John Forbes Nash Jr. is one of the revolutionary minds in the field of mathematics during our times. By the time he shared the Nobel Memorial Prize in Economic Science in 1994, Nash had contributed significantly to partial differential equations, differential geometry, and game theory. I know you are wondering what does any of this information has to do with schizophrenia. Well, what if I told you Nash was schizophrenic starting at the age of 30 years and he fought this condition successfully to lead a nearly normal life with his wife, Alicia, until their premature death through a road accident on May 23, 2015. His struggle with schizophrenia and ultimate recovery led to the creation of the chef-d’oeuvre movie, A Beautiful Mind, by Ron Howard in 2001. Like many other admirers of Nash’s achievements, even amid a debilitating health condition, I have always wondered what really goes on in the mind of a person with this condition. What does it really feel like to have schizophrenia and live with it? Well, to understand these questions, I found someone who has been living with this mental disease for over a decade and gave me some insights.
My guiding question when I met Lewis, a 42-year old male living with schizophrenia since he was 29, was – how is it like to live with this condition. “It feels like paranormal”, he quipped without giving it much thought. “Sometimes it feels like I live outside my own mind – as if am watching my life from a distance”, he quickly added. Lewis’s schizophrenia started in the privacy of his mind when he was aged 29 years. He noted that his thoughts would wander from reality and continually live in the fantasy that he had created in his mind, which is basically hallucination. According to Aleman (2014), hallucinations are common among schizophrenic patients, and they occur in about 70 percent of these individuals. In neuroscience, hallucinations are associated with reduced grey matter volume, especially in the superior temporal gyrus (Boksa, 2009). The common forms of hallucinations are auditory, but they could also occur in visual, somatosensory, gustatory, or olfactory. Lewis’s hallucinations were unique in that he could not classify them as such – he was an idea that came from his fascination with mathematical formulas.
He told me that sometimes when he was 25 he was exposed to the idea of fractals, which is a mathematical idea. He would spend days on end thinking of fractals and infinity to the extent that he was convinced he was on the verge of discovering novel mathematical principles. This preoccupation with mathematical ideas was so intense that he could not concentrate on anything else. As such, his normal life was disrupted and he was eventually fired from his job, due to poor performance. However, nothing of these occurrences mattered – all he cared about was the grandiose ideation of solving a complicated mathematical problem to unravel a side of the universe that has not been known before. Lewis was undergoing what Aleman (2014) calls the processes that work together to contribute directly to perception, even though they do not come from the external world, but from one’s brain. In other words, what Lewis was experiencing was a lack of cognitive inhibition whereby his brain would create scenarios not being shaped by the outer world. His perceptual experience was hinged on autonoetic agnosia, which is the inability to differentiate between self-generated thoughts and externally generated events.
Lewis continued to think about these abstract mathematical ideas for almost five years without noting that whatever problems he was trying to solve were beyond his mental capability. He was deeply convinced that he was like Albert Einstein and within a short time, he became paranoid that someone else would beat him and solve the riddle first. This state-led to his first paranoid episode when he was 29. Together with his brother, they were outside their house in a kitchen garden tending some vegetables when he started imagining a horrific incident whereby a violent man walks into the house and chopped everyone’s head using an ax. He truly believed that this event was going to happen. He thus ran towards the house screaming that someone was about to kill them and he needed to call for help. Bentall et al. (2009) explain this occurrence by noting that paranoid patients exaggerate the likelihood of future threatening events, and such thoughts remain relevant even after controlling for their recall of such events – a claim supported by Zmigrod et al. (2016). Therefore, Lewis overestimated the possibility of these events happening in real life, which explains why he responded the way he did.
Soon afterward, Lewis started developing this strange feeling that people were watching him. He would think about this issue repeatedly close to a hundred times a day. It did not help that at the time, he was employed in a high-security facility fitted with many security cameras. He would obsess with the idea that someone was watching him behind those cameras, so he developed the habit of avoiding eye contact with the cameras. He would walk around with his head dropped to hide his face from whoever was watching him. When I asked him how it feels to live such a life, Lewis admitted that the hard part is when insanity starts kicking in as rationality fades away. Interestingly, even in the midst of this chaos, some rational thoughts still exist in the mind. For instance, he would rationalize that no one person could be watching him all the time, which means there was a group of individuals needed to accomplish such a difficult task. Revsbech et al. (2015) argue that the basis of rationality in schizophrenia is a syllogism, which is a certain argument structure whereby the viability of a conclusion is exclusively dependent on the truth of the premise, which explains the validity of his conclusion that several people were watching him.
Lewis told me that amidst all his psychotic thoughts, he maintained some rationality. Deep down he knew that he had changed – that he was not the person that he used to be before these episodes. Therefore, he would attempt to reconcile his past with his present – essentially matching the reality that he knew before and the one that he knew then. However, he admitted that this task was almost impossible. His new thoughts had infiltrated the way he constructed reality and processed information. As such, every experience that he had in the past was now being shaped by his new reality, and thus he basically became delusional. His state degenerated into having psychotic episodes characterized by visual and auditory hallucinations. His mental images were so real to him that he could not distinguish them from the truth. This scenario could be explained by the argument by Mækelæ, Moritz, and Pfuhl (2018) that reduced deliberate reasoning might potentially contribute to the occurrence of delusions, thus creating thinking bias, which is not dependent on a person’s general intelligence. Perhaps Lewis’s earlier experiences and obsession with mathematical ideas reduced his ability to think reflectively.
What is interesting in all these accounts is that Lewis was unaware that he was sick. This phenomenon is common among schizophrenic individuals. In answer to my question about how it feels to live with schizophrenia, Lewis noted that the experience could not be captured in a sentence. According to Aleman (2014), the neural basis of schizophrenia could be summarized as the marred activation of and connectivity between frontotemporal, frontoparietal, and frontostriatal brain networks, which are mainly used in assisting cognitive functioning and integration of thoughts and emotions. This assertion forms the basis for understanding the neural and cognitive basis of hallucinations and other problems associated with schizophrenia. So what happened to Lewis, you might ask. Just like John Nash Jr., Lewis has now recovered from schizophrenia and he lives with his beautiful family. He is a productive member of society in gainful employment leading a normal life. The journey to understanding the neuroscience of schizophrenia continues and firsthand stories like that of John Nash and Lewis continue to play a central role in this process. Their brains are different from ours and the quest to understand how different they underscore the role of neuroscience in schizophrenia.
References
Main Article
Aleman, A. (2014). Neurocognitive basis of Schizophrenia: Information processing abnormalities and clues for treatment. Advances in Neuroscience, 2014, 1-15.
Supplementary Articles
Bentall, R. P., Rowse, G., Shryane, N., Kinderman, P., Howard, R., Blackwood, N., Moore, R., & Corcoran, R. (2009). The cognitive and affective structure of paranoid delusions: A transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry, 66(3), 236-247.
Boksa P. (2009). On the neurobiology of hallucinations. Journal of Psychiatry & Neuroscience, 34(4), 260-262.
Mækelæ, M. J., Moritz, S., & Pfuhl, G. (2018). Are psychotic experiences related to poorer reflective reasoning?. Frontiers in Psychology, 9(122), 1-10.
Revsbech, R., Mortensen, E. L., Owen, G., Nordgaard, J., Jansson, L., Sæbye, D., Flensborg-Madsen, T., & Parnas, J. (2015). Exploring rationality in schizophrenia. BJPsych Open, 1(1), 98-103.
Zmigrod, L., Garrison, J. R., Carr, J., & Simons, J. S. (2016). The neural mechanisms of hallucinations: A quantitative meta-analysis of neuroimaging studies. Neuroscience and Biobehavioral Reviews, 69, 113–123.