Talk is Not Cheap: A Narrative Approach to the Successful Discharge of a “Dangerous Male With Schizophrenia” From a Medium Security Ward

Abstract

This case presents a man diagnosed with paranoid schizophrenia and persistent violent behavior admitted to a security ward. A treatment deadlock characterized by a defeatist personal narrative and a staff narrative highlighting alleged antisocial traits and unpredictable violence called for a new clinical approach. Assessment confirmed a schizophrenia diagnosis and disconfirmed a diagnosis of antisocial personality disorder.Violence only appeared inside the ward. This enabled an alternative narrative to manifest itself. According to the new staff narrative, he struggled with persistent psychotic symptoms and used violence to deal with negative emotions, such as anxiety arising from perceived interpersonal rejection or potential failure at independent living. The new client narrative included a sense of agency. The case illustrates how oppressing narratives can block treatment progress and how this can be overcome by allowing alternative narratives. Violence was reduced, and he was discharged 3.5 months after the start of the narrative intervention.