Case of Charlotte
Charlotte shows symptoms of schizophrenia, a psychotic disorder in which the individual loses touch with reality. According to the DSM, the criteria for schizophrenia are as follows: having at least two of the symptoms of the disorder for a period of 1 month. These symptoms include; Delusions, Hallucinations, Disorganized speech (e.g., frequent derailment or incoherence), Grossly disorganized or catatonic behaviour and Negative symptoms (i.e., diminished emotional expression or avolition).
Of these symptoms, hallucinations, delusions or disorganized speech must be present and in Charlotte’s case, she has disorganized speech and delusions. Charlotte displays 2 types of delusions. These are delusions of grandeur and delusions of persecution. Delusion of grandeur occurs when an individual think that he/she is an important person. This can be seen in her belief that she has some special connection with the spiritual world. She believes that she is able to tap into spiritual energy which allows her to create unique art. Her sense of importance is further emphasised by her playing the role of a doctor and telling the nurse who was there to administer the medications, not to disturbed her. She also has an in-depth knowledge of the other patients, how much medication they are on and about the personalities of some.
She also has delusions of persecution. She believes that her mother and uncle had team up to have her admitted and this was facilitated by the psychiatrist whom she has little regard for because according to her, he is not a spiritual man.
Charlotte’s speech was also disorganized. In replying to a question related to her functioning at home, charlotte was making loose associations. That is, she was jumping from one topic to the other with no connection between one though and the next. She started with how her sister came with her things, then jumped to how she needed energy to write her book, then talked about writing and painting then lamenting on how she couldn’t get to dance again. Another feature of her disorganized speech was perseveration which was when Charlotte was kept on repeating the same words and statements. Another criterion from the DSM-V is that the person has to show major disturbance one or more areas which may include interpersonal relations.
We can see this in how she related to other people on the psychiatric ward. She didn’t interact with them and was socially withdrawn from them and though she was better than them, referring to the other patients as germs. manner. Also, according to her family, she was unable to function at home.
The DSM-V also requires that Schizoaffective disorder and depressive or bipolar disorder with psychotic features be ruled out. This can be done because from the interview, we can see no major depressive or manic episodes. The symptoms she is displaying do not appear to be as a result of drugs or other substances.
The cognitive theory could explain how Charlotte developed her illness. Her delusions can be analysed using social cognition which is the study of how we perceive the social world. In particular, the concept of attribution. This concept is people’s belief about cause-effect relationships. Charlotte has difficulty with this and has wrongly interpreted spirituality as a cause of her unique art which has led to her delusions. Drury, Robinson and Birchwood (1998) said that schizophrenic patients have trouble interpreting interpersonal contexts. This difficulty in interpreting interpersonal context which stems from social cognition might also lead her to jump to conclusions, thus creating delusions of persecution. There is also the concept of information processing which says that we use heuristics when reasoning but these can often lead to cognitive errors. Also, not knowing how to process information effectively could lead to an overload and be reflected in disorganized speech.
Cognitive-behavioural therapy can be used to treat Charlotte by changing her social perception of the world. She would be taught how to process information more efficiently to avoid cognitive errors. She would also be shown how to analyze social situation to improve her social cognition.
We can also use Freud’s psychoanalytical theory to help Charlotte. Freud states that trauma can help prevent the usage of defence mechanism that help us cope with reality and maintain the ego. Charlotte probably went through some traumatic event which made her unable to use the defence mechanism stated by freud as effectively as they ought to have been used to protect the ego. Psychoanalysis could help Charlotte by helping her to gain insight which the act of making her unconscious thoughts and motivation conscious. According to freud, by doing this, one experience catharsis and can be cured. Way of doing this includes free association which is reading a list of words and having the patient say the first thing that comes to mind. Doing this might evoke a strong, vivid flashback called abreaction which leads to catharsis. Another way of using the psychoanalytical theory to gain insight is by doing a dream analysis. Writing down your dreams will help Charlotte to understand her hidden desires and helped her to gain insight.