An Altered Sense of Reality; Schizophrenia

Throughout history many explanations have been offered to explain why people act in unnatural ways; from supernatural explanations such as possession by demons or gods to an imbalance of bodily fluids (blood, phlegm, black bile, and yellow bile). Today, western civilizations' theories of abnormality emphasize biological causes. Our advanced knowledge of human biology has allowed us to systematically name, diagnose and offer treatment for an ever expanding list of psychological disorders.

But we still face many problems identifying abnormality, one of the biggest difficulties faced by anyone trying to define abnormality is having a good idea of what normal is, and making the distinction between strange behavior and clinical abnormalities. With enough observation, most people could display behavior that might be defined as abnormal culturally, socially or otherwise but there has to be a differentiation between strange and clinical. It is for these reasons that professionals generally use specific criteria within which they can define abnormality, all of these criteria relate to whether a person’s behavior or mental state is detrimental to the well-being of themselves or that of other people.The authors of the Diagnostic Statistical Manual (DSM) define a mental disorder as-- “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual that is associated with present distress e.g. painful symptom or disability (i.e. impairment in one or more areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom and it is not typical or culturally expected.”(1)(2)

This statement taken from the DSM can be broken down into the criteria that can be used to define whether or not a person’s behavior or mental state should be considered abnormal. The first of these criteria identify impairment i.e. is the individual's behavior maladaptive in a way that it prevents them from functioning in their daily life. For example, if their behavior or mental state prevents them from being able to hold a job or maintain a relationship.

The second criteria suggests that behaviors should be considered abnormal if the individual suffers discomfort as a result of their behaviors or mental state.Additionally, if an individual poses a “risk to self” or other people. When an individual‘s actions pose a direct threat to their own life or to the life of others, the behavior is considered to be abnormal. I.e. A severely depressed individual who is at risk of committing suicide. Similarly, an individual suffering from Schizophrenia who is out of touch with reality and may put themselves or others at risk.

According to this model, when a person’s behavior or mental state interferes with their ability to go about their daily life, such as in employment and relationships, or poses a risk to their health or life or that of others, it should be considered a mental disorder and should be treated as such looking into the causes of the disorder and applying appropriate treatment.

According to the DSM, the most effective treatment for these types of disorders is often, a combination of medication, cognitive and behavioral therapy, and interpersonal therapy. Medication is often seen as the most useful tool in the management of most psychological disorders including Schizophrenia, ADHD, depression, anxiety, obsessive-compulsive behaviors, and the racing ‘over indulgence of negative thoughts’ that may accompany many of these illnesses.

The cognitive approach to abnormal psychology is the belief that this negative thought process is the be all and end all of mental illness, that the person suffering is completely responsible for their own state of consciousness, which, in a way, for certain psychological disorders could be the case (although context always plays a role, the situation within which an individual finds themselves is just as important as the symptoms that it causes).

However because of a greater understanding of the processes that cause such states, this is not the model currently being used by medical professionals, instead a model has been adapted to combine cognitive and medical approaches which seeks to help people based on whether they are suffering distress as a result of their symptoms, such as negative thought processes (delusions) and looking to treat the causes.

To be diagnosed with Schizophrenia a person must display two or more specific symptoms for a ‘significant portion’ of time within the space of one month. These symptoms can be ‘negative’ or ‘positive’ and range from visual/auditory hallucinations, lack of emotional responses and disorganized speech to full catatonic states. By looking at these symptoms such as visual hallucinations and delusional thoughts a lot can be discerned as to the best course of treatment. As we know that these specific symptoms are in many cases caused by malfunction of dopaminergic neurotransmission systems.

But by introducing drugs to combat these chemical malfunctions are the causes being treated or just overridden by other chemicals? It has been argued that many of the treatments currently used, seek to address these symptoms rather than the root cause of the problem and that this method is flawed, that problems are only being glazed over and the patient will need to continue taking the medication indefinitely which in its self, causes more side effects and could also cause patients to disengage from treatment and refuse to seek help.

The point has also been made by the opposition of the current psychological society’s methods, that this power can be used to remove and forcefully medicate undesirable aspects of society. Personally I am unsure whether this is an intentional attempt to exert social control, which it could very well be, or whether it is simply too difficult or maybe too expensive to run full diagnostic tests and look inside the brain of every patient who may have Schizophrenia to see exactly what malfunctions, if any, are present and how they should be treated, instead by looking at the symptoms professionals can make an ‘educated guess’ as to the best course of treatment.

Schizophrenia, which affects around one percent of the population (the World Health Organization estimates that there are 24 million people affected by Schizophrenia worldwide), has received a lot of attention and a lot of progress has been made into understanding why it occurs and how it can be treated, currently antipsychotic medication is the first line of treatment, this is because Schizophrenia has been identified through medical research, as a disease caused by abnormalities in brain function, chemistry or brain structure (or at least the symptoms are caused by these abnormalities) and in trying to understand the underline causes of abnormality from the biological perspective, mental health professionals and researchers look at the processes within a person‘s body, such as physical disturbances, like damage or malfunction of the central nervous system.

It has been observed in research subjects with Schizophrenia, abnormal activity within several sections of the brain. One such area, the prefrontal cortex, is associated with attention, short term memory and what are referred to as ‘executive functions’. These executive functions serve to process higher aspects of cognition such as thoughts and emotions, inhibition of detrimental behavior and in thought processing related to building a coherent picture of the outside world. (3)(4)

It has also been observed in sufferers of Schizophrenia, an imbalance of several neurotransmitters (dopamine, serotonin, glutamate, and GABA) and inadequate functioning of the related receptors. Imbalance of dopamine has been observed in many psychological disorders including Parkinson’s disease, one of the most detrimental side effects of current antipsychotic medication is that ‘conventional’ antipsychotics act by targeting dopamine receptors in the brain and interfering with dopaminergic neurotransmission, this can help treat ‘positive’ symptoms associated with Schizophrenia as was mentioned earlier, but also causes Parkinson’s like symptoms i.e. tremors, involuntary muscle movements and restfulness.(6)

Aside from being detrimental to the patient, this may actually put people suffering with Schizophrenia in a situation of anxiety towards the idea of seeking help, knowing that the treatments may further isolate them and make them seem and feel ‘different’.

The precise role that GABA plays in the manifestation and symptoms of Schizophrenia is not entirely clear but GABA is thought to exert an effect on the regulation of dopamine levels within the brain, so it is possible that the interaction between GABA and dopamine is responsible for some of the symptoms of the disorder.

Serotonin which is a neuro-modulatory neurotransmitter is also seen to be malfunctioning within the brains of sufferers of Schizophrenia. Serotonin is very important within alert, problem solving, waking consciousness as it mediates other systems and neurotransmitters.

The behavioral effects of serotonin are complex and without these neuro-modulatory systems, executive functions and the range of other neurotransmitters and their related receptors functioning adequately, what we would refer to as ‘normal’ consciousness and thought processing is impaired causing confusion, anxiety, low moods and the altered perception of reality which is often associated with Schizophrenia.

Ultimately it may be that all of these factors, all of these neurotransmitters, all of these parts of the brain, and more that we are yet to identify play a role enabling, perpetuating or even causing malfunctions within each other’s functioning and therefore causing mental illness.

It is thought by many that psychological disorders like Schizophrenia hold a strong genetic link/ genetic pre-disposition. The chances of a person developing Schizophrenia are greater if either of their parents suffers from it. Although the genetics behind Schizophrenia are not completely understood and continue to undergo research, it is today generally accepted that abnormalities within specific genes can play a large role in whether or not a person is likely to suffer from the disorder. But while certain genes can be associated with mental illnesses it is a complex subject and as such environmental factors that influence whether or not those genes are expressed are ultimately easier to identify and address.

Many factors can lead to the expression of certain genes and so to can they cause damage and malfunction of the central nervous system profound enough to manifest as any number of mental illnesses including, Schizophrenia; exposure to certain environmental stimuli (exposure to chemicals in foods and water, toxic substances, allergens), ingestion of medicines and drugs etc. Interestingly, high doses of amphetamines (such as methylphenidate, which is used to treat children with ADHD) can result in psychosis resembling Schizophrenia. Exposure to these (and probably many more) external stimuli can all cause disturbances in the physical functioning of the body and in turn cause emotional, behavioral and in extreme cases physical disturbances that lead to psychological disorders.

It is also thought that emotional states or traumatic life experiences can have an impact on an individual‘s personality and constitute psychological factors in the development of abnormality. For example, a person who is sexually abused as a child may develop serious mental health issues. But also perceived traumatic experiences, such as would not be seen to be overly traumatic to you or me but to the individual play an important role in the development of their personality and in the manifestation of mental health issues and abnormal behavior. (It is important to understand in this instance that the underline cause is relative to the person in question and that all of these factors are interlinked, enabling and perpetuating one another.)

It could also be argued that such traumatic experiences might have an effect changing the physical structure or the functioning of the brain as has been studied in some PTSD cases. (5) Especially if such trauma occurs in early life when the individual is still developing. The question is, does the manifestation of Schizophrenia cause changes in the brain, or do changes in the brain as a result of any number of stimuli cause Schizophrenia? If this is the case then it is not unusual, in fact many psychological disorders and diseases, in general, have links to the overall health of the individual when an individual is ill or is suffering from emotional problems it seems it makes them more susceptible to other illnesses. Freudians would put Schizophrenia down to an individual’s abnormal upbringing in particular if the individual had a ‘schizogenic’ mother, resulting in a weak ego allowing the id or impulsive side of a person to be more pronounced.

A lot of Freud’s theories are very limited by the world view that was prevalent at the time. Victorian England was very withdrawn and uptight, and this is reflected in his work and in his thinking. It could also be noted that because of a lack of scientific ability a lot of Freud’s theories are just attempts to define psychological concepts, especially when he starts talking about the brain and its functions. At the time very little was known about the brains functions or chemistry and so whenever Freud starts to talk about psychological issues, in a way he is trying to understand a complex system that he had absolutely no way of measuring. Despite this, if we take seriously the notion that psychological manifestations of trauma can be brought on by emotional states. Then maybe some of Freud’s ideas have some grounding in reality. The idea that traumatic experiences in early life or even into late developmental years can cause psychological manifestations of abnormality could in a way be linked to a person having a rough upbringing with a ‘schizogenic’ parent.

Also, culturally accepted or rejected behavior can, in the same way, cause traumatic emotional experiences for those who are discriminated against and forced to feel somehow subhuman or less than their peers, they are inevitably going to suffer some form of trauma which in later life may manifest as any number of psychological disorders. If this is the case then accepted or programmed behaviors and belief systems can lead people to behaviors or mental states that should be considered abnormal and detrimental to society, i.e. the culturally accepted view that it is ok to condemn and harass a person or people based on their beliefs, race, their gender, class status, sexual orientation or disability, as this may cause psychological trauma.

If we take seriously this notion, that these psychological illnesses can be brought on by the way a child is treated either by their parents or peers, then it can be viewed as a symptom of a toxic society. This point can be backed up by Fernando’s (1988) studies that found ethnic minorities in the UK were between two and seven times more likely to develop Schizophrenia. Also, this study could be linked back to environmental factors. It is a little-known fact that many of the environmental factors which are thought by many (myself included) to contribute to neurological diseases and psychological abnormalities (ADHD, ASD, Schizophrenia etc.) actually have a more damaging effect on certain genetics. (7) (8)

Similarly to critiques like Ivan Illich (1976) who pointed out that medical professionals of the time (doctors, surgeons, and pharmaceutical companies) had a vested interest in ensuring there was plenty of disease, the way the [Diagnostic and statistical manual] DSM has been structured today, as well as the substantial and ever increasing expansion of the number of categories, are representative of an attempt to move into an over medicalization of human nature, which may be attributed to disease mongering and profiteering tactics by pharmaceutical companies, the power, influence and connection to medical and political institutions of which having grown dramatically in recent decades. The idea that for nearly every facet of human emotion and behavior there is a clinical diagnosis and medical treatment leads many, myself included, to the thought that this kind of system is set up to benefit the “big pharma” corporations more so than the people it claims to be trying to help. It seems to pathologize normal human behavior when it doesn’t fit into an organizational structure that suits the society. This is not to say that psychological disorders are none existent, but rather that the definitions seek to incorporate anyone who fails to fall into a category of state sanctioned behavior. In an attempt to turn a profit whilst also being an organization capable of a form of social control.Why do we want to drug away peoples unique perspectives? So the individual can function to the standards which the society demands? Maybe it is just easier to treat the symptoms of a sick society than to work to create a healthier one.

“When the only tool you have is a hammer, every problem must look like a nail” -Abraham Maslow- The Psychology of Science, published in 1966.

It is undeniable that in recent decades with technological advances allowing us unprecedented access into the structures of the human body and with the medical knowledge we have available today, our understanding of and ability to treat psychological disorders has grown exponentially, but I cannot help but feel we are missing something fundamental, that in years to come people will look back at the way we attempt to treat mental illness, by perturbing brain chemistry with what we see as advanced psychopharmacology, as savage and backwards in the same way we today look back upon bedlam and the roots of western cultures understanding of mental illness.

It is clear to see that it is societies which ultimately determine where the line between normal and abnormal behavior is drawn and therefore every mental illness is invented, not discovered.

Works Cited

Word count: 2722Reference: 1) Stein. D, Phillips. K, Bolton. D, Fulford. K, Sadler. J, and Kendler. K “What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V” (Published online 2010 Jan 20.) Available online; [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101504/]

2) Boundless. “Classifying Abnormal Behavior: Introducing the DSM.” Boundless Psychology. Boundless, (05 Nov. 2014). Available online; [https://www.boundless.com/psychology/textbooks/boundless-psychology-textbook/psychological-disorders-18/introduction-to-psychological-disorders-90/classifying-abnormal-behavior-introducing-the-dsm-344-12879/]

3) Perlstein WM, Carter CS, Noll DC, Cohen JD. Relation of prefrontal cortex dysfunction to working memory and symptoms in schizophrenia. Am J Psychiatry. 2001 Jul;158(7):1105-13. PubMed PMID:11431233. Available online; http://www.ncbi.nlm.nih.gov/pubmed/11431233

4) Gollub. R, Benson. E, Searl. M, Goff. D, Halpern. E, Saper. C, Rauch. S Schizophrenic subjects show aberrant fMRI activation of dorsolateral prefrontal cortex and basal ganglia during working memory performance Available online; http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2800%2900227-4/fulltext

5) Hull.A, The British Journal of Psychiatry Aug 2002, 181 (2) 102-110; DOI: 10.1192/bjp.181.2.102 Neuroimaging findings in post-traumatic stress disorder Available online; http://bjp.rcpsych.org/content/181/2/102

6) Ashton. M, Todd. A. The Pharmaceutical Journal, Vol. 286, p174 | URI: 11068376 Available online; http://www.pharmaceutical-journal.com/opinion/comment/current-research-and-development-of-new-treatments-for-schizophrenia/11068376.article

7) http://www.morganverkamp.com/august-27-2014-press-release-statement-of-william-w-thompson-ph-d-regarding-the-2004-article-examining-the-possibility-of-a-relationship-between-mmr-vaccine-and-autism/

8) http://www.dailymail.co.uk/news/article-3143238/Family-cries-foul-suicide-anti-vaccination-doctor-Jeff-Bradstreet-open-community-fund-investigation.html