless. I didn't want him to rely too much on me, otherwise this would always be a time bomb in his life, so I flatly refused. But I was actually a little worried that I would fail physical examination A because the side effects of antipsychotics can cause abnormal heartbeats.

After the results came out, it turned out that the electrocardiogram was abnormal. Despite this, the company still hired him. But what I didn’t expect was that A actually refused! The willingness actually means that he feels that it is too far away from here and does not want to go. I'm on fire, I'm really on fire this time! On the one hand, it was because all his efforts were in vain, and on the other hand, he was shocked that he didn't understand A so well. A was also shocked by my anger, and the atmosphere was very bad.

But things have happened, and anger cannot solve the problem. In the afternoon, I wanted to find a quiet place to have a full introductory psychological interview with A, so as to understand his thoughts in depth, so I took him to the sparsely populated Yangcheng Lake Peninsula.

At the ecological farm in Yangcheng Peninsula, I asked probingly: "Do you still have hallucinations now?"

"What hallucinations?! I don't admit it at all. That's an illusion! And I don't think I'm sick!" A was very angry, probably because he was upset about my anger in the morning, and his answer surprised me - he had already realized that he was sick, so why did he do so? Yaguchi denied it? Although anger is not a good emotion compared to joy, it is better than numbness. The saying "Making someone angry is the most effective way to hear the truth" really makes sense.

This unexpected answer immediately made me sober up a lot - A's condition did not get better, but he pretended to be submissive in order to avoid disputes (A is the ninth personality type in the Enneagram, and is particularly afraid of conflicts. dispute). So, I decided to patiently find out how many secrets A had hidden in his psychology.

After three hours of persuasion, I finally came to know that A really couldn’t tell the difference between illusion and reality. On the one hand, he was very dependent on his mother, and on the other hand, he was extremely suspicious that his mother wanted to cooperate with others. He plotted to kill him, and was still worried about his mother not believing that he was being followed and teased. He was also worried that his mother would put drugs in his food to punish him (because A tried his best to resist taking medicine, his mother did secretly put antipsychotics in his food. (drug), and for a while he even suspected that I was also working with his mother (do I count as working with his mother? Actually, I was a little confused), but later he became convinced that I was helping him and eliminated my suspicion. . He didn't have any plans for the future, he just felt like he was drifting with the flow in his dream.

Through this detailed intake interview, I found that compared to the previous constant auditory hallucinations and the crazy behavior of reporting the crime, A has not actually recovered now, but is suffering from obvious positive symptoms (hallucinations) , delusions, confused thinking) turned into secret and stubborn negative symptoms (emotional indifference, language poverty, loss of will)? Although positive symptoms may seem crazy, they are actually easily controlled by medication. On the contrary, these mild negative symptoms are secretive, less effective with medication, and extremely stubborn. They can be called "doctor killers"!

Overall, this meeting was very successful, so I decided not to tell him yet that he had been taking medication without knowing it, so as not to affect the treatment.

8. Don’t be excited, let’s sit down and chat (November 21st, overcast and light rain, Su Daxiangmen Houzhuang, Pingjiang Road, Suzhou Museum, residence)

A few days Queen, another company also hired Mr. A, and he barely passed the physical examination this time. Although it was a happy event, another problem arose - after work, A's medication became a problem. His mother could no longer secretly add medication to A's food, and if the medication was stopped, A's The situation is likely to take a turn for the worse, and all the previous months of taking medication will be in vain, and you will have to start over again. The worst thing is that once the symptoms relapse, A’s job is 80% impossible to keep, and once he is unemployed now, the possibility of A wanting to re-enter the workplace in the future is almost zero. In addition, the public's prejudice due to their lack of understanding of schizophrenia will make them regard A as a monster, which will further deepen A's fear and withdrawal from society. But A has a poor sense of illness, and if he is told the truth, he will probably stop taking the medicine immediately. This is really a dilemma.

At first I thought that A didn’t admit that he was sick because he was afraid that if he did, he would be labeled a “madman” and his job, marriage, and life would be far away from him. Later, after a lot of After reviewing the literature, it was found that this was not the case. He did not admit it because the frontal lobe of his brain really had organic lesions that made him completely unable to distinguish between reality and hallucination. It was not something he could pretend not to admit. Therefore, it is almost an impossible task for you to convince him that he is sick.

But I had no other choice. This time I decided to go against the norm and engage in a head-on confrontation. I tried every means to make him realize that he was sick. I firmly believe that conflict itself is also a kind of communication. So, after visiting Su Daxiangmenhouzhuang, Pingjiang Road and the Suzhou Museum, on the way back to his residence, I told him about the medication he had been taking.

A was surprised and hurt after hearing this: "You mean you have been working with my mother to deceive me, right?!"

"Don't get excited first, I won't To argue with you, you should first think about it, do all the things I have done for you these days seem to be harming you?" Then he was speechless all the way.

When I returned to my residence, I did not rush to persuade him, but took a nap first, because I knew that the next work of persuasion required me to activate every cell in my body and work hard. spirit.

After dinner, A calmed down a lot, but still insisted that he was not sick and that those were not hallucinations. So, I turned on the computer and searched some information in front of A, convincing him that although antipsychotics have side effects, they will never cause normal people to become mentally ill. Why do people with schizophrenia really not realize that they are not aware of themselves? ill. And patiently explain to him the consequences that stopping the medication will have on his career.

After nearly three hours of fierce confrontation, A gradually relaxed his attitude on taking medicine, but still refused to admit his illness: "If you say that, I can't help it. The logic of your explanation is It makes sense, but my logic is also correct! I'm not sick, you are the problem!" I have to admit that although his thoughts about his mother being bribed and conspiring to persecute him are crazy and weird, they are really logical. It makes sense. So I decided to try another way to convince him.

I searched for the famous "60 Incredible Mental Pictures" to convince him that human senses are not as reliable as we think (PS: You can see that the colors A and B in the picture are actually Is it the same? ). Then he said to him: "Maybe you are really normal, maybe we are all abnormal, but we abnormal people are trying to make you become as abnormal as us. Do you think you can accept it? "

A thought carefully for a while: "That's okay."

A is finally willing to take medicine.

Now, A has successfully joined the company, and his nearly two-month treatment plan has come to an end. But for therapy, this is not the end, but the beginning. I wish Mr. A’s life path will lead to a bright future and become more stable as he goes.

Supplement: Popularization of knowledge about schizophrenia

The incidence of schizophrenia1 is slightly higher than we imagined.

It is divided into several subtypes such as paranoid type, adolescent type, nervous type, simple type, residual type, and indefinite type. Among them, paranoid type is the most common (both Mr. A and John Nash are of this type).

The main symptoms of paranoid schizophrenia are: hallucinations, auditory hallucinations, delusions, a sense of being persecuted and exposed, confused thinking, nervous behavior, emotional withdrawal, poor speech, diminished willpower, refusal to treat, and More than 60% of patients are completely unaware of their illness. At present, the cause of the disease is still unclear. It mostly affects young adults and generally occurs in groups with higher IQs. The main possible factors are attributed to heredity, physiological lesions, personality and environment. Treatment method: Generally, it is impossible to recover on its own. Psychological counseling is the main method, and drug treatment is supplemented. Exercise has a certain positive effect on the treatment. Stable social relationship support plays an important role in maintaining the curative effect.

Most patients who recover after treatment will relapse at least once in their lifetime. The public often does not have a detailed understanding of the disease, and is influenced by some false movies and TV dramas, creating prejudice and discrimination against patients. They believe that patients are highly dangerous and prone to hurtful behaviors. In fact, due to a lack of behavioral motivation, they Safer and docile than ordinary people (schizophrenia and mania are completely unrelated). The isolation caused by this kind of prejudice and discrimination often makes it more difficult for patients to be cured. Therefore, we call on everyone to have more understanding and support for patients, and less prejudice and discrimination. I wish them to get out of the shadow of life as soon as possible.

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