Schizophrenia is fascinating

Brown, Robert

We can all understand the dimensions of length, height, and width. These three dimensions define the space in which we live. All of the matter around us which we see, feel and use are contained within these dimensions.

Scientists tell us there is a fourth dimension which is time. All matter in the universe is in motion and its location is defined or interpreted with respect to the time dimension. Albert Einstein postulated that as an object approached the speed of light, then time for that object would slow down and its mass would exponentially increase such that if it moved at the speed of light, time for it would stop and its mass would approach infinity.

Astronomers measure distance of the earth from other celestial bodies by determining the rate at which they are moving away from us. Even though we look at a night sky full of stars which appear to be static, these stars and galaxies are constantly retreating from us as the universe expands.

This four dimensional time-space continuum is widely understood to be true. All the objective evidence supports it. But, there are scientists who postulate that we may actually exist in a nine dimensional universe! The problem comes when we try to conceptualize and describe this hypothesis. This somehow seems too difficult for my naïve brain to accept.

I can easily understand a two dimensional framework. Suppose we existed as stick people on a flat world, like a piece of paper. An object or dimension could exist one millimeter above or below the plane of the two dimensional world on which we lived and we would have no clue as to its existence. We would not know it was there. Our reality would not perceive it.

People with the diagnosis of schizophrenia are said to suffer from a form of psychosis and their thought pattern tends to be fixed and rigid, or delusional. That is to say that part or all of their reality markedly differs from our understanding of reality. They have a particular dimension to their reality which is hidden from our reality. Like stick people in a two dimensional universe, we cannot get into their other dimension.

Schizophrenia can be difficult to diagnose but generally the sufferer must have the presence of both delusions and hallucinations most of the time. The disorder is commonly thought to involve the neurotransmitter dopamine. This particular substance seems to be an important molecule in determining how we feel and perceive our world. Nearly all chemicals or drugs which cause a change in mood or perception affect dopamine levels in various parts of our brains.

Most schizophrenic individuals look and sound like you and I most of the time. You could carry on a brief conversation with such individuals and not really understand that there were parts of their reality which did not match with your perception of reality. However, if you talked with them long enough you would notice something odd about how they talked and perceived things around them.

When I was a medical student, I recall one of my Radiology Professors relate a rather amusing story which happened to him. Dr. H. was an avid bird watcher and would retire to the countryside at every opportunity to pursue his pastime. It turns out on one such outing that he was in a canoe in the middle of a lake in northern Saskatchewan with an acquaintance who was also a bird watcher. Dr. H. had met this person once before, and this person seemed to be a nice enough bloke, but maybe a slight bit eccentric.

While waiting to see some interesting bird species, Dr. H. engaged his canoe partner in idle chatter. After conversing for a few minutes about numerous topics, his partner began to talk in a convoluted way and describe things which clearly were not in the reality of the world which Dr. H. was accustomed to.

Dr. H. then went on to describe to us over a dinner meeting at his house how he came to realize that he was sharing a canoe in the middle of a remote lake with a person who was an undiagnosed schizophrenic! Being more used to interpreting broken bones on an x-ray than to conversing with a psychotic person, Dr. H.’s pulse began to quicken and he no doubt perspired a bit more than usual.

In the end, however, there was no unpleasant event which occurred and they came back to shore and went their separate ways. The point I make is that people whom we call schizophrenic may look and often act just like us. They simply have different thought constructs and different realities than we do.

I rather like talking to schizophrenic people for the most part. They are not dangerous provided they are not showing paranoid ideas. Paranoia is a delusional belief whereby the sufferer believes other people or objects are intent on harming the sufferer. This can cause the sufferer to act aggressively to defend themselves and even kill unsuspecting people who merely seem to be a threat.

Society has a common misbelief that all schizophrenic people fall into the category of raging paranoid lunatics. Fortunately, this depiction represents only a small fraction of the population in question.

A family called me in a panic one day to relate that Grandma was acting crazy. She was hearing voices which were not there, and had barricaded herself in her home. I went to visit her and found that all the windows of the house had been covered over with brown wrapping paper.

As well, all the wall sockets had been filled with putty and all the light bulbs had been removed from their sockets in her house.

This sweet lady went on to tell me how some very unusual people were whispering about her through the wall sockets and spying on her through her windows. In addition, vapors were coming from the light bulbs in her home.

It would not take a rocket scientist to understand that she was suffering from a delusional psychosis consistent with schizophrenia. Such was my conclusion after having a chance to talk with her. She was not a threat to anyone, but certainly by all discernible measures in our society she needed help. The problem was that she did not want help and did not believe that she had a problem.

Her reality did not conform to the common reality of society. As her Physician, I needed to help and protect this person. I needed to initiate medical treatment even though she did not want it nor did she feel she needed it. It was within my power to force this lady against her will to receive treatment and to be admitted to hospital to a Psychiatric ward. This is what I did.

Most jurisdictions empower Physicians under a Mental Health Act to take away a person’s rights and freedoms and subject them to assessment and treatment based on their perceived psychotic state. This legal power has been available for a long time and is mostly beneficial for people and society at large.

Presently, there are refined and sophisticated drugs which can be administered to a schizophrenic person to help bring them back to our reality. I didn’t feel badly for taking this lady’s rights away, because I knew that we would not harm her and hopefully would help her.

This was not always the case. Prior to the 1950’s, there was no effective pharmaceutical which could subdue the unreal thought processes of schizophrenic individuals. The medical profession, however, had various treatments at its disposal to perpetrate on the unwilling and unsuspecting patient who was diagnosed with schizophrenia.

Surgery was occasionally performed on their brains. A procedure called a pre-frontal lobotomy could be carried out. This involved surgically cutting the brain cell fibers which connected areas of the brain’s frontal lobe from the rest of the brain. The effect was variable but almost always caused a marked personality change and often caused to recipient to be sedated to a variable extent. At times the recipient was left in a catatonic or non-functional state.

Prefrontal lobotomy was a highly controversial procedure because it could render a person to be totally emotionless and non-functioning. The perceived threat or danger to society by a person’s irrational behavior was now gone. However, the patient’s perception of reality after the operation could become so substantially reduced that their lives became analogous to a person viewing a perpetual “test pattern”. Brain function could be reduced to the visual equivalent of a bowl of mashed potatoes without gravy or butter ( i.e. plain, white and whipped).

Notwithstanding the shocking nature of the treatment, schizophrenia was frightening to a society which could not tolerate a concept of reality which differed substantially from the mainstream concepts. As such, in 1949 the Nobel Prize for Physiology or Medicine was awarded to Dr. Antonio Egas Moniz for his work in the therapeutic value of prefrontal lobotomy in certain forms of psychosis.

Dr. Frederic Banting, a Canadian researcher who discovered insulin, can be indirectly credited for another treatment used on schizophrenic people decades ago. This was insulin shock therapy.

In this procedure, the patient was laid supine on his or her back and strapped to a metal gurney. Through an intravenous site in the arm, insulin was injected into their body. This would cause a precipitous drop in the patient’s blood sugar. You remember that the brain must have a constant supply of sugar or glucose to function. Brain cells can use no other fuel, and cannot store this fuel within their structures.

Immediately upon the blood glucose falling below a critical level, a person will lose consciousness and start to convulse. The extent and the length of convulsions experienced are directly related to the extent of glucose lowering.

A side effect to this profound hypoglycemia was a forceful clenching of the jaw or mandible of the patient. Many patients who underwent this form of therapy would break teeth and chew up their tongues and internal parts of their mouths while experiencing the seizure.

It was somehow believed that a violent cataclysmic event like this perpetrated on the brain would somehow rid the person of the unreal visions which plagued them. Evidence for benefit of this procedure was anecdotal, but the fear of “unreality” in society was strong. It continued as an accepted form of therapy for several years.

Time marched on and drugs became available which had a profound effect on behavior and thinking, and which could be used in the treatment of schizophrenic individuals.. Thus, prefrontal lobotomy and insulin-induced seizures went by the wayside in the treatment of schizophrenia. All of this brings us to our present sad yet poignant story of a young woman who came to be a patient of mine while I worked in South Dakota.

The weatherman was calling for it to be hot and dry that afternoon. On August days like this the Midwest can turn into an oven. With the flat landscape and never ending open sky, the unimpeded wind felt like a blast of dragon’s breath from a furnace. By noon, the landscape shimmered as heat waves reflected off melting asphalt roadways.

American interstate highways are made of concrete and I wonder if this is to prevent their breakdown by the relentless summer heat. The smaller highways around Aberdeen were made of less expensive asphalt. The tar in the asphalt heated up throughout the hot summer days. It went soft and gooey in the summer heat, like melting taffy. Thus, it could easily burn the skin of an unsuspecting person who walked on it with only bare feet.

Our one Psychiatrist in town had gone on vacation for a few days and I was placed in charge of the twenty bed locked psychiatry unit at our hospital. While I did not specifically have advanced training in Psychiatry, I have always been intrigued by the study of mental disorders, in particular schizophrenia. My interest had caused me to develop a higher proficiency in understanding thought disorders. Aberdeen had only one Psychiatrist so that made it a problem when he needed a break. I was the pinch hitter.

Schizophrenia usually affects adolescents and young adults. It is a thought disorder sometimes characterized by extreme paranoid thinking and a loss of touch with the real world.

Individuals suffering from schizophrenia often develop complex and intricate delusions which take control of them. At its worst, schizophrenia causes people to think and act in bizarre fashions which seem normal to the sufferer but are bewildering to the unsuspecting onlooker.

When the sufferer is paranoid as well, then that person is in real danger of hurting other people whom the sufferer perceives to be a threat.

When I got the urgent call to come to the “locked room” I responded at once. She looked so diminutive crouched in the corner of the empty room but her small size belied the danger. Her features were striking and her countenance mysterious. Eyes darted back and forth sizing us up.

Squatting down on her haunches she looked like a raging leopard ready to pounce.

She had been spotted that afternoon walking along the centerline of a small rural highway leading to our city. She was totally naked and had been walking for hours. Her body was scorched like that of a cooked lobster and the soles of her feet were covered in blisters from her trek on the melting asphalt highway. Daggers flew from her eyes. Her rage was openly displayed. A solitary individual dare not approach her.

Acutely paranoid psychotic people can be very dangerous both to themselves and to others. She could easily attack and kill someone in her deranged state even if she was small in stature. I’m not sure how many police officers it took to get her to the hospital, but most of the State Troopers in South Dakota were big beefy boys well over six feet in height. Our problem at this time was finding a way to approach her. We could not reason with her since her extreme paranoid state had her convinced that we were some form of evil monsters.

I immediately felt extreme pity for this girl. She was maybe twenty years old. Young women her age are supposed to be discovering life. They should be going to parties at college fraternity houses, having nice boyfriends, laughing and going out with their girl friends. They should spend time doing their hair and nails and dream about careers, marriage and kids.

But not her…..not this day. Who knows how long she had been locked in her own private hellish world. Who can say what raced through her mind or how she viewed the world and those around her. She lived a reclusive life out in the country with her parents who were farm people. There was no apparent history of psychosis. She did no street drugs. I don’t think her parents, who were of a simple background, could quite fathom what was happening to their daughter and I am sure they had no idea of the meaning of the term schizophrenia.

We had managed to round up several large male security staff members and we cautiously approached the caged lioness. As she pounced we somehow managed to subdue her long enough for a staff nurse to plunge a syringe filled with a large dose of anti-psychotic medication into her. In my career I have not seen a more out of control and aggressive psychotic person. My heart broke for her.

I often became angry at the way life deals harsh blows to innocent people. Why should a thought disorder such as schizophrenia develop in a wonderful young person and rob her of the chance for a normal life? Why should irrational and paranoid thoughts be generated in the same brain which you and I have? As far as we can tell, the neurons and biochemical pathways are almost identical in the brain of a schizophrenic person as in my brain.

Sometimes I wonder if we are not all just a little bit schizophrenic at times. We can all suffer from disordered thinking. Have you ever asked how on earth you could have done or thought such a thing? Do you wonder where dreams come from? What about contorted nightmares? They are not real but they come from the same brain that allows us to feel conscious joy and pleasure. The same brain that allows us to distinguish between the smell of a rose and a rotting fish. The same brain that fills us with irrational fear at times and then indescribable joy at other times.

Why are some of us dominated by our emotions and others devoid of them? How could a murderer have no feelings such that he would kill another, yet laugh at the same joke that you and I might laugh at? I am brought back to the concept of dimensions. Do schizophrenic people possess the ability to see or perceive dimensions which we cannot perceive? What, in fact, is reality anyway? Why does my nightmare, which exists in my subconscious brain, become her reality which embodies her conscious processes? We call our own thinking normal, yet our normal society throughout its history has condoned war, poverty, hunger, malnutrition, slavery, torture and burning people alive. Maybe we are the delusional ones.

I wonder how that girl is doing today, and how her disordered thinking has affected her ability to live a meaningful life. I am thankful that I had a chance to know her and at least try to help.

Theme: Patients | Patients
Theme: History | Histoire

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