March 2016

Danielle Corcione

nonfiction

When the Sun Bursts: The Enigma of Schizophrenia by Christopher Bollas

We live in a world where people with schizophrenia are heavily medicated, dehumanized, and incarcerated. If we refuse to understand the disease, we will continue to stigmatize those diagnosed with it. In When the Sun Bursts: The Enigma of Schizophrenia, psychoanalyst Christopher Bollas offers insight on his experiences with psychiatric patients over the past forty years. His studies at the University of California, Berkeley and University of Buffalo, in addition to mentorship by psychologist Erik Erikson, contribute to his prominence in contemporary analytic theory.

In this three-part narrative, Bollas includes lessons learned from working with adults and children diagnosed with schizophrenia, his own psychoanalytic theories, and recommendations for alternative therapy. When The Sun Bursts follows Catch Them Before They Fall: The Psychoanalysis of Breakdown, which explores a radical approach to treating mental breakdowns. The alternatives Bollas proposes could potentially help combat stigma and improve treatment among those diagnosed with schizophrenia.

Describing his work as a psychotherapist in Part I, Bollas details some of the fascinating personalities he encountered while serving psychiatric patients. Take Ernst, a teenager with schizophrenia: In response to a stressful upbringing, Ernst disassociated from his family. He celebrated his reclusion and abstained from eating and drinking for extended periods of time to help induce hallucinations, an unpleasant step to achieve the trance-like state that followed, in which he felt at peace. Although he had believed that he could fully control his world, he began to realize that he had, in fact, lost control of his life: "Things began to appear, morph, and vanish without him being in charge."

Early diagnosis, especially during childhood and adolescence, greatly benefits those with schizophrenia. It presents the opportunity to pursue treatment, especially an alternative one. But children with schizophrenia differ from their adult counterparts. While adults may be able to deny schizophrenic sensations and perceptions to others, even close family members or friends, children might not self-censor their experiences. Bollas explains, "Often, those [adults] suffering will be high-functioning, charming, sociable people, and the last thing they can imagine is telling a close friend: 'I am being taken over by something.'" This denial serves to further repress emotion, exacerbating the disruption to mental health.

Bollas argues in Part II that schizophrenic tendencies are a natural reaction to the pressures of society, as those with schizophrenia often experience anxieties similar to those without it. The condition may causes sufferers to perceive and process common noises differently as natural sounds into morph fictitious ones:

At first, often the voices a schizophrenic hears seem to come from the inanimate object world: a tree speaks, or a stream, or a rock. Then in time the voices generally become disconnected from the objects and begin to speak from inside the self's mind.

In the '80s, Bollas coined the term "unthought known" to describe experiences which may somehow be known to an individual, but that they're unable to think about. Mental breakdowns can fall into the category of the unthought known: someone with schizophrenia may, for instance, experience a breakdown, but may not have the ability to fully comprehend and analyze the memory of it.

To help explain the breakdown phenomenon, Bollas describes how someone with schizophrenia no longer has the ability possess authority over themself with "I" statements. Losing control of their own perceptions, reality fragments and hallucinations are projected into their surroundings.

[Schizophrenics] are not able to take part in any collective unconscious process. Their break from what we term reality is so severe that they lose touch with the national unconscious, the regional or local unconscious, their family -- indeed, with everyone.

Perhaps most controversial and compelling is Bollas's stressing the importance of alternative therapy, specifically intensive psychotherapy. When a patient asks about a clinician's personal life in what Bollas refers to as "schizophrenic curiosity," the clinician oftentimes refrains from sharing any details about herself for the sake of professionalism, inadvertently imposing on a patient's comfort. Without a mutual relationship, who will be there for these patients, especially if they have difficulty expressing themselves to close friends and family? Who will be there to listen?

As a solution, Bollas emphasizes the importance of immediate intervention following a breakdown, and of recounting experiences through "I" statements in an effort to transform the unthought known into clear thoughts:

Narrating the self invariably strengthens the I. [...] [T]he simple act of talking and talking and talking, recounting in minute detail the events of the previous days, is structurally efficacious. As the I speaks, again, and again, it resumes its representative function. Consciousness begins its return to the self.

The aim, then, would be to focus on introspective thought and, with the mediation of a clinician, potentially replace schizophrenic hallucinations with post-breakdown reflection.

Bollas's approach to treating schizophrenia is not only hopeful, it's plausible. To better serve those in need of recovery, we need to offer different paths of treatment. Through his own work as a practitioner and his discussion throughout the book, Bollas demonstrates the value of a patient's relationship with and connection to their clinician. We need to open ourselves to alternative methods to keep humanity intact. Although this is not the endgame, When the Sun Bursts sparks a progressive discussion on understanding and treating those with schizophrenia.

When the Sun Bursts: The Enigma of Schizophrenia by Christopher Bollas
Yale University Press
ISBN: 978-0300214734
240 pages