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  • It's perhaps the most stigmatized and misunderstood psychological disorder of them all, even among

  • psychologists. Maybe because it's pretty rare, affecting about 1% of the population, schizophrenia

  • causes more anxiety in the media, in the public, and even in doctors' offices than any other mental illness.

  • As a result, its sufferers have often been shunned, abused, or locked up. And among the

  • many fallacies that surround the disorder is simply what it means. The word "schizophrenia"

  • literally means "split mind" but contrary to popular belief, the condition has nothing

  • to do with a split in personality or multiple personalities.

  • The term refers instead to what's sometimes called a "split from reality." Multiple Personality

  • Disorder, now known as Dissociative Identity Disorder, is a totally different type of condition,

  • a kind of dissociative disorder. And these too, are shrouded in misconceptions, partly

  • because they were the subject of, probably, the greatest psychological hoax of all time.

  • While many of us can relate on some level to the emotional swings, nervousness, and

  • compulsions that come with mood and anxiety disorders, it can be a lot harder for those

  • without direct experience to relate to the symptoms of schizophrenia and dissociation.

  • Unfortunately we tend to fear and avoid what we don't understand in each other, whether

  • it's a friend of family member or just some stranger on the bus. But thankfully part of

  • the psychologist's job is to demystify the things that can happen in our heads, and as is

  • often the case, understanding may be the key to compassion.

  • Schizophrenia is a chronic condition that usually surfaces for men in their early to

  • mid-20s, and for women in their late 20s. For some the disorder comes on gradually,

  • but for others it could arise more suddenly, perhaps triggered by stress or trauma, although

  • no event can actually cause the disorder.

  • Once thought of as a single discrete condition, schizophrenia is now included in the DSM-5

  • as a point on a spectrum of disorders that vary in how they're expressed and how long

  • they last, but they share similar symptoms.

  • Schizophrenia Spectrum Disorders are currently thought of as characterized by disorganized

  • thinking; emotions and behaviors that are often incongruent with their situations; and

  • disturbed perceptions, including delusions and hallucinations.

  • They all involve a kind of loss of contact with reality on some level. The resulting

  • behaviors and mental states associated with this break from reality are generally called

  • "psychotic symptoms" and they usually impair the ability to function.

  • When someone's experiencing psychotic symptoms, their thinking and speech can become disorganized,

  • rambling and fragmented. This tendency to pick up one train of thought and suddenly

  • switch to another and then another can make communication painfully difficult.

  • People exhibiting these symptoms can also suffer a breakdown in selective attention,

  • losing the ability to focus on one thing while filtering others out.

  • In extreme cases, speech may become so fragmented it becomes little more than a string of meaningless

  • words, a condition given a name that sounds like its own kind of non sequitur, "word salad."

  • Classic schizophrenia is also often marked by delusions or false beliefs not based in

  • reality. These delusions can be rooted in ideas of grandeur like "I'm the queen of England!"

  • or "I won an Olympic gold medal for the luge!" Or they can become narratives of persecution

  • and paranoia, believing your thoughts and actions are being controlled by an outside

  • force or that you're being spied on or followed or that you're on the verge of a major catastrophe.

  • And there are some complicated variations on these delusions, like feeling that you've

  • died or don't exist anymore or that someone is madly in love with you or that you're infested with parasites.

  • Delusions of one kind of another strike as many as four out of five people with schizophrenia.

  • While some delusions can seem fairly logical, they can also be severe and bizarre and frightening.

  • Unfortunately maybe the most memorable examples of people suffering from severe delusions

  • come from serial killers and yeah, while Son of Sam did claim that he was taking orders

  • from his neighbor's dog, that kind of stuff is in the tiny, tiny, tiny minority.

  • Brian Wilson of The Beach Boys and Syd Barrett of Pink Floyd both suffered psychotic symptoms.

  • And then of course there's John Nash, the Nobel Prize winning American mathematician

  • and subject of the movie "A Beautiful Mind."

  • Through proper treatment, some people with schizophrenia have not only learned to live

  • with their illness but also made fantastic creative contributions to the world.

  • Maybe people with schizophrenia also suffer from perceptual disturbances, or sensory experiences

  • that come without any apparent sensory stimulation, like hallucinations. This is when a person

  • sees or hears something that isn't there, often lacking the ability to understand what is real and what isn't.

  • Auditory hallucinations, or hearing voices, are the most common form, and these voices

  • are often abusive. It's as if you're inner monologue, that conversation that you have

  • with yourself or the random things that float through your head, were somehow coming from

  • outside of you. It's as if you couldn't sort out whether the voices in your mind were internal

  • and self-generated, or external and other-generated.

  • To me, it sounds terrifying.

  • Other common symptoms include disorganized, abnormal, or incongruent behavior and emotions.

  • This could mean laughing when recalling a loved one's death or crying while others are

  • laughing. Acting like a goofy child one minute, then becoming unpredictably angry or agitated the next.

  • Movements may become inappropriate and compulsive, like continually rocking back and forth or

  • remaining motionless for hours.

  • Broadly, most psychotic symptoms fall into three general categories traditionally used

  • by psychologists: positive, negative, and disorganized symptoms.

  • Positive symptoms are not what they sound like. They're the type that add something

  • to the experience of the patient. Like, for example, hallucinations or inappropriate laughter

  • or tears or delusional thoughts.

  • Negative symptoms refer to those that subtract from normal behavior, like a reduced ability

  • to function, neglect of personal hygiene, lack of emotion, toneless voice, expressionless

  • face, or withdrawal from family and friends.

  • Finally, disorganized symptoms are those jumbles of thought or speech that could include word

  • salad and other problems with attention and organization.

  • Symptoms like these are useful in diagnosing a disorder on the schizophrenia spectrum,

  • but there's a physiological component too. Like many of the disorders we've talked about,

  • schizophrenia has been associated with a number of brain abnormalities.

  • Post mortem research on schizophrenia patients has found that many have extra receptors for

  • dopamine, a neurotransmitter involved in emotion regulation and the brain's pleasure and reward centers.

  • Some researchers think that overly responsive dopamine systems might magnify brain activity

  • in some way, perhaps creating hallucinations and other so-called positive symptoms as the

  • brain loses its capacity to tell the difference between internal and external stimuli.

  • For this reason, dopamine blocking drugs are often used as anti-psychotic medications in

  • treatment. Modern neuroimaging studies also show that some people with schizophrenia have

  • abnormal brain activity in several different parts of the brain.

  • One study noted that when patients were hallucinating, for example, there was unusually high activity

  • in the thalamus, which is involved in filtering incoming sensory signals. Another study noted

  • that patients with paranoid symptoms showed over-activity in the fear processing amygdala.

  • So, schizophrenia seems to involve not just problems with one part of the brain, but abnormalities

  • in several areas and their interconnections.

  • But what might be causing these abnormalities?

  • Earlier I mentioned how a stressful event might trigger psychotic symptoms for the first

  • time, even though it can't actually create the disorder. Psychologists call this the

  • "diathesis-stress model."

  • This way of thinking involves a combination of biological and genetic vulnerabilities

  • -- diathesis -- and environmental stressors -- stress -- that both contribute to the onset

  • of schizophrenia. This model helps explain why some people with genetic vulnerability

  • might not always develop schizophrenia and why the rates of schizophrenia tend to be

  • higher with some degree of poverty or socioeconomic stress.

  • And it seems too that there is some kind of genetic predisposition for the disorder. The

  • one-in-a-hundred odds of developing schizophrenia jumped to nearly one in ten if you have a

  • parent or sibling with the disorder, with about 50/50 odds if that sibling is an identical

  • twin, even if those twins were raised apart.

  • One recent landmark seven year study looked at genetic samples across 35 countries, examining

  • more than 35,000 people with schizophrenia, and another 110,000 without the disorder.

  • The study identified more than 100 genes that may increase the risk of schizophrenia. As

  • expected, some of these genes involve dopamine regulation, but others are related to immune

  • system functioning. Researchers continue to tease out what is exactly going on here, but

  • many are hopeful that these new findings will lead to better treatment.

  • Clearly, schizophrenia is a challenging disorder to live with and one that's hard for outsiders

  • to understand, but maybe even more rare and more elusive are the dissociative disorders.

  • These are disorders of consciousness, called dissociative because they're marked by an

  • interruption in conscious awareness. Patients can become separated from the thoughts or

  • feelings that they used to have, which can result in a sudden loss of memory or even

  • change in identity.

  • Now, we might all experience minor dissociation at times, like maybe the sense that you're

  • watching yourself from above, as in a movie, or like you're driving home and get so zoned

  • out that suddenly you find yourself in front of Taco Bell thinking, like, "How did I get here?"

  • Those things would generally fall into the normal range of dissociation, but most of

  • us don't develop different personalities.

  • Dissociative disorders come in several different forms, but the most infamous of the bunch

  • is probably Dissociative Identity Disorder. This has long been known as Multiple Personality

  • Disorder and, yes, it is a thing. It's a rare and flashy disorder in which a person exhibits

  • two or more distinct and alternating identities and the best known case was that of Shirley

  • Mason, whose story was famously rendered in the 1973 best seller "Sybil" and later in

  • a popular mini-series.

  • The book was marketed as the true story of a woman who suffered great childhood trauma

  • and ended up with 16 different personalities, ranging from Vicky, a selfish French Woman,

  • to handyman Syd, to the religious and critical Clara.

  • The book became a craze and within a few years reported cases of multiple personality skyrocketed

  • from scarcely 100 to nearly 40,000.

  • Many believe the book was essentially responsible for creating a new psychiatric

  • diagnosis. It turns out though, Sybil's story was a big fat lie.

  • Yes, Shirley Mason was a real person and one with a troubled, traumatic past and a number

  • of psychological issues. As a student in New York in the 1950s she started seeing a therapist

  • named Connie Wilbur and taking some heavy medications. And somewhere in there, maybe

  • because she was coaxed, or maybe because she wanted more attention, Shirley started expressing

  • different personalities.

  • Dr. Wilbur built a career and a book deal out of her star patient, even after Shirley

  • confessed that her split personality was a ruse.

  • The Sybil case is a powerful reminder that we really don't understand dissociative disorders

  • very well or even know if they're always real. Indeed, some people question if Dissociative

  • Identity Disorder is an actual disorder at all.

  • But some studies have shown distinct body and brain states that seem to appear in different

  • identities, things like one personality being right handed while the other is left handed,

  • or different personalities having variations in their eye sight that ophthalmologists could actually detect.

  • In these cases, dissociations of identity may be in response to stress or anxiety, a

  • sort of extreme coping mechanism.

  • Either way, the debate and the research continue.

  • Today we talked about the major symptoms associated with the schizophrenia spectrum disorders, including

  • disorganized thinking, inappropriate emotions and behaviors, and disturbed perceptions.

  • We also discussed brain activity associated with these disorders and talked about their

  • possible origins including the diathesis stress model.

  • You also learned about dissociative disorders, and Dissociative Identity Disorder in particular,

  • and the scandal that was the Sybil case.

  • Thanks for watching, especially to all of our Subbable subscribers who make Crash Course