I was talking with Chris last night before dinner and he kept breaking into big yawns from his comfortable position in the easy chair. His whole face contorted, he opened his mouth wide and he sucked in air. In other words, a typical yawn. He yawned three or four times, enough to make me wonder if I was boring him. Why is this so interesting? Well, for one, a yawner he is not.

Apparently, people with a diagnosis of schizophrenia do not yawn. Based on my knowing Chris, by golly that’s right. I had never seen Chris yawn. Maybe he did as a baby. If so, I’ve forgotten, but for sure I never saw him yawn as a child, teen and adult. A few weeks after Chris underwent the assemblage point therapy, I caught him yawning. Haven’t seen much since. Chris has told me repeatedly recently that his life lacks fun. It appears that he is beginning to be uncomfortable in his role of stay-at-home guy with little fun in his life.

Here’s a partial explanation for what’s going on, from the Bulletin of the Menninger Clinic. I don’t necessarily agree with the final paragraph’s hypothesis about chronicity.

YAWNING
A homeostatic reflex and its psychological significance
Heinz E. Lehmann, Professor of Psychiatry, McGill University

Clinical Observations : It is an old clinical observation (Russell 1891; Geigel 1908) that persons suffering from an acute physical illness never yawn as long as their condition is serious. Nurses have learned to recognize the return of yawning as a sign of patients’ convalescence, particularly in those patients who have infectious diseases. The literature, however, reports few observations regarding yawning in psychotic patients, although Hauptmann (1920) made mention of its possible significance.

Some time ago I was struck by the conspicuous scarcity of yawning among mental patients. I informally recorded the incidence of people yawning in public gatherings, on buses, in restaurants, at scientific meetings, and on mental hospital wards. These observations confirmed my impression that yawning among the mentally ill is unusually rare. There were two exceptions: patients receiving large doses of sedatives and those diagnosed as suffering from organic brain syndrome. Of course, the absence of yawning in patients with psychoses associated with constant psychomotor excitement or increased nervous tension was not surprising since excitement or emotional tension usually excludes the occurrence of yawning in normal individuals. However, the majority of patients I observed were quiet, inactive, indifferent persons suffering from schizophrenia. Their failure to yawn requires an explanation.

One of the most consistent physiological findings about patients with schizophrenia is defective homeostasis. The schizophrenic patient’s ability to adjust to changes in the internal milieu is impaired. Slight reductions of the schizophrenic subject’s brain metabolism would, therefore, provoke a homeostatic response less easily than in a normal person. Yawning might not be elicited unless the yawning provoking stimulus assumes an unusual strength such as that provided by hypoglycemia or by barbiturates.

As I have mentioned, the principal psychological agent to produce yawning-boredom-is an affect characterized by an extraverted attitude, a searching tendency toward reality. The schizophrenic subject’s typical withdrawal from reality and his affective blunting make it almost impossible for him to be truly bored; his passivity, indifference, and daydreaming must not be confused with boredom. In addition, the schizophrenic individual can hardly be expected to imitate unconsciously the yawning of another person since he is not likely to transfer sufficient interest to other persons in his surroundings. Therefore, when a schizophrenic patient yawns as a result of boredom or unconmous imitation, it shows that the patient’s contact with reality is not entirely lost and that he is making an effort to maintain it. In fact, when any psychiatric patient yawns, it is a signal that he is in an accessible mood, regardless of his general mental state or diagnosis.

Of course, yawning is by no means completely absent in schizophrenic patients. Its incidence, however, appears to be much lower in schizophrenia than in normal mental conditions or in other mental diseases. The occurrence of yawning in early schizophrenia may be evaluated as a favorable sign; however, it seems to be of ominous significance in chronic schizophrenia. One may theorize that yawning in the acute schizophrenic patient is the reflection of a fairly intact homeostatic system and possibly the expression of the patient’s efforts to retain his contact with reality. In the chronic stages of the disease, yawning may be indicative of structural brain changes and the formation of a new, permanent, and pathological relationship to the outside world, characterized by complacency and the complete loss of the inner stress and tension that should accompany even partial insight.