Integrative and sealing-over recoveries from schizophrenia: distinguishing case studies.

The types of recovery from an acute schizophrenic break are manifold: one patient "returns" to reality and walks away as if untouched; another despairs for months about "losing control" of himself; still another finds his reentrance into the world less attractive than his psychotic exit. Each "copes" with his psychosis uniquely, both during and after the acute regression. Nevertheless, from observing and treating several acutely psychotic and recovered schizophrenics on a National Institute of Mental Health clinical research unit, we have noted that individual recovery styles tend to cluster around one of two distinct types--integrative or sealing-over. Broadly defined, the sealing-over patient prefers not to think about his psychotic experience during recovery, the integrator, by contrast, is interested in the psychotic experience and desires to place it into some coherent perspective. Specific behavioral definitions and dynamic considerations of these concepts have been presented elsewhere (McGlashan et al., 1975; Levy et al., 1975). As recovery "styles," we are talking about dichotomies, such as expansion versus constriction and flexibility versus rigidity of controls over consciousness, which in turn determine the range of feelings, thoughts, and actions that a person permits himself and is reasonably comfortable with. This paper illustrates and further delineates these recovery styles with specific cases of two young women who each experienced a first psychotic break and were treated on our clinical research unit. Though but two of many acute schizophrenics admitted to our unit, these patients demonstrated clinical courses most representative of each recovery style and provided rich material for a greater understanding of the dynamics of integration and sealing-over.