The Acute Schizophrenic Psychosis
Charles Konia, M.D.
Reprinted from the Journal of Orgonomy, Vol.13 No. 1
The American College of Orgonomy
In the orgone therapy of schizophrenia, all degrees of anxiety, from the oldest form (as ambulatory cases) to full-blown panic, are encountered. The significance of this panic in the schizophrenic is that a clamping down of the ocular segment leads to an increased disruption of the unitary biophysical functioning and to psychosis. In dealing with the schizophrenic patient, it is therefore necessary that the therapist understand the limits of each individual's capacity to tolerate anxiety and know exactly what to do in cases where a psychotic episode (which constitutes a biopsychiatric emergency) does occur.
In general, the extent of preexisting bodily injury (exclusive of the ocular segment) determines how successfully the schizophrenic can defend against a psychotic breakdown. The acute schizophrenic has a better prognosis and is easier to treat than chronic cases. 1 With each successive psychotic attack, biophysical deterioration may occur. This is because breakdown of armor in the lower segments is accompanied by an intensification of ocular armor which is needed to deal with the increase in anxiety. Therefore, unless armoring of the lower segments occurs spontaneously in untreated cases, therapy becomes increasingly difficult depending on the length of time this process of deterioration has continued. Reich felt that this impairment actually involved shrinkage of the brain itself.
The differential diagnosis of the acute schizophrenic psychosis consists of psychosis due to other causes: organic syndromes, drug and alcohol psychosis (alcoholic hallucinosis 2 ), epileptic furor, and the so-called functional psychoses including manic depressive psychosis.
The organic psychosis can be ruled out by taking a careful history, testing for organicity in the mental status, and performing appropriate medical tests. In cases of drug or alcohol abuse, one elicits a history of ingestion. The diagnosis of manic depressive psychosis and epileptic furor (which can be mistaken for catatonic excitement) is more difficult during the acute psychotic attack. Once the psychosis is eliminated, however, and the underlying premorbid personality emerges, one can usually differentiate these cases. A positive EEG is helpful in diagnosing epilepsy. An important differentiating feature in the premorbid makeup of the manic depressive is that he is basically extroverted. Similarly, there is no disturbance in thinking in the nonpsychotic manic depressive.
Three cases of paranoid schizophrenia will be presented. All three cases dealt with the patients' first psychotic episode. The first two will deal only with the acute psychotic phase. In the third case, a detailed description of the onset of an acute psychotic attack that occurred during the end stage of therapy will be given to provide a deeper understanding of the origin of the psychotic attack.
The patient was a 37-year-old, single, white, male policeman who came to therapy because of severe anxiety attacks and restlessness accompanied by almost uncontrollable homicidal urges. These were primarily directed towards his girl friend and had intensified in the past month. His anxiety first began after several heavy bouts of drinking hard liquor. He was given tranquilizers, which gave him moderate relief. Although he had been very conscientious and had high goals in life, he began feeling totally alienated from society and gradually lost all his ideals. Continued heavy drinking brought out his paranoia and made him belligerent and socially obnoxious. Sexually, he behaved like an extreme Don Juan but was becoming threatened by fears of erective impotence. He began smoking marijuana to relieve his anxiety and help his sex drive. Potency was vital to him, and he attempted to over-come feelings of inadequacy by behaving sadistically toward his sexual partners with either fantasied or actual beatings. He realized that underneath his apparent toughness there was a great deal of anxiety.
One month prior to my seeing him, his anxiety attacks, as well as his sadistic urges during sex, suddenly increased in both intensity and frequency. One night, after heavy drinking, he began retching violently. This was the onset of a further intensification of his sadistic impulses and he had insomnia and constant nightmares 3 . He could not concentrate, was afraid of strangling his girl friend, and felt that he was going insane. He consulted a psychiatrist who gave him tranquilizers and recommended that he be hospitalized because of his homicidal tendencies.
It was at this time that I first saw him. On the initial interview, he appeared extremely tense and frightened. Biophysical examination revealed that he was athletic in build and had a very high energy level. The musculature of the face, scalp, and head was severely contracted. His occiput, especially the deep musculature was very tender, and his face was pale. Subjectively, the patient felt a generalized tightness in his head, which was especially severe on the left side. He complained that his forehead and eyes felt numb. Little armor was present in the lower segments including his pelvis, however, and he had a very strong pelvic reflex. 4
He had difficulty thinking clearly. His past history was unremarkable except that he had had surgery for strabismus in the left eye as a child. He was amblyopic in this eye.
On the couch, he appeared terrified, tense, and ready to explode. When I asked him what he thought of me, he became bristly and antagonistic, immediately venting his negative criticism. He saw me as being "authoritarian." He thought I was "cold" and "businesslike." This gradually led to a violent outburst of rage with hitting and kicking the couch. He strangled a towel and shouted at an imaginary authority figure, and then at his mother and sister. This rage produced momentary relief and alternated with a feeling of pressure and clamping down in his head.
My impression was that this patient was on the verge of psychosis because of the emergence of uncontrollable sadistic impulses to over-come his deep fears regarding his sexual potency. Despite the severity of his illness, I felt that his prognosis was good because of his strong phallic structure and the easy accessibility of his intensely sadistic impulses, provided, of course, that he could confine his outbursts to the therapeutic situation. Another reason for a favorable prognosis was that he was in good contact with his fears and distrust of therapy. This enabled him to have an objective attitude and cooperate with my therapeutic efforts. I emphasized that it was crucial to restrict his murderous impulses to therapy and told him that I could agree to treat him only if he assured me that he would contact me immediately if he could not control these impulses. He agreed. I also told him to continue taking tranquilizers whenever he felt homicidal or in danger of losing control.
By the second session, he appeared somewhat quieter. He reported an improvement in potency. Mobilization of his tense occiput produced deep breathing. He "saw" his mother's hand coming to pick him up. Then his father's face became superimposed on hers. He became acutely fearful that he might be a homosexual. His pelvis began to writhe. In an attempt to overcome these feelings, a strong outburst of sadistic impulses followed. He shouted "Stop it!" as he hit his head and pelvis violently on the couch.
By the fourth session, his eyes felt clearer and he was feeling better generally. Further mobilization of the occiput revived the memory of a recurrent childhood nightmare: There are two glass telephone booths. He is boxed in one of them. His mother has a choice of going into either booth, and she chooses the empty one, which leads him to feel abandoned and terrified. This dream illustrates not only the extreme fragility of his armor (he is enclosed in a glass cage), but also his intense terror of maternal abandonment. I asked him to breathe. He felt the walls of the room closing in on him, and he became acutely belligerent. I therefore told him to stop and relax. Later in the session, he reported feeling generalized, pleasurable tingling, "like after sex."
I continued to mobilize his eyes and focused on his expressing anger. My object was to enable him to express increasing intensities of anger to the point of losing control in order to relieve the severe ocular armor and panic. Expressing anger with his eyes open regularly produced feelings of well-being and reduced his fears. He expressed intense sadistic impulses, fantasizing all kinds of sexually sadistic acts towards everyone in his life for entire sessions at a time. Anger that was not expressed through the eyes, however, resulted in a further clamping of the head. I, therefore, discouraged any expression unless it was shown in the eyes as well. Another situation that produced a clamping down of his head was when he behaved in a sexually sadistic way with his girl friend. Typically, pressure would develop in his head, together with an intensification of his fears of insanity. This sadistic acting out also had to be constantly discouraged.
Providing an outlet for his intense sadistic impulses in therapy eliminated his homicidal impulses and produced an improvement in his sexual functioning and in his general well-being. He was gradually able to taper off tranquilizers and finally stopped taking them entirely. Very slowly, as the tightness he felt in his head was relieved, it became possible to reach progressively deeper layers of armor. He began tolerating soft feelings for women and felt more genuinely sexual. Accompanying these changes, he became able to think more clearly and was more rational in dealings with people and his work. At this time, his amblyopia was eliminated.
This 23-year-old, white, male, married factory worker came to therapy because of feelings of insecurity at work and progressively severe anxiety.
Several months before, he had developed ideas of reference and began having accusatory auditory hallucinations. This occurred when he attempted to control his anxiety at work. He heard voices calling him a homosexual.
He found it increasingly difficult to cope with his work situation, to deal with his relationship with his boss and his coworkers, and he began experiencing sexual difficulties (impotence) with his wife. Auditory hallucinations began following a period of intense anxiety accompanied by an "inner shakiness." These symptoms were triggered by anxiety-producing work situations.
During the initial interview, the patient appeared tense and anxious. There was no thinking disorder on this occasion, and he spoke relevantly and coherently. He stated that his problem began when various union officials began to exert pressure on him to slow down on his work. He acquiesced even though he was typically a hard worker. He felt intimidated by them and had fears of being a homosexual. He felt this especially when he saw these men scratching their crotch area, which made him think they were interested in him sexually. He attempted to overcome his passive homosexual feelings by becoming bristly, but this only further alienated him from his coworkers.
Biophysical examination revealed that the eyes were proptotic, and they appeared frightened and suspicious. When asked to move them, he could do so only by moving his head as well. The occipital muscles were extremely tense and tender. His face was stiff and the jaw tightly clenched. His neck was armored, and his chest was held high in inspiration. The rest of his body appeared to be relatively free of armoring. Since his terror was close to the surface, as indicated by the frightened expression in his eyes, I asked him to open his eyes wide and express his fear through screaming. This produced considerable relief. In addition, I pressed on the tense occipital muscles and asked him to scream when he felt frightened. This produced a fear so intense that he felt his head was about to come off. This led immediately to feelings of anger, which I encouraged him to express as well.
By the fourth session, the hallucinations had diminished, and he began to feel calmer. I asked him to roll his eyes from side to side and look out of the corners to elicit feelings of suspiciousness. This intensified his fears of being a homosexual, and he discussed the homosexual feelings he'd felt from talking to the union leader.
By the sixth session, the patient appeared more aggressive and less frightened. He reported that the hallucinations were becoming less derogatory. At this time, I was able to mobilize more terror from his chest. Deep breathing produced a feeling of tightness under the sternum. Manual pressure to relieve the tension produced terrified screaming. This was immediately followed by a complete disappearance of the hallucinations. He felt a tingling and pulsation of the face, eyes, and occiput. During the following week, he felt more relaxed in dealing with people.
By the twelfth session, the auditory hallucination had been eliminated. Within the next few months, he regained his confidence and lively sense of humor that had been present prior to his illness, and he became more effective in dealing with others. He stated that for years he had had to bend backwards to accommodate others. Now, he is finding alternate ways of handling people. As his sexual sensations increased, his heterosexual functioning markedly improved, and his fears of being a homosexual disappeared. Although this patient had not achieved orgastic potency when discharged (over six years ago), he has retained his inroads in health and has been functioning satisfactorily since then.
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* Medical Orgonomist. Diplomate in Psychiatry, American Board of Psychiatry and Neurology.
1. Hebephrenia is an exception to this rule. In these cases, the prognosis is unfavorable even at the onset of any manifest symptomology.
2. Alcoholic hallucinosis is probably an acute paranoid psychosis that is triggered by alcohol.
3. Gagging spontaneously mobilized the armor in the lower segments and increased the energy push from below.
4. Pelvic armoring binds great quantities of energy. Schizophrenics typically have light pelvic armoring. However, this absence of armor does not imply the presence of orgastic potency since the energy is not available for genital discharge.
© 2008 The American College of Orgonomy. All rights reserved.
