What is Schizophrenia?

My recent thoughts.

           Early this year, I read Bertrand Russell’s book, “Human Knowledge, its Scope and Limitations.” It’s an amazing book and well worth reading. At one point, the author points out that Schizophrenics “hear” their own inner voice but interpret it as coming from outside the self; that is, an external voice. Or as generally spoken: “They hear voices”.

           I was astounded to read this. Even though I had been to medical school and had worked with Psychiatrists and Schizophrenics for decades, I had never heard of “hearing voices” spoken about in such an insightful way. I know it sounds obvious when you think of it. As my great-uncle used to say: “Where genius has gone, fools can follow.”

           We were talking about this the other day and my wife mentioned that she had come to the same realization regarding a family member. My son also read much of the book and had come to similar thoughts on the matter.

           That lead to an interesting discussion. What exactly would it be like to not appreciate that your inner voice is your own? As Russell pointed out, all we can know is via our inner neurological mechanisms using our senses and our memories. So in a sense, all “voices” are internal. We only “hear” someone else’s words after our brain interprets them and feeds them to our conscious mind as a voice. Our brain transmits our own thoughts as a voice, which our conscious mind “hears”.

           Thus there is not as much difference as you might think between hearing someone else’s voice and our own inner voice. However think what it would be like if your conscious mind had no way of distinguishing the self’s inner voice from external voices. It would be chaotic and at times, terrifying. I had always appreciated how scary it must be to be psychotic but now I began to see it in a new and even more frightening way. Imagine if every thought seemed to come from an external source, especially if there was no-one else around! Surely this would lead to paranoia, projection and psychotic thoughts of demons/angels/god/aliens/KGB agents/telepathy (depending on your cultural background).

           Could the underlying cause of schizophrenia be a fundamental inability to be able to distinguish one’s own thoughts from external voices?

           How do we tell which is our internal voice and which are external voices? Remember to the brain there is no real difference, except external voices are interpreted from external sensory data in a real-time manner. You might just say that we just do know which is our internal voice (self) and which are the external voice(s). Which I suppose is true although it’s not very helpful. We know the difference because we know the difference. You could say the same thing about how we move our hands. We just do it because we can do it because that’s how we are made. However we know that there are very complex and fascinating neurological structures which allow us to move when we want to move. Not to mention the neurological structures enabling us to “want” to do something. And we are completely unaware of all these unconscious processes.

           Just imagine that there are neurological structures in our brains that tag internal thoughts as being initiated by the self as opposed to external voices which are initiated by contemporaneous sensory data (other peoples’ voices). In the same way that we are unaware of how we move our arms when we want to, we are unaware of how we know (feel, believe, experience) that our internal voice is ours and not someone or something else’s voice. If we lost or damaged or were born without the parts of our brain that control motion, we would be unable to move. And in the same way, if we lost or were born without the neurological structures that tag our internal voice as self, we would be unable to tell that our internal voice was ours. We would be constantly “hearing” our own thoughts and thinking they were external. We would be incredibly confused. We would be hearing voices. We would, in short, be schizophrenic.

           Say a child was born without the structures that tag internal thoughts as self. At first the internal voice is fairly rudimentary. There are emotions and there is sensation. There is no language either so there are no voices only sensation of sounds. Later the child learns language. Now there is an internal voice and the sensation of external voices. Most of the external voices are much more sophisticated, complex and compelling. The internal voice would be weaker and easily drowned out and not particularly important. Thus at early stages of development a child with the inability to tag the inner voice as self might seem “normal”, which here means “non-schizophrenic”. Perhaps we could figure out experiments which could detect this neurological dysfunction (if as I suggest, it exists). In any case the child gets older and more mature. The inner voice becomes more complex, sophisticated and compelling. At some point it becomes as “strong” as the external voices. At this time, the inability to tag the internal voice as self would become more and more troublesome. At early adulthood, it may manifest as illness.

           Do neurological structures underlie our ability to distinguish self from non-self? The very fact that Schizophrenics seem to be unable to so distinguish, is one possible piece of evidence. When we are dreaming, we believe the dream is a real experience. It may be that in the dreaming state the “tagging” of internal imagining as internal is turned off. We know that there are neurological mechanisms that disable our motor responses so that if we move a body part in a dream, we do not move our real body part. These structures can be damaged so that a dreamer will move the body part in question (possibly to his own detriment). In just such a way, the tagging mechanism might be lost/damaged or never formed in embryonic development leading to schizophrenia.

           What of the medications that are used to ameliorate the suffering of Schizophrenics? When I was in training, they were called “major tranquillizers”. Could it be that they work by a general suppression of neurological activity such that the inner voice is to some degree “weakened”? An inner voice that is “quieter” might indeed lead to quieter “voices” that are less disturbing. Other substances, such as ethanol, which Schizophrenics use to “self-treat”, might have similar effects.

           Thus I have come to the conclusion that schizophrenia may be due to a malfunctioning neural structure that may in non-schizophrenics, tag the internally generated thoughts (self-voice) to differentiate them from voices generated from sensory information. This is a purely intellectual exercise and if true would need to be supported by evidence.

           If it were true, then it may be possible to develop tests that could distinguish people who may be more susceptible to developing schizophrenia before they become ill. It may even be possible to develop cognitive exercises or treatments that could allow the susceptible person to more reliably distinguish self from non-self.

           It is my hope and wish that my thoughts might, in some small way, inspire some gifted person(s) to delve into the origins of schizophrenia and possibly lead the way to novel treatments for schizophrenia.

           Thank you for reading this.

-Lloyd Gordon

May 16, 2014