5 ms·

Just so we are clear: the approach taken in the studies described is “we looked at a bunch of blind people and couldn’t find a schizophrenic”, and “we looked at

Just so we are clear: the approach taken in the studies described is “we looked at a bunch of blind people and couldn’t find a schizophrenic”, and “we looked at a bunch of schizophrenics and couldn’t find a blind person.” The appropriate question is: can such an approach, in a wildly fractured series of data sets, overlook 600 people?

Uhhrrr 7y ago
It sure can, but the odds are against it overlooking all of them. Of course, maybe the genes leading to blindness and schizophrenia together also lead to some other defect that results in miscarriage or some other kind of early death.
- ajross 7y ago
  To be clear: the odds are against it assuming no confounding interference. And given that, I don't know that an error of 600 is really that much of a statement. I mean, just to invent an example (not the only possible one, obviously!): Congenital blindness is likely diagnosed with near 100% certainty in early childhood. It's easy to spot. The same is very much NOT true of mental health problems. Schisophrenics are diagnosed, almost always, when their condition manifests in such a way to interfere with their life (or someone else's) to the extent that the doctors get called in. There are widely assumed to be LOTS of undiagnosed mental health cases in society, simply because the sufferers live in situations where their disorder can be managed (or suppressed!) in an ad hoc way. Now, the question becomes: are blind people more likely to be living in a circumstance where their mental health troubles are more easily managed/ignored/suppressed without the involvement of doctors who would otherwise diagnose schizophrenia? That seems not at all unlikely to me. And frankly: this kind of confounded measurement strikes me as MUCH MORE likely than a heretofore unrecognized link between vision and schizophrenia. Significant results require significant proof, and I don't think this is it.
  - sophacles 7y ago
    There are other links between vision and schizophrenia - e.g. https://www.wired.com/2009/04/schizoillusion/ https://www.wired.com/2009/04/schizoillusion/ (although that may better be described as a link between visual processing and schizophrenia. vision -> visual processing is a fairly well accepted link however, so vision -> visual processing -> schizophrenia seems plausible enough to look at a bit more.)
  - wpietri 7y ago
    > are blind people more likely to be living in a circumstance where their mental health troubles are more easily managed/ignored/suppressed without the involvement of doctors who would otherwise diagnose schizophrenia? That seems not at all unlikely to me. Could you explain your thinking to me? I'd think that people with one serious condition would me much more likely to have a second serious condition diagnosed, purely because of increased attention from medical professionals. That's certainly been my experience.
    - type0 7y ago
      That depends on the specialty, if the symptoms are overlapping and the treatment produces strange side effects - that diagnosis could be delayed for many years.
    - kelnos 7y ago
      > I'd think that people with one serious condition would me much more likely to have a second serious condition diagnosed, purely because of increased attention from medical professionals. Does that apply to blindness at birth, though? I mean, you don't get continuing "treatment" or checkups for blindness, right? (At least, no more than a sighted person would go in for a yearly eye exam.) Obviously there are unique needs a blind person has to function in society, but it's not like something like cancer or a mental illness where you need to follow up and have continuing care and treatment for many years, possibly the rest of your life. For birth blindness, it's basically "yep, kid's blind; need to adapt to that", and that's it from the standpoint of medical care, no?
      - GauntletWizard 7y ago
        No.
    - skat20phys 7y ago
      The issue is that psychosis/schizophrenia isn't like testing for a bacterium or looking at an x-ray. It's really a label for a set of presenting behavioral patterns, and is heterogeneous (I don't mean this critically, just the way it is). So let's say someone is blind, and they come in. They will almost certainly be more likely to receive attention than someone who is not. But how their presenting disorganized thoughts, etc. are described is likely to be different given their history of blindness, especially if they had a lifetime history of associated cognitive deficits or issues. It's also the case that overlapping presence of two pathologies is not necessarily same as them disjointly. So blindness etiological factors + psychosis etiological factors may not equal schizophrenia with blindness, but rather a more severe cognitive and/or physical disorder that receives an entirely different diagnosis. This latter scenario isn't necessarily a measurement issue, but it could be construed that way.
  - jasonlfunk 7y ago
    Significant results do not require significant proof. This is a common misunderstanding. All hypothesis would require the same amount of proof, regardless of a person’s biases going into it.
    - ajross 7y ago
      You're just being pedantic. That's not helpful. Obviously the point here was about "credulity", not proof. The very existence of a replication crisis in statistical science like this is an existence proof of what I meant. You don't just take papers like this at face value. You can't. They're simply wrong too often. In the kind of first principles sense you are thinking of, sure, proof is proof. But in the real world the burden of proof for an epidemiological headline like this absolutely is much higher, in the practical sense of "should I believe this bullshit or is there a mistake somewhere?"
- type0 7y ago
  This could be a simple survivor bias. These are two highly debilitating conditions, chances are that they simply don't live long enough if it's severe, or if they do it just remains without diagnosis.
  - vintermann 7y ago
    You'd think there'd be case histories for it, though, if it was just that schizophrenia led to an early death for blind people.
    - jacobr1 7y ago
      Only if it was diagnosable as schizophrenia
- skat20phys 7y ago
  This is a good point but similar kinds of phenomena could lead to something more benign but equally problematic. For example, let's say someone inherits (genetically or environmentally) etiologic factors for psychosis and blindness. It's possible that whatever these factors are, they are severe enough to have widespread enough effects that the person no longer receives a psychosis diagnosis, but instead some other diagnostic label that's more comprehensive in nature. Schizophrenia is really just a label for a semi-heterogeneous set of pathologies that might be labeled something else. I'm not saying that these problems don't exist, just that how they are perceived and described might vary a bit from scenario to scenario (this is one of the main impetuses for DSM-III and later actually). So someone with one pathology might receive a diagnosis of schizophrenia, someone else, bipolar disorder, and yet someone else developmental disorder NEC/NOS. It's entirely possible that if there is a negative correlation, it's because one reflects some preventative factors for the other, or something like that, but it's also possible that whatever causes the conjoint presence of the etiologies is catastrophic, leading to death, like you suggest, or the need for some entirely different label.
- ginko 7y ago
  >Of course, maybe the genes leading to blindness and schizophrenia together also lead to some other defect There are many potential causes of being born blind, not all of them genetic.
mlyle 7y ago
Given that this is something that is talked about as a phenomenon, a psychiatrist encountering a congenitally blind, schizophrenic person would be really inclined to publish a case report... (e.g. not a 1 in 600 chance, and people with chronic mental health conditions tend to encounter more than one psychiatrist).
- touisteur 7y ago
  Maybe that's the plan all along. 'huh strange correlation, let's put this in a paper, wait for case reports'. Might not be a bad process, if explicit.
  - shalmanese 7y ago
    An analog version of Cunningham's law!
- deleted 7y ago
  [deleted]
wwarner 7y ago
I didn't open my stats book to confirm this, but my hunch is that you can estimate the likelihood of what we observe (0/300M) with what we expect (600/300M) in the following way. Think of 1 six sided die. The odds of not rolling a six is 5/6. In two rolls, the chance of not seeing a six is 25/36, in 3 rolls (5/6)^3. At 4 rolls, the odds of not ever rolling a 6 are 0.47, at 20 rolls 0.02 and at 30 rolls 0.004. So in this case, the category is being both born blind and developing schizophrenia. The odds of a single person being in this category are 2/1M, and the odds of a person not being in the category are 999998/1M. The expression for never observing a person in the category for a population of 300M is ((10^6-2)/(10^6))^(300x10^6). Wolfram Alpha says this is equal to 2.6x10^-261. It is very unlikely that the two distributions for blindness and schizophrenia are independent!
Balanceinfinity 7y ago
The number 600 would be the number of expected blind schizophrenics in the US right now. But as people have been looking for them over time, the actual number should be higher.

Uhhrrr 7y ago

It sure can, but the odds are against it overlooking all of them. Of course, maybe the genes leading to blindness and schizophrenia together also lead to some other defect that results in miscarriage or some other kind of early death.

ajross 7y ago
To be clear: the odds are against it assuming no confounding interference. And given that, I don't know that an error of 600 is really that much of a statement. I mean, just to invent an example (not the only possible one, obviously!): Congenital blindness is likely diagnosed with near 100% certainty in early childhood. It's easy to spot. The same is very much NOT true of mental health problems. Schisophrenics are diagnosed, almost always, when their condition manifests in such a way to interfere with their life (or someone else's) to the extent that the doctors get called in. There are widely assumed to be LOTS of undiagnosed mental health cases in society, simply because the sufferers live in situations where their disorder can be managed (or suppressed!) in an ad hoc way. Now, the question becomes: are blind people more likely to be living in a circumstance where their mental health troubles are more easily managed/ignored/suppressed without the involvement of doctors who would otherwise diagnose schizophrenia? That seems not at all unlikely to me. And frankly: this kind of confounded measurement strikes me as MUCH MORE likely than a heretofore unrecognized link between vision and schizophrenia. Significant results require significant proof, and I don't think this is it.
- sophacles 7y ago
  There are other links between vision and schizophrenia - e.g. https://www.wired.com/2009/04/schizoillusion/ https://www.wired.com/2009/04/schizoillusion/ (although that may better be described as a link between visual processing and schizophrenia. vision -> visual processing is a fairly well accepted link however, so vision -> visual processing -> schizophrenia seems plausible enough to look at a bit more.)
- wpietri 7y ago
  > are blind people more likely to be living in a circumstance where their mental health troubles are more easily managed/ignored/suppressed without the involvement of doctors who would otherwise diagnose schizophrenia? That seems not at all unlikely to me. Could you explain your thinking to me? I'd think that people with one serious condition would me much more likely to have a second serious condition diagnosed, purely because of increased attention from medical professionals. That's certainly been my experience.
  - type0 7y ago
    That depends on the specialty, if the symptoms are overlapping and the treatment produces strange side effects - that diagnosis could be delayed for many years.
  - kelnos 7y ago
    > I'd think that people with one serious condition would me much more likely to have a second serious condition diagnosed, purely because of increased attention from medical professionals. Does that apply to blindness at birth, though? I mean, you don't get continuing "treatment" or checkups for blindness, right? (At least, no more than a sighted person would go in for a yearly eye exam.) Obviously there are unique needs a blind person has to function in society, but it's not like something like cancer or a mental illness where you need to follow up and have continuing care and treatment for many years, possibly the rest of your life. For birth blindness, it's basically "yep, kid's blind; need to adapt to that", and that's it from the standpoint of medical care, no?
    - GauntletWizard 7y ago
      No.
  - skat20phys 7y ago
    The issue is that psychosis/schizophrenia isn't like testing for a bacterium or looking at an x-ray. It's really a label for a set of presenting behavioral patterns, and is heterogeneous (I don't mean this critically, just the way it is). So let's say someone is blind, and they come in. They will almost certainly be more likely to receive attention than someone who is not. But how their presenting disorganized thoughts, etc. are described is likely to be different given their history of blindness, especially if they had a lifetime history of associated cognitive deficits or issues. It's also the case that overlapping presence of two pathologies is not necessarily same as them disjointly. So blindness etiological factors + psychosis etiological factors may not equal schizophrenia with blindness, but rather a more severe cognitive and/or physical disorder that receives an entirely different diagnosis. This latter scenario isn't necessarily a measurement issue, but it could be construed that way.
- jasonlfunk 7y ago
  Significant results do not require significant proof. This is a common misunderstanding. All hypothesis would require the same amount of proof, regardless of a person’s biases going into it.
  - ajross 7y ago
    You're just being pedantic. That's not helpful. Obviously the point here was about "credulity", not proof. The very existence of a replication crisis in statistical science like this is an existence proof of what I meant. You don't just take papers like this at face value. You can't. They're simply wrong too often. In the kind of first principles sense you are thinking of, sure, proof is proof. But in the real world the burden of proof for an epidemiological headline like this absolutely is much higher, in the practical sense of "should I believe this bullshit or is there a mistake somewhere?"
type0 7y ago
This could be a simple survivor bias. These are two highly debilitating conditions, chances are that they simply don't live long enough if it's severe, or if they do it just remains without diagnosis.
- vintermann 7y ago
  You'd think there'd be case histories for it, though, if it was just that schizophrenia led to an early death for blind people.
  - jacobr1 7y ago
    Only if it was diagnosable as schizophrenia
skat20phys 7y ago
This is a good point but similar kinds of phenomena could lead to something more benign but equally problematic. For example, let's say someone inherits (genetically or environmentally) etiologic factors for psychosis and blindness. It's possible that whatever these factors are, they are severe enough to have widespread enough effects that the person no longer receives a psychosis diagnosis, but instead some other diagnostic label that's more comprehensive in nature. Schizophrenia is really just a label for a semi-heterogeneous set of pathologies that might be labeled something else. I'm not saying that these problems don't exist, just that how they are perceived and described might vary a bit from scenario to scenario (this is one of the main impetuses for DSM-III and later actually). So someone with one pathology might receive a diagnosis of schizophrenia, someone else, bipolar disorder, and yet someone else developmental disorder NEC/NOS. It's entirely possible that if there is a negative correlation, it's because one reflects some preventative factors for the other, or something like that, but it's also possible that whatever causes the conjoint presence of the etiologies is catastrophic, leading to death, like you suggest, or the need for some entirely different label.
ginko 7y ago
>Of course, maybe the genes leading to blindness and schizophrenia together also lead to some other defect There are many potential causes of being born blind, not all of them genetic.

mlyle 7y ago

Given that this is something that is talked about as a phenomenon, a psychiatrist encountering a congenitally blind, schizophrenic person would be really inclined to publish a case report... (e.g. not a 1 in 600 chance, and people with chronic mental health conditions tend to encounter more than one psychiatrist).

touisteur 7y ago
Maybe that's the plan all along. 'huh strange correlation, let's put this in a paper, wait for case reports'. Might not be a bad process, if explicit.
- shalmanese 7y ago
  An analog version of Cunningham's law!
deleted 7y ago
[deleted]

wwarner 7y ago

I didn't open my stats book to confirm this, but my hunch is that you can estimate the likelihood of what we observe (0/300M) with what we expect (600/300M) in the following way. Think of 1 six sided die. The odds of not rolling a six is 5/6. In two rolls, the chance of not seeing a six is 25/36, in 3 rolls (5/6)^3. At 4 rolls, the odds of not ever rolling a 6 are 0.47, at 20 rolls 0.02 and at 30 rolls 0.004. So in this case, the category is being both born blind and developing schizophrenia. The odds of a single person being in this category are 2/1M, and the odds of a person not being in the category are 999998/1M. The expression for never observing a person in the category for a population of 300M is ((10^6-2)/(10^6))^(300x10^6). Wolfram Alpha says this is equal to 2.6x10^-261. It is very unlikely that the two distributions for blindness and schizophrenia are independent!

Balanceinfinity 7y ago

The number 600 would be the number of expected blind schizophrenics in the US right now. But as people have been looking for them over time, the actual number should be higher.