Milton: Paradise Lost
Schizophrenia is an illness of long duration, often beginning in adolescence or early adulthood, that alters the ability of the mind to gather in outside experience, current and immediate past , integrate it with that which is stored away, and by holding it in mind, remembering the bit being used, to use it towards their future behaviour.
The example to hold onto when trying to appecate the dilemma and behaviour of someone affected by schizophrenia is an observation confirmed by a family carer.a family experience ... ' Hasn't been able to read a book for years'.
' Said he couldn't remember the top of the page by the time he got to the bottom. '
The same applies to watching a film or a TV story line.
I know of no more succinct account of the prime difficulty of those who are affected by schizophrenia than thatHow do you manage your life when what you require to get the point that was there at the beginning, has slipped away ?
Think of managing your ' off duty thinking' [ there is nothing to focus on puts you into the wandering inner 'voicing' of 'day dreaming states ] when you can't place where you should go back to.
It is likely going to be the hippocampus region in the brain that is essential for this 'holding on to the point'
This is an experimental studyThe brain is the organ of the mind.
Mental illness is an enduring change in the working practice of the brain, that leads to a reduction in the mental stability and the capacity to respond with the appropriate responses to matters inside and outside.Schizophrenia should start with a definition of what has gone wrong.
That's too difficult or too unclear at this stage
Because the condition is uncertain in it's first presentation,
the diagnosis is best made on those who
continue to have some residual disability following a first presentation.usually who show the condition over six months.
There is a great risk of misdiagnosis in the first flurry of disorganised presentation and limited observation
Some 10 -20 % of first presentations do not go on to be schizophrenia. Of those who do, 40% do not get better.
Drug misuse and the mania side of mood illnesses can mislead.
Begin with an introduction.The work of the mind rests on the connecting up of those parts - the networks of connections - in the brain, within itself. which have been learnt from experience, built up over time, and have been stored. in an accessible manner.
There is somewhere an internal library of experience within the brain, with the associated generalisations and the background context that were around at that time, categorised in some way that allows retrieval, and then allows sorting out, what is relevant at the moment of an intention, and that relevant experience held along, so that any adjustments that are to be made, as an intention proceeds, can be accessed at the appropriate time.
The brain goes on comparing that library of skills and habits, with what it senses and receives from what is currently is going on 'outside' itself , and what it can anticipate, from past experience, that is likely to come up next, and be required to be responded to, or not ; in the minute ahead, hour ahead, day ahead , in the weekly programme, for the whatever are the aims in the future.
Ordinarily the normal brain is prepared by what it knows from a previous routine; is primed by what is perceived, to connect to what will be required, so as to be able to fit in with what is going on, what will be going on, and so join in appropriately.To do that the brain has to reach inside for relevant experience, to hold onto that appropriate experience, so as to be able to meet and adjust to whatever comes up - most of which can be anticipated from past behaviour.
Day by day we follow an established routine, settled by a previous practice in famiiar surroundings.
The stimulus to retrieving past experience and skills can be an outside expectation - the 'normalising experience' drawing on what is a mostly a habitual living framework ; work situations or domestic schedules.
Or it can be an intention from inside, which to be realised, needs to have some internal reflection on what will be required,
and what might come up outside that will need to be addressed on the way to the fulfilling the intention.This brain function - the internal framework of experience - balancing within its parts - is variably, not always predictably, broken up in schizophrenia, leading to disordered connections in thinking, both silent and 'audible' inside. .
The whole is unco-ordinated
[ maybe, the 'Will' - the librarian, is out to tea, or does not have a full familiarity with the library, so retrieval is imperfect; or, the library is not now catalogued as it was, but is in some disarray.
When the illness is active and the person anxious , some of the necessary brain organaising, function is 'split off' [ schizo-phrenia ] , temporarily, and does not take part appropriately.
It isn't available when needed, or does not take a proportionate part in what the mind 'wills'.
The ability to hold onto the lead intention, and to refer back to it as things move along, is not always there,
so that the flow of engagement in what is going on, loses connection temporarily.Other associations may slip in, to be attended to with inner thinking, and doing that, lose the initial point and the sequence of the intended direction.
The difficulty is less when the direction comes from an inside intention - there residual associations come with it, although completing that, meets sidetracking on the way.
Responding to outside interactions brings greater difficulty in 'holding on to the point of it - too much irrelevant matter impinges - takes the mind eye off the ball.What is required in the context of what is being discussd or going on, is not immediately avaIlable. when required.
Keeping up is hard when other people or events interrupt. So, then, is returning to the subject under conversation.Prompting, cueing in, signalling, tactfully easing back to getting on track without condescemtion, or patronising, are helpful in conversation and managing,
At other times or at the same time, other things may be going on in the brain, intrude, take over and divert threads of intention and apllication.Schizophrenia - is a splitting off, a splintering into separated parts - instead of coordinating associations, of the relevant mental connections at any one time, within the stores in the mind at any particular time, leaving judgement and action less coherently based, less well-founded, less appropriate.
'There are often unexpected 'roadworks' going on'. The illness is there all the time, in variable intensity. but it is always difficult for sufferers to attend to things appropriately, and straightaway - illness bits have to be set on one side - not always possible.
Sufferers hold and sometimes act on erroneous conclusions and beliefs that 'harden' into an abnormal internal framework , from inadequate evidence, which can be inaccessible to others..
Enacting goes on with less than normal backgtound consideration.
The association material that is there in the background that enables people to do a full and reflective assessment of any situation is sometimes not available, or fluctuates.
The illness carries within it disrupted thought disorder, ideas not always being put in the appropriate contexts when the constraining associations built up from memories of experience are not present as they should be.sufferers can be distracted by 'voices' which seem to be forced upon them.Brain imaging points to this.
The first of our studies showed that, when patients experience auditory hallucinations (i.e. hear voices), activity is increased in Broca's area, that part of the brain which we normally use to generate our own inner "mental" speech.
This indicates that the words which people with schizophrenia hear as voices are self-generated in the same way that most of us would say the words of a poem or a prayer silently to ourselves.But why do those with schizophrenia not realise that they have generated the words themselves?
Researchers have shown that during hallucinations patients also activate their auditory cortex, the part of the brain which normally processes external speech.
In short, when a patient is hearing voices, there is activity in two parts of the brain: first in Broca's area, the part that would normally be involved in generating inner speech, and secondly in the auditory cortex, the part that would normally be active only while listening to another person speaking to them.
Thus the person with schizophrenia first produces words in their brain but then mistakenly activates the auditory cortex, and this seems to mave the brain into 'deciding' that there must be some external source for the words.
For example, we can study the effect of a new treatment on the abnormal brain activity when a patient is ill.The visual hallucinations or delusions associated with psychosis are perhaps similar to the day dream state, the function of which is to generate such 'hallucinatory' realities.
Neuroscientists ? have shown the same neuronal pathways are activated in psychotic episodes.Whilst dreaming we may believe completely in the reality of our dreams, just as the schizophrenic person believes in the reality of their inner abnormal associations .
But we can dismiss tany mis belief - going to some checking out appraisal in the brain.
Activity in certain areas of the brain is suppressed while performing mentally demanding tasks, like solving a puzzle. But when a person is at rest or performing nonstimulating tasks, these areas become very active [ 'the default stage' ] , triggering daydreams and other introspective thoughts
try out this technical mapping exercisedaydreaming and this to dream ay there's the rub
"We appear to use memory systems often in our default states. This may help us to plan and solve problems. Maybe it helps us be creative.
It is reported that sufferers from autism do not daydream ?
Try an analogy - never fully satisfactory.
Take the mind as an assembled jigsaw of network connections, a library sorted into interconnected sections, from which can be assembled, a background picture for any contingencyFor learning disability there never were enough parts to complete other than life as a simple picture.
In schizophrenia, when active, something has shaken up the complex picture, and left islands of connected pieces - but no framework that brings them together, holds them together, available for what it is necessary to do in reaction to innere intention or outer reaction. But the pieces are all there; the trick in treatment is to rebuild, to provide time, and a template to practice reconnecting, re-associating.As well, people with schizophrenia can have such a chameleon like 'sensitivity' to what is actually going on - it impacts disruptively on them, that they are distracted both externally and internally: they need time and recall of context; too much expectation as criticism can scatter the pieces all over again.
In dementia increasingly in ageing the pieces are lost, In brain damage some of the pieces have been lost - so that the whole picture cannot be restored, but enough are left to have some idea of what might be going on.
In illness of the mood feelings - depression/hypomania -the affect ( mood ) illnesses, the relevant level of interest and drive to assemble the jigsaw , and the proper level of mood to keep at it, does not kick in, or lifts too much, or falls; and there is little drive or too much drive to be applied; it cannot be sustained. They are stuck in low/high energy and difficulty. and cannot adjust it enough, or for enough time, themselves.There are not different kinds of schizophrenia.What makes the different categories - the expression of the illness - depends upon at what age it arrives, upon gender differences , and onto what kind of personality - normal, extrovert, and introvert, it descends.
There are two main divisions in the schizophrenia classification and they derive from the underlying personality of the victim of the illness.
There are not different types of schizophrenia - but different types of people upon whom schizophrenia falls.
Personalities which are introvert ( bobby charlton like: attlee like ? ) or extrovert ( jackie charlton like: churchill like ? ) exhibit symptoms accordingly. On normal people - a middle ground.Schizophrenia accordingly falls into negative - introvert; and extrovert - positive, categories of behaviour.
The negative symptoms take the part of withdrawal from engagement with people in the world; incompletion - things just run out of continuity; retreating into restricted 'driven', idiosyncratic patterns of behaviour - autisms; holding on to things and words as things; broken bits of habits of behaviour - postures , repeated phrases - stereotypies. Ambivalences : for; against - both together, not partitioned off.Those living with sufferers often feel depressed tht they cannot make contact, with sharing tasks or with conversations , pleasures, and affection.
If the world then insists on intruding without time being given time to become attentive, an angry explosive negative rejection is likely.
Positive symptoms are noisier, acted out in public more, lead to personal presentation, to actions and decisions taken forward on insufficient grounds, to mistakes in dealing, with people, in actions , and to mistakes in decisions of conclusions and significance. With that sometimes a touchy wariness, an attitude of suspicion, frustration and apprehension, worked out into misplaced locked-in private explanations - thay have their own inner explanation of what's going on in the world - paranoid delusions.
People with schizophrenia sometimes are 'forced' to 'hear as voices'; commenting, intruding, command, intrusions, forcing in on them from outside.
Brain Imaging taken at at the same time shows activity in the speaking part of the brain, not the listening part - suggesting the 'voices' are really inner speech thoughts, the internal talk with oneself -something like what we all experience before full waking or whilst falling asleep or into daydreaming - which this brain in schizophrenia faultily places to come from outside.People with schizophrenia experience 'passivity' - that is - from what their brain records, from what they feel as happening - they become certain something is imposing from outside on their inner thoughts with inexplicable significance and conviction of importance.
Passivity expereinces; They are not directing themselves, their thoughts, their intentions their acts, but these are imposed, go on by themselves - 'made' by outside intervention. Sometimes their own thinking is stopped other than by their own volition.If you or I had this highly personalised experience we would think we carry a personal importance - to be kept secret because nobody else seems to have it.
So we must be very important , too.
Hence important and powerful people with powerful force must be doing it Those who can do this must have extraordinary power. Hence witches, the gods , sects , political movements , electricity , and anybody who seems to be behaving oddly towards you is representative of that source of imposed influence. ( there will be odd reactions if you behave oddly yourself.) (including the mental health services !?)The extent and the predominant aspect of the disability that follows from schizophrenia depends upon which personality predominates and endures, but as well on the age and sex and circumstance of the person at the time the illness descends.
Where the illness arrives after a personal maturity - a settled individuality has been achieved - after the age of twenty-four - then the individual will have acquired and tested individual and social skills; a certain basic coherence may then continue, and enable the disability to be sustainable with some social skill. In this culture women have more individual skills - shopping, cooking, coping with an 'inferior social position' - they generally hold together better personally under schizophrenia.
But schizophrenia commonly intervenes in late adolescence and early adult ages.
These victims are hampered as well by ill developed skills at work, in unsteady companionships, in poor domestic maintenance. Their support system is generally poor, fragmented and their status low.
They then drop out to the bottom of the human heap.Life goes forward for all the other people - but not for them.
For them - it stops. Re-engaging can need help and sheltering.After the illness descends, confident and workable schema which guide life, cease to assimilate; the old ones - workable before the illness - fade out.
The sooner treatment can be accepted, the better the social skills hold up and keep their guiding relevance and further deterioration is held in check.
Less effective where the previous personality was introverted, and where family 'emancipation' - to personal style social assimilation - into personal work skills and a bank account, into personal play and interest areas, into success with personal companionships, had not yet occurred.
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250experience of a family carer the best source of facts about schizophrenia
history of the ideas about schizophrenia
There is a link to Paternal age at time of conception .... paternal age
*** family treatment; a caution
How to behave with schizophrenia
a new study of prospective memory helps explain the difficulties
Red,,,, Is memory difficulty the disability ? Three studies
more on working memory in schizophrenia: the disadvantage it imposes.
medical treatment and management
Schizophrenia aftercare Treatment :- guided and sheltered aftercare treatment is an unmet need
good website advice links -for carers of schizophrenia scroll down to Coping - in understanding how to live with schizophremia in a family member.
My wild idea about how schizophrenia comes
Licznik Odwiedzin, Licznik Wizyt