What is schizophrenia?

09 April 2019

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Question

What makes someone schizophrenic

Answer

Jack wanted to know about schizophrenia, so Chris Smith put the question to Stephen Lawrie...

Stephen - I'm going to start by saying what it isn't. Because very often what people think it is, is exactly what it is not so it is nothing to do with a split personality or having opposing views about things. I think that is a terrible misunderstanding of what it is. And what it is, schizophrenia is basically hearing voices and/or having bizarre beliefs. And beyond that it's hearing certain types of voices and having certain types of experiences or beliefs. So classically people with schizophrenia will hear one or more voices which gives a running commentary on their actions or may tell them to do certain things or may even repeat or sometimes anticipate their thoughts and any of those things you can imagine to be quite, kind of, scary experiences. Over and above that a lot of people with schizophrenia will have persecutory delusions so-called paranoia but those are diagnostically non-specific you get them in basically any psychotic condition including dementia or delirium, but the key beliefs that people with schizophrenia tend to have are, and they overlap with experiences and it's sometimes very difficult for them to describe exactly what it is that they're experiencing or believing, but they have the experience that thoughts are sucked out of their head, so-called thought withdrawal, or thoughts are put into their head, thought insertion.

Chris - Yeah I talked to a lady once who told me she was very worried that her television was tuning into her thoughts.

Stephen - Exactly, They have these basic experiences and then they elaborate them with beliefs to try and explain them, that's a natural thing of what the human brain/mind does isn't it. So we are to a large extent at least kind of explaining machines. And when one has these experiences very commonly people will attribute them to the IRA, MI5, Brexit so far I'm glad to say but it is conceivable that Brexit will get incorporated into people's delusions

Chris - So they basically have an experience that they find frightening or out of the ordinary and then they develop a story to rationalise it for them. So it seems reasonable for them why that is happening.

Stephen - So they may be being poisoned by family, friends, neighbors, or they may be bugged by all these things.

Chris - So all these things you're saying that people's thoughts being tuned into by television, the IRA, that kind of thing they're all contemporaneous aren't they so they presumably is schizophrenia only a 20th century phenomenon presumably not. It must have been people back in history who had it so would they have invented new stories that were contemporaneous to their timeline?

Stephen - Well we don't know. I'm afraid there are no really good accounts of schizophrenia per se from any later than about seventeen hundred or so. The ancient Greeks and Romans for example they did recognise a number of different severe mental illnesses which resemble severe depression or delirium but they don't clearly resemble schizophrenia. That's an interesting but open question it's basically unknowable we can't know for sure whether schizophrenia is a relatively new condition or that is a condition with a relatively different manifestation.

Chris - Can I just chuck in a quick one there because the other thing that's that's risen to prominence a lot in recent years is use of cannabis. And people who use that sometimes develop symptoms a bit like schizophrenia. So or we of the mindset that use of cannabis is a risk factor for getting schizophrenia or does it produce a similar sort of symptoms that then go away when you stop using it

Stephen - Both. So cannabis is a psychoto-mimetic drug. It produces psychotic experiences that resemble psychosis. But if you stop smoking it. Even if that occurs, the psychotic experience will dissipate or gradually disappear. If however you've got that kind of experience and you carry on smoking it you've got a roughly three times elevated risk of getting schizophrenia from the background level of about 1 percent to about 3 percent.

Chris - John?

John - Have the instances increased then, with social media and targeted ads? Because it's like people getting into your head.

Stephen - No it's intriguing. But schizophrenia seems to have a lifetime risk of about 1 percent. And interestingly enough despite all the talk in the media about epidemics of mental health problems for example which are I think, essentially forcefully attributed to social media, there's no good evidence that the rates of anxiety or depression are increasing let alone that social media are a cause of a non-existent apparent epidemic.

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