Another alternative would be to make him a good hypnotic subject, with the goal of creating a new personal history for him. Get him to agree to using hypnosis, not for recovery of his memories, but for building him a new personal history. If you got a bad one the first time around, go back and make yourself a better one. Everybody really ought to have several histories.

Janet: How would you do that?

Directly. You can say «Look, you're a talented guy, but you don't know where you came from. Where would you like to have come

from?»

Janet: This is an unsophisticated farmer.

That makes it easier. The toughest of all clients to deal with are sophisticated psychotherapists, because they think they have to know every step of what you are doing. They have nosy conscious minds.

In the book Uncommon Therapy a case is described in which Milton Erickson built a set of past experiences for a woman. He created a history for her in which he appeared periodically as the «February Man.» That case is an excellent source for studying the structure of creating alternate personal histories.

Fred: Is schizophrenia another example of sequential incongruity and dissociation?

People diagnosed as schizophrenic usually have certain aspects of themselves which are severely dissociated. However, the dissociation is generally simultaneous. For example, a schizophrenic may hear voices and think the voices come from outside of himself. The voices are dissociated, but both «parts» of the person are present at the same time.

Fred: OK. I have been working with schizophrenics for a long time. I have been using some of your techniques, but not as efficiently or precisely as I would like. What particular adjustments would you suggest with so–called schizophrenics?

From the way you phrased your question, I take it you've noticed that some people who are classified schizophrenic don't manifest the symptoms which other people with that label have. There are two ways in which working with a schizophrenic is different from working with any of the people here in this room.

One is that people labeled schizophrenic live in a different reality than the one most of us agree upon. The schizophrenic's reality is different enough that it requires a lot of flexibility on the part of the communicator to enter and pace it. That reality differs rather radically from the one that psychotherapists normally operate out of. So the issue of approach and rapport is the first difference between dealing with the so–called schizophrenic, and someone who doesn't have that label. To gain rapport with a schizophrenic you have to use all the techniques of body mirroring and cross–over mirroring, appreciating the metaphors the schizophrenic offers to explain his situation, and noticing his unique nonverbal behavior. That is a very demanding task for any professional communicator.

The second difference is that schizophrenics—particularly those who are institutionalized—are usually medicated. This is really the most difficult difference to deal with, because it's the same situation as trying to work with an alcoholic when he's drunk. There's a direct contradiction between the needs of psychiatric ward management and the needs of psychotherapy. Medication is typically used as a device for ward management. As a precondition to being effective in reframing, I need access to precisely the parts of the person that are responsible for the behaviors I'm attempting to change. Until I engage those parts' assistance in making alterations in behavior, I'm spinning my wheels— I'm talking to the wrong part of the person. The symptoms express the part of the person that I need to work with. However, the medications considered appropriate in a ward situation are just the medications which remove the symptoms and prevent access to that part of the person.

Working effectively with people who are medicated is a difficult and challenging task. I have done it a half–dozen times, but I don't particularly enjoy it. The medication itself is an extremely powerful anchor that is an obstacle to change.

Let me tell you a little horror story. A young man was wandering down the street of a large city after a party. He was a graduate student at the university there. He'd been smoking some dope and drinking a little bit of booze. He was wandering along, not really drunk, but certainly not sober. At about three o'clock in the morning he was picked up by the police and taken in for being drunk in public. They fingerprinted him and ran a check on him, and it turned out that he had been in the nearby state mental institution several years previously. When he was there, he'd been classified as a schizophrenic, and had the good fortune to run into a psychiatrist who is a really fine communicator. After the psychiatrist worked with this young man, he had altered his behavior, was released, and was doing quite nicely in graduate school. He'd been fine for years.

When the police discovered this history of «mental illness," they decided that his behavior wasn't the result of alcohol or drugs, but rather the result of a psychotic lapse. So they sent him back to the state mental hospital. He was put back on exactly the same ward he'd been on before, and given the same medication he'd been on before. Guess what happened? He became schizophrenic again. He was anchored right back into crazy behavior.

This kind of danger is my reason for insisting that the test for effective work with an alcoholic be exposure to the chemical anchor that used to access the dissociated alcoholic state—to have the client take a drink. Then you need to be able to observe whether taking a drink leads to a radical change in state—whether there is a radical shift in breathing and skin coloring, and all the other nonverbal indications of a change in state. If there is such a shift, then you don't yet have an integrated piece of work; you still have more integration to do.

If you take the challenge of working with institutionalized schizophrenics, you can make your work a lot more comfortable and a lot more effective if you make some arrangement with whomever is in charge of drugs on the ward. Being effective in a reasonable amount of time is going to depend upon your ability to work with people while they are not on drugs, or upon your ability to establish hypnotic dissociated states in which they are essentially independent of chemicals. Those are very difficult tasks; it's a real challenge.

Janet: I have a client who was diagnosed schizophrenic. She was on medication which she's off of now, but she's beginning to hear voices again. That's scaring her. She's very frightened.

Well, first of all, it doesn't frighten her. She has a physiological kinesthetic response to hearing the voices. At the conscious level she has named that response «being frightened.» That may sound like semantics, but it's not. There's a huge difference between the two, and reframing will demonstrate that difference.

My first response to this woman would be to say «Thank God the voices are still there! Otherwise how would you know what to do next? How would you do any planning?» One or two generations earlier, a person who heard voices was characterized as being crazy. That's a statement about how unsophisticated we are in this culture about the organization and processing of the human mind. Voices are one of the three major modes in which we organize our experience to do planning and analysis. That's what distinguishes us from other species. So my first response is «Thank God! And now let's find out what they are trying to communicate to you.» I might say «Good! Let me talk to them, too. Maybe they've got some really good information for us. So go inside and ask the voices what they are trying to tell you.»

Janet: «How I should kill my mother.»

«Good! Now, ask the voices what killing your mother would do for you.» You go to the meta–outcome. If an internal part voices a goal which is morally, ethically, or culturally unacceptable, such as «kill my mother," then you immediately go for a frame in which that is an appropriate behavior. It may sound bizarre as you hear it, but it's quite appropriate given some context. The question is, can you discover the context? «What would killing your mother do for you? Ask the voices what they are trying to get for you by having you kill your mother.»