Schizophrenia is unique amongst most brain disorders because of the social stigma that is attached to it, a stigma that leads to marginalization and a life exclusively defined by the condition. We don’t have the same negative associations with sufferers of Parkinson’s disease or Alzheimer’s disease for example. We understand that those conditions evolve from some molecular changes in the brain that need to be corrected, be it by medication and/or a variety of different therapies. That’s not the case with schizophrenia, which has an air of mystery associated with it that undoubtedly contributes to the idea that people who suffer it “are just crazy”. Ignorance is what drives the fear and rejection of schizophrenia, so the more we know about this difficult condition, the better we will be able to help those who suffer from it and their relatives and friends. The first thing to know is that schizophrenia is an illness like most others, in the sense that there is a biological reason for it and there is intensive research going on in pursuit of a cure or a treatment. Indeed, there are several clinical trials in place that are based on sound scientific findings and that offer some hope.
One interesting fact about schizophrenia is that it occurs at more or less the same rate across all cultures, which suggests that it may be inherent to the human condition and has led to scientist to search for “universal” theories explaining the origin of schizophrenia. Perhaps the most fascinating of those theories is related to the so-called Theory of Mind (ToM). The ToM refers to our ability to imagine the mental state of other people as well as ours. For example, we “assume” what someone else may be presently thinking, or infer what their beliefs are, or in general assess their behavior as if we were “in those people’s shoes”. The idea is that, by being able to continuously check people’s “intentions”, we are able to deal with complex social environments, where we interact with many people at many levels in many different situations.
Clearly, for this skill to be useful in society there have to be checks and balances within the brain to make sure that our inferences and assumptions about other people’s thoughts and intentions do not conflict with the signals from the environment that also reach the brain. In other words, we need to understand context in our social interactions, we need to sort out what matters from what doesn’t. And that’s where scientists think there might be a problem in the schizophrenic brain, the context is not accurately identified and taken into account, most likely because of the neuronal damage that pervades the schizophrenic brain in the relevant areas. The result is that objective and subjective thoughts can be one and the same, or at least they can overlap significantly, leading to delusional conclusions. An obvious consequence is a breakdown in communication with others, because of failure to identify their signals and intentions, and when that failure concerns the patient’s own signals, what occurs is the perception that foreign entities have taken over their minds (alien control). Obviously, not all patients suffer exactly the same symptoms all the time; the severity and scope of those symptoms will depend on what part of the ToM is more impaired, which in turn is probably a consequence of what exact area of the brain is more affected.
Some scientists think that the main cause of poor ToM abilities in schizophrenia sufferers is a breakdown of their communication and language skills. This is a very intuitive idea, because language is the main vehicle that we use to interact with others at the most complex levels, so perhaps part of the problem is that schizophrenia sufferers can’t use language tools as effectively. That could be the case, as it is not uncommon for them to take words and expressions literally, unaware of any context. For example, they can fail to recognize irony, a concept that is more complex than the plain use of words, or they may provide unclear or inadequate references in a conversation, which suggests lack of awareness regarding what may be required for a meaningful interaction.
As you can gather from all of the above, research on schizophrenia is moving along at several levels, all of which are important. Scientists are working on the molecular aspects of the disease, as well as on more abstract, but also testable, concepts, and the hope is that soon we’ll be able to blend all the information into a coherent body of knowledge that will help us cure, or at least contain, the disease. For those interested in learning more, please visit the schizophrenia research forum, a great site with access to the latest research on the disease as well as all sorts of support and learning resources.
Finally, remember that science alone is not enough in the fight against schizophrenia. We need better awareness of the disease in society, because perception matters and right now schizophrenia has an unacceptable stigma associated to it. Even today many patients can lead relatively normal lives if appropriately diagnosed, medicated and surrounded by their loved ones, so we can achieve a lot already by staying informed and participating at some level, perhaps even contributing a little; research is costly, and every little helps. If you are affected by schizophrenia at any level or want to learn more, click here to find support groups and related resources