Jessica Berger - Towards an Understanding of Schizophrenia

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Towards an Understanding of Schizophrenia
by Jessica Faller-Berger, RN

SUBJECTIVE EXPERIENCE

The inextricable link between one’s life and one’s psyche is amalgamated within an organ susceptible to disease. Intrinsic to one’s entire existence is the health of the brain. So, imagine living for one day amidst a floridly psychotic break from reality, as might occur during an exacerbation of the lifelong illness, schizophrenia. Pretend that momentarily, your brain could transform into that of someone suffering from this disease. All at once, the pools of cerebrospinal fluid in the ventricles expand, neurochemicals misfire, prefrontal cortex activity malfunctions, and your hippocampus shrinks. These degenerations bring forth hallucinations and delusions that make you decide to abandon your boring job at the paper company because you are now the President of Bell Atlantic. You need to run for cover because the FBI is trying to kidnap you so they can insert microchips below your jaw to steal your thoughts. You would like to drive away, but behind the wheel of your car is a giant bird with the head of Lord Jeffrey of Amherst. He bellows “I am going to kill you with smallpox, cut your body into little slivers, and store them in my short-wave radio.” OK, you will have to walk home. A glittering emblem outside of a Northampton Main Street shop transfixes your attention. You explain that “Its not that I can’t concentrate right its just that I can’t concentrate on the major issues. I get fogged up with all the different bits and lose the important things in the picture. I find myself paying attention to all sorts of tiny things instead of getting on with the things I should be doing (McGhie en Chapman from Robert J van den Bosch, Communication and Cognition, 1995). An enhanced proclivity for detail is coupled with a debilitating inability to perceive entities as totalities- especially faces. Now, a Meter-Maid instructs you to move along. However, your ability to integrate parts into wholes (Gestalt) is lost. To process the Meter-Maids’ words and respond to her appropriately is impossible as: “ I preceived a statue, a figure of ice which smiled at me. And this smile, showing her white teeth, frightened me. For I saw the individual features of her face, separated from each other; the teeth, then the nose, then the cheeks, then one eye and the other. Perhaps it was this independence of each part that inspired such fear and prevented my recognizing her even though I knew who she was (Sedhehaie, 1950).” Every move you make intensifies the experience of fragmentation. Thus, you are compelled to remain completely motionless (catatonia/psychomotor poverty). Standing frozen in time, gaze fixed, you remark:“Everything is in bits. You put the picture up bit by bit into your head. It’s like a photograph that’s torn in bits and put together again. You have to absorb it again. If you move it’s frightening. The picture you had in your head is still there but it’s broken up. If I move there’s a new picture that I have to put together again (McGhie en Chapman, 1961)”. Due to frontal lobe dysfunction, interactions which were once automatically processed now require superhuman concentration (van den Bosch, 1995). Lacking is the streamlined ability to filter out extraneous details, such as specks of dust in a shaft of light. Illustrative of this psychic fatigue is a “Corrosive sensation in the limbs, muscles as if twisted, then laid open; brittle feeling of being made of glass; wincing and cringing at any move or sound...Willpower constantly inhibited in even the simplest gestures, renunciation of simple gestures, overwhelming and CENTRAL fatigue, sort of a dark horse fatigue running for something or other. Body motions run haywire in sort of death exhaustion, mind fatigued at simplest muscular tension like gesture of grasping-unconsciously clinging to something, holding it together by constant will power (Antonin Artaud, Description of a Physical State,1924).” Next, imagine the entire visual world literally decomposing (van den Bosch, 1995). The universe crumbles into a hallucination which combines a sense of the cosmic with delusionary content: “The sun seems to be staring. But it stares as if it were staring at the sun. This stare is a cone which stands headfirst in the sun. And the air is all like some clotted music, but a vast profound music, well put together and secret and full of congealed ramification. And all this in a masonry of pillars, in a sort of draftsman’s wash by which belly and reality are in contact” (Artaud,1924). <end> You’ve just read published excerpts by writers with schizophrenia, alongside fabricated events representative of the schizophrenic experience. Alienating motifs characteristic of schizophrenia include delusions of grandeur/persecution, sensation/belief of bodily invasion, grotesque auditory/visual hallucinations, disintegration and fragmentation of perception, difficulty communicating, and immobility

PATHOPHYSIOLOGY
The brain of the person with schizophrenia differs radically from that of the non-schizophrenic. One striking structural difference manifests as enlarged ventricles- the cerebrospinal-fluid containing cavities in the brain. There is a concurrent decrease in the size of the hippocampus, that area which transforms sensory experience into memory (Marieb,1994). Cerebral blood flow studies implicate frontal lobe hypoactivity as the etiology of symptoms such as mental fatigue (van den Bosch,1995).

NARSAD corroborates this data, reporting decreased activity in the prefrontal cortex, where higher mental processes occur. Neurotransmitters in the brain allow nerve cells to send messages to eachother, making thoughts and actions possible. One widely accepted view purports that schizophrenia is caused by excessive production of the neurotransmitter, dopamine. New studies by Heresco-Levy published in the British Journal of Psychiatry (1996) suggest that “disturbances in glutamate neurotransmission” lead to schizophrenia. Glutamate is the salt of glutamic acid, the only amino acid metabolized in the brain. (Taber’s Cyclopedic Medical Dictionary,1993). The co-agonist, glycine works with glutamate at its receptor sites(Heresco-Levy, 1996). Underscoring the veracity of Heresco-Levy’s theory, treatment resistant schizophrenic patients with low serum glycine levels at baseline, significantly improved after six weeks of exogenous glycine therapy. Researchers caution that more data is still needed to substantiate this pilot study.

SIGNS & SYMPTOMS
Schizophrenia is often mistaken for the extremely rare Multiple Personality Disorder. Actually, schizophrenia is one of the most common mental illnesses, affecting one in every hundred people worldwide. In the United States, an estimated 2.5 million citizens are living with this disease. Onset of the disease usually occurs between the ages of 15 to 25. Symptoms of schizophrenia are often categorized as either positive or negative. The terminology does not infer moral imperatives, but rather implies opposing ends on a continuum of behavior. ‘Positive’ symptoms embellish, whereas ‘Negative’ symptoms detract

Positive symptoms include paranoia, hallucinations, delusions, bizarre deportment, and disordered thinking. The person may make up words, use clanging associations, or talk in rhymes. Delusions refer to fixed beliefs based upon fiction. For instance, the patient may believe that his pancreas produces Ancient Egyptian papyrus. Auditory hallucinations voice pejorative comments like “You are a repulsive whore”; or issue dangerous commands, such as “Tie a bowling ball around your neck”. Researchers believe that excessive subcortical dopamine causes these positive symptoms (Keltner,Schweke, Bostrom,1995).

Negative symptoms refer to a lack of normal emotion - the patient may appear expressionless, avoid eye contact, or even become catatonic. Avolition, anhedonia, and attention deficit comprise a triad of negative symptoms. Avolition suggests a total lack of energy. Anhedonia denotes an inability to feel pleasure or interest in activities which used to provide enjoyment. Attention deficit means difficulty concentrating. Cognition itself is fueled by finite energy. Compensatory mechanisms of schizophrenia induce the brain to consciously process details that are normally rendered subconsciously. This continuous intentional effort ransacks the brain of its energy supply, resulting in the negative symptoms(van den Bosch1995)

SUICIDE AND SCHIZOPHRENIA
“...By suicide, I shall for the first time give things the shape of my will... Certainly it is abject to be created and to live and feel yourself in the darkest corners of your mind, down to the most unthought of ramifications of your irreducibly predetermined being. After all, we are only trees and it is probably written in some crook or other of my family tree that I shall kill myself on a given day.”(Antonin Artaud, 1956). Schizophrenia does indeed have a genetic component: if both parents have schizophrenia, there is a 40% chance that their child will inherit the disease (NARSAD, 1996). Likewise, according to Dr. Kenneth Rothman at Epidemiology Resources, the rate of suicide in schizophrenics may be 50 times higher than that of the general population. Suicide is the number one cause of death for young people with schizophrenia. Artaud’s foreboding of a predestined suicide foretold later statistical and genetic data which would substantiate his existential dread. He proclaims an absence of free will in this life, which can be understood from a neurological perspective as losing agency of his consciousness to the pathology of his disease. The most dangerous time for patients with schizophrenia is not when they are hallucinating, but rather, when they are thinking clearly. When lucid, patients may gain cataclysmic insight into their illness. Depressed from beholding the panorama of a devastated mental landscape, 2 out of every 10 people with schizophrenia will attempt suicide, and about 1/2 succeed (NARSAD, 1996).

Fortunately, new medications are successfully controlling the symptoms of schizophrenia. The American Journal of Psychiatry (1995) reports an 86.4% reduction in suicide attempts by patients using the drug Clozaril. These patients must have their blood tested regularly for the potentially fatal side effect of agranulocytosis- a serious reduction in the number of white blood cells. Consistently adhering to the prescribed drug regimen is the key to preventing relapse. NARSAD(1996) relays that while there is still no cure for schizophrenia, proper treatment can usually control symptoms so that patients can lead productive and fulfilling lives. If you would like more information pertaining to Schizophrenia, call NARSAD, the National Alliance for Research on Schizophrenia and Depression at 1-800-829-8280.