Scientific Research On The Causes Of Schizophrenia Is Inconclusive

Today I was studying some of the more recent research at Schizophrenia.com about the causes of schizophrenia, but none of it, it turns out, is conclusive.  Researchers tend now to see the illness from a biological and "environmental" perspective.  Environmental means there are both psychological and social factors.  The writer of the research article went on to offer many possible reasons for the development of schizophrenia from inherited defective genes to emotional neglect in childhood to illicit drug use to lack of vitamin D during pregnancy to growing up in the city to a common parasite gotten from handling cat feces to being born in the winter months, etcetera.  In short, no one knows for sure.  One thing that does seem somewhat clear, aside from having a history of mental illness in one's family, is that stress factors into it.  Stress can trigger changes in the brain.  Also, you may have the gene for schizophrenia, but if there are no environmental factors triggering it, it remains dormant.  A gene has to be turned on in order for illness to manifest itself.

Those of us who developed schizophrenia most likely had not only a genetic predisposition, but multiple psychological and social factors as well.  Children and youths are said to be five to ten times more sensitive generally than adults, which is why the formative years are so crucial to anyone's development.  I wonder how many of us with the illness suffered from some sort of abuse when we were young.  In my case, I believe I suffered from some emotional neglect from my parents, ironically because they were so focused on my older brother who from a young age had "emotional problems".  My brother in turn argued that it was my parents who had the emotional problems and needed to go see a shrink more than he did.  (My mother and I did in fact visit with my brother's therapist on several occasions which was something my mother deeply resented.)  Personally, I think it is true that my parents, though very responsible financially and for covering our basic needs (particularly my mother), were not exactly parent material.  My father was emotionally distant and my mother critical, cool and resentful (again) of having to take care of two children without much help.  Her mother had told her early on that she would not be available to baby sit that often. I'm sure that hurt my mother and left her without a guiding resource to rely on.  Growing up, I resented my mother more than my emotionally absent father, because I was around her more.  It was only later after college, around the time I began hearing voices, that I began to sympathize with her as she graduated from taking care of her children to taking care of her mother and my father's mother as they began to age.  Now, of course, years after my brother and I left home and my grandmother's had died, she is a much happier person.  

Don't get me wrong, I love my parents.  I think they did the best they could, but I won't rule out the possibility that their behavior towards me when I was young contributed to me growing up dysfunctional.  Once the dysfunction had set in, I myself continued the trend by behaving badly too, but by then I was an adult or rather an adult child because they continued to take care of me.  The truth is there is no parenting manual and a lot of parents learn through trial and error...unless they fail to learn at all.  I know some people cringe at the idea that a mother (or any major caretaker) should be held responsible for their child's development of schizophrenia or any major psychological illness, but it seems as if there may be at least a touch of truth to that assertion.  It's not the whole truth because I believe genetics play a factor and are no one's fault.  Still, behavior affects biology, just as stress affects brain chemistry.  A human child is a wonderful, but delicate being and there needs to be a balance between physical care and mental/spiritual/emotional care.  Also, mothers (and fathers who step up to their parenting responsibilities) need a support system, friends and family, even a therapist and more and more these days, qualified daycare professionals.  Mothers in isolation are asking for trouble.

The area of schizophrenia that most practical scientists veer away from and ignore is the spiritual aspect of the illness, which of course necessarily intertwines with the psychological/social aspects.  It is not surprising to me that much about the illness is unknown because the very nature of spirit is that it goes beyond common knowledge and into the unknown.  I continue to assert that though biology probably sets the stage for schizophrenia, the voices themselves originate from someplace external to the individual.  Some call them spirits or angels or devils or, in my case, aliens.  Be they higher or lower powers because they are not tangible and visible, people assume that they don't exist.  And tangibly they don't exist, at least not in this dimension, but that doesn't mean that there isn't a link between us and them nonetheless.  It's more convenient to dismiss the idea and stick with scientific bias than to explore the other possibilities, however distant.  I've interacted with my voices for a long time and it has been my assumption that they don't want to be revealed to the public for whatever reasons.  And yet they do choose to reveal themselves at least in part to the mentally ill.  That's a safeguard for them because the mentally ill have in the past and now not been taken seriously, though I believe that is changing the more the mentally ill, such as myself, speak up.

The question remains in my mind why these spirits/beings either create mental illness in individuals or take advantage of genetic/psychological/social tendencies towards the illness.  It seems to come back to the miracle of biology, of life.  I don't believe in human telepathy, but I do believe in alien telepathy.  It's the stuff of science fiction I know, but once so was the idea of flying machines and computers.  Recall once it was common knowledge that the world was flat and the sun revolved around the earth.  It's the brave individual who can come forward to speak an unpopular truth.  And really, who would want to consider what I say if it means that another non human life form can get inside our minds?  That's a threatening thought for the most stable of persons.  It no longer threatens me because I have established a compassionate relationship with these beings and I believe they are trying in some very challenging ways to help this world.  God works in mysterious ways and so do these beings who I believe are guided by a higher power.  I believe the whole universe and all the life in it is ultimately being guided.  But for all my beliefs, I do not know what happens after death.  Somehow I think these beings do know, but are either forbidden or unable to reveal it.  I sit with the fact that I don't know and may never know, at least not in this lifetime.

Acceptance

I told a friend the other day that I was okay with where I was at these days.  Maybe it's just that Spring has sprung around here and I'm feeling the release from a long winter into a kind of hopefulness.  I'm not sure.  I still go in and out of depression and some anxiety.  Just the other day I slept the day and night away because of depression.  I have a low tolerance for any kind of stress.  I can just manage to deal with my minimal responsibilities, more than that and I feel pain.  And yet, for all that, I am able to value my life.  I have a lot to be grateful for:  a safe home with cats for company, a caring family, enough money to live month to month, basic physical health, several creative outlets.  I also count myself as my own best friend.  Apart from perfection, which none of us can attain, I like and love myself.  Talking into a tape recorder these last four or five years has only gone to reinforce my friendship with myself.  My code of ethics is the discipline of self-honesty and honesty towards others.  I don't always succeed in that, but I do try.  And though I like and love myself, I still fall into thinking negative thoughts about myself.  I worry.

I work a program to help myself continue to heal from my own mental illness.  It's not a typical recovery program.  I have no support group.  I do not do volunteer work or part-time work.  Except for in this blog, I am not a mental health advocate.  I don't go to church each week and get involved with my local community.  And yet, I am in recovery and am doing fairly well.  Why am I okay?  Having financial support is a big reason why I think I am okay.  I know that may not last forever, but for now I am grateful for the space and time it allows me to work through watching over my illness.  Because I have had success combatting my illness due to financial support, I strongly believe that the mentally ill in this country should have the financial support they need.  Guilt free.  The general population has little idea how incredibly horrible the acute stages of psychotic illnesses are, lasting for not months, but years.  I used to say that it was like being mentally crucified.  That sounds so exaggerated, but it really isn't.  If you manage to survive the acute stage and get into the recovery stage, what kind of recompense can you be given for psychological torture lasting so long?  But aside from the idea of recompense for extreme suffering, there is the idea that spending some money is way more cost-efficient than having the mentally ill in hospitals, jails and rehabs or just plain homeless.  We can't afford to keep putting "undesirable" people away somewhere.  So a home, medications, therapy and some means of transportation are all basic needs that must be met for those unfortunate enough to have a severe mental illness.

Other than having my basic needs covered, I pay attention to myself and my voices and, as far as I am able, I reach out and care about a few people.  The computer has been a godsend for me because it has allowed me to meet other people in similar situations, all of whom really impress me with their intelligence, determination to recover and creativity.  Almost all of them are bloggers and many of them are artistic.  Before I was diagnosed as having schizophrenia, I thought people just got crazy and stayed crazy, but this is not true at all.  I continue to submit that psychosis goes through stages from a prodromal stage that leads up to the acute stage, which varies in length from person to person, and several recovery stages.  Many people who aspire to recover or who are actively in recovery start blogs.  I think blogging is therapeutic and informative.  It can boost self-esteem while forming a support network.  It's a positive creative outlet.  For some it is a means of doing advocacy work.  Some people blog daily or every other day, when so motivated, others, like myself just several times a month.  You can go at your own pace.  Life before the advent of the personal computer was very circumscribed for the majority of schizophrenia sufferers.  Especially those living far from active city centers.  The people I've met through blogging or mental health forums have helped me to recover.  I am indebted to them, which is why I continue to blog.  I have the hope that I am helping a few people along their way through mental illness.

My attitude about mental illness is that it is a journey rather than a life sentence.  I work with my voices.  They are no longer the enemy that they once were.  Through Buddhism I have come to see how to use my illness as part of my spiritual path.  I'm grateful to the voices.  They continue here and there to challenge me, sometimes calling me evil, but I feel so far away from being evil.  When I was acutely ill it was as if I were inside an evil world, but now, no longer.  I am free.  More often these mysterious voices tell me that they like and love me and I am comforted.  Perhaps my attitude of working with the voices through active compassion is not the usual perspective, but it is another strong reason why I am in recovery.  From the beginning the voices have been a mixture of good and "evil" with the good trying to help me survive the onslaught of the bad voices.  I have had friends with the illness tell me that some of the people they know have just horrible, tormenting voices that they have to detach from and that's the general view that voices are just plain bad.  I have real trouble believing this.  Even in hateful voices there is something to appreciate such as intelligence, creativity, determination.  Yes, those, too, are woven into the voices.  Even in the midst of hell there can be respite, some kind of humor, detached perspective.  Another point is that during the acute stage things are just that, acute.  The whole situation is perilous and yet you still have to find your way out of it even on your hands and knees, that, or die.  My acute stage lasted for 3 and a half years, possibly because I didn't commit to taking the anti-psychotic medications.  I was fortunate in that early on I was applying compassion to my voices even through my three psychotic breakdowns.  And if some voice did me a good turn, I remembered it.  For a long time into early recovery I was resentful of the voices.  My attitude was "why me?" Gradually as I turned towards Buddhism, the resentment faded.  Now I am no longer resentful which has brought me a lot of peace.

I keep hoping that some sufferer will take me seriously about applying compassion to the voices.  And compassion is part of every religion out there and part of humanitarianism itself.  It's hard to do when you're under attack, but it can be done.  Also, it takes time and repeated effort.  Recovery goes in stages too.  For me, it has taken years to get to this point, over a decade.  I think the more resistant an individual is the longer it takes, but as water over time smooths the roughest stone, so does compassion reduce the general suffering.  When I talk about compassion, I always mean it to include compassion for oneself as well.  Self-acceptance and friendship is really a must.  Most voices during their abusive phase, try to tear the individual down and that is why you have to build yourself up, not by being an egotist, but by loving and caring for yourself.  It is the individuals who internalize the voices negativity that get caught in self-destructive cycles.  Resist that negativity and eventually you liberate yourself and possibly the voices as well.

The Mind-Body Connection

Thank you Karen, for your thoughtful response to my last blog post.  I can definitely understand how you could feel angry at your schizophrenic friend for committing suicide.  Just about all of the people I've encountered online who have mental illness strike me as extraordinary and not freaks of nature.  If anyone one of them were to kill themselves, I would be very upset because it would seem to be such a waste of rich, human potential.  But, as you pointed out, it does take guts, strength and courage to survive and during our weaker moments sometimes we just give in and give up.  My ex-boyfriend committed suicide in 1999 when I was still quite psychotic.  My reaction then was shock and numbness.  I knew he was overwhelmed by his circumstances (paraplegia and dual addictions) and so, for him, I wasn't angry, just very sad.  I tried to put myself in his place and I realized that I, too, might have considered suicide.

You also wrote about how devastating family influence can be on those who suffer from serious mental illness.  I hear that and know that there's truth to it, though it can also work both ways depending on the family and the extent of a person's illness.  Some family members may be ignorant yet not abusive and generally well-meaning.  I've been very fortunate in that my family has been that way.  They provided me with a home and transportation and access to a therapist on a weekly basis.  I went insane mostly on my own private turf alone.  That was a blessing because I didn't pull them into my illness, but also difficult because I lived in such isolation.  I've since almost come to terms with my isolation because I know I impose it upon myself in order to reduce stress in my life.  People can be wonderful, can be stress reducers, but they can also create situations of daily stress.  So you're right, I don't have to live up to other people's standards of what should be my normal behavior; instead, I decide for myself on a day to day basis.  I also in turn give up most face to face friendships, have no support from a mental health support group and no place in my local community.  Because I have the financial support of my family, I have made the choice to be a recluse.  I know full well that many people don't have this ability, they live with their families and therefore the family dynamics come into play each day, each night.

When I compare the negative thought processes of mental illness to an addiction, I know I'm perhaps jumping to a conclusion, but, to me, it makes a fair amount of sense.  I look at my journals from when I was very psychotic and my delusional thoughts are as pervasive as an addictive substance.  I keep repeating the same pattern of thought over and over again and remained stuck inside something I almost wasn't willing to let go of.  I had an obsessive need to re-confirm my delusion each day and didn't leave room for other, healthier perspectives.  It wasn't my brain that was failing me so much as my own unshakeable attitude.  You wrote that the anti-psychotic medications make you less suicidal and I believe that; they make me less delusional and paranoid, but the drugs alone are not enough to get through this life.  You have to work a program inside your head, which includes monitoring what your thoughts are telling you and how it makes you feel.  I do that when I talk into a tape recorder each day and then listen back to it.  Or when I write in a journal and then re-read it.  I do the same thing when I write a blog entry or send an email to a friend.  Most often, when things go wrong for me, it's not outer circumstance and people, but my own mistaken assumptions and attitudes.  This is very good news because it places the power to change negative circumstances in my grasp.

There's a Tibetan Lojong slogan that goes, "Drive all blame into the one."  The one means into yourself. This is not an instruction to be a masochist, it's an instruction to realize just how much self-centeredness figures into negative circumstances.  When you take on the responsibility of truly taking care of yourself, you realize that no-one has the ability to make you unhappy but yourself.  To send the blame outwards is to give up control over your life.  In my last blog I was being critical of the media, but really, if I am aware, it is up to me how I respond to the media, just as it was up to your friend who committed suicide how he responded to his family's shame.  One problem is that we don't respond, we react and there's a big difference.  A response is measured and thought out and civil, a reaction is unmeasured, thoughtless and often angry.  My brother has called my mother a "reactionary liberal" meaning she doesn't stop for a moment to consider the other right leaning perspective, instead she gets indignant and the problem remains a problem.  We all have a tendency to do this, but it is a tendency that can be arrested.  In meditation that tendency is called practice and practice involves returning to the breath when you get caught up in self-centered thinking.  You learn to let go of the reaction and allow room for the response.  In addictive thinking my reaction to seeing someone smoking a cigarette is to want to smoke one myself, but if I interrupt that reaction and respond to myself with compassion, I can let the craving go.  If I apply the balm, the wound begins to heal.  The hard part is becoming aware of what it is you do, where the traps and triggers are and how to avoid them or override them.  The next hard part is just not engaging in the addictive activity.  Both are very hard to do, but it can be done, that's the main thing.  It is not impossible or someone else's fault or responsibility.  That's the thing about addiction, it's self-contained.  It really has very little to do with other people.

I place psychosis and addiction in the same general category because they are both about physical illness and mental illness combined.  Maybe the physical illness came first, but maybe not.  Addicts talk about having an addictive personality, but lots of people who would not be called addicts have addictive personalities.  We learn through repetition both positive behaviors and negative behaviors.  It is fair to say that someone with an addictive personality will become an addict of one sort or another if he or she engages in risky actions.  The mental illness precedes the physical illness (though not the genetic predisposition).  And honestly, I wonder about that in terms of psychosis.  Is it possible that our thought patterns could actually create physical imbalances/illnesses making a cycle, so that even if you took the anti-psychotic medications your thoughts could be working against your recovery?  We too often overlook the mind/body connection.

My purpose in bringing all this up is because I care; I don't want to lose anymore people to suicide when I feel and believe that they can overcome some of their negative circumstances through working with the very mind that seems to be betraying them.  There's a saying that goes, "Happiness is an inside job."  Well mental health is an inside job, but no one outside of you is watching over what you do except yourself, which means you've got to be very honest with yourself and keep monitoring your thoughts and feelings.  I will never say that it is easy.  It is not easy.  But it's worth it.

On Suicidal Thoughts

Several of my friends suffer from bouts of suicidal ideation despite taking medications for depression and/or psychosis.  After my last psychotic break close to 10 years ago, I, too, fell into suicidal depression while taking greater and greater doses of my anti-psychotic medication.  I spent a lot of time considering and imagining how I could end my life.  Ultimately, I settled on death by carbon monoxide poisoning in my garage.  Obviously, I didn't do it, but for a while I really wanted to.  From what I can remember, thinking about the ways I could kill myself became like an addictive narcotic.  It was oddly soothing to get serious about once and for all ending my suffering.  Instead of doing that I just held on through the following months of this.  My depression after my last break was so strong that I couldn't do much of anything.  I wound up forcing myself to go to a good local library so that I could check out a bunch of audiobooks to listen to and that's how I spent hours of my time, passively listening to story after story.  It made me realize that there was a larger world outside my sad corner of it.  It made me realize that other people were also struggling, yet living to tell their stories in a therapeutic way.

Suicide is the leading cause of death amongst schizophrenia sufferers covering about 10 percent or more of all deaths.  It's a massive problem, one that I think could be partially remedied through the reduction of the stigma attached to the illness.  The people I know attack themselves for not being "normal"; their self-esteem is always shaky.  There is a before/after scenario going on in their heads.  Before the illness struck them they were still a part of the human race, but afterwards they see themselves as defective, lacking in basic human resources such as the resilience to take on the responsibility of having a family, a job and a place in their community.  Even if they do have a family and/or a job and/or a place in their community, they are acutely aware that they have these things but at a greater cost than the general population.  They tire more easily and suffer from stresses that "normal" people would shrug off.  Their ability to get things done and to stay organized is challenged.  They fall into regularly comparing themselves to others, especially extremely successful people.  These comparisons in particular I think are the culprit that spurs on suicidal ideation and underlying these comparisons is this pervasive sense of isolation even when in the midst of people.

Is life easy?  No, it is not and that goes for all of us.  Yes some people are on the top of the Wheel of Fortune, but they can't stay there.  The illusion that there are people out there who are deliriously happy all the time is something that is taken for granted.  The media gorge on showing the success of popular figures who never seem to age and who stay forever bright, talented and wealthy.  Of course they also gorge on the crashing failures ad nauseam, and yet people continue to believe that some people are statically successful.  They are not.  They eat, shit, puke, age, worry and die just like the rest of us.  This is a very important point.  We ALL suffer.  No one is exempt.  To stay stuck in the comparison game, which is also more addiction, is to live in a delusion.  Easily said, but how do you stop comparing?  When you live among people, it is very difficult for even "normal" people to abstain from comparing their lot to someone else's.  Television brought the rich world into poor living rooms years ago and that continues with films and computers.  That is the lay of this land, there are those who have and those who have not.  But again, it's an illusion.  People who have also get struck by calamity, just as people who have not escape from calamity.  It's the luck of the draw.

So how do the handicapped who feel their disability every day fight off thoughts/feelings of suicide?  How do you get someone who wants to die to be willing to fight to live?  There's no easy answer, but I think it is very healthy to talk/write about these thoughts and feelings to other people.  That's a healthier response than shutting down and closing people out of your life.  It's also less shame based and it gives other people the opportunity to share their own stories of struggles.  For myself, believing in a higher power helped me to stay alive, though I know there are those who do not believe, but for them as well, there must be a belief in something greater than yourself, a cause or organization of people.  Belief in something greater puts your place in a better perspective.  You are not a god or demi-god with the weight of the world on your shoulders, you are instead a small but essential part of the whole.  Believing in a higher power is especially motivating because it involves the unknown potential in all things.  To suspend disbelief is to open to the world around you.  For me suspending disbelief means believing in the Buddha Nature of all living things, a belief in our essential goodness.  Belief in that one thing takes a great burden off of me.  I don't have to shame myself or others.  What I do have to do is understand myself and others to the best of my ability, understand and then communicate honestly.

Besides communicating with others and having a belief in something greater than yourself, you have to work on years of conditioning, the conditioning of seeing the glass as half empty instead of half full, years of negative thinking or what 12 steppers would call "Stinking Thinking".  And again, the addiction model I keep bringing up hooks in with the phenomenon of suicidal ideation.  In fact, suicidal ideation IS stinking thinking.  If you can become aware of your thought pattern while honestly acknowledging that it is unhealthy, you then have a choice in front of you.  Glass half empty or half full?  Do you stay with the negative thoughts which invariably wind you up back in thoughts of self-destruction or do you take a look around you and break out of your tunnel vision?  It's the tunnel vision of addiction--you take the substance, or do the action, or obsess on the thought which will bring pain to you, but before the pain comes the pay-off, the pleasure and yes there is pleasure in negative action/thoughts.  Some would call it comfort.  The comfort of doing things the way you've always done them.  And then the pain comes and seems to justify all the negativity making it all by then a vicious cycle.  Still, think back...there was a moment when you were aware of your negative thoughts stirring, when you had a choice.  Well, that choice always returns as long as you let yourself become aware of what the hell it is you are doing.

I still have suicidal thoughts when I get depressed, but I don't take it into the fertile ground of my imagination.  I leave it be.  So it never gets into the planning stage.  The challenge for me now is to not only stay alive but to find my place here and that means sitting with my own discomfort.  It's a conundrum, a riddle--how to live in this sea of constant change, this dimension of pleasure and pain.  It's also a challenge for every one of us.  I do believe that Nirvana exists and it is right here, right now.  Change your attitude, change your life, that's essentially what Buddha did when he woke up.