it's perhaps the most stigmatized and misunderstoodpsychological 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, andeven in doctors' offices than any other mental illness. as a result, its sufferers have often beenshunned, abused, or locked up. and among the many fallacies that surround the disorderis simply what it means. the word "schizophrenia"
crash diet documentary, literally means "split mind" but contraryto popular belief, the condition has nothing to do with a split in personality or multiplepersonalities. the term refers instead to what's sometimescalled a "split from reality." multiple personality disorder, now known as dissociative identitydisorder, is a totally different type of condition,
a kind of dissociative disorder. and thesetoo, 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 levelto the emotional swings, nervousness, and compulsions that come with mood and anxietydisorders, it can be a lot harder for those without direct experience to relate to thesymptoms of schizophrenia and dissociation. unfortunately we tend to fear and avoid whatwe don't understand in each other, whether it's a friend of family member or just somestranger on the bus. but thankfully part of the psychologist's job is to demystify thethings that can happen in our heads, and as is often the case, understanding may be the keyto compassion.
schizophrenia is a chronic condition thatusually 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 thatvary in how they're expressed and how long they last, but they share similar symptoms. schizophrenia spectrum disorders are currentlythought of as characterized by disorganized thinking; emotions and behaviors that areoften incongruent with their situations; and
disturbed perceptions, including delusionsand hallucinations. they all involve a kind of loss of contactwith reality on some level. the resulting behaviors and mental states associated withthis break from reality are generally called "psychotic symptoms" and they usually impairthe ability to function. when someone's experiencing psychotic symptoms,their thinking and speech can become disorganized, rambling and fragmented. this tendency topick up one train of thought and suddenly switch to another and then another can makecommunication painfully difficult. people exhibiting these symptoms can alsosuffer a breakdown in selective attention, losing the ability to focus on one thing whilefiltering others out.
in extreme cases, speech may become so fragmentedit becomes little more than a string of meaningless words, a condition given a name that soundslike its own kind of non sequitur, "word salad." classic schizophrenia is also often markedby delusions or false beliefs not based in reality. these delusions can be rooted inideas 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 andactions are being controlled by an outside force or that you're being spied on or followedor that you're on the verge of a major catastrophe. and there are some complicated variationson these delusions, like feeling that you've died or don't exist anymore or that someone is madly inlove with you or that you're infested with parasites.
delusions of one kind of another strike asmany 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 examplesof people suffering from severe delusions come from serial killers and yeah, while sonof sam did claim that he was taking orders from his neighbor's dog, that kind of stuffis in the tiny, tiny, tiny minority. brian wilson of the beach boys and syd barrettof pink floyd both suffered psychotic symptoms. and then of course there's john nash, thenobel prize winning american mathematician and subject of the movie "a beautiful mind." through proper treatment, some people withschizophrenia have not only learned to live
with their illness but also made fantasticcreative contributions to the world. maybe people with schizophrenia also sufferfrom 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 lackingthe 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 innermonologue, that conversation that you have with yourself or the random things that floatthrough your head, were somehow coming from outside of you. it's as if you couldn't sortout 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 aloved one's death or crying while others are laughing. acting like a goofy child one minute, thenbecoming 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 intothree general categories traditionally used by psychologists: positive, negative, anddisorganized symptoms. positive symptoms are not what they soundlike. they're the type that add something
to the experience of the patient. like, forexample, hallucinations or inappropriate laughter or tears or delusional thoughts. negative symptoms refer to those that subtractfrom 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 jumblesof thought or speech that could include word salad and other problems with attention andorganization. symptoms like these are useful in diagnosinga 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 numberof brain abnormalities. post mortem research on schizophrenia patientshas found that many have extra receptors for dopamine, a neurotransmitter involved in emotionregulation and the brain's pleasure and reward centers. some researchers think that overly responsivedopamine systems might magnify brain activity in some way, perhaps creating hallucinationsand other so-called positive symptoms as the brain loses its capacity to tell the differencebetween internal and external stimuli. for this reason, dopamine blocking drugs areoften used as anti-psychotic medications in treatment. modern neuroimaging studies alsoshow that some people with schizophrenia have abnormal brain activity in several differentparts 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 filteringincoming sensory signals. another study noted that patients with paranoid symptoms showedover-activity in the fear processing amygdala. so, schizophrenia seems to involve not justproblems 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 eventmight trigger psychotic symptoms for the first time, even though it can't actually createthe disorder. psychologists call this the "diathesis-stress model."
this way of thinking involves a combinationof biological and genetic vulnerabilities -- diathesis -- and environmental stressors-- stress -- that both contribute to the onset of schizophrenia. this model helps explainwhy some people with genetic vulnerability might not always develop schizophrenia andwhy the rates of schizophrenia tend to be higher with some degree of poverty or socioeconomicstress. and it seems too that there is some kind ofgenetic predisposition for the disorder. the one-in-a-hundred odds of developing schizophreniajumped to nearly one in ten if you have a parent or sibling with the disorder, withabout 50/50 odds if that sibling is an identical twin, even if those twins were raised apart.
one recent landmark seven year study lookedat 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 thatmay increase the risk of schizophrenia. as expected, some of these genes involve dopamineregulation, but others are related to immune system functioning. researchers continue totease out what is exactly going on here, but many are hopeful that these new findings willlead to better treatment. clearly, schizophrenia is a challenging disorderto live with and one that's hard for outsiders to understand, but maybe even more rare andmore elusive are the dissociative disorders. these are disorders of consciousness, calleddissociative because they're marked by an
interruption in conscious awareness. patientscan become separated from the thoughts or feelings that they used to have, which canresult in a sudden loss of memory or even change in identity. now, we might all experience minor dissociationat 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 frontof taco bell thinking, like, "how did i get here?" those things would generally fall into thenormal range of dissociation, but most of us don't develop different personalities. dissociative disorders come in several differentforms, 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 rareand flashy disorder in which a person exhibits two or more distinct and alternating identitiesand the best known case was that of shirley mason, whose story was famously rendered inthe 1973 best seller "sybil" and later in a popular mini-series. the book was marketed as the true story ofa 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 criticalclara. the book became a craze and within a few yearsreported cases of multiple personality skyrocketed
from scarcely 100 to nearly 40,000. many believe the book was essentiallyresponsible for creating a new psychiatric diagnosis. it turns out though, sybil's storywas a big fat lie. yes, shirley mason was a real person and onewith a troubled, traumatic past and a number of psychological issues. as a student in newyork in the 1950s she started seeing a therapist named connie wilbur and taking some heavymedications. and somewhere in there, maybe because she was coaxed, or maybe because shewanted more attention, shirley started expressing different personalities. dr. wilbur built a career and a book dealout of her star patient, even after shirley
confessed that her split personality was aruse. the sybil case is a powerful reminder thatwe 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 atall. but some studies have shown distinct bodyand brain states that seem to appear in different identities, things like one personality beingright handed while the other is left handed, or different personalities having variations in their eyesight that ophthalmologists could actually detect. in these cases, dissociations of identitymay 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 associatedwith the schizophrenia spectrum disorders, including disorganized thinking, inappropriate emotionsand behaviors, and disturbed perceptions. we also discussed brain activity associatedwith these disorders and talked about their possible origins including the diathesis stressmodel. 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 ofour subbable subscribers who make crash course possible. to find out how you can become asupporter, just go to subbable.com.
this episode was written by kathleen yale,edited by blake de pastino, and our consultant is dr. ranjit bhagwat. our director and editoris nicholas jenkins, the script supervisor is michael aranda. he is also our sound designerand the graphics team at thought cafe.
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