4 ms·

It's been awhile since I read about this stuff...is schizophrenia a spectrum disorder like autism? If so, I wonder if there's a point on the spectrum where it's

It's been awhile since I read about this stuff...is schizophrenia a spectrum disorder like autism? If so, I wonder if there's a point on the spectrum where it's not worth treating it because of possible side effects. I feel like our society over-pathologizes a lot of stuff and it would be a shame if we "cured" something that doesn't need a cure.

ceejayoz 7mo ago
To this point, some cultures see schizophrenia as friendly, not scary. https://news.stanford.edu/stories/2014/07/voices-culture-luhrmann-071614 https://news.stanford.edu/stories/2014/07/voices-culture-luh... > In the United States, the voices are harsher, and in Africa and India, more benign, said Tanya Luhrmann, a Stanford professor of anthropology and first author of the article in the British Journal of Psychiatry.
- shermantanktop 7mo ago
  This idea relocates the problem from the individual to “culture” or “society,” leaving no solutions for someone suffering from schizophrenia. I also have a hard time believing that schizophrenia manifests as something like benign quirkiness in some other country.
  - ceejayoz 7mo ago
    > I also have a hard time believing… Well, publish that null result in a journal! > This idea relocates the problem from the individual to “culture” or “society”... No, one could incorporate this information just fine on an individual level by treating it as less of a scary symptom and more of something to understand.
    - shermantanktop 7mo ago
      I'm skeptical that doing mental visualization exercises can cure cancer, or that crystals give off healing energy. I'm generally skeptical of too-good-to-be-true factoids. My skepticism is not publication-worthy, it's pretty common, and taken too far it becomes cynicism. Every once in while my skepticism is misplaced. I am curious though - do you have individual examples, or personal experience, of how some other culture handles schizophrenia in an understanding way? I saw the journal reference...i'm more interested in specific examples.
      - ceejayoz 7mo ago
        > I'm skeptical that doing mental visualization exercises can cure cancer, or that crystals give off healing energy. But if a respected peer-reviewed journal published a study demonstrating evidence of it, you'd want to at least take a peek. > I am curious though - do you have individual examples, or personal experience, of how some other culture handles schizophrenia in an understanding way? I saw the journal reference...i'm more interested in specific examples. These are in the article and the study itself. "Among the Indians in Chennai, more than half (11) heard voices of kin or family members commanding them to do tasks. “They talk as if elder people advising younger people,” one subject said. That contrasts to the Americans, only two of whom heard family members. Also, the Indians heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining. Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did."
- blazarquasar 7mo ago
  > To this point, some cultures see schizophrenia as friendly, not scary. That should not be your conclusion from the article. "the voices" are hardly the only symptom that people with schizophrenia suffer from. A lot of those affected don't have auditory hallucinations at all and are still suffering from one of the (if not the) most debilitating mental disorders out there. Calling it "friendly" risks trivialising of the very real symptoms.
  - ceejayoz 7mo ago
    > The striking difference was that while many of the African and Indian subjects registered predominantly positive experiences with their voices, not one American did. Rather, the U.S. subjects were more likely to report experiences as violent and hateful – and evidence of a sick condition. > In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms. When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. “‘Mostly, the voices are good,’” one participant remarked. This seems clinically useful. The existence of other symptoms doesn't really change that fact.
    - blazarquasar 7mo ago
      I don't disagree at all. I am merely commenting on your takeaway that this somehow means that some cultures see schizophrenia as "friendly", which does absolutely does not follow from the fact that the "mostly, the voices are good". I would also think that this is likely due to cultural differences and in many cases probably adds to the problem. https://doi.org/10.3109/09540261.2012.711746 https://doi.org/10.3109/09540261.2012.711746 From the full Article: "People suffering from psychotic illness continue to hold multi-explanatory models. The cultural, religious and social explanatory models are predominant in non-western cultures." "Limited evidence suggests that traditional belief models affect [duration of untreated psychosis], and explanatory models based on spiritual and social causes of illness may result in delayed presentations for professional help."
prophesi 7mo ago
I liked how this blog[0] describes it. Schizophrenia itself isn't a spectrum, but rather you have varying levels of schizophrenia risk genes. They have positive fitness functions (creativity, cognitive flexibility, linguistic skill) until you cross the threshold to schizophrenia. [0] https://www.psychiatrymargins.com/p/schizophrenia-is-the-price-we-pay https://www.psychiatrymargins.com/p/schizophrenia-is-the-pri...
breggles 7mo ago
You might be interested in this book: https://en.wikipedia.org/wiki/Doctoring_the_Mind https://en.wikipedia.org/wiki/Doctoring_the_Mind
- booleandilemma 7mo ago
  Thanks, seems right up my alley.
mothballed 7mo ago
I have some primary care providers in the family and I've asked them since I often have differing opinions. I've asked if some people with bipolar and schizophrenia refuse specific medical treatment and just go on with their life. I've gotten the answer that many of them have learned to recognize what is happening and ride it out well enough that they can live with it. I'm sure it's highly dependent on the severity and the person. I've noticed something similar with people on say heavy doses if hallucinogens. Some people just ride it out knowing it's the mind playing tricks on them, others hopelessly panic or make irreversible decisions.
- ryanjshaw 7mo ago
  Depending who you believe, approximately half of them are unable to see they are ill (re: anosognosia).
  - Cthulhu_ 7mo ago
    I suspect this is the case with many mental health conditions / neurodiverse conditions; after all, people grow up with them and if their environment is not affected or making observations (e.g. people are told or convinced that what their brains do or tell them is abnormal), why would they doubt themselves? But this is a narrow path to walk, because if you see something and someone tries to convince you it's not there, who is right? This is why some mental health conditions are pretty terrifying, because doubting your own mind is terrifying.
asveikau 7mo ago
> is schizophrenia a spectrum disorder like autism? I'm a non expert but I believe some people are starting to see it that way. See: https://www.google.com/search?q=schizophrenia+spectrum+disorder https://www.google.com/search?q=schizophrenia+spectrum+disor... Also there's huge overlap in symptoms between bipolar I with psychosis, schizoaffective disorder, and schizophrenia. People sometimes move around between these diagnoses throughout treatment, different doctors have different opinions, patient behavior changes, etc. I personally think these symptoms come about through many different causes and the labels are somewhat inadequate. They capture a symptom profile rather than a full understanding.
- interiorchurch 7mo ago
  I remember reading in Courtenay Harding's (now very old) book, Recovery from Schizophrenia: Evidence, History, and Hope, that populations with a higher prevalence of bipolar tended to have a lower prevalence of schizophrenia, and vice versa. The implication was that the same thing was being expressed differently in differing contexts. I would be curious if more contemporary studies bore this out.
  - asveikau 7mo ago
    I believe I've heard that synaptic pruning may be implicated in both.
- tokai 7mo ago
  The overlap is not huge at all. Beside psychosis, they have no overlap, and the quality of the psychosis in the two illnesses is far removed from each other.
  - asveikau 7mo ago
    I'm speaking about people I've known and been close to. As an example, my brother shifted around diagnosis between bipolar I, schizoaffective, and schizophrenia often while I was growing up. He's not the only person I know like this. I've spoken to psychiatrists about the ambiguity between these diagnoses. I also know of numerous people who have spoken publicly about receiving a schizophrenia diagnosis and having it later be revised to schizoaffective disorder. I also came to the impression that it is common to receive a bipolar I diagnosis during a psychotic episode and have it later the diagnosed as schizophrenia or schizoaffective disorder. Sometimes if your doctor sucks you may stay in the less accurate diagnosis, sometimes for years.
lenerdenator 7mo ago
Well, there's gotta be a line you can draw somewhere between "treating people who actually need it" and "treating people because that's what policy says and we don't care about the individual". Sometimes, that line is whether or not the state is somehow involved through social services or the criminal justice system.
- ryanjshaw 7mo ago
  It’s more complicated than that, re: anosognosia.
reliablereason 7mo ago
No but it is a behaviourally defined disorder like autism. Which means it can and has many different causal patterns behind it. That is there are many different things that can cause the behaviour. Anyway on your main point, the definition of all psychiatric disorders has requirements of subjective suffering. So if you don't have subjective suffering you don't have the disorder.
observationist 7mo ago
Not in the same way. The degree to which the symptoms manifest can range from mild to extreme, but it's dependent on the person, and each person can have symptoms exacerbated to more or less the same degree. A psychotic break can result in you believing you're chosen by god to shovel snow off the sidewalks for your neighborhood, and for the rest of your life, you will deeply and genuinely believe that to be true, and accordingly orient your life around it. You might be very normal appearing in almost every other way, but have that one singular delusion that overwhelms your capacity to think rationally about it. You might end up confabulating that you are individually responsible for making the weather warm during spring, summer, and fall, and responsible for the lack of snow. Other delusions, hallucinations, hearing malicious voices, hearing voices which you feel you must obey, end up with individuals who have the same relative level of schizophrenic dysfunction, in terms of the way the brain operates, but the nature of the delusion can make them dangerous - "god told me to direct traffic on the freeway" or "god told me to slay demons disguised as humans". The particulars of the case make a huge difference in how much medicine and treatment can help them live independent, normal lives. This potential treatment would be wonderful if it restores normal brain function. It also hints at why antipsychotic and other drugs which increase inhibitory signaling were partially effective. Heck, it even has explanatory power for the different triggers of psychotic breaks - once a threshold of activity gets passed, the brain loses its ability to discriminate between legitimate, reality grounded signals and feedback that should have been inhibited, and once those neural connections are made and "configured" to operate as part of the default mode network, that person will have permanent cognitive problems. Very cool research, and I hope it bears fruit.
adi_kurian 7mo ago
It is a spectrum disorder. Among those who have had first episode psychosis, the first break, there is precisely zero point on the spectrum where it's not worth treating it. A tragic illness that wreaks havoc on the lives of the individual, and often those around them. Employment rate in the single digits, for competitive jobs. A part of the spectrum where research shows there is nothing to cure is schizotypy/apophenia and magical thinking, but only when paired with conscientiousness and high intelligence. The combination of these traits may be linked to creative genius. But those people don't have schizophrenia. The other Serious Mental Illness, bipolar, is far less debilitating when medicated. Esp. Type II. And linked to creative success, esp. in the arts and when paired with high verbal intelligence. Kanye, Churchill, Cobain, Woolf, Hemingway, Van Gogh. John Gartner, psychologist @ Hopkins, wrote a book about 20 years ago called The Hypomanic Edge. The thesis somewhat comical yet believable, America has tons of folks on the bipolar spectrum, experiencing low level hypomania. The idea is you have to be slightly mad to leave home and travel to a distant land with nothing. Risk taking, competitiveness, etc. As far as curing something that doesn't need a cure. There's a conversation to be had with mild forms of bipolar, especially if it never tips into full mania. Schizophrenia, after the first psychotic break, there isn't. And the lives of those even when medicated is often really, really hard.

ceejayoz 7mo ago

To this point, some cultures see schizophrenia as friendly, not scary. https://news.stanford.edu/stories/2014/07/voices-culture-luhrmann-071614 https://news.stanford.edu/stories/2014/07/voices-culture-luh... > In the United States, the voices are harsher, and in Africa and India, more benign, said Tanya Luhrmann, a Stanford professor of anthropology and first author of the article in the British Journal of Psychiatry.

shermantanktop 7mo ago
This idea relocates the problem from the individual to “culture” or “society,” leaving no solutions for someone suffering from schizophrenia. I also have a hard time believing that schizophrenia manifests as something like benign quirkiness in some other country.
- ceejayoz 7mo ago
  > I also have a hard time believing… Well, publish that null result in a journal! > This idea relocates the problem from the individual to “culture” or “society”... No, one could incorporate this information just fine on an individual level by treating it as less of a scary symptom and more of something to understand.
  - shermantanktop 7mo ago
    I'm skeptical that doing mental visualization exercises can cure cancer, or that crystals give off healing energy. I'm generally skeptical of too-good-to-be-true factoids. My skepticism is not publication-worthy, it's pretty common, and taken too far it becomes cynicism. Every once in while my skepticism is misplaced. I am curious though - do you have individual examples, or personal experience, of how some other culture handles schizophrenia in an understanding way? I saw the journal reference...i'm more interested in specific examples.
    - ceejayoz 7mo ago
      > I'm skeptical that doing mental visualization exercises can cure cancer, or that crystals give off healing energy. But if a respected peer-reviewed journal published a study demonstrating evidence of it, you'd want to at least take a peek. > I am curious though - do you have individual examples, or personal experience, of how some other culture handles schizophrenia in an understanding way? I saw the journal reference...i'm more interested in specific examples. These are in the article and the study itself. "Among the Indians in Chennai, more than half (11) heard voices of kin or family members commanding them to do tasks. “They talk as if elder people advising younger people,” one subject said. That contrasts to the Americans, only two of whom heard family members. Also, the Indians heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining. Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did."
blazarquasar 7mo ago
> To this point, some cultures see schizophrenia as friendly, not scary. That should not be your conclusion from the article. "the voices" are hardly the only symptom that people with schizophrenia suffer from. A lot of those affected don't have auditory hallucinations at all and are still suffering from one of the (if not the) most debilitating mental disorders out there. Calling it "friendly" risks trivialising of the very real symptoms.
- ceejayoz 7mo ago
  > The striking difference was that while many of the African and Indian subjects registered predominantly positive experiences with their voices, not one American did. Rather, the U.S. subjects were more likely to report experiences as violent and hateful – and evidence of a sick condition. > In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms. When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. “‘Mostly, the voices are good,’” one participant remarked. This seems clinically useful. The existence of other symptoms doesn't really change that fact.
  - blazarquasar 7mo ago
    I don't disagree at all. I am merely commenting on your takeaway that this somehow means that some cultures see schizophrenia as "friendly", which does absolutely does not follow from the fact that the "mostly, the voices are good". I would also think that this is likely due to cultural differences and in many cases probably adds to the problem. https://doi.org/10.3109/09540261.2012.711746 https://doi.org/10.3109/09540261.2012.711746 From the full Article: "People suffering from psychotic illness continue to hold multi-explanatory models. The cultural, religious and social explanatory models are predominant in non-western cultures." "Limited evidence suggests that traditional belief models affect [duration of untreated psychosis], and explanatory models based on spiritual and social causes of illness may result in delayed presentations for professional help."

prophesi 7mo ago

I liked how this blog[0] describes it. Schizophrenia itself isn't a spectrum, but rather you have varying levels of schizophrenia risk genes. They have positive fitness functions (creativity, cognitive flexibility, linguistic skill) until you cross the threshold to schizophrenia. [0] https://www.psychiatrymargins.com/p/schizophrenia-is-the-price-we-pay https://www.psychiatrymargins.com/p/schizophrenia-is-the-pri...

breggles 7mo ago

You might be interested in this book: https://en.wikipedia.org/wiki/Doctoring_the_Mind https://en.wikipedia.org/wiki/Doctoring_the_Mind

booleandilemma 7mo ago
Thanks, seems right up my alley.

mothballed 7mo ago

I have some primary care providers in the family and I've asked them since I often have differing opinions. I've asked if some people with bipolar and schizophrenia refuse specific medical treatment and just go on with their life. I've gotten the answer that many of them have learned to recognize what is happening and ride it out well enough that they can live with it. I'm sure it's highly dependent on the severity and the person. I've noticed something similar with people on say heavy doses if hallucinogens. Some people just ride it out knowing it's the mind playing tricks on them, others hopelessly panic or make irreversible decisions.

ryanjshaw 7mo ago
Depending who you believe, approximately half of them are unable to see they are ill (re: anosognosia).
- Cthulhu_ 7mo ago
  I suspect this is the case with many mental health conditions / neurodiverse conditions; after all, people grow up with them and if their environment is not affected or making observations (e.g. people are told or convinced that what their brains do or tell them is abnormal), why would they doubt themselves? But this is a narrow path to walk, because if you see something and someone tries to convince you it's not there, who is right? This is why some mental health conditions are pretty terrifying, because doubting your own mind is terrifying.

asveikau 7mo ago

> is schizophrenia a spectrum disorder like autism? I'm a non expert but I believe some people are starting to see it that way. See: https://www.google.com/search?q=schizophrenia+spectrum+disorder https://www.google.com/search?q=schizophrenia+spectrum+disor... Also there's huge overlap in symptoms between bipolar I with psychosis, schizoaffective disorder, and schizophrenia. People sometimes move around between these diagnoses throughout treatment, different doctors have different opinions, patient behavior changes, etc. I personally think these symptoms come about through many different causes and the labels are somewhat inadequate. They capture a symptom profile rather than a full understanding.

interiorchurch 7mo ago
I remember reading in Courtenay Harding's (now very old) book, Recovery from Schizophrenia: Evidence, History, and Hope, that populations with a higher prevalence of bipolar tended to have a lower prevalence of schizophrenia, and vice versa. The implication was that the same thing was being expressed differently in differing contexts. I would be curious if more contemporary studies bore this out.
- asveikau 7mo ago
  I believe I've heard that synaptic pruning may be implicated in both.
tokai 7mo ago
The overlap is not huge at all. Beside psychosis, they have no overlap, and the quality of the psychosis in the two illnesses is far removed from each other.
- asveikau 7mo ago
  I'm speaking about people I've known and been close to. As an example, my brother shifted around diagnosis between bipolar I, schizoaffective, and schizophrenia often while I was growing up. He's not the only person I know like this. I've spoken to psychiatrists about the ambiguity between these diagnoses. I also know of numerous people who have spoken publicly about receiving a schizophrenia diagnosis and having it later be revised to schizoaffective disorder. I also came to the impression that it is common to receive a bipolar I diagnosis during a psychotic episode and have it later the diagnosed as schizophrenia or schizoaffective disorder. Sometimes if your doctor sucks you may stay in the less accurate diagnosis, sometimes for years.

lenerdenator 7mo ago

Well, there's gotta be a line you can draw somewhere between "treating people who actually need it" and "treating people because that's what policy says and we don't care about the individual". Sometimes, that line is whether or not the state is somehow involved through social services or the criminal justice system.

ryanjshaw 7mo ago
It’s more complicated than that, re: anosognosia.

reliablereason 7mo ago

No but it is a behaviourally defined disorder like autism. Which means it can and has many different causal patterns behind it. That is there are many different things that can cause the behaviour. Anyway on your main point, the definition of all psychiatric disorders has requirements of subjective suffering. So if you don't have subjective suffering you don't have the disorder.

observationist 7mo ago

Not in the same way. The degree to which the symptoms manifest can range from mild to extreme, but it's dependent on the person, and each person can have symptoms exacerbated to more or less the same degree. A psychotic break can result in you believing you're chosen by god to shovel snow off the sidewalks for your neighborhood, and for the rest of your life, you will deeply and genuinely believe that to be true, and accordingly orient your life around it. You might be very normal appearing in almost every other way, but have that one singular delusion that overwhelms your capacity to think rationally about it. You might end up confabulating that you are individually responsible for making the weather warm during spring, summer, and fall, and responsible for the lack of snow. Other delusions, hallucinations, hearing malicious voices, hearing voices which you feel you must obey, end up with individuals who have the same relative level of schizophrenic dysfunction, in terms of the way the brain operates, but the nature of the delusion can make them dangerous - "god told me to direct traffic on the freeway" or "god told me to slay demons disguised as humans". The particulars of the case make a huge difference in how much medicine and treatment can help them live independent, normal lives. This potential treatment would be wonderful if it restores normal brain function. It also hints at why antipsychotic and other drugs which increase inhibitory signaling were partially effective. Heck, it even has explanatory power for the different triggers of psychotic breaks - once a threshold of activity gets passed, the brain loses its ability to discriminate between legitimate, reality grounded signals and feedback that should have been inhibited, and once those neural connections are made and "configured" to operate as part of the default mode network, that person will have permanent cognitive problems. Very cool research, and I hope it bears fruit.

adi_kurian 7mo ago

It is a spectrum disorder. Among those who have had first episode psychosis, the first break, there is precisely zero point on the spectrum where it's not worth treating it. A tragic illness that wreaks havoc on the lives of the individual, and often those around them. Employment rate in the single digits, for competitive jobs. A part of the spectrum where research shows there is nothing to cure is schizotypy/apophenia and magical thinking, but only when paired with conscientiousness and high intelligence. The combination of these traits may be linked to creative genius. But those people don't have schizophrenia. The other Serious Mental Illness, bipolar, is far less debilitating when medicated. Esp. Type II. And linked to creative success, esp. in the arts and when paired with high verbal intelligence. Kanye, Churchill, Cobain, Woolf, Hemingway, Van Gogh. John Gartner, psychologist @ Hopkins, wrote a book about 20 years ago called The Hypomanic Edge. The thesis somewhat comical yet believable, America has tons of folks on the bipolar spectrum, experiencing low level hypomania. The idea is you have to be slightly mad to leave home and travel to a distant land with nothing. Risk taking, competitiveness, etc. As far as curing something that doesn't need a cure. There's a conversation to be had with mild forms of bipolar, especially if it never tips into full mania. Schizophrenia, after the first psychotic break, there isn't. And the lives of those even when medicated is often really, really hard.