{"id":794,"date":"2016-10-27T09:14:19","date_gmt":"2016-10-27T09:14:19","guid":{"rendered":"http:\/\/blogs.cardiff.ac.uk\/mental-health\/?p=794"},"modified":"2016-10-28T14:09:38","modified_gmt":"2016-10-28T14:09:38","slug":"schizophrenia-and-the-paradoxes-of-insight","status":"publish","type":"post","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/schizophrenia-and-the-paradoxes-of-insight\/","title":{"rendered":"Schizophrenia and the paradoxes of insight"},"content":{"rendered":"

When we think of the symptoms of schizophrenia, perhaps the first examples that emerge in our minds are the chaotic thoughts, disturbing suspicions and invisible voices tormenting the sufferer. These are indeed the most striking manifestations of an acute psychosis \u2013 delusions, hallucinations and thought disorder \u2013 but as I wrote a few months ago<\/a>, these symptoms are not exclusive to schizophrenia and can even occur (albeit often in milder forms) in healthy people.<\/p>\n

Contrary to popular belief, these \u2018positive symptoms\u2019 (\u2018positive\u2019 as in \u2018additions\u2019 to normal experiences) are not actually the most common occurrences in a schizophrenic disorder. The most frequent symptom is in fact a lack of awareness into the unreality of their own psychosis: in medical terms, a \u2018lack of insight\u2019 which is thought to occur in 97% of patients<\/a> compared with 74% for auditory hallucinations and 70% for ideas of reference.<\/p>\n

Explanations for this lack of insight range from ego-defence mechanisms to abnormalities in the cortical midline structures (a group of brain regions considered key in differentiating self and other); either way, it is widely accepted that lack of insight contributes significantly to treatment non-adherence and sometimes eventual relapse, simply because many patients do not believe their experiences are not real and are symptoms of mental illness.<\/p>\n

From the patients\u2019 perspective, these symptoms create their own reality even though such a reality is often extremely frightening and unwelcomed. It is also indisputable, however, that these symptoms have no factual bases in external reality. Hence a permanent paradox is evident: which of these two realities is to be adopted by the patient?<\/p>\n

\"clara-humpston-on-schizophrenia\"<\/a><\/p>\n

Is reality nothing but a representation of our senses and beliefs? If so, who are we to decide that patients with schizophrenia have suffered \u2018a break from reality\u2019? This of course is a very philosophical question, with neuroscientific and social roots.<\/p>\n

A schizophrenic reality does not even have to be \u2018adopted\u2019 \u2013 it can enter one\u2019s awareness and take hold as if it was the only position from where one experiences the world. Imbued with significance, salience and meaning, the patient is simply unable to take on another perspective. A delusional elaboration \u2018fits well\u2019 with the structure of their consciousness and feels \u2018just right\u2019. Here, another paradox is apparent: to adopt a \u2018false\u2019 reality implies a volitional act, but in order to do so one has to give up the same volition.<\/p>\n

To have an integrated understanding of the world, one must first possess an undisrupted core of awareness. Symptoms of schizophrenia are very effective in destroying this very basic sense of self, upon which one constructs identities and personal narratives. Without this minimal layer of self, it should not be surprising that one will become unable to tell apart the multitude of internal and external worlds. This is why I view schizophrenia as fundamentally a disorder of the self.<\/p>\n

Given that the disturbance lies in the most basic level of the self, the paradoxes schizophrenia creates have the ability to carry on without solutions. Even insight itself is intrinsically just another unsolvable paradox: the desperate efforts to keep one\u2019s \u2018sanity\u2019 intact pushes one deeper into the abyss of simply being aware.<\/p>\n

Indeed, if one was completely unaware, one would not experience any pain or suffering either. In other words, patients with schizophrenia suffer immensely not always because they are unaware of external or everyday reality, but because they are too aware of another kind of reality \u2013 namely the reality created by their own minds.<\/p>\n

If there is anything of which the patient with schizophrenia is truly unaware, it will be their own self and not the factual, \u2018rational\u2019 reality. It may be controversial, but to say that lacking insight is a sign of losing touch with reality is like saying a colour-blind person is unable to see anything at all. Schizophrenia is like colour-blindness in this way; it taints and distorts everything one sees but does not cause one to lose eyesight altogether.<\/p>\n

Here is a scary thought: would the world truly become black-and-white if absolutely everyone became colour-blind simultaneously? Many might think the answer is no, because surely people would still remember seeing colours. But one could also argue that remembering is a mental event, therefore a \u2018reality\u2019 residing in our minds. How is this different from a schizophrenic reality?<\/p>\n

\"clara-humpston-on-schizophrenia-as-illness\"<\/a><\/p>\n

Perhaps the discrepancy in all the different \u2018realities\u2019 is one of degree rather than of nature, and one only crosses the line of \u2018normality\u2019 if one deviates too much from the consensus. But this should not make one \u2018ill\u2019 if there is no distress or impairment to functioning. What is normality without the other end of the spectrum? The paradox of reality is one we all struggle with, and not just one faced by patients with schizophrenia.<\/p>\n","protected":false},"excerpt":{"rendered":"When we think of the symptoms of schizophrenia, perhaps the first examples that emerge in our minds are the chaotic thoughts, disturbing suspicions and invisible voices tormenting the sufferer. These […]","protected":false},"author":1030,"featured_media":809,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[10,65],"tags":[138,141,139,72,142,140],"class_list":["post-794","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-adult-mental-health","category-schizophrenia","tag-illness","tag-neuroscience","tag-reality","tag-schizophrenia","tag-self","tag-unreality"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7swiU-cO","jetpack-related-posts":[{"id":1004,"url":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/schizophrenia-from-abnormal-memory-genes\/","url_meta":{"origin":794,"position":0},"title":"Schizophrenia from abnormal memory genes","author":"Nicholas Clifton","date":"17 February 2017","format":false,"excerpt":"For a disorder characterised by delusions, hallucinations and false beliefs, it may come as a surprise to know that schizophrenia is thought to originate from the abnormal processing of memories. In order for us to understand and respond appropriately to our surroundings, we continuously learn associations between the things we\u2026","rel":"","context":"In "Health news"","block_context":{"text":"Health news","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/category\/health-news\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/02\/iStock-490433128-1.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/02\/iStock-490433128-1.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/02\/iStock-490433128-1.jpg?resize=525%2C300&ssl=1 1.5x"},"classes":[]},{"id":916,"url":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/is-schizophrenia-an-autoimmune-disease\/","url_meta":{"origin":794,"position":1},"title":"Is schizophrenia an autoimmune disease?","author":"Professor Paul Morgan","date":"20 December 2016","format":false,"excerpt":"The concept that psychiatric diseases such as depression and schizophrenia might have an immune component dates back at least 40 years, with numerous studies providing evidence implicating the immune system and autoimmune responses at least in some patients with these diseases. Various \u201canti-brain cell antibodies\u201d have been reported but lacking\u2026","rel":"","context":"In "Adult mental health"","block_context":{"text":"Adult mental health","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/category\/adult-mental-health\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2016\/12\/Brain-scan.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2016\/12\/Brain-scan.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2016\/12\/Brain-scan.jpg?resize=525%2C300&ssl=1 1.5x"},"classes":[]},{"id":1162,"url":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/schizophrenia-from-new-brain-cells-to-the-immune-system\/","url_meta":{"origin":794,"position":2},"title":"Schizophrenia: from new brain cells to the immune system","author":"Niels Haan","date":"8 June 2017","format":false,"excerpt":"We still don\u2019t really know much about one of the most common psychiatric diseases \u2013 schizophrenia. However, my research, and that of many others, shows things such as neurogenesis (formation of new neurons) and the immune system are all involved in this challenging condition. Genetic risk for schizophrenia Schizophrenia is\u2026","rel":"","context":"In "schizophrenia"","block_context":{"text":"schizophrenia","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/category\/schizophrenia\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/06\/Hippocampal-stem-cells-which-generate-new-neurons-growing-in-a-dish-in-the-lab.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/06\/Hippocampal-stem-cells-which-generate-new-neurons-growing-in-a-dish-in-the-lab.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/06\/Hippocampal-stem-cells-which-generate-new-neurons-growing-in-a-dish-in-the-lab.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/06\/Hippocampal-stem-cells-which-generate-new-neurons-growing-in-a-dish-in-the-lab.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/06\/Hippocampal-stem-cells-which-generate-new-neurons-growing-in-a-dish-in-the-lab.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":1566,"url":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/meet-the-researcher-amy-lynham-research-associate-psychosis-and-major-affective-disorders\/","url_meta":{"origin":794,"position":3},"title":"Meet the Researcher – Amy Lynham, Research Associate, Psychosis and Major Affective Disorders","author":"Amy Lynham","date":"11 September 2018","format":false,"excerpt":"Why did you choose to do research into mental health? I studied psychology at university because I was fascinated by the brain and human behaviour. I spent a year working in the MRC Centre of Neuropsychiatric Genetics and Genomics as part of a professional placement and this stimulated my interest\u2026","rel":"","context":"In "Adult mental health"","block_context":{"text":"Adult mental health","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/category\/adult-mental-health\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2018\/09\/Amy-Lynham.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2018\/09\/Amy-Lynham.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2018\/09\/Amy-Lynham.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2018\/09\/Amy-Lynham.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2018\/09\/Amy-Lynham.jpg?resize=1050%2C600&ssl=1 3x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2018\/09\/Amy-Lynham.jpg?resize=1400%2C800&ssl=1 4x"},"classes":[]},{"id":1116,"url":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/the-immune-system-and-the-brain-complement-or-casualty\/","url_meta":{"origin":794,"position":4},"title":"The immune system and the brain: complement or casualty?","author":"Laura Westacott","date":"12 April 2017","format":false,"excerpt":"For a long time it has been assumed that the sole purpose of the immune system is to defend the body against infection. 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These non-immune duties\u2026","rel":"","context":"In "Adult mental health"","block_context":{"text":"Adult mental health","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/category\/adult-mental-health\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/04\/Type-1-and-2a-cells.png?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/04\/Type-1-and-2a-cells.png?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/04\/Type-1-and-2a-cells.png?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/04\/Type-1-and-2a-cells.png?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/mental-health\/wp-content\/uploads\/sites\/502\/2017\/04\/Type-1-and-2a-cells.png?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":571,"url":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/what-has-neuroscience-ever-done-for-psychaitry\/","url_meta":{"origin":794,"position":5},"title":"What has neuroscience ever done for psychiatry?","author":"Professor Jeremy Hall","date":"14 July 2016","format":false,"excerpt":"Psychiatry has a problem. I love my profession of psychiatry, but one of the reasons I entered this most fascinating branch of medicine was because it seemed clear to me that it had problems and would see change in my lifetime. What then, is the problem with psychiatry? 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