Symptoms of schizophrenia: normal adaptations to inability.

The usual thinking about schizophrenia is that symptoms arise from altered gene products, irregularities in brain development, or interruptions of brain circuitry due to more fundamental causes still unknown. It is possible, however, that some of the diagnostic symptoms of this illness result from attempts at healing the primary unknown lesion, that they are, to use a metaphor, consequences of scab formation rather than of wound. Because too little is known at this time about basic intracellular flaws in schizophrenia, this paper, while hypothesizing precisely such a sequence (from damage to attempt at healing to symptom formation) uses examples from the more accessible psychological level. For instance, it is known that individuals suffering from schizophrenia struggle with interpersonal demands because they find them, on the whole, ambiguous and complex. Given these interpersonal inabilities, it is understandable that they protect themselves from the experience of failure through avoidance of social conduct and through relative isolation. Another example comes from the domain of cognition where a number of deficits have been shown to exist in people with schizophrenia. Aware of these difficulties, individuals with schizophrenia narrow their field of activities and compensate for deficiency by repetitive rituals and over-rehearsal. Side-lined and disregarded because of illness, it makes psychological sense that they draw attention to themselves in ways (eccentric clothes, unusual phraseology and tone of voice) that are judged by others as socially inappropriate. Unsuccessful in the customary pursuit of happiness (worldly success, material possessions, intimate relationships), it also makes sense that individuals with schizophrenia adopt habits and routines that are considered by others as impractical, illogical, and unfathomable. Adoption of this compensatory view of the origin of schizophrenia symptoms by clinical scientists does not markedly change treatment approaches and does not immediately lead to new discoveries. What it does is to situate the actions of those with schizophrenia clearly within the normal range of human behaviors and, as a consequence, it diminishes the stigma that attaches to severe mental illness. It evens the playing field between patient and therapist, making the psychiatrist less a zoo keeper and more a fellow traveler along a road that inevitably leads, for everyone, to physical and cognitive decline with attempts, some more successful than others, at compensation in the face of a difficult reality.