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The descriptions "crazy, insane, mentally ill" mostly refer to schizophrenic patients who can be inappropriate, sometimes bizarre, and occasionally dangerous. Schizophrenia is a psychosis and is considered to be the most severe form of mental illness. The diagnosis is sometimes made hastily with little evidence. The diagnosis is always prejudicial. Physicians are usually given the legal authority to detain psychotic patients for evaluation and treatment. Detention of psychotic patients intends to protect the patients from self-harm and society from the harmful actions of disturbed people. The power to imprison humans against their will, however, is an invitation to abuse patients and to ignore their human rights.
There is little doubt that some adolescents and young adults develop confusion, agitation and believe that they are being controlled by an external agency. Ordinary events become more salient and judgment is impaired. An acute schizophrenic does not process ordinary information properly. Hallucinations and delusions (false beliefs) are two key symptoms. Spontaneous brain activity increases, so that routine self-talk and abnormal sensations from the body mingle with dreams, hallucinations and delusions to produce a collage of disturbing experiences. This mind activity may sometimes be interesting (as dreams are interesting), but has little value in the attempt to understand or treat the illness. The paranoid schizophrenic is a potentially dangerous person because of his or her exaggerated suspicion, hostility and inability to evaluate the relevance of events. Paranoid schizophrenics sometimes injure or kill innocent victims who were mistaken for conspirators in some evil plot or another.
Several patterns of schizophrenia have been recognized. The name is probably
a liability as is the concept of one disease with variations. “Schizo” refers to
a split and “phrenia” to mind. A popular misconception is that schizophrenics
have “split personalities.”
The core features of schizophrenia is loss of social abilities and impaired self-regulation that often preclude an independent, productive life. The features of the disease are usually sorted into two groups – the negative features or loss of function and the positive features or abnormal mind activity such as delusions hallucinations and behavioral disturbances. An acute attack of schizophrenia is easily recognized by confused, agitated, disruptive behavior. Adolescent onset of schizophrenia is typical and early symptoms are often indistinguishable from the psychosocial turmoil that most adolescents manifest. The disorder begins with odd or eccentric interests and behaviors, withdrawal, and decline in cognitive and social functioning. The schizophrenic withdraws progressively, whereas an unhappy but otherwise normal teen will withdraw episodically and re-engages when opportunities arise.
Humans are social animals who need others to assist in self-regulation. The schizophrenic loses the ability to relate to and interact successfully with others. Schizophrenics lack empathy and lack insight into their own disability. When they have odd experiences and feel funny sensations in their body, they tend to project blame and explain these occurrences as the work of others, evil spirits and demonic possession. Ordinary experiences may have exaggerated salience and some delusions are stories that attempt to explain the feelings of heightened salience. The mechanism of schizophrenia remains obscure; although many observations and preliminary explanations have identified a brain “disease” that produces dementia over a period of months to years, often leading to permanent disability. The incidence of schizophrenia is about 1% in North America and Europe.
The core cognitive and social disturbances that all schizophrenics share are prevalent in the general population. If you list 10 features of schizophrenia and rate 30 “normal” adult family-members, friends and colleagues you are likely to find several that have at least some of these features and you may become concerned. Heydebrand reviewed studies of the families of schizophrenics and while noting difficulties in defining exactly what is wrong, stated that: “More than 50 peer-reviewed studies have been conducted on cognitive deficits in the families of patients with schizophrenia, providing convincing evidence that relatives perform more than half a standard deviation lower than that of healthy participants on a range of cognitive measures... The most robust finding on deficits among relatives is of impaired verbal memory and executive function (verbal fluency, cognitive flexibility and inhibition, working memory) with a possible underlying deficit in the ability to perform 'maintenance plus' tasks requiring increased effort and higher central executive processing.”
The terms “schitzy”, “schizoid” or more recently “borderline personality” point to schizophrenic characteristics. You could argue that 1% of the general population is conspicuously disabled and is diagnosed with schizophrenia, and a larger group shares some of the features of this disease but are less conspicuously disabled. Mildly disabled people who are well supported by family and do not go to a psychiatrist never receive a “psychiatric diagnosis. To estimate how large the mild schizoid group might be, you have to begin by understanding and defining the core features of schizophrenia. The schizophrenic naturally generates delusions that are common in fundamentalist religious groups. You can argue that these groups are “schizoid” organizations. Similarly, people who believe in ghosts, UFOs, alien abductions and other weird experiences may pursue their eccentric interests alone or gather together in “schizoid” organizations.
This argument leads to interesting considerations of who is “normal” or sane in a society that is populated with irrational ideas, bizarre beliefs, antisocial behaviors, and supports popular entertainment that rivals the most chaotic content of the schizophrenic mind. The idea of the movie, Matrix, for example, is that the whole world could be simulated in a computer and that humans could coexist in a physical form, displaced in time and space and in a simulated form in software. The Matrix plot is all mixed up, ludicrous, but interesting from the point of view of cognitive distortions and psychopathology. Matrix was really a movie about insanity-- developing the confusion that a schizophrenic might experience during an acute psychotic episode. A schizophrenic may lose the distinction between the inside and the outside, past and present, and will feel controlled by an external manipulator who uses television or radio waves to send messages. Loose talk, bizarre fantasies and paranoid delusions have become so commonplace in print, movie and television plots that you can argue that the expressions of schizoid minds are mainstream in the entertainment media.
A psychiatrist may decide that one person should be in hospital when God speaks to her, but is tolerant of a similar claim by a more respectable member of the local church interviewed on TV. There may or may not be real differences in the two experiences. The respectable church-lady is probably not hallucinating, just delusional. She is describing her inner monologue (self talk) as a conversation with God, following the conventions of her church. The hospitalized patient may be hearing the voice of God inside her head. An auditory hallucination sounds like a real voice coming from the outside. A hallucination is brief and vivid, often just a single word. Many “normal” people, for example, report hearing their mother’s voice saying their name. This common auditory hallucination may only occur a few times in the lifetime of an individual. A hallucinatory conversation of any duration probably never occurs. Everyone has an inner monologue that is almost continuous; sometimes people report selftalk as a conversation with God or as advice from some other imaginary being.
Schizophrenics tend to experience spontaneous, dream-like episodes with symbolic material that resembles symbolic expression in art, myths, literature and movies. This material tends to be similar in schizophrenics from many backgrounds and cultures and suggests a common substrate of brain activity. Carl Jung referred to this as the collective unconscious and suggested that a basic repertoire of common patterns or archetypes were built into each human brain. The boundaries that normally distinguish real world events from movies, inner monologue, fantasies and dreams tend to vanish in schizophrenics and they often seem preoccupied with noumenal events.
The disabled brain withdraws into old patterns. As the disease progresses, the contents of consciousness reported by schizophrenics become less and less interesting and more disorganized. “Attacks” of brain disturbance may occur with agitated behavior, conspicuously abnormal thoughts and behavior that distinguishes the “mentally ill” person who ends up in hospital with the diagnosis of a psychotic illness. People continue to refer to “nervous breakdowns" and may claim that Mary Jane went crazy because her husband was having an affair and she was under “too much stress.” Johnny had a nervous breakdown because he was “studying too hard.” R.D. Laing, a non-conforming Scottish psychiatrist, suggested that schizophrenics were exploring interesting mental experiences and should be allowed to do so, in protected environments.
The schizophrenic patient has yet to receive medical care appropriate for someone with a serious brain disease. Schizophrenia is not a structural brain disease that shows up early in X Rays, CAT scans or MRIs. This is a dynamic disturbance of brain that interferes with the cognitive performance and the behavior of the victim. Since some schizophrenics tend to deteriorate over many years, you might assume that there is continuously active or recurrent disease process that damages the brain. Late in the disease, generalized atrophy of the brain may become apparent on a MRI.
Mirnics et al described Schizophrenia as: “ a complex and devastating brain disorder that affects 1% of the population and ranks as one of the most costly disorders to afflict humans… the onset is late adolescence or early adulthood, presenting as positive (delusions, hallucinations, and thought disorganization) and negative (impaired motivation and decreased emotional expression) symptoms. Alterations in cognitive processes, such as attention and working memory, however, may be present prior to the onset of the clinical syndrome. In addition, many individuals with schizophrenia experience difficulties with depression and substance abuse, factors that contribute to the 10%–15% lifetime incidence of suicide in this disorder. The cause of schizophrenia remains elusive but appears to be multifaceted, with genetic, nutritional, environmental, and developmental factors all implicated …a number of brain regions, including the hippocampus, superior temporal gyrus, and thalamus, appear to be disturbed in this disorder... the dorsal prefrontal cortex (PFC) is a major locus of dysfunction…. reductions in gray matter volume in the dorsal PFC have been observed in neuroimaging studies and these volumetric changes are associated with an increase in cell packing density but no change in total neuron number in the PFC… these findings likely reflect a decrease in the number of axon terminals and in the distal dendrites and dendritic spines that represent their principal synaptic targets. Consistent with this interpretation, both the levels of synaptophysin, a presynaptic terminal protein, and the density of dendritic spines are decreased in the PFC of subjects with schizophrenia. The typical age of onset of schizophrenia coincides with the termination of the adolescence-related reduction in the densities of synapses and dendritic spines in the PFC. Changes in gene expression also have been observed in the PFC of subjects with schizophrenia. In particular, alterations in gene products related to neurotransmission or second messenger systems have been observed. However, each of these studies have focused on only one or a few gene products at a time, without the ability to investigate the simultaneous expression of large numbers of genes. Consequently, complex gene expression patterns in the PFC of subjects with schizophrenia are currently unknown.”
For many years, Dohan advocated a gluten-schizophrenia link and there continues to be a trickle of evidence suggesting that he may be right. He stated: "Many diseases are caused by genetically-deficient utilization of specific food substances. Perhaps the best studied example is phenylketonuria...far more common disorders, for example, atherosclerosis, and coronary heart disease, are strongly suspected of being due to genetically defective utilization of certain food constituents. Similarly, considerable evidence indicates that the major cause of schizophrenia is the inborn inability to process certain digestion products of some food proteins, especially cereal grain glutens..." Among Dohan's interesting recommendations is the "gluten tolerance test". A gluten tolerance test could be initiated with routine evaluations before and after ingestion of cereal grain foods. Some patients report changes in their level of psychic energy, cognitive abilities, and emotional states. Arousal disturbances in schizophrenics may be similar to the disturbances we see in food allergic children and adults with mood swings, episodes of irritability, hyperactivity and attention-memory deficits. Food control should alleviate these disturbances within the schizophrenia complex even if an underlying disease process remains intact.
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