Cloudscape

Perhaps all the symptoms of schizophrenia, paranoia in particular, are a direct result of ego-splitting, in which the person's sense of self, or ego, becomes split into separate compartments which seem to assume a role of their own. For instance, the person's own thoughts may seem as though they are those of someone (or something) else, leading to the delusion that thoughts have been inserted into the person mind. These thoughts which have separated from the ego may then turn to intrusive thoughts or voices.

At the same time, if the ego has been split into many compartments, it becomes harder to focus one's attention on one specific compartment, because one's thoughts have basically become scattered across each of these many compartments. In this way, one's attention may become distracted as it rapidly shifts from one train of thought to another.

In ego splitting, the central part of one's ego is still in one's physical body, but most of it has become transferred onto other areas of one's consciousness, such as daydreams, to such extent that these may become extremely vivid. These may then have such impact on one's emotions that they seem real, whereas the part of the ego concerned with reality has become so small that real events have a much smaller impact on one's emotions. The result is an increased response to imaginary stimuli, and a decreased response to real stimuli. In other words, the ego has partly dissolved into imagination.

In addition, parts of the ego may become transferred onto objects in the person's environment, so that it seems as though these are alive, or as though they contain cameras, microphones or other means through which they might be spied upon, or it might seem that the person can control these objects with his mind.

This may also happen with people: when parts of the ego are transferred to other persons, the person's emotions about him- or herself may become projected upon them. It follows that if the person has a high self-esteem, this may lead to the feeling that people will likewise have a high esteem of him or her, increasing the feeling of high self-esteem and so forth. This interaction may lead to grandiloquence. On the other hand, if the person has a low self-esteem, this may lead to paranoia, because he or she then projects his or her feelings about him- or herself onto others.

In addition, some people who suffer from self-loathing may use daydreams to punish themselves, especially people who have a lot of imagination. They may do this by hurting themselves in their thoughts, but also by making other people hurt them in their daydreams. In one's daydreams, one has the ability to exert full power over all things, and for people who live largely in daydreams, this ability might distort their image of reality, leading to the delusion that reality differs little from daydreams.

As the ego splits up, the person comes to feel one with things that are in reality separate from his physical self. In this way, the person's sense of separation becomes blurred. This may cause the feeling that people are too close to oneself and so worsen the sociophobia already caused in part due to the paranoia. Furthermore, because of this lack of sense of separation, it becomes as if all things in the world are in fact part of the person's own mind, things that are therefore controlled by the person's own thoughts. As the person dissociates from their own thoughts, however, and they come to appear to take a form distinct from the ego, it seems as if their thoughts are not their own, and that they are instead thoughts that they pick up from other people.

Furthermore, because of this lack of sense of separation, it may also seem that everyone is much too close to them. Close enough, for instance, to harm them, or to read their thoughts. Strictly speaking, this is not in itself ego splitting, since the ego is one's sense of self, and the paranoid still knows the difference between themselves and other people, and does not see them as part of themselves as one would see one's arm as part of oneself, for example; but the feelings they believe others to have towards them still originate from their own. This is so because the paranoid's sense of self has partly dissolved, so that they no longer recognize these feelings as their own.

If the person hates him- or herself, it may seem to them that the entire world hates them. If the person is also self-destructive, it will seem as if the entire world is keen on destroying them. But to paranoids, this feeling becomes so extreme that is no longer a mere emotion, but a reality to them.

One might argue that ego dissolution is not the only thing that may cause paranoia. Traumas can be another cause, for instance, which neither directly nor indirectly have anything to do with ego dissolution. On the other hand, one might question if this is paranoia at all, since people who develop fear of people because of traumas have an actual reason to do so, namely, the chance that the trauma might repeat itself. The traumatized person's estimation of this chance isn't even necessarily irrationally high, but he or she is so terrified of this chance that no matter how small it may be, it is still significant to him or her.

In ego dissolution, emotion has become a continuum from the ego to empathy, with no well-defined line in between, and so emotion can readily flow back and forth from the ego to empathy. At the other extremity, in the case of egotism, the line between the two becomes an impenetrable wall that cuts the ego off from empathy, and the little shared emotions there are are attributed to the ego.

It may be that schizophrenics are highly empathic, though this does not have to mean that they are compassionate, and, if they have low self-esteem, they will likely not be.

Some Buddhists, and other practitioners of meditation, practice a form of meditation called metta meditation, or compassion meditation, in which the meditator tries to generate compassion for living beings: first him- or herself, then loved ones, then acquaintances, then enemies, then strangers, and ultimately all that lives.

This form of meditation would not actually work with paranoids, because the issue with paranoids is not their own hate for others, but the imagined hate others have for them. However, if this form of meditation were reversed, it might actually serve as a potential cure or prevention for paranoia.

Since the paranoid's emotions have become projected onto other people, he must deal both with the emotions ascribed to the ego as those ascribed to others, meaning that he must re-place him- or herself in the place of others and then deal with the emotions he feels for himself in others' place.

To the paranoid, the metta meditation should be focussed entirely on the first stage of generating compassion for him- or herself, but from the viewpoint of others. In other words, he or she should imagine other people to love them and send them love. This is unlikely to work, but in the process, he or she might resolve the hate that he or she imagines others to feel for them, which is actually their own self-hate projected onto others.

As this form of meditation would require insight on the paranoid's part that he or she is paranoid, this would sometimes be more useful as a preventive than a curative method, at least in severe cases. Nonetheless, it can also be used in less severe forms of paranoia, or while the illness is already or still in full force.

Though most likely not in the modality of classical astrologies, it is factual that the month in which one is born is likely to have an influence upon one's personality, much like the time during pregnancy. When the child is still unborn, the environment can affect it through the mother once the brain is active, because of hormones received from the mother. After the child is born, however, the environment directly affects the child through its own experiences. It is quite logical that, since the brain is still not yet fully developed during the first few months after birth, its growth will still be affected by the environment. In fact, the brain is affected by the environment throughout life, because it keeps growing new connections with every experience.

However, it is mostly in childhood that the personality is formed. It makes sense that the earlier in one's life, the more one's experiences impact one's personality, because there is still so much empty space to be filled in. It is not to be wondered at, then, that people who were born through Cesarian section have been observed to be calmer than those born through the far more traumatic natural delivery.

My idea is that while the time of year also has an effect on the early formation of one's personality, it also depends on all environmental factors at the time of one's birth, including weather and the pervading mood in the family.

It has already been observed, for instance, that the chance of developing schizophrenia is higher if one was born during winter or early spring, with a ten percent difference between february and august. It is also known that schizophrenic symptoms are generally worse in winter than in summer. This former correlation, however, is also likely partly caused by the last three months of pregnancy, as the brain of the fetus activates at nearly six months after conception.

There is a possibility that, through the passage of observation from one generation to the next, correlations were observed between the month of one's birth and personality, although this is no excuse for proper scientific method. These may later have formed a core of truth in some astrologies, but since astrology is based mostly on the significance one would be inclined to attribute to zodiacal signs, most of it is still likely to be fantasy.

Instead, it would be interesting if, as an extension of earlier investigations which correlated schizophrenia with birthdays in winter or early spring, researchers would investigate further links between the month of one's birth and personality. The correlation already said above, for instance, could mean that people born in winter or spring are generally more fantastic or more nervous than other people. By that logic, people born in summer or early fall would generally be more practical and cheerful.

It would be interesting to see a scientific replacement for astrology, although the correlations actually found would likely be less dramatic than those affirmed by astrologies. Furthermore, the correlations would likely be less specific for each month, instead being spread out over many months.

Imagine how it must be like for a newborn to suddenly emerge from the womb and begin to experience its environment. Only months before, there had been nothing but a great blackness. You can remember absolutely no past; nothing whatsoever. There was nothing. There has never been anything. You are unable to form a single concrete thought; all you can do is to experience the world in its overwhelming intensity. Everything is new, alien, impossible. You are constantly learning. Every single sensation or movement is a new lesson to understand. Your mind is filling itself with qualia like a black hole. Life suddenly explodes from a narrow space in a mother's womb into an entire, infinite universe. In this time, how can it be otherwise than that the nature of our first experiences impacts our personality for the rest of our lives?

Madness is an abandon of reality to escape into fantasy; schizophrenia is also an abandon of the self in order to do so.

In schizophrenia, severe chronic stress resulted in the failure of the individual's coping mechanisms; she or he loses courage to face his difficulties and therefore to care for her- or himself. In other words, the ego dissolves. Practical thought becomes reduced because the individual has lost the will to concern her- or himself with it. Not finding safety in reality, the individual is then forced to flee into unreality, leading to psychosis.
What remains is simple experience, be it of a sensory nature (i.e. sensations) or abstract (i.e. imagination). No longer having the will to filter perceptions of practical value from those without, perceptions that are normally filtered at once become more prominent. This is referred to as decreased latent inhibition. Perceptions that are normally unconscious encroach upon the conscious, while normally conscious (practical) perceptions become unconscious.
Because the individual's awareness is partly transferred from the practical thought which usually accounts for a large part of our mental processes to experience, this may lead to a state of expanded consciousness. While this may be experienced as pleasant at times, as the illness progresses it becomes so inescapable that it becomes horrifying.

To this day, there is no therapy specific for psychosis except for antipsychotics. A therapist can talk to a psychotic in the hopes that they will gain more insight in their own situation just like any other patient, but they can't give them any treatment which focuses particularly on psychosis.
Perhaps to this purpose, psychologists could subject the patient to a kind of training, a reality training. In such training, questions could be asked about a purely hypothetical person in a specific circumstance which relate to the patient's psychosis, such as:

"Person A finds that someone is following him or her. Is it more likely that:
A) the follower is involved in a governmental conspiracy, or
B) the follower wants to ask person A directions.

It may be useful to sketch the characters in the hypotheses as specifically as possible, so that, although they may be similar to the patient, the patient can think of them as other people. They do not have to be of the same age, sex, race, or personality. Important is that it is asked not what IS true, but what is more likely to be true. Implying that their delusions are false may make them defensive about their truth; they have to decide for themselves if they are true or false, but we can make them have a clearer view of their own situation by projecting it onto other people, so that they learn how others deal with them.
If one tries to convince a patient that their delusions are false by arguing about it, it is very possible that they will see one as being part of the conspiracy in their delusions. This probability is increased by the fact that many schizophrenics are often highly sensitive and might see criticism about their beliefs as a personal attack.
Because psychotics have a lot of imagination, they think highly parallel. They think in multiple possibilities, but are unable to see which is most relevant. They see so many possibilities in their mind that they no longer see which are likely to happen in reality and which are not.
Most people will tell psychotics that their delusions are impossible. In fact, nothing is impossible: it is always possible that they are being followed by someone who is involved in some conspiracy, but it's just very unlikely. Because psychotics are so good in hypothesizing, when they are told that something is impossible, they will eventually realize that this isn't true. "What if my father had somehow gained access to top secret information without my knowing and is keeping it somewhere, what if the FBI is pursuing me for this?" What often happens then is that when the psychotic realizes that their delusions are, after all, a possibility, they will wonder why whoever is telling them that they are impossible is "deceiving" them, which might make them believe that they as well are involved in some conspiracy which is meant to keep them from knowing the truth. Instead, it is better to tell them that their delusions, while possible, are very unlikely.
To a schizophrenic, the relevant possibility is no longer the most probable one, but the most drastic one. Because of their high faculties of imagination, they will also be able to imagine all possibilities very vividly; what then matters to them most is those imagined possibilities which elicit most emotion when they imagine them, that is to say, those which they fear or hope for the most. It doesn't seem to matter how likely they are because in their minds, they are already real: they happen in their fantasy as vividly as a dream happens in our own.

A. A Comparison between Schizophrenia and Autism

Although there is some similarity in the symptoms between schizophrenia and autism, there is also a dichotomy in their causes: schizophrenics are thought to have a lack of glutamate function, while autistics are thought to have an excess. Glutamate is implicated in latent inhibition, the blocking of seemingly irrelevant stimuli. Autistics will only assimilate stimuli which are most relevant to them, while schizophrenics will be flooded by an overflow of irrelevant stimuli.
Obviously, latent inhibition impairs concentration, but it also enhances abstract thought. This is why autistics can’t think abstractly, while psychotics think too abstractly, so that they both have trouble communicating with others. In autistics, high latent inhibition may also lead to fear of novelty, obsessive-compulsive behavior, and lack of imagination, while in schizophrenics, low latent inhibition may also lead to delusions, paranoia, and thought disorder.
Glutamate decreases serotonin, modulates dopamine (increases dopamine in some areas and decreases it in others), increases acetylcholine, decreases noradrenaline, and decreases melatonin - these changes are all found in autism except for increased acetylcholine, which is decreased - in schizophrenia, the exact opposite of the effects of glutamate are seen except for increased melatonin. Autism and schizophrenia may be considered to have opposite chemical causes, even though many of their symptoms seem similar. Autism could potentially be treated by glutamate antagonists, just like schizophrenics are treated by glutamate agonists (atypical antipsychotics).

B. More on Schizophrenia

Psychotic depression, a relative of schizophrenia, has a neurological pathology which is very similar to that of schizophrenia, but in a milder version . Psychotic depression, like schizophrenia, is characterized by delusions, paranoia, and often hallucinations. Both schizophrenic and psychotically depressed people often hear voices, which will either judge them or order them. In psychotic depression, these will always be persecutory, while in schizophrenia, they may sometimes seem benevolent. In both, these may criticize the patient or tell him or her to commit suicide.
Both syndromes are caused primarily by a combination of stress and diathesis, although the diathesis (the genetic and neurological susceptibility to suffer from a condition) is usually more pronounced in schizophrenia than in psychotic depression. Both syndromes are caused primarily by a combination of stress and diathesis, although the diathesis (the genetic and neurological susceptibility to suffer from a condition) is usually more pronounced in schizophrenia than in psychotic depression. Schizophrenia can therefore be interpreted as a severe form of psychotic depression. The hallucinations and delusions that characterize is are either a manifestation of stress (eg thinking that the entire world is against the patient, or hearing voices which criticize the patient or encourage him or her to commit suicide) or, conversely, as a defense mechanism against it (eg thinking that one is sent for a mission or an imagined friend).
All symptoms of schizophrenia are a manifestation of stress, even though stress that induces schizophrenia in one person needn’t do so in all people. However, all people have susceptibility to schizophrenia, each having a different threshold of stress needed to cause it. This threshold may or may not be altered by other factors such as substance, but it is inherently there in each of us.
Research has shown that chronic stress leads to an increase of serotonin and noradrenaline and a decrease in glutamate, which are all seen in schizophrenia. Thus, one could say that anyone who suffers for a long time will become slightly schizotypal, although this is usually in such a mild form that it is not psychotic. Psychosis is still so common not only because evolution has preserved it, but also because it is not fully evolutionary.

In schizophrenia, imagination and reality merge. It is as if their dreams impinge on their waking days, which is why schizophrenics have less dream recall. This may be attributed to a disruption in the circadian biorhythm: normally, we can only distinguish imagination from reality when awake, but not in our sleep. One could say that all of us are schizophrenic, but our schizophrenic episodes are all restricted to our sleep. This could be why chronic insomnia can lead to psychosis, something sometimes seen in the manic episode of bipolar disorder. And while mania is associated with elevated glutamate, manic psychosis as well as schizophrenia are associated with reduced glutamate.
Glutamate is a neurotransmitter which enables us to distinguish imagination from reality, but schizophrenics have a deficit of this neurotransmitter. Normally, glutamate cycles from day to night, but in schizophrenics, this cycle is disrupted. The glutamate is one of the neurochemicals involved in the day-night cycle, its rhythms not only caused by but also causing it , which is why administration of glutamate may increase both wakefulness and sleep . During sleep, glutamate is normally counteracted by adenosine , which triggers, so to say, healthy nighttime psychosis.
We are all somewhat mad, but our madness usually occurs only in sleep: our insanity is usually safely relegated to our dreams. Although dreams have many more functions, they can also be said to be a deposition of psychosis. Arthur Schopenhauer said that "Dreams are brief madness and madness a long dreams.” Actually, it may be that dreams and madness have the same duration, but occur respectively during night and day - in psychosis, the order is reversed.
The involvement of adenosine in the day-night cycle also explains why adenosine agonists can alleviate the symptoms of schizophrenia and why caffeine, an adenosine antagonist, worsens positive symptoms of schizophrenia . Although an acute administration of adenosine will cause a short-term decrease in glutamate, more chronic administration will cause an amplification of the glutamate rhythms. This is so because the adenosine agonist will have more effect if more adenosine is present. This principle applies to for every neurotransmitter: any neurotransmitter agonist will have more effect if it has more of the neurotransmitter to act upon.
Possibly, schizophrenia may largely be attributed to anomalies in circadian rhythms. In schizophrenia, this cycle is disrupted, so that restoring this cycle might reduce the symptoms of schizophrenia. Ironically, by by treating its nighttime symptoms, we may also be able to treat the daytime symptoms of schizophrenia. This is also one reason why melatonin has proven useful in the treatment of schizophrenia: melatonin is one of the most important chemicals involved in the biological clock. Melatonin is dubbed the “sleep hormone,” and low levels have been observed in schizophrenia as well as in depression. In addition to the voices, this is also a reason why schizophrenia have trouble sleeping. Furthermore, there is evidence that melatonin potentiates glutamate transmission.
An insufficiency of glutamate could cause both positive and negative symptoms, which are respectively delusions, paranoia, hallucinations, and thought disorder, and apathy, blunted affect, anhedonia (lack of pleasure) avolition (lack of will), alogia (saying little), and hypomimia (lacking mimic). The cooccurrence of these symptoms seems paradoxical because positive symptoms are caused by an excess of dopamine, and negative symptoms are caused by a shortage of dopamine. This apparent contradiction is resolved by the fact that glutamate is self-modulatory, meaning that the increase of glutamate in one brain area will cause a decrease of glutamate in another. As glutamate increases dopamine levels, this will likewise affect dopamine throughout the brain. This is clearly illustrated in how increased dopamine is found in the striatum and MPOA in schizophrenia, which is an effect caused by increased glutamate. The dichotomy of positive and negative symptoms in schizophrenia is proportional to the imbalance of glutamate.
The lack of dopamine in some brain areas which ensues from lack of glutamate can set in motion a vicious circle consisting of two separate cycles, together leading to the positive and negative symptoms of schizophrenia. These cycles may occur as follows. (Mentioned symptoms may or may not be present, according to severity and type of schizophrenia.)

1) In brain areas where glutamate is decreased:

- glutamate ↓
NEUROLOGICAL:
→ dopamine ↓
NEUROLOGICAL:
→ GABA ↓
→ glutamate ↓
→ serotonin ↑
PSYCHOLOGICAL:
→ anhedonia
→ motor retardation
→ acetylcholine ↓
NEUROLOGICAL:
→ serotonin ↑
→ noradrenaline ↑
→ dopamine ↓
PSYCHOLOGICAL:
→ attention / concentration ↓
→ GABA ↓
NEUROLOGICAL:
→ serotonin ↑
→ noradrenaline ↑
PSYCHOLOGICAL:
→ hallucinations
→ anxiety
→ insomnia
→ serotonin ↑
NEUROLOGICAL:
→ glutamate ↓
→ acetylcholine ↓
→ GABA ↓
→ noradrenaline ↑
PSYCHOLOGICAL:
→ blunted affect
→ noradrenaline ↑
PSYCHOLOGICAL:
→ blunted affect
→ dissociation
→ inhibition
PSYCHOLOGICAL:
→ blunted affect
→ attention / concentration ↓
→ latent inhibition ↓
→ thought disorder
→ hallucinations
→ delusions
→ avolition
→ apathy

2) In brain areas where glutamate is increased:

- glutamate ↑
NEUROLOGICAL:
→ dopamine ↑
NEUROLOGICAL:
→ melatonin ↓
→ GABA ↑
→ glutamate ↑
→ serotonin ↓
PSYCHOLOGICAL:
→ obsessive-compulsive disorder
→ latent inhibition ↓
→ thought disorder
→ hallucinations
→ delusions
→ acetylcholine ↑
NEUROLOGICAL:
→ serotonin ↓
→ noradrenaline ↓
→ dopamine ↑
PSYCHOLOGICAL:
→ blunted affect
→ ACTH ↑
PSYCHOLOGICAL:
→ anxiety
→ GABA ↑
NEUROLOGICAL:
→ serotonin ↓
→ noradrenaline ↓
PSYCHOLOGICAL:
→ auditory hallucinations
→ blunted affect
→ serotonin ↓
NEUROLOGICAL:
→ glutamate ↑
→ acetylcholine ↑
→ GABA ↑
→ noradrenaline ↓
PSYCHOLOGICAL:
→ paranoia
→ obsessive-compulsive disorder
→ anxiety
→ noradrenaline ↓
PSYCHOLOGICAL:
→ attention / concentration ↓
→ memory ↓
→ melatonin ↓
PSYCHOLOGICAL:
→ insomnia
→ anxiety
→ depression
PSYCHOLOGICAL:
→ anxiety

GABA, or gamma-aminobutyric acid, may have an important yet little recognized role in schizophrenia. GABA is implicated in the auditory pathways, and most hallucinations in schizophrenia are auditory. Also, it modulates latent inhibition : both an increase and decrease of GABA reduces it, which is why benzodiazepines, which act on the GABAA receptors, are weakly hallucinogenic. Moreover, withdrawal of Zolpidem, a benzodiazepine, may lead to both auditory and visual hallucinations. In schizophrenics as well as in people withdrawn from benzodiazepines (which can lead to delirium tremens) GABA receptors are decreased.