To Learn From a Patient Who Broke His 30-Year Silence To Talk About Himself

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Length: 45 minutes


Yuko Katsuta, MD (Chair) & Masaaki Fukagawa, MD

After suffering from schizophrenia for 30 years, Mr. T, a 45 year-old man, broke his autistic shell and initiated talking, for the first time in his life, about his experience fabricated with deeply seated psychotic symptoms and anguish.

Prompted by recently introduced medication, his isolated life at the hospital began to change. It was utterly moving and thrilling to observe the gradual transformations of his facial expressions, body movements, and finally his rich discourse. He disclosed what really happened when he was 15 and what he observed and felt after his hospitalization at the age of 33. It is a heart rending as well as rewarding experience to us, too.

In his adolescence, even though he was intensely influenced by a religion in which his family was involved, he was embracing uneasy feelings about their belief. Having no one to talk with, he eventually found a niche in his psychosis. He “created” his own religion when he was 21, but it has only an extremely minute difference from his parents’ beliefs. We infer it must have been a way to hold on to himself to individuate and separate from the parents.  Retaining a great deal of similarities to their beliefs, he ended up duplicating his parents’ value system, which he had already internalized throughout his childhood. The religious sect to which the parents belonged is famous for aggressive rejection of other beliefs. He suddenly attacked his neighbors, thinking his thoughts of the new religion were transported via telepathy and aroused antipathy in them. This incident brought him to the hospital after his 18 year secretive life. And his secretive life continued for another 12 years.
When we took charge of him in 2007, he was regarded as “residual schizophrenia” with no hope to improve. He spent hours glued to the TV with a slobbering mouth, which produced few words in a flat tone only when asked. His vacant eyes, cast downward without blinking, scarcely met ours. His body movement was minimal and mechanical. It was difficult to evoke his emotions, and unattainable to assume what his internal life was like. In short, negative symptoms were in the foreground, though it was highly possible that side effects of anti-psychotics aggravated the condition. Nobody expected he would crack out of a glacier to unfold raw personalities until new medication was introduced.
As he opens up his experience, it becomes clear how he shapes pathological object-relations instead of interpersonal relationships in reality. We allow him to let us reside in his delusional matrix for the sake of his safety and security. At the same time, we tentatively challenge his delusion to make him ready for departing from his familiar template. It is crucial to detect his delicate balance between his need of psychotic shell and his budding urge to relate to us. We are cautiously tapping into his past and present not exactly knowing where to go. Every step is a gift to learn a human process and a challenge to help him to create his future.

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