So interesting! It is crazy how often diagnoses result from the external effect of someone's mental disorder instead of what's happening internally. "You can't be autistic because you have friends" yeah and I literally can't eat vegetables unless they're blended into a soup, both can be true lol
Haha I love the soup analogy. I agree, it's off the wall. I wonder if the focus on external behavior rather than inner experience is based in part on distrusting people when they describe their subjective experience?
I read Why Fish Don't Exist in my book group a few years ago and loved it, because I'm a sucker for epistemological revolutions, and the Cladistics people really pulled it off. And it's kinda funny, too, as you mention: I will know this stuff, but then when I'm thinking of eating fish: they're all just "fish" - even at a sushi restaurant. Unagi/eel...I even ate octopuses until I found out how intelligent they were. Why did I react that way to intelligence?
I often think about the level of scientific knowledge. We know an astounding amount. But I suspect it's closer to 1% of what can be known, and not 99% that some think. I think we hardly know anything. I know I don't know much at all.
I love how you linked cladistics to the DSM. It's really witty and smart and...intelligent. Thank you!
I had a brother who had schizophrenia. He died of an asthma attack just before he would turn 40. The schizophrenia didn't kill him, but he wasn't able to think clearly and get his rescue inhaler refilled.
He heard voices so intrusively in his consciousness that "they" would interrupt our conversations. When he was diagnosed I read 80-100 books on schizophrenia. 1908: Bleuler called...whatever this was..."schizophrenia": etymologically "split mind." The mind is NOT "split" in any meaningful way, though. But still, "they" "have" "schizophrenia." No, they have a bunch of specific neurobiological imbalances (<---- there's another problematic metaphor, I know!) that seem to be related, that cause them to, quite often, lack insight into their own dis-ease.
I followed those stories about treating people for an entirely different thing and they become more lucid. I taught myself to not get too excited. But maybe there finally is hope for effective treatment now. Maybe. It was a nightmare to deal with my brother. One heartbreak after another.
And the clinicians are just going with what they learned in medical school. We can hope for a Clade group for mental disorders, can't we? I know it has to do with origins - they once thought they'd find "the" gene that caused schizophrenia. Then they did!..
...But then they found another one linked to that dis-ease, on another chromosome. Then another one on another chromosome. That it's not an OGOD disease: One Gene, One Disease, was a tough pill for me to swallow back then. But I think there's hope. I hope there's hope. Is there hope?
Thanks for sharing about your brother, and I'm so sorry to hear about his tragic death.
I had been intending to get back to your other comment too, but wanted to prep a more fulsome response (which I still haven't done, yet I won't let the perfect be the enemy of the good). Here's what I wanted to say more or less: I've stumbled across schizophrenia in my own research wanderings and (as you say), it has a complex genetic basis: both polygenic variants and de novo mutations contribute, much like autism. In fact, autism and schizophrenia are highly connected, which I found interesting. From a meta-review: "Youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels." (Article: https://pmc.ncbi.nlm.nih.gov/articles/PMC8931527/)
I just watched a truly excellent BBC show called River starring Stellan Skarsgard. The main character is schizophrenic, and quite obviously (to me) autistic as well, and I thought it was a wonderful portrayal. I hesitate to recommend it to you, though, because some things can hit too close to home. But if you're at all interested, you might check it out.
Thanks as always for reading and commenting with so many rich ideas. I love that you read Why Fish Don't Exist in a book group! I've always found book clubs impossible to navigate. My demand avoidance (don't tell me what to read!) blended with group socializing difficulties blended with frustration when meetings don't stick to a plan (i.e., when book club sessions don't discuss the book enough). I'm pretty much the worst book clubber possible, it turns out, even though I love reading and discussing books.
Thanks for the alert on River. I’m able to detach my own experiences with my brother. It’s a human problem. I remember watching A Beautiful Mind on the same day my brother exhibited florid symptoms.
I’ll try to see River.
The metaphor of “spectrum” feels right, but I don’t know how to think about it in any precise way. Clearly, doing math at that high level while also being that disturbed: can’t wrap my head around it.
There are specific circuits that still function while an all-too-real paranoid narrative plays in your mind? It’s too much for me to understand.
Laura: I didn’t know about the high level of convergence with schizophrenia and autism spectrum. I don’t even know how to think about that, but I have seen “paranoid schizophrenia” up close for 15 years (ending with my brother dying) and can’t imagine a spectrum person tipping over into that. But apparently it does happen…at more often a rate than I would have imagined.
I thought I’d be like you with book clubs, but it turned out to be the opposite: I flower in that setting. I often think I’m on the spectrum, but, as your work here shows, who knows? It doesn’t apply in a book group. I don’t know what happens to me in that setting. I drive to the meeting thinking, “Do I have anything interesting to say?” and then I end up leading the group discussion. It’s weird.
Etiology, yes -- that seems like the best foundation. I don’t know what will rescue clinical psychiatry either. And I don't fully understand the divisions between psychiatry, psychology, and neuroscience, or why they're needed. From the outside looking in, it feels more like bureaucracy than rationality. Territorialism, siloed funding, and even disciplinary identity probably stand in the way of integrated models.
As for academic psychiatry, my sense is that they're getting dragged along by neuroscientific, behavioral, and genetic scientists rather than leading the charge on anything (this is based on my review of relevant research). But again, I only bring an outsider's view.
So interesting! It is crazy how often diagnoses result from the external effect of someone's mental disorder instead of what's happening internally. "You can't be autistic because you have friends" yeah and I literally can't eat vegetables unless they're blended into a soup, both can be true lol
Haha I love the soup analogy. I agree, it's off the wall. I wonder if the focus on external behavior rather than inner experience is based in part on distrusting people when they describe their subjective experience?
I read Why Fish Don't Exist in my book group a few years ago and loved it, because I'm a sucker for epistemological revolutions, and the Cladistics people really pulled it off. And it's kinda funny, too, as you mention: I will know this stuff, but then when I'm thinking of eating fish: they're all just "fish" - even at a sushi restaurant. Unagi/eel...I even ate octopuses until I found out how intelligent they were. Why did I react that way to intelligence?
I often think about the level of scientific knowledge. We know an astounding amount. But I suspect it's closer to 1% of what can be known, and not 99% that some think. I think we hardly know anything. I know I don't know much at all.
I love how you linked cladistics to the DSM. It's really witty and smart and...intelligent. Thank you!
I had a brother who had schizophrenia. He died of an asthma attack just before he would turn 40. The schizophrenia didn't kill him, but he wasn't able to think clearly and get his rescue inhaler refilled.
He heard voices so intrusively in his consciousness that "they" would interrupt our conversations. When he was diagnosed I read 80-100 books on schizophrenia. 1908: Bleuler called...whatever this was..."schizophrenia": etymologically "split mind." The mind is NOT "split" in any meaningful way, though. But still, "they" "have" "schizophrenia." No, they have a bunch of specific neurobiological imbalances (<---- there's another problematic metaphor, I know!) that seem to be related, that cause them to, quite often, lack insight into their own dis-ease.
I followed those stories about treating people for an entirely different thing and they become more lucid. I taught myself to not get too excited. But maybe there finally is hope for effective treatment now. Maybe. It was a nightmare to deal with my brother. One heartbreak after another.
And the clinicians are just going with what they learned in medical school. We can hope for a Clade group for mental disorders, can't we? I know it has to do with origins - they once thought they'd find "the" gene that caused schizophrenia. Then they did!..
...But then they found another one linked to that dis-ease, on another chromosome. Then another one on another chromosome. That it's not an OGOD disease: One Gene, One Disease, was a tough pill for me to swallow back then. But I think there's hope. I hope there's hope. Is there hope?
Thanks for sharing about your brother, and I'm so sorry to hear about his tragic death.
I had been intending to get back to your other comment too, but wanted to prep a more fulsome response (which I still haven't done, yet I won't let the perfect be the enemy of the good). Here's what I wanted to say more or less: I've stumbled across schizophrenia in my own research wanderings and (as you say), it has a complex genetic basis: both polygenic variants and de novo mutations contribute, much like autism. In fact, autism and schizophrenia are highly connected, which I found interesting. From a meta-review: "Youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels." (Article: https://pmc.ncbi.nlm.nih.gov/articles/PMC8931527/)
I just watched a truly excellent BBC show called River starring Stellan Skarsgard. The main character is schizophrenic, and quite obviously (to me) autistic as well, and I thought it was a wonderful portrayal. I hesitate to recommend it to you, though, because some things can hit too close to home. But if you're at all interested, you might check it out.
Thanks as always for reading and commenting with so many rich ideas. I love that you read Why Fish Don't Exist in a book group! I've always found book clubs impossible to navigate. My demand avoidance (don't tell me what to read!) blended with group socializing difficulties blended with frustration when meetings don't stick to a plan (i.e., when book club sessions don't discuss the book enough). I'm pretty much the worst book clubber possible, it turns out, even though I love reading and discussing books.
Thanks for the alert on River. I’m able to detach my own experiences with my brother. It’s a human problem. I remember watching A Beautiful Mind on the same day my brother exhibited florid symptoms.
I’ll try to see River.
The metaphor of “spectrum” feels right, but I don’t know how to think about it in any precise way. Clearly, doing math at that high level while also being that disturbed: can’t wrap my head around it.
There are specific circuits that still function while an all-too-real paranoid narrative plays in your mind? It’s too much for me to understand.
Laura: I didn’t know about the high level of convergence with schizophrenia and autism spectrum. I don’t even know how to think about that, but I have seen “paranoid schizophrenia” up close for 15 years (ending with my brother dying) and can’t imagine a spectrum person tipping over into that. But apparently it does happen…at more often a rate than I would have imagined.
I thought I’d be like you with book clubs, but it turned out to be the opposite: I flower in that setting. I often think I’m on the spectrum, but, as your work here shows, who knows? It doesn’t apply in a book group. I don’t know what happens to me in that setting. I drive to the meeting thinking, “Do I have anything interesting to say?” and then I end up leading the group discussion. It’s weird.
A really fascinating read Laura, thank you 🙂
Thanks Alys!
Etiology, yes -- that seems like the best foundation. I don’t know what will rescue clinical psychiatry either. And I don't fully understand the divisions between psychiatry, psychology, and neuroscience, or why they're needed. From the outside looking in, it feels more like bureaucracy than rationality. Territorialism, siloed funding, and even disciplinary identity probably stand in the way of integrated models.
As for academic psychiatry, my sense is that they're getting dragged along by neuroscientific, behavioral, and genetic scientists rather than leading the charge on anything (this is based on my review of relevant research). But again, I only bring an outsider's view.