Schizophrenia is a chronic and debilitating mental illness which disrupts the quality of life of individuals and their families. Arguably, schizophrenia is one of the most stigmatised and misunderstood psychiatric disorders. After more than a century of research, the causes of schizophrenia remain elusive to both neuroscientists and psychologists.
Craig Finn’s ‘self-portrait’ is an arresting image often used by educators when first introducing schizophrenia to students.
The causes of schizophrenia remain mysterious, and our ability to help patients is relatively poor.
Things become complicated by the heterogeneous nature of the disorder; experiences are very different across individuals.
In an attempt to characterise the disorder. doctors and scientists have grouped the multifaceted range of symptoms into three main domains:
Positive symptoms: delusions, hallucinations and ‘distortions to reality’.
Negative symptoms: social withdrawal, self-neglect and often ‘depression-like’ symptoms.
Cognitive deficits: problems with decision making, attention and memory.
From Micro to Macro
I’m Ashleigh, a final year PhD candidate in neuroscience, whose doctoral research has focussed on the biological basis for schizophrenia. Over the past four years, I’ve spent most of my time looking down microscopes and considering schizophrenia at the ‘micro’ scale.
After a few years of examining these tiny molecules, I started to consider psychiatric disorders and their implications on the macro scale. Over time, I started to see find unexpected parallels between schizophrenia and our modern, hyperconnected society.
I believe there are lessons which we can all learn from schizophrenia, especially as we attempt to navigate our ever-changing technological landscape.
These ideas didn’t arise from any laboratory breakthrough or academic pursuit. They were sparked from seemingly innocuous social media newsfeeds.
Information Overload
Let’s start experiences which I think we can all relate to: the pervasive social media news feed, the unread email inbox and the 24-hour news cycle.
When I first started my PhD, I came up with the ‘genius’ idea of curating a social media news-feed that would deliver me the most important new discoveries in neuroscience. I logged on to Facebook and Twitter and followed, followed, followed.
I tracked down news pages, prominent scientists and journals. I joined Facebook groups and set up notifications for forums.
‘I’ll never miss a beat’, I thought. ‘I’ll be up to date with everything. Always.’
Before long, I found myself wading through enormous Twitter feeds, bombarded with notifications and equipped with a ‘to read’ list that I’d never reach the end of.
What’s more, I was accessing this information via social media, where I follow all of my friends. Hence, my newsfeed was inevitably peppered with posts from them… And they were down at the pub, they were on some sunny beach or scaling a beautiful mountain in Scotland.
‘How are they managing all of this? I can barely keep up with the dishes.’
And there I was, alone in my living room, completely paralysed by the information that I’d signed up for.
Looking back, I recognise two key symptoms.
Firstly, I had a serious case of information overload; the volume of information was overwhelming to the point that it wasn’t useful anymore.
But more than that, I had a completely distorted perception of reality.
Between the volume of information, conflicting articles and all of these ‘perfect moments’ posted by my friends, I ended up with a completely distorted perception of myself and of reality. My view of who I should be, what I should be doing and what was expected of me was entirely awry.
So, what has this got to do with schizophrenia?
Here is the concept from neuroscience which first propelled me down the path of drawing parallels between schizophrenia and the information-rich, connected world we live in:
Sensory gating.
The Sensory Gate
Sensory gating is the neurological process by which we filter out or ‘gate’ redundant or non-important sensory information from the environment.
When sensory information comes into the brain it is transmitted to a region called the thalamus. Within the thalamus there are a set of neurons which are essentially responsible for sifting through all of this information, deciding what’s important and projecting the significant stuff up into the higher cortical regions, areas which deal with things like decision making.
Everything else is filtered out.
Our sensory gating mechanism is critical for our survival, but also for or ability to thrive, communicate and interact in our environment.
It is your sensory gate that allows you to listen to a friend talk in a bustling coffee shop for more than a few seconds, without completely distracted by the crunch of grinding coffee beans or the hiss of milk foaming.
What we observe in schizophrenia are abnormalities in the sensory gating mechanisms.
It’s as though patients with schizophrenia have a ‘leaky gate’.
The inhibitory neurons of the thalamus aren’t operating as they should and subsequently, excessive information floods into the cortex. From here, we start to see various symptoms of schizophrenia arise.
Are we the ‘leaky gate’?
As I noticed the barrage of information that we’re all subjected to on a daily basis and felt the consequences of this in my life, I started to wonder…
Are we, as individual information consumers, behaving like this ‘leaky-gate’?
When we interact with our news-feed in a way that’s unfiltered; when we fail to consider the quality, source relevance of value of the information that we’re being presented with, we’re behaving similarly to those dysfunctional thalamic neurons.
We open the gates wide and allow just about everything to stream in.
I think we can draw a lot of important analogies from schizophrenia in this regard.
Coming back to my personal experience, I found over time that I began to have a completely distorted perception of reality. I find this very analogous to some of the positive symptoms of schizophrenia.
Beyond that, there’s research which highlights the negative impact that social media can have on mental health, including increased rates of anxiety, depression, apathy and confusion. These symptoms are all very analogous to the negative symptoms and cognitive deficits of schizophrenia, some of the core aspects of the disorder.
This realisation was important for me as an individual, and I felt that it might be helpful for others suffering from similar modern problems.
I quickly realised; these analogies aren’t confined to the individual.
Our hyper-connected society
We don’t live in isolation. Just as a single neuron doesn’t form a brain, one human doesn’t constitute a species.
This isn’t a revolutionary statement. We’ve always lived and organised ourselves in communities. Humans are an innately social species; it’s how we’ve survived and thrived.
With the advent of the internet, social media and global information sharing, we’re more connected than ever. And, with the importance of sociability to humans considered, I supposed that things should probably be better than ever.
I looked around my own research community and realised that this wasn’t the case. Our hyper-connect, information-rich world didn’t seem to have been beneficial as I’d expected…
The first diagnosed case of schizophrenia was documented well over a century ago. Sadly, the understanding of the disorder and mental ill-health was rudimentary.
Treatments were often cruel and people were mistreated for many years. Research progress was slow and meaningful developments in therapeutic interventions were few and far between.
It’s important to remember though, that during these years, research proceeded at a much slower pace. Scientists and doctors couldn’t access information as freely and with such immediacy as we can now. Sharing their work, experiences and perspectives to research communities further a-field could be challenging.
The world of research couldn’t be any further from this now.
Modern scientists exist in an incredibly fast-paced and hyper-connected domain. The digital era has ushered in a global network of researchers, with world-wide collaborations now being somewhat common.
The information published and available has exploded too.
There are multiple journals dedicated entirely to schizophrenia research, with contributions spanning from neuroscience and psychology to immunology, physics and computer science.
Scientists even have their own social network, ResearchGate.
But, despite this wealth of information, despite all of this connectivity, we’re still not that much further forward in our ability to actually help people with schizophrenia.
I wondered, ‘what’s going wrong?’
Last year alone, thousands of scientific papers were published with the keyword ‘schizophrenia’, many of which went uncited.
Information is missed, overlooked and lost. We’re experiencing an overwhelming flood of information.
But ultimately, the way in which scientists interact with this information shapes the way research questions are formulated and conducted, and this shapes our understanding and ability to help patients.
We simply can’t catch everything. But, there’s nothing harmless about missing or overlooking information. The consequences are damaging.
Consider this scenario. You’re a scientist with a specific hypothesis. A literature search would reveal to you that, in fact, research published a few years ago resolved or better shaped this question.
But you missed it amidst the torrent of research published daily. Instead, you and your colleagues spend months, possibly years, chasing their tail on a path leading nowhere.
It’s wasted time, and it doesn’t bring us closer to finding solutions.
We have impressive tools. We have intricately designed technologies. However, the weight of unfiltered information weighs heavy on entire communities, harming their ability to progress at the rate at which they are capable of.
Information overload doesn’t just affect the individual, it impacts the movement and progress of entire communities.
From community to society: ‘global’ brain dysfunction
Now, wherever you’re reading this from, I’d like to ask you to engage your imagination and play along with me for just a second.
Consider yourself as one intricate and beautiful individual neuron. Now consider everyone you know in a similar light and imagine that together, as a society, we make up a network of neurons. Something like a ‘global brain’ that is interconnected and ever-developing.
Think again about the dysfunctional neurons in the thalamus of a patient with schizophrenia.
Consider how those tiny dysfunctional neurons can lead to brain-wide functional abnormalities. Ultimately, wide-scale neural disruption can distort the reality perceived by an individual and impair their ability to interact with others and the environment.
If we’re behaving like those dysfunctional neurons in our individual interactions with our new-feeds and our communities are malfunctioning under the weight of these streams; then, our society is going to start behaving abnormally and in-cohesively.
I believe we’re observing symptoms of this around the globe.
It’s easy to miss this when we’re all so wrapped up in the bubbles of our daily lives. It’s easy to lose sight of the big issues, what really matters and of each other in a torrent of thousands of opinions, facts and concepts; often summed up in 140 characters or less.
Quality Control?
Let’s returns for a moment to the ‘leaky gate’ in schizophrenia, whereby vast quantities of redundant information flow into the cortex without appropriate consideration of their quality.
Quality goes hand in hand quantity when considering information. And while we can have control over the of the quantity of information we consume (we can limit exposure, hide posts, filter our news feeds). What about our control over the quality of our information streams?
The Danger of Echo Chambers
All forms of our news-feeds are subject to some amount of analysis, and companies implement a range of algorithms which enable you to see more of what you like and more of what your social group likes. In the end, we end up with a tailored stream of information, unique to the individual.
While you might find it a relief to miss out on updates from Kim Kardashian, or the Conservative Party of Britain; we ought to tread carefully with this hyper-customised information flow.
I believe we must remain vigilant and take care that our online interactions don’t become individual echo chambers, potentially providing each of us with our own slightly distorted perception of reality.
I’m a neuroscientist and it seems I think in all things brain and neurons. So, before I finish, I do have a couple of extra concepts from neuroscience which I think we all should consider:
Synaptic Plasticity & Synaptic Pruning
Synapses are microscopic pieces of machinery which neurons use to transfer information and communicate with each other. Synapses signal information between neurons and allow us to function.
Synapses are essential for every action and ability that we have, everything that we learn and everything that we remember.
Synaptic plasticity is the ability of these information-transmitting synapses to strengthen or weaken over time in response to increases or decreases in their activity.
Synaptic pruning is the process by which weakened synapses, which are rarely or never used, can be eliminated or ‘pruned’.
This process works on a kind of ‘use it or lose it’ principle.
It’s an efficient way for our brains to store the information that we need, while allowing enough flexibility for new thoughts, memories and experiences.
For anyone who has ever tried to learn a new language, you’ll know how quickly you can lose your skill without practice. That’s until the point where these synapses become so strong, so important, so highly active – that it becomes like ‘muscle memory’.
We see some evidence of abnormal regulation of synaptic plasticity in schizophrenia, meaning that synaptic connections are being managed in a manner that isn’t effective in the long term.
It’s suggested that this can lead to some dysconnectivity that is observed in the neuronal networks of schizophrenia patients.
It’s not that there aren’t synaptic connections, just that they’re a little bit disorganised, a little bit mismatched.
If we apply the concepts of synaptic plasticity and pruning to our news-feeds, the things we interact with less often will gradually disappear. This is true of many news-feed algorithms that are currently in place.
Although in some sense this appears to be useful… Because you just don’t want to hear one more word about reality television! It may not always be advantageous; it can lead to a very one-sided feedback loop. Slowly disconnecting you and your immediate community from wider society.
Very slowly and incrementally, small echo chambers for individuals and for communities can be created on these platforms.
This is essentially distorting the view of reality.
Of course, the beauty of diversity of perspective is the range of new ideas and concepts that it can spark. But we can’t have a real conversation without looking at each other in the eye.
We can’t solve problems with just one perspective or outlook. Whole arguments or opinions in a societal conversation can be missed. And without access to those opinions you ‘can’t believe someone could hold’, without knowing about these seemingly ‘ludicrous perspectives’… We are simply in a feed-back loop.
We’re hyperconnected, but we’re not communicating.
With our information gates left wide open, we risk information overload. With a narrow field of vision, we risk pruning critical perspectives.
How do we address this challenge? How do we make these information streams work for us?
When I first addressed these ideas in my TEDx talk, I wrote the talk for individuals, but I shared them with an entire community.
I’ve never had all of the answers, but I’ve always believed in the importance of posing the questions.
As I write this article, I’m trying to reach us all as a society.
Change starts with us all on an individual level, but it ends widely across our whole society.
And, with that in mind, the small changes we implement as individuals, the ideas that we spread, and the ideas that we listen to, are vital to the health of our society.
“If subjective worlds are experienced too differently, there occurs a breakdown in communication…And there is the real illness.” – Phillip K Dick
I hope that’s a lesson from schizophrenia that we can all learn.
I’m Ashleigh, a neuroscientist who loves to write. If you enjoyed the ideas presented in this article, you can check out a filmed version of my TEDx talk where I unpack these ideas further.
Thanks to my friend J Kennedy for creating all of the incredible animations, and for filming the talk.
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