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[NOTE: The following selection comes from "Broken Lives" (subsequently published as "Case Studies in Schizophrenia") by David McMillin.  Copyright © 1995 by David McMillin.  Used with permission.  All rights reserved.  "Case Studies in Schizophrenia" is currently available from A.R.E. Press in Virginia Beach, Virginia.]
 
 

CHAPTER ONE

DEMENTIA PRAECOX 


 
    Schizophrenia is an exceedingly complex illness.  In fact, if you were to have the opportunity to observe an ample number of individuals diagnosed as schizophrenic, you might find yourself wondering if they were all suffering from the same disorder.  Your observation would not be unreasonable. It is widely accepted by leading researchers that there is considerable variability within schizophrenia as it is currently defined.
 
    Many researchers have interpreted this variability to mean that schizophrenia may consist of a group of related disorders.  This confusing situation has arisen, in part at least, from our ignorance of the causes of schizophrenia.  The first part of this book will examine the sources of variability in schizophrenia by considering some of the causes noted in the Edgar Cayce readings.  In a sense, we will be allowed lift the curtain of our ignorance - to peek behind the veil of puzzling biological, psychological, and spiritual factors which have been implicated as causes of schizophrenia.
 
    To help us understand the nature of schizophrenia, we will take a glance down the historical avenue leading to our current diagnostic dilemma.  In considering the history of insanity, we may gain a deeper understanding of our subject. Such a review will also help to set the stage for Edgar Cayce's perspective on this devastating disorder.
 
    The term schizophrenia was created by Alfred Bleuler in 1911.  Literally, it refers to a split between thought and emotion which Bleuler regarded as the hallmark of the illness.  Bleuler's interpretation reveals a psychological emphasis which has persisted until recent times.  The focus has been on mental and emotional processes.  Naturally, this viewpoint was strongly influenced by the early popularity of the psychoanalytic movement in this country. Hence, aberrant childhood developmental stages were sometimes cited as a cause of schizophrenia.
 
    Can faulty potty training cause schizophrenia?  Not likely, yet psychoanalytic theorists found in schizophrenia a fertile ground for hypotheses.  One of the strongest and most persistent views focused on poor mothering as the source of the problem.  Consequently, guilt ridden mothers suffered through years of "mom bashing" because their child became afflicted with schizophrenia later in life.  Modern scientific research has largely debunked this unfortunate way of thinking about schizophrenia.
 
    During the 1950's, the discovery of the antipsychotic medications shifted the focus to the biological dimensions of the illness.  The discovery of the antipsychotic properties of certain drugs (such as Thorazine) can be traced back to the French physician Henri Laborit.  Laborit was looking for a drug to prevent a drop in blood pressure during surgery. Although the drug he used failed in that respect, it did have noticeable sedative effects.  Subsequent research by French psychiatrists was by trial and error - they gave the drug to persons suffering from a wide range of disorders to see if it had any effect.  The medication had powerful calming effects on agitated psychotic patients and thus: "The first powerful drug available to treat serious mental illness was discovered in much the same way as was penicillin: by accident.  The discovery was the happy consequence of a chance finding being observed by a person with a fertile mind who could recognize its larger implications."  The preceding observation was noted by Nancy Andreasen, M.D., Ph.D., a leading researcher in the field of mental illness.
 
    Modern brain-scan technology has further bolstered the biological focus in schizophrenia.  Through a variety of techniques, scientists have noted brain abnormalities in many persons diagnosed as schizophrenic.  Some of the strongest evidence comes from studies which document an enlargement of the brain's ventricles in cases of schizophrenia.  The ventricles carry cerebrospinal fluid.  It is thought that an enlargement of the ventricles results from a degeneration of brain tissue itself.  In a sense, the flexible ventricles may expand to take up the space left when nerve cells in the brains deteriorate and shrink in volume.  As with most research in schizophrenia, the brain-scan literature is complex and variable.  We can only hope that improved technology and further research can unravel the details in this fascinating and significant area of investigation.
 
    So this is where we find ourselves today, in the midst of a biological revolution which has transformed psychiatry. Consequently, psychological explanations have taken a back seat to physiological theories.
 
    In a sense, we have returned to an earlier viewpoint. Previous to Bleuler's psychological rendition, psychiatrists had used the term dementia praecox as a diagnostic label for chronically psychotic patients.  This term has a strong biological flavor because dementia refers to irreversible brain degeneration and praecox means precocious or early.  Since the illness often manifested during the late teens and early twenties, this designation was quite literal as a descriptive diagnosis.
 
    Emil Kraepelin, the father of modern psychiatry, was very influential in clarifying the meaning of the major mental illnesses including dementia praecox.  He believed that dementia praecox involved brain degeneration which most likely resulted from a metabolic disorder.  Kraepelin's insights are more than mere historical curiosity.  Modern psychiatry has shifted its focus away from psychological theorizing and is currently re-examining the seminal work of Kraeplin and the early biological psychiatrists.
 
    So while the emphasis has shifted back to a biological perspective similar to Kraepelin's concept of dementia praecox, we have kept the term schizophrenia in use.  We have experienced an almost constant revision of diagnostic criteria and types of schizophrenia, yet the term remains.     However the problem of variability still plagues medical research.  This is particularly evident in the problem of replication in research studies.  For example, one team of researchers may report a significant finding, yet other researchers are unable to confirm the important finding in follow-up studies.  Thus many researchers have come to the conclusion that schizophrenia actually consists of a group of related disorders.  Each study may use a slightly (or greatly) different blend of schizophrenic subtypes.  Consequently, findings would also be diverse and difficult to replicate.  Replication is so important because it is fundamental to the scientific process.  Without replication, we cannot know if any particular research finding is true or simply the result of a faulty experiment.
 
    I have made this effort to discuss the diversity of the population of individuals diagnosed as suffering from schizophrenia for an important reason.  The Cayce readings were decades ahead of current research in discussing the causes of this diversity.  Therefore, it is imperative that readers be aware of this acknowledged variance before proceeding to the case studies which follow.  To be sure, there are many causes of schizophrenia and they will be addressed in this book.
 
    Likewise, I have emphasized the strong biological aspect of schizophrenia for an important reason.  While both terms (dementia praecox and schizophrenia) were in use by the health care professionals of his era, Edgar Cayce consistently preferred the term dementia praecox.  Although several individuals came to Cayce with a diagnosis of schizophrenia, he did not use that term when diagnosing their condition.
 
    Cayce's reluctance to describe persons as schizophrenic may have involved more than diagnostic obsolescence.  Dementia praecox was a useful diagnostic category.  It affirmed organic degeneration and deteriorating course.  These were clinical and pathological realities which the readings graphically described.
 
    On the other hand, Bleuler's schizophrenia was conceptualized as a psychological construct inferring splitting of the personality (i.e., a splitting of thought and emotion).  From Cayce's perspective, this description apparently did not adequately fit the illness.  Such a vague and insubstantial concept may have been deemed unsuitable for the condition of those seeking Cayce's help.
 
    So while modern psychiatry has generally deferred to a more biological stance which is reminiscent of Kraepelin's and Cayce's perspectives (dementia praecox), the term schizophrenia has remained part of the psychiatric lexicon. Many researchers and clinicians have decried its use calling it a "wastebasket" diagnosis.  It has come to include so much that its meaning has become muddled.  The medical establishment has sought to remedy this problem by tightening up the diagnostic criteria for schizophrenia.  Theorists have sought to define the subgroups with labels such as reactive, endogenous, process, type I and type II schizophrenia, etc. Some researchers have even created the classification of "Kraepelinian schizophrenia" to call attention to the foresight of modern psychiatry's founder.  These attempts are clearly oriented toward clarifying the biological nature of the illness.
 
    This is where the work of Edgar Cayce may make a significant contribution.  Apparently, he was able to "see" the physiological condition involving nervous system degeneration.  Furthermore, he claimed to be able to look backwards through time and find the source of the problem.
 

"dementia praecox (as some have diagnosed it)"

    Mr. [271] was about thirty years old when he developed schizophrenic symptoms.  Reading 271-1 described his condition in explicit anatomical terms.  Cayce's account predated by several decades contemporary models of schizophrenia which emphasize brain dysfunction.  This reading given on February 13, 1933, noted that "In a general manner the condition may be termed dementia praecox (as some have diagnosed it)."  Obviously, the entranced Cayce was already tuned into the problematic nature of diagnosis.  "As some have diagnosed it" affirms the relative nature of psychiatric classification.
 
    He went on to note that such diagnoses were variable. He said, "but the type and nature of the disturbance - physically and mentally, as we find - would indicate that" help might be afforded if certain treatments were provided. Again, the wording is important.  He is saying that even within the relatively specific diagnosis of dementia praecox, there could be various types with different natures.  In the chapters which follow we will have the opportunity to closely examine these types and natures.
 
    However, the connecting thread which ran through all the cases which Cayce diagnosed as dementia praecox was inevitable brain pathology which modern medical science is so keen on investigating.  In this particular case, he cited, "softening of cell cord and brain tissue."
 
    He then commented on the source of the disorder.  He traced the pathology all the way back to the womb.  The cause was:

    Pressures and incoordinations that are shown from prenatal conditions, and the activities in the physical that have brought about and indicate the abrasions to the nervous system in such a manner as to make for a ... condition existent as diagnosed ...

     The expression "prenatal conditions" is vague in this context.  In certain cases it included problems with gestation.  In other cases, prenatal conditions referred to genetic factors.  Sometimes it was suggestive of "karmic" factors (we will discuss these concepts in later chapters). The only thing we can be certain of here is that Cayce was stating that the problem originated before birth.

     The explicit descriptions of nervous system pathology were repeated in subsequent readings.  For example, in reading 271-5 Cayce described how there was a problem with "those glands that secrete fluids which in the circulation sustain and maintain the reaction fluid in the nerve channels themselves."  Considering that this reading was given on May 1st of 1933, it has a remarkably modern ring to it.  He seems to be describing the basis for a breakdown in nerve cell functioning - perhaps in neurotransmission itself (the process of passing nerve impulses between nerve cells via chemical messengers).

     A little later in this reading he went on to describe how the electrical treatments were causing the nervous system to regenerate itself.  Cayce noted that:

... there is being sent out from these [nerve] ganglia those infinitesimal feelers, as it were, that will gradually make connections with those ganglia and centers in the system that have been destroyed by the reactions in the system which destroyed gland functioning for the creating of these fluids ...

     The electrotherapy treatments just mentioned were of two natures.  The primary therapy for regenerating the nervous system was the Wet Cell Battery carrying a gold chloride solution.  For a period of three to five weeks, the contact plates of this appliance were to be positioned directly over key ganglia in the nervous system.  Cayce said that the low form of electrical energy would allow the vibrations of the gold solution to be assimilated into the body.  The glands would thus be stimulated to secrete the fluids required by the nervous system.  The combination of these secretions and the direct electrical stimulation would lead to restoration of nervous system functioning - a literal "rebuilding" of the nervous systems.

     I want to be clear about what Cayce meant when he used the expression "rebuild" the nervous system (in certain cases of dementia, he actually said that one could rebuild a brain).  He was not saying that new nerve cells would be created.  Rather, that the existing degenerated nerve tissue would be nourished and stimulated to regain a normal healthy state (to send out "from these [nerve] ganglia those infinitesimal feelers") .

     This was not viewed as a quick or easy process.  It would require patience and persistent application of a variety of related therapies which we will be considering in the case studies of this book.

      The second form of electrotherapy recommended for this young man was a device referred to as the Radio-Active Appliance.  The Radio-Active Appliance (also referred to as the Impedance Device) was frequently recommended by Cayce for the treatment of a variety of problems.  It was said to function strictly at the vibratory level working directly with the low electrical energy or life force of the physical body.  The readings state that this appliance works with the same vibrational energy as the Wet Cell Battery but is less powerful.

     The Radio-Active Appliance was often suggested to relax and coordinate the systems of the body.  The readings insisted that the appliance did not produce any energy, rather it utilized the body's own vibratory energies by redirecting them to establish equilibrium.

     The term "radio active" in no way signifies atomic radiation of a toxic nature.  In fact, the vibrational energy associated with this appliance cannot be measured with current scientific technology.  The original designation was intended to describe the interaction of the appliance and a subtle energy or "life-force" (i.e., like a radio and radio waves).  The name was later changed to Impedance Device to avoid confusion as to the nature of the energies involved.

     The amazing thing about both these two forms of electrotherapy is how mild they are.  Most persons feel little or no sensation while using them.

     Several other physical therapies were recommended in addition to electrotherapy.  Specific recommendations for diet and exercise were provided.  A gentle spinal massage was to be given in the evening when the man was ready for bed. During the massage and as the man was drifting into sleep, suggestions were to be given:

... during such periods [of massage] (for most often we would find the body would gradually fall into that state of near between the waking and sleeping state) make gentle suggestions that QUIET, REST, PEACE, HAPPINESS, JOY, DEVELOPMENTS IN EVERY MANNER THAT ARE CONSTRUCTIVE PHYSICALLY AND MENTALLY, will come to the body through its rest period! Or, the suggestion to the deeper portion of the subconscious forces of the body.

     Cayce referred to this natural form of hypnosis as suggestive therapeutics.  Suggestive therapeutics is a powerful hypnotic technique for dealing with behavioral problems and facilitating the healing process.  Suggestive therapeutics was often recommended in cases of major mental illness.

     The application of suggestive therapeutics is simple. Because most people were unfamiliar with the techniques for inducing a hypnotic trance, the readings advised that suggestions be provided during the various physical treatments.  At that time, the person was usually in a relaxed receptive state of mind.  Thus during the electrotherapy, massage, and manipulations the caregiver was directed to talk to the patient in a calm, firm voice; giving positive suggestions for physical, mental and spiritual healing.  The suggestions could also be directed towards undesirable behaviors or lack of cooperation.

     As was the case with Mr. 271, the readings also frequently advised that bedtime be utilized as a time for suggestive therapeutics.  During the first few minutes of sleep, a slumbering individual is in a hypnogogic state and is very open to suggestion.  This form of suggestive therapeutics is sometimes referred to as presleep suggestions.

     As with all forms of suggestive therapeutics, presleep suggestions are made to the person's unconscious mind and should be positive and constructive in tone and content.  The particular content of the suggestion for this man was changed in reading
271-5:

      Then, in the suggestions that we would make when the body is sleeping, resting, there should be had those that will make for the better creative forces; for to reach the subconscious self it must be without the physical-mental self.  See?  Yet in the waking state, in the activity, there will be seen those reactions occasionally; at first possibly once a week, possibly once a day, possibly several times a day, dependent upon how persistent the suggestions are made with the active forces that are being set out in the system from the physical angle.  See?  Change the suggestions, then, in this manner, or to this:

THERE WILL BE, IN THE WHOLE OF THE PHYSICAL AND MENTAL BODY, THAT RESPONSE TO THAT CREATIVE ENERGY WHICH IS BEING CARRIED INTO THE SYSTEM.  PERFECT COORDINATION WILL COME TO THE BODY. THERE WILL BE NORMAL REACTIONS IN EVERY WAY AND MANNER THROUGH THE CREATIVE FORCES OF DIVINE LOVE THAT IS MANIFEST IN THE HEARTS AND MINDS OF THOSE ABOUT THE BODY.

     This should be repeated three to four times, until it has gradually reached the subconscious, or the unconscious, or the consciousness of the living forces that are impelling activity in a distorted condition, as to the balance in the mental forces of [271].

     In a sense, you can think of suggestive therapeutics as a form of mental programming similar to computer programming. Only in cases of chronic schizophrenia (i.e., dementia praecox), where there was actual nervous tissue degeneration, the process was more complicated.  It was as if both the "hardware" and the "software" of the system would have to recreated.  The physical therapies focused on rebuilding the "hardware" (the nerve tissue) while suggestive therapeutics (and a group of "spiritually" oriented therapies which we will discuss presently) were to serve as the "software" or mental program, as it were.  In other words, the readings stated that as the nervous system was being rebuilded, it was important to give it constructive information for its new "program."

     This brings us to the "spiritual" dimension of therapy. The business of speaking, acting and even thinking constructively in the presence of a suffering individual might be called manifesting the "fruits of the spirit," to use a biblical expression.   In contemporary psychiatric terms, it is called providing a "therapeutic milieu."  In other words, the total environment (or milieu) is structured to be therapeutic.  For example, the first reading given for Mr. 271 insisted that he be put:

... in an environ that is as of a growth - and the body physically and mentally treated as an individual, a unit, rather than as a class or as a mass consideration ...

     At the time of this reading, Mr. [271] was in Pinewood Sanitarium, a private mental institution in Katonah, New York.  He was likely receiving better care there than he would have gotten at one of the state mental asylums of that era.  And yet he was apparently still being treated as a dementia praecox case (or in today's terminology, a schizophrenia case).  Remember that we are speaking of 1933, over twenty years before the antipsychotic medications were introduced.  To receive a diagnosis of dementia praecox was essentially a therapeutic "kiss of death."  As Cayce noted in a similar case of a twenty-two year old man, Mr. 5405:

     In the present environs, and under the existent shadows, very little may be accomplished for those individuals in authority take little interest in even possibilities, where there have been, and are evidences of this nature or character of dementia praecox ...
      Very often, these persons were simply herded together in locked wards and encouraged to vegetate.  Cayce stated the first step in the treatment of this young man was to remove him from the institution and provide him with individual care in a positive, constructive environment.  Specifically, he recommended a place with a "clean atmosphere, in plenty of sunshine and out-of-door activity.

     To implement the treatment plan in a proper environment, Cayce suggested that Mr. 271 be provided:

... with a companion constantly that would make for those engagements mentally and physically in activities that are constructive and yet, with patience and persistence, have those activities carried on in such a way as to make for constructive thinking, constructive activity, both as to the association and as to the speech, and as to the environment.

     The recommendation for companion therapy was commonly made in cases of dementia praecox.  Cayce was decades ahead of his time in making this recommendation.  There are several contemporary psychosocial rehabilitation models using a similar approach.  The modern terms for such adjunct caretakers include companions, advocates, counselors, advisors, operatives, attendants, and support persons.

     Cayce's clearly stated the role of the companion.  Naturally, adherence to the treatment plan was a top priority.  This was a particularly difficult assignment in the case of 271.  First of all, the man chosen as a companion had no experience in working with persons suffering from mental illness.  Even if he had been trained in the social services of his day, it is unlikely that he would have been prepared for some of his assignments.  For example, recall the recommendations for suggestive therapeutics.  This is not a skill commonly taught to mental health professionals, even in our time.

     The use of behavioral modeling was also recommended by Cayce.  Behavioral modeling is a term derived from research in social learning theory.  It is a well documented fact that we learn much of our behavior from observing others.  This process is fittingly referred to as "observational learning." From a clinical standpoint, therapeutic observational learning can best be accomplished with the aid of a person "modeling" the appropriate behavior - hence the term behavioral modeling.  This may all seem painfully obvious to readers.  However, keep in mind that these theories and the research which supported them were not accomplished until the 1960's and 1970's.  Yet Edgar Cayce was incorporating such concepts into treatment plans thirty to forty years ahead of mainstream psychiatric rehabilitation.  Here is a sample of his advice for utilizing behavioral modeling.  This excerpt comes from the fifth reading given for 271:

Q.  Is there any way in which to get this body to eat any form of fruit?
A.  Gradually.  Listen to just what has been given!  The body assumes activities and acts by suggestion of everyone around the body!  If all around the body eat fruit, the body will gradually eat fruit itself!  Isn't that just what we have been saying?
Q.  Should I [the companion] insist upon his getting up in the morning, or does it antagonize him?
A.  As given, it is best that the body arise as soon as it awakes.  Do not antagonize, but suggest!  Do so yourself, and the body will get up too!

      Note that Cayce is describing behavioral modeling as almost a form of suggestion (i.e., suggestive therapeutics). Instead of words being programed into the person's mind, behaviors are being suggested.  In the same reading, Cayce actually elaborated upon the physiology of how behavioral modeling is incorporated into nervous system patterns.  He described how stimuli from the sensory organs were relayed to the rest of the nervous system for processing:

     Hence by speech, by vision, by odor, by feeling, all make a sensitive reaction on a body where there is being electrical stimulation to ganglia to make for connections in their various activities over the system.
     Hence it may be easily seen how careful all should be, how much precaution, patience and persistence must be had in making every suggestion; by speech, by sight, by feeling, by vision, by eating, by sleeping, by all senses of the body; to coordinate with the proper balance being made in the system. See?

     Remember that the physical therapies (and especially the electrotherapy) were rebuilding the nervous systems.  Sensory information was being implanted into the new nerve relays, as it were.  Thus all sensory stimuli in the environment, whether it be suggestive therapeutics, behavioral modeling, the cleanliness of the facility, etc. was to be constructive in nature.  He stated that if you merely provided the physical therapies without regard for the type of information that was being encoded into the nervous systems, you could end up with a mess.  Cayce's view of therapeutic milieu even included the mass media:

     When reading matter is desired, do not give the body reading matter other than that which is constructive.  No gang land.  No underworld. Not a great deal of animosity or excitement in the reading matter ...
Q.  Are movies occasionally well for the body?
A.  Provided they do not carry that same element of reaction to the mental body as we have indicated [violence].  Those that present reactions of a constructive nature are well.
     Remember, you are dealing with mental recuperative forces; and conditions act upon the mind just as would be experienced in the development of a six to eight, to twelve year old child!
     But the mind is being rebuilded!  Give it the proper things to build upon!  else there will be found that the reactions and tendencies will be towards those things destructive, or whatever is taken in the mind.
     Speak, act, think constructively about the body!  Some may consider it a hard job, but it's worth it ...

     I regard therapeutic milieu and companion therapy (as presented in the Cayce material) as representing the spiritual aspect of treatment.  In order to effectively provide the therapies recommended by Cayce, one has to have a great deal of love for another human being.  Call it what you will - use another word if you find the term "spirituality" offensive.  Cayce used the Biblical expression "fruits of the spirit" to express this dimension of treatment.  Spirituality included patience, persistence, kindness, gentleness, and so forth.  You get the idea.

     And yet, he insisted that the companion maintain certain boundaries and not give into every whim of his charge - "not condoning or allowing the body to have its own mental way, and react to same, but in an even, gentle tone and manner" to provide a constructive environment for healing.  The readings tended to view the issue of personal boundaries on an individual basis, taking into consideration the resources at hand.  In cases of severe disability, the companion carried a great deal of responsibility in the initial stages of treatment.  As the suffering individual gained sanity, more self-responsibility was expected and encouraged.

      This approach is similar to modern therapeutic models which place the initial burden of responsibility on professional caretakers (such as the staff of a hospital psychiatric ward or state hospital).  As the individual responds to treatment, more self-responsibility is expected. Because some psychiatric patients develop manipulative techniques for avoiding responsibility, the question of how much self-responsibility is appropriate must always be addressed.  We will note instances of how Cayce dealt with the issue of balance of responsibility in subsequent chapters.  For now, I simply want to point out that this is not an easy assignment.  As we shall see, it was not effectively carried out in this case.

     Before discussing the outcome in this case, I do want to make a point concerning Cayce's philosophy.  I will not go deeply into theory here except to designate Cayce's approach as a prime example of "holism."  In fact, Edgar Cayce has often been acknowledged as the "father of modern holistic medicine."  Cayce repeatedly insisted that we are each triune beings comprised of body, mind and spirit.  His treatment plans typically reflected this conceptualization of the human condition.  Regarding the case of 271, note the emphasis on a holistic treatment plan.  The foundation was laid with a strong physical emphasis as one would expect in a case involving neurological impairment.  However he went on to prescribe mental and spiritual interventions such as suggestive therapeutics, companion therapy and therapeutic milieu.  This theme of holism is so important, it will be echoed numerous times in various contexts in following chapters.

     The outcome in this case is difficult to assess.  Reading 271-7 notes:

... there are tendencies towards betterments, and of conditions that may be builded to bring about a much nearer normal reaction in the coordinating of the mental and physical reactions of the body.

     The reading went on to discuss that the progress was necessarily slow due to the severity of the condition.  Cayce encouraged a continuance of the therapies which were producing the "improvements or the stopping of deterioration in the white matter of the brain impulse."  The general tone of this reading is that the neurological deterioration had been halted and modest gains in rebuilding the system were being made.  He went on to observe:

     For there are periods when the reactions are near normal.  The periods then of what may be termed rationality, in reasoning, are longer; they may not be but a moment longer, but to this experience that may mean many years of sane rationalism, if those moments are taken advantage of.

     In reading 271-8, Cayce cautioned that:

... while there may not be said to be at present any greater deteriorative forces active in the membranes, or those disorders that disturb the equilibrium of the reactions in nerve systems through the activity of the brain centers, little of a contributory cause to a betterment has been added since last we had the body here.

     Apparently the burden of responsibility weighed too heavily on the companion at this point.  The small observable gains (and Cayce's assurance that unobservable neurological healing was occurring) were not enough to bolster the morale of the companion.  After about four months of struggling to implement Cayce's treatment plan, the companion quit and a new companion was enlisted.

     A few weeks later 271 was returned to a mental institution.  In a letter dated May 1, 1934, the mother states, "I am glad to tell you that 271 is doing very well ... He has certainly improved a lot and is contented ..."

      While the readings noted a halting of nerve deterioration in this case, the rebuilding process was apparently not fully achieved.  One of the primary stumbling blocks cited in the readings was the lack of application of the electrotherapy.  Repeatedly, the companion was chided for not being able to get 271 to accept this therapy.  Reading 271-8 did acknowledge the beneficial effects of outdoor physical exercise, yet:

... without ... the low electrical forces, with those supplies of the minerals necessary to be active in constructive influences in brain tissue and nerve elements of the system, ... [the outdoor activities] are hardly efficient in keeping constructive forces.

     The powerful therapeutic effects of minerals such as gold was strongly emphasized in the readings and we will discuss this intriguing topic in later chapters.  Evidently, in this case the electrotherapy was not utilized consistently enough to produce the full desired results (although a decided improvement was noted by the mother).

     The actual period of treatment in this case was only about five months.  Keep in mind the meaning of the term dementia praecox.  It referred to a chronic degenerative form of psychosis with actual brain deterioration.  To translate this into modern diagnostic context (in which schizophrenia is viewed as collection of types or related subgroups), dementia praecox would be considered as a "worst case scenario."  We are not talking here of a splitting of psychological processes or anything of that nature.  The pathology is organic (and from a mainstream medical standpoint, irreversible).

     With this in mind, it is not surprising that Cayce recognized the necessity of a long duration of treatment in this particular case.  In reading 271-5, he remarked:

     It [treatment] will be long (as time is counted by individuals), it will mean persistence, it will mean patience, it will mean keeping the mental balance in spiritual creative forces that are the builders for the body.

     Although Cayce sometimes provided a specific time frame as part of his prognosis, in this case he did not.  Perhaps this was linked to the duration of the illness.  In other cases, he sometimes commented that early intervention could mean faster (and surer) results.  This is consistent with the views of contemporary psychiatry.  Early diagnosis and treatment of schizophrenia is associated with shorter duration of treatment and better outcome.

     Naturally, in cases of long-standing pathology, it would be difficult for a companion to maintain a consistent treatment regimen.  Frequently in such cases, the entranced Cayce would make a referral to the Still-Hildreth Osteopathic Sanitarium in Macon, Missouri.  This remarkable institution was employing many of the natural methods of healing recommended in the readings.  Doctor A. G. Hildreth, using records maintained at the Still-Hildreth Sanatorium, also emphasized the importance of early diagnosis and intervention by citing the following statistics:

     RESULTS IN 840 CASES of DEMENTIA PRAECOX
     Admitted within first 6 months of illness
          263 patients.  Recovered 179, or 68 per cent.
     Duration of illness 6 months to 1 year
          163 patients.  Recovered 78, or 48 per cent.
     Duration of illness 1 to 2 years
          129 patients.  Recovered 37, or 29 per cent.
     Duration of illness over 2 years
          285 patients.  Recovered 57, or 20 per cent.

      When all cases of dementia praecox were considered as a group, a cure rate of 38 per cent was reported.  The dramatically improved prognosis produced by early intervention led Hildreth to proclaim, "It is our firm belief that if patients could be given osteopathic treatment at the onset of the condition in dementia praecox, the percentage of cures would be much greater: nearer one hundred per cent than thirty eight."
 

Some Key Points To Remember

    In many respects, this chapter has laid the foundation for the chapters which follow.  First, we encountered the concept of variability within schizophrenia.  Variability is a bugaboo for medical research.  Inconsistent research findings, lack of replication and constantly changing diagnostic criteria result from variability.  If schizophrenia is actually a group of related disorders, we need to define these groups and adjust our classification system accordingly.
 
    It is important to recognize variability now at the beginning of our consideration of the Cayce material.  The numerous case studies which we will examine acknowledge the various "types and natures" of schizophrenia.

     We have taken the time to review the history of the diagnosis of schizophrenia.  We have encountered the term dementia praecox.  Dementia praecox referred to a relatively specific illness involving brain degeneration, long term decline in functioning and poor outcome.  When psychiatry replaced it with schizophrenia, the strong biological emphasis was lost and has only recently been re-established.  Apparently, Edgar Cayce recognized the inherent problems with the term schizophrenia.  Perhaps he stuck with the older diagnosis because it was less ambiguous.  When he gave readings for individuals presenting with psychotic symptoms without the characteristic brain degeneration of dementia praecox, he usually abstained from making a formal diagnosis. He would simply state the cause, the nature of the pathology, and a treatment plan to address it.  There was so much variability in such cases, he wisely avoided labeling these people with an ambiguous and limiting diagnosis.

     In the chapters which follow, we will be using the terms schizophrenia and dementia praecox interchangably.  This is the simplest way of translating the older terminology into its modern counterpart.  However, it may be helpful to also keep in mind that schizophrenia may be comprised of various subgroups.  Dementia praecox might more accurately translate into the more severe and degenerative forms of schizophrenia - schizophrenia with strong biological pathology.

     Furthermore, dementia praecox itself probably included various subgroups.  I don't want this complex point to be a stumbling block for readers unfamiliar with the intricacies of psychiatric classification.  If you find this distinction confusing, simply think of dementia praecox as being the same as schizophrenia.  If you desire a deeper understanding of this subject, you may wish to consult a more academic treatment of the topic (see the Appendix for a more scholarly book I wrote on the treatment of schizophrenia).

      We have considered the case of a young man which Cayce diagnosed as suffering from a form of dementia praecox.  We have noted the brain pathology and treatments recommended to correct it.  The causative factor in this case was not as clearly defined as in most of the case studies which follow. Cayce simply called it a "prenatal" condition.  Several readings were given and nonprofessional caregivers had considerable problems implementing the treatment recommendations.  However, after several months of therapy, the mother reported noticeable improvement in her son's condition.

      We have also been introduced to the concept of holism. Holism is the foundation of Cayce's approach and will be strongly emphasized in the chapters which follow.
 

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