I want to begin by talking about schizophrenia in part because it's the most important and most terrible of all mental illnesses. By some estimates, about one percent of the world's population suffer from schizophrenia, but about half the beds in mental hospitals are occupied by schizophrenics. It is a terrible devastating illness. The people with schizophrenia have been described as the lepers of the 20th century, this was written a little while ago. They're rejected and shunned by society. To get an understanding of it, the first thing you have to realize is, it's not split personalities, it's not multiple personalities, that's another disorder, a type of dissociative disorder, we'll talk about it later. People think it means that because of the root of the word. It comes from the Greek words meaning "split" and "mind". But the split refers to a loss of touch with reality. Before getting into the details of schizophrenia, here's a wonderful depiction from the movie, The Soloist in which Jamie Foxx plays a schizophrenic. Stevie Wonder fan? Oh, [inaudible] life. Signed, sealed, delivered. But you really shouldn't rattle the violin like that, because you have treat the violin like a child, you have to protect it. You only got two strings. All I want do is play music, and here's the problem that I'm having right here. This was gone, this was gone, this little one's out of commission. But you get that in Cleveland public schools, a lot of military statues in Cleveland. Is that where you're from? Very military war in the city, you're not going to get musicians or parade there. You got Severance Hall there, you have the Music Settlement, Ohio State University, whereas in Los Angeles you have Los Angeles PD, you have LA Times, you have Los Angeles Lakers. Those are armies too, military regimentation, experimentation [inaudible] Roman Catholicism, Colonel Sanders. But this guy right here is recorded into the orchestra. Now, the cello can back this guy with the same music but the cello can't be concert master at all. He leads out this is just Roman, [inaudible]. You can't play music in the winter in Cleveland because of the ice and the snow that's why I prefer Los Angeles, the Beethoven city because it never rains in Southern California and if it does, all I have to do is just go in the tunnel I can play to my heart's content. I'm flabbergasted about the statue, aren't you flabbergasted about this? Anyway, nice to meet you. You have any idea how it got here? No. Maybe they dropped it off late at night because it's just astonishing to sit here for hours and just gaze at it. It just blows me away. No idea. It really blows me away. That someone as greatest Beethoven is the leader of Los Angeles. Yeah. I'm Steve Lopez, LA Times. Lopez, L-O-P-E-Z? Yeah. Lopez. Los Angeles Times, Mr Lopez. What's your name? Nathaniel Anthony Ayres Junior, N-A-T-H-A-N-I-E-L A-N-T-H-O-N-Y A-Y-R-E-S J-U-N-I-O-R, or Jr period. I apologize for my appearance, I've had a few setbacks. Me too. Who are Nancy, Paul, and Craig? Those were my classmates at Juilliard. So, here are the symptoms of schizophrenia, and to be diagnosed as having schizophrenia among other things, you have to have at least two of these. So, there are positive symptoms, and positive means things that you do, things that happen to you and ways in which you're different. These include hallucinations, where you experience things which don't really happen. Typically they're auditory, they're sounds. So, you might hear voices. You might hear voices from God, or from the devil, from relatives, or from sinister people asking you to do terrible things. A second symptom is a delusion, and a delusion is different from hallucination. Hallucination is a sensory experience that didn't really happen. A delusion is an irrational belief. So, you might believe, for instance, that you're Jesus Christ. If you're Christian, one way schizophrenia might manifest itself in believing that you're Christ. Often, the delusions are what they call delusions of reference, where you have certain structured believes that circle around you. Maybe the government is tracking you, or aliens are trying to recruit you, there's something going wrong in the world and it might manifest itself in some sort of paranoid feelings or disturbed feelings that are based on you getting a lot of attention, a lot of focus. Perhaps, for instance, you might believe that people are reading your mind. There is disorganized speech or word salad, often schizophrenics sort of gabble, and disorganized behavior, which is a polite word for odd behavior for doing weird things. There's also negative symptoms which involve an absence of cognition or affect, where people become emotionless or their emotions are dulled. They don't talk, they don't move. In the most extreme case of catatonic schizophrenia, they may just be perfectly still and not even move at all. There are different subtypes and these are not all of them, but this will give you a flavor of this, which is that there's paranoid schizophrenia. Paranoid schizophrenia may well be what people think about when we think about schizophrenics, which is, you might believe you had delusions of persecution and some delusion of grandeur that others are jealous of you, they're inferior, you have super and special powers. As I mentioned before, there's catatonic schizophrenia, you're just kind of frozen. There's disorganized schizophrenia. Just a general breakdown of regular thought without much of a focus, you have delusions, hallucinations, disorganized speech, and behavior and a flat affect. Then there's undifferentiated type, which is kind of where hard to classify aspects of schizophrenia. So, you might wonder what's wrong with schizophrenia? What do all of these things have in common? The basic malfunction may well be an inability to sequence and coordinate your thoughts to get your head together. Essentially, this leads to a certain unfortunate effect is you lose contact with others. So, this original split in your mind, your inability to reason, makes it difficult to deal with others and then because you can't deal with others, your disorder gets worse. This is a typical vicious circle one finds in mental illnesses and in fact, a lot of delusions and hallucinations may well be seen as an elaboration of the private world of a person who's lost contact with other people and is also having a difficulty distinguishing fantasy and reality. What causes this sort of neuro malfunction as malfunction thinking? Well, there's some evidence. It could be due to too much dopamine, and in fact, studies of schizophrenia find abnormally high dopamine activity. One reason to believe this is that anti-psychotic drugs have some beneficial effect with schizophrenia and they work by blocking dopamine reception at the synapse so dopamine doesn't work as well. It's also supported by the fact that if somebody who's not schizophrenics takes a lot of amphetamines, you sometimes get amphetamine psychosis, which is a lot like schizophrenia. But, this is a crude theory of schizophrenia, nobody believes it in the simple form I'm giving. For one thing, anti-psychotic drugs if it was really caused by an excess of dopamine, anti-psychotic drugs should work for everybody, but they don't. For another, there's structural abnormalities in the brains that can't be accounted for by this dopamine hypothesis. There's been a lot of studies on heritability of schizophrenia, and as you'll see here there's a powerful role of genetics to the extent that a close biological relative has schizophrenia, your increase in likely to have it yourself. In fact, if your identical twin has it, you're about 50 percent likely to have it. But notice, the numbers are not 100 percent. So, if it was entirely genetic, then if your twin had it, you would have it too, and you don't. So, it has to be some sort of environmental triggers so that one person has it and another doesn't. There are different hypotheses about what these triggers could be. It could be, even very early in life a difficult birth or some potential viral infections. It's argued that more schizophrenics are born in the winter than summer. Then later in life, it may be due to stress producing circumstances or difficult family environment, and in fact, schizophrenics report more of these than non schizophrenics. But, it's a complicated problem to determine cause and effect here. For instance, it might be that schizophrenics early on are showing schizophrenics symptoms which leads to more difficulties in the families or more stressful environments, it also might mean that people who know they have mental illnesses are more prone to remember bad events. So, as always figuring out cause and effect, figuring out what is the consequence of a disorder, and what is the cause of a disorder, and what's merely related to a disorder are very difficult indeed.
