Some Logical Reasonings about Schizophrenia by João Leite Ribeiro

To open this article on Schizophrenia nothing is better than Epictetus’s saying: “It is not things that trouble you, but your opinions on them”(Enchiridion 5). Perhaps this article will lead you, the reader, to have a more favorable opinion about people with Schizophrenia, and this will yield some peace to your heart.

I was diagnosed with Schizophrenia when I was nineteen. I am now forty eight. I never really profited from medicines (although I see they do help many people) , but I improved by way of studying philosophy, especially the Stoics and the Indian Shankara. I now do many voluntary activities to help other diagnosed people. In this article I will discuss some observations I made, both from myself and from my peers. As this is a Stoic blog, I will focus more on  Stoic ideas, leaving Shankara aside.

This article is aimed to be of interest to those unfamiliar with Schizophrenia, and useful for those who are familiar. There is nothing definitive here, just speculation.

Anthropologist Jane Goodall when asked if she preferred Chimpanzees or Humans, answered she preferred some Chimpanzees and some Humans. Me too. I prefer some people with Schizophrenia and some “normal” people. This article is about those people with Schizophrenia I prefer. As Seneca said: “ In the choice of our friends, we should choose  the least maculated (the best ones).” ( Of Tranquility of the Soul, VII.7)

Most therapists assume there is something immature in a person with Schizophrenia. For them, the best to do is to provide us some reflection about ourselves or about the world that will make us “deal with our feelings” in a superior way. However, there is a mistake here. Because this way of seeing the problem is usually (though not always) vertical, not horizontal, i.e. the therapist is placed superior to the patient.

That vertical positioning is not true. That is (I think) the reason I am successful in my work, and that is what I will try to show in this article. Here I include a quotation from Marcus Aurelius: “Have in mind that all rational beings are related, and to care for everybody is of human nature” (3.4). I think from this quote we can infer everybody should be treated with equal respect.

So, let´s be Stoic. The obvious question is: What is a superior person?. This is a question some people may judge politically incorrect, but one that is necessary for this inquiry.

The first answer for the readers of this article is “a virtuous person”.

But that is a little vague, especially for whom doesn´t know Stoicism. I will start with another premise, with which I think most people would agree: a peaceful person is a superior one.

The reader says: Are you saying people with Schizophrenia (I avoid using the term “schizophrenic” because that reduces the person to this definition i.e. I believe we are more than our diagnostic) are peaceful? Yes, I am. At least those I prefer. I am a facilitator, that is, I direct peer support groups of people with Schizophrenia. I don´t know how useful I really am, but I remember Seneca: “What is demanded from a man is that he be useful to the most people possible” (On Leisure, 3 )

In one of my groups a girl declared: “I am going to give birth to the devil.” There was a respectful silence, and an opportunity for her to explain that was because she had a divine mission to bring peace to the world, and giving birth to the devil she would make him give up his hate, and by way of that make the world more peaceful. Nobody opposed her opinion. Here I quote Marcus Aurelius: “Reason is common to us all” (4.4.)

Everything in this event was peaceful. And one should notice here my behavior: I adopted a logical position. I did not allow myself to rush into telling her not to fantasize (although it seemed she was delusional). I gave her the opportunity to explain why she thought that way. And I, and everybody, respected her view, as her viewpoint. And all that was logical, and peaceful. Once, discussing with some followers of Pyrrho, I suggested his viewpoint of having  no opinions was a peaceful one, and they agreed. If you are not eager to uphold your opinion, you become more open to others. Or, if you wish, you should be the superman or the child of Nietzsche (Thus Spoke Zarathustra, part 1, discourse 1).

Another day one of the patients started to hug me, and hold  my hand. I did not oppose. I noticed some people were finding that a bit “gay”, but we did not mind. He now repeats that behavior every time we meet. Even in the street. In fact, he may have set a pattern, I think those of my groups have more physical contact than the average. What is that, if not peace?

My friends have difficulties in sustaining romantic relationships. It is really difficult if you depend on your parents or other relatives, if you don’t drive, if you sometimes get anxious and most importantly, if it is difficult for you to walk around.

Nevertheless sometimes two people in those groups start a relationship. And, it should be noticed, they often agree not to engage sexually. So, it is just about the love between two people. What is that, if not peace?

Yes, says the reader, but this is a Stoic blog, we want to hear about self control. And there you are in trouble! We all know all the emphasis of the Stoics in discipline. Perhaps we could remember Epictetus: “When by reasoning you judge you should do something, do it” (Enchiridion 35)

But I answer to the reader : not at all ! Because you should not judge the sailor before you know the storm! We are all crossing the ocean, but for some there´s a friendly wind, while for others there is a tempest.

Many therapists ignore this, but it is a centrally important fact : my peers have often been abused. They suffered bullying. They experienced trauma. Their own parents were disappointed and aggressive with them. They are more sensible and perhaps more vulnerable (some people are, and that´s not their fault), and there is a feature of many people to abuse others who are more vulnerable. It is not the majority but that happens. Some people don´t let escape any opportunity of abusing others. And that is tragic, as then the abused generalize from that, and start thinking they will be abused forever. I believe Marcus Aurelius is wise when he says: “Remember we live only the present” (3.10). My peers forget this. Their past rules their present.

It is upon knowing that that you should think. And perceive these people may actually be good sailors, given the storms they face.

OK, says the reader. What are you suggesting, that we elect our next president a schizophrenic?

 I thank you for the question. Let´s be logical once again. Who makes beautiful chairs? A good carpenter, correct? Who plays football well? Brazilian players, who play in the difficult fields of the streets since their childhood, correct? And who is able to be a good president? An honest person who knows how things work, correct?

And then, the proper question is: what do people with Schizophrenia know how to do? As a facilitator I tell you. They make you exercise your logic, your patience, your sense of justice, even your courage. People with schizophrenia might make you more virtuous. Is there a better talent than that?

Marcus Aurelius spoke about turning obstacles into fuel. People with schizophrenia are an obstacle of a special quality, they provide more fuel than other obstacles.

But then I can hear the angry father: What the hell are you suggesting? That Schizophrenia is good? That I should not give medicine to my son?

No. Schizophrenia brings a lot of bad feelings. To the person and to everybody who coexist with the person.And yes. Statistics are undeniable. Those who take medicine have less surges and less suicide attempts. But let’s think this though together, and figure out the best we can do.

Some observations are possible. My peers are afraid. They all are. They are highly insecure, and they feel deeply misunderstood. All of them (I have never seen one who did not agree with this) report a deep sense of loneliness.

I was once an employee in a psychiatric clinic. I was paid just to talk to the patients, to have what I called “a philosophical conversation”. One day, as I arrived, a nurse approached me and speaking low, as if afraid someone could hear, told me to be careful, because one guy there was very aggressive, and he might attack me physically. I thought, well, I have a challenge here and I will face it.

He was making strange gestures with his arms and hands, something I could not at first understand. But then I realized he was conducting a music that was playing, like a maestro. I did not know what to do, but I started to mimic him. He apparently thought I appreciated the music the same as him, and laughed. That started an understanding. He lowered the music, so that we could start talking. And a bit later, he turned off the music. As we talked, I asked if there was someone he trusted. He said no, only me. I was sad and happy at the same time.

But we can infer something from this experience. At first, he was completely alone, just making his gestures, with no hope of being understood. Then, it seems, a hope appeared in his heart. And finally he seemed to feel I understood him.  As Marcus Aurelius puts it: “Judge things as they really are, not as a hasty man judges them.” (4.11)

That experience is not an exception. I felt similar in my life. Nobody had the least idea what was going on inside me. So, it seems to me, it is useful to make the person feel he is being understood. It is a first step he can acquire confidence. But he will never feel understood if he perceives you judge yourself superior. So, here we have a delicate situation. We need to show both respect and comprehension.

I think a good way to do that, is focusing in on logic. Trying to understand what the person is saying, and just that, with no wish to show anything, that you have some knowledge or experience he doesn’t have. And, very important, the person should not think you are talking to him in order to acquire prestige, that is, that you want to show everybody you understand him. Here a lot of quotations would fit, I believe all Stoic thinkers stressed the importance of logic. Perhaps I could quote Marcus Aurelius: “Do you have an ability of being rational? If so, why don’t you use it?” (4.13)

Other people may have other approaches. I don’t want to rule those out, but I think logic is a good start. Someone may argue logic is cold, and the greatest need is to be warm. That is true. But I believe, as I said, logic is a start. You begin the relationship trying to understand what the person has to say, and agreeing, whatever he says. And then, as the talk goes, you can reach an emotive understanding.

I am not saying it is easy, or that there is a precise answer. However, I work in a hospital. Anyone can see that those who participate in my groups, (or some other person´s group) are better. It is also because those who search for these groups are already in a better condition, but I keep the argument, because the reason they are better before coming to the groups, is the same they improve with the groups. That is, they feel understood.

To provide that, my feelings are it is better to forget any preconceived ideas. In other words, to be logical. And logic here is also to acknowledge you never understand all of the person. We may today reach an agreement, but tomorrow this same person may surprise you. So, I think we can help my peers by way of making them feel understood. They may grow more confident, they may improve their communicative  skills, and ultimately make friends, and be able to walk around. Logic pervades all this process.

And something interesting happens, that sometimes the participants in the group learn from the facilitator a more logical attitude. And this improves their lives.

Logic for me is perhaps the subtraction of the Ego. What hinders us from being logical? Our wishes and desires? Logic is opposed to a big Ego. It helps you to be more detached, and therefore more free. As Epictetus said: “You won´t wish to be a general, a priest or a consul, you will wish to be free. And the only way to be free is to despise what we are not in charge”(Enchiridion 19) (here we know that logic is perhaps what is most up to us).

My peers are not inferior. They should be treated as equals, and we should not judge that all of Schizophrenia is bad. It brings undoubtedly much suffering, but also some qualities to the sufferer.

And, to that angry father, I do not oppose the use of medicines. But something should be said. The drugs available in the market, they don’t teach you anything. Nobody learns from the experience of consuming Haldol or Clozapine. It is true that we observe when the person stops taking the medicine, all symptoms come back. They do not disappear with the use of these drugs as some people argue they do, they only diminish, and they all resurge when we stop taking the medicine. So, what have we profited from those drugs? While a more logical attitude the patients may learn from the example of the facilitator, is more likely to last, and to really make us better people, more confident, more open. “Happy is the person who is led by reason”  (Seneca, On The Happy Life, 6).

João Leite Ribeiro was diagnosed with schizophrenia when he was 19.He is now 48, and has had a very surprising story of recovery. He now facilitates peer supports groups and gives lectures. He is mainly a self taught  person, but he completed the course of the School of Essential Studies on Stoicism. He is also the author of the book Memórias de um Estoico (The memoirs of a Stoic) which unfortunately has not been translated into English.

         

Author: Gregory Sadler

Editor of Stoicism Today

4 thoughts on “Some Logical Reasonings about Schizophrenia by João Leite Ribeiro”

  1. There is an interesting point here! I perfectly understand the need of a relationship of confidence. But I will talk a little more of logic. I believe, as you are an erudict person, you know about the ancient Skeptics. Then , let´s remember. I think, at least some of them assumed, that an empirical evidence is trustable, and a good guide for life, whereas any inference, any construction of your mind is doubtful, and should not guide your life.Let´s use this in the field of delusions. As you know, it is not a good policy to tell someone who believes he is Jesus he is not. Because, if you put yourself in his shoes, that is indeed disrespectful. However, I applied to my delusions, a different approach. The question ” How can you be sure? “. I used to think my neighbor was a mossad agent. Just telling me he was not, was of little use. But then, I asked myself, from a logical point of view, can I be sure he is a mossad agent? I noticed I could not. Nobody could prove me he was not, but I also couldn´t prove he was. Even to myself. Because, as the ancient Skeptics noticed, any construction of our minds is doubtful. Any. And in this universe delusions are included. This was a perception that we all venture into conclusions everyday that may not be true. It is natural that we take for granted things that are not. But we can correct that. In this very conversation we are having. I could think you are a mossad agent.And tell everybody a mossad agent replied to my article. It would take people quite an effort to prove me wrong, but not so hard an effort to show me I could not be sure.
    This way of thinking was helpful for me. If other people can benefit from it, I am not sure.

  2. Dear mr Ronald Pies, I agree with all you said. But while I am not claiming I have a magical solution, I do think Logic is a good tool to be used. I think there´s a point here if you permit me. Pay attention to what most therapists say (at least I have heard that time and again) . There´s an emphasis on paying attention to your feeligs, and despising all they call ” rationalism “. I believe an advance was made when the approach became “relational”, I mean, trying to figure out what hinders you from realating well with your therapist and people in a general way. But I think there´s another advance to be made, which is not despising Logic. Sure a person in a surge can not assimilate the message. A person not in a surge will have difficulty with that. But other tharapies will suffer the same. In my opinion it is profitable an effort to think properly. To search where your opinions come from. This may help you figure your dellusion may be false. (notice the word “may ” here) I never saw an approach to the dellusions in a logical manner.You observed there´s the CBT line wich would be a more rational line. However my approach to dellusions, in a really logical manner, I don´t think is there, as I know some therapists who follow this line, and my approach was new for them. Realising delusions are not necessarily true is something not very used. So, in short, all you said is correct, but I think there´s a great contribution here to make patients think more carefully. If you wish we can have further discussions on that. Especially about dealing with delusions. Thank you for reading my article!

    1. Thank you for your further comments, Mr. Ribeiro. Yes, indeed–logic can play a part in helping patients examine their delusions. But first, trust, rapport, and empathic understanding must be established–and this is often a very slow process, when working with patients. Without that foundation, the patient with schizophrenia typically perceives the therapist’s “logic” as merely a failure to grasp the import of the delusion and its associated fears.

      I suspect we would both agree with Marcus Aurelius on the critical need for an empathic connection between therapist and patient (and between people in general). As Marcus puts it,

      “In conversation, one should attend closely to what is being said, and with regard to every impulse attend to what arises from it; in the latter case, to see from the first what end it has in view, and in the former, to keep careful watch on what people are meaning to say” – Marcus Aurelius, Meditations, 7.4

      Best regards,
      Ron

  3. Thank you, João Leite Ribeiro, for an enlightening and important discussion of schizophrenia, Stoicism, and what I would call, the “humanistic” treatment of persons with schizophrenia. As a psychiatrist (and student of Stoicism) with long experience in treating schizophrenia, I appreciate your emphasis on understanding the person with schizophrenia (“I think we can help my peers by way of making them feel understood.”). Respect for the patient’s personhood, world-view, and dignity are certainly essential in working with people with schizophrenia and related conditions.

    I also appreciate that–unlike some critics of psychiatry!–you do not rule out the importance of antipsychotic medication, such as clozapine. This medication not only reduces the likelihood of psychotic relapse, it also reduces suicide rates among persons with schizophrenia. And while medication may not be a “great teacher” in the sense that philosophy (or psychotherapy) teaches people, medication can restore mental stability to the point where learning, insight, and emotional growth are possible. Indeed, as you know, schizophrenia is often so severe as to destroy these capacities for many patients. Stoicism and its utility as a life-enhancing philosophy presuppose a certain level of rationality and cognitive ability–which cannot be taken for granted in schizophrenia and other types of psychosis.

    Furthermore, there is no binary choice between medication and some form of “talk therapy” in the treatment of persons with schizophrenia: the best treatment combines medication with various forms of supportive psychotherapy, vocational therapy, and family therapy. There is also increasing interest in the role of cognitive-behavioral therapy (CBT) as an adjunctive treatment for schizophrenia [1]–a form of psychotherapy that has drawn upon the views of Epictetus and the Stoics, as the late Dr. Albert Ellis has explicitly stated (see, “Reason and Emotion in Psychotherapy,” by Ellis and Harper).

    In short, the best approach to schizophrenia is a holistic, “bio-psycho-social-spiritual” model, which, alas, is rarely the case in many mental health centers in the U.S. And while “logic” alone is no panacea, it has its place in the context of CBT–a secular beneficiary of the Stoic tradition.

    Best wishes,
    Ronald W. Pies, MD

    Author, Everything Has Two Handles; The Three-Petalled Rose.

    1. See: Dickerson FB, Lehman AF. J Nerv Ment Dis. 2006 Jan;194(1):3-9. Evidence-based psychotherapy for schizophrenia. (These authors conclude that “cognitive behavior therapy has the strongest evidence base.”)

    For further reading:

    https://www.nytimes.com/2009/05/05/health/05case.html

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