Maruta N
Tokyo University Branch Hospital, Department of Psychiatry.
Seishin Shinkeigaku Zasshi. 2000;102(11):1157-86.
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.
在本研究中，作者观察了慢性精神分裂症住院患者的行为模式，以追踪诸如兴趣缺乏、思维贫乏、社交淡漠和沟通障碍等意志缺失症状的改善过程。在病房的日常生活中，意志缺失的患者不仅在完成诸如按时起床、睡觉、打招呼、刷牙、洗澡和洗衣服等基本习惯行为方面存在困难，而且在履行病房分配给他们的职责时也有困难。此外，他们无法遵守住院患者的规定，无法适当地表达自己的情感，也无法建立正常的人际关系。作者发现，五名住院患者在上述习惯行为的改善过程中出现了一些自主选择的自发行为。随着这些自发行为经历几个阶段，他们日常生活中的行为模式也有了明显改善。短暂自发行为的初始阶段之后是持续自发行为的第二阶段。最后，在访谈环节中，患者在进行持续自发行为时开始表现出愉悦的情绪和身体感受。这种现象在治疗背景下似乎很有价值，因为精神分裂症患者被认为很少能够对自己的经历产生积极的感受。因此，这些愉悦的持续自发行为可以被称为“游戏样行为”，与凯洛瓦所定义的“游戏”的特征相比较可以证实这一点。在考虑精神分裂症的孤独症时，明可夫斯基将“孤独症活动”描述为精神分裂症患者生活方式的一种内在特质。这种特质在自发行为中的表现可以被认为有两种意义：一种是病理性发泄的表现，另一种是恢复到现实行为的迹象。治疗师在进行治疗时应考虑这两个方面。虽然患者在住院期间恢复了日常生活的习惯和规范，但“游戏样”行为所涉及的规则似乎与他们日常生活中的习惯行为或分配职责中的一些规则相矛盾，因为在“游戏样”行为中，自由比规则更占主导地位。“游戏样”行为中的规则大多是通过模仿他人习得的。这些规则不是带有惩罚的固定法则，而是根据行为过程的情况可变的规则。从这个角度来看，“游戏样”行为使患者能够获得实用的规则，并理解规则的相对性。大多数“游戏样”行为源于个体患者的偏好，这些偏好可能是他们已经经历过的事情、他们渴望的事情或能给他们带来自我满足感的事情。这些特质有助于获得令他们愉悦的体验。对患者来说，在访谈环节中回忆每一个“游戏样”行为能够使他们把握自己行为的全貌，加强他们对这些行为作为自己经历的依恋，并促进行为与思维之间的动态过程。从这个意义上说，纳入“游戏样”行为方面的心理治疗似乎有助于精神分裂症患者改善他们的思维方式。培养“游戏样”行为有助于慢性精神分裂症患者恢复意志力、独立性和社交能力，并有助于改善临床症状和日常生活活动。
