For a common affliction that strikes people of every culture and walk of life, schizophrenia has remained something of an enigma. Scientists talk about dopamine and glutamate, nicotinic receptors and hippocampal atrophy, but they’ve made little progress in explaining psychosis as it unfolds on the level of thoughts, beliefs, and experiences. Approximately one percent of the world’s population suffers from schizophrenia. Add to that the comparable numbers of people who suffer from affective psychoses (certain types of bipolar disorder and depression) or psychosis from neurodegenerative disorders like Alzheimer’s disease. All told, upwards of 3% of the population have known psychosis first-hand. These individuals have experienced how it transformed their sensations, emotions, and beliefs. Why hasn’t science made more progress explaining this level of the illness? What have those slouches at the National Institute of Mental Health been up to?
There are several reasons why psychosis has proved a tough nut to crack. First and foremost, neuroscience is still struggling to understand the biology of complex phenomena like thoughts and memories in the healthy brain. Add to that the incredible diversity of psychosis: how one psychotic patient might be silent and unresponsive while another is excitable and talking up a storm. Finally, a host of confounding factors plague most studies of psychosis. Let’s say a scientist discovers that a particular brain area tends to be smaller in patients with schizophrenia than healthy controls. The difference might have played a role in causing the illness in these patients, it might be a direct result of the illness, or it might be the result of anti-psychotic medications, chronic stress, substance abuse, poor nutrition, or other factors that disproportionately affect patients.
So what’s a well-meaning neuroscientist to do? One intriguing approach is to study psychosis in healthy people. They don’t have the litany of confounding experiences and exposures that make patients such problematic subjects. Yet at first glance, the approach seems to have a fatal flaw. How can you study psychosis in people who don’t have it? It sounds as crazy as studying malaria in someone who’s never had the bug.
In fact, this approach is possible because schizophrenia is a very different illness from malaria or HIV. Unlike communicable diseases, it is a developmental illness triggered by both genetic and environmental factors. These factors affect us all to varying degrees and cause all of us – clinically psychotic or not – to land somewhere on a spectrum of psychotic traits. Just as people who don’t suffer from anxiety disorders can still differ in their tendency to be anxious, nonpsychotic individuals can differ in their tendency to develop delusions or have perceptual disturbances. One review estimates that 1 to 3% of nonpsychotic people harbor major delusional beliefs, while another 5 to 6% have less severe delusions. An additional 10 to 15% of the general population may experience milder delusional thoughts on a regular basis.
Delusions are a common symptom of schizophrenia and were once thought to reflect the poor reasoning abilities of a broken brain. More recently, a growing number of physicians and scientists have opted for a different explanation. According to this model, patients first experience the surprising and mysterious perceptual disturbances that result from their illness. These could be full-blown hallucinations or they could be subtler abnormalities, like the inability to ignore a persistent noise. Patients then adopt delusions in a natural (if misguided) attempt to explain their odd experiences.
An intriguing study from the early 1960s illustrates how rapidly delusions can develop in healthy subjects when expectations and perceptions inexplicably conflict. The study, run on twenty college students at the University of Copenhagen, involved a version of the trick now known as the rubber hand illusion. Each subject was instructed to trace a straight line while his or her hand was inside a box with a secret mirror. For several trials, the subject watched his or her own hand trace the line correctly. Then the experimenters surreptitiously changed the mirror position so that the subject was now watching someone else’s hand trace the straight line – until the sham hand unexpectedly veered off to the right! All of the subjects experienced the visible (sham) hand as their own and felt that an involuntary movement had sent it off course. After several trials with this misbehaving hand, the subjects offered explanations for the deviation. Some chalked it up to their own fatigue or inattention while others came up with wilder, tech-based explanations:
. . . five subjects described that they felt something strange and queer outside themselves, which pressed their hand to the right or resisted their free mobility. They suggested that ‘magnets’, ‘unidentified forces’, ‘invisible traces under the paper’, or the like, could be the cause.
In other words, delusions may be a normal reaction to the unexpected and inexplicable. Under strange enough circumstances, anyone might develop them – but some of us are more likely to than others.
My next post will describe a clever experiment that planted a delusion-like belief in the heads of healthy subjects and used trickery and fMRI to see how it influenced some more than others. So stay tuned. In the meantime, you may want to ask yourself which members of your family and friends are prone to delusional thinking. Or ask yourself honestly: could it be you?