mhm me? Yeah. The e could tell.

I could tell I was hurting him, not hurting

him. But I was. I was bothering him

. He was acting crazy in the house. No

person can't stand something like that. What we're doing

. I couldn't control my voice. 1000 screen,

that screen, but sort of half scream. Thank

you. Then you should control yourself on then.

The most important thing about the about what happened?

I didn't tell you yet. It's like I was

being possessed by the devil. He was telling me

. It was like he was telling me what to

do and I would do it and I would go

along with it. I would couldn't fight it.

I know it's hard to you to believe that,

but what was it? What did it feel like

? It was horrible. But I know I was

destroyed. I was on the verge of destroying my

father. The voice said, Kill your father.

Something like that. Stab your father. Then I

would answer. No, I won't do it.

I'll do it later. That, uh, I

couldn't stand on. Drove me nuts was a real

struggle. Well, I was I wasn't getting anywhere

I was just getting deeper and deeper into the intra

mess. Every action I took was against my father

. Then I said, after my father, I'm

gonna kill my aunt and uncle, then all my

relatives that I killed that I that I do the

supreme act of eliminating eliminate the universe destroyed the entire

universe. I felt I could do it. Actually

. Did you really feel you could do it at

the time? You know, it's not. It's

not that hard. I mean, I heard people

when I walk on the street, I look at

people, people look at me and I turn away

, and I heard some a little bit. You

do this enough times. It can affect people on

their jobs. When they go, come back from

the lunch hour on their job. They make a

mistake on their job based on a reaction expression that

I passed on to them in a purposeful expression.

No, it's not the whole I don't wanna hurt

anyone, but I don't know what to do when

people look at me in the street. Once in

a while, every once in a while, a

person looks at me in the street like a very

friendly look. You know, like he sees something

that he likes. He sees in me something that

he likes a panic stricken. I have no idea

what to do. It was a man usually no

men or women e they smile at you. They

don't smile about sometimes sometimes women smiling Pastor, I

don't know what they don't smile back. Haven't been

able to do that. Young man you've just been

looking at has been diagnosed as suffering from a schizophrenic

illness. And at the time of this visit,

one week after he had had an acute exacerbation of

his symptoms uh, he is beginning Thio tell us

how the recurrence of this episode occurred. He stopped

taking his medicine, which is a very common problem

in patients suffering from long standing chronic mental conditions.

As you'll see, he describes a variety of delusional

experiences, hallucinations and other terrifying things which are very

disconcerting to him is well as to his father with

whom he lives, the important thing in this tape

is that once his symptoms are under control, the

problems he's got to deal with are largely social problems

faced by other young people who are still very dependent

on very attached to their families. I think this

is the underlying theme that has the widest significance,

the most significance in terms of the problem of managing

patients such as this. Because with the advent of

chemotherapy in the past 15 years, it's now possible

to treat people suffering from schizophrenic conditions in the community

. And almost half the hospital beds in New York

state alone have been emptied as a result of the

advent of the major tranquilizers, the Fino thighs scenes

. But once they're in the community, they oftentimes

face the same problems that they did when they were

in the large institutions. That is custodial is,

um, a an excessive concern and sensitivity for their

problems. Experience by their families, which leads to

a over protectiveness, a kind of reluctance to let

the young man go out on his own, become

independent. In turn, the young man begins to

experience some of the same frustrations and feeling that his

father parents are very dependent upon him. And it's

the generation of guilt and frustration because of of this

feeling of obligation towards the family, which creates much

of the pent up hostility which is then reflected in

the kind of delusional formation which he describes. But

if you compare me with all the evil people in

this world, I come out the worst. What

have you done? That's been evil. I told

you evil thoughts about my father Stand evil thoughts.

Yeah, but you haven't. Evil accident is not

what you've done. A lot of people have evil

thoughts. What you're saying is angry feelings. Why

would I want my father? Why would I wanna

hurt my father? I don't know. Purely.

It's purely an evil thing. It has no basis

. There's no rationality for Well, maybe there is

. E, have you ever gotten angry? Yeah

. Thank you. Yeah. Again. You probably

get angry. And sometimes, without even being willing

to express that anger, I try not to express

Try to impress her. That's right. What is

that? Where's that feeling? Go. I know

. Uh huh. Builds up. Where'd you go

? Doesn't any. Doesn't sign. It builds up

inside you builds up these evil thoughts. Were these

angry thoughts which you then interpret his evil. Okay

, if you were evil, you wouldn't. You

sort of get having angry feeling. You express it

and you wouldn't be concerned with the consequence, they

wouldn't have any evil. That's no good. When

I express my anger, that's gonna be very well

not be because you feel guilty for doing that,

too. Question is, what can you do to

prevent yourself from getting angry to prevent myself from getting

? I get angry at everything. Every little thing

in the course of the day gets me angry or

everything. Everything gets me angry. Your father make

it particularly difficult to get angry with him because he's

so kind to you. I can't stand that way

. He's so come to me. You can.

That really makes me feel guilty. Does everything.

For me, everything is to sacrifice a little thing

, like making some bacon for lunch. He'll take

the old package. You don't say, and I'll

give you see? Tell me you start the new

package. It's a trivial little item, yet that

happens 10 times a day. I guess me that

great guilty on mad. But you can't express it

because he's done. What he feels is an act

of kindness. Is that I think so. I

can't think too well. Did you understand that?

I think you've explained it quite clearly. Kids.

He's nice to you. It makes you feel a

little bit helpless. Makes you feel a little bit

guilty. It makes you feel a bit resentful the

same time it obligates you and your kind of caught

in that trap. Oh, yeah, I see

what you mean. I mean, if he was

sort of nasty to you. Yeah. Then you

could get nasty back. But he is kind to

you. It makes it very difficult. Think like

you feel like he's doing it for you when maybe

he's really doing it for himself. Maybe he feels

more comfortable. Maybe it makes him feel good that

he's kind. Mhm? Well, he thinks he's

kind because from what you're saying doesn't sound like it's

real kindness. Real kindness would give you a kick

in the tail, let you go out and discover

that you really have more. Resource is Then you

believe you dio Yeah. How much do you help

him? Help him? How do you know what

we spend? How much are you supporting him?

Even though it looks like he's taking care of you

Well, I try to support of a lot.

It means that I I listen to all this conversation

. I pretend to listen to those conversations without really

listening toe. That's that's no good. You're cheating

. It's cheating. What about sort of his conversations

are so bad? Why can't I just listen to

him? Really? Maybe you don't want to All

the time. Yeah, but you have to do

it. You have toe, do you? Well

, he has certain needs that I have to help

him with, do you? Well, who else

? Don't be anyone else there. Is that his

problem? Your problem? Well, I have to

help him out. Why? Because your father let

me. Oh, that means a lot. What

do you say? What does that mean? What

we're you know how much is good for me.

Yeah, but you've got your own nice lead to

, but I can't lead at this point. He's

supporting me. He's not even he's not even criticizing

me. He's myself support. He knows I can't

. He senses that I can't go out in the

street. But I wonder whether you couldn't do Mawr

. If you didn't feel like you have. He

needs you to be dependent on him. It makes

him feel good to take care of you. Yeah

, that true? Yeah. And so for you

to go out and get a job becomes self supporting

are self sufficient. I don't think it goes that

far. That doesn't want me to get a job

, but I think it definitely means live on your

own. You have your own life with that.

Well, he'd be glad if I got married.

He'd be glad. Of course you have a conflict

with the we've been read. I don't think he

you would be. That hung up Thio. Protest

. Something like that. If I got a job

, got married. He's encouraging me to go out

and meet friends. He's coming to club this friend

. Try and get it. Go with him.

He wants me to work that well tomorrow. That's

an upsetting thoughts that he wants me to get.

Well, but he doesn't. Well, he does

. He doesn't want me to go well, but

you're afraid of e. Think like you're putting a

lot of emphasis now My father's problems. I don't

think my father has been such a big problems.

I don't know, but you have these feelings about

your father. You compromise yourself to some extent in

order to please him. Listen to him when you

don't feel it, but but the reason I do

it is because I think he's an exceptional human being

. The fact that he never complains about it work

, they in it, they get, somebody goes

to work, there's a four o'clock in 15 o'clock

, goes out and does a good days work.

It's even hard to beat that. I mean,

it makes him a saint, but he he is

in a way that's so I mean anything less than

that. You know, Certainly if you're not even

getting up going up and you really are the devil

from that point of view, e don't think you

are, But I mean, I could see where

you might feel like you are. You can't measure

upto. It makes you feel very guilty. I

think I said to the truth and what you're saying

. I can't really think about it. I can't

really follow with that great good. I think I

said What do you think about it? As you

can see, it's quite possible to engage the quite

irrational and disturbed young person in a psychotherapeutic encounter.

It's quite possible to, uh, acknowledge that you

understand how he feels but that you don't necessarily agree

with him. I think it's important not to argue

with people and not to discount the way they're feeling

. He really believes that he was talking to the

devil. He really believes that he's one of the

worst people of all time. The important thing is

to acknowledge and to recognize, uh, that he

does feel that way and try to understand what the

sources of it are, because the sources are likely

d o t. To turn out to be very

much of similar experiences, to the kinds of things

everybody experiences in the process of growing up so that

his delusions are understandable and it's in trying to get

at the source of them that one is able to

see what the root of his current problem is.

I think he's vulnerable in the sense that he tends

under stress and under difficult circumstances to become schizophrenic in

terms of the symptoms he has. But I think

at the same time the problem he has is one

which can be worked with. It's funny, I'm

trying to be such a good point. I want

. I'm not being a good boy because the good

boy is out of the house at home. He's

his in his own home with his own wife and

Children. So where my good boy? Not even

a good boy at home he's been. He's been

very, very helpful. He helps you with the

cooking. He helps. You were cleaning up the

apartment. Hey, takes a shower every day very

clean about himself. Last week, when he was

so disturbed, was his behavior peculiar at home?

Yeah, it all started Wednesday night when I got

married when I came home, by the way,

he said, Dad, he says, I'm not

gonna trouble you. I want to go to the

hospital. I want to go to Rockland said.

What? I'll stay home. We'll take care of

you. You'll be all right. There's no he

doesn't wanna. He doesn't want to make things worse

for me. So finally I I calmed him down

. I said, Let's get in touch with Dr

Keith on board. That's when I called you Andi

. I spoke to you. But is he rather

a difficult problem for you to handle it? No

, no, no, no. He's very nice

. He's not difficulty. Oh, he's very nice

. You do a lot for him. No,

he does everything. So the only thing that I

do is when he doesn't feel like going shopping.

Hey, used to go shopping every Saturday on board

. You stay care of the laundry. But there

Recently, in the past few weeks, he stopped

doing everything but this survey right after the visit with

you, he did the laundry. I did the

shopping on. We clean up the apartment way on

. Hey, was all right over the language.

Do you depend on him? I don't depend at

all on it. I wonder if he has the

feeling that that if he went off became independent,

lead his own life. You'll be all alone.

You have that said? Well, hey, he

had that feeling here in the office that Thursday.

Uh, when uh, you mentioned hospital? You

know, he says to me, You think Dr

people send me the hospital said I don't think he

will. Then he says if he does, you're

gonna be all alone. So I I said,

don't worry about me. I can't believe that you

He is worried about that. I'll be alone.

Andi. I told him that there wouldn't be any

problem. I told him many times It says,

Go out world, get friends. He has no

friends but I think he feels a tremendous sense of

royalty when feels like that's why that's why he probably

feels He feels that if he if he doesn't get

better and go out with friends on DE so I'll

be all alone. So I told him I said

, Don't worry. I said, I have plenty

of places to go. I have plenty of friends

have. How much of a life of your own

delete? Well, I don't. After all,

I'm not an age where life has passed me by

already. I'm gonna be 65 years old. I

went hard all my life. I feel that How

many more years? If I got to go?

So I I go to visit my sister. Uh

, I have a nephew. I have plenty of

places to go. If if he would only shown

inclination to settle down, I mean, that would

be my feel. Probably my life. Leave him

. No, I that's it. That said I

couldn't even find e. I mean the way and

the way he is way is now. See,

he would. And I mean, leaving for a

day, leaving for a weekend. You're leaving to

go to work? Oh, yeah, Yeah.

Could you leave me for a evening? Oh,

yeah. Sure I could. I could leave.

I couldn't even fucking see. What did you think

? Obviously, E H The thing is, if

if I would leave him, I know he would

stay in the house. He wouldn't. He wouldn't

go anywhere. Okay, One of the important ingredients

and treating such patients is obviously to involve the family

, as I'm doing right here talking to his father

because it's in getting the family to understand how they

are burdening the patient, how they are, uh

, taking on a martyr role and creating what has

been called a double bind situation where the messages to

the patient are twofold. Uh, the father is

encouraging him to get out on his own and to

meet young people at the same time as he's doing

all kinds of things to encourage and foster this dependency

. It's clarifying that which is quite a task,

but which is critical to the long range prognosis for

this patient the important role of the therapist is to

help the patient to, uh, make these decisions

to take advantage of what strengths and resource is he

has and not to focus so much on the psycho

pathology. That is to say, in this instance

, I've been talking with him, trying to understand

the, uh, root of this delusion formation by

way of trying to minimize it, uh, and

to bring the problem down into a workable area.

I don't really know very much about exercising devils,

but I can help him to see how it's perfectly

all right for him to go off on his own

, that his father need not be so dependent upon

him that he's not totally responsible. If, in

fact, he's responsible at all for his father's welfare

, it's not so much to tell him to rebel

or be antagonistic, but to begin to think about

his own welfare. And in the long run,

that will have much more positive benefit for him as

well as for his father. Yeah, yeah,