Sunday, July 8, 2012

The Human Dimension: An Imaginative Model of Schizophrenia

In other essays I have written about the unique aspect of human experience which seems to be absent in the rest of nature- the human imagination: specifically the part of the mind that is able to access and create alternative realities or viewpoints of reality (such as day dreaming or planning future events). Animals most likely do not posses this trait because they do not preoccupy themselves with abstract or symbolic affairs like humans do. It seems that animals are only preoccupied with the sole reality of biological nourishment, while humans seek not just biological stratification, but moral, aesthetic, transcendent and many others not tied to biological survival.

With that said, we can call this unique human access to and preoccupation with the symbolic and abstract parts of the imagination: The Human Dimension. Its is a part of the world (dimension) that only humans can inhabit. Thus there is a unique “disorder” which again only seems to effect humans called schizophrenia. I believe that this “disorder” is not an illness in the same way we think of polio or cancer, but rather it is an inevitable part of human variation due to our ability to access the human dimension. That is, it cannot be eradicated nor can it be cured. This is why schizophrenia keeps a steady population without ever going down or up. One will never see an epidemic of this “disorder” like you would with other illnesses. Therefore it becomes clear how schizophrenia is only present within humans because of their unique ability for abstract and symbolic thought (imagination).
I want to take the time to explain how and possibly why schizophrenia is only present in humans. All other mental disorders from bipolar to anxiety is related to biological function, and therefore can be present in animals. For instance, it is imaginable to picture a dog with anxiety, or depression. On the other hand, its impossible to envision a dog with bizarre beliefs or disorganized thinking. This is because unlike humans, animals do no have an imaginative dimension to get lost in like schizophrenics do (more on this later).
Moving on, most mental health professional agree that Schizophrenia is a neural-chemical imbalance, probably of dopamine. They came to this conclusion after seeing that the positive symptoms were treatable with drugs that inhibit the release of dopamine into the synapse. Since then, all psychological explanations for this disorder have been thrown by the wayside in favor of a purely chemical model. I believe that just because one can give a drug (which is like a chemical lobotomy) to someone and see them behave less responsive to stimuli (because the drugs don’t completely remove the symptoms, just handles them) is not a valid reason to think that the “disorder” is caused only by that imbalance. Those kinds of medications/drugs give the same effects to mostly everyone. So why assume, because it gives the same effects to schizophrenics, that its pharmacological action becomes the key to knowing the causation of this peculiar condition. If anything, these drugs are good ways to handle the rough times they may face, but it is not the answer to the causation their mental state.

Although I wont argue that schizophrenia has nothing to do with levels and ratios of neurotransmitters, I will contend that it is not solely a chemical imbalance, rather I think it is a natural variation of human psychology. That is, people with schizophrenia may not have an illness, but instead be a kind of person with the ability to find subtle meaning much more then the average person; an ability that may have had an evolutionary advantage (being why it has not been eradicated) which may have had profound effects on the cause of our idiosyncrasies from the rest of nature. One just needs to think of the figure of the shaman (who resemble schizophrenics) as the prototype for most of human professions unseen in nature: doctor, priest, politician, artist, judge, etc. What may be considered an illness or disorder might in fact be a natural but rare variance of human cognition; one that is crucial to the origins of society and perhaps other creative and useful ideas in history.

It seems that for schizophrenics, they live more in the human dimension then the average person. Because of this, I have developed an imaginative model of schizophrenia which incorporates the three basic levels: paranoid, disorganized, and catatonic. As for the other less known ones like undifferentiated, for now I can just say they fall somewhere on the spectrum that is central to this model.

This model is simple to understand and has two main aspects: (1) a way to prevent and perhaps treat psychosis and (2) a novel theory of schizophrenia that sees it as a spectrum disorder involving varying degrees of immersion in the imagination. It assumes that schizophrenia is not an disorder but a rare inevitable product of human cognition and imagination. With this said, the model acknowledges that if untreated, schizophrenia can develop to a undesirable state which characterizes most schizophrenic mental states today. The model postulates that if treated, the individual may come to understand and accept their condition, not as a problem of society, but as a unique and potentially fragile condition that reserves much respect in society and cultures and may continue to contribute to it through creatively expressive means. This model essentially views the schizophrenic not as an unnecessary invalid, but as a fragile but piquant artist; this latter part must be cultivated through treatment.

The spectrum can be thought of as a line with the left end being the “baseline” of average human preoccupation with the imagination. The right end of the line represents the total immersion in the imagination. In between these extremes we have degrees of immersion in the imagination. Therefore, beginning at the left end “baseline” we find the average person with a foot in two worlds, one of biological survival and the other of the imagination. He is able to daydream and not let it get out of hand. Moving from the left most spot toward the right we begin to leave the baseline of most people and start to enter the field of awareness held by “healthy” artists and dreamers. These individuals may have a profession or lifestyle which fits with their peculiar perceptions. But again unlike schizophrenics, they are not in need of assistance. While on the other hand, schizophrenics need assistance in helping to control their imagination. So moving right of the artists and dreamer we find a point where beyond it the imagination starts to become uncontrollable. The first example of this (right of that point) is the paranoid subtype of schizophrenia. Here, the individuals imagination starts to work against them making them paranoid; their imagination, like an autoimmune disorder, turns on the person, using its resources to make them paranoid rather then helping them achieve their goals. Moving right of the paranoid subtype we find the disorganized who although may not be suffering, is even more immersed in the imagination; they are unable to interact and are continuously engaging with their imagination much more then the paranoid. Whereas the paranoid is obsessed with social affairs with less imaginative influence, the disorganized is obsessed with self-referential thoughts which have much more imaginative influence by virtue of their novelty as contrasted with the mundane sphere of social relations. Finally at the right end of the spectrum we have the catatonic subtype who is characterized by an inability to move and by holding rigid postures for long periods of time. Here we can see the total immersion in the imagination at the expense of the autonomy of the individual. Unlike the disorganized subtype, the catatonic has no autonomy to act out or perform what they feel. Instead they are completely lost in the imagination, not having any room for stability and tangible physical reality leading them, somewhat like the paranoid, to see the world as hostile. Some can be thought to hold their positions in order to regain some form of basic yet fleeting stability.

Thus this model shows how we can both treat and think of schizophrenia in a new way which emphasizes cultivating meaningful expression of their state and a new understanding of how the condition is part of a spectrum of degrees of immersion in the imagination. The aim here is to provide a framework as to give a more positively constructive perspective on this rare but adaptive human variation.

For a more in depth understanding of this model, please read the essay below. The essay was based on an article about the case studies of individuals going through the onset of schizophrenia in early adulthood and late adolescence.

Toward a Model for Prevention of Psychotic Breaks in Schizophrenia

After reading the article “Which Way Madness Lies: Can Psychosis be Prevented?” by Rachel Aviv, I came up with my own idea of how psychosis and not schizophrenia per se can be prevented. My idea is twofold and simple: (1) Meditation practice of at least 10 min every day school day for the general school population. (2) Once the first signs of “pathological thoughts” appear, cognitive restructuring (from CBT&CT) will be applied so the client can approach their sensory and mental distortions with a positive outlook that will enable them to make use out of it in some artistic or expressive way this will give them self-esteem by showing that their illness may hold some promise for them as contributors to culture/society. This along with a whole school career of mediation to help the mind not become overwhelmed by hallucinations and delusions.

Although my idea may appear radical or maybe even bordering on irrational, I came to these conclusions/strong-hunches completely logically and sensibly. My first assertion comes from the fact that mindfulness meditation has been proven to ease the mind and train it through non-judgmental awareness of events to help maintain a sense of equilibrium and balance with emotions and cognition. In other words, mediation helps one achieve more self-control of their mind from external influences. In the article, when Anna started to become aware of her thoughts as pathological she started to become more overwhelmed and freighted. This can be seen as a vicious cycle where a casual weird idea can escalate (because of anxiety). Like a Chinese finger trap, the more one tries to pull away from those thoughts, the tighter the grip of fear and hopelessness becomes. Therefore, I believe if Anna was trained in meditation beforehand in her school years, she would have had the mental discipline to not “freak out” as much and develop more self-control, consequently preventing her psychotic break with consensual reality.

My second assertion is more radical yet it has been reached through the same kind of sound reasoning. I got inspiration for this idea from two main sources, one being the article mentioned before and the other from the first two chapters of the book The Invisible Landscape by Terence and Dennis McKenna. The authors show the correlations between schizophrenia and shamanism(ideas of reference, thought insertion/broadcasting/withdrawal, feelings of numinous/divinity). They conclude that shamans are a kind of sanctioned schizophrenic; the shamans delusions become abilities and are seen as useful. In return the shaman is a functioning and important member of society, although their perceptions are “off-kilter” with most of society. This showed me how a reinterpretation of these psychotic symptoms can cause changes in the schizophrenic themselves, giving them more self-esteem by seeing their illness or particularity as contributing and meaningful to society. Yet we cant tell people they are shamans, that would be wrong as we live in a secular humanistic culture (for the most part in public dealings). In thinking of a secular way of reinterpreting the odd behavior of schizophrenics, I recalled how in the article by Aviv(my second inspiration for this assertion), many of the clients in the COPE program were interested or occupied with philosophical, religious, or metaphysical questions; also the clients including Anna had distortions of self and world(all is particles, expanded or diminished self, etc) which are views that can be philosophically argued to be true. This lead me to think what if we can through the use of cognitive restructuring, help clients approach their pathological ideas and thoughts will the supposition that they can learn to read these experiences and express them though different mediums.

Basically my understanding is that if the clients are able to focus and harness their delusions and visions with the help of mindfulness meditation and cognitive restructuring, the result will be prevention in psychotic breaks, an increased self esteem which will alleviate suffering, and creating new and exciting art works and methods with minds that are not pathological as much as they are extra-sensory(that being that the clients have more access to their unconscious in addition to having unique interpretations of things/events). The best part of all this is that the clients themselves will be better integrated into society not as hopeless misfits but as engaging yet somewhat dysfunctional artists.

I want to note that this idea is primarily for those in the “prodrome” period before schizophrenia. Perhaps it can be applied to the paranoid and even less to the disorganized subtypes to help them regain control; yet there is no hope for the catatonic subtype, for they have let their delusions and hallucinations get the better of them to the point that some of them cannot move for fear of upsetting their reality even more.