The role of “loss of significance” in “schizophrenia”

 I recently read an article on teenagers, brain pruning, and how apparent differences in brain pruning seem to occur in individuals headed toward “schizophrenia.”  Some dots started to connect in my mind, and I sketched out how this might all work; note I’m not seeing the “brain pruning” differences as having a primarily medical explanation.  I like my sketch, partly because it addresses how neuroleptics appear to be part of the solution but actually aggravate the underlying problem (just as they seem to increase the brain pruning or brain shrinkage that was seen early on as part of the problem.)

Anyway, here’s my sketch, it gives a broad overview of my thinking about the problems in psychosis and in the usual sorts of “treatment.”  I’d be curious to hear what you think of it.

Sketching out the role of “significance” in “schizophrenia:”

When people are stressed, they are more likely to think in black and white terms, and to narrow attention to the stressors.  Diversity of thinking is reduced.  (Note that depression has been found to involve thinking slowly, but with a narrow focus, while anxiety involves faster thinking that is also narrow.  See http://www.sciam.com/article.cfm?id=rapid-thinking-makes-people-happy)

It is known than many mental connections are “pruned” away during adolescence, as the brain apparently sorts out which connections are significant and which are not.  It has also been observed that this “pruning” appears to be greater in those who go on to develop “schizophrenia” and that this results in reduced brain volume on average for those who develop this condition.  While this is thought by many to be evidence that schizophrenia is a “brain disease” it could also be that this excess pruning just reflects an excess narrowing of a sense of significance that comes about perhaps as often a reaction to chronic stress. 

Of course, a lot of what earns people a diagnosis of “schizophrenia” is not limits to a sense of significance, but instead seeing significance where others don’t.  This goes along with “jumping to conclusions” and often holding onto conclusions when others think they should be given up.  Or disordered thinking, where so many things are seen as significant that there is no logical order.  One possibility of why this is so could be that the person is trying to fight back against the process of narrowing of significance, by grasping at straws so to speak to find significance, and then is very reluctant to let it go once it is found, because significance has been so hard to come by.  It is this “fighting for significance” that we see as positive symptoms.

Of course, seeing significance in the wrong places can lead the person into more stress, and stress tends to lead to a narrowing of focus as discussed earlier, so the attempted solution backfires.  Lacking insight into the dynamics of the problem however may cause the person to try even harder to come to quick conclusions, to jump at impressions of significance, and to hold onto perceptions of significance even more tightly, just making the whole vicious circle accelerate.

Then the person is diagnosed and becomes the recipient of psychiatric care.  What happens next?  The person is told that his or her perceptions have no significance, they are just an illness, and the person is given neuroleptic or “antipsychotic” medications which are really indifference pills – in other words, they reduce the perception of significance.  This typically results in fewer “positive symptoms” or less jumping to and hanging onto poorly thought out conclusions, but also less spontaneous or original thinking of any kind.  This means that the excess narrowing of a sense of significance that happened early on in the process is just accelerated by the “treatment.”  The medications accelerate the brain shrinkage that had already been a problem.  The accelerated shrinkage of mental connections means the person is even more desperate for a sense of significance, and is even more likely to jump to conclusions or inappropriately hang onto conclusions when that can be accomplished (which makes relapse even more likely when medications are discontinued for example.)

What would work better?  Understanding this whole process, and not being so quick to try and solve one part of the problem in a way that causes other problems.  It has been pointed out that those who have been able to see some significance in their psychotic process are actually more likely to recover.  The trick is to be able to see “some significance” in it, without seeing it as so significant that it is all taken literally.  When we understand thoughts or perceptions as expressing part of the truth, but also being partly wrong or inadequate, then we become curious and open minded in a way that encourages further thought, further mental connections, a broader sense of significance.    

Ultimately, the search for significance is a spiritual search, which is why “schizophrenia” is really about spiritual issues.  Positive symptoms are about trying to find significance, but doing it in too grasping of a manner, leading for example often to definite conclusions where they are not justified.  We need to get out of our mental ruts in order to nurture mental diversity and a broad sense of significance, so there is something quite positive about seeing significance where others do not, as long as we can learn to do it in a non-grasping manner, seeing things as partly or maybe true, keeping an open mind, and noticing the ways in which we do not know – just as mystics have always stressed that we cannot “know” the divine in any fixed way, in any definite form.

Neuroleptics may reduce some of the “grasping” but they just aggravate the underlying problem of lack of significance.  This suggests they should be used very sparingly if at all.  Telling people their psychotic experiences are meaningless is the interpersonal equivalent of a neuroleptic:  it also may make some people give up on their perceptions, but most likely in a way that would aggravate the underlying problem of failing to find significance.  Better might be conversations that opened up the story, that get people to explore both ways that the experiences may be significant and ways they may not be, so that mental connections are made, complex understandings developed, etc.  This could overcome both the problems that come from “grasping” meaning, and those that come from too much loss or letting go of meaning.  Then real recovery becomes possible. 

I think in a narrow sense good therapists try to do this in meetings with clients.  However, we also need to see this happen much more broadly in society:  the acknowledgment that many possible ways of looking at things have some meaning, but they also have limitations, and so encouraging curiosity and connection with other perspectives.  This would help us both integrate “mad” perspectives, as well as those of other cultures.

Note:  In coming up with this sketch, I drew on my own experiences as a young man who had a lot of psychotic or psychotic-like experiences (but never drifted so far that I lost control of my life or got caught up in the mental health system.)  I was able to get out of the vicious circle by finding meaning in my experiences but also learning not to grasp them so tightly that I couldn’t see other perspectives or relate to other people.  And it really helped that just a few other people didn’t shut me out, and did see possible meaning in my experiences.