The following text is taken from Gordon Claridge’s book Origins of Mental Illness: Temperament, Deviance, and Disorder, 2nd edition (1995).
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Our second line of enquiry into the nature of the psychotic nervous system has taken a somewhat different direction, though it too has used a similar strategy; namely, examining selected normal individuals to see whether on certain experimental measures they behave like schizophrenics. The focus for this research has been the extensive evidence, described in the previous chapter, that schizophrenics show unusual patterns of hemisphere organisation. Is this also true of some normal people?
Recent results we have obtained suggest that it is. Here the subjects were chosen according to their scores on the new questionnaire of 'borderline' characteristics mentioned above. Comparisons made on a variety of hemisphere function tasks have demonstrated, almost without exception, that people with high scores on the questionnaire do differ in performance in a way that is compatible with their having schizophrenic-like nervous systems.
Thus, a general finding that emerges is that schizotypal individuals, like schizophrenics, show weakened, or even reversed, laterality of function as measured on standard divided visual field tasks. This is particularly evident for the processing of verbal material – nonsense syllables or letters – where the left hemisphere's usual superiority is diminished in schizotypes. We have also found that they differ when examined in the auditory modality: the task used here was the same as that referred to earlier as showing effects in both schizophrenics and their children; namely the comprehension of stories played either to one ear or to both ears simultaneously.
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Although these unusual brain asymmetries are most clearly observable with respect to verbal processing – and, for that reason, least ambiguously comparable to those found in schizophrenics – other differences in hemisphere function can also be observed among individuals who score highly on our questionnaire of 'borderline' characteristics. Thus, we have found that they differ, too, in the relative extent to which their hemispheres are engaged during simple perceptual processing; specifically when asked to do a task which requires them to process stimuli either 'locally' or 'globally'. These two abilities are known to be partly hemisphere dependent, the left brain for example, normally being better at detailed or local analysis of a stimulus. In schizotypal individuals, however, the reverse seems to be true. This may be significant because several psychologists who have explained schizophrenia as a disorder of information processing have suggested that a crucial features may lie in the schizophrenic's inappropriate use of 'local' and 'global' modes for analysing perceptual data.
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Note: In these passages, Claridge uses the term borderline in the broader, historical sense of borderline states, referring to a range of conditions and characteristics situated at the boundary between personality disturbance and full-blown psychosis, rather than simply to what is now termed borderline personality disorder.)
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Clearly we have a long way to go before we can arrive at a precise description of the schizotypal nervous system. But, as a general principle, the idea of a continuity between the normal and the psychotic – long considered likely by those outside the arena of academic debate – seems to be well supported by experimental evidence. In this respect, it is especially satisfying that at the biological level the continuity should be evident for both aspects of brain activity that have proved useful in describing schizophrenia itself; namely, in dynamic process variations – as reflected in patterns of psychophysiological response – and in hemisphere organisation.
There is thus a remarkable similarity in the pieces of the two jigsaws – that for schizotypy, on the one hand, and that for schizophrenia, on the other. In each case we find evidence for a tendency towards instability of brain activity from which, in schizophrenia, we inferred that there may be a relative lack of homeostasis in the nervous system – both vertically and horizontally – and it seems that this might also be true, to a lesser degree, of the schizotypal or psychotic personality.
At a psychological level there is also a parallel, in the normal schizotype's readiness to admit to perceptual aberrations, unusual thought styles and beliefs, openness to experiences, disharmony of personality structure, ambivalence of emotional response to others, and an uncertainty about the self-concept. All of these features could be said to mirror the 'psychotic' form of brain organisation found in the schizotype. As, extrapolating from theories about the illness itself, could other probable characteristics: an unusual sensitivity to events in the internal and external environments, a heightened Id awareness of the contents of consciousness, and a highly tuned selectivity of attention.
Returning to schizophrenia itself, let us now see whether it is possible to construct a plausible account of how, in this case, illness might proceed from the dispositional characteristics that underlie it. A convenient place to start is at the point of contact between the schizotypal individual and his social environment. For it is the interaction and communication with others that almost certainly place the greatest demands on the kind of nervous system just described. The idea that social, or more narrow family influences can by themselves cause schizophrenia now flies in the face of considerable evidence to the contrary, some of which we referred to briefly in the previous chapter. However, it is the case that the immediate family environment of the schizophrenic can, once the illness has started, worsen the condition and cause relapse into further psychotic episodes. This conclusion is clearly supported by the work of Leff and his colleagues, who have demonstrated that the schizophrenic is extremely sensitive to the amount of face-to-face contact and level of expressed emotion he encounters from close relatives. Now Leff and his co-authors studiously avoid inferring from this that similar effects may be at work prior to the onset of illness or that they could, through prolonged exposure to such influences, contribute to subsequent breakdown. However, I would suggest that indeed may be the case and that the overall vulnerability to schizophrenia consists of a genetic disposition, compounded by a particular form of interaction between the schizotypal nervous system and the family environment. How, in detail, might this work?
Part of the clue, on the biological side of the equation, might lie in what we have seen to be the unusual manner in which schizophrenics (and schizotypal individuals) process events around them. The way they deploy their attention is certainly odd, two particular features which I would like to emphasise here being as follows:
_ one is the tendency to utilise local and global perceptual strategies in a peculiar fashion
_ and probably to rely much of the time on detailed, rather than holistic, modes of analysis; the other is to do so especially in the analysis of social stimuli, such as facial – and therefore non-verbal – expressions of emotion in others.
Given that the latter are among the most elaborate stimulus configurations encountered in life – but also vital to social development – it seems probable that the schizotype, merely because of the arrangement of his nervous system, will be at greater risk of misinterpreting non-verbal social signals, because of his tendency to focus on, or attend selectively to, their constituent parts rather than consider them in a total context.
Put more generally, he might just have more difficulty sorting out meaning in the complicated flow of verbal and non-verbal interchange that makes up social communication, particularly if this signifies strong emotion, and especially so given the unusual organisation of both the expressive and receptive aspects of language in the schizotypal brain. Occurring from childhood onwards this form of interaction with others could exacerbate a pre-existing genetic disposition, to produce a cognitive and personality style that is vulnerable to schizophrenic breakdown.
So much for the contribution of the individual's nervous system 'type'. What about family influences that may interact with it? If, as suggested, recent work on 'expressed emotion' in schizophrenia can be generalised to childhood, we could conclude that particular kinds of family milieu, because of their emotional climate of criticism, overinvolvement and so on, might be especially powerful in bringing about the effects just described. Here, incidentally, there may be something to be said in favour of the old idea of 'double-bind', as a pathological form of communication in which the sender in a social interaction emits verbal and non-verbal messages of conflicting meaning: a typical example is the parent who, aggressively hugging the child, simultaneously says 'I love you'. The theory that such interactions by themselves can cause schizophrenia is now discredited. On the other hand, they would present to the schizotypal child a particularly difficult example of the kind of interpersonal situation with which his nervous system is ill-equipped to deal. The double-bind aside, there is considerable evidence that the communication patterns in schizophrenics' families are abnormal. Undoubtedly these partly arise as a reaction to the schizophrenic or potentially schizophrenic family member. But another important element, often overlooked, is that the parents will, through genetic affinity with their offspring, share some of the temperamental makeup of the vulnerable child and therefore some of his or her difficulties with social interaction. This would mean that communication within the family may be mutually ambiguous or otherwise unusual, biological and social factors operating synergistically to push the most genetically prone individual towards schizophrenia.
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According to some opinion it might be said that what I have just described is schizophrenia, especially if one sees that condition as part of a broad spectrum of deviance. For the above account does not depart too drastically from the explanation offered by those with Laingian and other radical psychiatric views – even though it does introduce a much more biological emphasis than they would prefer. On the other hand, even they would recognise that as a full-blown illness, schizophrenia involves a very marked discontinuity of function, a recognisable break into bizarre, and apparently incomprehensible symptoms. It is therefore still necessary to explain how and why this occurs. A crucial factor here, I believe, is the other unusual feature of the psychotic brain; namely the relative instability of mechanisms responsible for central nervous arousal. As we have seen, this can result in marked shifts in physiological state which will, inevitably, cause the individual to respond inappropriately – and on occasions strongly – to situations that evoke arousal. Now it can be stated as a general principle, which applies to all organisms, that excessive arousal will disrupt psychological functions, finding the weakest point in potential sources of abnormality and throwing these into sharp relief: in the schizotypal person this would seem to be the arrangement of the higher nervous system as it relates to the organisation of language, thought, attention and social perception. It is not difficult to see how such psychological functions might become deranged under conditions of particularly acute stress. To take a highly specific example, the pre-schizophrenic's tendency to 'read 7 the behaviour of others in an unusual way may only take on pathological valence at times of heightened emotional arousal. Only then perhaps is he likely seriously to misinterpret and attach sinister significance to perceived non-verbal (or verbal) signals which otherwise may remain below the threshold at which they disturb consciousness: the road from there to elaboration through delusional thought is a short one.
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Let us now turn upside down some of the questions being addressed over the last few pages and consider another set of issues raised by the continuity view of schizophrenia. If the predisposition to schizophrenia varies in a graded fashion among the general population, why is it that, relatively speaking, only a few become ill? Certainly an important factor, strongly indicated by the genetic evidence, is the difference between individuals in their degree of inherited liability to schizophrenic breakdown. Interacting with this will be their amount of exposure to critical influences that either further increase overall vulnerability or, alternatively, allow what might otherwise be a strong genetic predisposition to lie dormant. Such influences include biological hazards, like minimal brain damage at or soon after birth, life events in childhood and adolescence, and the quality of the family environment during upbringing. Another important, though less definable, factor is undoubtedly the extent to which even highly schizotypal individuals are protected from breakdown by intellectual and other personality resources – their 'ego-strengths' – which enable them to cope with, and sometimes profit from, unusual, psychotic, states of mind.
An illuminating example of this last point is Jung who, after his break with Freud just before the start of World War I, entered what can only be considered a period of schizophrenic turmoil – or, as he himself, recalling it years later in Memories, Dreams, Reflections, referred to as his 'confrontation with the unconscious. He describes the experience in a vivid detail that accurately recapitulates many features of the psychotic state, which he, as a psychiatrist, felt compelled to explore:
“An incessant stream of fantasies had been released, and I did my best not to lose my head but to find some way to understand these strange things. I stood helpless before an alien world; everything in it seemed difficult and incomprehensible. I was living in a state of tension; often I felt as if gigantic blocks of stone were tumbling down upon me . . . But since I did not know what was going on, I had no choice but to write everything down in the style selected by the unconscious itself. Sometimes it was as if I were hearing it with my ears, sometimes feeling it with my mouth, as if my tongue were formulating words; now and then I heard myself whispering aloud. Below the threshold of consciousness everything was seething with life . . . When I was writing down these fantasies, I once asked myself, 'What am I really doing? Certainly this has nothing to do with science. But then what is it?' Whereupon a voice within me said, 'It is art.' I was astonished. It had never entered my head that what I was writing had any connection with art. Then I thought, 'Perhaps my unconscious is forming a personality that is not me, but which is insisting on coming through to expression.' I knew for certainty that the voice had come from a woman. I recognised it as the voice of a patient, a talented psychopath who had a strong transference to me. She had become a living figure within my mind.”
Jung leaves us in no doubt that he was aware of the schizophrenic quality of his experience, for he goes on to note that at every stage of it he had 'run into the same psychic material which is the stuff of psychosis and is found in the insane . . . the fund of unconscious images which fatally confuse the mental patient/ Yet he had retained his sanity and indeed it was on the basis of the fantasies he encountered during that period that he went on to formulate his own, very influential, theory of the psychology of Man.
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The following text is not from Claridge's book.
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Breakdown:
For Claridge, schizotypy is best understood as part of a continuity between normality and psychosis: a neuropsychological organisation that shares important features with schizophrenia, but can remain relatively stable and adaptive rather than necessarily progressing to psychosis.
- Continuity with psychosis. Schizotypy lies on a continuum between normality and schizophrenia. The distinction is therefore not simply between having and not having psychotic characteristics, but between different degrees and forms of an underlying organisation.
- A schizotypal nervous system. Claridge proposes that schizotypal individuals show aspects of nervous-system organisation resembling those found in schizophrenia, although generally to a lesser degree. Evidence includes atypical hemispheric organisation, weakened or reversed lateralisation, differences in perceptual processing, and possible instability of brain activity and reduced neural homeostasis.
- Unusual information processing. This organisation is reflected in the way schizotypal individuals process information. They may show unusual local/global processing strategies, a tendency toward detailed rather than holistic analysis, highly selective attention, and heightened sensitivity to events in both the internal and external environment.
- Psychological manifestations. At the psychological level, this may be expressed through perceptual aberrations, unusual thought styles and beliefs, openness to unusual experiences, uncertainty about the self-concept, ambivalence in emotional responses to others, and some disharmony in personality organisation. These characteristics can be understood as psychological expressions of the same organisation that, in a more extreme form, appears in psychosis.
- Heightened awareness and attention. Claridge also emphasises a heightened awareness of the contents of consciousness and an unusually selective deployment of attention. Thus, schizotypy involves not only unusual beliefs or perceptions, but differences in what enters awareness and how experience is processed.
- Social perception. Social interaction may be a particularly demanding domain because it requires the integration of complex verbal and non-verbal information. A schizotypal individual may be more likely to focus selectively on particular components of social signals rather than apprehending them as an integrated whole, increasing the risk of misinterpreting facial expressions, emotional cues, and other interpersonal signals.
- From vulnerability to psychosis. Schizotypy constitutes a vulnerability to schizophrenia rather than an inevitable progression toward it. Genetic predisposition interacts with developmental, biological, environmental, and interpersonal factors. Under conditions of heightened emotional arousal or stress, normally manageable peculiarities in perception, thought, attention, or social interpretation may become increasingly disorganised and acquire pathological significance.
Adaptation and protection. Highly schizotypal individuals do not necessarily become psychotic. Intellectual and personality resources—what Claridge calls “ego-strengths”—may protect against breakdown and may allow unusual states of mind to be integrated into relatively stable, or even productive, functioning.
Source: r/Schizotypal · by /u/DiegoArgSch