Neurodiversity - The Book

Professor Demonstrates the Inner World of Schizophrenia through Second Life

The Economist had an article in its September 28, 2006 issue that featured a California psychiatry professor who used the Internet to demonstrate the inner experience of schizophrenia:

"Peter Yellowlees, a professor of psychiatry at the University of California, Davis, has been teaching about schizophrenia for 20 years, but says that he was never really able to explain to his students just how their patients suffer. So he went online, downloaded some free software and entered Second Life...

Mr. Yellowlees created hallucinations. A resident might walk through a virtual hospital ward, and a picture on the wall would suddenly flash the word "shitface". The floor might fall away, leaving the person to walk on stepping stones above the clouds. An in-world television set would change from showing an actual speech by Bob Hawke, Australia's former prime minister, into Mr Hawke shouting, "Go and kill yourself, you wretch!" A reflection in a mirror might have bleeding eyes and die."

Experiences like this one can help quash preconceptions of schizophrenia as due to "split personality," and assist in creating a sense of empathy for the daily dilemmas faced by many people with schizophrenia.

What Causes Schizophrenia? The American Journal of Psychiatry Provides an Answer

I just read an interesting editorial in the current issue of The American Journal of Psychiatry on schizophrenia.  In particular this paragraph intrigued me:

"What causes schizophrenia? The short answer may be "nothing" or more precisely "no one thing." In most cases, schizophrenia is an end result of a complex interaction between thousands of genes and multiple environmental risk factors—none of which on their own causes schizophrenia. Daniel Weinberger, in his classic paper on brain development and schizophrenia , entertained the "unlikely" possibility that schizophrenia is "not the result of a discrete event or illness process at all, but rather one end of the developmental spectrum that for genetic and/or other reasons 0.5% of the population will fall into." Over 20 years later, this unlikely scenario is looking more realistic. Schizophrenia is increasingly considered a subtle neurodevelopmental disorder of brain connectivity, of how the functional circuits in our brains are wired. Schizophrenia may in fact be the tail end of a distribution of how the estimated 20 billion neurons and their trillions of synaptic connections in our brains are generated, eliminated, and maintained. Schizophrenia may be the uniquely human price we pay as a species for the complexity of our brain; in the end, more or less by genetic and environmental chance, some of us get wired for psychosis."

What strikes me is the characterization of schizophrenia as part of a developmental spectrum.  We've heard about the autistic spectrum, but very little about the schizophrenia spectrum.  In my book, Neurodiversity, I suggest that many neurodiverse conditions, including ADHD, dyslexia, mood disorders, anxiety disorders, and intellectual disabilities, form part of the continua for attention, literacy, mood, anxiety, and intelligence, respectively.  This is an important point, because it suggests that each one of us is somewhere on each of these spectra, and thus, in a way, linked to those whom we mistakenly believe are suffering from discrete "disorders" or "illnesses."

People With Schizophrenia Fare Better in Developing Cultures

International studies conducted by the World Health Organization over the past three decades, have concluded that people with schizophrenia fare better over time in developing countries compared with industrialized nations.  In the current issue of The New York Times Magazine, writer Ethan Watters has an article entitled The Americanization of Mental Illness, wherein he provides some interesting cross-cultural evidence of why this might be the case: 

"...the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.

"McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity."

It's interesting to speculate about how these cultural practices influence the brain.  In our fragmented Western culture, it seems that the best we can do for the schizophrenic brain is to provide psychoactive medications.  Yet these other cross-cultural approaches seem to be more powerful in directing the course of the illness along favorable lines.  Western rational scientists would perhaps call this "the placebo effect. "  There's a kind of quiet denigration implied here.  What it really is, is the organization of the entire culture (into a massive cultural placebo if you will), that serves to provide the positive context for healing.   Unfortunately, we can't do controlled studies that have two matched groups of individuals with schizophrenia, one in an industrialized country, and the other in a developing country, because, as Watters points out in his article and his book Crazy Like Us, the Western model of mental illness has been exported to developing countries, and such a study would be skewed toward the Western rational viewpoint.  The individuals in the developing countries cohort would still be viewed by western scientists through the lens of  modern psychiatry. 

Who Are You Calling Crazy? Book Review [The Nation Online]

By Melissa Harris-Lacewell. 

"Americans have an interesting history of conflating our political disagreements with diagnosis of mental illness. In a terrific new book, psychiatrist and historian Jonathan Metzl tells one of these fascinating stories. Metzl's book, The Protest Psychosis: How Schizophrenia Became a Black Disease is exceptional and unexpected.

The text's central argument is that mental illness is not solely (or even primarily) a biological or medical reality; it is largely a social construct. Madness is often diagnosed in those who do not conform to social norms, especially norms governed by identities like race, gender, and class."

via www.thenation.com

Schizophrenics Are Least Likely to Commit Homicide

Despite public fears to the contrary, a new report published in the journal Schizophrenia Bulletin reveals that schizophrenics are the least likely of any group to commit homicide. According to the report, people have only a one in 14 million risk of being killed by a stranger who has been diagnosed as suffering from schizophrenia. ‘What the paper shows, more than anything else, is that the public fear of the mentally ill is completely misplaced," said Dr Matthew Large of the Prince of Wales University. "These events are so rare that they are almost impossible to study, yet the fear of serious violence by the mentally ill is a major cause of stigma,"