This is hard to write.
I’m sitting here enraged. Confused. Fearful, even, of what I’m about to share.
I told myself I’d only start another blog if I had important things to say, and we’ve covered some very important topics, most recently pertinent information in the series Is Psychology A Science? where we concluded the subject’s only scientific attributes are being ignored and/or underutilized due to political and monetary factors such as an APA president calling randomized clinical trials “fundamentally insane”.
These last few weeks have been incredibly tough for me, hence my lack of posting–because trust me, I have plenty to say–and I’ve spent too much time this week in my head, not exercising, falling into old eating habits and connecting dots that shouldn’t be connected. There are enough thoughts in my mind right now to fill an Olympic pool and they’re not rushing like Olympic swimmers, but they are kind of clustered like when all the palm leaves from the tree near your pool cover the surface until you finally get your lazy ass off the couch to scoop them out.
Jokes aside, there were a few nights I considered voluntarily committing myself. Things have been broadcasted to me, twins are following me, Juice WRLD died not because of Percocet and whatever the fuck “lean” is (I know what it is but because it’s so stupid I just can’t comprehend it’s actual existence), but because of possession, a sign to me–then I remembered I have shitty, low tier health insurance and don’t want medication. So I’m somewhat functioning here in what I’m starting to feel is purgatory. Part of this is stress. My lack of tending to myself. The other part is the effects of Klonopin which does indeed act upon serotonin–I researched it–and had that psychiatrist I ranted about last time listened to my incessant pleas that drugs which so much as touch my serotonin really mess with me–anyway.
In studying for my final, my distracted mind wondered about randomized clinical trials and about psychosis. I wondered if the studies done on those experiencing psychosis for the first time, un-medicated, before the *possible* structural changes due to antipsychotic use, showed structural changes.
This is important. Why?
Well, a disease isn’t a disease unless there is definitive (i.e substantial, valid, reviewed and repeated) proof physical abnormalities are attributed to the alleged progression of the alleged disease.
And so I went onto my favorite place to find psychological research papers. And no, it’s not Healthyplace.com. It’s not some person’s Instagram. It’s not The Mighty or anything related to any kind of advocacy because advocacy is very rarely based in research. It’s NCBI, otherwise known as the National Center for Biotechnology Information. I find myself most often in the PMC section because it’s free and I can use the paper references to find the full length articles in a database. There’s great neuroscience and clinical psychological research articles there, including the PubMed database.
So I’m sure we’ve all heard that “severe mental disorders” like Schizophrenia have notable brain abnormalities such as deformed (enlarged or constricted) ventricles, changes (reduction or increase ) in gray matter, or white matter, or certain neurotransmitters, or this, or that, up, or down, right, or left–and that’s about how accurate all the information you hear is.
Most of it is coming from secondary sources like a textbook or from what I like to call Triple-Source advocacy websites like HealthyPlace that continuously vomit basic and quite honestly uninformed opinions labeled as facts. And I’m not talking about personal stories. I’m talking about those faux information pages that blurt lists of symptoms that pretty much overlap with normal shit and make people worry that hearing their name called in a store means schizophrenia. Here, kind of like this page. Beautiful example of a well-structured, well-written, horribly basic-bitch attempt at explaining something we have no real understanding of.
That’s what I hate the most about advocacy pages I think. I love personal stories and empowerment. I hate the perpetuation of the idea that we really know what’s going on physically in our heads. We don’t. If someone tells you we do, they’re either in the middle of a delusion of grandeur or they’re lying.
And so my first topic to research revolved around first-episode psychosis because that psychosis is *mostly* untouched by heavy psychiatric medications. I researched under the assumption that psychiatric medications influence the structure of our brains and could very well be presenting the “structural abnormalities” which are being used as “evidence” of a “brain disease”. You will find studies that support this. You will find studies that don’t support this. And I found a study tonight, which you can read here, which concluded we don’t really have solid evidence for either hypothesis.
Next post we’ll talk about how to read these papers and determine whether a study has a proper operational definition (is the measurement procedure correct?) and construct validity (is the study measuring what it claims to be?) and how to spot confounding variables (which should be NOTED).
In 2017, a review paper entitled Structural brain changes at different stages of the illness: a selective review of longitudinal magnetic resonance imaging studies concluded there is “adequate evidence that schizophrenia is associated with progressive grey-matter abnormalities particularly during the initial stages of the illness”. These results were concluded after reviewing studies done on patients labeled as “pre-clinical stage” patients, first-episode psychosis patients, and patients labeled with “chronic schizophrenia”.
Even in the abstract, which you can get on the NCBI, they WARN AGAINST using these results as a way to EXPLAIN symptoms of patients. They even mention their confounding variable: antipsychotic medication and long-term treatment.
In 2011, a study entitled Lack of progression of brain abnormalities in first-episode psychosis: a longitudinal magnetic resonance imaging study concluded there were no ventricle abnormalities which could be contributing to symptoms, and that the gray matter abnormalities found have the potential to be easily reversed.
Because they did not list their confounding variables in an easy to find place, and it’s 10:30pm at night as I write this, I searched their references for a study which could either contradict or confirm their findings. I found this study, which you can download as a PDF from Google Scholar. IT concluded gray matter decreases were due to both the natural progression of the illness and use of antipsychotic medication.
They gathered 34 patients labeled with schizophrenia who had been taking medication for 0-16 weeks and compared them, over a year span, to a control group of “healthy” participants. 24 had never taken medication. Those who had taken medication had been taking them for 16 weeks or less. In their conclusion, they admit their findings are in agreement with some studies, but not others, perhaps due to rating differences, group differences, focus differences, and even mental state; some studies, they said, found that the patient’s mental state may have influenced the outcome of the brain volume measurements–those studies I’d like to read too.
I’ve spent the last three hours painstakingly reading variables, reading evidence for grey matter changes, against grey matter changes, for ventricle changes, against ventricle changes, longitudinal studies, short studies, childhood-onset schizophrenia studies, chronic schizophrenia studies, and studies which measured whether or not medication is destroying brain matter.
This was hard to write because I knew there was no definitive answer. And I wanted the answer to be an obvious, valid, no.
But the reality of science is that your wants don’t matter. The reality of science is you read the facts and you either accept them or you start a basic-bitch advocacy site.
What it seems, at this day and age, is that we’ve accepted a bunch of opinion and ignored the facts. My hypothesis? Even as we continue to study this, we will only conclude the same thing as the grief studies in Europe: individual variation is the only certain thing with schizophrenia.
Grief studies showed that some people recovered better by distracting themselves, and others by going into therapy. Both recovered at the same rate when allowed to choose what was best for them.
I purport we’ll find the same for psychosis. Some will do better with medication. Others will do better without medication. We’ll find that medication isn’t the only factor playing the game here, especially if mindset has any influence on brain measurement.
So, is Schizophrenia a disease? As of right now?
There’s no solid evidence pointing in either direction.
What does that mean?
Well, for me it means I need to keep doing what I’m doing, caring for myself in the way that’s been working. Because there’s no study which has proved that won’t help me recover.
For the general public, it probably means ignore all the evidence and keep fighting for mental health to be treated like physical health, as if it isn’t already: in the doctor’s door, out the doctor’s door, five minutes tops.