If medical literature was a love letter I would print your words and keep them close to my heart.
Thank you for an outstanding article.
Posted by: nemo at October 17, 2007 10:44 AM
As NAMI and others keep saying... It is NOT MENTAL ... it is biological. It is the BRAIN.
I had chicken pox while pregnant. The doctors all suspected the fetus would be affected, but when the baby was born, she "looked" fine.
It took another couple decades to figure out that a part of her brain really HAD been affected.... which in turn had been affecting her entire body.
Posted by: Naomi at October 18, 2007 06:59 AM
Pregnant women should avoid hanging out with young mothers for a mere 9 months, because young children are germbags and if the pregnant women succumbs to infection their child may suffer lifelong mental problems, surely a small price to pay;
Posted by: Matt at October 18, 2007 07:30 AM
Hi Contributors - I'd like to make two points:
1. All the schizophrenia researchers we talk to tell us they think the research clearly shows that there are both psychological and biological factors that contribute to and cause schizophrenia. In fact they say it is both "mental" and "biological" - both areas contribute stresses and toxins to the brain. Addressing both areas is important for prevention and optimal outcome for those that do develop schizophrenia.
2. There is some truth to the idea that young children are frequently passing germs around because of their frequent contact with other sick children in playschools and other schools. We've seen information that suggests the most important thing for a future mother is to avoid getting exposure to the infections by avoiding close contact with infected people - and also to wash your hands frequently if you ever do touch a potentially ill person. Of course, this can be difficult depending upon one's career and if a person already has children.
Posted by: szadmin at October 18, 2007 08:39 AM
You cannot "avoid young children" when you already HAVE "young children". The only real solution is for scientists to have proper treatments available to pregnant women for when they inevitably do become ill, and more vaccinations. At the time I got chicken pox, there was no vaccine for it. The baby was BORN affected - so there was no "mental" component to it.
Posted by: Naomi at October 18, 2007 02:42 PM
szadmin, would you be kind enough to explain to all what is the meaning of your distinction between 'mental' and 'biological' areas? This is not clear to me. Thanks in anticipation.
Jean (John) C. Desclin (Ph.D., M.D., Brussels)
Posted by: Jean Desclin at October 19, 2007 02:17 AM
I think I can answer your question Jean, mental I belive would mean an event that cause some kind of damage to a childs mind other than genetic, viral, parasitic, substance abuse, physical abuse, or dietary deficiencies for example emotional or verbal abuse. children that are subjected to emotional or verbal abuse are thought to have impaired brain development, which incresse there chances of developing schizophrenia later in life. To my knowledge emotional and verbal abuse has been linked to schizophrenia several times, althought as yet it has not been conclusively proven. Basical mental in this instance means causing a child so much emotional distress that it cause damage to a developing childs brain.
Biological means factors other than emotional or verbal abuse, for example viral infections(Flu, HPV), parastes(Toxoplasma gondii), genetic disposition and so on.
Posted by: nemo at October 19, 2007 03:43 AM
Nemo, I am afraid this does not answer the question. so-called 'mental abuse' has indeed not been proven to cause schizophrenia
Posted by: Jean Desclin at October 19, 2007 08:17 AM
Jean you are correct mental abuse has not been proven to cause schizophrenia, it has been linked to schizophrenia, as has stress in general.
Please read the information available on the following web pages,
Stress and schizophrenia
Social Stress and schizophrenia
Social Isolation, Stress and schizophrenia
"enriched environments" lower schizophrenia risk
Child Abuse and schizophrenia risk
I hope these pages can provide you with the information you seek.
Posted by: nemo at October 19, 2007 08:58 AM
Hi Jean,
What I mean by "mental" is psychological or social factors. All the researchers that I've talked to say that both psychological factors and social factors (in addition to prenatal and postnatal biological factors (lead exposure, nutritional deficiencies, infections, etc.) are all linked to increased risk for schizophrenia.
Of course - researchers and psychiatrists are also saying that psychological and biological factors are basically the same thing - but viewed at different levels. see this write-up to read more on this topic: Psychological and Biological Influences in Schizophrenia Risk
For additional information on Risk Factors - see our listing of news on this topic: Schizophrenia Risk Factors and causes
Given your knowledge - would you agree with what these researchers and psychiatrists are saying?
Posted by: SzAdministrator at October 19, 2007 01:31 PM
If everyone is correct ... we are probably talking about DIFFERENT illnesses all getting lumped under the same "schizophrenia" label... much like we used to think hypothyroid was "schizophrenia" because we didn't know any better.
As we continue to tease apart what is what, I hope less medical cases will be lumped under the "mental illness" label simply because we will know the actual cause.
My baby was not born with a "mental" problem - she was born with a brain problem.
Posted by: Naomi at October 19, 2007 03:33 PM
Dear Mr Szadmin., as an answer to the question of whether I agree or not with what you report of the opinions you were told by some researchers, I would like to quote the following sentence: "But just as the dancer and the dance are indistinguishable, so too are the brain and the mind. They are two different words that refer to the same thing/activity, and neither exists without the other in living human beings."
Prof. Nancy C. Andreasen, M.D., Ph.D.: Brave New Brain, p. 27 Oxford University Press 2004, ISBN 0-19-516728-7
Much confusion also results from not defining the meaning of words. To me - and I am confident I share this with
most scientists, 'mental' is not some virtual thing, it is tightly dependent on the activity of the brain: it is a process.
Let me also quote from renowned US psychologist Barkley (an acknowledged authority on ADHD): "Most
findings on etiologies are correlational in nature, not permitting direct, precise, immediate molecular evidence of primary causality. But then that is the case for all psychiatric disorders..."
Most of the so-called evidence in favor of 'psychological, social, cultural, etc.' influences on the development of schizophrenia is of the post hoc propter hoc kind: correlational at best. Causality and correlation are two completely different things!
By the way, I completely agree with Naomi's post.
Posted by: Jean Desclin at October 20, 2007 01:50 AM
Hi Jean,
I completely agree with what Dr. Andreasen and Dr. Barkley suggest in your quotes give. I believe that their viewpoints are entirely consistent with the information we provide in the links I've given above.
Here at schizophrenia.com we follow what we believe is the most widely taught general model for psychiatric illness - specifically the Bio-Psycho-Social Model that holds that biological, psychological and social factors all are (or can be) significant contributors to mental illness. This is the model that the researchers and PHD students we talk to on a regular basis at Harvard, Stanford, University of California (UC Berkeley, UCSF and UCSD) subscribe to and encourage us to follow, and those are the schools where most of our graduate students who work on the site come from. I have no idea if this is the predominant approach taught in the universities in Europe, but it is here in North American. You can read indepth about the bio-psycho-social model here:
Bio-Psycho-Social Model of illness
We take a balanced approach to bio-psycho-social model - covering all three areas to significant depth. All of this research into the causes of schizophrenia are relatively early in "proof" stage - and the exact statistical weighting of each of these factors is not (to my knowledge) at all certain, and likely varies greatly on a person by person basis. For some people the biological factors may play a larger role in the development of schizophrenia, for others is likely that the social/psychological factors play a larger role. Additionally, many researchers say that there are likely to be different classifications (or continuums) of schizophrenia - different genes, different pathways or processes with similar outcomes.
Certainly of course you are accurate in the statement that there is a difference between causality and correlation. One of our goals here is to let people know of factors that are under their control and have been linked to schizophrenia so as to help lower the incidence of mental illness in future generations. We'll let the researchers continue to determine whether a given factor linked to schizophrenia is "causal" or "correlated" - but in the mean time we think its important to let families know that there are some factors that may be under their control with regards to risk for mental illness. While some of the factors we list as linked to schizophrenia undoubtedly will turn out to be correlated rather than causal - a significant number of them are (schizophrenia researchers are telling us) are likely to be causal - and we'd rather err on the side of caution in this area. Most of the factors (e.g. good nutrition, supportive and empathetic and loving relationships, a optimistic (or growth) mindset, close friendships, avoidance of child abuse, trauma, neglect, and avoidance of infections, etc.) are likely good things to work towards even if some of them are only correlated (rather than causally related) with lowering the risk of schizophrenia. We are not an academic publication - we aren't waiting for iron clad proof before we cover something. Our focus is on giving people information that they can use, today, to improve their lives and lower the risk of developing mental illness in the future.
Naomi and you seem to focus (correct me if I'm wrong) more on the "biology" aspect of the model. That is definitely one aspect of mental illness. I would encourage you to read up on the latest neuroplasticity research coming out of Dr. Merzenich's neuroscience lab at UCSF - as covered in the book "The Brain that Changes" see link here:
The Brain that Changes Itself. This book talks about research that shows how psychological functioning can change the wiring of the brain - for good or ill.
The research is showing that while the Mind is certainly a result of the Brain/biology - the Mind (i.e. psychological and social factors) have a significant impact on the Brain - as the new field of social neuroscience is revealing. See link here:
Social Intelligence and Social Neuroscience
We prefer a more comprehensive approach that covers all three areas; biology, psychology and social factors so as to provide the most information and most value to our readership. This information on the causes of schizophrenia is primarily targeted at the next generation of individuals who have experienced mental illness in their families - so that they take some reasonable actions to lower the risk for their children.
Posted by: szadmin at October 20, 2007 04:12 PM
SZAdmin,
We can build up muscles, and much muscle damage can be heal. The same applies to the brain. We can improve the brain, and the brain can heal. Yet we do not call damage to muscles "mental". We do not call a biological predisposition to muscle weakness mental, and when there is wasting of the muscle due to polio, nerve damage, or any other insult to the organism, we do not call it mental.
I see what happens to the brain the same. Most severe "mental illnesses" are no more "mental" than the illnesses that ravage muscles.
That does not mean that much cannot be done over extensive time and with great effort, to heal the brain damaged by illness, after the worst has passed - the same way that people can begin to heal and strengthen muscles severely damaged, as long as what is causing the damage has been addressed.
I have seen both the ravaging of the brain by illness (not anything "mental"/"psychological") and I have seen the healing that it slowly does after the severe injury to it.
But as to what caused the injury to the brain to begin with? In the case of what is called "schizoaffective disorder" and "schizophrenia" that has occurred time and again in my extended family, and from what I read from so many others... there was nothing psycho-social that caused it. The only psycho-social impact is on the person's mental health with which the person then proceeds to handle their extreme illness and recover. That is the same mental health that helps any person going through any extreme illness or trauma persevere and handle it.
Mental health (and psycho-social influences) is as important in having a good outcome in schizophrenia (at least the type I know) as it is in handling cancer, MS, war trauma, paraplegia, etc. It does not prevent them, nor does it guarantee a good outcome if the biological insult is too grave.
The emphasis on mental health and raising mentally healthy children is a sound goal and is expounded upon at length in all parenting sites, books, and boards. It is already a goal of every parent who is concerned enough to become educated about their childrens' and grandchildrens' illnesses or potential illnesses.
We all benefit from mental health.
But mental health doesn't prevent neurobiological brain disorders that are being labeled "mental illness" from happening. It just helps the person survive and recover when possible -- just as it does people with cancer, etc.
Posted by: Naomi at October 20, 2007 08:08 PM
Naomi, I could not put it better than you did.
Posted by: Jean Desclin at October 21, 2007 12:08 AM
All I can say is that the view on mental illness that Jean and Naomi have is very different from the bio-psycho-social model of mental illness that the schizophrenia researchers that we talk to say best explains mental illness, (and that is taught in all the psychiatry programs of the leading universities in North America). All we can suggest is that people read and study the scientific evidence that is presented by the news we cover on the factors linked to schizophrenia risk, and make their own decisions.
Since neither Naomi nor Jean are schizophrenia researchers we will have to continue to follow the path that the schizophrenia experts in the field are telling us, and believe what the research results and researchers are saying.
Naomi suggests that mental health has nothing to do with schizophrenia - or as she says "mental health doesn't prevent neurobiological brain disorders that are being labeled "mental illness" from happening".
I'd be interested in understanding how Naomi explains the research that shows how talk therapy (a "mental therapy" for people who are at high risk for schizophrenia, greatly reduces the risk of developing schizophrenia. In other words Cognitive behavioral therapy, or "talk therapy" research is demonstrating that it can (in a statistically significant way) stop the development of psychosis/serious mental illness (what Naomi calls "neurobiological brain disorders" in some significant percentage of the people. Naomi suggests that this is impossible - yet the research is saying it is happening. I think I'll choose to believe the research (though of course more research needs to be done). I don't believe that the National Institutes of Mental Health and other research groups would be putting millions of dollars into this area of research if they didn't believe it would be effective. The fact that as research results are coming out, more money is being invested in this area (the NIMH was recently reported as having dozens of new studies on the effectiveness of CBT) suggests that the results are getting better all the time and the data more compelling.
In fact this is a very active area of research in the world today (see all the research we have on early treatment of high risk people) - and area that Naomi would suggest is impossible. See this link for more information:
Cognitive Therapy May Prevent High Risk Populations From Developing Psychosis
Naomi and Jean are also saying, in effect, that the entirely new field of science - the area of study called Social Neuroscience - should not exist. What they seem to be saying is that psychological and social factors don't have significant impact on the brain and risk of mental illness - which is completely opposite to what many neuroscientists and psychologist are saying and that the new field of social neuroscience is revealing. See link here:
Social Intelligence and Social Neuroscience
How many social neuroscience studies have Jean and Naomi read that gives them the expertise to so easily disregard the entire field of science?
We will continue to report on all aspects of the biological, psychological and social factors that have been identified as potential causal factors in schizophrenia that the world's schizophrenia researchers are uncovering (despite the fact that some people may not like this approach).
Posted by: szadmin at October 21, 2007 08:52 AM
There is also significant research indicating that with enough poitive thoughts, we might have much less illness in general. I think about MS... and I know I have lots of positive thoughts and happiness... but I'll take my dose of sunshine to help prevent MS anyway. Studies also show that positive thinking may help prevent cancer, but I'll try to avoid bad chemicals and too much sunshine for that as well.
If a person needs a significant amount of therapy to avoid the worst of the illness, the person obviously already has the illness, albeit not in the most severe form. I strongly suspect that part of the partial success intervention has shown has been the fact that the people were correctly diagnosed early and not given all the usual incorrect treatments that normally make the illness so much worse - like the stimulants frequently given children who are actually in schizophrenia prodromes. Also, they are probably also avoiding all the other multitude of "no-nos' that would worsen the illness. Such as antidepressants if they have a bipolar component, caffeine, resorting to drugs as self-medication, erratic sleep schedules, etc.
Early interventions in prodrome stages in other illnesses and avoidance of improper treatments can also help other illnesses.
That shows that mental health can help the illness. And proper course of treatment and avoidance of the improper treatments can have a statistical impact on the illness developing to full-blown worse-case condition.
That does not mean that the psycho-social aspect caused the illness, and that is what Dr. Desclin and I are saying.
The fact that the babies are born with autism and schizophrenia prodromes show that these cases have nothing to do with mental health being able to prevent the illness in them. They already have it. Talking, playing and a very enriched environment and extensive intervention helps them. But they already have the illness (the biological insult already exists).
When you talk about me saying things are impossible, you have twisted my words. I am saying the opposite. Mental health is important to quality of life. It helps illnesses. But mental health does not prevent the illnesses that are not caused by lack of mental health. Can a messed up life and mental processes make the illness worse regardless of cause? Of course. But there are many cases of biological illnesses getting called schizophrenia, and the mental health aspect helps them just as much as anyone else.
We keep coming back to another point in this whole discussion... are we sometimes comparing apples and oranges? Are we really even always talking about the same illness(es)? Just because I have a baby who gets labeled with "schizoaffective" after I have chickenpox does not mean it is the same "schizoaffective" as the person who abuses drugs as an adult and gets psychosis, or the person who was born to a mother who abused drugs and now has dopamine receptors inside the brain cells instead of on the surface, nor are those the same as the families whose schizophrenia comes from a mitochondrial defect manifesting itself in the brain. Until there are medical diagnoses for these babies, children, and even teens and adults... we most likely are lumping many different illnesses into the same diagnostic bucket.
I do, believe however, that the parents and grandparents who come to this site are, for the most part, the ones who already are not abusing the kids, taking drugs while pregnant, etc. I suspect that most are the ones who were normal loving parents...who got them the therapy as soon as possible (unless the child was already an adult), tried to keep the kid from abusing drugs as a teen, and their kids got sz anyway - whether because the biological insult was just too great, or the doctors misdiagnosed and gave the wrong treatments, or the child themself chose a wrong path.
But I never - not once - said that it was impossible for psycho-social treatments to help, and I am totally baffled by why that bit of venom was aimed my way. I completely believe that IF a dear person I know with intractable bipolar had not started down the path she had started down, and could have led a healthy lifestyle doing all the right things, she would never have had the severity of the illness she now has. She would have had the illness - but it would have been so much more mild without added components of anxiety, etc.. IF her sleep hygiene, physical health, nutrition, mental health, etc... (these are "psycho-social) had remained impeccable -- something which a person without the illness already would not have to do to not succumb to the severe illness that bipolar can be. After all, most people go through their lives doing whatever and not needing mood stabilizers - the ones who have to be impeccable in their lifestyle already have the biology. It might look like intense psycho-social intervention and adherence is "preventing" the illness - at least the full-blown type... but she would actually have needed all that because she really already had the bipolar illness (biology)... just not as bad as it got with the lousy life-style. I do believe that. But... I also read how one little slip up - like pulling an all-nighter - can be what finally triggers the illness lurking beneath.
I am not your adversary... unless you are saying that all cases of schizophrenia can be prevented by psycho-social interventions, or that lack of mental health is what causes all these cases of neurobiological brain disorders that are getting lumped into the "schizophrenia" bucket... or if only the parents had been better parents, that would have protected the baby/child/teen/adult from getting whatever the problem they later developed (or was born with) that got labeled schizophrenia... or anything like that. And I don't think you are saying that... anymore than I said what you construed.
-Naomi
Posted by: Naomi at October 21, 2007 01:14 PM
Naomi,
This isn't a personal attack - I'm trying to evaluate your claims in your argument and provide evidence to the contrary where I think things we differ on opinion or things may be misunderstood.
I know that we have a lot of shared beliefs in this area - for example your understanding of positive psychology is something I agree with, an also with much of your understanding of neuroplasticity. I think the difference we hold are in two areas:
1. The bio-psycho-social model of mental illness disagrees with your statement that if a psychosocial treatment prevents psychosis or schizophrenia it "does not mean that the psycho-social aspect caused the illness" - The bio-psycho-social model (the primary model taught in medical schoosl today) means precisely that the psycho-social is a contributing or causal factor.
Additionally, when you say "If a person needs a significant amount of therapy to avoid the worst of the illness, the person obviously already has the illness" - in reference to the CBT study preventing psychosis, you seem to believe that even if there are no symptoms of schizophrenia - that a person can still have schizophrenia, and I haven't seen any research to support that idea. The people in the study were, to my understanding, not symptomatic of either prodromal schizophrenia, or schizophrenia itself.
2. You say there are "many cases of biological illnesses getting called schizophrenia" - and I've never seen any data to support this belief. I have talked to many researchers say that there are likely a number of different types of schizophrenia - but they are still calling them schizophrenia(s) - I haven't seen any researchers talking about a significant percentage of the case actually being a pituitary gland disorder or something like that. That may be the case - but please provide some quotes from researchers that support this argument.
Let me cover the first point in more detail:
When the research study is called a "3-year follow up study on the ability of Cognitive Therapy (CT or CBT) to prevent psychosis" - they aren't saying "improves outcome for people who already have prodromal schizophrenia - they are saying "Prevents psychosis" (a key part of schizophrenia). You seem to be interpreting this as halting "the worst of the illness" - but thats not what they're saying. They're saying the person doesn't have the illness - and doesn't get it. They're using the term "Prevent" - prevent means, in the dictionary:"to keep from occurring; avert;" - it doesn't mean to "avoid the worst".
In other words - "Prevent" means to prevent! To stop from happening! You seem to be saying these researchers are wrong - which is fine - but provide some data for your argument.
I think another problem with your commentary is that you seem to be defining schizophrenia as the "biological predisposition" to schizophrenia or mental illness - which is very different than how the psychiatrists, psychologists and schizophrenia researchers define schizophrenia.
You convey this belief when you say "If a person needs a significant amount of therapy to avoid the worst of the illness, the person obviously already has the illness," I know that psychiatrists and schizophrenia researchers I've talked to would completely disagree with you.
If the people getting the CBT have never had, and don't have the symptoms of schizophrenia then they don't have schizophrenia - period. These are simply people at high risk due to family backgrounds. If a child is born without the symptoms of schizophrenia - then they don't have schizophrenia. They may be born with the predisposition to schizophrenia - They may develop it later - but I think most researchers would agree that something triggers schizophrenia - and there are many psycho-social, stress, and other environmental factors (cannabis, etc.) that seem to be these triggers. I don'be believe that any researchers I've ever talked to would say a child "has schizophrenia" at birth. Certainly they've never conveyed that to me. So - therefore - something triggers schizophrenia later in life.
You seem to be saying that if a person has the biological predisposition for schizophrenia (for example due to the Flu during pregnancy) - then they already have schizophrenia and that it just isn't accurate. If you have support for this belief - please link to the research.
Therefore - if, as the CBT study showed, a much smaller percentage of people who where likely to be biologically predisposed to schizophrenia (because their mother had schizophrenia for example), due to a psycho-social environment improvement (e.g. CBT treatment) then I believe that it strongly suggests that it is the psycho-social environment that is triggering the schizophrenia in the person who is predisposed.
Certainly not all cases of schizophrenia are triggered by psycho-social factors - but certainly the evidence suggests a significant portion are. Given the finding from the Finnish study that showed an 86% reduction in schizophrenia in high risk children in healthy family environments - the evidence seems pretty compelling.
With regard to the second point:
You mention also "all these cases of neurobiological brain disorders that are getting lumped into the "schizophrenia" bucket" - which seems to suggest you have a hypotheses that a significant percentage of cases of schizophrenia (or a type of schizophrenia) are purely biological - with no psychological contributing factor. Certainly this could be the case - but I've never seen any evidence and no researcher I've talked to has ever suggested this - and I"m wondering why you have this opinion?
In the key models of schizophrenia I'm familiar with (the Bio-psycho-social model) and the Stress/Diathesis (stress/predisposition) model - both suggest that it takes both factors - predisposition and other ingredient (stress or psycho-social factors) to cause schizophrenia. Its not just one of the factors.
Anyway - I think we've beaten this topic into the ground. I'm moving my attention to future news topics.
Posted by: szadmin at October 21, 2007 03:36 PM
One of the greatest barriers to advancement in mental health has been the egotistical drive to see whose fiddle plays the best tune while for the patient Rome continues to burn.
Posted by: tjg at October 21, 2007 05:40 PM
I do wish the Finnish study, for example, had gone further, or would review its findings in light of more recent findings: for ex, season of birth (compared to fluctuation in the general population), area of residence, flu outbreak in area of mother's residence during pregnancy, nutritional quality of prenatal diet,symptom profile (ex., pos vs. neg symptoms), mental health profile of (extended) birth family, interventions sought (if any) in adoptive family, "unavoidable" stress in the adoptive family (ex., death, unemployment,moves).
Also, were interviews conducted with family members alone, or with others present ? (Can't remember). I only ask because our entire family changed its communication pattern when our son was having a "bad day" (years prior to diagnosis-- prodrome) -- though apparently dysfunctional, we were trying to interact in ways that would not upset him (ex., gentle silliness among us would upset him, as would discussions of any depth).
What effect does the at-risk family member receiving CBT have on the interactions with-in the family ? (Or does CBT help regardless of family enviornment ?)
Posted by: flooby at October 21, 2007 08:11 PM
Hi Flooby,
The Finnish Study was only completed a few years ago (though it was a 40 year long study) - and the findings was specifically looking at the psycho-social aspects. Many other studies have covered the points you've mentioned - generally the studies focus on a couple of key targets so I'm not surprised they didn't add all the other variables to the study. You can check the study again - there were a whole bunch of papers written on the long term Finnish study - but they all came to similar conclusions so we didn't report on them all.
All the interviews were tape recorded in the Finnish study and multiple psychiatrists listened to the tapes and made sure that the analysis was consistent. The procedure included joint interviews with the whole family and the parents, as well as personal interviews with extended family members.
I think its hard to generalize about the impact of CBT on the at-risk family member receiving it - generally it just makes people more conscious of inaccurate thoughts and it corrects them - and this can greatly lower the stress that the person experiences (which is one of the reasons it helps so much). To the degree that those inaccurate thoughts caused problems within the dynamics of the household - it would tend to improve the interactions with other family members. CBT also helps irrespective of the family environment - but the better the family environment, the more its going to help the person.
To learn more about CBT - I recommend you check out the books by Dr. David Burns. They are called "Feeling Good", and "Panic.." you can find them on Amazon.com.
Posted by: szadmin at October 21, 2007 08:46 PM
I guess I fit right into this category. My Mom and her Dad both had schizophrenia. My Grandfather is now deceased but Mom is still alive. I'm due for my first and only child around Christmas. I'm very scared. Very scared of passing any schizophrenia genetics on to my soon-to-be daughter. I'm hoping I don't get sick but because of my current situation I thankfully have no contact with children. I am quite reclusive so that keeps me statistically less likely to be in touch with germs though that is not the reason why I live the way that I do.
I've been under major life stress this past year. The loss of a job, I've officially cut contact with my Mom a few months ago because she was acting erratically and it was just too much for me to deal with so I chose not to anymore. I'm also suffering from a major depression along with panic attacks. I honestly have not been this sick emotionally since I was 15 yrs. old when I had my MAJOR depression that lead me to two suicide attempts.
So here I am, I'm due exactly two months from today. I have been going to counseling for two years and thank God I'm there. I've been talking a lot about how I'll raise my daughter. I'm very well aware that I do not want undue stress in our family life. I see what all the stress did to me, I grew up in a VERY abusive household and I'm still struggling with my psychological issues to this day. I do not suffer from schizophrenia and neither does my Brother. But...we are very aware of our family history. I want my daughter to live a good life (and by that I don't mean having lots material possessions). I'm very cognizant of the fact that I want to raise a psychologically healthy little girl. It is so very important to me that she has the psychological support that my Brother and I never grew up with.
Posted by: Lisa at October 22, 2007 07:32 PM
Sorry it took me so long to respond, but we have been without phones/Internet.
You asked me, I believe, to
1- Provide links saying that schizophrenia is a physical condition - it is the brain and not "mental".
I shall, but many of the links are from this website. One of them is THIS very article (http://www.jneurosci.org/cgi/content/abstract/27/40/10695 ) in which the researchers are investigating how the immune activation "alters fetal brain development". It is not that people are mentally weak... their BRAIN, or other systems are weak.
Many researchers, doctors and family who love people with these disorders have been fighting against this very stigma for years. It is a medical illness. It is not their "fault". It is not some "psychological" problem with them... but a real BRAIN problem.
Even the “bio-psycho-social” model, does not indicate that it is “mental”. It does not even mean that each facet of the 3 plays an equal role in the development, nor treatment, of the illness.
In fact, we don’t even know which “illness” we are discussing since there is no medical test for "it".
When we discuss “schizophrenia”, Is it the one from chromosome deletions (VCF) or the one from mitochondrial defects? Or is it the one with catatonia? Is it the one that is fleeting – that just happens once or twice under extreme stress and never returns? Or is it the one that causes severe cognitive dysfunction that persists? Is it the one that happens in adolescence or the one that happens as a baby/toddler? Is it the one intertwined with autism, or the one that isn’t? Or the genetic one that is all positive symptoms and obesity, and just in males? Is it the one that is intertwined with severe migraines or the one with endocrine system dysfunction? Or is it the one with word salads, or the one that gets precipitated by childbirth? Is it the one this article talks about that is presumed to have a weakness caused by a malformation of the brain caused by the mother’s own immune system
Out of all the different kinds of “illnesses” we call schizophrenia, maybe there ARE some that are “mental”, and the people should just get therapy. That’s not the kind most parents come to this website about.
This article says that the viral infection can raise the risk that the baby will have autism or schizophrenia. This is not some “mental”, problem resulting from a weak mind that talk therapy with the baby can fix. It is just the (un)luck of the biological draw.
By the way, In my child's entire life, not one psychiatrist, therapist, or GP has ever said that her illnesses are "mental", but rather, are biological. Even her depression they said was BIOLOGICAL. It was not SITUATIONAL. Therapy helps... helps her cope with her own biology and helps dampen the impact and trauma her own biology was having on her. Unfortuantely, the diagnoses are categorized as "mental", only because there is no medical test... but then again, when she was little, they didn't run many tests.
2- Explain why talk therapy can help "prevent schizophrenia" if it is not "mental",
As for it preventing "it" in older people (or are they including our babies and children as well?) I wonder which "it" in the above list of causes they are referring to? I suspect that it is NOT the cases which many children succumb to, such as the cases triggered by a combination of pot and genes,although I can see it possibly preventing them from the bad choices that can contribute to the triggering of certain genetic predispositions (again - medical). I can see many types of therapy, however, lowering the possibility that emotional “sparks” will “kindle” some of these highly inheritable illnesses… at least in the cases where kids can be trained to relax more, dampen a very hypersensitive, irritable disposition (biology)… but that is mental health that can help everyone, and even those with a lot of it (the mental health) get these illnesses.
3- Refute the idea that people are diagnosed with schizophrenia who have not something "mental" wrong with them, but rather, a physical/medical/biological problem, since the researchers you talk to don't see people who actually have medically diagnosable problems.
That one is easy! Researchers not seeing these does not indicate that these cases are not out there. Research studies tend to exclude all the people with “other” contributing factors. The ones they find with a multitude of hormonal problems, are excluded. They exclude from the adult studies the children and even the adults who had childhood-onset. For decades, people diagnosed with schizoaffective were excluded from schizophrenia studies.
Case studies do get written up and articles get written about doctors misdiagnosing. Here are some of those links:
After 3 months, she’s still ‘mad’
http://www.currentpsychiatry.com/article_pages.asp?AID=4891
Hypothyroidism and Psychiatric Illness
http://www.schizophrenia.com/sznews/archives/004348.html
Lingering Psychiatric Symptoms May be Due to Hyperthyroidism
http://www.schizophrenia.com/sznews/archives/004296.html
Conversion disorder? One patient’s ‘moving’ story
http://www.currentpsychiatry.com/article_pages.asp?AID=3922
Here are links requested, including cases where the mitochondria caused the schizophrenia, cases where whatever the biological process was – it resulted in multiple NON-“mental” problems. Some links are to cases where drugs cause horrible problems in the brain that are not reversible, and some where things like marijuana trigger the genes that then result in the schizophrenia, much like substances or normal aging processes trigger genes or cancer (which of course can also be caused by viruses.
Neurodevelopment and Schizophrenia
http://www.schizophrenia.com/sznews/archives/003488.html
Is this child bipolar? What’s needed to improve diagnosis With genetic and brain imaging biomarkers, early intervention could protect at-risk kids.
(These kid should not be given stimulants because the BIOLOGY dictates they should not be… their illness is not “mental” – not some psychological problem)
http://www.currentpsychiatry.com/article_pages.asp?AID=5381
Researchers Analyze Brain Changes in Schizophrenia
http://www.schizophrenia.com/sznews/archives/003841.html
"Metabolomics" to be Used to Study Schizophrenia And its Treatment
http://www.schizophrenia.com/sznews/archives/005079.html
Might Some Cases of Schizophrenia Be 'Diabetes' of the Brain?
http://www.schizophrenia.com/sznews/archives/005264.html
Protein Biomarkers for Schizophrenia Studied in Cerebrospinal Fluid
http://www.schizophrenia.com/sznews/archives/004187.html
SCHIZOPHRENIA GENES AND CANNABIS
http://www.schizophrenia.com/sznews/archives/001559.html
Neuregulin 1 (8p12) and childhood-onset schizophrenia: susceptibility haplotypes for diagnosis and brain developmental trajectories.
Addington AM, Gornick MC, Shaw P, Seal J, Gogtay N, Greenstein D, Clasen L, Coffey M, Gochman P, Long R, Rapoport JL
Mol Psychiatry. 2007 Feb ; 12(2): 195-205
http://www.hubmed.org/display.cgi?uids=17033632
Differential diagnosis between pervasive developmental disorder and schizophrenia
Ishii T
Nippon Rinsho. 2007 Mar ; 65(3): 497-501
Velocardiofacial syndrome.
Gothelf D
Child Adolesc Psychiatr Clin N Am. 2007 Jul ; 16(3): 677-93
(“the most common known genetic risk factor for schizophrenia.”)
http://www.hubmed.org/display.cgi?uids=17562586
Risk factors for the emergence of psychotic disorders in adolescents with 22q11.2 deletion syndrome.
Gothelf D, Feinstein C, Thompson T, Gu E, Penniman L, Van Stone E, Kwon H, Eliez S, Reiss AL
Am J Psychiatry. 2007 Apr ; 164(4): 663-9
http://www.hubmed.org/display.cgi?uids=17403981
Velocardiofacial syndrome, DiGeorge syndrome: the chromosome 22q11.2 deletion syndromes.
Kobrynski LJ, Sullivan KE
Lancet. 2007 Oct 20; 370(9596): 1443-52
(Says it affects organ systems, too)
Elevated prenatal homocysteine levels as a risk factor for schizophrenia.
Brown AS, Bottiglieri T, Schaefer CA, Quesenberry CP, Liu L, Bresnahan M, Susser ES
Arch Gen Psychiatry. 2007 Jan ; 64(1): 31-9
(These researchers suggest it may cause “developmental effects on brain structure and function and/or through subtle damage to the placental vasculature that compromises oxygen delivery to the fetus.” Which sounds quite physical – not caused by the child’s faulty “thinking”).
http://www.hubmed.org/display.cgi?uids=17199052
Disruption of interneuron development.
Epilepsia. 2005; 46 Suppl 7: 22-8
http://www.hubmed.org/display.cgi?uids=16201992
Psychotic symptoms in pediatric bipolar disorder and family history of psychiatric illness.
Rende R, Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Keller M
J Affect Disord. 2006 Nov ; 96(1-2): 127-31
http://www.hubmed.org/display.cgi?uids=16814395
Central role of hypothalamic digoxin in conscious perception, neuroimmunoendocrine integration, and coordination of cellular function: relation to hemispheric dominance.
Journal The International journal of neuroscience2002 Jun; 112(6):705-39.
Authors Kurup RK, Kurup PA
(hypothalamic also)
MITOCHONDRIA links
Mitochondrial DNA is abnormal in bipolar disorder and schizophrenia
http://www.schizophrenia.com/sznews/archives/002935.html
Mitochondrial dysfunction in schizophrenia: evidence for compromised brain metabolism and oxidative stress.
Mol Psychiatry. 2004; 9(7):684-97, 643 (ISSN: 1359-4184)
Mitochondrial dysfunction and molecular pathways of disease.
Exp Mol Pathol . 2007 Aug ; 83(1): 84-92
http://www.hubmed.org/display.cgi?uids=17239370
Psychiatric comorbidity in 36 adults with mitochondrial cytopathies.
CNS Spectr. 2007 Jun ; 12( 6): 429-38
http://www.hubmed.org/display.cgi?uids=17545953
Mitochondrial DNA HV lineage increases the susceptibility to schizophrenia among Israeli Arabs.
Schizophr Res. 2007 Jun 11 ;
http://www.level1diet.com/research/id/229193
Mitochondrial Dysfunction as the molecular basis of bipolar disorder : therapeutic implications.
CNS Drugs. 2007;21(1):1-11.
http://www.hubmed.org/display.cgi?uids=17329000
Cerebral glucose utilization and platelet mitochondrial complex I activity in schizophrenia: A FDG-PET study.
Prog Neuropsychopharmacol Biol Psychiatry . 2007 May 9; 31 (4): 807-13
http://www.hubmed.org/display.cgi?uids=17329000
Mitochondrial-related gene expression changes are sensitive to agonal-pH state: implications for brain disorders.
Mol Psychiatry. 2006 Jul ; 11( 7): 615, 663-79
http://www.hubmed.org/display.cgi?uids=16636682
New variants in the mitochondrial genomes of schizophrenic patients.
Eur J Hum Genet . 2006 May ; 14(5): 520-8
http://www.hubmed.org/display.cgi?uids=16538224
Review of the literature on major mental disorders in adult patients with mitochondrial diseases.
Psychosomatics. 2006 Jan-Feb ; 47( 1): 1-7
http://www.hubmed.org/display.cgi?uids=16384802
The role of mitochondrial dysfunction in bipolar disorder.
Drug News Perspect. 2006 Dec;19(10):597-602.
http://www.level1diet.com/research/id/750279
Posted by: Naomi at October 31, 2007 05:44 PM
http://news.bbc.co.uk/1/hi/health/7081298.stm
Posted by: CopperKettle at November 9, 2007 09:01 PM
If medical literature was a love letter I would print your words and keep them close to my heart.
Thank you for an outstanding article.
Posted by: nemo at October 17, 2007 10:44 AM
As NAMI and others keep saying... It is NOT MENTAL ... it is biological. It is the BRAIN.
I had chicken pox while pregnant. The doctors all suspected the fetus would be affected, but when the baby was born, she "looked" fine.
It took another couple decades to figure out that a part of her brain really HAD been affected.... which in turn had been affecting her entire body.
Posted by: Naomi at October 18, 2007 06:59 AM
Pregnant women should avoid hanging out with young mothers for a mere 9 months, because young children are germbags and if the pregnant women succumbs to infection their child may suffer lifelong mental problems, surely a small price to pay;
Posted by: Matt at October 18, 2007 07:30 AM
Hi Contributors - I'd like to make two points:
1. All the schizophrenia researchers we talk to tell us they think the research clearly shows that there are both psychological and biological factors that contribute to and cause schizophrenia. In fact they say it is both "mental" and "biological" - both areas contribute stresses and toxins to the brain. Addressing both areas is important for prevention and optimal outcome for those that do develop schizophrenia.
2. There is some truth to the idea that young children are frequently passing germs around because of their frequent contact with other sick children in playschools and other schools. We've seen information that suggests the most important thing for a future mother is to avoid getting exposure to the infections by avoiding close contact with infected people - and also to wash your hands frequently if you ever do touch a potentially ill person. Of course, this can be difficult depending upon one's career and if a person already has children.
Posted by: szadmin at October 18, 2007 08:39 AM
You cannot "avoid young children" when you already HAVE "young children". The only real solution is for scientists to have proper treatments available to pregnant women for when they inevitably do become ill, and more vaccinations. At the time I got chicken pox, there was no vaccine for it. The baby was BORN affected - so there was no "mental" component to it.
Posted by: Naomi at October 18, 2007 02:42 PM
szadmin, would you be kind enough to explain to all what is the meaning of your distinction between 'mental' and 'biological' areas? This is not clear to me. Thanks in anticipation.
Jean (John) C. Desclin (Ph.D., M.D., Brussels)
Posted by: Jean Desclin at October 19, 2007 02:17 AM
I think I can answer your question Jean, mental I belive would mean an event that cause some kind of damage to a childs mind other than genetic, viral, parasitic, substance abuse, physical abuse, or dietary deficiencies for example emotional or verbal abuse. children that are subjected to emotional or verbal abuse are thought to have impaired brain development, which incresse there chances of developing schizophrenia later in life. To my knowledge emotional and verbal abuse has been linked to schizophrenia several times, althought as yet it has not been conclusively proven. Basical mental in this instance means causing a child so much emotional distress that it cause damage to a developing childs brain.
Biological means factors other than emotional or verbal abuse, for example viral infections(Flu, HPV), parastes(Toxoplasma gondii), genetic disposition and so on.
Posted by: nemo at October 19, 2007 03:43 AM
Nemo, I am afraid this does not answer the question. so-called 'mental abuse' has indeed not been proven to cause schizophrenia
Posted by: Jean Desclin at October 19, 2007 08:17 AM
Jean you are correct mental abuse has not been proven to cause schizophrenia, it has been linked to schizophrenia, as has stress in general.
Please read the information available on the following web pages,
Stress and schizophrenia
Social Stress and schizophrenia
Social Isolation, Stress and schizophrenia
"enriched environments" lower schizophrenia risk
Child Abuse and schizophrenia risk
I hope these pages can provide you with the information you seek.
Posted by: nemo at October 19, 2007 08:58 AM
Hi Jean,
What I mean by "mental" is psychological or social factors. All the researchers that I've talked to say that both psychological factors and social factors (in addition to prenatal and postnatal biological factors (lead exposure, nutritional deficiencies, infections, etc.) are all linked to increased risk for schizophrenia.
Of course - researchers and psychiatrists are also saying that psychological and biological factors are basically the same thing - but viewed at different levels. see this write-up to read more on this topic: Psychological and Biological Influences in Schizophrenia Risk
For additional information on Risk Factors - see our listing of news on this topic: Schizophrenia Risk Factors and causes
Given your knowledge - would you agree with what these researchers and psychiatrists are saying?
Posted by: SzAdministrator at October 19, 2007 01:31 PM
If everyone is correct ... we are probably talking about DIFFERENT illnesses all getting lumped under the same "schizophrenia" label... much like we used to think hypothyroid was "schizophrenia" because we didn't know any better.
As we continue to tease apart what is what, I hope less medical cases will be lumped under the "mental illness" label simply because we will know the actual cause.
My baby was not born with a "mental" problem - she was born with a brain problem.
Posted by: Naomi at October 19, 2007 03:33 PM
Dear Mr Szadmin., as an answer to the question of whether I agree or not with what you report of the opinions you were told by some researchers, I would like to quote the following sentence: "But just as the dancer and the dance are indistinguishable, so too are the brain and the mind. They are two different words that refer to the same thing/activity, and neither exists without the other in living human beings."
Prof. Nancy C. Andreasen, M.D., Ph.D.: Brave New Brain, p. 27 Oxford University Press 2004, ISBN 0-19-516728-7
Much confusion also results from not defining the meaning of words. To me - and I am confident I share this with
most scientists, 'mental' is not some virtual thing, it is tightly dependent on the activity of the brain: it is a process.
Let me also quote from renowned US psychologist Barkley (an acknowledged authority on ADHD): "Most
findings on etiologies are correlational in nature, not permitting direct, precise, immediate molecular evidence of primary causality. But then that is the case for all psychiatric disorders..."
Most of the so-called evidence in favor of 'psychological, social, cultural, etc.' influences on the development of schizophrenia is of the post hoc propter hoc kind: correlational at best. Causality and correlation are two completely different things!
By the way, I completely agree with Naomi's post.
Posted by: Jean Desclin at October 20, 2007 01:50 AM
Hi Jean,
I completely agree with what Dr. Andreasen and Dr. Barkley suggest in your quotes give. I believe that their viewpoints are entirely consistent with the information we provide in the links I've given above.
Here at schizophrenia.com we follow what we believe is the most widely taught general model for psychiatric illness - specifically the Bio-Psycho-Social Model that holds that biological, psychological and social factors all are (or can be) significant contributors to mental illness. This is the model that the researchers and PHD students we talk to on a regular basis at Harvard, Stanford, University of California (UC Berkeley, UCSF and UCSD) subscribe to and encourage us to follow, and those are the schools where most of our graduate students who work on the site come from. I have no idea if this is the predominant approach taught in the universities in Europe, but it is here in North American. You can read indepth about the bio-psycho-social model here:
Bio-Psycho-Social Model of illness
We take a balanced approach to bio-psycho-social model - covering all three areas to significant depth. All of this research into the causes of schizophrenia are relatively early in "proof" stage - and the exact statistical weighting of each of these factors is not (to my knowledge) at all certain, and likely varies greatly on a person by person basis. For some people the biological factors may play a larger role in the development of schizophrenia, for others is likely that the social/psychological factors play a larger role. Additionally, many researchers say that there are likely to be different classifications (or continuums) of schizophrenia - different genes, different pathways or processes with similar outcomes.
Certainly of course you are accurate in the statement that there is a difference between causality and correlation. One of our goals here is to let people know of factors that are under their control and have been linked to schizophrenia so as to help lower the incidence of mental illness in future generations. We'll let the researchers continue to determine whether a given factor linked to schizophrenia is "causal" or "correlated" - but in the mean time we think its important to let families know that there are some factors that may be under their control with regards to risk for mental illness. While some of the factors we list as linked to schizophrenia undoubtedly will turn out to be correlated rather than causal - a significant number of them are (schizophrenia researchers are telling us) are likely to be causal - and we'd rather err on the side of caution in this area. Most of the factors (e.g. good nutrition, supportive and empathetic and loving relationships, a optimistic (or growth) mindset, close friendships, avoidance of child abuse, trauma, neglect, and avoidance of infections, etc.) are likely good things to work towards even if some of them are only correlated (rather than causally related) with lowering the risk of schizophrenia. We are not an academic publication - we aren't waiting for iron clad proof before we cover something. Our focus is on giving people information that they can use, today, to improve their lives and lower the risk of developing mental illness in the future.
Naomi and you seem to focus (correct me if I'm wrong) more on the "biology" aspect of the model. That is definitely one aspect of mental illness. I would encourage you to read up on the latest neuroplasticity research coming out of Dr. Merzenich's neuroscience lab at UCSF - as covered in the book "The Brain that Changes" see link here:
The Brain that Changes Itself. This book talks about research that shows how psychological functioning can change the wiring of the brain - for good or ill.
The research is showing that while the Mind is certainly a result of the Brain/biology - the Mind (i.e. psychological and social factors) have a significant impact on the Brain - as the new field of social neuroscience is revealing. See link here:
Social Intelligence and Social Neuroscience
We prefer a more comprehensive approach that covers all three areas; biology, psychology and social factors so as to provide the most information and most value to our readership. This information on the causes of schizophrenia is primarily targeted at the next generation of individuals who have experienced mental illness in their families - so that they take some reasonable actions to lower the risk for their children.
Posted by: szadmin at October 20, 2007 04:12 PM
SZAdmin,
We can build up muscles, and much muscle damage can be heal. The same applies to the brain. We can improve the brain, and the brain can heal. Yet we do not call damage to muscles "mental". We do not call a biological predisposition to muscle weakness mental, and when there is wasting of the muscle due to polio, nerve damage, or any other insult to the organism, we do not call it mental.
I see what happens to the brain the same. Most severe "mental illnesses" are no more "mental" than the illnesses that ravage muscles.
That does not mean that much cannot be done over extensive time and with great effort, to heal the brain damaged by illness, after the worst has passed - the same way that people can begin to heal and strengthen muscles severely damaged, as long as what is causing the damage has been addressed.
I have seen both the ravaging of the brain by illness (not anything "mental"/"psychological") and I have seen the healing that it slowly does after the severe injury to it.
But as to what caused the injury to the brain to begin with? In the case of what is called "schizoaffective disorder" and "schizophrenia" that has occurred time and again in my extended family, and from what I read from so many others... there was nothing psycho-social that caused it. The only psycho-social impact is on the person's mental health with which the person then proceeds to handle their extreme illness and recover. That is the same mental health that helps any person going through any extreme illness or trauma persevere and handle it.
Mental health (and psycho-social influences) is as important in having a good outcome in schizophrenia (at least the type I know) as it is in handling cancer, MS, war trauma, paraplegia, etc. It does not prevent them, nor does it guarantee a good outcome if the biological insult is too grave.
The emphasis on mental health and raising mentally healthy children is a sound goal and is expounded upon at length in all parenting sites, books, and boards. It is already a goal of every parent who is concerned enough to become educated about their childrens' and grandchildrens' illnesses or potential illnesses.
We all benefit from mental health.
But mental health doesn't prevent neurobiological brain disorders that are being labeled "mental illness" from happening. It just helps the person survive and recover when possible -- just as it does people with cancer, etc.
Posted by: Naomi at October 20, 2007 08:08 PM
Naomi, I could not put it better than you did.
Posted by: Jean Desclin at October 21, 2007 12:08 AM
All I can say is that the view on mental illness that Jean and Naomi have is very different from the bio-psycho-social model of mental illness that the schizophrenia researchers that we talk to say best explains mental illness, (and that is taught in all the psychiatry programs of the leading universities in North America). All we can suggest is that people read and study the scientific evidence that is presented by the news we cover on the factors linked to schizophrenia risk, and make their own decisions.
Since neither Naomi nor Jean are schizophrenia researchers we will have to continue to follow the path that the schizophrenia experts in the field are telling us, and believe what the research results and researchers are saying.
Naomi suggests that mental health has nothing to do with schizophrenia - or as she says "mental health doesn't prevent neurobiological brain disorders that are being labeled "mental illness" from happening".
I'd be interested in understanding how Naomi explains the research that shows how talk therapy (a "mental therapy" for people who are at high risk for schizophrenia, greatly reduces the risk of developing schizophrenia. In other words Cognitive behavioral therapy, or "talk therapy" research is demonstrating that it can (in a statistically significant way) stop the development of psychosis/serious mental illness (what Naomi calls "neurobiological brain disorders" in some significant percentage of the people. Naomi suggests that this is impossible - yet the research is saying it is happening. I think I'll choose to believe the research (though of course more research needs to be done). I don't believe that the National Institutes of Mental Health and other research groups would be putting millions of dollars into this area of research if they didn't believe it would be effective. The fact that as research results are coming out, more money is being invested in this area (the NIMH was recently reported as having dozens of new studies on the effectiveness of CBT) suggests that the results are getting better all the time and the data more compelling.
In fact this is a very active area of research in the world today (see all the research we have on early treatment of high risk people) - and area that Naomi would suggest is impossible. See this link for more information:
Cognitive Therapy May Prevent High Risk Populations From Developing Psychosis
Naomi and Jean are also saying, in effect, that the entirely new field of science - the area of study called Social Neuroscience - should not exist. What they seem to be saying is that psychological and social factors don't have significant impact on the brain and risk of mental illness - which is completely opposite to what many neuroscientists and psychologist are saying and that the new field of social neuroscience is revealing. See link here:
Social Intelligence and Social Neuroscience
How many social neuroscience studies have Jean and Naomi read that gives them the expertise to so easily disregard the entire field of science?
We will continue to report on all aspects of the biological, psychological and social factors that have been identified as potential causal factors in schizophrenia that the world's schizophrenia researchers are uncovering (despite the fact that some people may not like this approach).
Posted by: szadmin at October 21, 2007 08:52 AM
There is also significant research indicating that with enough poitive thoughts, we might have much less illness in general. I think about MS... and I know I have lots of positive thoughts and happiness... but I'll take my dose of sunshine to help prevent MS anyway. Studies also show that positive thinking may help prevent cancer, but I'll try to avoid bad chemicals and too much sunshine for that as well.
If a person needs a significant amount of therapy to avoid the worst of the illness, the person obviously already has the illness, albeit not in the most severe form. I strongly suspect that part of the partial success intervention has shown has been the fact that the people were correctly diagnosed early and not given all the usual incorrect treatments that normally make the illness so much worse - like the stimulants frequently given children who are actually in schizophrenia prodromes. Also, they are probably also avoiding all the other multitude of "no-nos' that would worsen the illness. Such as antidepressants if they have a bipolar component, caffeine, resorting to drugs as self-medication, erratic sleep schedules, etc.
Early interventions in prodrome stages in other illnesses and avoidance of improper treatments can also help other illnesses.
That shows that mental health can help the illness. And proper course of treatment and avoidance of the improper treatments can have a statistical impact on the illness developing to full-blown worse-case condition.
That does not mean that the psycho-social aspect caused the illness, and that is what Dr. Desclin and I are saying.
The fact that the babies are born with autism and schizophrenia prodromes show that these cases have nothing to do with mental health being able to prevent the illness in them. They already have it. Talking, playing and a very enriched environment and extensive intervention helps them. But they already have the illness (the biological insult already exists).
When you talk about me saying things are impossible, you have twisted my words. I am saying the opposite. Mental health is important to quality of life. It helps illnesses. But mental health does not prevent the illnesses that are not caused by lack of mental health. Can a messed up life and mental processes make the illness worse regardless of cause? Of course. But there are many cases of biological illnesses getting called schizophrenia, and the mental health aspect helps them just as much as anyone else.
We keep coming back to another point in this whole discussion... are we sometimes comparing apples and oranges? Are we really even always talking about the same illness(es)? Just because I have a baby who gets labeled with "schizoaffective" after I have chickenpox does not mean it is the same "schizoaffective" as the person who abuses drugs as an adult and gets psychosis, or the person who was born to a mother who abused drugs and now has dopamine receptors inside the brain cells instead of on the surface, nor are those the same as the families whose schizophrenia comes from a mitochondrial defect manifesting itself in the brain. Until there are medical diagnoses for these babies, children, and even teens and adults... we most likely are lumping many different illnesses into the same diagnostic bucket.
I do, believe however, that the parents and grandparents who come to this site are, for the most part, the ones who already are not abusing the kids, taking drugs while pregnant, etc. I suspect that most are the ones who were normal loving parents...who got them the therapy as soon as possible (unless the child was already an adult), tried to keep the kid from abusing drugs as a teen, and their kids got sz anyway - whether because the biological insult was just too great, or the doctors misdiagnosed and gave the wrong treatments, or the child themself chose a wrong path.
But I never - not once - said that it was impossible for psycho-social treatments to help, and I am totally baffled by why that bit of venom was aimed my way. I completely believe that IF a dear person I know with intractable bipolar had not started down the path she had started down, and could have led a healthy lifestyle doing all the right things, she would never have had the severity of the illness she now has. She would have had the illness - but it would have been so much more mild without added components of anxiety, etc.. IF her sleep hygiene, physical health, nutrition, mental health, etc... (these are "psycho-social) had remained impeccable -- something which a person without the illness already would not have to do to not succumb to the severe illness that bipolar can be. After all, most people go through their lives doing whatever and not needing mood stabilizers - the ones who have to be impeccable in their lifestyle already have the biology. It might look like intense psycho-social intervention and adherence is "preventing" the illness - at least the full-blown type... but she would actually have needed all that because she really already had the bipolar illness (biology)... just not as bad as it got with the lousy life-style. I do believe that. But... I also read how one little slip up - like pulling an all-nighter - can be what finally triggers the illness lurking beneath.
I am not your adversary... unless you are saying that all cases of schizophrenia can be prevented by psycho-social interventions, or that lack of mental health is what causes all these cases of neurobiological brain disorders that are getting lumped into the "schizophrenia" bucket... or if only the parents had been better parents, that would have protected the baby/child/teen/adult from getting whatever the problem they later developed (or was born with) that got labeled schizophrenia... or anything like that. And I don't think you are saying that... anymore than I said what you construed.
-Naomi
Posted by: Naomi at October 21, 2007 01:14 PM
Naomi,
This isn't a personal attack - I'm trying to evaluate your claims in your argument and provide evidence to the contrary where I think things we differ on opinion or things may be misunderstood.
I know that we have a lot of shared beliefs in this area - for example your understanding of positive psychology is something I agree with, an also with much of your understanding of neuroplasticity. I think the difference we hold are in two areas:
1. The bio-psycho-social model of mental illness disagrees with your statement that if a psychosocial treatment prevents psychosis or schizophrenia it "does not mean that the psycho-social aspect caused the illness" - The bio-psycho-social model (the primary model taught in medical schoosl today) means precisely that the psycho-social is a contributing or causal factor.
Additionally, when you say "If a person needs a significant amount of therapy to avoid the worst of the illness, the person obviously already has the illness" - in reference to the CBT study preventing psychosis, you seem to believe that even if there are no symptoms of schizophrenia - that a person can still have schizophrenia, and I haven't seen any research to support that idea. The people in the study were, to my understanding, not symptomatic of either prodromal schizophrenia, or schizophrenia itself.
2. You say there are "many cases of biological illnesses getting called schizophrenia" - and I've never seen any data to support this belief. I have talked to many researchers say that there are likely a number of different types of schizophrenia - but they are still calling them schizophrenia(s) - I haven't seen any researchers talking about a significant percentage of the case actually being a pituitary gland disorder or something like that. That may be the case - but please provide some quotes from researchers that support this argument.
Let me cover the first point in more detail:
When the research study is called a "3-year follow up study on the ability of Cognitive Therapy (CT or CBT) to prevent psychosis" - they aren't saying "improves outcome for people who already have prodromal schizophrenia - they are saying "Prevents psychosis" (a key part of schizophrenia). You seem to be interpreting this as halting "the worst of the illness" - but thats not what they're saying. They're saying the person doesn't have the illness - and doesn't get it. They're using the term "Prevent" - prevent means, in the dictionary:"to keep from occurring; avert;" - it doesn't mean to "avoid the worst".
In other words - "Prevent" means to prevent! To stop from happening! You seem to be saying these researchers are wrong - which is fine - but provide some data for your argument.
I think another problem with your commentary is that you seem to be defining schizophrenia as the "biological predisposition" to schizophrenia or mental illness - which is very different than how the psychiatrists, psychologists and schizophrenia researchers define schizophrenia.
You convey this belief when you say "If a person needs a significant amount of therapy to avoid the worst of the illness, the person obviously already has the illness," I know that psychiatrists and schizophrenia researchers I've talked to would completely disagree with you.
If the people getting the CBT have never had, and don't have the symptoms of schizophrenia then they don't have schizophrenia - period. These are simply people at high risk due to family backgrounds. If a child is born without the symptoms of schizophrenia - then they don't have schizophrenia. They may be born with the predisposition to schizophrenia - They may develop it later - but I think most researchers would agree that something triggers schizophrenia - and there are many psycho-social, stress, and other environmental factors (cannabis, etc.) that seem to be these triggers. I don'be believe that any researchers I've ever talked to would say a child "has schizophrenia" at birth. Certainly they've never conveyed that to me. So - therefore - something triggers schizophrenia later in life.
You seem to be saying that if a person has the biological predisposition for schizophrenia (for example due to the Flu during pregnancy) - then they already have schizophrenia and that it just isn't accurate. If you have support for this belief - please link to the research.
Therefore - if, as the CBT study showed, a much smaller percentage of people who where likely to be biologically predisposed to schizophrenia (because their mother had schizophrenia for example), due to a psycho-social environment improvement (e.g. CBT treatment) then I believe that it strongly suggests that it is the psycho-social environment that is triggering the schizophrenia in the person who is predisposed.
Certainly not all cases of schizophrenia are triggered by psycho-social factors - but certainly the evidence suggests a significant portion are. Given the finding from the Finnish study that showed an 86% reduction in schizophrenia in high risk children in healthy family environments - the evidence seems pretty compelling.
With regard to the second point:
You mention also "all these cases of neurobiological brain disorders that are getting lumped into the "schizophrenia" bucket" - which seems to suggest you have a hypotheses that a significant percentage of cases of schizophrenia (or a type of schizophrenia) are purely biological - with no psychological contributing factor. Certainly this could be the case - but I've never seen any evidence and no researcher I've talked to has ever suggested this - and I"m wondering why you have this opinion?
In the key models of schizophrenia I'm familiar with (the Bio-psycho-social model) and the Stress/Diathesis (stress/predisposition) model - both suggest that it takes both factors - predisposition and other ingredient (stress or psycho-social factors) to cause schizophrenia. Its not just one of the factors.
Anyway - I think we've beaten this topic into the ground. I'm moving my attention to future news topics.
Posted by: szadmin at October 21, 2007 03:36 PM
One of the greatest barriers to advancement in mental health has been the egotistical drive to see whose fiddle plays the best tune while for the patient Rome continues to burn.
Posted by: tjg at October 21, 2007 05:40 PM
I do wish the Finnish study, for example, had gone further, or would review its findings in light of more recent findings: for ex, season of birth (compared to fluctuation in the general population), area of residence, flu outbreak in area of mother's residence during pregnancy, nutritional quality of prenatal diet,symptom profile (ex., pos vs. neg symptoms), mental health profile of (extended) birth family, interventions sought (if any) in adoptive family, "unavoidable" stress in the adoptive family (ex., death, unemployment,moves).
Also, were interviews conducted with family members alone, or with others present ? (Can't remember). I only ask because our entire family changed its communication pattern when our son was having a "bad day" (years prior to diagnosis-- prodrome) -- though apparently dysfunctional, we were trying to interact in ways that would not upset him (ex., gentle silliness among us would upset him, as would discussions of any depth).
What effect does the at-risk family member receiving CBT have on the interactions with-in the family ? (Or does CBT help regardless of family enviornment ?)
Posted by: flooby at October 21, 2007 08:11 PM
Hi Flooby,
The Finnish Study was only completed a few years ago (though it was a 40 year long study) - and the findings was specifically looking at the psycho-social aspects. Many other studies have covered the points you've mentioned - generally the studies focus on a couple of key targets so I'm not surprised they didn't add all the other variables to the study. You can check the study again - there were a whole bunch of papers written on the long term Finnish study - but they all came to similar conclusions so we didn't report on them all.
All the interviews were tape recorded in the Finnish study and multiple psychiatrists listened to the tapes and made sure that the analysis was consistent. The procedure included joint interviews with the whole family and the parents, as well as personal interviews with extended family members.
I think its hard to generalize about the impact of CBT on the at-risk family member receiving it - generally it just makes people more conscious of inaccurate thoughts and it corrects them - and this can greatly lower the stress that the person experiences (which is one of the reasons it helps so much). To the degree that those inaccurate thoughts caused problems within the dynamics of the household - it would tend to improve the interactions with other family members. CBT also helps irrespective of the family environment - but the better the family environment, the more its going to help the person.
To learn more about CBT - I recommend you check out the books by Dr. David Burns. They are called "Feeling Good", and "Panic.." you can find them on Amazon.com.
Posted by: szadmin at October 21, 2007 08:46 PM
I guess I fit right into this category. My Mom and her Dad both had schizophrenia. My Grandfather is now deceased but Mom is still alive. I'm due for my first and only child around Christmas. I'm very scared. Very scared of passing any schizophrenia genetics on to my soon-to-be daughter. I'm hoping I don't get sick but because of my current situation I thankfully have no contact with children. I am quite reclusive so that keeps me statistically less likely to be in touch with germs though that is not the reason why I live the way that I do.
I've been under major life stress this past year. The loss of a job, I've officially cut contact with my Mom a few months ago because she was acting erratically and it was just too much for me to deal with so I chose not to anymore. I'm also suffering from a major depression along with panic attacks. I honestly have not been this sick emotionally since I was 15 yrs. old when I had my MAJOR depression that lead me to two suicide attempts.
So here I am, I'm due exactly two months from today. I have been going to counseling for two years and thank God I'm there. I've been talking a lot about how I'll raise my daughter. I'm very well aware that I do not want undue stress in our family life. I see what all the stress did to me, I grew up in a VERY abusive household and I'm still struggling with my psychological issues to this day. I do not suffer from schizophrenia and neither does my Brother. But...we are very aware of our family history. I want my daughter to live a good life (and by that I don't mean having lots material possessions). I'm very cognizant of the fact that I want to raise a psychologically healthy little girl. It is so very important to me that she has the psychological support that my Brother and I never grew up with.
Posted by: Lisa at October 22, 2007 07:32 PM
Sorry it took me so long to respond, but we have been without phones/Internet.
You asked me, I believe, to
1- Provide links saying that schizophrenia is a physical condition - it is the brain and not "mental".
I shall, but many of the links are from this website. One of them is THIS very article (http://www.jneurosci.org/cgi/content/abstract/27/40/10695 ) in which the researchers are investigating how the immune activation "alters fetal brain development". It is not that people are mentally weak... their BRAIN, or other systems are weak.
Many researchers, doctors and family who love people with these disorders have been fighting against this very stigma for years. It is a medical illness. It is not their "fault". It is not some "psychological" problem with them... but a real BRAIN problem.
Even the “bio-psycho-social” model, does not indicate that it is “mental”. It does not even mean that each facet of the 3 plays an equal role in the development, nor treatment, of the illness.
In fact, we don’t even know which “illness” we are discussing since there is no medical test for "it".
When we discuss “schizophrenia”, Is it the one from chromosome deletions (VCF) or the one from mitochondrial defects? Or is it the one with catatonia? Is it the one that is fleeting – that just happens once or twice under extreme stress and never returns? Or is it the one that causes severe cognitive dysfunction that persists? Is it the one that happens in adolescence or the one that happens as a baby/toddler? Is it the one intertwined with autism, or the one that isn’t? Or the genetic one that is all positive symptoms and obesity, and just in males? Is it the one that is intertwined with severe migraines or the one with endocrine system dysfunction? Or is it the one with word salads, or the one that gets precipitated by childbirth? Is it the one this article talks about that is presumed to have a weakness caused by a malformation of the brain caused by the mother’s own immune system
Out of all the different kinds of “illnesses” we call schizophrenia, maybe there ARE some that are “mental”, and the people should just get therapy. That’s not the kind most parents come to this website about.
This article says that the viral infection can raise the risk that the baby will have autism or schizophrenia. This is not some “mental”, problem resulting from a weak mind that talk therapy with the baby can fix. It is just the (un)luck of the biological draw.
By the way, In my child's entire life, not one psychiatrist, therapist, or GP has ever said that her illnesses are "mental", but rather, are biological. Even her depression they said was BIOLOGICAL. It was not SITUATIONAL. Therapy helps... helps her cope with her own biology and helps dampen the impact and trauma her own biology was having on her. Unfortuantely, the diagnoses are categorized as "mental", only because there is no medical test... but then again, when she was little, they didn't run many tests.
2- Explain why talk therapy can help "prevent schizophrenia" if it is not "mental", As for it preventing "it" in older people (or are they including our babies and children as well?) I wonder which "it" in the above list of causes they are referring to? I suspect that it is NOT the cases which many children succumb to, such as the cases triggered by a combination of pot and genes,although I can see it possibly preventing them from the bad choices that can contribute to the triggering of certain genetic predispositions (again - medical). I can see many types of therapy, however, lowering the possibility that emotional “sparks” will “kindle” some of these highly inheritable illnesses… at least in the cases where kids can be trained to relax more, dampen a very hypersensitive, irritable disposition (biology)… but that is mental health that can help everyone, and even those with a lot of it (the mental health) get these illnesses.
3- Refute the idea that people are diagnosed with schizophrenia who have not something "mental" wrong with them, but rather, a physical/medical/biological problem, since the researchers you talk to don't see people who actually have medically diagnosable problems.
That one is easy! Researchers not seeing these does not indicate that these cases are not out there. Research studies tend to exclude all the people with “other” contributing factors. The ones they find with a multitude of hormonal problems, are excluded. They exclude from the adult studies the children and even the adults who had childhood-onset. For decades, people diagnosed with schizoaffective were excluded from schizophrenia studies.
Case studies do get written up and articles get written about doctors misdiagnosing. Here are some of those links:
After 3 months, she’s still ‘mad’
http://www.currentpsychiatry.com/article_pages.asp?AID=4891
Hypothyroidism and Psychiatric Illness
http://www.schizophrenia.com/sznews/archives/004348.html
Lingering Psychiatric Symptoms May be Due to Hyperthyroidism
http://www.schizophrenia.com/sznews/archives/004296.html
Conversion disorder? One patient’s ‘moving’ story
http://www.currentpsychiatry.com/article_pages.asp?AID=3922
Here are links requested, including cases where the mitochondria caused the schizophrenia, cases where whatever the biological process was – it resulted in multiple NON-“mental” problems. Some links are to cases where drugs cause horrible problems in the brain that are not reversible, and some where things like marijuana trigger the genes that then result in the schizophrenia, much like substances or normal aging processes trigger genes or cancer (which of course can also be caused by viruses.
Neurodevelopment and Schizophrenia
http://www.schizophrenia.com/sznews/archives/003488.html
Is this child bipolar? What’s needed to improve diagnosis With genetic and brain imaging biomarkers, early intervention could protect at-risk kids.
(These kid should not be given stimulants because the BIOLOGY dictates they should not be… their illness is not “mental” – not some psychological problem)
http://www.currentpsychiatry.com/article_pages.asp?AID=5381
Researchers Analyze Brain Changes in Schizophrenia
http://www.schizophrenia.com/sznews/archives/003841.html
"Metabolomics" to be Used to Study Schizophrenia And its Treatment
http://www.schizophrenia.com/sznews/archives/005079.html
Might Some Cases of Schizophrenia Be 'Diabetes' of the Brain?
http://www.schizophrenia.com/sznews/archives/005264.html
Protein Biomarkers for Schizophrenia Studied in Cerebrospinal Fluid
http://www.schizophrenia.com/sznews/archives/004187.html
SCHIZOPHRENIA GENES AND CANNABIS
http://www.schizophrenia.com/sznews/archives/001559.html
Neuregulin 1 (8p12) and childhood-onset schizophrenia: susceptibility haplotypes for diagnosis and brain developmental trajectories.
Addington AM, Gornick MC, Shaw P, Seal J, Gogtay N, Greenstein D, Clasen L, Coffey M, Gochman P, Long R, Rapoport JL
Mol Psychiatry. 2007 Feb ; 12(2): 195-205
http://www.hubmed.org/display.cgi?uids=17033632
Differential diagnosis between pervasive developmental disorder and schizophrenia
Ishii T
Nippon Rinsho. 2007 Mar ; 65(3): 497-501
Velocardiofacial syndrome.
Gothelf D
Child Adolesc Psychiatr Clin N Am. 2007 Jul ; 16(3): 677-93
(“the most common known genetic risk factor for schizophrenia.”)
http://www.hubmed.org/display.cgi?uids=17562586
Risk factors for the emergence of psychotic disorders in adolescents with 22q11.2 deletion syndrome.
Gothelf D, Feinstein C, Thompson T, Gu E, Penniman L, Van Stone E, Kwon H, Eliez S, Reiss AL
Am J Psychiatry. 2007 Apr ; 164(4): 663-9
http://www.hubmed.org/display.cgi?uids=17403981
Velocardiofacial syndrome, DiGeorge syndrome: the chromosome 22q11.2 deletion syndromes.
Kobrynski LJ, Sullivan KE
Lancet. 2007 Oct 20; 370(9596): 1443-52
(Says it affects organ systems, too)
Elevated prenatal homocysteine levels as a risk factor for schizophrenia.
Brown AS, Bottiglieri T, Schaefer CA, Quesenberry CP, Liu L, Bresnahan M, Susser ES
Arch Gen Psychiatry. 2007 Jan ; 64(1): 31-9
(These researchers suggest it may cause “developmental effects on brain structure and function and/or through subtle damage to the placental vasculature that compromises oxygen delivery to the fetus.” Which sounds quite physical – not caused by the child’s faulty “thinking”).
http://www.hubmed.org/display.cgi?uids=17199052
Disruption of interneuron development.
Epilepsia. 2005; 46 Suppl 7: 22-8
http://www.hubmed.org/display.cgi?uids=16201992
Psychotic symptoms in pediatric bipolar disorder and family history of psychiatric illness.
Rende R, Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Keller M
J Affect Disord. 2006 Nov ; 96(1-2): 127-31
http://www.hubmed.org/display.cgi?uids=16814395
Central role of hypothalamic digoxin in conscious perception, neuroimmunoendocrine integration, and coordination of cellular function: relation to hemispheric dominance.
Journal The International journal of neuroscience2002 Jun; 112(6):705-39.
Authors Kurup RK, Kurup PA
(hypothalamic also)
MITOCHONDRIA links
Mitochondrial DNA is abnormal in bipolar disorder and schizophrenia
http://www.schizophrenia.com/sznews/archives/002935.html
Mitochondrial dysfunction in schizophrenia: evidence for compromised brain metabolism and oxidative stress.
Mol Psychiatry. 2004; 9(7):684-97, 643 (ISSN: 1359-4184)
Mitochondrial dysfunction and molecular pathways of disease.
Exp Mol Pathol . 2007 Aug ; 83(1): 84-92
http://www.hubmed.org/display.cgi?uids=17239370
Psychiatric comorbidity in 36 adults with mitochondrial cytopathies.
CNS Spectr. 2007 Jun ; 12( 6): 429-38
http://www.hubmed.org/display.cgi?uids=17545953
Mitochondrial DNA HV lineage increases the susceptibility to schizophrenia among Israeli Arabs.
Schizophr Res. 2007 Jun 11 ;
http://www.level1diet.com/research/id/229193
Mitochondrial Dysfunction as the molecular basis of bipolar disorder : therapeutic implications.
CNS Drugs. 2007;21(1):1-11.
http://www.hubmed.org/display.cgi?uids=17329000
Cerebral glucose utilization and platelet mitochondrial complex I activity in schizophrenia: A FDG-PET study.
Prog Neuropsychopharmacol Biol Psychiatry . 2007 May 9; 31 (4): 807-13
http://www.hubmed.org/display.cgi?uids=17329000
Mitochondrial-related gene expression changes are sensitive to agonal-pH state: implications for brain disorders.
Mol Psychiatry. 2006 Jul ; 11( 7): 615, 663-79
http://www.hubmed.org/display.cgi?uids=16636682
New variants in the mitochondrial genomes of schizophrenic patients.
Eur J Hum Genet . 2006 May ; 14(5): 520-8
http://www.hubmed.org/display.cgi?uids=16538224
Review of the literature on major mental disorders in adult patients with mitochondrial diseases.
Psychosomatics. 2006 Jan-Feb ; 47( 1): 1-7
http://www.hubmed.org/display.cgi?uids=16384802
The role of mitochondrial dysfunction in bipolar disorder.
Drug News Perspect. 2006 Dec;19(10):597-602.
http://www.level1diet.com/research/id/750279
Posted by: Naomi at October 31, 2007 05:44 PM
http://news.bbc.co.uk/1/hi/health/7081298.stm
Posted by: CopperKettle at November 9, 2007 09:01 PM