I would probably go for his meta–goals then. «You want to recover memory. For what purpose?» «So that when I meet people from my past I would know how to treat them.» «Oh, so what you really want is not to recover memory. You want a way of gracefully dealing with the situation of meeting people who claim to be from your past.» One way to get that outcome for him would be to teach him a little «fluff.» «Gosh, it's been so long! Where was it?» It's quite easy to teach him «fillers» that will gracefully elicit all the information he needs to respond appropriately.
Whenever there is a direct conflict on any level, you just jump up to the next level. You ask for the meta–outcome. «What will you gain from this? What purpose will this achieve for you?» Once you know this, you can offer alternatives that are much more elegant. He will soon give up his original request, because recovering his history will have no function for him anymore.
Janet: As far as I can tell, his family situation continues to be horrendous. I tried saying «Well, you can't remember anything, so why don't I just have your family tell you the good things that happened in your life?» His family couldn't come up with anything!
Another alternative would be to make him a good hypnotic subject, with the goal of creating a new personal history for him. Get him to agree to using hypnosis, not for recovery of his memories, but for building him a new personal history. If you got a bad one the first time around, go back and make yourself a better one. Everybody really ought to have several histories.
Janet: How would you do that?
Directly. You can say «Look, you're a talented guy, but you don't know where you came from. Where would you like to have come
from?»
Janet: This is an unsophisticated farmer.
That makes it easier. The toughest of all clients to deal with are sophisticated psychotherapists, because they think they have to know every step of what you are doing. They have nosy conscious minds.
In the book Uncommon Therapy a case is described in which Milton Erickson built a set of past experiences for a woman. He created a history for her in which he appeared periodically as the «February Man.» That case is an excellent source for studying the structure of creating alternate personal histories.
Fred: Is schizophrenia another example of sequential incongruity and dissociation?
People diagnosed as schizophrenic usually have certain aspects of themselves which are severely dissociated. However, the dissociation is generally simultaneous. For example, a schizophrenic may hear voices and think the voices come from outside of himself. The voices are dissociated, but both «parts» of the person are present at the same time.
Fred: OK. I have been working with schizophrenics for a long time. I have been using some of your techniques, but not as efficiently or precisely as I would like. What particular adjustments would you suggest with so–called schizophrenics?
From the way you phrased your question, I take it you've noticed that some people who are classified schizophrenic don't manifest the symptoms which other people with that label have. There are two ways in which working with a schizophrenic is different from working with any of the people here in this room.
One is that people labeled schizophrenic live in a different reality than the one most of us agree upon. The schizophrenic's reality is different enough that it requires a lot of flexibility on the part of the communicator to enter and pace it. That reality differs rather radically from the one that psychotherapists normally operate out of. So the issue of approach and rapport is the first difference between dealing with the so–called schizophrenic, and someone who doesn't have that label. To gain rapport with a schizophrenic you have to use all the techniques of body mirroring and cross–over mirroring, appreciating the metaphors the schizophrenic offers to explain his situation, and noticing his unique nonverbal behavior. That is a very demanding task for any professional communicator.
The second difference is that schizophrenics—particularly those who are institutionalized—are usually medicated. This is really the most difficult difference to deal with, because it's the same situation as trying to work with an alcoholic when he's drunk. There's a direct contradiction between the needs of psychiatric ward management and the needs of psychotherapy. Medication is typically used as a device for ward management. As a precondition to being effective in reframing, I need access to precisely the parts of the person that are responsible for the behaviors I'm attempting to change. Until I engage those parts' assistance in making alterations in behavior, I'm spinning my wheels— I'm talking to the wrong part of the person. The symptoms express the part of the person that I need to work with. However, the medications considered appropriate in a ward situation are just the medications which remove the symptoms and prevent access to that part of the person.
Working effectively with people who are medicated is a difficult and challenging task. I have done it a half–dozen times, but I don't particularly enjoy it. The medication itself is an extremely powerful anchor that is an obstacle to change.
Let me tell you a little horror story. A young man was wandering down the street of a large city after a party. He was a graduate student at the university there. He'd been smoking some dope and drinking a little bit of booze. He was wandering along, not really drunk, but certainly not sober. At about three o'clock in the morning he was picked up by the police and taken in for being drunk in public. They fingerprinted him and ran a check on him, and it turned out that he had been in the nearby state mental institution several years previously. When he was there, he'd been classified as a schizophrenic, and had the good fortune to run into a psychiatrist who is a really fine communicator. After the psychiatrist worked with this young man, he had altered his behavior, was released, and was doing quite nicely in graduate school. He'd been fine for years.
When the police discovered this history of «mental illness," they decided that his behavior wasn't the result of alcohol or drugs, but rather the result of a psychotic lapse. So they sent him back to the state mental hospital. He was put back on exactly the same ward he'd been on before, and given the same medication he'd been on before. Guess what happened? He became schizophrenic again. He was anchored right back into crazy behavior.
This kind of danger is my reason for insisting that the test for effective work with an alcoholic be exposure to the chemical anchor that used to access the dissociated alcoholic state—to have the client take a drink. Then you need to be able to observe whether taking a drink leads to a radical change in state—whether there is a radical shift in breathing and skin coloring, and all the other nonverbal indications of a change in state. If there is such a shift, then you don't yet have an integrated piece of work; you still have more integration to do.
If you take the challenge of working with institutionalized schizophrenics, you can make your work a lot more comfortable and a lot more effective if you make some arrangement with whomever is in charge of drugs on the ward. Being effective in a reasonable amount of time is going to depend upon your ability to work with people while they are not on drugs, or upon your ability to establish hypnotic dissociated states in which they are essentially independent of chemicals. Those are very difficult tasks; it's a real challenge.
Janet: I have a client who was diagnosed schizophrenic. She was on medication which she's off of now, but she's beginning to hear voices again. That's scaring her. She's very frightened.
Well, first of all, it doesn't frighten her. She has a physiological kinesthetic response to hearing the voices. At the conscious level she has named that response «being frightened.» That may sound like semantics, but it's not. There's a huge difference between the two, and reframing will demonstrate that difference.