Page    1   2   of this article. Journal of Orgonomy Volume 25 no. 2 A Three-Year-Old Schizophrenic Virginia W. Lyon, Ph.D. This three-year, four-month-old patient was brought for therapy by her mother because of severe panic and tantrum episodes. To the parents, these unprecipitated episodes were unmanageable and emotionally intolerable. The focus of this paper is twofold. It shows first, the importance of mobilizing the ocular segment in a schizophrenic child and second, the role of a parent in the child’s functioning and armor. The mother’s intolerance of emotion and the importance of assisting her in tolerating and not interfering with the child’s movement are noted as they occur in therapy sessions. Each step of the way, when aggression was forthcoming, the mother’s resistance had to be dealt with in order to help the child. This paper also documents the progressive sensory-motor integration of the child as therapy moved forward. Behavior, quite primitive initially, became more organized, with movement through several segments observed. From little organization within the ocular and oral realms, integration occurred, with looking, purposeful "not looking," then oral "no’s," verbally and coherently expressed, stuttering (holding in the armored muscles of the throat and jaw), and biting, then, through the chest and hands, vigorous and purposeful hitting. The patient was seen for 79 sessions.   Parent’s Report Lee was without speech except for a few words spoken at home. She did not play with other children. At preschool, her teachers described unpredictable panic attacks: her face would become very worried-looking, her hands would flap in agitation, her voice would take on a higher pitch; she might cry, bolt, or run. The mother described Lee as becoming frantic and frustrated if she did not get to do something or to have something she wanted, such as food. She would then scream single words such as, "Raisin, raisin," repetitively, have tantrums, and become upset and unresponsive. She also had unusual fears. Anything that might cause her to lose her balance was frightening. This included walking in the snow or on a dock. Her parents used extra caution, her father noting that he never threw her up in the air. Confusion, staring, and hanging back were described. She did not like to be touched and had shown no interest in the "potty." Recent attempts at training met resistance. She typically slept 12 hours at night, and her appetite for food was described as "enormous."   History Lee’s family included two likable, educated, quiet parents who each had some sense of humor. Her preschool described them as an asset, supportive, understanding. The mother, depressed, had been in therapy with me for about a year and had repeatedly brought up issues and concerns about her child, asking for direction in management. As her depression lifted, she chose to bring Lee in for examination and therapy. Lee was the product of an unplanned pregnancy. Plans for her home birth were disrupted by a lengthy labor, and she was delivered vaginally in the hospital. No abnormalities were noted. Although a "high rate of breathing" prompted a pediatric consultation, she was reportedly fine within a few hours. As an infant, Lee nursed a great deal, cried a lot, and got upset. The mother stated that she anticipated that Lee, "even when first born," would be willful and tantrumming. A friend reported that Lee was difficult as a baby. She had a period of diarrhea (medical tests showed nothing) and would stick out her arms and legs stiffly rather than bend them when touched or played with. The mother suffered from postpartum depression but also related that she was "very happy" with Lee. In the course of therapy, she once stated that while she hated to admit it, there were periods in the early years of Lee’s life when she (the mother) was physically present but "not there." Since eight months of age, Lee has been in full-time daycare. After the first four days, her first caregiver said Lee cried too much and that she could not take care of her. Lee was nursed until 11 months. She fell off the bed once at about one year of age without losing consciousness and without and evidence of head trauma. The father felt the mother was overanxious. Independent testing showed 10-14 months delay in gross and fine motor coordination, cognitive development, and socialization skills. Neurological examination with EEG and CT-scan showed no neurological abnormalities.   Initial Presentation At initial consultation, Lee was without speech or communicative sound and responded to few verbal or non-verbal directives. She appeared shy, moved haltingly at first, and showed little contact. She did not want, either then or in subsequent therapy sessions, to be separated from her mother. She clung to her mother, and her mother clung back to her. Her physical movements were awkward, and she tripped occasionally as if she did not see what was in front of her or near her feet. Although a few objects attracted her interest, she did not visually scan or look about in an organized manner, and details of the environment did not seem to register. The parents’ initial concern and questions, mainly of a management nature, had not given hint of the severe lack of integration now observed. On the Stanford-Binet Intelligence Scale, Lee successfully responded to several of the non-verbal items at the 24-month and 30-month levels, but either did not respond to, or failed, all other items, verbal and non-verbal, at these levels or beyond, indicating significant intellectual delay. She was active, and there was at times a brightness about her, although communication was clearly quite primitive, contact highly fragmented, ego functioning severely limited, and development pervasively delayed.   Biophysical Picture She was a pleasant-looking child, unremarkable in height, weight, and appearance. At times a placid expression appeared on her face. Occasionally, slight facial contortion suggested worry or incomprehension. The appearance of her eyes was vague, and she made only fleeting contact. When upset, her eyes were unfocused, unseeing, and completely contactless. She was very sensitive to touch, exquisitely so in the occipital region. Her forehead and jaw, and the area around her eyes, were also sensitive, though not rigid. Tight paraspinal muscles were slightly less sensitive. In contrast to the severe ocular armoring, the rest of her body was only lightly armored. Her pelvis, in particular, seemed very loose.   Course of Therapy In the initial therapy session, Lee appeared very frightened, stayed close to her mother, but ventured to retrieve a stuffed animal. In the next session, placed on the couch, she cried, screamed, as in great terror, and seemed unconnected and far out of contact; in was difficult to get her to focus but she followed my finger for a few seconds. Asked to look around the room for her mom (who had stayed in the room as in all therapy sessions and was, in fact, sitting right next to her), she did so, sometimes smiling as if deeply relieved to find her. After a few minutes, she was cheerful and playful. The father, in consultation, noted that "letting Lee have her fits" around the dinner hour and giving her more time in the morning to dress herself was helpful. It seemed the parents needed assistance and encouragement to allow the child to find her own way in activities such as dressing or getting ready to go somewhere. After several sessions, Lee would smile rather beguilingly and clutch her mother when I tried to put her on the couch. Asked to "find mother," she began pushing her mother away and then grabbing her back as if acting out coming and going and asserting control over the disappearance and reestablishment of her mother. She seemed to find comfort in this and laughed lightly. The unpredictability of her mother’s presence or its lack of relation to her behavior seemed to be an issue for her. Through the next several sessions, much terror was visible in Lee’s periodic screaming. Following my finger or looking for her mother seemed to focus her, occasionally bringing her into the present. At these times she seemed relieved. Her mother, on the other hand, was barely tolerating the expression of her daughter’s fears, although she was now more aware of and talked about her own degree of limited emotional contact with Lee in the past. In the next session, using gestures, Lee asked to be put on the couch. She looked less frightened but just as scattered. She took the cloth bats and hit her mother once, then the teddy bear, and me, and was delighted. In a subsequent session, Lee initiated a hitting interaction with her mother by giving her a cloth bat. Quickly, however, she made a decidedly worried-looking face, said, "No hitting," and put the bats away. Lee began showing an interest in movement; standing up and jumping from the couch to me, clearly not trusting herself to leave much ungrounded room between herself, the couch, and my hands. On the couch, there was some crying, then smiling. She enjoyed kicking, saying, "Momma, come," and then, "Momma, go," reaching for, then letting go of her mother or pushing her away. More words were appearing in therapy. Frantic behavior was still evident, however, as if she had to have-a glass of water, a toy. She was unable to wait or delay, to speak coherently or engage in purposeful, problem-solving behavior to obtain what she needed. She would lose focus and contact with the world around her. In session, she cried, then yelled without focus, and without real expression of anger. She neither looked at nor engaged in any behavior directed toward the object she wanted, but had momentarily lost, e.g., a stuffed animal she had brought from home which had fallen out of her hands. It was difficult to engage her directly, but with repeated work on her eyes and talking to her, some eye contact and focus appeared, accompanied by spontaneous, purposeful, kicking. Afterward, she was bright-eyed, cheerful, calmer, and more talkative on leaving. The mother reported Lee was becoming more verbal with the family, was dancing beautifully, and was more responsive to suggestions and "no’s." Work continued on the ocular segment, mobilizing the eyes and allowing her screaming discharge of terror. She was encouraged to "come back" when she frequently "went off," by my asking her to focus with her eyes on her mother or myself. She gave me a vigorous, sustained hug on leaving. Speech was developing with the use of more sophisticated words such as "canoe" and "broccoli." This atypical development helped to clarify the child’s condition, signaling an intelligence obscured by ocular contraction. Biting occurred. Extreme and persistent pronoun reversal, unusual syntax, echolalia, and stuttering punctuated her developing speech, further substantiating the case against retardation and for pathological development of the ego, related to armor in the ocular and oral segments. She spoke with longer phrases and began speaking to people other than her parents and myself. In the next therapy session, she was behaviorally active, wanting to throw, hit and laugh. On the couch, she voiced loud, contactless protest. I said, "It’s okay to get mad," and "You can say no." That seemed to help- she calmed and seemed more focused. Encouraged, she thought it quite funny to say "no." (The mother reported that at home Lee was newly assertive, saying, "No, not want to.") When she was on the couch and was "off," she was asked to look at me. When she could and did look into my eyes, she seemed at first disconcerted, as if far away, and then lit up with much apparent joy and relief. Five months into therapy, she had become more verbal and seemed desperate to be heard; I began repeating everything she said in an attempt to affirm her speech. At times on the couch, when asked to focus, she still evidenced extreme fear and little contact; but after some expression of her feelings, play was more sophisticated and imaginative - she acted out activities and simple stories. Work continued to address her ocular manifestations. In the initial session, when Lee was curious but not yet focused on or attached to an object, her mother was encouraged to "go with her" the three feet or so it took to get to some object of her curiosity rather than getting it for her; this worked well, and it wasn’t long before she was exploring and acting on her own. More commonly, however, when she wanted an object not immediately available, she would frantically cry (instead of reaching), "give up," become upset, and go out of contact. At this point in therapy, she began to respond to encouragement to reach out toward objects, was more active in getting them, sometimes even aggressively so, and laughed when her own efforts succeeded. She showed more problem-solving ability as well as more tolerance for what must have been an overwhelming sensation of frustration. Rather than go "berserk," Lee was now capable of doing something directed when she did not get an object she wanted.   Intellectual Progress At 3 years, 11 months of age, Lee passed the vocabulary test of the Stanford-Binet at the four-year-old level. Prorated, and using the tables of norms, this accomplishment suggested an IQ of about 90. Lee was looking sturdier intellectually. In interaction on the couch, Lee more vigorously pushed my hand away in a game or, with encouragement, when she did not want to follow my fingers with her eyes. She spontaneously kicked with delight. In the next session, Lee looked tired, worn, and seemed to have a veil over her eyes. It was difficult getting any focus from her. Her mother found it difficult tolerating Lee looking like this and said she didn’t know if she should make Lee go through therapy. It is terribly painful for a mother in symbiotic relationship with her child to see these intense, raw emotions. After a session of working her eyes and allowing discharge, Lee hugged me warmly several times. At the next meeting, Lee was reported to have been more assertive at home, telling her dad, without panic, to go away when he told her "no." In the therapy session, as before, even the anticipation of parting with a toy made it difficult for her to engage and make eye contact or for others to make contact with her. After some "giving up" behavior that looked like hopelessness, she spontaneously kicked, said, "No," pulled on my hair and clothes once, seemed more present, and, on leaving, hugged me. In the next session, Lee was charming, bright-eyed, and difficult to engage. She wanted to push against my hands with her hands and feet and did. Her stubbornness was also most cheerfully evident-although now able to engage, she refused at times any attempt at looking. She said "no" with equanimity and seemed pleased to be able to refuse. On a family outing, Lee played well with a family friend her own age and with the other children as well. The mother reported that at home Lee was frequently saying, "No, I don’t want to." Sometimes on the couch, as she started to "go off," she would, instead, purposefully and literally peek out from behind something and look. Experimenting with movement and space, she converted the top of the couch into a downhill slope, jumping and sliding and pushing stuffed animals on it. Nine months into therapy, Lee’s speech was more elaborate, and she spoke to more people outside the home, including strangers. Her syntax was still unusual and disturbed. Leaving therapy sessions was difficult for Lee. She often got quite upset, focusing on something she wanted or some activity she would like to do after she left but which her mother seemed unable to provide. I noticed that if stayed right with her, engaging her eyes and attention throughout the activity of leaving, her typical screaming episode was aborted. The next time, Lee seemed a bit tired, but when she went "off" it was less severe. She cried for her mother’s hand, which she received. Her mother volunteered that perhaps crying and asking for her hand was "just a habit" and that she should leave the treatment room (although she did not attempt to do so). This seemed to reflect the mother’s ambivalence and impatience with her child’s emotional working through as well as her difficulty in tolerating the pain Lee was still experiencing. The mother reported further improvement in her daughter’s manner with other children. Active with and around children, she was, nonetheless, still behind in her capacity for abstract thought. She went to a birthday party and enjoyed herself but did not understand the concept of birthday. During the following week she behaved less frantically. In session, Lee was less contracted biophysically. Given free range, Lee made herself a slide out of the couch and now threw herself about or slid down in a new and vigorous fashion. One felt the need for alert supervision in order to prevent injury. Contained on the couch after this active play, she began to look frightened and disorganized; the vigorous movement seemed to have stirred her up beyond her tolerance. She demanded some item and when this was not provided, she began to scream without letup. Although her recent improved functioning helped her to get what she wanted, her cry was heartbreaking and contained anger.      next page Page    1   2   of this article.