Some Problems in Communication with Schizophrenic Patients

I have discussed some of the problems of communication with schizophrenic patients, with particular reference to one patient with whom my efforts to facilitate communication were initially hampered by my assumption of total responsibility for understanding the verbal content of his communications. With the aid of sound recordings and a study seminar, my concept of my therapeutic task changed from that of providing expert translation to that of helping the patient assume his share of responsibility for successful communication. My view of the obscurity of the patient's communications changed from one vaguely describing his language as jumbled or crazy to one recognizing various meanings of the obscurity as a result and index of the patient's anxiety, a means of concealing frightening feelings and a compromise between the patient's intense desire for and equally intense fear of an extraordinarily intimate relationship. I then found myself less bound to a search for a single meaning of the verbal content, and the patient's communications took on an expanded range of meaning for me. I was more alert to cues such as tone, rhythm, volume of voice, and body movements. Noting the timing and context of verbal obscurity was often more useful than efforts to translate the obscure content. His uses of talk for direct pleasure, relief of loneliness, "filler" to sustain our relationship and a means of dramatizing conflicting self-concepts were often revealed more by the form of his speech than its content. Meanwhile, the verbal content itself also became less obscure to me. A number of factors contributing to the obscure content were delineated, including: the use of concrete verbal imagery instead of abstract symbolic terms, inability to focus thoughts and speech and maintain their organization into separate categories, need for verbal self-instructions, inability to discriminate between essential and minor details,

and the perception of different Gestalten. The elucidation of some of the attitudes and concepts which facilitated my better understanding of the patient's communications furnished a more explicit statement of what might otherwise have been lumped under the rubric of increased intuitive awareness.