SOCIALIZATION FACTOR (PART 6)

DEALING WITH THE GOOD AND THE BAD OF “PROSOCIALIZATION THERAPY”

6-A) The problem of agitated behavior. Taking a small dose of mecamylamine/ Inversine can make some individuals have wild psychotic behavior or become very socially disinhibited. Other medications which enhance socialization can cause the similar problems. Such a property does not give the use of these medications an overwhelming endorsement. However, the magnitude of the life changes that can be effected by their use demands that clinicians will have learn how to use them effectively. There seem to be several ways to minimize the risk of behavioral side effects:

6-A1) Giving very small initial doses. This helps prevent these problems from occurring as frequently, but there remains a certain percent of patients whose response to even very small doses of these medicines will be some form of agitated behavior.

6-A2) Not raising the dose of medicine for a considerable time once there is a positive effect. It seems that some individuals can handle only so much stimulation at the beginning or else they develop agitated behavior. After gaining some experience with improved socialization, many will later be able to tolerate higher doses and make further progress.

6-A3) Treatment of various other psychiatric conditions before starting the prosocialization medications. This seems to be a very important precaution. The entire process of socializing depends upon the individual’s ability to have a mutually interactive social function. Otherwise the attempt at socializing may be driven by the primitive autistic or symbiotic drives and cause disruptive behavior — even schizophrenic-like psychosis or manic-like disinhibition. Currently it seems advisable to make sure that any potential for autistic psychosis and for manic-like disinhibition are treated before giving prosocialization medications.

6-B) Comparisons of “socialization side effects” with the major psychiatric breaks. The severe behavioral side effects seen with the use of “prosocialization medications” are typically an aggressive psychotic self-oriented agitation, a socially intrusive disinhibited hyperactivity, or a mixture of the two. These behaviors are quite similar to the dysfunctional states which occur in the two major acute psychiatric disorders – the schizophrenic break and the manic break. It seems possible that in some individuals the prosocialization medication opens up a reactivity that was previously repressed by being in a state of dissociation. Similarly, it is theorized that prior to the actual schizophrenic or manic break there are dissociatively suppressed psychotic processes functioning in the brain– one built on grandiose “autistic” social isolation, the other built on a grandiosity which causes a “symbiotic” breakdown of social barriers.

6-B 1a) The schizophrenic break- a breakthrough of the autistic phase dissociation. Most commonly the symptoms of schizophrenia appear suddenly, and rapidly take over the functional personality. A reasonable explanation of what happens in a schizophrenic break is that a previously hidden negative withdrawal dissociation emerges. The concept proposes that prior to the actual break the individual has been reacting to life with a paranoid sense of being singled out for negative treatment by those in the social environment. However, most of this reaction is hidden from the individual—and from his acquaintances. Superficially, the individual functions with normal social activity and emotions—although there may be hints of the social estrangement evident if one carefully observes the behavior. Despite apparent normal function, the individual has dissociatively hidden feelings of persecution, estrangement, and isolation coupled with thinking that focuses on internal world autistic grandiosity. (Note that this is not the grandiose social intrusion of the manic break.) This internal world paranoid thinking is what the individual actually feels about life. The mind clings to this irrational thinking because it “feels right”—despite being unpleasant and emotionally empty. Once the break occurs, the formerly dissociative isolation drive runs the personality – and the socialization drive becomes dissociatively suppressed.

6-B1.b) Treatment with the atypical antipsychotics and other prosocialization medications may again open the socialization function for use. In many cases, simply reestablishing the social capacity is adequate to suppress the paranoid psychosis but there are some individuals with such a strong paranoid, delusional system that they do not tolerate prosocialization meds. These individuals may require treatment with the older strictly dopamine-blocking antipsychotics which simply suppress the chemical imbalance which perpetuates the psychotic thinking.

6-B1.c) Observation from the past about the pre-schizophrenic and dissociation. Dr. Harry Stack Sullivan, who treated hundreds of schizophrenic young adults n the 1930’s and 40’s, talked about the presence of a dissociation prior to the onset of schizophrenic symptoms. He also stated that the former mental activity, which had kept the dissociation hidden, remains functional (but presumably it is now dissociatively hidden.)

“The schizophrenic change, I believe, is quite generally due to an inability to maintain dissociation. Now in order for there to be dissociation, a rather elaborate body of processes must be built into the self to maintain it; and when one is unable to maintain the dissociation, it does not mean that all this invention in the self totally vanishes.” Harry Stack Sullivan. The collected work of Harry Stack Sullivan V2 Clinical Studies in Psychiatry The Schizophrenic Dynamism, 1954,W.W. Norton, New York page 187 ®6-1

6-B1.d) Present day understanding. There is not much attention paid to the possibility of schizophrenia having a dissociative component. I have never heard a lecture or seen an article on the subject. Most internet cross-references for dissociation and schizophrenia are on sites which seek to deal with mental illness more as a psychological phenomenon not simply a chemical one. Most of material is dedicated to explaining the differences between typical dissociative disorder and schizophrenia. There are only rare references to the possibility of dissociation in schizophrenia. The reference below hardly attempts to maintain a strict science view of the various phenomena of this illness. .
Schizophrenia can be characterized as a dissociative state. From a psychological perspective, dissociation is when parts of the psyche are 'split-off' or fragmented. From a shamanic perspective, these split-off parts are not just psychological, but parts of the soul or consciousness that have left the body..
® www.newhatstories.com/jennifer/schizophrenia/ ®6-2

6-B2.a) The manic break – The release of the grandiose “symbiotic” socialization drive. Mania may be said to be a regression toward Dr. Mahler’s symbiotic stage – where there is an uninhibited sense of oneness with “what is out there.” Manic individuals do not self-monitor their socializing activities. They feel good about their socialization interactions without reflecting on their own sense of social rules or noticing the effect they are having on others. It is like being an after-dinner speaker with whipped cream stuck under the nose – everyone but the speaker is aware something is wrong. Instead, the manic individual sees everything as being wonderful – the socialization drive, normally inhibited by the experience of life can express itself in its primitive form. Money can be spent without restraint; romance and sexuality drives can be acted on. Any activity attempted is perceived as being done well. The unrestrained manic individual feels more “real” but this “reality” represents the individual’s immature expression of the socializing. Mania is like childhood’s naughty grandiosity which intrudes into the social environment without restraint. Because mania is related to actions in the environment, its grandiose activities are somewhat more sensitive to the social environment than is schizophrenic grandiosity.

6-B2.b) Mania can be altered more easily by the social environment. If the manic individual’s inner sense of “getting by” with social intrusiveness is diminished, then the force driving the activity may be weakened. For example, when a hospitalized manic schoolteacher was informed that the staff and the other patients had agreed to stop imposing penalties for stripping off clothes, the individual stopped taking off her clothes. Even though stripping her clothes was an act of basic sexual expression, it was also influenced by the feeling that she had been controlling the way she was affecting others.

6-B2.c) There are ordinary states of disinhibited socialization.
Certain common life experiences are like mania. Individuals are sometimes granted the privilege to “break the social rules” and act in a manic-like self-oriented disinhibited way. For example, at junior high slumber parties the girls collectively break the rules about going to sleep and in a disinhibited way talk excitingly about “adult things”. Couples falling in love, brides, and nursing mothers all can act with a hyperactive self-focus that is like mania. And, of course, there is the very common scene of social disinhibition following the use of alcohol and various drugs.

6-B2.d) The first-time release from inhibited socialization may be somewhat manic-. When suddenly able to act on a personal drive, individuals instantly feel more grown up—more on their own. Their response may be an exaggerated thrust of activity. There may be seen excess energy, less need for sleep, and repetitive behavior: The child obtains a much-wanted toy—and rides the tricycle till after dark. The adolescent gains the freedom of self-transport ---and drives aimlessly till out of gas. The young couple is involved in early romantic love activities --- and prolongs the good-night kiss till two in the morning. (Note that theses actions are similar to the actions of true mania, but true mania seems to be caused by an innate change in the body rhythms not necessarily related to outside social situations.) This same disinhibition occurs in individuals whose previously inhibited socialization drive is released by medication; there is often a period of disinhibited behavior. Such behavior may calm itself after a time – but in some situations it may persist even when the prosocialization medication is stopped.

6-B3) All prosocialization medications can cause disinhibited behavior. The excess outgoing activity produced by prosocializing medications was noted when risperidone /Risperdal was given to autistic children. On “standard” doses of 1 mg a day, they were often actively “in the face” of the caregivers. If the dose was started at the tiny dose of 1 drop (1/20 mg.) there often was a meaningful improvement in socialization: but if two drops were given, a child might wake up at two a.m. and play for several hours. Use of more activating medicines such as mecamylamine /Inversine and the glycine agonists often produce some symptoms of over-activation even while providing positive benefits. The use of the very small initial doses helps but does not eliminate this problem.

6-C) “Treatment failures” Over time, most individuals who gain benefit from prosocialization meds develop control over their socialization activity. They will cease to have overactive behavior and may tolerate higher doses of the medicine. But there are those who do not develop behavior stability when treated with the prosocialization agent alone. Such individuals will most often demonstrate two major types of behavioral disturbances. The majority will maintain manic-like uninhibited intrusiveness. A few severely disrupted individuals will have a schizophrenic-like psychotic state. Most of the time such symptoms can be treated or prevented by using mood-stabilizing medicines or non-activating antipsychotics. However, there are some individuals who seem never to tolerate prosocialization medications without developing such undesirable symptoms. This is the major challenge to the use of prosocialization medications.

6-D) Understanding the new concepts. The materials given in this section are newly formulated and based on fragmentary evidence, but there is enough correlation to state at a few principle concerning the implications of prosocialization medications to psychiatric theory.

[35] There is a enough of a similarity between (1) Margaret Mahler’s autistic and symbiotic stages of infant development, (2) the symptoms of the major psychotic breaks, and (3) the symptoms of psychotic isolation and manic disinhibition released as side effects of prosocialization medications to support the idea that all three must have some type or relationship in primitive brain function.
[36] The socialization factor, which seems to be “released” by prosocialization medications, is seemingly a different, more mature dissociative process from these two primitive, psychotic personality states which are seemingly held in check in the subconscious by dissociative processes.
[37] In individuals who are responders to prosocialization medications, the ability to use the socialization response had been inhibited by a variety of factors including hereditary tendencies, threatening social environment, physical health, abnormalities of the central nervous system, and experiences involving failure in attempts to socialize.