Deborah's Delusions

Pathology Profile: Somatic Symptom Disorder
The book, I Never Promised You a Rose Garden, is the story of a teenage girl named Deborah Blau and her struggle with mental illness. When Deborah is five years old, she undergoes surgery to remove a tumor in her urethra. The procedure itself causes Deborah tremendous pain that continues long after the surgery. The lie that the procedure would be only slightly uncomfortable creates mistrust towards others. Before and after the surgery, Deborah is subjected to humiliation and shame from her parents due to the nature of her condition and the distress it creates. Deborah’s condition is sexualized by her father and the author alludes to the possibility that Deborah had been objectified if not abused

sexually by her father. Deborah is also the victim of anti-Semitic ridicule by her peers and teachers because of her heritage. These early childhood traumas causes Deborah to create an alternate reality to which she escapes during times of pain, anxiety, fear, and mistrust. This alternate reality provides Deborah with personalities that assist her in coping with the unpleasantness of “Earth” reality.
As an adolescent, Deborah attempts suicide, and is placed in an institution. This causes her family more distress. Deborah’s mother and father attempt to hide her whereabouts from family and friends just as they attempted to conceal the “shameful, fearful, and ugly” (p.104) symptoms of her medical condition when she was a young child. This tendency to conceal the unpleasant is saturated in Deborah’s family history and so I find it no wonder that Deborah created an alternate reality to escape the mental and possibly physical abuse to which she was subjected due to circumstances beyond her control.
In the institution, Deborah receives the typical treatment for most mental patients when their symptoms overwhelm them, which is to be wrapped in cold, wet sheets and strapped to a gurney for no less than four hours until they are calm. Debora’s receives therapy from a world-renowned psychologist, Dr. Fried, who finds Deborah’s case very intriguing. Dr. Fried attempts to show Deborah that Yr is a creation within her own mind without discrediting the reality that Yr holds for Deborah. Dr. Fried accomplishes this task by helping Deborah work through the different events in her life that caused her to create the alternate reality by helping Deborah face the emotions surrounding the events. At story’s end, Deborah learns where her emotions originate, how to cope with her fears, anxieties, and mistrusts as they arise, and she has chosen to live in the reality of Earth.
Deborah is initially diagnosed with schizophrenia before her sessions with Dr. Fried. It is widely known that during the era in which the setting of the book takes place, cases that could not be identified under any other category received the diagnosis of undifferentiated schizophrenia. It is also widely known that this book and the character Deborah is based on the life of the author, Joanne Greenberg, who, as a teenager, was receiving treatment under Dr. Frieda Fromm-Reichmann, Dr. Fromm-Reichmann was part of a team attempting to a establish a psychoanalytical basis for diagnosing and treating schizophrenia. The National Association for Rights, Protection, and Advocacy states that not all of the patients seen by the team were considered schizophrenic, and that a many patients were analyzed for the purpose of differentiating conditions (“Joanne Greenberg,” 2015). Ronald J. Comer, (date) calls schizophrenia a “wastebasket category” for any person in the United States during this time that displayed anomalous behaviors. Using these two sources for perspective, it can be said that Deborah’s diagnosis of schizophrenia is accurately portrayed by the symptoms and treatment described by the author, only because there was no other diagnoses or treatments at that time that better encompassed the symptoms that Deborah displayed.
The symptoms for schizophrenia include delusions, hallucinations, disorganized thinking, abnormal motor behavior and other negative symptoms including avolition (DMS-V).

Deborah’s delusions are characteristically somatic in nature. She continues to feel physical pain from the removed tumor. Deborah’s delusions can also be describes as bizarre because she believes she is contaminated; capable of poisoning others with her emanations, however this could also be considered somatic. The delusions are also referential in nature because Deborah perceives normal happenings as pivotal changes that reflect and predict her death. Deborah has both visual and auditory hallucinations of her alternate reality and the characters within. Deborah frequently uses neologisms she believes is the language of her alternate reality. This can be considered incoherent speech and because of loose associations and losing topic, her thought process can be considered disorganized. Deborah describes herself as exceptionally clumsy and as losing the ability to see, hear and speak during a distressful episode, which can all be considered abnormal motor behavior. Because many persons diagnosed with schizophrenia do not meet the criterion of avolition many professions make a distinguishes, labeling them Type I and a Type II Schizophrenia where in Type II, loss of volition is not a criterion (Comer,

date).
Research by Wigman et al. (2012) notes how environmental factors such as early childhood trauma has been linked to the development of schizophrenia. Traumatic experiences such as sexual abuse and bullying, both of which Deborah was subjected to, significantly impact the probability of developing a psychosis. The intent of Wigman’s study is to see what roll genetics plays in how trauma effects a large sample of adolescents from the general population and if it trauma has a greater impact on those genetically marked for psychosis through heritability. These findings were that “no interactions were found between childhood trauma and genetic liability” (Wigman et al., 2012), however he notes that the approach used for this study was significantly different that previous approaches and that more study is required in this area.
Most research done on schizophrenia involves finding a genetic link or structural brain abnormalities as the cause of the psychosis. Juuhl-Langseth, et al. (2015) recently studied twenty-four patients diagnosed with early onset schizophrenia and how neurocognitive performance and brain structure are related to EOS. The findings were that there is a link between brain structure and information processing speed, which may cause disorganized thinking. In an interview with Professor Michael O’Donovan (2015) he states that corroborating research has identified the genomic region associated with schizophrenia, but also notes prenatal environment and traumatic childhood experiences may contribute to the development of the disorder. O’Donovan’s biggest question however, is still the role of gene-environmental interactions in the development of schizophrenia. It seems that there is still a great deal of research to be in this area.