Lost Wanderer

The short list of things I would do to try to prevent schizophrenia will sound very familiar to anyone who reads this blog:  Both the future mother and offspring should get lots of vitamin D, should be on a Paleolithic Diet, have hookworms and whipworms, get plenty of sleep, have a good family, and live in a close community.  They should not be exposed to lead, should have low stress, no X-rays, and be of high status.  Neither of them should be exposed to the flu, toxoplasmosis, the Borna virus, rubella, cytomegalovirus, herpes simplex 2, and syphilis.  They also should avoid tobacco, cannabis, and other illegal drugs.  Also, the father should not be old. 

For a more detailed discussion you can read the rest of this blog entry:    

A diagnosis of schizophrenia is made on the basis of a patient’s symptoms, since there is no laboratory test for it.  Because of this, there is every likelihood that it is actually a cluster of conditions, each with a different etiology.  One school of thought even argues that we should diagnose people in terms of a series of dimensional continuums, instead of having a cut off for a diagnostic category.  Perhaps partly because of the uncertainties involved there many theories about schizophrenia’s ultimate cause.

Before I get to the more mainstream perspectives, I want to touch on the viewpoint of Thomas Szasz.  He’s skeptical of the whole medical model, and argues that schizophrenics have a legitimate way of looking at the world, are simply making people uncomfortable, and that society doesn’t have the right to control people for this reason alone.  (His position is closely related to the reasonable insight that cultural differences influence the rates of diagnosis, and that different cultures have different ways of dealing with the various forms of what we would call mental illnesses.)

My response to Szasz is to say that it isn’t true that schizophrenics are only making people uncomfortable, but that there are potentially lethal consequences in allowing someone who is delusional behind the wheel of a car.  Even if it were the case that schizophrenics universally had no complaints regarding their condition (which, in fact, isn’t true), I think that society should have the right to protect itself from the likely consequences of these people’s, so called, “different equally legitimate patterns of thought,” and in many circumstances it should be able to do so whether or not the schizophrenic agrees.  And, while we’re at it,  if others have to pay the bill for their maintenance, then those who have to work to support them should also have a say in their getting treatment.  If Szasz can show me the hard data that proves that schizophrenics are able to function perfectly well by living up the responsibilities of supporting themselves, of being responsible capable citizens, and they are happy with their condition then I might agree that we should drop the whole concept from the DSM.  But until then, I’m going to see it as a problem. (Schizophrenia – Schizophrenia as a social construct – Wikipedia) 

Szasz also argues that schizophrenia is simply a social construct, and as such doesn’t actually exist.  It’s true that we pick out those aspects of the world we find important, and package them into the concepts of our languages.  But the world imposes itself upon us, and so it is, at best, misleading to say that by doing so we are engaged in “constructing reality,” as opposed to responding to and taxonomizing it.  Using similar reasoning people have argued that gender doesn’t actually exist either.  (See: Deconstructionism is Horsesh*t – Lost Wanderer)       

Traveling further into la la land, in 1976, Julian Jaynes speculated that schizophrenia was the normal operation of the human mind until fairly recently.  Supposedly, up until about 3,000 years ago, people went around with minimal self awareness much of the time, and every now and then they would hallucinate, and “the Gods” would speak to them, which was actually their verbal left hemisphere sending them a message.  Civilization’s beginning marked the beginning of what we currently call normal self consciousness.  Jaynes’ ideas, like Szasz’s, don’t pass the giggle test, and strike me simply as an example of what has been called “fashionable nonsense,” since no one has ever reported any such observations with hunter gatherer peoples.  (The Legacy of Julian Jaynes by Dan Hartwig) (See also: Schizophrenia – Other proposed causes - Wikipedia)

Moving away from la la land, one theory is that schizophrenia is the price we pay for our large brains’ energy demands.  (Are big brains to blame for schizophrenia?)  Or perhaps it’s the result of our left brain specializing in language.  (Schizophrenia as failure of hemispheric dominance for language by TJ Crow) 

There are many genes which contribute to schizophrenia, (Schizophrenia Risk Gets More Complex) overlapping those that code for manic depression, (Unlocked: the secrets of schizophrenia by Steve Connor) and the fact that schizophrenics have low fecundity raises the question of why the genes that increase its incidence haven’t been selected out.  It could be that there are major advantages to having them, however currently there is no good theory as to what these might be.  It could also be that it’s a recent phenomenon arising out of some change in the relevant triggering environmental factors.  If this idea proves to be correct, it would mean that schizophrenia can be added to the long list of “Diseases of Civilization.”

A very credible candidate as a major cause of the disease is vitamin D deficiency.  John Cannell, of the vitamin D council, makes the case for this by pointing out such facts as the incidence of schizophrenia is much higher in people with dark skin who live at northern latitudes, and there is a 10 fold variance in the rate of schizophrenia that also follows the lines of latitude.  (Vitamin D and Schizophrenia)  Also, in a Finnish cohort study, vitamin D supplementation of at least 2,000 IU/day during a child’s first year was associated with a lower rate of the disease.  (Vitamin D supplementation during the first year of life and risk of schizophrenia: a Finnish birth cohort study)  Vitamin D might explain the fact that schizophrenia varies by the season of a child’s birth. (Relative Risk for Schizophrenia depending upon Month of Birth)  And one route through which Vitamin D could be acting is through its neuroprotective role in cleansing the body of heavy metals, such as lead. (See below) (Vitamin D protective against toxins – Vitamin D and Schizophrenia)

Another candidate cause is milk protein.  In one study 95% of autistic and schizophrenic children had 100 times the normal levels of milk protein in their blood and urine, and 80% of them had their symptoms resolve when they were put on a milk free diet.  (University of Florida Researchers Cite Possible Link Between Autism, Schizophrenia and Diet)

There is some evidence that gluten is the problem for a subset of patients.  (Schizophrenia – Alternative Medical Treatments – Wikipedia and Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature)  Consistent with this, the Specific Carbohydrate Diet (SCD), which restricts complex carbohydrates and eliminates sugar, has been promoted for a wide variety of diseases, including schizophrenia.  (Specific Carbohydrate Diet – Wikipedia and Everything about The Specific Carbohydrate Diet totally explained)  (The SCD has much in common with the Paleolithic Diet (PD).  However, the PD allows tubers, and doesn’t allow cheese, yogurt, and legumes. (Everything about Paleolithic Diet totally explained and The Paleo Diet))

In the Dutch Famine Study, prenatal nutritional deprivation during the second trimester was found to double the rate of schizophrenia. (Dutch famine of 1944 - Wikipedia and Prenatal Risk Factors in Schizophrenia) 

Catching the flu in the first half of pregnancy leads to a 3-fold increase in the incidence of the disease, and if a women contracts this disease in the first 13 weeks the risk goes up 7-fold.  Although the nature of why this relationship exists isn’t clear, researchers estimate that 14% of cases might be linked to the flu in this way.  (Womb flu link to schizophrenia)  (See also: Coughs and sneezes spread mind diseases) 

Another infections organism that might lead to the disease is toxoplasmosis. (Toxoplasmosis Parasite May Trigger Schizophrenia And Bipolar Disorders)  The Borna virus might play a role (Borna Virus by Sean Henahan), as well as catching rubella or cytomegalovirus (a 17-fold risk increase) before age 12. (Prenatal Infection as a Risk Factor for Schizophrenia by Alan S. Brown and Childhood brain infections risk of schizophrenia )  Also, herpes simplex virus 2 (HVS-2) might be a risk factor. (Mother’s Herpes Virus Infection Associated With Schizophrenia In Her Offspring, Hopkins Researcher Finds).  When syphilis became treatable thousands of schizophrenics were cured. (Diseases of the Mind by Janet Ginsburg)  Some researchers believe that schizophrenia is caused by ancient viral DNA that became incorporated into our genome, which then becomes reactivated. (Is schizophrenia caused by an enemy within? by Joanna Marchant)  (See also: Plague Time by Paul Ewald)

A mother’s stress can be a contributing factor.  Looking at a cohort of Israeli children, who were in their second month of gestation during the 1967 Arab-Israeli conflict, for girls there was a 4-fold increase in schizophrenia later in life.  And when researchers looked at the mothers who had been subject to the worst stress of direct shelling they found a 30-fold increase.  (Early pregnancy trauma boosts schizophrenia risk)     

The children of older fathers suffer a slight reduction in IQ (2 points), and are at higher risk for such disorders as schizophrenia (50% more likely), autism and bipolar disorder.  (Children of older dads pay IQ price and Father’s age linked to schizophrenia risk)

Another factor that might increase the rate of schizophrenia is prenatal X-rays.  (X-Ray Radiation during Pregnancy & Early Childhood may increase risk of schizophrenia for child)

Perinatal traumatic events such as obstetric complications have been associated with schizophrenia in retrospective studies, however in the only prospective study done to date no such association was found.  (Prenatal Risk Factors in Schizophrenia by Alan S. Brown)

The use of cannabis and cigarette tobacco is associated with the disease.  Especially in this case I have to wonder about whether this is a causal relationship, or merely the case that those with the condition are more likely to use these products.  (Cannabis Increases Risk Of Psychosis and Brain Disorders, Smoking and Nicotine Addiction – Report Summary (March, 2006))  (See also: Psychiatric epidemiology: searching for the causes of mental disorders  by Ezra S. Susser) 

The same question can be raised about schizophrenia’s association with parental absence during early childhood (Causes of schizophrenia by Stephe Ellis and Children at risk for schizophrenia: a longitudinal perspective By Norman F. Watt), child abuse (Child Abuse can Cause Schizophrenia by Rick Nauert), living in an urban environment (Does the urban environment cause psychosis? and The schizophrenia envirome), poverty, migration, poor housing, racial discrimination, family dysfunction, double bind messages (Double bind – Wikipedia), bad sleep habits (Are bad sleeping habits driving us mad? by Emma Young), prenatal exposure to lead (which might double the risk) (Prenatal lead exposure linked to schizophrenia by Joanna Marchant), and unemployment. (Schizophrenia – Wikipedia, citations 60-65)

Looking more closely at what proximate mechanisms might be involved with the disease, studies indicate that inflammation as part of an overactive immune response is likely involved.  (Anti-Inflammatory Medications May Become A Treatment For Schizophrenia and Immune System Linked To Schizophrenia)  And glial cells, which play a key role in brain development, supporting the neurons, and fighting infection, have been suggested as a cause of the disease. (New schizophrenia theory by Alison Motluk)  (Of course, any mention of an overactive immune response leads me to bring up the topic of helminths as one potential therapeutic and preventive option.) (Autoimmune Therapies)

In looking for ways to develop a test for this disease researchers have noted that people who go on to develop schizophrenia lose their ability to identify smells before any clinical symptoms occur. (Could You Suffer From Psychosis? The Nose Knows) A blood test for schizophrenia might soon be available that is based on RNA molecules expressed from genes linked to the disease.  (Blood test for schizophrenia draws nearer by Marina Murphy)  Using brain imaging, researchers have shown that schizophrenic’s brains are much less reactive to images of bizarre facial images than controls. (Decoding Funny Faces To Detect Mental Illness) And another team of researchers has shown that children at high risk for later developing schizophrenia perform very poorly on tasks related to memory and executive functioning (planning, classifying, and interpreting information).  (Toward A Test For Childhood Detection Of Risk Of Bipolar Disorder And Schizophrenia) 

As for current treatments, factors which influence the likelihood of recovery include: “1) family relationships, 2) substance abuse, 3) duration of untreated psychosis, 4) initial response to medication, 5) adherence to treatment, 6) supportive therapeutic relationships, 7) cognitive abilities, (8) social skills, 9) personal history, and 10) access to care.”  (UCLA Study Names 10 Keys To Recovery From Schizophrenia) 

I do not have a citation for the source, but I remember once reading that in the United States years ago patients were treated by going to religious revival meetings.  They were in a supportive environment that made sense of their condition as a result of sin in the world.  This form of treatment was reported to have had a great deal of success until it broke down by being overwhelmed by the increasing number of patients.  Apparently a Hindu Temple can accomplish the same thing.  Researchers report that patients who spent six weeks in a temple had as much improvement as a month long course of standard drugs.  The secret is apparently a community that gives people a supportive environment, in tune with their own cultural beliefs, along with the hope of recovery.  (Temple treatment for psychiatric illness by Anil Ananthaswamy, Bangalore)

Looking at the more invasive types of treatments, researchers have found that electroshock can be productively combined with conventional drug therapies, making them more effective. (Electroshock Therapy Speeds Improvement In Schizophrenia Patients)   

An interesting fact about schizophrenics is that they see through the “hollow mask illusion.”  In controls communication between the parietal cortex, which is involved in the top-down control processing of visual information, and the lateral occipital cortex, which is involved in bottom-up processing, increased when the hollow faces were presented.  This did not happen with schizophrenics, which indicated that these different areas of the brain were unable to communicate normally. (Hollow Mask Illusion Fails To Fool Schizophrenia Patients) 

For those who might want to know what it’s like to be a schizophrenic, one doctor has recreated the experience of schizophrenia in a virtual second-life type of world.  (A Lever to Move the Mind)

Finally, to end on a somewhat positive note, some genes that increase the odds of schizophrenia also appear to increase creativity.  (Artistic tendencies linked to ’schizophrenia gene’ by Ewen Callaway)