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The fundamental work for a new psychological understanding of schizophrenic disorders: A cognitive theory of neuroses based on memory psychology for the first time leads to the knowledge of neurotic-psychotic developments as a result of the Overencoding of irrational neurotic attitude structures in memory. They lead to one-sided search processes in the memory and provoke extremely irrational (delusional) processing errors and further overneurotic changes in the thinking, feeling and acting of the schizophrenic. A comparison with the disturbable artificial intelligence of an Internet search engine serves to illustrate memory-psychological connections. A four-stage psychotherapy of schizophrenic disorders based on the Overencoding theory is presented in contrast to conventional neurosis therapy and discussed in an article by Prof. Manfred Bleuler.
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About this book and its author...
This book approaches the causes, symptoms and psychotherapy of schizophrenic psychoses with a new memory-psychological understanding of neurotic disorders. It did that almost 4 decades ago after its author, who was still a psychology student at the time, had tried for the first time to transfer his cognitive-psychological understanding of neuroses to the mysterious experiences he had as an intern in the closed ward of a psychiatric clinic. To his surprise, he had not only recognized neurotic prehistories in the biographies of schizophrenics, but also striking symptomatic overlaps between the neuroses and schizophrenic psychoses, which are generally considered to be dissimilar in nature. So he began to write down his discoveries while he was still doing his internship. Unfortunately, the resulting first version of this book was to remain unpublished. Even though it was none other than the internationally well-known Swiss psychiatrist Manfred BLEULER (son of Eugen BLEULER), who has since passed away, who presented the book in its original form to international experts even before it was published. After a lively exchange of ideas by letter with the author, he did so in his introductory contribution to a handbook of schizophrenia research, in which he stated about his own disharmony theory:
“This ‘disharmony concept‘ of schizophrenic psychoses is so evident when surveying our manifold knowledge that several clinicians and researchers have arrived at similar concepts even when their studies have started from different points of view. Particularly important are the concepts of Zubin who contrasts the vulnerability to schizophrenic psychosis with their outbreak, and of CIOMPI who opposes the chronic development to the acute episodes. From a biological and genetic point of view, KETY and GOTTESMAN, from the analytical point of view BENEDETTI and SCHARFETTER and from the point of view of cognitive psychology CHRISTMANN have arrived at similar concepts.“(“Introduction and overview” in “Handbook of Studies on Schizophrenia”, Burrows et al. 1986)
But that's not all: From the point of view of a schizophrenia researcher who is psychologically open to all sides and has decades of professional experience, Manfred BLEULER also wrote an article especially for the first version of the book now available. In it he compares the Overencoding-Theory of neurotic-psychotic developments with his Disharmony theory and comes to the conclusion that these do not contradict each other in any respect.
Nevertheless, this book was not to be published. First of all, its author and still a student had to write a second diploma thesis, because his first one (“Irrationalität und Wahn“/“Irrationality and delusion”) had been rejected as “inadequate” by the second examiner, frustrated by its incompatibility with basic psychoanalytic assumptions. He dismissed Manfred BLEULER's professional judgment as "friendliness" and later only said to BLEULER’s quote about the student’s schizophrenia theory in an international manual: "I don't want to comment on this and I don't want to comment on why I don't want to comment on it!“ So the delay in completing his diploma and the associated material struggle for existence caused the young author to turn away from schizophrenia research and to find an other professional orientation after a successful second diploma thesis.
Still, this book was given plenty of time to mature. Because the more certainty grew for his author that he would never again have to be dependent on an elitist, authoritarian academic establishment determined by personal narrow-mindedness, he returned to his topic. Through further clinical research results and results from other scientific fields, such as findings on the neuronal plasticity of the brain after learning experiences (cf. NIERHAUS, 2019) and from the broad research field of artificial intelligence (cf. SCHMIDT-SCHAUß & SABEL, 2016), the core theses of the Overencoding-Theory were further supported and more and more differentiated.
But the form of the book also began to change. Its content was gradually reformulated in such a way that it could also be understood and thus helpful for a non-academic readership, for all psychiatric assistant professions and also the relatives of schizophrenics ( 7.12 7.13). Again and again the author looked for new ways to clarify even more clearly the central message of a cognitive psychology of neurotic-psychotic developments.
In particular, with recent developments in the field of artificial intelligence of Internet search engines, another generally understandable area emerged that was suitable for clarifying mental connections of cognitive-emotional information processing. After all, the mental information processing of humans and that of an Internet search engine not only overlap in their objective of being useful through knowledge for individual coping with life and to reach subjective well-being. They are also similar in their methods of achieving this:
To selectively perceive information on a wide variety of sensory channels and store it mentally in order to be able to use it again later according to its relevance for a situational assessment of reality and for the retrieval and emotional motivation of behavior.
In this way, this book in its current version became an exciting adventure with a number of uncertainties. Not because there were doubts about his goals and actual core statements. These have been clearly defined since its inception in the 1980s:
A cognitive psychology of human error in reasoning up to their neurotic and delusional forms should be designed. One that should particularly take into account the undeniable existence of a human database, the memory and its importance for mental information processing.
Rather, the risk of this book lies in the fact that it compares the information reservoir of the Internet with human memory, this immeasurable database from a person's biography. Consciously or unconsciously, there is a constant search for information that, depending on the search result, decides on the rationality or irrationality of individual thinking, feeling and acting.
The readers of this book can now judge for themselves whether this comparison also facilitates the psychological understanding of neuroticpsychotic developments.
D.K.C. in spring 2023
Meaning of the pictograms used
neural bases of mental processes
Section particularly interesting for relatives / partners of schizophrenic people
Case histories / clinical observations
Psychotherapeutically relevant facts
Contents
Preface
100 years of schizophrenia research
If computers could become schizophrenic
Our memory - control center of thinking, feeling and acting
Irrational thinking, feeling and acting in Neurosis
Causes of neurotic-psychotic developments
5.1 Overneurotically frequent stressing experiences
5.2 Neurotic attitude conflicts
5.3 Extremely traumatic experiences
5.4 Brooding memorizing thought activities
5.5 Attitude deficits
5.6 Irrational indoctrinations
The symptomatology of schizophrenic disorders
6.1 Changes in the content and awareness of schizophrenic thinking
6.2 On the emotionality of schizophrenic disorders
6.3 On the behavioral symptoms of schizophrenic disorders
6.4 Attention symptoms of schizophrenic disorders
The psychotherapy of schizophrenic disorders
7.1 The unknown affinity of neurosis and schizophrenic psychosis
7.2 The psychiatric pathologization of the neurotic history of schizophrenics
7.3 Drug treatment for schizophrenia: half a thing half-heartedly implemented
7.4 Classic medical treatment methods: only incidentally psychotherapy
7.5 The psychology of schizophrenic disorders: unloved by all
7.6 Overencoding-theoretical basics of a psychotherapy of schizophrenic psychoses
7.7 Neurosis vs. schizophrenia therapy: Fundamental differences from an overencoding-theoretical point of view
7.8 Psychotherapy for schizophrenic psychoses -
Stage 1:
The delusion-suppressive therapy phase
7.9 Psychotherapy for schizophrenic psychoses -
Stage 2:
The stimulus-controlled therapy phase
7.10 Psychotherapy for schizophrenic psychoses -
Stage 3:
The attitude-centered therapy phase
7.11 Psychotherapy for schizophrenic psychoses -
Stage 4:
The rehabilitative therapy phase
7.12 The cooperation of relatives in the psychotherapy of schizophrenic psychoses: opportunities and limits
7.13 A guide for family members, partners and friends of schizophrenic fellow human beings
For the prevention of neurotic-psychotic developments
8.1. Preventive health policy
8.2 Preventive education policy
8.3 Preventive labor market and economic policy
8.4 Preventive family policy
Contributions to a psychotherapy of schizophrenic psychoses
9.1 Comparison between two views on the development of schizophrenic disorders: Christmann's overencoding theory and M. Bleuler's dysharmony theory
Bibliography / Web-links
Index
Preface
Ever since Eugen BLEULER coined the term “schizophrenia” in his Psychiatric Manual in 1911, entire libraries have been filled with information about this mysterious mental disorder. And yet it has remained a mystery! So why another book about it? Where do we get the optimism or even the "megalomania" that we couldn't, like everyone else, fail because of the many unanswered questions about the development, the symptoms and the therapy of schizophrenic disorders?
The answer is, we have a guess why the many scientists in the past have had to fail! Couldn't it be that the essence of schizophrenia can only be understood if one has first understood the neuroses? After all, it would be possible that one, schizophrenic illnesses, arises from the other, the neuroses. Then it would not be surprising that scientists who have not even understood the neuroses must also fail in the even more complex world of phenomena of schizophrenic changes in human beings!
But we have another assumption that drives us: We not only assume that the many schizophrenia researchers have so far lacked and still lack a psychological understanding of the neuroses, but that there is also a simple reason why they had and still have their problems to understand the neuroses. It is quite the confusion and the scientific inability to theoretically explain even the healthy thinking, feeling and acting of humans without contradiction and comprehensively to make useful predictions about it! So how can it be surprising that they have so far not been able to derive any understanding of the neurotic thinking, feeling and acting in humans?
With these assumptions, our stages on the way to a comprehensive understanding of schizophrenic disorders are already mapped out:
Our concept of neurotic-psychotic attitude developments naturally contradicts the previous convention of the strict separation of neurosis and psychosis. After all, almost every psychologist and psychiatrist has learned that mental disorders are either neurotic or psychotic and that the two classes of disorder have nothing to do with one another - as if they showed completely different symptoms and therefore had to have different causes. This fallacy is due to the fact that physicians unfortunately deal less with neuroses than with schizophrenic psychoses. Psychologists, on the other hand, are seldom forced to apply their already contradictory conceptions of the neuroses to the phenomena of schizophrenic disorders. But both professional groups would only have to compare the history of schizophrenics with that of neurotics to be able to recognize
Instead, however, psychology is currently still leaving the schizophrenic and depressive psychoses to medical psychiatry, because of the limitations of its neurosis therapeutical methods. So in psychiatry, "evidence-based", neuroleptics are used with modest success and unpleasant side effects, of which no one can say to this day why and how they have a limited effect on the delusional conviction of schizophrenics and whether they could have an even better and even lasting effect if they were used in combination with subsequent social- and psychotherapy, as we shall describe later (7).
1100 years of schizophrenia research
Brief review of 100 years in Psychology Failure and Medical wishful thinking
Summary
The currently prevailing psychiatric understanding of schizophrenia is characterized by a lack of psychological foundations and the dominance of biological assumptions. The fact that the neurotic biography and the overneurotic symptoms of schizophrenics today remain unrecognized goes back to 100 years of failure in clinical psychology and to biological wishful thinking in psychiatry, with which it is still trying to distinguish itself as a medical subdiscipline.
If we want to look back at the bleak history of schizophrenia research, we don't do it to gloat over its failure, but to learn from it. Having the advantage that we can look back on the history of research from the point of view of our own scientific knowledge we can quickly guess, why the common answers of psychiatry to the "riddle of schizophrenia" (cf. e.g. HÄFNER, 2016) are not revolutionary different today like 100 years ago during Eugen BLEULER’s lifetime (cf. E. BLEULER, 1911)
The first evil that we encounter again and again in the history of schizophrenia research is their refusal to apply a general psychology of human psychic life also to the psychic life of schizophrenics. In the history of schizophrenia research, we repeatedly encounter the dominance of "medical hardware specialists" who absolutely wanted to find the cause of schizophrenic diseases in "organic hardware errors" (e.g. in genetic defects of the brain substance or brain chemistry) unable to unterstand the psychology in human information processing. Whether out of prestige-laden professional thinking or out of necessity, as a medical professional not having been trained to deal with psychological illnesses anyway, the schizophrenic should only be a “defective organism” that should be repairable with pills, devices and treatments.
So we have to report dark times when schizophrenics had all their teeth pulled out because medical theories of general infections suggested this. In the 1920s, driven by theories of self-poisoning of the organism, enemas were used and sometimes bowel resections were performed on schizophrenics (cf. KLERMAN, 1978). Other "theories" of alleged physical causes even ended in castration or sterilization for schizophrenics - not to mention the darkest times of the murder of schizophrenics from the 1930s onwards, when schizophrenics were only considered a "danger for public health" because of their alleged "genetic burden. (cf. BRÜCKNER, 2014).
As early as the end of the 19th century, when brain research had gained in importance, the idea, or rather the wishful thinking, was circulating among physicians that all mental disorders, especially those of “the crazy ones”, were nothing more than different brain diseases. Since Emil KRAEPELIN (1856 - 1926), psychiatrists have therefore seen their only task in assigning the alleged brain diseases to "disturbed brain areas" or "biochemical metabolic diseases of the brain" and sorting them according to superficial symptomatological similarities.
Emil KRAEPELIN (KRAEPELIN, 1899) undertook the first attempt at categorizing according to this model with his attempt to differentiate what he believed to be schizophrenia (“dementia praecox”, KRAEPELIN, 1899), which ended in early dementia, from “benign” “schizo-affective” psychoses with predominantly emotional symptoms. In the end, however, KRAEPELIN had to admit that his superficial system of categories was not enough to classify in it the incomprehensible variety of schizophrenic symptoms. Finally, he even conceded that the personality of a patient, his (in our opinion overneurotic) life story, his material and social situation, which cannot be overlooked, could at least be “pathoplastic”: they should at least be able to “shape” the appearance of a schizophrenic illness, but under the dominance of medical brain research and in the absence of a usable psychological theory of schizophrenia, were still not allowed to be causal.
The next psychiatrist to become internationally known in schizophrenia research was Eugen BLEULER, who “invented” the term schizophrenia in 1911 when he first spoke of a “group of schizophrenias” (“Gruppe der Schizophrenien“, E. Bleuler, 1911). He was even more concerned than KRAEPELIN with the supposedly "disease-forming" (but not causative) factors of schizophrenic diseases and also drew on theoretical considerations of Sigmund Freud's psychoanalysis, which was emerging at the time later dominating psychiatry up to the 1970s (cf. FREUD & BLEULER, 2012).
The fact that these psychoanalytic ambitions in psychiatric research had to lead it into a psychological dead end brings us to the second evil in the history of research on schizophrenia: the inability of psychology and medicine to develop a useful general psychology from which the nature of schizophrenic disorders could also be grasped. Unfortunately, however, Freud was an example of fruitless theoretical drafts in his efforts to prove his medical qualifications by means of a medical-biological general psychology. From the outset, its usefulness for schizophrenia research must be very limited, because it paid no attention to two essential theoretical requirements for psychological theory formation:
Unfortunately, psychoanalysis, with its biologistic theory of instincts and its “highly medical”, mechanistic energy model, was only of little use for Eugen BLEULER and the entire research on schizophrenia afterwards (cf. FINZEN, 1984, CULLBERG, 2008). Human beings had to be incapable of learning, even in their thinking a victim of sexual and aggressive impulses. Instead of learning from experience (and thus being able to succumb to an equally extreme delusional worldview under the most extreme life experiences), instead of being able to react effectively and use their physical strength purposefully, people should be motivated by "animal instincts" in continuous Operation and in their thinking be determined by (sometimes "repressed" / obstructed) energy flows instead by their saved life experiences. FREUDS belief in his medical model of ominous energy flows even went so far that he hoped that one day it would be possible to heal mental disorders directly chemically by succeeding in “...using special chemical substances to directly influence the amounts of energy and their distribution in the mental apparatus. Perhaps there are still unimagined other possibilities of therapy..." (Freud, 2016). Of course, psychoanalysis was also unable to provide any information to where this "drive unit" should be found inside the “mental apparatus“, how it could have functioned neurologically plausible and how and where the "amounts of energy" flowed to be able to cause so much psychological damage.
However, since Eugen BLEULER and the generally increasing importance of psychology the special living conditions of schizophrenics have increasingly come into the focus of clinically researching psychiatrists. In the absence of a general psychology that was fruitful for schizophrenia research, a "phenomenological school" developed in the 1950s. It dealt with great accuracy with the inner experiences reported by schizophrenics and their recognizable emotional and behavioral phenomena (cf. Schneider, 1952, Conrad, 1958, Huber, 1961). Without using a theoretical model of schizophrenia, they meticulously described the developmental character of the emergence of schizophrenic disorders (cf. “stages of delusion/"Stadien des Wahns" Conrad, 1958), the central importance of delusional thought disorders (cf. “first-rate symptoms“/ “Symptome ersten Ranges", Schneider, 1952) and recognized that the (medical wishful) idea of an inevitable dementia in schizophrenics caused by organic brain processes (cf. “dementiapraecox”, KRAEPLIN, 1899) did not correspond to clinical reality.
Nevertheless the hope for a medical miracle, not been given up in schizophrenia research to this day, was to be given a boost by a special event in the 1950s. After trial and error, until then only a few physical treatment methods had been able to develop into the therapeutic standard for schizophrenic diseases because they were able to free some patients from their madness at least temporarily - albeit with some life-threatening risks (including insulin shock treatment, cardiazole treatment, electroshock treatment, Sleep therapy using somnifen, treatment with malaria pathogens, see LANGER, 1983, Hess, 2007). As we will show in more detail, in the end they all achieved their limited therapeutic effect without knowing it, in a psychotherapeutic way, through a more or less deep and longer-lasting sleep-like interruption of the delusional thinking: delusional attitude structures in memory in this way could be deactivated and dismantled by the onset of regular forgetting processes followed by a temporary reduction of schizophrenic symptoms (until renewed stress, psychotherapeutically unresolved conflicts, traumata, delusional memories, etc. set a new neurotic-psychotic development in motion, see chapter [7]). In 1952, however, the French naval doctor Henri LABORIT happened to come across a new calming substance for patients before operations. He recommended its psychiatric use and soon it took over the sleep-promoting, calming function in the already mentioned "major cures" (“große Kuren“) using i.a. Insulin, Cardiazol, Malaria pathogens (cf. BRANDENBERGER, 2012). There was talk of a “pharmacological turnaround”, a “milestone of progress” (Angst, 1968) and it was believed that the limited successful use of this substance (Chlorpromazine) had finally brought psychiatric research closer to an organic cause of schizophrenia. Psychiatry, which was striving so hard for its social recognition as a medical discipline, hoped to finally have a “modern drug” in order to be able to distinguish itself as a place of successful science and research (cf. DIVIDE & CONQUER, 2006).
Subsequently also the influence of a pharmaceutical industry increased on the research and therapy of schizophrenic disorders primarily interested in sales. A never-ending flood of neuroleptics coming from the laboratories of the pharmaceutical industry overran the psychiatric clinics over the next few decades. They only had to replace again and again the cheap generics with new, more expensive preparations all having a similar somatopsychic effect. While the psychopharmacological treatment now aim for a longterm medication of schizophrenics psychological research on schizophrenia, which was already blocked by psychoanalysis, inevitably receded more and more. Psychiatrists were kept in suspense by the clinical testing of ever new neuroleptics having to avoid their diverse side effects (including muscle cramps, salivation, tremors, eye problems). By changing and combining medications they had enough to do with finding by trial and error the best tolerated neuroleptic in the right dosage for each patient (cf. WEINMANN, 2019).
It took several years for schizophrenia research to end its psychopharmacological high-altitude flight and, also under pressure from its critics, to return to the hard ground of clinical reality. Depending on the drug, this consisted of different side effects, individual physical intolerances and, in particular, an increase in relapse rates when the drugs were discontinued and/or when the patients returned to their old pathogenic everyday world (with unchanged existential, professional, family stresses, unresolvable conflicts, traumatic memories , irrational indoctrinations by others etc. [5]). The sobering term "revolving door psychiatry" (“Drehtürpsychiatrie“) came up and it wasn't long before an antipsychiatricmovement was formed worldwide against an unsuccessful, conceptless, only random “therapeutic hits“ producing, humanly and professionally overwhelmed psychiatry.
Within a short time, four books were published independently of one another, which still resonate with opponents of psychiatry today. Thomas SZASZ (1920 - 2012), who incidentally did not feel himself to be part of an anti-psychiatric movement, under the impression of state forced psychiatry (especially in the "Eastern Bloc" states of the time) and in view of the unclear psychiatric diagnostic criteria anyway, he felt that every psychiatric diagnosis was a discriminatory state “Myth” (Szasz, 1961). Because of the danger of political abuse, he spoke of "compulsory medical treatment", which is still readily accepted today by angry opponents of a psychiatry with its technically overwhelmed, understaffed and chronically underfunded psychiatric service (see also UN Convention on the Rights of Persons with Disabilities (United Nations, 2016)). In his later book, Schizophrenia, the Sacred Symbol of Psychiatry (Szasz, 1973), he specifically formulated the fundamental critique of a medical understanding of schizophrenia. He denounced the belief in a disease model that could endanger the life and limb of those affected in therapeutic practice and could not even prove its assumptions and reliably offer successful therapeutic help. In the face of this "biggest scientific scandal of the century" the term schizophrenia should disappear completely because of its misuse by psychiatric institutions. It should not be enough to free it from its unproven medical assumptions, to fill it with a new, e.g. psychological, understanding and to improve its therapeutic implementation in the interest of those affected. The dominant wish, also from disappointed psychiatric patients, was to snatch the concept of schizophrenia, this “diagnostic tool of power“ out of the hands of the medical institution “psychiatry”. Also unconsciously, in order to get rid of one's own burden, the riddle of schizophrenia and the difficult task of having to solve it. So catastrophic psychiatric failures provided and still provide today the pretext for no longer placing even schizophrenic fears and depressions in the hands of medical helpers. Rather, they should be declared as a trivial normality that is to be accepted as an opportunity to process reality according to one's own needs.
From this point of view, also Michel Foucault (1926 - 1984) could only see a scientifically dubious psychiatry as a social instrument of power that would repressively and selectively define what "madness" is and what is not (cf. Foucault, 1961). A statement that, in its generality, of course ignored the suffering recognizable for everyone of those who, because of their insane fears and discouragements, also have a right to an adequate diagnosis and to therapeutic help (which, in view of psychopathogenic social living conditions, tragically often only can be given in a protected inpatient environment - very few people grew up in a psychiatric clinic and were driven insane there, but "close to the community" in socially disadvantaged families that have broken up, in schools that are not very supportive of mental health etc. and then have to live and to work in social communities whose rules have not necessarily contributed to their happiness in life and their mental health (see Chapter [8]).
Ronald D. Laing (1927 - 1989), after failed attempts at psychoanalytic therapy with schizophrenics, also formulated his discomfort with a "reificational psychiatry". He claimed that the therapist had to live with the patient in order to accompany their "acting out" of socially induced schizophrenic symptoms (Laing, 1960).
Finally, Erving GOFFMAN (1922 - 1982) practiced radical criticism, in particular of psychiatry as for him a "total institution" (GOFFMAN, 1961) and thus still influences today the opponents of a "revolving door psychiatry" that is as expensive as it is useless in their eyes. For them, neuroleptics are only the “weapons” of the “perpetrators” against “defenseless patients”. An understandable reaction from deeply disappointed people affected by the failure of psychiatric services. This distrust will probably only be able to change when psychiatry can prove through therapeutic success that its "weapons" are not aimed at the sick, but at their illness! If professional mental health service then also recognize and criticize the social grievances that can drive people crazy (see [8]), more people will surely be able to turn again to professional help with confidence.
2If computers could become schizophrenic...
A computer model to understand neuroticpsychotic developments
Summary
Mental processes could only contribute to human evolution through more and more efficient information processing. In order to recognize in time on the basis of previous experiences, realities that promote or threaten survival, the human ability evolutionary grew to absorb information through sensors, the capacity to store it and to process it cognitively to control survival-promoting behavior and its psychovegetative (emotional) motivation. An attitude psychology that depicts these relationships should be functionally illustrated using the parallels to artificial intelligence in information processing systems. In particular, based on those who, like Internet search engines, also collect information and have to make relevant data available for certain requirement situations (search queries). In this way, mental algorithms can also be used to demonstrate the conditions under which irrational, neurotic to psychotic information processing must inevitably occur in humans.
Let's imagine we are sitting in front of our computer and, as always, it is connected to its "worldwide memory", the Internet. Because we want to know something from it, we enter our question in keywords into the search mask of the Internet search engine and wait excitedly. But instead of the otherwise so clever and appropriate facts, this time we only get search hits that either contain strange, illogical claims or don't even answer our actual question. Suddenly a pop-up window opens and a strange voice speaks to us...
We would think, “My computer must have gone crazy! I ask it about the value of the British crown jewels with the search terms 'England, Queen, crown, value' and it informs me about corona diseases in the English royal family! And now this strange voice telling me about the corona incidence values in England!”We involuntarily ask ourselves whether we or our computer are having hallucinations.
If we were psychiatrists who considered schizophrenia to be an inherited defect in brain chemistry, we would also look for the cause of the strange search hits and the “hallucinations” of our computer in its hardware (“WLAN errors?” or “Memory problems?”). We would perhaps first shut down the computer, as we do with our schizophrenic patients, whose brain and confused thinking activity we ultimately only “switch off” for a longer or shorter period of time and more or less completely with medication. Just as our male and female colleagues have done over the past 100 years and considered there to be no alternative: Whether it was sleep therapy using "Somnifen" at the time after Egon Bleuler had just introduced the term schizophrenia in 1911, or hot baths, the insulin shock treatment or even the so-called "electroconvulsive therapy". Like today's treatment with neuroleptics, they all had only one thing in common, which could be their sole therapeutic factor: They interrupted the delusional thinking of the schizophrenic deactivating and reducing delusional attitude structures in memory by forgetting (usually through their distracting treatment procedure and in particular through a subsequent terminal sleep)! They did this for so long and so often until the delusional thinking had reduced to a level of so-called distancing from delusion (DFD), i.e. the person concerned was able to critically question his delusional errors and distance himself from them. However, earlier generations of psychiatrists knew just as little why these physical treatment methods reduced schizophrenic symptoms - as their colleagues today, who use antipsychotics to put their patients into a more or less deep permanent half-sleep speculating about a alleged biochemical fight against the causes.
As unsuccessful as switching off a computer for a long time with "delusional Internet search results"might be, the medical treatment methods for schizophrenic psychoses have always been just as unsustainable ("revolving door psychiatry"). As a rule, they could only be permanent if the brain of the affected person was more or less inactive (or even non-functional, as in the case of the lobotomy that won the Nobel Prize in 1949!) by medication or in some other way - unfortunately with all the physical, intellectual, emotional and social impairments that this has brought with it to this day. Otherwise, after an initial successful distancing from delusion (DFD), a psychotic relapse is to be expected in most cases. Because as soon as a person can then consciously access his memory again and this is once more repeatedly "overfed" with information about neurotic stresses, conflicts, dependencies, irrational indoctrinations etc., he will again make delusional search errors.
It would be no different for a computer that would access the global Internet memory, as in our thought experiment, using a human search algorithm. If it were unilaterally overfed with scary corona information even more than before and if its relevance for search queries were determined by a human algorithm and not by that of a regular Internet search service, we would really have to expect delusional search results, as in our example.
However, if schizophrenia were not a neuronal hardware error for us, then in order to understand errors in reasoning, we would first have to take a closer look at how people process information in order to be able to recognize it correctly in the sense of an evolutionary survival strategy and to be able to react to it rationally. The assumption that comes closest to everyday experience is probably that humans (and computers) can only draw their answers, conclusions and assessments of reality from the information with which they were previously “fed”. In the case of erroneous neurotic or even delusional information processing, there are only two possibilities:
(1) Either the memory of a human or a computer was "fed" with irrational or even delusional information (opinions/"attitudes") (the Internet memory e.g. with fake information; emotionally dependent people e.g. with socially anxious-suspicious or hypochondriac attitudes through close reference persons or groups, see also the so-called “folie à deux” and “induced delusion”) and/or
(2) errors in thinking go back (possibly also additionally) to the overgeneralizing and therefore incorrect processing of new information by old data stocks that are overrepresented in memory: In this case, the computer would interpret a search query less according to its actual meaning, but e.g. on the basis of oversized, extremely frequently linked and retrieved databases (hence, for example, the delusional corona answer to the question of the value of the British crown jewels). People make such mistakes in thinking in a neurotic or even delusional way if they have accumulated emotionally stressful previous experiences to a neurotic or even overneurotic extent, which distort the individual processing of subsequent information like a black hole. Then there are memory structures (attitude structures) from overneurotic frequent and dramatic traumata, chronic conflicts, helplessly experienced humiliations and failures, dependencies, irrational (e.g. religious, socially anxious-distrustful) indoctrinations, etc., which, through the human search algorithm of the brain, reach such an extreme relevance in information processing: Neurotic-irrational, self-damaging and/or dangerous to others and finally even delusional false conclusions (overgeneralizations) must come from a frightening past, for example, to a present that appears just as threatening.
In humans, it is ultimately a one-sided memory that is overfed with irrational and/or burdensome information, which we must regard as the cause of neurotic information processing and, following a neurotic-psychotic development, delusional information processing.
With our computer and its Internet memory, such a onesided "overfeed" with perhaps even irrational information on a certain topic is far less likely given the global supply of information on alternative topics with different opinions on it. Its memory is not (yet?) hijacked by irrational political and commercial information, like that of a neurotic, e.g. by frightening attitude structures that Internet searches would always have to go astray in the same direction. The question remains: Could it be that a computer is also less at risk of becoming psychotic thanks to its less "schizophrenia-prone" search algorithm?
Repeated learning processes and memorizing thought loops (see the endless, even nightly irrational brooding of schizophrenics before psychotic crises) result in overneurotic encoded complexes of attitudes. They determine an overneurotic, extreme willingness to process current experiences and thoughts that have nothing to do with them logically, generating initial experience-reactive delusional misjudgements and while endless brooding delusional ideas. Information in a person's memory that determines their attitudes towards themselves and the world (attitude structures) can at least achieve such a high level of encoding and synaptic networking that a whole range of hyperneurotic symptoms must be expected (see Chapter [5]). So the transition from the neurotic to the delusional schizophrenic after a neurotic-psychotic development can also be seen:
But how is it possible to heal schizophrenic people if their information processing is determined by extremely overstored delusional attitude structures that have been burned into their memory sometimes from childhood? In fact, this is easier with humans than with a computer and its Internet memory, because that never forgets! Unless you could delete your irrational fake information from political propaganda and commercial advertising populism on all servers worldwide and prevent all Internet users from refreshing the deleted databases by uploading private backups.
It's a good thing that the human memory has an extra neural automatic deletion mechanism to clean up old, outdated and possibly even irrational or even delusional attitude structures. This evolutionarily significant, time-dependent deletion process for old memory structures, called forgetting, which have not been confirmed and refreshed by similar information, ensures that these continuously decrease in their storage strength and relevance for individual information processing over time. It is precisely this forgetting mechanism that psychotherapy for schizophrenic psychoses can make use of. Your first goal must therefore be to do everything possible to ensure that delusional attitude structures have time to be reduced (forgotten) to a “merely” neurotic level of memory and relevance through inactivity. This is exactly what all previous, more or less successful medical treatment methods have done. They are, so to speak, the “psychotherapeutic hits of chance” of classical biological psychiatry! It was and is still not aware of the somato-psychic effect of its pragmatic treatment strategy derived from therapy experiences. But as grotesque as it may sound, traditional psychiatry owes its modest successes to its somatic (including drug-) psychotherapy.
It may come as a surprise to some that we are recommending antipsychotic medication from a psychological point of view and also understand this as psychotherapy within the framework of a graded psychotherapy of schizophrenic psychoses (cf. Chapter [7]). Yet:
In our understanding, psychotherapy is any systematic therapeutic approach that is suitable for sustainably improving a person's cognitive-emotional experience in harmony with its environment through individual changes in attitude.
For example, the verbal suggestions of a therapist can bring about psychotherapeutic changes in attitudes in the client, but antipsychotic substances can also do this in their own special way. They do not convey any new, e.g. trusting social attitudes or skills. Metacognitively, they also do not convey an insightful negative attitude to previous neurotic-irrational personal thought patterns that are harmful to oneself and/or others. However, antipsychotic medication can still achieve something in schizophrenics in particular that no otherwise successful conventional neurosis therapy can achieve in them:
Neuroleptic medication interrupts by reducing all cognitive processes also the delusional thinking of the schizophrenic and can thus weaken the conviction of delusional structures (delusional certainty) over time through the onset of natural forgetting.
Just as the psychotherapist does with neurotics, consciously or unconsciously, for example, when he interrupts his neurotic thinking by dealing with rational, healthy attitudes, thereby automatically forgetting irrational attitude structures and strengthening his existing rational attitude structures with new rational thought and behavior models. Unfortunately, this is no longer possible with schizophrenics using conventional neurosistherapeutic methods!
His hyperneurotic one-sidedness in thinking would also inevitably allow therapeutic messages to get caught up in the over-generalizing maelstrom of one-sided, delusional processing of reality (overinclusiveness).
They would rather increase the schizophrenic delusion and reactivate it to new psychotic crises! Here, only delusional-neutral, non-problem-related therapeutic methods, such as antipsychotic medication, can achieve the psychotherapeutic interruption of delusional thinking, feeling, and acting that harms oneself and/or others, without provoking delusional reactivation and delusional expansion. This is the only way to reduce delusional structures in the memory over time to such an extent that the person concerned discards their delusional worldview and cognitively returns to reality (distancing from delusion).
However, the latter is of the utmost importance for the further course of psychotherapy of schizophrenic psychoses. Only a medicinal reduction of overstored delusional attitudes (delusional suppressive therapy level I, see Chapter [7.8]) and an additional stimulus-controlled therapy level II (see Chapter [7.9]), in which attention is paid to the avoidance of delusional reactivating stress stimuli in the environment of the still vulnerable postschizophrenic, creates the prerequisite for subsequently being able to safely work neurosistherapeutically on the neurotic initial problem of a neurotic-psychotic development (attitude-centered therapy level III, see Chapter [7.10]). Only then is the risk of delusional misinterpretation of therapeutic communication reduced. A rehabilitative therapy level IV (see Chapter [7.11]) can then finally form the conclusion of a graded psychotherapy. It prepares those affected for (re)integration into everyday life after their neurosis-therapeutic stabilization with new behavioral skills and a living environment freed from conflicts and chronic stress.
3Our memory - control center of thinking, feeling and acting
Memory-psychological basics of a cognitive attitude psychology
Summary
The function of human memory is central to our attitude psychology of neurotic-psychotic developments. It stores and links evaluating (connotative) attitude structures with one another and uses them to call up behavior-controlling (conative) attitude structures appropriate to the situation. At the same time, through the coupling of thinking and feeling, it ensures an emotional evaluation of the information retrieved from memory and, with the corresponding emotional state, ensures a pleasantly motivated approach reaction, an anxiety blockade of behavior or an anger and rage reaction requiring aggressive coping.
If we had to explain our following attitude psychology (see ROKEACH, 1972) to 10-year-old elementary school students in a (certainly long overdue) subject “man studies”, the easiest way to do this would probably be to start with the importance of human memory. We could tell the children about a boy who received an order from his mother to buy bread and cakes from the bakery and, thanks to his memory, remembered what he had been told to do in the shop. So the boy is standing in the shop and because of his order stored in memory to buy bread and cakes, he would certainly have noticed the breads and cakes in the window - his attention was increased on the conscious perception of bread and cakes by his information stored in his memory. Because the mother had previously activated the corresponding images in his memory through her order. If the boy has already thought about the cake he should buy on the way to the bakery, his thoughts have already triggered feelings in him. So he learned that a person's feelings depend on what his memory is thinking about at the moment. He doesn't even have to be aware of the thought of the delicacies and yet he could have felt anticipation on the way to the bakery. The boy might even feel his heart pounding and other emotional changes in his body as he thought of all the delicious things that awaited him. According to our attitude psychology, these reactions of the body (cf. BÖSEL, 1981) are triggered psychovegetatively by conscious or unconscious memory activities and are consciously experienced by the boy as a feeling. We could also put it this way:
The memory structures in the cerebral cortex are linked to functional centers in subcortical structures of the brainstem, through which certain vegetative reaction patterns of the organism can be triggered. These different, complex neurohumoral organism reactions are the physical basis of joy, fear, anger, sadness and sexual arousal that are consciously experienced as feelings. These assumptions are related to basic concepts of emotion theory, as they first became known under the James-Lange theory (James, 1884, cf. COFER, 1975): feelings are ultimately understood as physical self-experiences. In addition, we bring the role of subcortical areas into play, which act as a kind of mediation center between thought processes and peripheral physiological consequences. Due to the fact that their functional processes can be influenced biochemically, they gain in explanatory importance, especially in connection with the druginduced modifiability of schizophrenic states of excitation. After all, it seems reasonable to assume that including these subcortical switching centers, emotional experience can be influenced psychopharmacologically on two levels:
Our psychosomatic understanding of emotions is clearly demonstrated by the many idioms that are popularly used to describe the physicality of feelings. Why else do we say, "That's up my stomach." "That'll get me to 180!" "It takes my breath away." "This all sucks!" "He must have gone weak in the knees." I'm so fed up!” or “My debts are giving me headaches”? A whole catalog of feelings is identified with specific bodily states! The conditional connection between thinking and feeling in cognitive behavioral therapy has long been a psychological finding that has been applied in practice (see, among others, "rational-emotive therapy" Ellis, 1977, Beck, 1979, Lazarus, 1980).
If healthy physiological processes are permanently disturbed emotionally, this can even lead to psychosomatic illnesses (cf. Adler et al., 1996). Chronic emotional states (e.g. permanent anxious tension, anger-neurotic states with a readiness for aggression) can, for example, disrupt the cardiovascular system or gastrointestinal functions in such a way that pathological over- or underfunctions become a permanent condition (e.g. high blood pressure disorders in chronic anger-neurotic emotional states). Finally, even pathological changes are to be expected, especially at constitutional weak points of the body (e.g. damage to the inner wall of the stomach / gastric ulcer as a result of overproduction of gastric acid in chronic states of anger with suppressed aggression).
If we are right and complex physiological reaction patterns of the organism become emotional experiences for us, we must accept the same processing possibilities for them as for all our experiences. So emotional experiences are also stored in an associative connection with the associated stimulus experiences, mental fantasies and their verbal expression (e.g. exam anxiety with the experience of the exam situation and the feeling of anxiety with the word “anxiety”). The feelings recorded in the memory can thus be consciously experienced again with words and by remembering the situations and triggers of their occurrence. (e.g. verbal suggestions of "rest and relaxation" recall memories of quiet situations, rest and relaxation already experienced and through this in turn also original psychovegetative relaxation). Even if feelings have been completely or partially deprived of their physiological basis due to special circumstances, such as after paraplegia (depending on which spinal cord segment the connection to physical emotional stimuli was interrupted), feelings can still be experienced: memory structures with emotional experience content from the past can be associative be called up (e.g. in a new examination situation or verbally through "fear"). In the case of complete paraplegia above the lumbar cord, there is no longer any original orgasmic emotional experience, despite intact erection and ejaculation reflexes, since the afferent nerve connections of the genital area with the brain are interrupted. Nevertheless, a remembered sexual experience (e.g. in a dream) can sometimes even increase to a remembered orgasm, but without having any genital effects (ORTHNER, 1955). However, the remembered re-experiencing of feelings will hardly be able to reach the intensity of physical emotional experience. For example, HOHMANN (1966) was able to show that paraplegics report a decrease in emotionality depending on the level of the lesion. In contrast, with unchanged verbal-motor behavior in emotional situations, their emotional experience is reduced ("a kind of cold anger", "I say I'm afraid, but I'm not really afraid, not so excited...", HOHMANN, 1966 , quoted from BIRBAUMER, 1975).
The nature and strength of an emotional response is clearly determined by the intensity and nature of the physiological response pattern elicited by cognitive processing. Although, for example, an acceleration of the heart rate can be involved both in the physiological pattern of a feeling of anxiety and in the reaction pattern of a pleasant, euphoric feeling (cf. BIRBAUMER, 1975), the total of all other physiological parameters creates differences enough that a feeling of fear clearly differs from a feeling of happiness in our experience.
According to our understanding, feelings, like all mental functions that we consider theoretically plausible, are of vital importance in several respects. First of all, physical emotional reactions in humans are always associated with a corresponding nonverbal expression of affect that is usually recognizable in the social environment. Conspecifics have always been able to receive valuable information about the feelings of another, about their assessment of their own behavior and about the common environment. The involuntary physical expression of emotional states was a kind of first emotional language, e.g. through facial expressions, body posture and different vocal sounds to warn fellow species of possible dangers, but also to point out things that would preserve the species, such as food sources or one’s own willingness to mate.
At the same time, our boy's anticipation of buying something tasty and (hopefully) being praised by his mother and loved by his parents is of further (survival) importance: in the boy's memory bread and cake was not only been linked to the attitude content "worth buying" from his mother (see below) and then triggered anticipation in him. At the same time, this feeling motivated him to go to the baker in the first place (cf. incentive theories of motivation, including Young, 1959, MCCLELLAND et al., 1953, COFER & APPLEY, 1964). Only a pleasant action goal, which is ultimately in one's own interest, can motivate human behavior. Even an allegedly "selfless", "sacrificing" social behavior of a person ultimately needs personal motives in order to be able to be implemented (e.g. unconscious expectations of social rewards / recognition, religious "forgiveness of sins", "paradise rewards", prevention of "Penalties of Hell"). In the case of our boy, as a result of his mother’s wish a current attitude had formed in his memory towards bread and cake and the possibly strenuous trip to the bakery, so we have to formulate it in terms of attitude psychology: bread and cake had become attitude objects for the boy, which, with the setting content “worth buying / wanted by mother” etc. had been linked in memory. This can be represented formally as follows:
Countless of these evaluative (connotative) attitudes, saved in memory, determine a person's personality. Many of them are stored (encoded) in memory from childhood and bring a person's past to life in every moment of their existence. In every situation, people consciously or unconsciously retrieve countless past experiences, stored in attitudes, from memory in order to use them, which is essential for survival, for rational recognition, emotional evaluation and behavioral coping with the present.
All that remains in the subject “man studies” is to explain to the students in terms of attitude psychology the boy’s ability to show behavior : in order to get to the bakery, the boy must of course first had to learn to walk. Through trial and error, through role models, etc. he must have stored appropriate behavioral programs (conative attitude structures) in his memory and linked them to the appropriate action situations. Then the boy just needs to be motivated and physically activated to carry out a behavioral program. This task is taken over by pleasant,motivating feelings, such as the anticipation of treats, the expectation of social recognition and other positive expectations that can be linked to a behavioral attitude in memory:
Going to the bakery is associated with a pleasant feeling that puts him in physical activation for a corresponding action and does not block his behavior in an anxious, disappointed (depressed) or frustrated manner. Themother's praise, the tasty treats, the joy of walking, the avoidance of negative consequences (e.g. the mother's disappointment) motivate the boy to put his behavioral attitudes into action.
That is almost all of the general psychology that we need in order to be able to build up our following theory of neuroses and then our understanding of neurotic-psychotic attitude developments. We have limited ourselves to as few mental functional units as possible, which everyone can understand based on our everyday experience alone. Their effects can be observed by everyone, can at least hypothetically be assigned functionally to an organ of the human nervous system and they are evolutionary vital for human beings to deal with the challenges of their environment.
4Irrational thinking, feeling and acting in neurosis
Neuroses from attitude psychology view
Summary
If frightening, frustrating, depressing experiences and/or correspondingly stressful social indoctrinations (e.g. hypochondriac expectations of illness) become established permanent and to an above-average extent in the attitude memory of a person, then in situations in which the relevant attitude
