No Human Being Is a Stone

How much are psychotic people like us? What do they feel? What do they need? What do they suffer from?
Yves Pélicier, professor of medicine in Paris and physician at Necker Hospital, answers these questions in this clear and humane article.
The great and welcome news that communication theory has given us in recent years is this: we cannot fail to communicate. Silence, gesture, refusal, mutism, even violence and agitation—all of these say or mean something. The most isolated human being, the one cut off by an inability to relate, is an extraordinary "book" in which we can discover much, provided we accept the challenge of deciphering it without losing heart.
No human being, whatever his handicap, is a stone. He feels. He can suffer. He can cause suffering. He can enjoy. So he speaks to us, sends us messages. The worst attitude is to see only chaos, incoherence, accident—when what is really there is need, fear, desire. It is so easy to lock another person forever into a stereotype, sparing ourselves the hard work of real encounter.

Understanding Without Words

The German philosopher Max Scheler wrote beautiful texts on sympathy—that movement of the spirit that allows us to coincide with another person, to rejoice or grieve together. He also emphasized empathy: the feeling that lets us understand what another person experiences and lives, without language. Here we touch the very root of love. It is striking how often we find this empathy in the parents of psychotic children.

At the root of every behavior lies the need for security, and therefore fear of whatever threatens that security.

At the root of every behavior lies the need for security, and therefore fear of whatever threatens that security.
A mother, and often a father too, can interpret the actions, gestures, and expressions of a psychotic child with extraordinary speed, as if some secret code of intimate language existed between them. Here, the contrast becomes clear between families where this understanding works well and those where communication is difficult, absent, or severely broken. In these latter cases, psychotic behaviors are almost always experienced as shocks, as traumas.
We should always ask ourselves about the deep motives of others, without letting our desire to understand be too easily diverted by their apparent differences and oddities.
Between a healthy person and a severely diminished human being, there are always far more things that draw them together than things that separate or distinguish them.

The Sources of Fear

At the root of every behavior lies the need for security, and therefore fear of whatever threatens that security.
Every person can be afraid; the threshold is higher or lower, but no one escapes it. Yet fear is almost always lived on a personal plane. My fear is not the fear of another, and what terrifies someone else may seem absurd and ridiculous to me. So we smile at children's fears without recognizing that they are the very root of our adult fears to come. One of psychology's great mysteries is surely the origins of fear in the psychotic child.
When experts tell us that what dominates in psychotic children is anguish over "fragmentation," they remind us that one of the most primitive phantoms concerns the integrity of our body. What is broken, or threatens to be broken intolerably, calls to mind—in a person who barely distinguishes herself from surrounding reality—her own destruction. For me to perceive danger properly, I must know where I begin and where I end. Otherwise, even walking on my own shadow will feel like an attack.

Between a healthy person and a severely diminished human being, there are always far more things that draw them together than things that separate and distinguish them

Between a healthy person and a severely diminished human being, there are always far more things that draw them together than things that separate and distinguish them
When you live with a patient, you gradually learn how far you can and cannot go, what you can and cannot say. This set of limits and rules is above all the fruit of unspoken and often uncodified experience about the patient's need for security. This explains why new people, new things so often provoke panic. Neophobia—fear of the new—is common to all fragile people. Change must always be gentle.

Those Trivial Little Things

Besides, when it comes to behavior, there is no universal scale of value. What is small to one person may be immense to another. The educator's whole art lies in recognizing and accepting the sensitivity—and hypersensitivity—of others. We cannot predict in advance how someone will react to what happens or what is done. The psychotic child is truly unpredictable only to those who "observe from above."
In practice, one of the most immediate sources of security is routine. That endless circling, that gesture repeated infinitely, that monotonous chant, those small things we call insignificant because we do not understand them—these are the means by which the psychotic child seeks to reassure himself and find safety.
What we throw away on the pretext of cleaning house is not merely a "dear scrap of paper" or a bit of string. It is the repository in which our child has placed some small measure of trust in himself.
Even if the phrase sounds too strong for the level of consciousness we imagine in such a diminished being, this is precisely what is at stake: to touch, and especially to destroy, the things that belong to a psychotic child—things that are at once external to him and intimately bound up with his being—is to mutilate him.
We learn another lesson from Kurt Goldstein's study of war wounded from the First World War. The German neurologist analyzed the "catastrophic reactions" provoked in people with severe brain injuries by situations that required—however minimally—an adaptation of behavior. Incapable of coping with their neuropsychic structure, they fled into aberrant emotional responses that bore no relation to the actual situation.

Those trivial little things, insignificant to us because we do not understand them, are the means by which the psychotic child seeks to reassure himself

Those trivial little things, insignificant to us because we do not understand them, are the means by which the psychotic child seeks to reassure himself
This is what the American sociologist Kurt Lewin observed in another way.
Take a normal individual and place him in an enclosed space with the task of finding the solution to a problem that actually has no solution. After many fruitless efforts, the individual faces a choice: discouragement and passivity (he falls asleep), delirium (he invents an unreal solution), or violence (he breaks the rules and leaves the enclosure).
Apply these insights to the psychotic person, and we see how easily we can provoke a "catastrophic reaction"—by failing to foresee whether the expected response lies within that person's capacity, and by failing to guard against the intolerable frustration that will follow failure.
Against surprise, novelty, and shifts in atmosphere, the psychotic person relies heavily on rituals and repetition. Life then seems reduced to a game of automatism and mechanism. But behind it always lies a living, very powerful emotional reality.

Atmosphere

We must also say something about the notion of atmosphere. (A great clinician, H. Tellenbach, devoted a beautiful book to it.)
Atmosphere is a dimension of encounter that precedes language. It is the result of what emanates from beings—through their attitudes, expressions, and intentions. It has long been observed that in certain hospitals, when doctors had conflicts among themselves, patients sensed it and grew worse.
Who does not know how sensitive psychotic children are to the family atmosphere?
Quarrels and worries cannot be hidden. What follows is the weight of anxiety and the threat that alters behavior. It is true that we cannot entirely avoid life's difficulties, but we must know how to reduce their impact.
Given what has been said, we can understand that agitation, negativism, violence, loss of appetite—these want to "say" something that can be heard. The important thing is to analyze the system within which the observed facts occur, and not to fall back on an elementary and often inadequate response. The psychotic person, more than the normal individual, *is* within a system. This system is what sustains him and allows him, possibly, to improve his presence.
The psychotic is not a presence defined only in negative terms. Moreover, the psychotic person is the soul of the system. This exchange is vital and must be preserved at all costs.

The True Face of the Other

The greatest obstacle, more than in the mental state of the psychotic child, lies in the attitude of those who make up the system: parents, brothers and sisters.
This is not about judging or criticizing from the outside—that is far too easy—but about highlighting how readily we fall into ambivalence and illogical strategies. The psychotic child evidently needs love, which is the foundation of all relationship. But he also needs continuity and stability in contact. In schizophrenia—a different problem altogether—the most serious factor in relapse seems to be the burden of family emotion. It is true that every psychotic child is sensitive, a barometer of the system's tensions and ruptures.
Toward any handicapped person, it is nearly normal that the thought of his death arises at some moment. We defend ourselves against such thoughts with guilt, and then redouble our attention and effort.
This reality is known, but it still creates a reservoir of overpowering emotional states that interfere with and disturb daily life.
Illness, especially grave mental illness, is a screen that masks the other's depth and authenticity. Beyond the mask, the gaze of love can, now and then, discover the true face of the other—who is also our child. This relationship, freed from accident, is still possible for us, provided we seek with humility and perseverance, beneath the sad rind of things, the great meaning of Being itself.

-by Yves Pélicier, 1984 from Ombres et lumière No. 61