Simulated Reality in Schizophrenia

Last week for PhilosophyFriday we talked about simulated realities and the “Brain in a Vat” thought experiment.

Today, for PsychologyTuesday, I’d like to discuss schizophrenia and how the people suffering from schizophrenia perceive their world.

First, however, I’m going to have to make something very clear.

As a Clinical Psychologist, I cringe every time when I hear someone say: “Schizophrenia? Isn’t that, like, when you have six personalities?” No, folks, that is not schizophrenia, but Dissociative Identity Disorder (better known as Multiple Personality Disorder).

Then, what *is* schizophrenia? Let me elaborate.

The symptoms and subtypes

The DSM (Diagnostic and Statistical Manual of Mental Disorders) lists the following symptoms as typical for schizophrenia:

- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized behavior (e.g., dressing inappropriately, crying frequently) or catatonic behavior
- Blunted affect and emotions, apathy, poverty of speech and/or thought (collectively called the negative symptoms)

To be diagnosed with schizophrenia, the patient needs to have showed two or more of these symptoms for two months (although there are exceptions. See this page for a more detailed overview).

You can see a (very old) video of a patient named Jerrrold here. He shows most of the typical symptoms related to schizophrenia.

There are several subtypes within the illness, and I will discuss three of them:

The paranoid type

The paranoid schizophrenic has a preoccupation with one of more delusions or has frequent auditory hallucinations. They are of persecutory nature – that means that the patient is convinced that his partner cheats on him, or that the FBI is chasing him (these are very common examples). The hallucinations, or voices, often order the patient to do (or not do) certain things.

Noteworthy is that in the paranoid type, the negative symptoms are (mainly) not displayed.

This is a video of a person who has lived with paranoid schizophrenia.

The catatonic type

The illness in the catatonic type is defined by the immobility of the patient because of their extreme loss of motor skills, or by excessive, but purposeless, motor activity. They are often extremely negative, or don’t talk at all. Sometimes they also display echolalia, which means that the person automatically repeats whatever another person says.

The disorganized type

Especially disorganized speech and behavior and especially blunted affect is common for this type of schizophrenia. The patient shouldn’t show any symptoms from the catatonic type of schizophrenia.

This video shows Peter, who was diagnosed with the disorganized type.

Schizophrenia, the worst psychiatric disease there is

Perhaps a bit dramatic, but generally, schizophrenia is seen as the worst psychiatric disease there is. Not just by the person suffering from the disease, or the family members of the patient, but by psychiatrists and psychologists. This has several reasons. Often, the disease is seen as chronic. The patient has to take medication for the rest of their lives to subdue the symptoms, but the medication often has very severe side-effects (see a – huge-  list of side-effects of antipsychotics here). Because of those side-effects, the patients often stop taking the medication. However,  as soon as they stop taking the medication, relapse is immediate. Of all people with mental disorders, schizophrenics commit suicide most often (much more often than those with bipolar disorder or depression) and because of that it is the most deadly mental disorder.

The simulated reality of a schizophrenic

You might have noticed I haven’t said anything particular about visual hallucinations. While they do occur in schizophrenia, they’re much rarer than auditory hallucinations. Have you ever considered that there are other types of hallucinations as well? Although they too occur much less often than auditory hallucinations, some people with schizophrenia report olfactory (most often unpleasant smells such as urine, rotting flesh or smoke), tactile (for instance, bugs crawling beneath the skin) and gustatory hallucinations.

In movies, they often focus on the visual hallucinations. That’s probably because olfactory hallucinations don’t make for interesting material! There is one movie, however, that portrays the life of a (paranoid) schizophrenic very well. Hopefully you’ve seen the movie because I can’t not spoil some of it!

It’s called A Beautiful Mind, and Russell Crowe plays the main character, John Nash. John Forbes Nash Jr. (the person the movie’s based on and a Nobel Prize winning mathematician) suffered from extreme paranoid schizophrenia, and experienced visual hallucinations and severe persecutory delusions.

People with schizophrenia often don’t realize that they’re hallucinating. 50% of all schizophrenics are anosognosic (anosognosia – it means that a patient doesn’t recognize the illness they have).

Anosognosia means for the schizophrenic that they don’t realize they need help – much like John Nash in A Beautiful Mind, he even found joy and purpose in his hallucinations (he had few friends, and so one of his hallucinations became a good friend – not all hallucinations are necessarily negative ones).

In the past, anosognosia in schizophrenics was attributed to denial, and the patients were treated that way. However, that kind of  treatment did not work, as people in denial would soon come to see that their hallucinations are not real, but an anosognosic schizophrenic can’t.

Those with schizophrenia are mostly convinced that what they see is real and aren’t aware that it’s not. This makes for a simulated reality that is so real for the schizophrenic that the only means a psychiatrist has of helping a schizophrenic is to prescribe medicine, and by now you know what that means. There are barely any ways to convince a patient with schizophrenia that their world is not real by talking to them, not in the least because they can’t even communicate properly themselves.

Could you say the brain of a schizophrenic is a “Brain in a Vat”?

In a way, I guess you could say it is. Their brains simulate their own reality, much like the supercomputer would do, which the “Brain in a Vat” theory suggests.

What do you think?