[On the improvement of everyday life behavior of chronic schizophrenic patients; from the viewpoint of "play-like behavior"].
In this study, the author examined the behavioral patterns of chronic schizophrenic inpatients to follow the process of the amelioration of abulic symptoms such as loss of interest, poverty of thought, lack of sociality, and poor communication. In everyday life in the ward, abulic patients had difficulties in accomplishing not only the basic habitual acts such as getting up or going to bed regularly, exchanging greetings, cleaning teeth, bathing, and washing clothes, but also their assigned duties on the ward. Furthermore, they were unable to behave according to the rules for inpatients, express their emotions appropriately, or build normal interpersonal relationship. The author found that five inpatients achieved some spontaneous behaviors of their own choices in the process of improvement in the above-mentioned habitual acts. As these spontaneous behaviors proceeded through several phases, obvious improvements in their behavioral patterns in everyday life were also observed. The initial phase of transient spontaneous behavior was followed by the second phase of continual spontaneous behavior. Finally, in the interview sessions, the patients became to express pleasurable emotions and physical feelings when they performed their own acts of continual spontaneous behavior. This phenomenon seemed valuable in the therapeutic context because schizophrenic patients are considered seldom capable of having positive feelings toward their own experiences. Therefore, these pleasurable continual spontaneous behaviors may be called "play-like behavior", as confirmed by comparison with the properties of "play" as defined by Caillois. In considering schizophrenic autism, Minkowski described "activité autiste" as an intrinsic quality of the way of life in schizophrenic patients. The manifestation of such quality in spontaneous behaviors can be regarded as having two meanings; an aspect of pathological acting out and a sign of recovery to realistic behaviors. Therapists should consider both aspects when conducting therapies. Although the patients regained the habits and norms of everyday life during hospitalization, the rules involved in "play-like" behavior seemed to contradict some rules in the habitual acts or assigned duties in their daily lives because within "play-like" behavior, freedom predominates over rules. The rules in "play-like" behavior are acquired mostly by mimicking other people. These rules are not fixed laws with penalties but are changeable rules depending on the circumstances of the behavioral process. From this viewpoint, "play-like" behavior allows the patients to acquire practical rules and to understand the relative nature of the rules. Most of the "play-like" behaviors originate from the preferences of the individual patients, which may be something that they have already experienced, something that they have longed for, or something that gives them self-fulfillment. These qualities contribute to the acquisition of experiences that they find pleasurable. For the patients, recalling each "play-like" behavior in the interview sessions enables them to grasp the whole picture of their behaviors, to reinforce their attachment to these behaviors as their own experiences, and to promote the dynamic process between behavior and thought. In this sense, psychotherapy incorporating the aspect of "play-like" behavior seems to prepare the schizophrenic patients to improve their way of thinking. To nurture "play-like" behavior helps the chronic schizophrenic patients to recover will power, independence and sociality, and contributes to the improvement of clinical symptoms and of daily life activities.
Maruta
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Tokyo University Branch Hospital, Department of Psychiatry.
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010988:Play and Playthings; D012565:Schizophrenic Psychology