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The "Praecox Feeling"

Schwartz and Wiggins (J Nerv Ment Dis, 175, 65, 1987) recently asserted the significance of the praecox feeling. Quotes:

Rumke (1942, 1959) has described a "praecox feeling" that he deems essential to the diagnosis of schizophrenia ... He characterized it as the psychiatrist's "inability to empathize" with the patient ... inability to enter into contact with the patients personality as a whole .

... Jaspers had already suggested that a failure of empathy and understanding (Verstehen) is the common element in diagnosing schizophrenia ... Jaspers himself called this failure of empathy an experience of "the ununderstandable".

Following Jaspers, Schneider also maintained that a lack of personal rapport ... is one of the most reliable diagnostic symptoms ...

Carpenter et al. (Science, 182, 1275, 1973) ... strongly supported this assertion ... the physician's judgment that the patient is incapable of good rapport was the second most reliable discriminator of schizophrenia (reliability = .86).

These observations support the view that a loss of empathy is central in schizophrenic psychopathology. The attached paper Brain/Mind & Schizophrenia (B/M&S)  shows how other symptoms may be understood as consequences of this deficit.

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The paper B/M&S develops the thesis that a defense against empathy  −  "a withdrawal pain reflex"  −  is the cause of the schizophrenic state. Empathic identification with other people is the basis of self-reflection from an outside viewpoint, by which the space of consciousness  −  an inner, cognitive, subjective space separate from the objective outside space  −  is generated. Therefore a defense against empathy may lead to a breakdown of the distinction between inner and outer. (See the sections Seeing Oneself through Vicious Circle in B/M&S).

Since, in our thinking, the self-reflection by which our inner space is generated depends on empathic identification with the viewpoint of another member of our species we refer to this high level human brain function by the term the I(nner You) (See Achieving the Outside Viewpoint in B/M&S). Thus, you may say that the One (the I, the eye) who does the seeing in our cognitive inner space is the I(nner You) . 

The defense against empathy is vividly described by both Eva and Hebriana when they think back on their years as schizophrenics. Eva: "In those years I perceived every YOU that tried to approach me as a THREAT or as a SCORNFUL MOCKERY." Hebriana: "I did not want to have anything to do with any YOU. Today I cannot understand how I could behave as I did. So crazy! So self-destructive!" 

Sometimes a schizophrenic person manages to maintain a virtually normal façade. Even though no characteristic schizophrenic symptoms are evident, the praecox feeling, indicating a loss of empathy, is there, and the self-experience of the patient may be that she is an automaton that behaves AS IF she were a living human being (failure of self-empathy, See under The Brain's Interpreter in B/M&S).

One day in 1980 Hebriana and I were walking in town. I missed her warmth and responsiveness. The spontaneous coordination of movements that normally takes place between two people in each others company was absent. When we stopped and sat down I asked: "How come that we are unable to keep pace with each other? No matter what I do you are always slightly ahead or behind me." Although she had been autistically quiet she answered me: "We are not in the same world" (Cf. Fig.1 in B/M&S).

The story of Eva is similar to that of Hebriana. She was rescued from serious schizophrenia by a person who had the courage to stay with her and love her. Now, some 15 years later, she is a good mother and is living creatively.

Recently she has had the strength to remember and write about memories from her childhood and her years as a mental patient,  −  memories that she dared not think about before. However, this work at self-understanding, by returning in memory to her psychotic experiences, is not without danger. One day some months ago she called me, fearful that her reality was disappearing and that she was getting lost in a state of psychosis.

She was misinterpreting her perceptions. The environment was threatening. She found messages to herself in every book she opened and on TV. A noise of catastrophe filled her head.

First of all I exhorted her to remember how she looks to other people, and what behaviors might give them the idea that she is mad. Somewhat calmed she replied: "I must think of not being mad outwardly".

This suggestion encouraged her to separate the inside from the outside world, cognitions from perceptions, imagination from reality, and to adopt an outside perspective = the viewpoint of the YOU.

Only from this vantage point can the individual exercise some control of her mental processes, and thus possess freedom and responsibility, intention and will. Only by self-reflection from an outside vantage point (See under Seeing Oneself  in B/M&S) does a person have a mind-space of her own, i.e. inner light and insight. When self-reflection is lost, the mind-space disintegrates and the fragments are sucked into the darkness of the Unconscious.

Since Eva was already familiar with the idea of the I(nner You) I asked her to use that idea now: "Take a YOU inside yourself. Take a real person as your YOU. Take me if you like. Hold the hand of the YOU and tell him what is happening. Imagine that I sit next to you at a movie. But only you can see the screen. Therefore you must tell me what happens. Describe in detail what happens out there, in your world".

Next day Eva called me again: "It worked! Perfectly! I lay down and felt your hand. And I talked to you about what I saw. I got a distance. As soon as I had some distance I could make it bigger. The noise of catastrophe disappeared. (Cf. HJÄRNLARM ="brain din" in the drawing Apocalypse in the paper Love, Hope & Brain Science). I fell asleep and slept like a drunk for ten hours".

"An important thing was that I did not try to stop the film, that I saw it as inevitable". This comment by Eva reflected my instruction that she must not interfere or worry about what happens on the screen. Her responsibility was to describe it in detail.

Eva continued: "When I woke up I went out. All of a sudden I was full of joy. I knew that now everything was as it should. All danger was gone. The sun was shining".  −  "Since then I have tried many times to take in the YOU. Not out of distress, but for the mere happiness of feeling that I am in control".

Later the same afternoon Eva sent me a letter describing her experience. During the next few days Eva revised and elaborated the letter  −  aided by my questions and suggestions to make its descriptions more complete and understandable to outside readers. Eva's letter with my comments follows below.

Reading the letter and the comments we see that the following things happened when Eva activated her Inner You:

• Focused perception became possible. 
• The objective situation could be distinguished from the subjective inner world. 
• Her will returned and catatonic symptoms disappeared. 
• Ideas and perceptions could be questioned and corrected. 
• Mind-space and the dimension of time were recreated. 
• The ego and its boundaries reappeared. 
• She experienced her body as warm and alive again.

These functional attributes of the I dynamism (the main intentional field generated by the I were restored and the psychosis was overcome. (Read about the I-dynamism and about self-empathy in B/M&S.)

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Later the incident was discussed with Hebriana and with Eva. Some of their comments follow.

Hebriana: "You cannot use the YOU as a trick. It was important that you were a real person to Eva. She recognized her relation."  −  Eva: "Yes. It was important that I was able to take in a a real "fragrant" YOU. I feel a great loyalty with you."

Eva was highly motivated to ward off the threat of psychosis. Her life has a lot of meaning and leaving the human community was the last thing she wished. In her desperate phone call for help she said: "For the sake of my children, I must not become mad now!" A young virgin schizophrenic, on the other hand, is pulled towards psychosis, because she cannot believe in herself, in life, in others.

Hebriana: "The problem with me during those years was that I did not want to have anything to do with any YOU. Today I cannot understand how I could behave as I did. So crazy! So self-destructive!"  −  Eva: "In those years I perceived every YOU that tried to approach me as a THREAT or as a SCORNFUL MOCKERY."

 Hebriana: "When you are so lonely you behave in ways that make you even more lonely and isolated. You are in a negative feed-back, in a vicious circle, without being able to understand what is happening to you."  −  Eva: "Without the distance (achieved through the Inner You) the process of disintegration just goes on."

The comments by Eva and Hebriana capture the essence of the human situation of a schizophrenic person. The "need-fear dilemma of schizophrenia" means that what you need the most you also fear the most.

A defense against activation of the I (the main frontal integrator) distinguishes schizophrenia from other types of psychosis (See under Vicious circle in B/M&S. See also Note 15 in B/M&S comparing schizophrenia with other psychoses). The result is a state of mental laissez-faire (cf. Emancipation of i's in B/M&S).

When I told Hebriana that my paper (Brain/Mind & Schizophrenia) explains hallucinations, she interrupted me and gave  −  as if she had read my mind  −  her explanation: "A person has the power to think. If you refuse to use your thinking power  −  if you abdicate  −  thinking will go on all the same, and your thoughts will be heard as hallucinations".

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We heard Eva and Hebriana agree that the YOU should be a real believable persons. On the other hand, an incident described by Ken, also a former schizophrenic, shows that he could use his theoretical, impersonal understanding to avert a psychotic break.

Ken became schizophrenic some 5 years ago, towards the end of his university studies. Today, however, he is free from symptoms and from drugs and has a demanding job with computers at Volvo. He has understood that psychosis is overcome when the individual is able to see himself and his situation from an outside point of view.

JOOTSing (=to Jump Out Of The System) is a term from D R Hofstadter Gödel, Escher, Bach, a book that I suggested to Ken when he asked for literature relevant to the problem of psychosis. JOOTSing implies the creation of a distance and a perspective. It means that the person sees himself in the situation from the outside.

Ken works in a group of engineers. Sometimes "discussions for the sake of discussion arise, and there is no purpose except to have the last word. It's a wretched spiritual poverty!" He recognized this kind of thing from before. When he became schizophrenic he had suffered from such attitudes among his student friends for some time before the psychotic break.

 − "The mad feeling I had 5 years ago came over me. Everything almost went black before my eyes". 
 −  "Blushing with anger I averted the situation". 
 −  "I think I JOOTSed at the last moment ". 
 −  "Now I have readjusted myself within this group of people".

Ken was able to use his theoretical insight to avert psychosis. JOOTSing means activation of the I(nner You).

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Appendix:  1.) The Letter from Eva.  2.) Comments to the Letter

Lars!

Its fantastic! Introduce a YOU into consciousness. You gain control of your attention. Things become distinct and sharp. By means of you, Lars, and Helen (another friend) I guided myself through my anxiety. I imagined that you were here very close, listening. Now I was no longer a helpless victim, but a witness. A distance arose. I was no longer engulfed and overwhelmed.

I became aware that my neck and the left half of my chest had become rigid. The rigidity was due to a terror turned inward and outward at the same time. Because my extreme vigilance was turned inward and outward at the same time the stress was so intense that my energy was burned out. Thus I became cold and rigid.

On the outside I was threatened by rape and murder − I heard the murderer outside my door (I did not realize that it could be the cat of my neighbour). The threat from the inside was an inexorable process of disintegration − a black hole was approaching while the din of catastrophe and chaos was sounding.

While I was telling you about all of this, the terror and the rigidity subsided. I recognized the cat as a possible explanation of the sound from my door. Thus I was not, as I had felt, back in my old schizophrenic life, back in my room on East Avenue ten years ago, where disturbed men came to me. Maybe they were attracted to me because their desperate hunger for love could only be expressed in a violence that sought my fear and defenseless vulnerability.

I could breathe again, I relaxed, and my body warmed up. In my inside I continued the dialogue with you and Helen about my old life. I came to the conclusion that the disturbed men I became involved with actually were ME. That explains why I could not identify with my terror and defend myself.

I also had the desire to understand what happens in the mind of those who torture other people. I wanted to help them to regain a feeling for the sacredness of life and of the YOU. I thought a lot about Amnesty International, but I cared as much about the persecutors as about the victims.

I have continued to observe myself by means of a YOU. The blood rushes through my body. I feel whole and alive. It is so wonderful! I am almost crazy with joy.

Thank you, Lars. And thank you, Eva, that you were not too stupid to take Lars' advice. Forgive me, help me, and thank you, God!

Eva.

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1.  "Introduce a YOU ... You gain control of your attention. Things become distinct and sharp." By means of the the I(nner You) the individual achieves a distance to her mental processes. This makes possible a focused perception. People and things become clearly defined. It also makes possible the separation of the outside objective from the inside subjective world ). "I was no longer engulfed."

2.  The rigidity in certain parts of the body described in the letter are catatonic symptoms. When the catatonia spreads to involve all of the body it turns into a statue. Even though vigilance and mental level of activity may be intense, the individual is powerless when the inside and the outside worlds have collapsed into an incomprehensible chaos. The I(nner You) means a deliverance from the catatonia. "While I was telling you about all of this, the terror and the rigidity subsided."

3.  Eva had lost her orientation in time and space and her capacity to question ideas and perceptions. She was both in her present life and back in an earlier life situation in another house. She was incapable to question the immediate interpretation by her brain of the sound from her door. This interpretation was determined, not by the present situation, but by fears belonging to her earlier life.

By means of the YOU the I-dynamism, consciousness, reality were restored. Consciousness is the mindspace that makes possible insight and a critical attitude to ideas and perceptions (See Hallucinations and Loss of Reality, Loss of Insight in B/M&S). "I recognized the cat as a possible explanation of the sound from my door". Reality is characterized by the dimensions of time and space, by which NOW and THEN, HERE and THERE can be distinguished. "Thus I was not ... back in my room on East Avenue ten years ago."

4.  " ... the disturbed men ... were ME." The boundaries to other people, between Self and other, were wiped out by an identification so complete that self-identity and the instinct of self-preservation disappear.

5. An activated I dynamism means not only insight and intellectual order, but also the overcoming of emotional and physical stress and disorder. The frontal lobe is at the top of the functional hierarchy of the brain in position to modulate functions in all of the nervous system. The I therefore spells order throughout brain and body. Eva writes: "I could breathe again, I relaxed ... The blood rushes through my body. I feel whole and alive."

6. "Forgive me ... God." Eva and Hebriana have characterized schizophrenia as "the greatest sin" and as "the ultimate hubris," respectively. They were thinking of the fact that schizophrenia is an abdication of responsibility and a denial of one's human relatedness.

Thus, we saw the following things happen when Eva activated her Inner You:

• Focused perception became possible. 
• The objective situation could be distinguished from the subjective inner world.
• Her will returned and catatonic symptoms disappeared. 
• Ideas and perceptions could be questioned and corrected.
• Mind-space and the dimension of time, were recreated.
• The ego and its boundaries reappeared.
• She experienced her body as warm and alive again.

As these functional attributes of the I dynamism were restored, the psychosis was overcome.

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