Depression has over time become everyday psychiatry. Those who experience depressive episodes can often keep up their daily work and in most cases are not less valued by colleagues and friends because of their illness. Such cannot be said for people who suffer from schizophrenia. If depression is somewhat a “feeling disorder”, the diagnosis of having a “schizoaffective disorder” felt to Elyn Saks “like a death sentence”, she writes in her book.
“People like me should not exist”
A few weeks ago the New York Times dubbed a long autobiographical article by Saks using the three words: “Successful and Schizophrenic“. Her doctor gave the diagnosis 30 years ago. She understood that to mean at the time: staying in a hospital or a nursing home, surrounded by moronic roommates, maybe a few simple undemanding jobs without responsibility. A life in phases involving delusions, voices in the head constantly delivering grueling messages. If things would have gone the way psychiatrists of former times were convinced that they would, “people like me would not exist”, after all, Elyn Saks has been happily married for many years and has made an amazing career. At the University of Southern California she occupies a chair in the legal department. At the same time she is doing research by means of a “Genius Grant” at the new Center for Psychoanalysis in San Diego.
Best friend and worst enemy
“What I did not accept was the prognosis”, writes Saks. She makes her rise in the profession attributable to an excellent drug treatment and psychoanalytic supervision. The disease for her has not ceased to exist. There are still “exit times” in which the delusions and hallucinations make a comeback. Using behavioral strategies she however tries to appease the “spirits”. Fulfillment with work, so says Saks, is however the best therapy: “My mind, as I describe it now, is my worst enemy and my best friend.” Saks is not alone in her experiences, despite there being no typical “course of schizophrenia”. Other authors such as Kurt Snyder or Hannah Green “I never promised you a rose garden” have told of their recovery from the disease, about which there is still very little understanding. Until now however, only vague predictions about the course of schizophrenia have been possible.
Interaction of genes and environmental factors
About one percent of the population falls ill at some point in their lives to this mental disorder. Men often between the ages of 18 and 20, women on average five years later. Psychoses with schizophrenic expression are about as common as rheumatoid arthritis, the most common rheumatic disease. Some experience only a single episode, for one-third however the disease lasts a lifetime. Most experts now speak of a “vulnerability-stress model” as the basis of schizophrenia. In simple terms, this means that genetic factors play a major role in the risk for the disease. In addition, triggers come from the environment, such as traumatic experiences, drug use or other special mental stress. How these factors interact is something currently being researched in one large EU research project (EU-GEI) which will run until 2015 and is funded with more than ten million euros.
Filter only for the unrefined?
What is it exactly going on in the brain which leads for instance to dreams and reality, fantasy and real experiences merging together? There are many theories on this, but few clear conclusions. Perhaps it is a late developmental disorder that is already created in the embryo and during the restructuring of the brain it makes itself noticeable during puberty. And what about the proverbial connection between “genius and insanity”? One of the models sees in schizophrenia an overloading of the “input filter” in the thalamus. This filter helps us as part of the concentration process in focusing on the essential. If it is set low, it facilitates lateral thinkers, that is highly creative people, in their work.
Indications for this are provided by the investigations of Frederik Ullén of the Swedish Karolinska Institute in 2010. He investigated the concentration of the dopamine D2 receptor, which is particularly high in this region, in healthy subjects. He found the lowest concentrations in particularly creative participants in his small study. Schizophrenics also have a very low concentration of these receptors in the thalamus. Studies from the USA show moreover that the structure and size of the white matter in the frontal lobe are associated with a creative mind.
Therapy approach using neurofeedback
Using this knowledge, doctors at the University Hospital Aachen also started a new treatment approach for schizophrenia. Through neurofeedback, the activity in the anterior cingulum of patients (ACC) should be made to willingly increase. They obtain information in MRI tomographs about current activity in real time and this activity should then have increased. In healthy individuals this method works well already and schizophrenic people also report that the annoying voices in their head had for the first time in a long time become silent. For now, however, the method is still in experimental stages.
So it seems that something has clearly happened in the “black box” of schizophrenia in recent years. The gloomy forecasts such as those given for Elyn Saks when she became aware of their disease no longer need exist. This applies not only for schizophrenia but also for other mental disorders which were until recently considered incurable. In the Journal of Child Psychology and Psychiatry there appeared a few weeks ago a report about children who a few years earlier were clearly diagnosed as autistic, but in their mental abilities are now no longer distinguishable from healthy peers and can communicate perfectly normally.
In the journal Schizophrenia Bulletin Saks writes: “Still, many physicians are relatively pessimistic about recovery from schizophrenia. They emphasise deficiencies, disabilities and dangers. Those who have recovered nevertheless have become more and more a part of society. They are now found to have more dignity and they acquire respected social roles. That also includes in their careers.”