7 ms·

I really recommend people interested in Schizophrenia to read the book “Hidden Valley Road”. I saw it recommended in a HN comment previously. The book follows

I really recommend people interested in Schizophrenia to read the book “Hidden Valley Road”. I saw it recommended in a HN comment previously. The book follows an American family who gave birth to 12 children, 6 of whom were later diagnosed with schizophrenia in their teens. It’s interesting because the book gives lots of insight into the historical to modern research on the condition. In the past psychologists thought schizophrenia was caused by the environment and/or bad childhood. But most of the research right now is pointing towards a genetic cause.

16bitvoid 3y ago
I can't speak to its validity, but the way it was explained to me from a neuroscientist a few years ago is that the general hypothesis now is that some people have a genetic predisposition to schizophrenia and that predisposition sort of lies dormant until triggered. That would explain how both could be true: it could be genetic and triggered by environment/trauma.
- peterfirefly 3y ago
  There are enough cases of identical twins where one twin gets it and the other doesn't that we are certain it can't just be genetic. We are also certain that genes matter. We even know roughly which genes and that many of the variants that increase the risk are de novo mutations. We don't know much more than that, though.
  - deleted 3y ago
    [deleted]
  - NoMoreNicksLeft 3y ago
    It's difficult to believe that there are many sets of identical twins out there where one was abused and the other treated well or whatever. Were these identicals raised apart, or together? Are there enough of each to see a difference in rates between those raised together and apart? Whatever the triggers are, I can't help but think that they're subtle and unmemorable.
  - balfirevic 3y ago
    > There are enough cases of identical twins where one twin gets it and the other doesn't that we are certain it can't just be genetic. Strictly logically speaking, this is consistent with it being genetic + random chance (where the odds are determined only by your genes) - meaning no identifiable environmental factors. Not saying it is (nor would I know).
  - jakeinspace 3y ago
    My grandmother’s twin sister developed schizophrenia, while my grandmother did not (though she did eventually suffer from Alzheimer’s). I have a moderately elevated genetic risk, and it’s something I do keep in mind. I believe her sister developed schizophrenia shortly after the 2 were separated from each other when my grandmother left for college, which is interesting timing.
  - pazimzadeh 3y ago
    So, epigenenic
- arrosenberg 3y ago
  Sounds similar to T1 Diabetes in that way.
- hirvi74 3y ago
  I would not be surprised if the "dormant until triggered" explanation is true for most conditions. This seems to be pretty compelling observations for various disorders like Alzheimer's, various autoimmune conditions, etc. being caused or exacerbated by previous infections. It was the case for me. I apparently have the genes for a semi-rare autoimmune condition (Guttate Psoriasis) that was triggered after a bout of some kind of viral illness. Typically, step throat is the trigger for many with the disorder, but that was not the case for me.
- lostlogin 3y ago
  > That would explain how both could be true: it could be genetic and triggered by environment/trauma. With siblings it is likely both generics and environment are similar. In terms of trauma and episode triggering events, imagine the stress of living with a large family where several are schizophrenic.
rajin444 3y ago
Did the study control for race then if genetics are a cause? ie other studies have shown those of ashkenazi descent are more likely to be schizophrenic. I hope this isn’t taken the wrong way - id very much like to know if my genetic ancestry made me more or less susceptible to things like schizophrenia.
- progmetaldev 3y ago
  It could be environmental imprinting on genetics from previous generations. Of the people that I am familiar with that developed schizophrenia, there is often something traumatic in their family's past, and it is not always the previous generation (but may be from 2 or 3 generations previous).
aatd86 3y ago
Genetic cause is often what is claimed of things that are not very well understood at all. Myopia being one of them for instance. (it's actually often an adaptation process that is actually found to be reversible) Wrt SZ, not only is it very badly understood but a lot of the symptoms can be attributed to biochemical disorders and that does not necessarily imply a genetic predisposition at all. Caffeine can induce psychosis, so can THC. For instance, caffeine is an adenosine antagonist, which itself is a dopamine antagonist. So from a DSM pov, a lot many people can be diagnosed SZ when in fact, the amplitude of the disorder is caused by repeated psychoactive substance abuse. Even owning a cat (parasites) is thought to be a possible cause for schizophrenia. Then again, who knows what lies in people heads too? Perhaps that the thoughts they hear are real and some people just can't process it properly which drive them to do strange things. We discount people's experience but there are so little ways to non-intrusively explore people's internal state. A true scientist wouldn't discount that possibility too.
- robbiep 3y ago
  No one is getting (properly) diagnosed with schizophrenia with incidents of drug induced psychosis, which is what you’re describing. Schizophrenia as a diagnosis relies on the presence of both negative and positive symptoms (as defined in the literature). Other people here have talked about the definition and fluidity of schizophrenia, things change but what does not change is schizophrenia is characterised by not only the positive and negative symptoms but also by being a degenerative condition. As opposed to drug induced psychosis, which is reversible if you remove the aetiological agent.
  - aatd86 3y ago
    The issue is that it is not clear cut at all. Psychosis is a positive symptom. But by changing the neuro-transmitter balance when treating psychosis with anti-psychotic medication, negative symptoms can also appear. Depending on who establishes the diagnostic, you can be diagnosed as schizophrenic while you are simply in one of the phase (acute or post) of psychosis. In general, if you repeatedly suffer from bouts of psychosis, you will get a diagnosis even though the real trigger has not been established. Also, the presence of negative and/or positive symptoms differs from people to people so even that is not clear-cut.
matthewbauer 3y ago
Interestingly, schizophrenia is really rare in accounts before the 1800s. It appears to be a modern disease, which would make it seem like it would be environmental. Another interesting thing about schizophrenia is it's much more common in cities, even after controlling for drug use and ethnicity[1]. Which again makes it seem like something that was rare in the past. [1]: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/does-the-urban-environment-cause-psychosis/147CF24A3837F9D2EAFED2ED4DA27B83 https://www.cambridge.org/core/journals/the-british-journal-...
- elliekelly 3y ago
  Does it show schizophrenia is caused by living in the city or does it show that cities tend to have more homeless people?
  - wahern 3y ago
    It's a complex function involving social and environment stressors which effect progression, and social and cultural context which effect manifestation, and there's also feedback between manifestation and progression. I think it's widely accepted, albeit in a somewhat loose way, that the reason "schizophrenia" was not previously attested is because society explained the behaviors differently and often in less negative terms such that there was less positive feedback that negatively effected progression and manifestation. An archetypal example would be that someone who experienced hallucinations might be understood to be highly spiritual, a mystic, or just quirky. Moreover, people lived in more tightly knit family and social groups, so someone who had trouble taking care of themselves would be more likely to live with or near compassionate family members. And if someone did become a poorly kempt recluse, that didn't by itself turn them into complete social pariahs, so they could more easily have some minimal normative social relations. OTOH, if someone just completely fell apart and died from exposure, or antagonized the wrong person and was killed, the cause wouldn't have been attributed to a mental disease, per se. And the effect of culture goes even deeper. Hallucinations among those living in modern, western societies tend to be more paranoid and violent; more likely to involve the threat of "the government" or "they" than, say, a beneficent god or playful tree fairy. Or more specifically, as seen in many recent anti-Asian assaults, acting out racial animus received from the culture. The increased negativity in hallucinations and behaviors feeds back into progression directly (more stress from the hallucinations) and indirectly (people are more afraid and wary of you, so you more quickly become separated from supportive social networks).
polalavik 3y ago
Reminds me of something i read once about WW2 Germany and schizophrenics [1]. The rates were just as high post Nazi germany. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800142/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800142/

16bitvoid 3y ago

I can't speak to its validity, but the way it was explained to me from a neuroscientist a few years ago is that the general hypothesis now is that some people have a genetic predisposition to schizophrenia and that predisposition sort of lies dormant until triggered. That would explain how both could be true: it could be genetic and triggered by environment/trauma.

peterfirefly 3y ago
There are enough cases of identical twins where one twin gets it and the other doesn't that we are certain it can't just be genetic. We are also certain that genes matter. We even know roughly which genes and that many of the variants that increase the risk are de novo mutations. We don't know much more than that, though.
- deleted 3y ago
  [deleted]
- NoMoreNicksLeft 3y ago
  It's difficult to believe that there are many sets of identical twins out there where one was abused and the other treated well or whatever. Were these identicals raised apart, or together? Are there enough of each to see a difference in rates between those raised together and apart? Whatever the triggers are, I can't help but think that they're subtle and unmemorable.
- balfirevic 3y ago
  > There are enough cases of identical twins where one twin gets it and the other doesn't that we are certain it can't just be genetic. Strictly logically speaking, this is consistent with it being genetic + random chance (where the odds are determined only by your genes) - meaning no identifiable environmental factors. Not saying it is (nor would I know).
- jakeinspace 3y ago
  My grandmother’s twin sister developed schizophrenia, while my grandmother did not (though she did eventually suffer from Alzheimer’s). I have a moderately elevated genetic risk, and it’s something I do keep in mind. I believe her sister developed schizophrenia shortly after the 2 were separated from each other when my grandmother left for college, which is interesting timing.
- pazimzadeh 3y ago
  So, epigenenic
arrosenberg 3y ago
Sounds similar to T1 Diabetes in that way.
hirvi74 3y ago
I would not be surprised if the "dormant until triggered" explanation is true for most conditions. This seems to be pretty compelling observations for various disorders like Alzheimer's, various autoimmune conditions, etc. being caused or exacerbated by previous infections. It was the case for me. I apparently have the genes for a semi-rare autoimmune condition (Guttate Psoriasis) that was triggered after a bout of some kind of viral illness. Typically, step throat is the trigger for many with the disorder, but that was not the case for me.
lostlogin 3y ago
> That would explain how both could be true: it could be genetic and triggered by environment/trauma. With siblings it is likely both generics and environment are similar. In terms of trauma and episode triggering events, imagine the stress of living with a large family where several are schizophrenic.

rajin444 3y ago

Did the study control for race then if genetics are a cause? ie other studies have shown those of ashkenazi descent are more likely to be schizophrenic. I hope this isn’t taken the wrong way - id very much like to know if my genetic ancestry made me more or less susceptible to things like schizophrenia.

progmetaldev 3y ago
It could be environmental imprinting on genetics from previous generations. Of the people that I am familiar with that developed schizophrenia, there is often something traumatic in their family's past, and it is not always the previous generation (but may be from 2 or 3 generations previous).

aatd86 3y ago

Genetic cause is often what is claimed of things that are not very well understood at all. Myopia being one of them for instance. (it's actually often an adaptation process that is actually found to be reversible) Wrt SZ, not only is it very badly understood but a lot of the symptoms can be attributed to biochemical disorders and that does not necessarily imply a genetic predisposition at all. Caffeine can induce psychosis, so can THC. For instance, caffeine is an adenosine antagonist, which itself is a dopamine antagonist. So from a DSM pov, a lot many people can be diagnosed SZ when in fact, the amplitude of the disorder is caused by repeated psychoactive substance abuse. Even owning a cat (parasites) is thought to be a possible cause for schizophrenia. Then again, who knows what lies in people heads too? Perhaps that the thoughts they hear are real and some people just can't process it properly which drive them to do strange things. We discount people's experience but there are so little ways to non-intrusively explore people's internal state. A true scientist wouldn't discount that possibility too.

robbiep 3y ago
No one is getting (properly) diagnosed with schizophrenia with incidents of drug induced psychosis, which is what you’re describing. Schizophrenia as a diagnosis relies on the presence of both negative and positive symptoms (as defined in the literature). Other people here have talked about the definition and fluidity of schizophrenia, things change but what does not change is schizophrenia is characterised by not only the positive and negative symptoms but also by being a degenerative condition. As opposed to drug induced psychosis, which is reversible if you remove the aetiological agent.
- aatd86 3y ago
  The issue is that it is not clear cut at all. Psychosis is a positive symptom. But by changing the neuro-transmitter balance when treating psychosis with anti-psychotic medication, negative symptoms can also appear. Depending on who establishes the diagnostic, you can be diagnosed as schizophrenic while you are simply in one of the phase (acute or post) of psychosis. In general, if you repeatedly suffer from bouts of psychosis, you will get a diagnosis even though the real trigger has not been established. Also, the presence of negative and/or positive symptoms differs from people to people so even that is not clear-cut.

matthewbauer 3y ago

Interestingly, schizophrenia is really rare in accounts before the 1800s. It appears to be a modern disease, which would make it seem like it would be environmental. Another interesting thing about schizophrenia is it's much more common in cities, even after controlling for drug use and ethnicity[1]. Which again makes it seem like something that was rare in the past. [1]: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/does-the-urban-environment-cause-psychosis/147CF24A3837F9D2EAFED2ED4DA27B83 https://www.cambridge.org/core/journals/the-british-journal-...

elliekelly 3y ago
Does it show schizophrenia is caused by living in the city or does it show that cities tend to have more homeless people?
- wahern 3y ago
  It's a complex function involving social and environment stressors which effect progression, and social and cultural context which effect manifestation, and there's also feedback between manifestation and progression. I think it's widely accepted, albeit in a somewhat loose way, that the reason "schizophrenia" was not previously attested is because society explained the behaviors differently and often in less negative terms such that there was less positive feedback that negatively effected progression and manifestation. An archetypal example would be that someone who experienced hallucinations might be understood to be highly spiritual, a mystic, or just quirky. Moreover, people lived in more tightly knit family and social groups, so someone who had trouble taking care of themselves would be more likely to live with or near compassionate family members. And if someone did become a poorly kempt recluse, that didn't by itself turn them into complete social pariahs, so they could more easily have some minimal normative social relations. OTOH, if someone just completely fell apart and died from exposure, or antagonized the wrong person and was killed, the cause wouldn't have been attributed to a mental disease, per se. And the effect of culture goes even deeper. Hallucinations among those living in modern, western societies tend to be more paranoid and violent; more likely to involve the threat of "the government" or "they" than, say, a beneficent god or playful tree fairy. Or more specifically, as seen in many recent anti-Asian assaults, acting out racial animus received from the culture. The increased negativity in hallucinations and behaviors feeds back into progression directly (more stress from the hallucinations) and indirectly (people are more afraid and wary of you, so you more quickly become separated from supportive social networks).

polalavik 3y ago

Reminds me of something i read once about WW2 Germany and schizophrenics [1]. The rates were just as high post Nazi germany. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800142/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800142/