“Calatonia in a case of Schizophrenia” – Leda Seixas

Leda Seixas is a clinical psychologist and teacher of the Calatonia and Subtle Touch at the Sedes Sapientiae Institute in São Paulo, Brazil. The text bellow is a summary of her master’s thesis: “Nina’s case: Treating Schizophrenia within a Jungian-Bodywork Approach”, defended in the Clinical Psychology program at Pontifical Catholic University of São Paulo, in 1989.

Nina’s case:

Nina, as I will call this patient, was referred for psychotherapy through a Medicaid program for people with low income and chronic mental health issues. 

At the time of our therapy, she was 27 years old and very difficult to approach due to her aggressiveness. She had previously attempted therapy with about five other psychotherapists at the clinic without establishing a continuing relationship with any of them. I was the only one she had not yet “tried.” 

She had the following history (summarized) in her file: In treatment since age 19; eleven psychiatric hospitalizations; complaining of frequent migraines, night terror; delirium; and hallucinations, both visual and auditory. She also presented with insomnia, aggressiveness, self-destructive behaviors, persecutory ideation, and disturbance of conduct and emotions. Nina was the last of five children (two sisters and two brothers), all of whom were still living together in the same household, due to financial hardship. 

Her diagnosis according to the ICD-9:

295.1 Schizophrenia, Hebephrenic Type

295.3 Schizophrenia, Paranoid Type

295.5 Latent Schizophrenia

Nina’s therapy lasted about four years, and those years coincided with the beginning of my practice as a Jungian body psychotherapist, in São Paulo, Brazil. 

In the first session, she entered the office and did not say a word. She stood by the door, head down, looking at me through long bangs that covered her entire face. She held her little purse very tightly. I offered her a seat and asked some questions, which she did not answer. After attempting to engage her in conversation – to no avail – I proposed a relaxation, as she looked very tense. To my surprise, she stood up, walked to the massage table and lay down. I requested that she take off her shoes and explained that I would touch her toes, the soles of her feet, her heels, calves and her head, briefing her on the Calatonia procedure. 

When I finished, I asked if she had any observations. She did not say a word, but stood up, put on her shoes, grabbed her purse and left. This scenario repeated for sixteen sessions! 

She did not miss one session and never came late, which led me to believe that we had a bond. On the seventeenth session, she answered my greeting for the first time. I smiled back, and she told me she could talk now; I could ask her “whatever I wanted.” Slowly, I gathered her history. 

Growing up, she was severely beaten by her parents, had tremendous sibling rivalry, and was unable to attend school because of her “bad behavior.” 

When she was twelve, her oldest brother raped her. Nina never told anybody, fearing her brother would retaliate. She became enraged by the fact that she was a woman. It was also painful for her to accept her parents’ sexual relationships, or their arguing about sex, which she was aware of because of the lack of privacy in the house arrangements. She had lived with her family up to that point in her life and slept in the living room, many times having heard her parents engaged in sex or fighting about it. When those incidents happened, she would come to the clinic very agitated, causing problems in the waiting room. 

When she was about nineteen years old, she was raped again at the house where she worked as a maid, by a handyman who had come to fix the wood floor. This incident probably triggered her first psychotic episode, as her first hospitalization occurred shortly after that rape. 

At the psychiatric hospital, she was treated with medication and electroshock (convulsion) therapy, without any positive results. After that, she had a series of hospitalizations, which were cyclical. Nina would stay at the hospital for long periods, then be released for short periods and hospitalized again when her symptoms became unmanageable. 

She reported seeing animals in her room, mostly at night. They were snakes, and white and colorful spiders, and Nina had to howl to make them disappear. She also heard voices that told her to kill or hang people; on other occasions, the voices only made noises, talking in a way that she could not understand. When those moments occurred, Nina drank alcohol (liquor) to decrease “the noise” in her head. In her hallucinations, there were also monsters, spaceships, and a character, who used to stick a wheel full of needles in Nina’s head. 

During the treatment, I utilized several bodywork techniques, which I proposed as some sort of play or game. I would touch her hands, and asked that she touched mine. I touched her face and she would touch mine. I taught her how to massage her feet, while I massaged mine. She told me she liked the touch because she felt it as an affection, which she had never received from anybody in her life. She told me she was afraid I was going to suffocate her during the relaxation or Calatonia procedure. With time, she learned to trust and surrender to the bodywork. 

One day, when she was extremely nervous, we did bodywork which consisted of shaking the hands and feet, as if there were gum stuck on them and we wanted to get rid of it. After we shook our bodies for a while, Nina began to laugh and said that anybody seeing us would think we were both “crazy.” 

The fact that we did bodywork together served several basic purposes. It established a stronger bond; it created trust – which had been so sorely lacking in her life, and I allowed her to touch me, establishing the fact that I trusted her. Also, it created a positive identification with a healthy aspect of her psyche: I, who was not a “sick person”, did the same things she did. 

It is important to stress here that I never touched Nina beyond what was necessary for the bodywork; I was clear and safe resorting to techniques I mastered. Thus, I was able to maintain a healthy therapeutic relationship with her, avoiding unnecessary transferences, or a mistaken interpretation of the bodywork. Even though she had voiced that she felt the touch in bodywork to be similar to affection, the boundaries gave her a clear notion of the nature of our relationship. She was able to retrieve from the bodywork the nurturance she needed without enmeshment. 

One day Nina brought me a dream: “I was in a dark place, resembling a huge, cold room. It was full of young women. I had a migraine, and one of them told me she would operate on my head. I woke up scared.” 

She believed that the characters of her hallucinations “dwelled” in her head, and they caused her migraines. I suggested that we play a game, in which we would perform a “make believe” surgery in her head. To ease her into the role playing modality, I told her we would do it as it was suggested in her dream. She did not accept my suggestion immediately. However, three sessions later, she asked me to be “operated on.” I told her to sit on a chair, and I worked on her face and head, massaging her scalp. 

At each touch, I associated one step of the surgery, ‘antisepsis’, ‘cutting of the scalp’, ‘opening of the skull’, etc. When I supposedly was to open her skull, she became tense, opened her eyes and told me that “people were getting out of her head.” I requested that she breathe deeply, “inhaling more anesthetic”; I told her she should allow those people to leave. 

When I finished, I informed her that the operation was successful and that we should wait until the effect of the anesthesia was over to check on the patient. She opened her eyes and told me she was “dizzy”, and felt a floating sensation. She reported seeing people and creatures leaving her head, and that for a moment, they threatened “to get” me (the therapist) in the room. However, she reported, they left by the window. It was a moving moment for the two of us, with a great sense of accomplishment and liberation.

After this day, she did not hear voices, nor did she see animals or spaceships threatening her any longer. We could then dedicate ourselves to other therapeutic activities, and spent a great amount of time studying together, as if she were therapeutically redoing a developmental phase that was missing in her life. She learned how to read, and science was the subject that most interested her.

About a year after the “surgery”, Nina started to have a relapse. She was too dependent on me and had not been able to develop a support system outside the therapy. Nina did not respond to the efforts and focus on developing and transitioning the therapeutic support to a personal support system. She began to neglect herself, i.e., not going to the dentist, to the doctor, etc. She neglected her personal hygiene, and developed ringworms and lice. She did not utilize the medication provided for her and started to skip sessions. I soon learned that she had been hospitalized again. The family did not provide the name of the hospital, and therefore I could not visit her. 

At the time, I did not understand the regression, since I perceived that her stable behavior during our last sessions before the regression attested to the positive effects of therapy. 

When she left the hospital, she came to see me and told me that during the hospitalization she thought “a lot.” She had come to a conclusion that everyone is born with a ‘cross’ to carry and that she would carry hers alone and would no longer involve other people in her issues. She asked that I burn everything she drew and wrote, including the picture she had given to me, as well as everything I had written about her. I did not comply with the request immediately, because I knew it was symbolic. She wanted to start a new life! Later, she consented to the writing of this thesis. 

We continued the therapy. She registered at a night school for adults, where she became respected by her classmates for being the best student in the classroom. She found a job as a customer service representative at a retail store, and after my vacation, she brought me a new picture of herself. In that session, she told me she would like to be my friend, assuring me that she would care for herself, asking if she could count on me if needed. 

Only then was I able to understand that the regression, although painful, was necessary for Nina to be able to become independent and self-sufficient. As we all need to do sometimes in order to overcome an obstacle in our path, Nina, like athletes do, moved backward in order to (symbolically) ‘build up strength to jump the obstacle’. The movement backward was also an attempt to retreat into her previous mental status, as if she could hide from life again in that stage. However, after bodywork and psychotherapy, going back to an unconscious state was no longer possible; she had definitely learned about herself and achieved a new inner structure. Nina went into her inner world only to discover that it was there that the strength to face her problems resided. 

The bodywork was fundamental to Nina’s growth process, because it was ‘the door’ to her inner world. Her inner world was not any longer the unconscious chaos of emotional turmoil that she had experienced before, but the healthy aspect of an inner Self, as understood by Jung, a center of guidance and strength. 

Perhaps because she did not have to talk and question, to judge and to be judged, Nina was able to surrender as a baby to the care of a mother and symbolically, was able to be born again, to trust, and to redo her pathway through corrective therapeutic experiences. This time she was walking on her own feet, and was not being dragged by overwhelming feelings, blind impulsiveness (acting out), and unconscious drives that overpowered her ego. As she strengthened her ego, Nina began to discriminate between reality and fantasy, right and wrong, and choices she could make for herself. 

The ideas of Jung (which were presented in the thesis) regarding the dynamics of the psyche and psychic energy were precious in the orientation and understanding of Nina’s therapeutic process. 
In her last session, Nina authorized me to “write her life story.”