WERTHEIMER presented (in about 1936-1937) the case of a wounded delusional Russian
Tartar - a prisoner of war - being treated in an Austrian Army hospital. He used
the case to illustrate the role of the social field in producing psychopathological
behavior. He contrasted the biological organism-centered or ego-centered approaches
of KRAEPLIN, FREUD and ADLER with the thesis that the nature of the person's social
world has to be understood in order to help him. WERTHEIMER pointed out that there
is a need in people to relate to others. The Tartar was unable to do so in the hospital
situation which he did not comprehend; he did not understand German and no one there
understood the Tartar language. Because of the need to be related, he developed
a pseudo- or idiosyncratic conception of his relationship to the others. In WERTHEIMERs
terminology, the Tartar became a "we-cripple" due to the social field
conditions.
Most of the seminar members, including MASLOW and other psychoanalytically-oriented
individuals, generally agreed with what WERTHEIMER was saying, partly because it
was stylish to explain behavior in terms of social factors. They did not focus on
whether or not the thesis presented was a Gestalt theoretical explanation of paranoic
behavior. They focused on the role of the social field in personality structure
and function, particularly in psychopathology.
At present, more than before I became a clinician, I regard the SCHULTE-WERTHEIMER
thesis as a kind of model rather than as a theory about paranoia. A model may be
used to convey information or to describe a phenomenon "without the pretense
of being unique, complete, or ultimate" (Robert J. SCIAMANDA, Quantum,
Nov./Dec. 1996, p.45). A model is as good as the data on which it is based and on
adequately reflecting the phenomenon for which it is constructed. The SCHULTE paper
presents seminal ideas. It implies a theory of delusions of paranoia but presents
meager data or information. What are the conditions under which a patient manifests
or does not manifest paranoid behavior - in what places, in what situations, with
what activities, and with whom, who, what, where, and when? Similarly a taxonomy
is needed of a patient's different we-relations. What are the conditions under which
he does or does not form we-relations as well as the conditions under which they
are transformed or destroyed? What factors minimize and maximize formation and maintenance
of we-relations? How does the larger field in which the we is formed affect its
structure and function?
Some answers to such questions can be found through small group research. This
is a field where clinicians and social psychologists can join in interdisciplinary
research to study group structure and group functioning of patients in and out of
the hospital.
Normal people also have hallucinations, delusions, or misperceptions and misconceptions.
What are the differences and similarities between their experiences and the corresponding
experiences of patients? And how do the ways in which individuals correct themselves
compare for normal people and psychotic patients? Preliminary studies were undertaken
with normal subjects, based on discussions in WERTHEIMERs seminars (e.g., WERTHEIMERs
Seminars Revisited: Problems of Perception, Volume V, 1974, pp. 261 ff). Preliminary
studies of patients' delusions and hallucinations were made when I worked for the
U.S. Army and Veterans Administration. Methods were also developed to help patients
correct their delusions and hallucinations. The methods and results are described
in papers on group psychotherapy, e.g., the role of the social field in restructuring
patients' perceptions. Some of the methods are related to the psychosocial biological
approach used by Adolf MEYER (1913) for treating and rehabilitating patients to
entertain alternative hypotheses as well as to the methods used by Oskar DIETHELM
(1936/1955) to introduce habits of doubt about false interpretations. Perhaps because
of the disruption of communications in World War I, MEYERs paper may not have been
read by SCHULTE. The methods are also related to Adhemar GELBs and Kurt GOLDSTEINs
treatment and rehabilitation of brain-injured soldiers of World War I. It is of
interest to compare the methods with those of moral treatment in American asylums
in the nineteenth-century.
In a general sense, the methods are similar to those described by WERTHEIMER
for productive thinking, problem solving, teaching and learning. They also fit WERTHEIMERs
challenge that the duty of the therapist is not merely to diagnose or theorize about
the patient but to help him. It is a problem solving situation for both the patient
and the therapist who, with social support, create a learning environment. The idea
is change the patient's focus and to help him to recenter his concepts of his social
relationships, e.g., through role-playing, psychodrama, and action research in his
everyday life. The goal is to help the patient restructure his phenomenal world,
to develop a viable world that is compatible with social reality. In my personal
experiences, it is important to be optimistic about achieving this goal and to convey
this optimism to the patient.
WERTHEIMER presented an illustration from psychopathology to show the effects
of the social field on a person (cf. SCHULTE, 1924). A wounded Russian Tartar was
captured alone and treated in an Austrian Army Hospital where he developed delusions
of being persecuted. He also heard voices, showed extreme anxiety and made suicidal
attempts. This was diagnosed as an acute paranoid episode. WERTHEIMER asked, What
is the cause of such behavior? According to KRAEPLIN, you must study his pedigree,
look for paranoid tendencies in his history and look for glandular disturbances.
One tries to show that paranoia is due to innate disposition. According to psychoanalysis
it has a homosexual basis; therefore, you study the historical development of the
libido to find that it is due to unconscious homosexuality. You may find an unresolved
Oedipus complex, he loves his father, is not loved by girls, he desires men but
finds men cold, he thinks that they hate him, and therefore he gets delusions. In
response to a question WERTHEIMER said that according to ADLER an inferiority complex
causes paranoia and then asked, What do all these explanations have in common? The
situation in which the man finds himself and what happens to him in it are ignored.
Someone said that these theorists do look at the situation, they look at it in terms
of their theories for the cues that indicate the operation of the factors that are
basic in their theories. WERTHEIMER remarked, There is a lack of realization of
what actually happens to the particular individual in the present. You get a different
picture if you consider that the Tartar was captured alone and was placed in a strange
hospital. He was brought into a field of which he is to be a part, a patient; he
is a member of a group of people in a room all of whom talk to each other but not
to him. In this field there are forces that make him feel that they are against
him; he is given medicine and an operation and is forced to cooperate. He does not
speak German, no one knew his Tartar language. He knows nothing of occidental hospitals;
he cannot understand the field that acts on him but he cannot escape. He is in a
hospital of the enemy. What are they trying to do to me, it hurts, I cannot resist,
I must do as they tell me. This led to excitement, caused tensions. He wants some
sort of relation to the field, he feels in need of communication but cannot get
it. He finally relates himself to it as the group versus him. A situation arose
in which he wanted to become part of a We but he was a We-cripple. The focus of
all his thinking is directed on this particular difficulty. He dashes himself against
the obstacle, he is excited, bewildered, panicky. He feels something is wrong; he
feels as someone apart from the others, as outside of the group. This feeling creates
isolation, a feeling of I versus others; they versus me. His ego becomes important;
it is an ego not related to anyone. WERTHEIMER asked, How does a man in such a situation
behave? He might take it as a theater scene, but he hears the others talk and he
is excluded. He wants to know what they are talking about; he makes a hypothesis;
they are talking about me, against me. Everything now is interpreted in light of
this conception of the situation; the disequilibrium is now changed into a equilibrium.
They are talking about me, the doctor wants to poison me. The situation is now clarified;
things have meaning; he has a relationship to the field and has a mode of conduct
in it; he fights to save himself; he tries to escape by suicide.
Someone interrupted to ask what happened to the Tartar. WERTHEIMER said, they
got a man who understood the Tartar's dialect; he talked to him and he was cured....
WERTHEIMER remarked that some say that paranoia is never cured.
1. Let me start by saying that the paper appears to be concentrating on abstraction.
People need to feel part of a group (we-ness). When this is interrupted they may
develop paranoia (ideas of reference, persecution or grandiose illusions) to reestablish
some we-ness. It may be useful to think of such behavior as related to a need to
belong to a group -- but that doesn't mean that the "need to belong to a group"
exists outside of our use of this as a construct.
2. The theory is not biologically based. It makes no reference to the brain or to
evolution. Currently most biological theories of psychopathology will make a reference
to at least one of these. For example, you can argue that people develop misidentification
syndrome because of damage to systems relating to facial recognition. Bowlby's work
on depression as related to maternal deprivation experiments in monkeys and the
biological importance of maternal-child bonding might be a second example.
Paranoia may have to do with evolution. Phobias may have an evolutionary basis.
The capacity to fear; the fear of falling; agrophobia - no place to hide - evolution
has given us the fear of being cut off from the tribe, cut off from comfort; the
social fear of strangers - a new face not in your tribe may be a threat. People
have a need to be connected in a tribe, a family, a group, a "we."
My own theory of paranoia would lean towards the evolutionary explanation. "If
you don't know what's going on, it's safer to think that it involves you than to
ignore it." You are walking in a wilderness 6 million years ago - a branch
breaks - do you think it might mean that there is a tiger planning to jump on you
or do you think, "Could it just be the wind?" It probably is to your advantage
to have the first view, the "fall back" position, and turn to the alternative
view when you know more about what is going on.
When people don't know or trust what's going on, paranoia may occur. They probably
fall back to a more familiar situation. For example, when the computer jams, you
may think it means, "O.K.. Watch out. You better watch out. It probably has
to do with something you did."
3. There is some support for this view. In experiments with hallucinogenics, students
start to show paranoia when they stop knowing what is really going on, i.e., this
is an experiment, that is an MD, I'm being paid to do this, etc. The same explanation
probably relates to the increased paranoia seen in people who are deaf, new immigrants,
after cataract surgery when visual images are interfered with, etc., etc. - all
situations in which there is a breakdown in the usual ability to "know what
is going on."
4. Obviously, one could say that in all the situations discussed in 3, there is
a reduction in "we-ness," but I don't believe that is adds anything, and
is rather too narrow. There is a breakdown in knowing what's going on. For example,
I was walking past a parked car one day and the windshield wipers moved. I thought
"Did I bang something, is there a light beam that I passed through?" I
walked back to inspect it and they moved again. Then I realized the car had been
turned off with the windshield wipers on automatic. But in the presence of a new
situation that I didn't understand, my first impulse was to be self-referential.
Among biologically-oriented psychiatrists concerned with paranoia or schizophrenia,
currently the emphasis is on neurotransmitters and neurochemistry. They may speculate
about why patients do this or that action, but they are usually more concerned with
why patients have obsessions than with the particular obsessions. Neurotransmission
drugs and their effects, e.g., on dopamine, do not have to do with treatment of
specific problems or actions. Why do patients repeatedly wash their hands, check
the door or the stove, or have ideas of reference of persecution? More discussion
is needed of the content as well as of the function and purpose of paranoia in specific
cases.*
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