Delusions, contd.
In my last post I pointed out that schizophrenia as defined by DSM is a confusing collection of human problems with no evidence of a common etiology or indeed any valid justification for including them under a common heading. I discussed delusions and made the point that cognitive distortions of this kind are a normal response to failure. When the experience of failure is profound and pervasive, the delusional speech tends to be commensurately extreme. Delusions are not symptomatic of an underlying illness, but rather are a normal human reaction to severe stress or profound failure, particularly in the late teens/early adulthood phase of life. This is the time of life in which our general coping skills are subjected to their first serious tests, and when people experience profound failure at this time, there is a risk that they will drift towards delusional speech. Onset of delusional speech is typically later for women than men, and probably corresponds with the process of giving birth and caring for small children. The potential for strong feelings of failure is high at this point of life also.
Although delusional speech emerges most often in late adolescence and early adulthood, it is obvious that feelings of profound failure can occur at any age and can precipitate delusional speech. In the previous post I listed some of the skills that might be lacking in individuals who fail in this way and the question naturally arises as to why some people develop these skills without apparent effort while others do not. The answers of course are as varied and diverse as human life itself. As parents we try to teach our children how to cope with life and its various vicissitudes, but this ongoing process of teaching doesn’t always go smoothly. Death and other forms of tragedy assail all families at some time, and these experiences can disrupt the normal day-to-day teaching/training of the children. Even in normal times, parents are sometimes overly protective and in particular try to protect their growing children from the experience of failure. But it is only in dealing with the small day-to-day failures of childhood that we learn to cope with major failures later on. Realistic critical self-appraisal is an important component of success in almost all walks of life – indeed in the very business of life itself, but it is only acquired through helping and encouraging the child to reflect constructively on adverse events. The overly protective parent who shelters his/her child from these kinds of situations unwittingly denies him the opportunity to learn from his particular mistakes and to learn how to cope with mistakes generally.
The bio-psychiatric school, of course, claims that the behavior labeled “schizophrenia” is caused by a brain disease, and they vehemently repudiate any attempt to link these behaviors to early family experiences. In my view, the notion that “schizophrenic” behavior is not rooted in childhood learning experience simply flies in the face of common sense and an abundance of evidence (Dozier et al), (Mickelson et al). Most of us as parents do our best to raise our children to be strong, healthy, resourceful adults. But it is naïve to imagine that this desire to do the right thing always translates into actual successful training. There are many obstacles to be overcome. Sometimes we simply don’t know what is the right course of action. Other times we are too busy with work or too engrossed with pressing problems to recognize the child’s need. And tragically, of course, there is the significant number of cases when the child is being blatantly abused at home, bullied at school, or victimized in some other way. Poverty also takes a toll, in that parents who are pre-occupied with financial hardship are often unable to devote as much time and energy to childrearing as they might like.
In short, there are many forces that militate against the child’s acquisition of the skills he/she needs to cope with adult life, and in particular to cope with the experience of failure. Telling parents the palliative falsehood that their child’s delusional speech is the result of a brain disease and has nothing to do with his/her childhood experiences is nothing short of insulting.
Delusional speech arises directly from the experience of failure – from the individual’s misguided attempt to deflect the blame for this failure onto others. And he does this because he has not acquired the skill of accepting and processing the experience of failure in a more rational and productive manner. This kind of speech is then maintained by the attention and various other benefits that it attracts. For instance, in most developed countries it can form the basis for a disability income. In regard to the latter, it is worth noting that people with delusional speech in underdeveloped countries recover much more quickly than is the case in the developed world.
The best way to help a person who habitually speaks delusionally is
- Ignore the delusional speech.
- Pay attention to sensible speech.
- Encourage other instances of cogency and common sense.
- Identify skill deficits. (The list in the previous post would be a good starting point.)
- Teach/coach the needed skills.
- Be patient
- Help the person find some measure of success, initially perhaps in small matters, but as skills develop, in more substantive areas.
- Remember that the skill deficits in question are ones that most of us take for granted (e.g. social interactions) but are extraordinarily taxing for the individuals concerned.
- Remember that delusional speech and “ordinary” speech are on a continuum. There is often a measure of cogency in delusional speech and a measure of nonsense in “ordinary” speech.
The brain is a pattern-seeking machine. It searches for meaning and regularity in the vast array of data presented to it by the senses. When a young person experiences profound failure within a social ethos in which failure is routinely condemned and censured, he has two options. He can acknowledge his skill deficits or he can search for an alternative explanation for the failure. The brain simply needs to make sense of what has happened/is happening and it is a small step to thoughts like “They’re out to get me,” or “I have special status that they don’t understand”, etc..
Next post: Schizophrenia is not an illness, Part 3
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#1 by anon - February 25th, 2010 at 18:43
I was just wondering if you have seen any of the research into the possible connection between schizophrenia and trypanosoma infection indicating that schizophrenia (or a subset of cases) may be an organic disease. Researchers have suggested that this is the reason that some populations have much lower incidence of schizophrenia, noting that the populations with a low prevalence of schizophrenia also have a low prevalence of trypanosomal infections. Furthermore it has been discovered hat antibody levels against trypanosoma are elevated in schizophrenics as compared to controls (who have trapynosomal infections but not schizophrenia). Lastly it has been suggested that some of the current anti-schizophrenia therapies may have anti-microbial properties and it has been noted that trapyansoma do posses enzymes that may be capable of causing dopamine imbalance in the brain.
#2 by Phil - March 3rd, 2010 at 23:01
Anon: Thank you for your comment/question. I have seen the Gaskell et al (2009) paper, though the biology was above my head. I have also read: Webster et al (2006); Torrey et al (2000); Torrey and Yolken (2003); and Yolken et al (2001).
I find this whole line of research interesting, and I look forward to seeing replication studies. I would quibble with the use of NAMI mothers as sources of information in Torrey et al (2000) on two grounds. Firstly, I don’t believe they are representative of the population in question; i.e. mothers of individuals who have been assigned a diagnosis of schizophrenia. Secondly, NAMI is an avid supporter of the bio-psychiatric position (and indeed derives a large share of its funding from pharmaceutical companies). I consider it extremely likely that the 264 mothers who were questioned were familiar with the “schizophrenia germ” hypothesis and would have been highly motivated to provide the “correct” answers. I’m not suggesting, of course, that they were deliberately lying, but simply stating the well-known fact that motivated respondents are not always reliable.
I also have a quibble with Torrey and Yolken (2003). This is a meta-analysis of 19 studies conducted in various countries between 1953 and 2003 and purports to show an increased incidence of antibodies in “schizophrenics” compared with controls. Setting aside definitional difficulties, I was struck by the fact that the controls in the US study (Boronow et al 2002) had only a 7% incidence of antibodies. The McConkey press release (2009) quotes a prevalence in the US of 22%. Even though the Boronow controls were matched to the “schizophrenic” sample, this discrepancy seems very large. One would expect the controls’ incidence to be close to the general population.
The implications of this body of research are more complicated. I have said elsewhere in my posts that neurological damage/malfunction can have an obvious effect on people’s behavior, and that when such a neurological issue is identified and described, it needs to be given a name and treated (if treatment is possible ) by neurologists. This, in my view, has nothing to do with the so-called “mental disorders.”
An additional consideration is the causal connection between physiology and behavior. If, for instance, you see a man starting to eat, you might conclude that he was hungry, and that the hunger mechanism (physiology) was the proximate cause of the eating (behavior). Life, however, is more complex than this. One man on becoming hungry might sit at this table and shout: “How about some lunch, woman?” Another goes to his kitchen and starts cooking. A third goes to his orchard and plucks some fruit. A fourth goes to a store and steals a cooked chicken. A fifth goes to McDonalds, etc., etc., etc.. And whilst the physiological hunger mechanism explains the eating, we must look to behavioral science to explain (or at least try to explain) the enormous variation in the way this drive is expressed.
The analogy to “schizophrenia” is that infection with toxoplasma gondii may impair neurological functioning in some general way, but it is quite a reach to suggest that cysts in the brain cause a person to say that she is the queen and deserves to be afforded special honor and privilege.
In my view, the brain, like any organ, is subject to a variety of assaults. Some of these impact the individual’s overall coping ability and render more likely the experience of failure. From profound feelings of failure in early adulthood to paranoid and grandiose speech is an understandable step, and I believe that this is the most fruitful way to conceptualize these issues. Of course failure can occur without neurological damage of any kind – hence the neurological heterogeneity of the “schizophrenia” population.
The fundamental principle underlying the DSM system is that unusual/disturbing behaviors are caused by mental disorders/illnesses. In my view this proposition is analogous to the notion that crop failures are caused by witchcraft. The issue is not whether Mrs. Jones is or is not a witch. The issue is that there are no witches. It is not possible to cause crops to fail by chanting curses or whatever. And there are no mental disorders. “Mental disorder” and “mental illness” are anachronistic pre-scientific terms similar to phlogiston. A century of behavioral science has demonstrated clearly that disturbing/unusual behavior is the product of the individual’s reinforcement history and the stimulus properties of the present situation (as is “normal” behavior). As long as “schizophrenia” is defined behaviorally, we should focus on behavioral explanations rather than vague pre-scientific pseudo-explanations.
Overriding this notion, of course, is the obvious fact that an organism can only perform actions of which it is physically capable. A person who has lost his eyes can’t be taught visual discrimination skills. Similarly, brain damage/malfunctions represent limits for general learning, though it is my experience that individuals in this latter category are often capable of acquiring far more skills than is often imagined.
The sad fact is that relatively little attention has been afforded to teaching the individuals concerned the skills they need to begin to find some sense of success and mastery. Indeed, the bio-psychiatric position for the past forty years has been that their position is intrinsically hopeless; that the best they can do is eat the pills, and the most they can look forward to is tardive dyskinesia. Big pharma is raking in the money and the psychiatrists, psychologists, and mental health centers are walking in perfect step to the corporate drumbeat.
The tragedy of the Webster et all (2006) study is that for all its elegance and achievement, it will be used by the bio-psychiatric/big pharma lobby to promote their dehumanizing agenda, which includes legally enforced drugging and leaves people in the same state of wretchedness and failure.
So – as always – a single question takes us in many directions. I greatly appreciate your interest and your taking the time to write. Best wishes.