S83 Psychiatria Danubina, 2013; Vol. 25, Suppl. 2, pp 83–89 Conference paper © Medicinska naklada - Zagreb, Croatia DIFFERENT FACETS OF SCHIZOPHRENIA ILLUSTRATED BY THE ANALYSIS OF THE HOMES OF THREE PATIENTS DIAGNOSED WITH SCHIZOPHRENIA Sławomir Murawiec 1 , Jonathan Britmann 2 & Krzysztof Krysta 3 1 Community Treatment Team, Institute of Psychiatry and Neurology, Warsaw, Poland 2 Faculty of Psychology, Warsaw University, Warsaw, Poland 3 Department of Psychiatry and Psychotherapy, Medical University of Silesia, Katowice, Poland SUMMARY Diagnosis and observation of patients’ behaviour during outpatient visits or hospitalisations strips the diagnostic process of the opportunity to consider their places of residence as their natural environment. In this way, patients present their symptoms and problems outside of the context of their daily life. Community-based psychiatric care, on the other hand, provides a chance to include, in the diagnostic process the environment created by a patient in their home. This image of a patient’s external reality can reflect a certain mental reality. Such elements as furniture and other objects, their number, quality, distribution may reflect the inner mental world of the objects featuring in a person’s mind. In some cases, this can become a valuable contribution to a diagnostic process. A description of three patients, all treated for schizophrenia, has been presented in this paper in order to explore this possible relationship. The first individual, “Patient N” lives in a flat in a state of extreme depletion of elements. “Patient N” suffers from chronic schizophrenia with severe negative symptoms. The second individual, “Patient D”, has been also diagnosed with schizophrenia. Yet his home is filled with a huge number of elements, writings on the wall, things, figurines and objects of symbolic meaning. A closer examination of his psychopathological symptoms (fantastic, colourful, bizarre content) and history of his illness (unstable diagnosis of schizophrenia), and unpredictable response to antipsychotics may indicate a dissociative type of schizophrenia. Finally, “Patient K’s” main living space is dominated by cats that live with him. Patient K was exposed to physical violence as a child and to him cats represent safe, non-threatening objects. He has been also treated for paranoid schizophrenia. The differences between these patients’ personal histories and the courses of their illnesses are clearly manifested in the way they create their immediate environment. Key words: schizophrenia - place of living – image - diagnosis * * * * * INTRODUCTION The aim of this paper is to draw attention to the possibility of significantly increased understanding of the patient’s intrapsychic organisation and of obtaining new diagnostic information based on the image of the patient’s place of residence, during home visits in community-based psychiatry. An image of a patient’s home can give a visitor a vivid, visualised idea of what could be otherwise very difficult to understand, empathise with or imagine. In a certain indirect way, it can provide us with an illustra- tion of the sick person’s psyche, both in its current condition and in a dynamic mental process taking place in the patient’s psyche. An actual examination of the patient’s home has the advantage of these aspects being visibly manifested; they do not have to be construed in the mind of the carer through other sources of infor- mation. When thinking about this in a right context, without giving in to unnecessary confusion of categories (the image of the patient’s home is obviously not the same as the patient’s psyche) one can say that the appearance of the patient’s place of residence may reflect the image of the psyche in its current state, with its reflection of prevailing psychopathological symp- toms, problems that the patient is struggling with, dynamics of these problems, and type of relations with the objects central to the patient’s mind. It also intro- duces new diagnostic information. On a different (meta-individual) level the appea- rance of the patient’s home can also provide significant diagnostic information, suggestive of certain specific sub-groups distinguishable among patients treated for the same illness and perhaps corresponding to different forms or subtypes of the illness. Home visits taking place within community-based psychiatry make it possible to obtain a unique know- ledge about patients in the context described here. When hospitalized, patients are subject to much more standar- dization and they are perceived within the context of their diagnosis, revealing a similar range of psycho- pathological symptoms and behaviours characteristic for a given diagnosis. Although, of course, individual variations in psychopathology and the ways patients establish relations with personnel are visible, and may contribute to the unique perception of a given person and their clinical situation, some areas are under these circumstances harder or impossible to penetrate. On the other hand, seeing the same patients at home, in their natural environment opens to a care provider an entirely new cognitive, emotional and relational perspective, and can introduce additional information regarding indivi-