The "no supposition" theory of Schizophrenia (only applies to the delusion subgroup)

[Justatheory]

Schizophrenia is a heterogeneous group, but the biggest subgroup appears to be the delusion one. What starts as a conspiracy theory/crackpot theory eventually ends up in a psychotic episode.

No supposition theory: The normal mechanisms that are at play in the formation of normal delusions (conspiracy theories, crackpot scientist situations, etc) are enough to explain everything, with no need for any suppositions (genetic influence, dysregulation of dopamine due to not working, etc.). The theory has 2 problems:

1) How do I make the jump from a normal conspiracy theory into a temporary psychotic state, with elevated dopamine levels? - Easy as a piece of cake.

2) How do I explain the power that such a delusion has right from the beginning, since before entering a psychotic state or while being between episodes? Are normal delusion mechanisms enough to explain this? - Difficult question, maybe yes maybe no

Supposition theory problem: If there is X, Y, Z factor (genetic influence, infection, dysregulation of dopamine, etc) then why isn't the whole thinking of the person affected equally? Why is it affected only when it comes to the subject of the delusion?

From your experience, what are your thoughts about the second problem of the no-supposition theory? Do you feel that the normal powers at play in delusion formation (self-esteem problems, taking narcissistic supply from the theory, the beginner effect, etc.) are enough to explain the power of the delusion prior to the triggering of a psychotic episode, or do you feel that an extra element might be needed?

 

[linus]

What do you mean by not the whole thinking is not affected? There are significant cognitive symptoms as well usually and people can’t focus anymore while in such a state. I had to see my son drop from being a super performer in high school to the level of a young child. He is just fine now, but there were about 5 months when we were thinking to accept that this will be his level.

 

[Justatheory]

Yes, that's true for the episodic, psychotic state. But at least in the case of my GF, after her psychotic episode faded and for 2 months prior to that, her thinking is "strange" only when it comes to the subject of her delusion. It's like a normal person having a strange opinion or strange religion, holding very tighly to that view because of taking self esteem from it. It looks like normal mechanism of delusion/conspiracy theory/crackpot theory mainteinence are at play while in a non-psychotic state.

My interest is in how the first episode started for other people and whether normal mechanisms at work in delusion/conspiracy theory formations are enough to explain the whole phenomenon.

 

[linus]

We are more than 1 year since it all started and I’ve tried to find a single way to explain everything, but it’s so much to deal with and the human mind is puzzling. In the first days at the psychatric ward when we were really scared the pmed told us that we shouldn’t worry that much because it seems to be a mild psychosis, just about delusions regarding the society. I gave this a though and later on reading here on the forum, reading a lot of books, indeed I see there are a lot of “grades” on how psychosis as a label actually inflicts people.
I can’t say how was my son thinking about all these before it all started, but we now know that he has what they called comborbidities (social anxiety, depression and they added autism (which was a shock for us, since for 17 years we couldn’t notice or we chose to ignore)). One of the other pmeds around said that it would be easier for the smarter ones to get out of the delusions with a little help, that gave me some hope and sometimes I find this connection in some cases, but it’s hard to generalize.
Anyway, for my son it went to the nut house when he mixed weed with lsd and alcohool and it took us around 12 days until we got to the hospital, we didn’t realise he wasn’t sleeping anymore.

 

[Justatheory]

Was he having problems with self-esteem before? The mechanism for delusions is well understood thanks to psychology and studies regarding politics and conspiracy theories. Until the 90s, it used to be believed that people who end up believing in conspiracy theories have paranoid traits or lower IQ, but this was proven wrong. Since then, it is considered that conspiracy theories/delusions are a mechanism for regulating self esteem. By just changing an opinion, suddently you are an important person, part of a small select group of people, highly inteligent, enlightened, etc. Other people can believe in stupid theories too, in fact a lot of people do, but to really fall in love with a theory one needs to have problems with self esteem at that particular moment. He has to start taking his self esteem from those ideas.

How does one get into a psychotic state from here? Very easy. At one point, the conspiracy turns global, turns super important. Imagine you made a big, super important discovery in your field that nobody knows about. You would then need to dedicate your life to spreading that idea. If you would spend hours per day thinking about that idea and how important it is, you would feel more and more pressure. It would become an obsession, it would become a burden. At that point where everything looks as important as possible, the most important thing in the world, the psychotic state begins.

 

[linus]

It’s hard to say what he felt like, he is working with a therapist for almost a year now and tries to get better at understanding himself, his weakness, what can drive him off the edge.
While it’s important to understand what are the risks factors before a FEP, once it’s all there it’s not that helpful to work with.
And btw, the psychotic state doesn’t just begin by ruminating on one theory, it’s not that much about logic, it’s about emotions. Yalom has some nice explanations on the internal dialogue, the struggle that we have with the extremes of the spectrum. Actually all the logic comes from our desire of giving meaning to anything that happens to us, it’s hard to really understand this since we are taught in school about other things.