While one hopes that properly medicated schizophrenic pts will become more neurotic (meaning at least aware – and accepting – of their unresolved conflicts as opposed to wholly mystified, magical thinking, truth-denying and/or delusional about them; see Jackson, below), many become borderline organized into two or more divided and mutually unaware “compartments” (see Kernberg, below).
One of the compartments is usually neurotic (and sometimes even pretty functional; there are fine examples here on this forum); the other is as mystified, magical thinking, distortion-asserting, truth-denying and/or delusional as the “integrated” schizophrenic.
The major problem I saw numerous times in “real” life, as well as among some here on the forum, is that “medication-facilitated” borderlinism tends to keep the pt locked in his or her delusions, positive and negative symptoms and self-destructive patterns.
It works this way: The neurotic but semi-conscious and teachable, borderline compartment is capable of learning new psychotherapeutic tricks. But the mystified but ego-assertive, magical thinking, truth-denying and/or delusional, “schizophrenic” (actually “psychotic”) “chamber” will soon launch an unconscious, but nevertheless energetic and often “successful” campaign against the neurotic compartment. It will hijack the very information that would help the pt dig out of his delusions to keep the pt stuck in them the very same way the pt’s parents did the same thing when the pt was a child or adolescent.
(We do tend to imitate our abusers, albeit without being aware of it; see Anna Freud and Van der Kolk below.)
Why does that happen? Because the ego-defending, magical thinking, truth-denying and/or delusional, “schizophrenic” (actually “psychotic”) compartment has a vested interest in keeping secrets from itself and in being RIGHT!.. in the very same way the pt’s parents had to be RIGHT! and kept unacceptable, “shaming” secrets from themselves. Jackson, Murray Bowen, Greg Bateson, Paul Watslawick, Virgnia Satir, Salvador Minuchin, Teddy Lidz, Ron Laing, Aaron Esterson and Jules Henry all saw – and reported on – this in the 1940s to 1970s.
But if one presents that FACT to sz pts (and borderlines), one will almost always see the pt’s “psychotic institution” – his or her chamber of ego-assertive, magical thinking, truth-denying delusionality – fight tooth and nail / hammer and claw to keep the neurotic compartment from seeing actual facts. Because the psychotic side believes those facts to be “intolerably shaming, frustrating and unacceptable.”
And he or she will march right back to his or her psychotic jail cell and complain some more about being there.
I did it for decades. I stopped 12 years ago. Anyone can. All they have to do is take AA’s Step One and change the word “alcohol” to “schizophrenia.” (See http://alcoholrehab.com/addiction-recovery/importance-of-step-1-in-alcoholics-anonymous/.)
Freud, A.: The Ego and the Mechanisms of Defense, London: Hogarth Press and Institute of Psycho-Analysis, 1937.
Bateson, G., Jackson, D., Haley, J.; et al: Perceval’s Narrative: A Patient’s Account of his Psychosis, Palo Alto, CA: Stanford University Press, 1961.
Esterson, A.: The Leaves of Spring: Schizophrenia, Family and Sacrifice, London: Tavistock, 1972.
Henry, J.: Pathways to Madness, New York: Random House, 1965.
Jackson, D. (ed.): The Etiology of Schizophrenia: Genetics / Physiology / Psychology / Sociology, London: Basic Books, 1960.
Jackson, D. (ed.): Myths of Madness: New Facts for Old Fallacies, New York: Macmillan & Co., 1964.
Kernberg, O.: Severe Personality Disorders: Psychotherapeutic Strategies, New Haven, CT: Yale University Press, 1977.
Laing, R. D.; Esterson, A.: Sanity, Madness and the Family, London: Tavistock, 1964.
Lidz, T.: The Origin and Treatment of Schizophrenic Disorders, New York: Basic Books, 1973.
Lidz, T.; Fleck, S., Cornelison, A.: Schizophrenia and the Family, 2nd Ed.; New York: International Universities Press, 1985.
Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.
Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory: Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.
Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.
Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.