I have lost two friends to schizophrenia in the last few months. Two, savory characters that didn’t know each other, but that I knew well, recently had psychotic episodes where they became totally delusional for several days. Both of my friends had been under a lot of stress (both had lost a parent) and their breakdowns were so severe that they had to be hospitalized for a few weeks. Both experienced a kind of temporary insanity, and now have diagnoses that include schizophrenia. In the weeks before hospitalization, their thinking was so distorted that they began to believe things that were totally irrational. My first friend thought his friends were saints and that he was an angel responsible for preventing an ensuing apocalypse. My other friend thought that every video on youtube.com was a personal message giving him clues about his future. I wanted to tell myself that there was no way that I would have the same delusions if I had a biologically similar episode. I figured that I couldn’t possibly believe what they believed. Perhaps I am not psychologically wired to have delusions involving the same content as those of my friends, but I would probably believe something else, something equally as delusional. My first friend believed more in the existence of angels and saints than I do and this must be one reason why he had this specific delusion. I stopped believing in supernatural phenomena completely as a child, so my delusions would probably be much less likely to feature superstitious or unscientific conceptions.
Chronic stress usually plays a large role in the onset of schizophrenia. If chronic stress is severe enough, and one has a genetic predisposition for it, the brain’s chemistry can change profoundly. Dopamine transmission to the prefrontal cortex is one the things affected the most and this skews perceptions (causing hallucinations) and also skews conceptions (causing delusions). In a general sense, skewed, psychotic or schizophrenic thinking causes people to take fewer mental representations into account when making decisions. This makes it so that the conclusions that they generate are hasty or poorly informed. For example, I might see a shoebox on the carpet in the corner of my eye and assume that it is my cat. Anybody might make this mistake, but the person with schizophrenia might feel certain that it was their cat, at least for that moment. The same changes that underlie hallucinations are probably also responsible for delusions.
Because our brains are constantly generating automatic conclusions from given assumptions, our minds become accustomed to this. All people tend to rely heavily on the perceptual and even conceptual conclusions that our brains jump to. If we had to consciously test every implicit conclusion that our brain makes, we would never get anything done. We are so used to trusting our snap judgments that we often don’t even question them, especially if they are accompanied by a feeling of certainty. I think that in schizophrenia, the certainty thermostat in the brain is set to a lower level. Delusions are usually caused when someone comes to feel the feeling of certainty even though their belief was based on limited evidence, causing them to feel strongly about superficial conclusions. If my mental abilities were similarly encumbered and if the certainty thermostat in my brain was equally off mark, what would I be delusional about?
The brain changes that accompany schizophrenia fundamentally change the process of generating conclusions. The snap judgments that a psychotic brain makes are less informed than they used to be, but most people don’t have any way of knowing this until their friends tell them that they are acting crazy. Certainty – the tendency to trust one’s judgments – stays the same, but because the judgments are less informed the psychotic person begins believing things that are patently wrong. It seems that in schizophrenia, and with some street drugs, this sense of certainty can be very compelling and falsely reassuring. In a psychotic episode, I might see someone do something vaguely familiar to something I saw in a horror movie. Because I wasn’t thinking on all cylinders, I might implicitly jump to the conclusion that this person was threatening me despite other evidence to the contrary. Because I have almost always been able to trust my sense of certainty in the past, I might fail to question or observe this impulse.
I feel like I have spent a good deal of my life actively avoiding irrational, unscientific and superstitious thinking. When I am not running on all cylinders, I don’t come up with fantastic, imaginative scenarios; instead I become dull and slow because I am not as good at thinking logically deliberately. Perhaps what I would be delusional about might not be quite as socially inappropriate or clinically recognizable as the delusions that my friends were having. Also, my clinical knowledge of schizophrenia and its symptoms might keep me from acting stereotypically schizophrenic. Perhaps people experiencing schizophrenia that are socially considerate and conscientious would simply be off compared to their former selves, but not compared to a social standard.
When your dopamine system is deranged, you are likely to act immature, emotional and to be driven by juvenile notions and goals. Even though I may have been psychologically sane enough not to do anything too out of the ordinary, the biological toll that prolonged stress took on me caused me to do things that I would normally know better than to do. After pronounced stress, I began to take up an obsessive interest in videogames, comics and Legos. I kept going to work, I kept trying to act normal and professional but I began to buy toys and intricately decorate whole rooms with them. I was so caught up with this that I did not question it the way I would have before the stress. At first I just saw it as a fun hobby that wasn’t taking up too much time but now, with hindsight, I believe that I never would have taken the resurgent interest in Legos to the same extent had my brain chemistry, my level of certainty and my judgment not been substantially altered.