Case of Charlotte
Charlotte shows symptoms of schizophrenia, a psychotic disorder in which the
individual loses touch with reality. According to the DSM, the criteria for schizophrenia are
as follows: having at least two of the symptoms of the disorder for a period of 1 month. These
symptoms include; Delusions, Hallucinations, Disorganized speech (e.g., frequent derailment
or incoherence), Grossly disorganized or catatonic behaviour and Negative symptoms (i.e.,
diminished emotional expression or avolition).
Of these symptoms, hallucinations, delusions or disorganized speech must be present
and in Charlotte’s case, she has disorganized speech and delusions. Charlotte displays 2 types
of delusions. These are delusions of grandeur and delusions of persecution. Delusion of
grandeur occurs when an individual think that he/she is an important person. This can be seen
in her belief that she has some special connection with the spiritual world. She believes that
she is able to tap into spiritual energy which allows her to create unique art. Her sense of
importance is further emphasised by her playing the role of a doctor and telling the nurse who
was there to administer the medications, not to disturbed her. She also has an in-depth
knowledge of the other patients, how much medication they are on and about the
personalities of some.
She also has delusions of persecution. She believes that her mother and uncle had
team up to have her admitted and this was facilitated by the psychiatrist whom she has little
regard for because according to her, he is not a spiritual man.
Charlotte’s speech was also disorganized. In replying to a question related to her
functioning at home, charlotte was making loose associations. That is, she was jumping from
one topic to the other with no connection between one though and the next. She started with
how her sister came with her things, then jumped to how she needed energy to write her
book, then talked about writing and painting then lamenting on how she couldn’t get to dance
again. Another feature of her disorganized speech was perseveration which was when
Charlotte was kept on repeating the same words and statements. Another criterion from the
DSM-V is that the person has to show major disturbance one or more areas which may
include interpersonal relations.
We can see this in how she related to other people on the psychiatric ward. She didn’t
interact with them and was socially withdrawn from them and though she was better than
them, referring to the other patients as germs. manner. Also, according to her family, she was
unable to function at home.
The DSM-V also requires that Schizoaffective disorder and depressive or bipolar
disorder with psychotic features be ruled out. This can be done because from the interview,
we can see no major depressive or manic episodes. The symptoms she is displaying do not
appear to be as a result of drugs or other substances.
The cognitive theory could explain how Charlotte developed her illness. Her
delusions can be analysed using social cognition which is the study of how we perceive the
social world. In particular, the concept of attribution. This concept is people’s belief about
cause-effect relationships. Charlotte has difficulty with this and has wrongly interpreted
spirituality as a cause of her unique art which has led to her delusions. Drury, Robinson and
Birchwood (1998) said that schizophrenic patients have trouble interpreting interpersonal
contexts. This difficulty in interpreting interpersonal context which stems from social
cognition might also lead her to jump to conclusions, thus creating delusions of persecution.
There is also the concept of information processing which says that we use heuristics when
reasoning but these can often lead to cognitive errors. Also, not knowing how to process
information effectively could lead to an overload and be reflected in disorganized speech.
Cognitive-behavioural therapy can be used to treat Charlotte by changing her social
perception of the world. She would be taught how to process information more efficiently to
avoid cognitive errors. She would also be shown how to analyze social situation to improve
her social cognition.
We can also use Freud’s psychoanalytical theory to help Charlotte. Freud states that
trauma can help prevent the usage of defence mechanism that help us cope with reality and
maintain the ego. Charlotte probably went through some traumatic event which made her
unable to use the defence mechanism stated by freud as effectively as they ought to have been
used to protect the ego. Psychoanalysis could help Charlotte by helping her to gain insight
which the act of making her unconscious thoughts and motivation conscious. According to
freud, by doing this, one experience catharsis and can be cured. Way of doing this includes
free association which is reading a list of words and having the patient say the first thing that
comes to mind. Doing this might evoke a strong, vivid flashback called abreaction which
leads to catharsis. Another way of using the psychoanalytical theory to gain insight is by
doing a dream analysis. Writing down your dreams will help Charlotte to understand her
hidden desires and helped her to gain insight.
American Psychiatric Association,. (2013). Diagnostic and statistical manual of mental
disorders (5th ed., pp. 99-103). Washington, D.C.: American Psychiatric Publishing.
DRURY, V., ROBINSON, E., & BIRCHWOOD, M. (1998). ‘Theory of mind’ skills during
an acute episode of psychosis and following recovery. Psychological Medicine, 28(5),
Durand, V., & Barlow, D. (2013). Essentials of abnormal psychology (6th ed., pp. 454-458).
California: Thomas Learning Inc.
Oltmanns, T., & Emery, R. (2012). Abnormal psychology (7th ed., pp. 55, 58-60). Boston: