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REPRINTED FROM PSYCHIATRY: JOURNAL OF THE BIOLOGY AND PATHOLOGY OF INTERPERSONAL RELATIONS VOLUME TEN, NUMBER Two, MAY

1947 WILLIAM ALANSON WHITE'PSYCHIATRIC FOUNDATION 1711 RHODE ISLAND AVE., N. W., WASHINGTON 6, D. C.

but he hated school and his lastic standing was only fair. For a r interpretation. Conceptions of Modern Psychiatry. When first seen.M.B.A.D. Union Theological Seminary 11. After seven years of roving he s down in this. M. according to the patient.C. PSYCHIATRY (1942) 5 also Exploration of the Inner World (Chicago. PSYCHIATRY (1940) 3 particularly pp.1 Let me begin with a case which exemplifies the schizophrenic reaction.country. Instructor Romance Languages Indiana Univ. In appearance he was a stocky man of 53 with barrel chest and heavy muscles. and the assign of jobs was determined by the union this reason he was often idle. and at the a 31 he married. All of the children lived to ma and have given a good account of selves. Earle Lecturer Pacific School of Religion 42-43. was brought to the hospital after an attempt at suicide. His wife. Harv D. B. Country Church Work. There had been a previous commitment 13 years before. Clark & Co. A.2 The patient in question. He went through grades in school without repeating grades. U. however. and he talked frankly of his experience in a sensible and matter-of-fact manner.F. For bibliography. seven of whom boys. see Sullivan. Field Investigator Dept.D. Ch Elgin State Hospital 32-. Instructor Boston Univ. Supervisor North Dakota Rural S Interchurch World Movement 19-20. Rural Pastorate 12-17. There had been the usual diff with masturbation in the adolescen riod.. at the time he met was a working girl. He lick any boy in his room. He was a native of Sweden. analogous to fever and inflammation in the body. in a family of nine.. He had been found in his home with the gas turned on and both wrists cut. the second 2 This case I have used before in an article which appeared in the Elgin Papers for 1932 and in another article in the Crozer Quarterly for 1940. 1936) chapter 1. In a however. Indiana 97. was "quite long—it was a whole week!" The wife states that she noticed nothing wrong until two days before. His vocational record excellent. Forest Asst. Boisen* T HIS PAPER will attempt to show that the successive stages in the develop of acute schizophrenia bear a striking similarity to those of insightful thin This similarity supports the view that the schizophrenic reaction should be sh distinguished from certain other formations with which it is commonly assoc formations which obscure its true significance as a manifestation of nature's p to heal. Willett. Washburn College 38. M. but he thought it had not been e sive.. His trade. 69-82. He became inter * A. School of Theology 29-31. S. He wanted to relieve the world of its sins. w highly specialized one. The Form and Content of Schizophrenic Thinking.Anton T. He considered himself to have be fairly normal boy. Then also the onset had been sudden. Boisen. [159] . then at the age of 21 he we sea. Harry Stack.F. he had just emerged from the disturbed condition. 99-03. After le school. see Ref Lists section of this issue. Service 05-08. Presbyterian Board of National M 11-12. and the duration brief. T. The onset of the illness. . Chaplain Worcester State Hospital 24-31.A. 1 Cf. from malignant involvements. While at sea he had sometimes with his mates to houses of prostitu but apparently he had kept within bounds of respectability as judged b group. She then observed that he had become selfabsorbed and unable to sleep. Yale Forest School 05. A. Lecturer and Re Associate Chicago Theological Seminary 25-42. According to the commitment papers the motive was self-sacrifice. He talked frankly of his sex a ments.E. a case unusually free. he served an apprenticeship mechanic. Oscar 0. He was eager to understand what had happened to him. Secretary Y. the disturbance severe. he was not so dumb. 17-19.

howAbout a week after that I was sent ever.were two sides and all right. But everything I have done I was waked up and a voice said.I had a feeling like when they bind up arm and give you a blood test. 'Are you will his life for others. I had not been thinking his wife were active in church. I have the feelin right in front of me and the voice seemed to that I am a new man. I dreamed I was dead. I was at a Socialist meeting one night. but he got A doctor understand that. and words from the Bible done my part. The wife is a quick. I had toward Socialism.' It seemed/as though God were it to keep my promise. That was before I under carries you away. In the hospital I was put in a strait wanted to.agrees. I did say when this came on i course that was a very strange thing to do. I got up and ran something talk to you." He says of himself that he has had to go to one side or the other in or good.pital that the trouble came from readin perience and allowed me to get it down Bible. I can't see any other explan Yes. I ha of him: "He says that anything I say is feeling that there .'was ready to believe. Something con getting into me." He claims to be something of and I was released at the end of three w a free-thinker. o Socialist speaker said and that I would gladly one daughter and the other for the give my life for my family alone. No. accustomed ap. You see I was in to church and Sunday school and that he lirium. • . will power and that whenever he get salvation. In religion. training he says that he was dragged off was full of power. My wife was told at th He was quite ready to talk of his ex. he came work and there was nothing to worry from Missouri: he wanted proof before During the last three years work has scarce and there has been plenty of'ti he. that. Here is his want to make her nervous. I talk about self-hypno at the time the idea came to him. He was in his bathtub with a doctor. It's jus came into my head. You must know how the some and I had it in my mind that ther whole thing started. Then it came to me that I had a s installment to pay. and the whole room was up in the Lutheran church. I began to feel very nervous. Neither he nor think. He don't so excited that he got up and ran out without stand about religion. You get an idea so big it just guess I did. . Of his early devils. I turned on the gas. It was a queer feeling—som parently to having her own way. I just felt that I had up your life. I did not tell my wife. . You can't me to go and get the Bible. That w That night I was thinking about what the my wife. When how to weigh a ship. It seemed as though something was when you sit and think. I didn't hear anything.'You must came to a good end. be God's voice. After that dream I was ne matriarchal. A bet with God. They were trying to hurt me.filled up. One gets the impression. account: The last attack began when somethin I must-give it to you in order. I was s tive. I suppose it out into the street in my underwear. No. I had to finish payi bet with God. how I made a sort of God. and something said it you are it. And I did to church. He asked if there were not commit suicide?' And it was just like many others who would be willing to do that.then to pray to God. about religion. I pretty much word for word. She says you don't understand what it is. and I have the f be put to the test to see if you will really give that this will too. Of from God. I seem The patient and his wife were brought be crucified. I had s understand unless we go back to.The first night I had. All this is over. In the night daughter. attrac. the begin. business-like person. to do it. In politics. Sometimes it comes quick jus she would not understand. I had been feeling ning 13 years' ago. a dream. You get puzzled as to who yo . but it was just like the old Greek who found out just like I hypnotized myself. I think it was the same night that blood You get happy and you wake up and came into my mouth. he did not hesitate to assert it. that the home life is somewhat ^hospital. I drea lying in the grave just like Jesus d hated it. I felt you. I' came then into a state o man there spoke of Jesus and of his giving Something said to me. He never did "grab anything in was In about three days my mind came religion. Then I slashed my wrists. so I put the Bible in the attic. Did I think of myself as Christ? Y anything on. he is inclined I got along very well after.

replied: ' "No. "Are there not information regarding the period of on many men who are willing to give their is deficient. th problem with which he was already is mention of praying and reading grappling. Oscar 0. His immediate response was: Bible. .. I have other men I can send to do that. Its representative character is ap. is suggested by the question had then become self-absorbed and which precipitated the disturbance.3 It has usually denly.:'... .was a situation here which. manded. Nearly always i . .' f 4 For an illuminating discussion of this point." or "resolved. . mission. and "broken up. I don't need you to preach. Boisen. some sense of perAsked if the. "everything she said was all right. -W. Human Nature and Its Re-mak (New Haven. He had been carrying out quite Abounding to the Chief of Sinners: faithfully the." As a matter of fact cases the patient had become absorbed he had been doing exactly that. . Religion (1942) 22:288-301.. nor persuasions nor thre give up your life. It will perhaps seem farfetched to suggest that his r '"•' This case shows th6 schizophrenic retionship with his wife had involved action with unusual clarity and completeness..'.". But that night he was waked it was so fixed on eternity and on the thi up and a voice said to him. cha 42. attention. chapter 6. It.. "You must be about the kingdom of God.tain therapeutic aspects.. The Problem of Sin and Salvation in the Light of Psychopathology. relative freedom from complications. in 4 of crying spells. I for my family alone. We would say that it came on v finally.'. At the time of the second desperate attempt at solution..writing." there .go its hold. professions of undying deBy these things my mind was so turn votion which he had undoubtedly made that it lay like a horse leech at the vein." Clearly there was could loose it or make it let. .clear evidence of a period of preoccu tion touched off an explosion may be tion lasting from a few days to a taken to. had.. .review its successive something in the nature of a "tra stages in the light of a statistical study of ference" involving dependence upo 75 other cases likewise characterized by finite love object which needed now to sudden onset. A classic description of this st tire life had been organized around his is to be found in John Bunyan's Gr home. it too been on the patient's mind for many years whole week. ' ... . In more than half of these. it would have been as diffi 2 Cf.'.the situation did not involve the sense of PERIOD OF PREPARATION OR FRUSTRATION sonal failure and guilt but rather a In.. in 15 of preoccupation... '•'• j | .. J. Sociology (1928) 33:555-567. Ame'r. and Exploration of the Inner World (reference footnote 1). b paient when we. The Sense of Isolation in Mental Dis'You was going right the way -you was. PERIOD OF NARROWED ATTENTION .. Hocking. This case would then differ. this problem involves. Oscar 0. . . In many of our cases Socialist speaker asked. yet indeed i a certain truth. . though I speak it with shame.. patient's' role in life—a problem which arouses intense emotion. The able to sleep.order: Its Religious Significance. majority of such cases in that.. B. . I would gladly give my life sleeplessness. His en. the wife did not notice anyth What the problem was in the case of out of the way until two days before. Y as a lover.from. 1923). J. severe disturbance. there comes a suddenly. .. in cases of this type. disturbance came on s sonal failure and guilt.f .. and it took a whole week as a source of distress and uneasiness until fore. that neither p put to the test to see if you will really sures nor profits.all of our cases we"find evidence of ward step in his development pr mat . .. some unsolved problem relating to the tion. but in 42 of them there lives for others?" The fact that this ques. ' . in 10 "Of course. .•." * . Yale University Press. . indicate that it bore on some weeks.[.

Of course. ' According to August Hoch in chapter 5 of B Stupors (New York. In the case of Oscar 0.7 When. It was just as if I was comma ing autohypnosis may not be worthy of to say certain words I had never hea consideration.5 flashed across my mind. .words. . 1916. The word 'J condition. he emphatically denied that it upon what the voices say. It the street in his underwear." L to many other cases. to write poetry. Psychology of Religion. I got up one morning a an idea so big it just carried him away. When this most frequently used. The term voice is the one this. G. In most of our 75 cases we find similar ideas. What the "big idea" on the idea came to her that she w was in his case is clear. Macmillan. C. T explains.' However." Another says. Then characteristic as to justify a question as came to me. W This is an explanation which will apply I put it together it was complete. "Communica Hindu holy men and others of the shaman came to me from out of the ether." "I can't explain it. It came to me volved is to be found in Coe's Psychology ligion (reference footnote 5). It seemed as though God were right in front of him. A. The mos was anything he heard with his ears. 1923. :. . Mohr. .Narrowing of attention is in fact so and sat around brooding." human source.6 The important sideration is what the voices say and cosmic identification.'s suggestion regard. "It was just like when you sit and think. I didn't have to search to whether Oscar O. most of these patients. he seemed to flow without my trying. will explain that it is of depression or stupor. It is employed 14 is passively accepted and no actio times. quent of all the ideas found in the sc Something comes to you. The Nature of I Coe.." Others has an important role in life—afte describe it as follows: "I got funny initial idea of death which is accepte thoughts and felt myself under some sort a spirit of sacrificial renunciation— of control. cases were stuporous and showed ma Many of them use other terms." ' The point to notice is that the me cept of his own role. called for. Chicago. . Things just popped into my head.in 50 of our 75 cases. however.was imparted by means of a "voice. She had spoken to him. type employ techniques for the narrowing felt as though I were directed by som of attention in order to induce the trance higher than myself. PSYCHIATRY (1941) 4:31-43. . J. Tuebingen. Seven of not something they heard with their ears. Gesammelte Ausaetze zur Religionssosiologie (3 vols. Also Weber. . B. the picture is likely to be when questioned. 1921). I hea infinite voice—though not human AN UPSETTING IDEA sound. He thought God have an immaculate conception. and in 42 we find the idea of of normal persons." So also in the phrenic reaction is that of death: We other cases. and he got a new con. University of Chicago Press. and the voice seemed to be PERIOD OF ELABORATION God's voice." A woman patient said: "I The patient states that he ran out into the inspiration. Thus one paucity of ideation. . Max."went into a tail spin. . B Cf. Certainly we know that before. that was a very strange thing to weren't any voices. The were inaccessible. p. . Eliot Dole. Se as a revelation in a dream." "I got inner Hutchinson. o'clock and wrote my first poem. . the upsetting fact that they are attributed to a s idea .). In 54 there nism involved in these voices is no is specific mention of contact with the ferent from the 'insights' or 'inspirat superhuman. It was "An excellent discussion of the 'dynamis just the way I felt. the i rebirth is characteristic of stuporous patients idea was clear in one of the seven cases. chapters 11 and 16. 193ff. but like Archimedes of old he had got came to me. the idea comes tha young man says: "I got such funny ideas. It was just ideas do. Questioned later regarding What happens next is likely to de this voice. 2:169ff.

THE SCHIZOPHRENIC REACTION MALIGNANT ' INVOLVEMENTS That there is much similarity between the process of creative thinking. Exhilaration marks such moments of insight. PSYCHIATRY (1941) 4:31-43. however. PSYCHIATRY (1942) 5:165-176. The'Phenomenon of Insight in Relation to Education. The Period of Frustration in Creative Endeavor.' 'given.' carrying authority because of the way in which it comes and producing a mood ' of exaltation and a sense of finality. For months or years. or evaluation. involves a period of preparation.' forming. Such a process may be an in one. The content of these insights . a period of renunciation or recession. Th difference between the process of c thinking. and the schizophrenic r is to be found in the intensely p significance of the problem which volved. The Nature of Insight. is the cycle of these stages in multiple and ever-changing emphasis. It is imp to recognize that such a disturba not an evil thing but a desperate a to correct a way of life which is l to destruction. The Phenomenon of Insight in Relation to Religion. a glow or elation goes with them. the creat tuitive forces take possession at pense of the organized self. It is generally following this that the idea of cosmic identification makes its "Varieties of Insight in Humans. in some de problem-solving effort.' In both there is the period of elaboration and criticism represented in the flood of new ideas and a consequent strain upon the critical faculties. PSYCHIATRY (1943) 6:347-357. PSYCHIATRY (1939) 2:323-332. or when the attention is absorbed by irrelevant matters. a useful 'hunch. unmarked by any stormy ep Frequently. accomplishment. this creative intention unfulfilled. reactions. as Professor Hutchinson scribed it. and that of the schizophrenic reaction is apparent. elaboration. it seems. usually in a moment when the work has been abandoned temporarily. In the simple type there are tho in the face of accumulating diff withdraw into the realm of phanta wishful thinking. . takes full form only in a later period of verification and criticism. . a brilliant hypothesis. as thus analyzed. But suddenly. likely then to see the reaction w refer to as schizophrenic. . As if 'inspired. This is a reaction tends to eventuate in progressive d tion. Attempts at solution have ended only in bafflement. the new idea or insight a period of intense preoccupation a centration!. and a period of verification. patients of th become aware of'their danger." We do find in a large proportion of our cases the renunciation of some longed-for hope and the sacrificial acceptance of the idea of death. comes an unpredicted insight into the solution. . finality. "What is not so clear is the period of "renunciation" or "recession.thinker—the profession makes little differ-' ence—has before him a problem involving some explicit production or decision in life situations. a short cut to artistic or scientific advance.' ideas arise which constitute a real integration of previously accumulated experience—an answer. PSYCHIATRY (1940) 3:351-359. This interpretation of schizo may help in the understanding o is found in the complex of reactio sented in most of our hospital case four types generally labeled schizo are to be regarded as four differen of dealing with the sense of p failure and intra-psychic disha three of these are not problem-solv actions but end results of malignan acter trends. Thus the pattern of insightful thinking . PSYCHIATRY (1942) 5:499-507. the unpredicted insight which comes' as 'inspired' or 'given. The explanation m found in Professor Hutchinson's tion that the period of recession w finds in normal creative thinking temporary giving up of the probl defence against emotional unbala follows then that the schizophren dition results when. this problem remains unsolved. in the profoundness of th tion which is evoked. it may be. They have in common the period of preparation or frustration. The Period of Elaboration in Creative Endeavor. The process of creative thinking. a period or moment of insight. and in the perspective and balance. . a feeling of adequacy.

he may conclude that he w going right the way he was. T sermon had been about the five loaves a two little fishes. In such cas the perplexity gives place to some degr of self-assurance. Alfred. "You was going right the way you was—I don't need you to preach. Yellow meant cowardice. SCHIZOPHRENIC THINKING AS A CREATIV PROCESS Professor Eliot Dole Hutchinson h set forth in a series of articles certain co ceptions regarding the process of " sightful" thinking in the fields of scien and art and religion from which I ha borrowed some of the categories used .lowing his readiness to give his life for his family. he was conveying some sort warning. however. A crow flying over ball field indicated a somber future for h A bunch of syringas on the ward were ora blossoms and meant that he was going to married. ideas of cosmic catastrophe appear in 43. He had to find the hidden meaning of things. and so on. 1908. Sometimes he had been born rich and sometimes poor. attached symbolic significance to the rangement of the furniture. the voice said to him.W. Felix Alcan. Out of our 75 cases. He knew that they w doctors' calls. Here is a set of ideas which occur in case after case. blue tru fulness. C.8 What claims our attention here is the fact that this period is not only characterized by elation. The 8 Reference footnote 1. Paris. See also Storch. of prophetic mission in 16. Here are some examples: H. exaltation. The proportion would ha been much higher if there had been f information regarding the period of ons In subsequent stages the patient m build up a new system of beliefs centeri in some new concept of his role in life like Oscar O. These ideas and their significance I have dealt with elsewhere. p. to snatches of song. When. Oscar 0. of rebirth or previous incarnation in 14.. it came to him that he was called upon to save the world from its sins. thought some strange struggle was going on and that it was his duty to fathom it. one of his friends being shot. He seeks communications from above not merely in the ideas which come into his head but also in all sorts of trivial happenings. fied by the bells. If another patient put his ha to his face. saw something strange in everyth that happened and ominous signs in the m trivial affairs. He interpreted this to re to himself and his wife and their five childr v R. Henri. 1924. the patient. was especially concerned with colors a sounds. 9 Delacroix.9 and the critical faculties are in abeyance. He was extremely servant of the feet.D." It seemed to him that he had lived for two thousand years. was not a good wom She felt herself influenced by everyone on ward and did not know which way to go Similar perplexity was shown in 29 our cases. black sorrow. became much disturbed after attend the religious services at the hospital. and a great profusion of new ideas but is also marked by bewilderment and perplexity.T. There is great enlargement of the field within which intuition is valid. 376. with the central problem pertaining usually to the patient's own role. They are however by no means absent. C.M. He thought he was going to have to preach. of cosmic identification in 42. Etudes d'Histoire et de Psychologie du Mysticisme. Washington. In many instances the patient is. was thus puzzled as to who he was and what he was to do. R. Primitive Archaic Thought in Schizophrenia. sure of only one thing—that things are not what they seem to be.C. but it came'to him that ev time a > bell sounded.. He saw himself lying in the grave "just like Jesus did. One sees it in the overwhelming perplexity which is so often present. red blood. to selections the radio. To touch a steam pipe was pecially alarming. the mind is stirred to its profoundest levels." he was able then to get well. purple dea The sight of a girl holding a banana signif that she. The food thus had symbolic significance. to incidental marks. As in mystical experiences generally. Nervous and Mental Disease Publishing Co.

Under this interpretation the term catatonic is the label which is usually given to those who are engaged in desperate struggle. While our statistical base is slender. RELIGIOUS EXPERIENCE Oscar O. also refere footnote 5. these figures suggest that the schizophrenic reaction tends either to make or break the "Boisen. 245ff. There have been times when actions which were clearly schizophre were regarded as evidence of psyc power and served as a source of cha matic authority. and he conside himself a free-thinker in matters religi During his psychosis. however. THE SCHIZOPHRENIC REACTION AN . They resort to other face-saving devices.the facts. relig was for him an all-absorbing subject. pp. New York. C. there M Cf. It is in this group that the leveled and inappropriate affect and the disjointed speech are found —characteristics which are sometimes mistakenly regarded as typical of the entire "dementia praeeox" group.of a spec schizophrenic reaction is destructive constructive depends chiefly upon honesty and sincerity with which the tient faces his difficulties. were grapp with the central problems of theology philosophy as with matters of life death. They belittle others and magnify themselves. In the hebephrenic type there is the actual disintegration of the personality from which the paranoic is seeking to save himself. he thought he was going to have preach.11 Few hebephrenics. Twenty-six were overwhelmed w remorse for past mistakes and sins. Out of our 75 patients. H. do not have periods in which they become aware of their unhappy state and struggle desperately to escape from the toils in which they are enmeshed. This may develop insidiously.12 Even today there religious groups -which value abnorm manifestations of a more or less sch phrenic nature. 54 themselves in direct contact with superhuman. Coe. reference footnote 1. there may come a time when the sufferer is awakened to his peril and a schizophrenic reaction develops which sometimes succeeds in breaking up the malignant formation. Such persons do not usually go to pieces. and 9 percent died before the outcome was fully clarified. upon the ance of assets and liabilities in his ch acter and in his life situation. More than half of them gaged in earnest prayer and Bible-r ing. 13 percent have developed paranoid formations. states that he "never did g much in religion. however.. Here again. chapter 11.. but the reaction is a malignant one. It is to be noted that of the cases under consideration which had not been selected from the chronic group 53 percent have made recoveries. 9 percent have gone hebephrenic. Wherever such exp ences occur within a social matrix a follow accepted social patterns. From Max Weber (translated and edited Gerth. those who are stirred to the bottommost depths of their mental life and in whom the malignant reactions have not become established. consequent upon a withdrawal'reaction. They blame others for their failures or find an alibi in the form of physical incapacitation. 16 percent have had recurrent episodes. or it may follow some desperate attempt at reorganization which fails. however." Neither he nor wife went to church. Ox University Press. They are not likely to arrive at any satisfactory solution. The Form and Content of Schizophrenic Thinking. and up the amount of social support which receives.. and Mills. It is to be borne in mind that a num of men of unquestioned religious gen have passed through schizophrenic sodes in the process of finding themsel episodes during which they received elations from above in accordance w the process which we have been c sidering and gave expression to the ch acteristic schizophrenic ideation. may say that all of them. . H. W. during the ac phase of the disturbance. 1946). Whether the outcome.

ELGIN. but they are not likely to contribute to. the constructive solution of the problem with which the schizophrenic patient is grap10 Boisen. PSYCHIATRY (1939) 2:185-194. it follows that the shock treatments and lobotomy are not to be used indiscriminately. the nee help him to interpret the experienc to see it in true perspective. It follows furthermore that the t the psychotherapist requires that h a true understanding of the const and destructive forces which are o ing in the acutely disturbed schizop and that he should assist the constr forces by providing the social s which the patient needs so despe With recovery or remission. Economic Distress and Religious Experience. Such treatments may produce peace of mind.THERAPEUTIC IMPLICATIONS If this interpretation of the schizophrenic reaction is correct. ILLINOIS .