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Integrated Christian Counseling


(A Case of Paranoid Schizophrenia)

by Dr. Brian Campbell

The Woman Who was Locked in a Box

 

Dear Students:

 

In my continuing efforts to help you understand the need for integration and multi-tasking, I want to present a long-term client diagnosed with paranoid schizophrenia. Some important points to notice with regard to this case are the following:

 

1.  Long-term Treatment:  I have been treating this woman for over 20 years.  Therapy is not always "short-term."  Believe it or not, we continue to make progress.  Also, surprisingly, even though I have heard her life story many times over, she still occasionally gives me new and relevant information regarding her past.  The human memory is very interesting--to say the least!

 

2.  Biological Causes:  Schizophrenia has an underlying biological (and probably "genetic") basis that continues to be explored.

 

3.  Medication:  Almost all individuals with this diagnosis benefit from appropriate psychotropic medication.  For information on psychotropic medications used for treating derpession, please click here.

 

4.  Traumatic Events:  Almost all cases of schizophrenia I have treated have been associated with trauma.  The level of traummatic events is beyond what most people would ever imagine or comprehend.

 

5.  Christian Cognitive-Behavioral Therapy (CCBT) Approach:  Even though the person in the case I will provide is actively psychotic, she is able to benefit from cognitive restructuring.  Her main faulty belief is:

 

"I have done something horrible, and man and God will punish me severely for my actions."  Over the years, I have worked hard to help her learn to forgive herself and to put her sins in proper perspective.  I emphasize God's love for her and God's complete and utter forgiveness when a person repents of sin.  The "TRUTH" is that God has forgiven her, and that she will spend eternity in heaven.  

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6.  Psychological Constructs:  I frequently tell her how her brain can "play tricks" on her and make it appear that she sees things when, in reality, they are not there.  This is a "hard-sell" since from her perspective, she really does see the things she reports.  The brain has a remarkable ability to create images and sounds when none exist in reality.



 


Integrating Psychology and Theology

"The Woman Who Was Locked in Box"

By Dr. Brian Campbell, © 2013

Dear Students:

 

During my career in private practice, I have treated many, many, individuals suffering from schizophrenia.  Even though you may never treat individuals with this diagnosis, you need to know the symptoms of this disorder and make a referral to someone experienced in working with persons diagnosed as suffering from schizophrenia.

 

In my experience, virtually all these individuals have had something traumatic occur in their lives that threatened their safety and the very sense of who they are.  For example, for over twenty years, I have been treating a schizophrenic woman who was a victim of extreme child sexual abuse.  Her father sexually molested her during most of her childhood.  At one point, she was locked in a box during the day and then her father would return from work and rape her.  In desperation, in an attempt to end the abuse, this woman set herself on fire with gasoline in an attempt to take her life.

 

As a teenager, she ended up escaping from Costa Rica where she was born and raised, only to find herself on the streets of California, living in a cardboard box.  She was raped and got pregnant and, while she was pregnant, she was raped again.  This is tragedy almost beyond belief. 

 

Today, Cindy (pseudonym) is in her 70’s.  She is married to a wonderful Christian man and attends church regularly.  She is taking several psychotropic medications, including major antipsychotic medications.  We have developed a very close relationship over the years and, as you might imagine, she has developed a lot of trust in me. 

 

Despite her medications, Cindy is still paranoid about police and feels that they watch her and are going to arrest her.  She experiences constant auditory hallucinations—voices that tell her to kill herself, or kill someone else.  Fortunately, there is zero possibility that she will act on the demands of these voices.  She also experiences visual hallucinations and feels that she has seen ghosts in her home and strange little people.

 

For the most part, we are now able to laugh at some of the things she “sees and hears.”  I have taught her to use her husband as a test of what is “real” and what is not.  I have convinced her that if her husband does not see or hear the things she sees and hears, then it is her mind playing tricks on her. 

 

She also talks to her spoons, and feels that they move around in her drawer.  At this point, we are able to laugh at the absurdity of this, and she laughs along with me at times.  One day, she asked me what she should do about her spoons talking to her.  I told her to “tell them to shut up.”  She laughed and said, “You can’t tell me that, Dr. Campbell.”  I told her, “Yes I can.  Just tell them to shut up.”

 

Interestingly, we have discovered that when she listens to certain music, the music helps reduce the incessant voices that whisper in the background of her mind.  Having discovered this, we have capitalized on this observation and she utilizes this “treatment” at home and while travelling in the car.  I think her husband is sick of the music, but he knows that it helps her “stay sane.”

 

My therapy with Cindy focuses on helping her understand the underlying processes that are “driving” her paranoid schizophrenia.  As a young woman, while raising her two boys, she did things about which she felt very guilty.  In subsequent years, every time her boys get into trouble, her paranoia magnifies tenfold.  She feels responsible for their behavior, regardless of the fact that they are in their 40’s. 

 

I work a lot on helping Cindy to forgive herself, and recognize that the “truth” is that it was her father who was the central cause of her problems in life.  I have a feeling that she will never totally stop blaming herself, but we still keep working on forgiveness.  We also focus on the fact that, despite her hardships, she ended up with a Godly man. 

 

Over the years, I have worked to identify her irrational thinking and correct it with the truth.  As you know by now, this is the main direction that my counseling takes.  Ultimately, it is my belief that the “truth will set you free.”  Cindy is not totally free of guilt.  However, she now has some very good days when her symptoms are tolerable.  I love this woman as a sister in Christ. 

 

In my opinion, the progress we have made could not have occurred without proper psychotropic medication.  Schizophrenia has definite underlying biological concomitants.  The disorder is associated with subtle differences in brain structures and brain chemistry.  Reduced brain volume has been shown in the frontal cortex and the temporal lobes.  In addition, MRI studies have established differences in brain activity in the frontal lobes, hippocampus, and temporal lobes.  Excessive activation of dopamine receptors may be related to the “positive” symptoms of schizophrenia, such as auditory and visual hallucinations.

 

Genetics are also involved in the development of schizophrenia, but in a complex way that is still being unraveled by science.  For example, if both parents of a child develop schizophrenia, there is a 46% chance that the child will also develop the disorder.  Typically, in my experience, genes are not the only cause of this disorder.  In the cases I have treated, there has also been a traumatic life event, or series of stressful events, that have been associated with the onset of the disorder.

 

The fact that the manifestations of schizophrenia are similar across all cultures and societies is also strong evidence for underlying biological causes.  In my opinion, the disorder is not caused by “demon possession.”  With appropriate psychotropic medication, many of the symptoms are significantly reduced.  I doubt whether these changes are due to the “evil one” fleeing the body because the individual is taking medication.  Nor do I believe that the evil one is being “suppressed” by the medication.

 

Bottom line, it is clear that this disorder it the result of a combination of biological (genetic) and environmental factors (experiences) that have resulted in a somewhat uniform series of symptoms that reflect the brain’s attempt to deal with traumatic life events.  The brain is literally trying to “make sense” out of events that are difficult to comprehend.  In its attempt to make sense out of the world, it develops a series of irrational beliefs that must be confronted in counseling.  These irrational beliefs are powerful strongholds that require skill, patience, medication, and expertise in order help individuals “come to knowledge of the truth.”

 

I will talk more about how I conceptualize schizophrenia and the model that I use in counseling individuals with this disorder.  I cannot change the underling biology of the disorder (except to encourage the individual to the take appropriate psychotropic medication), but I can help the individual change his/her underlying irrational beliefs about the world.  This is the point at which my logic and my faith enter into the clinical picture.  In essence, the flesh (brain) has overreacted to a hostile world (experience), and I attempt to bring individuals into a knowledge of God’s love and God’s truth.

 

I have been working with Cindy for over 20 years, and she has made great progress.  The “Hell” of her childhood has subsided, and she thinks about her trauma less often.  However, the scars are still there and she may never be fully healed until God completely restores her and she enters heaven with her glorified body.  I am looking forward to sharing eternity with her and the hundreds of other “hurt” people whose lives I have been privileged to be a part of in this world.

 

Blessings,

 

Dr. Campbell

 

For information on medications used for schizophrenia, visit: