Not A Romantic Illness
Schizophrenia affects roughly one in every hundred people. Men and women are equally affected, although it tends to strike men in their late teens and early twenties and women in their 20s and 30s. While onset in childhood is rare, it does occur in children as young as five. Symptoms include unusual thoughts or perceptions, hallucinations, delusions, thought disorders, a decrease in the ability to make plans, initiate actions, or feel pleasure in everyday activities; and problems with attention and memory. Despite popular opinion to the contrary, it does not mean split personality, but rather refers to a broader fracturing of the sense of self and a disturbance in the relationship between the subjective and objective worlds in human personality.
Another common stereotype is that many or most are violent, while in reality, violence is no more common than normal people. Unfortunately, violence against self – suicide – is a major problem, with up to one in four attempting suicide and one in ten succeeding. Schizophrenia is an extremely inheritable condition. A first-degree relative (parent, sibling) is ten more likely to get the disease, and an identical twin a 40-65% chance.
The underlying neurological issues surrounding schizophrenia are complex and still largely unknown. It appears not to be a focalized disease where a lesion in a specific area of the brain causes dysfunction but rather a broad-based disorder affecting connectivity between several areas of the brain. There is a progressive loss of grey matter, beginning in the parietal lobes (affecting sensory experience), the spreading to the temporal lobes (affecting language and auditory experiences), and finally reaching the frontal lobes (affecting executive functioning, cognition, and restraint of impulses). The earlier the onset, the more extensive the brain damage. If the onset is in the early teen years, the loss of gray matter may be as much as 25% over several years’ time. In particular, there is a loss of a specific category of neurons known as “basket cells” that constitute only about 10% of brain cells (and act in an inhibitory way) but control the other 90% of cells (which act in an excitatory way). Also in cognitively impaired schizophrenics, there is reduced volume of white matter – the “wiring” or fatty tissue surrounding and insulating the axon of each neuron. White matter allows for the speedy processing of messages between brain cells (up to 100 time faster). Finally, there appears to be an excess of connectivity in an area of the brain involved in self-reflection. This tends to create self-absorption even when the person is engaged in activities in the outer world. For example, when watching TV, an individual may perceive the announcer’s voice as talking directly to him. These and other findings suggest that schizophrenia is a serious disorder of the brain.
The Schizophrenia Paradox
On one hand, it’s a disease that leaves its subjects unlikely to procreate and pass their genes on to the next generation (few schizophrenics have offspring). On the other hand, the genes for schizophrenia are still in the gene pool. In fact, the rate of schizophrenia worldwide has been relatively stable at 1%. If it is such a terrible and non-adaptive disease, why haven’t its genes (and there appears to be many) been selected out by evolution? The answer seems to be that although a full dose of these genes may be disadvantageous, at least some of the genes have value to the culture. There are partial versions along the schizophrenia spectrum that are not as destructive as full-blown schizophrenia but confer certain advantages.
In schizoid personality disorder, individuals are socially isolated with odd behaviour and often unconventional beliefs. They have some of the eccentricity of schizophrenia but don’t suffer from large-scale damage to the brain affecting executive functioning, learning and memory. Because of their nonconformist personalities, they often show higher levels of creativity. Given a variety of household articles, they were better able to suggest new creative uses for the objects than either the schizophrenic or normal group. “Thought processes for schizophrenic individuals are often very disorganized so they can’t be creative as they cannot get all their thoughts coherent enough to do that, but schizoids tended to activate more of the right hemisphere than either of the other groups.
Many of these schizotypical personalities are first-degree relatives of individuals with schizophrenia. The two greatest scientific discoveries of the 20th century (the theory of relativity and the double-helix model of DNA structure – Albert Einstein and James Watson – and perhaps the greatest writer of the of the 20th century, James Joyce, had a schizophrenic daughter. This may suggest that they had some of the genes of their offspring, and were at least working close to the realms of madness. Who would believe, that the shortest distance between two points is a curved line? Who would believe that time can slow down, that space can shrink, that energy is matter? Who would believe that biological life is based on the shaper of the double helix? In studies of the entire population of Iceland, people who scored at the top of their class in academic subjects, especially in mathematics, or who showed more creativity, were more likely to have first-degree relatives who had psychosis than those who less successful or creative?
Schizophrenia and the Origins of Humanity
It is suggested that the origins of schizophrenia can be found in the evolutionary developments that took place during the emergence of Homo sapiens around a hundred thousand years ago. Mutations controlling the fat content brains ultimately led to the ability to make quicker and more complex neurological connections. This was a quantum leap in the ability of humans to think creatively, develop religions, use symbol systems, create languages, and build civilizations. But it also left the human brain vulnerable to a variety of mental disorders, including schizophrenia. The pathological behaviour was relatively mild because the biochemical changes were compensated for and attenuated by our water-based diet, rich in fatty acids needed by the brain. But the change was sufficient to unleash the extraordinary surge of creativity that characterized the last 100,000 years. Instead of becoming uniform, we became diverse, instead of being relatively stable, we created constant change, instead of being egalitarian, we began more and more, to differentiate from the rest those with special skills in technology, art, religion and psychopathic leadership. We became human. As the human diet changed from a hunter-gatherer diet rich in fat to an agricultural one that contained less fat, the incidence of schizophrenia increased. People with schizophrenia are deficient in some of these fatty acids, in particular omega-3, whose addition can improve symptoms.
Several gene variants for schizophrenia were actually positively selected and stayed relatively unchanged over time, suggesting that there must have been some advantage in possessing them. 76 gene variants most closely associated with schizophrenia, when compared with the evolution of other genes, 28 of the schizophrenia genes had been selected by evolution. You can think that of schizophrenics as paying the price of all the cognitive and language skills that humans have – they have too many of the alleles that taken individually, might have a positive effect, but together they are bad.
Milder versions where executive function has not been too badly compromised have positive elements. There are many examples of accomplished individuals with schizophrenia. The most famous example is John Nash, the American mathematician who won the Noble Prize in Economics in 1994 (the best-selling book and movie “The Beautiful Mind”). Although Nash did his best work before developing schizophrenia, he had been considered an odd duck even during his childhood and adolescence. “The ideas I had about supernatural beings came to me the same way mathematical ideas did. So I took them seriously.”
Other examples of highly accomplished individuals who have had mild to moderate schizophrenia are jazz musician Charles “Buddy” Bolden, Russian dancer Vaclav Nijinsky, artist Salvador Dali, author Jack Kerouac, dramatist Antoin Artaud, Beach Boy superstar Brian Wilson, Broadway star Meera Popkin, and science fiction writer Philip K Dick.
Thought Disorder or Creative Act?
Even in full-blown schizophrenia, the creative impulse still makes itself evident. One can see this in the supposedly incomprehensible language or “word salad,” expressed by some. Schizophrenics tap into the collective unconscious more readily than normal people.
Links between creative writing and full-blown schizophrenia have been demonstrated. They scored better on coming up with more unique and novel uses for household objects and gave more nonconformist answers in a word-association task. They harness their creative side and use their symptoms to work for them rather than against, both in writing and art forms. The symptoms feed them the tools to become creative. They seem to be thinking all the time and the psychosis is not necessarily destructive. The experience of a hallucination can often be recalled in the creation of artwork or poetry. Bizarre artistic tendencies combine surrealistic patterns of thought, feelings and belief, along with an impressionistic view to construct their work. They use internal strife and love lost as a means to create. They use colour to compose works to appease their current state of mind. They aim to reach beyond the obvious and instead delve into the subconscious mind’s potential.
The creative side of schizophrenia may go unrecognized because it represents an unconventional form of creativity. Most psychosis in creative individuals is manic-depressive rather than schizophrenic. Studies showing low creativity in schizophrenics are based on a romantic understanding of creativity, which measures it in terms of spontaneity, high levels of emotionality and Dionysian passion.
It is also the aesthetic of Outsider Art. This genre refers to a class of art produced by individuals “outside” the realm of professional art culture, which nevertheless possesses its own artistic merit. Many of those included within this movement were psychiatric patients and others with mental illness. Henry Darger was a reclusive writer and artist who worked as a janitor in Chicago for many years. After his death, a great treasure trove of art and writings were discovered in his apartment, including a 15,145-page manuscript titled The Story of the Vivian Girls, in What is Known as the Realms of the Unreal, of the Glandeco-Angleinnian War Storm, Caused by the Child Slave Rebellion. There were also several hundred watercolor paintings illustrating this fantasy tale of a battle between good and evil in a terrifying world wracked by war and natural disasters. Johann Knopf, a German baker, factory worker, and locksmith. Institutionalized after a suicide attempt, Knopf believed he was “the Resurrection” and that nobody suffered as much as he – not even Christ. His art includes images of Christ/Knopf in simple geometric style. Bodies are transparent, revealing internal organs such as knives and keys. Kopf believed he could understand the language of birds, and his art included many images of these, which in his mythology represented tragic creatures. He filled the empty space in his art with “explanatory” writing. While displaying symptoms of schizophrenic delusions in their art, these individuals nevertheless were able to couch their symbology in an aesthetic framework that caught the attention of art and literary critics who viewed the work on their own merits and not as the ravings of a bunch of lunatics.
An important caveat to the above material is that the worse the symptoms of the schizophrenic, especially with regard to thought disorders ad executive function (the ability to coordinate many cognitive tasks at one time) the worse their performance on creative tasks. Poor executive functioning is advantageous in the ability to make a creative response, but only up to a point. Severely disruptive executive functioning is detrimental to creative performance whereas milder levels of reduced function can be advantageous on some facets of creative cognition. Both individuals with schizophrenia and creative people appear to be more open to incoming stimuli from the surrounding environment and less likely to file them into convenient categories that can be sorted and then forgotten. Thus, they are always open to new possibilities. With severe schizophrenia, however, subjects are likely to be overwhelmed by the stimuli and unable to edit, select, and choose the appropriate stimuli for creative production.
The regulator that funnels certain information to you and filters out other information suddenly shuts off. Immediately, every sight, every sound, every smell coming at you carries equal weight, every thought, feeling, memory, and idea presents itself to you with an equally strong and demanding intensity. You’ve receiving a dozen different messages in a dozen different media-phone, email, TV, CD player, friend knocking at the door, ideas inside your head – and you’ve unable to choose which ones come to the front and which are related to “later.”
Assault on Rationality
Schizophrenia violates the value of rationality, a basic value of modern Western culture. When they experiences delusions and hallucinations, they do not display logical acumen and thus pose a threat to the basic order of things in our reason-able culture.
One aspect of irrationality is their avid interest in religion, spirituality, and mysticism. While religious delusions can sometimes be harmful, spiritual and mystical experiences in schizophrenia can also represent an uplifting element in their lives. In ancient Greece, Socrates praised the role of the divine in madness. Their experience might be described as “beyond years” and mood as “ecstasy” and “rapture”. They believe they have unlocked some deep truths of universal importance. Many clinicians fail to recognize the value of these experiences or the importance of religion and spirituality to their schizophrenic clients.
Shamans, Holy Fools, and the God-Intoxicated
Other cultures based less on rational grounds than contemporary Western culture, may celebrate schizophrenics as gifted and their talents are used by the community. The adolescent onset of schizophrenia may be regarded as a mythical breakthrough in a shamanic culture. The shaman who in early adolescence underwent a severe psychological crisis might today be called a psychosis. Normally the child’s apprehensive family sends for an elder shaman to bring the youngster out of it, and by appropriate measures, songs, and exercise, this experienced practitioner succeeds. He who is seized by the shaman sickness, and does not begin to exercise shamanism, must suffer badly. He might lose his mind, he may even have to give up his life. Therefore, he is advised, “You must take up shamanism so as not to suffer or to escape illness.
Some shamans (note that there is a wide variety of types of shamans around the world) exhibit non-reality-oriented ideation, profound emotional upheavals, and bizarre mannerisms. They may go through a psychological process that includes guilt, failure, isolation, estrangement, narrowing of attention, fusing of dream-like states with waking experiences, and a reorganized sense of reality. The major difference is that in indigenous cultures, this process is supported, seen a helpful to the individual, and regarded as beneficial to the collective. In a culture that does not provide referential guides for comprehending this kind of crisis experience, the individual schizophrenic typically undergoes an intensification of his suffering over and above his original anxieties.
India has a long tradition of “God-intoxicated” individuals who appear to be psychotic but who are seen to possess special spiritual status and are taken care of and pampered by the local community. Essentially, these individuals had found a particular “niche” within which their “pathologies” are tolerated and their perceived inner talents and abilities were acknowledged and celebrated by the surrounding culture. Diagnosed schizophrenics in third world countries have better outcomes than those in Western culture.
Niche Construction in Schizophrenia
John Nash and Associate Dean of USC Law School Elyn Saks, both who struggled with schizophrenia, endured hospitalizations, underwent difficult treatments like shock therapy and insulin coma therapy, were able to overcome adversity and find their place in society. Both found as safe haven in the library, a place where they could concentrate on their intellectual specialities relatively free from the disturbances of schizophrenia and the stigma of mental illness. During the 1970s and 80s, John Nash sought refuge in the library of Princeton University, where he was known as the Phantom of Fine Hall. His odd behaviors, if not exactly understood, were at least tolerated by students and faculty. Princeton functioned as a therapeutic community – it was quiet and safe, its lecture halls, libraries, and dining halls were open to him; its members were for the most part respectful; human contact was available, but not intrusive. His delusions were seen not just as bizarre and unintelligible, but as having an intrinsic value, and paved the way for an eventual remission. The advent of computers may have given him a special focus that took his mind off his bizarre thoughts. He used them to test many of his mathematical problems.
Elyn Saks also used the library as a refuge, but her psychoactive medications and long-term psychoanalysis seemed to have the most dramatic benefits. She had difficulty coming to grips with the fact that medications were necessary to control her symptoms. She felt that she had to overcome schizophrenia through sheer willpower, yet repeatedly deteriorated when she went off her medications. Her many years-long process of tinkering with her meds was for her parents, friends and physicians but was a necessary stage that whe needed to go through to become her full-fledged self. Talk therapy was a godsend in building her self-structures as a person in the midst of chaos. By unwinding all her fragmented parts, she found a life worth living.
Although interpersonally distant, constructing a niche by having a relationship with someone who accepts them as a whole human being is calming and reassuring. Making something constructive out of psychotic/poetic sparks gives a sense of closure and ultimately serves to reconnect something that has been disconnected, so that the ultimate wholeness of the individual is revealed.
On one hand, schizophrenia represents a fracture of wholeness generally referred to as the “self”. Schizophrenia has connections to realms that are themselves imbued with wholeness: creativity, spirituality, magic, imagination. It’s this paradox that makes understanding schizophrenia so difficult. It leaves one puzzled to understand how the positives and negatives fit together. However, it seems clear that it is connected to something very profound having to do with our evolution. Vulnerability to it is associated with the workings of the creative process, with language, high sensitivity, and imaginativeness generally and in many instances with enhanced spirituality and empathy. Eliminating it may do serious and irreversible damage to our species.