I’ve posted before about the high frequency of mental illness in my family on both sides - paternal grandfather had OCD, I have OCD, my sister is bipolar-2, my maternal aunt has something like schizophrenia (although we’ll never know for sure because she refuses to see doctors to be diagnosed) and my mother has some odd beliefs that don’t seem to rise to the threshold of a mental illness but aren’t normal either.
Speaking of schizo and bipolar-2, though:
I understand a lot of this stuff is genetic. If you have a close blood relative who has schizo, does this basically mean that you yourself may have some form of “latent/buried” schizo that is lurking deep within you, waiting to be triggered into life by some major traumatic event? In other words, it’s like a seed - as long as you never plant and water it, it will remain nothing but a seed.
Same for bipolar-2, too?
If so, how common is such “seeding?” For what it’s worth, I am 35, male, and have never once had symptoms that could be described as bipolar or schizo - so either I don’t have such seeds, or if I do, I’ve managed to keep them dormant.
I’ve known only three people in my life diagnosed as schizophrenic. One Caucasian guy, one Indian guy and one Chinese guy. All of them grew up in societies where they were obvious ethnic minorities.
I lean towards there being some sociological triggers.
It is already 11 years old and 1 hour and 40 minutes long (schizophrenia starts at 23:12) but Robert Sapolsky’s lecture on schizophrenia is still very watchable:
The whole lecture cycle is very recommendable, the man can explain!
And yes, there seem to be genetic components that can be triggered, particularly at some key stages of development. Early childhood abuse leads to the worst prognosis (very condensed over-simplification here, the lecture makes up for that).
I don’t think schizophrenia exists except as a set of reponses to situational stressors. I think the concept of it as “a disease” the some people “have” is not a useful improvement over the medieval notion that it is an “evil wrongness” that some people “are”; what would be both more accurate and a better model for treatment and response is to think of schizophrenic as an adjective, a way that a person may be at any given time if the circumstances evoke that.
There is solid evidence that certain constellations of experience are an overwhelmingly significant correlate for ending up with a psychiatric diagnosis of schizophrenia, whereas there is still no evidence support for the existence of the oft-touted “chemical imbalances” that are so often still described as the etiology of schizophrenia. (“Chemical imbalances” were hypothesized in retro, based on the notion that the pharmaceuticals that seemed to be addressing the symptoms: if the pills are helping, it must be because the pills are either replacing or substituting for a missing neurochemical, or are accelerating or blocking how the brain uses them, or something like that, so effectively they are balancing the patients’ neurochemistry. But that isn’t supported by research).
If you look at the research, there’s a genetic component to schizophrenia and bipolar disorder. You can’t develop either condition unless you have genetic loadibg or a physiological vulnerability. However, the genetic loading is not an absolute. It requires triggers or conditions to activate it. This is called the diathesis–stressor model. This means that there is an underlying vulnerability to the genetic or physical condition, but it may not become active in a person’s lifetime. Really good stressors to kick up the underlying condition include trauma, hormonal changes, and ubstance use, including some prescribed medications. Irregular sleep and eating patterns may also contribute. If you’re interested, read about Social Rhythm interventions for bipolar disorder, which can also be useful for schizophrenia.
A virus has been hypothesized as a trigger for schizophrenia as well. There are lots of examples of identical twins where one is schizophrenic, and one is not.
There’s also something not understood at all that is simply a truism at present, and is something like "If you don’t develop symptoms by age 28, you won’t, despite having a parent or sibling-- even a twin-- with the condition.
Well, I had my schizoid psychotic break at 30 and my family is well (I’m well too now, it never happened again, in my opinion thanks to medication), so here’s one data point breaking your rule.
It isn’t “my” rule. I took a few psychology classes in college, because they satisfied the science requirement, and I went to some symposia later when I was in community living for disabled people, and we had some diagnosed schizophrenics. I heard this repeated a number of times.
It’s probably something that plots on a bell curve, because it’s pretty rare (or so it was also said) to see it in someone before puberty.
For clarification, does this mean if you don’t have symptoms by 28, you are not likely to ever get schizo even if a trigger event happens (trauma, doing shrooms) - or you may still carry the dormant schizo seed but it will remain silent as long as you avoid anything triggering?
Even if you have two parents who are bipolar, it is not a guarantee you’ll have it. In fact the chances are like 40% or 50%. It is also treatable, so it’s not the end of the world if you have it. Not sure what the stats are for schizophrenia, but I imagine they’re similar.
Dear ol’ Dad didn’t exhibit bipolar symptoms until his mid forties.
When I researched the question 30 years ago it was written that a first degree relative of a bipolar person has a 15% chance of developing that disease.
Well that was one of the best hour and 40 minutes I have spent in a long time. Fabulously well explained and covered.
Watch the video linked to above. He provides a very clear and compelling description about what schizophrenia is and, just as importantly, isn’t. It becomes very clear that it is a very real and characterisable disease. It isn’t about response to stressors. But it is also one where bad diagnostic practice can lead to very bad outcomes.
I don’t know, because I have no idea what triggers are.
All I know is that when I spent a lot of time learning about schizophrenia, I was told ad infinitum that first psychotic breaks started in adolescence, incidences increased to a point, something like age 22 or 23, then begin decreasing, until they became statistically insignificant around age 28.
One lecturer I listened to opined that people whose first break was later-- in their early 30s, say, had almost certainly had an earlier one, it just hadn’t been identified.
Apparently, IIRC, in some people, schizophrenia relapses and remits.
IANAD, nor do I have a doctorate or even master’s in a relevant field. Posters who do may correct me. I can only repeat what I’ve read or been told-- I have done no original research, nor even compiled meta-studies.
What I gather is that the schizophrenia, however it develops, needs a certain “growth medium” of hormones, and when you are very young, or past youth, you don’t have the right mix. Although, it now appears that women may also offer a growth medium of hormones during menopause.
All that discordant identical twins means is that the disease is not 100% genetic. I certainly wouldn’t rule out a viral infection as one of the stressors that can lead to schizophrenia.
Schizophrenia is a neurodevelopmental disease characterized by anatomical changes in the brain. These changes are caused by both genetic risk factors and environmental stressors, but exactly how is not known. There are hundreds of genetic loci now associated with schizophrenia. Some of the risk allelles are common, others are rare. There are many more rare ones we don’t know about.
This is all probabilities. People have a hard time understanding probability. If I say the chance of something happening is 80%, and then it does not happens, I wasn’t wrong (repeated events may show the probabilities are just as predicted). Similarly, when the chances of something happening are only 1%, having it happen doesn’t mean the event is actually common (and again, repeated tests may show that).
Schizophrenia occurs in about 1% of the population. Having a close relative with schizophrenia increases your risk. Most people with close relatives with schizophrenia do not have schizophrenia themselves. Though, there is evidence that other disorders are also more common.
I guess I wasn’t clear, but that’s pretty much what I was saying. It can’t be 100% some virus either, because it would probably be more common, and you’d see swaths of it running across geographical regions.
It is sometimes hard to tease out genes and exposure to risk factors. It’s not uncommon that a whole family is exposed to a pathogen or poison.
The tremendous advancements in molecular genetics, large mental health studies such as the Psychiatric Genetics Consortium, and massive population studies like the UK Biobank have lead to huge advancements in understanding the etiology of many disorders over the last few years.
It is now possible to look with far greater resolution than just family relationships. The exact stretches of DNA that relatives share can be known, and analyzed for their relationship to any particular trait.
