A Few Strange Notes About Schizophrenia

September 29, 2009 9:50 AM

Here's a strange one for the books: Science has taken notice that a really, really LARGE proportion of schizophrenic patients smoke. In fact, Scientific American Mind reports that an average of 85% of schizophrenic patients smoke cigarettes compared to only 20% in the general population. Many schizophrenics also appear to have abnormal thermoregulation, an impaired ability to understand body language, an inability to perceive an optical illusion called "the hollow mask illusion," an impaired ability to produce a brain protein known as the muscarinic M1 receptor, and an abnormally large number of genetic mutations known as CNV's or "copy number variations."
posted by mdpatrick (65 comments total)

This could be self-medication. Tobacco has a relaxing effect.
posted by No Robots at 9:54 AM on September 29, 2009 [2 favorites]

That's actually what that particular article is about: "The extraordinarily high incidence of smoking in individuals with schizophrenia—about 85 percent of patients smoke compared with some 20 percent of the general population—has spurred researchers to investigate the therapeutic effects of nicotine in the diseased brain."
posted by chunking express at 9:56 AM on September 29, 2009 [2 favorites]

I was under the impression that nicotine was an anti-psychotic, and they were self-medicating. Any smoker will tell you that a cigarette makes you feel a little less psychotic.
posted by mullingitover at 9:57 AM on September 29, 2009 [2 favorites]

Lots and lots of people with mental illnesses self-medicate like this.
posted by Pope Guilty at 9:58 AM on September 29, 2009

This has been known for a long time. The SA article is amazingly disingenuous. It fails to mention the extent to which the problems addressed by nicotine might be side-effects of the medications prescribed to schizophrenics. It conflates "schizophrenic patients" (ie, those likely to be, or to have been, on anti-psychotics) with schizophrenics. These are two different groups. What's the rate of smoking among people newly diagnosed with schizophrenia? What's the rate among those on mood stabilizers and anti-psychotic medications who are not also diagnosed with schizophrenia? What's the rate among those who have spent substantial time in the hospitals and day-use facilities that many schizophrenics are forced to spend time in? What's the rate among the homeless population?
posted by OmieWise at 10:01 AM on September 29, 2009 [8 favorites]

Nicotine is a stimulant.
posted by chocolatetiara at 10:02 AM on September 29, 2009

Cigarettes aiding concentration in schizophrenics is old news. I've read advice that schizophrenics use nicotine patches and the like to get the beneficial effects while avoiding the negative effects of smoking.

Anecdotally, yes, schizophrenics tend to be smokers, and very heavy smokers. I was surprised recently when one of my schizophrenic clients quit smoking without severe problems. Prior to that he smoked about 7 packs per day. He rolled his own, but with recent tax increases, he couldn't afford it anymore and up and quit. I haven't noticed any cognitive degeneration since he quit, but he's a pretty severe case to start with.

Schizophrenia is particularly interesting to me because it is so distinct and so consistent compared to many other forms of mental illness. When I sit down to talk to someone knew, I know immediately when they have schizophrenia. The diagnosis is so much more clear-cut than many others.
posted by threeturtles at 10:02 AM on September 29, 2009 [2 favorites]

Stimulant and relaxant.
posted by No Robots at 10:03 AM on September 29, 2009 [4 favorites]

That hollow mask illusion is really freaky. No matter how hard I try, I can't wrap my head around the fact that it's concave and see it in that way. Guess I'm not Schizophrenic (whew!).
posted by The Light Fantastic at 10:04 AM on September 29, 2009 [2 favorites]

The rotating-Chaplin-mask video in the hollow mask link is freaking awesome!
posted by oddman at 10:05 AM on September 29, 2009 [2 favorites]

People smoke continuously in mental hospitals for the same reason they do in prisons and on oil-rigs: There's fuck all else to do.
posted by Artw at 10:08 AM on September 29, 2009 [4 favorites]

Nicotine is a stimulant and helps people focus. Self-medicating with it is actually pretty common. Its been suggested that a lot of people who are chronic smokers are actually ADHD and are self-medicating.
posted by damn dirty ape at 10:08 AM on September 29, 2009 [1 favorite]

The Charlie Chaplin mask video hurt my brain. The article says that some people can beat the illusion when their drunk or high, so I guess I'm going to have to remember to try again after my next bar trip.
posted by cyphill at 10:09 AM on September 29, 2009 [1 favorite]

In a similar vein a number of people have noticed that individuals under the influence of datura constantly mimic smoking cigarettes.

The discussion centered around whether or not cigarettes contained a certain kind of agonist and that the mimicry was actually the brain trying to prompt the user to smoke as a method of combating the poisoning.

I also feel the need to point out that only the most desperate and stupid of fools tries datura.
posted by unixrat at 10:15 AM on September 29, 2009 [1 favorite]

I'm surprised that 85% of some sub-population has even tried smoking. I wonder what the number is for the general population?
posted by Western Infidels at 10:17 AM on September 29, 2009

In addition to the self-medicating effect, it should be noted that for decades (or longer) there simply wasn't anything to do in mental institutions other than sit and smoke and maybe watch TV or play cards. I'm sure in this "enlightened" age institutionalized patients can't smoke any more, but they certainly used to-- and took full advantage of this.
posted by dersins at 10:25 AM on September 29, 2009 [1 favorite]

Fake smoking on Jimson/Datura. Goes on for about 10 seconds.
posted by unixrat at 10:26 AM on September 29, 2009 [1 favorite]

After starting antidepressants a few months ago, I was overcome with an incredibly powerful urge to smoke. I had quit 18 years ago, and was never a heavy smoker - maybe a pack or two a week.

I was surprised to discover that I respond differently to the cigs than before. They used to be just a little pick me up. Now they are incredibly powerful mood lifters. If I go a few hours between cigs, sometimes the next one gives me an incredible rush, something very close to a two minute long orgasm. Really.

I know I shouldn't smoke...but daaamn.
posted by Xoebe at 10:28 AM on September 29, 2009 [8 favorites]

Dima thinks when healthy subjects see the illusion, which is somewhat ambiguous, their brains strengthen this connection such that what they expect — a normal face — becomes more influential, overpowering the actual, though unlikely, visual information. Schizophrenia patients, meanwhile, may be unable to modulate this pathway, accepting the concave face as reality.

So schizophrenics see what's actually there.

I have to say I sat here and played that mask video two and a half times before I gave up trying to see it correctly.
posted by Marisa Stole the Precious Thing at 10:28 AM on September 29, 2009 [1 favorite]

Well, great. The hollow Chaplin mask looks hollow to me. I have no cognitive impairment of which I am aware, and I see that as a concave face. That's rather disturbing. And for the record I am at this time neither drunk nor high. Wonderful. Something else to worry about.
posted by BitterOldPunk at 10:31 AM on September 29, 2009 [6 favorites]

Wow. The concave face illusion is absolutely fascinating. I wonder what other things we "normal" folks aren't able to see.
posted by Yimji at 10:33 AM on September 29, 2009

I'm sure in this "enlightened" age institutionalized patients can't smoke any more

Um..yeah, at least in the US they can and do.
posted by mattholomew at 10:33 AM on September 29, 2009

yay! i'm not schizophrenic. i totally fell for the hollow mask illusion.
posted by saulgoodman at 10:34 AM on September 29, 2009

damn, the chaplin mask video is deeply unnerving.
posted by saulgoodman at 10:37 AM on September 29, 2009

I'm not schizophrenic and I can see the Chaplin mask as concave if I focus. If I relax at all it reverts back to looking convex. Feels like the illustrator\3D artist part of my brain is working when I do it.
posted by autodidact at 10:38 AM on September 29, 2009 [1 favorite]

I've noticed that if I watch the Chaplin mask video, and pay attention to the inside bottom part of where it is attached to the post I can orient my mind to the mask's rotation and prevent my brain from interpreting it as convex at the moment of transition, and then if I follow the line of the mask up into the nose to orient my mind just after the moment of transition I can see the mask as concave all through the rest of that pass. But in the next pass I still get the convex face illusion if I don't do the same thing, and I can't recover, either, by looking down towards the attached area and then back up towards the nose.

Dunno if this is an exception that works for other normal people, or I'm just borderline.
posted by Reverend John at 10:43 AM on September 29, 2009 [1 favorite]

> an average of 85% of schizophrenic patients smoke cigarettes compared to only 20% in the general population.

After visiting a friend in a public mental health facility, I wouldn't be all that surprised if 85% of institutionalized mental health patients pick up smoking habits, regardless of their illness.

I'd actually be interested in knowing how that 85% figure compares before and after the past 25 years of spending cuts in public mental health care that ensure a lot of people who need treatment will never be inside an institution, bored out of their wits, with nothing to do all day but watch TV, smoke, play cards, smoke, do crafts, smoke, read and smoke.
posted by ardgedee at 10:43 AM on September 29, 2009

Um..yeah, at least in the US they can and do.

Well, good. There's fuck all else to do in those places.
posted by dersins at 10:45 AM on September 29, 2009 [1 favorite]

I dont buy the whole "there's nothing else to do" argument. Why smoking? Why not munching on Cool Ranch doritos or playing checkers? Or writing angry letters to the editor?

Nicotine is a legal and potent stimulant. When youre depressed or unfocused you can mix it with caffeine and suddenly feel a lot more in control.
posted by damn dirty ape at 10:47 AM on September 29, 2009

It fails to mention the extent to which the problems addressed by nicotine might be side-effects of the medications prescribed to schizophrenics. It conflates "schizophrenic patients" (ie, those likely to be, or to have been, on anti-psychotics) with schizophrenics.

A few years ago, I was involved in some work that interviewed people with psychotic disorders who had been hospitalized about their cannabis use -- trying to get at why, given that it may be indicated in relapses and exacerbating their condition, people still continued to smoke it.

Their responses were really interesting and almost all had to do with ameliorating either the effects/side effects of the medication or their illness. People said things like 'it makes the meds tolerable', and 'I still hear voices, but the things they are saying aren't quite so obnoxious when I've been smoking weed as they are when I don't.'
posted by PeterMcDermott at 10:49 AM on September 29, 2009 [3 favorites]

Agh! implicated in relapses
posted by PeterMcDermott at 10:52 AM on September 29, 2009

Nicotine is a stimulant and helps people focus. Self-medicating with it is actually pretty common. Its been suggested that a lot of people who are chronic smokers are actually ADHD and are self-medicating.

Speaking as someone who used to smoke who is ADD, it can help a great deal with anxiety due to social situations (which is something of a side-effect of being unfocused, that you're getting far too much input at once and can't process all of it). One of my major problems was social anxiety, and smoking helped with that a lot, but I quit even before I was diagnosed ADD. A combination of sugar and caffeine really helped, as in a typical sugary soda, but I had to quit sugar, too, and caffeine by itself never worked very well. Adderall helps more, though, dramatically. The stress which came to the surface after quitting smoking never quite left me until I started getting treatment for ADD with Adderall.
posted by krinklyfig at 11:06 AM on September 29, 2009 [1 favorite]

i can see the convex mask in the chaplain vid but for the image above on that page, i can't get my brain to do the switch to see it as concave. i just keep thinking the lighting is all wrong for it to be hollow. the shadows are being cast in all the wrong places.
posted by fuzzypantalones at 11:18 AM on September 29, 2009

I'm sure in this "enlightened" age institutionalized patients can't smoke any more

Um..yeah, at least in the US they can and do.

I know you can't smoke in county run substance abuse centers, and as of Jan. 1 2009 smoking in all state buildings was prohibited. I didn't see anything in the law exempting state psychiatric hospitals. And that is in North Carolina, one of the more tobacco friendly states.

It is going to be prohibited in state prisons here beginning October 1.
posted by marxchivist at 11:22 AM on September 29, 2009

That hollow mask video is amazing. I really, really tried to see it as concave but there's just no way.
posted by ob at 11:23 AM on September 29, 2009

I'd always wondered about smoking and mental illness: actually it probably first occurred to me while watching One Flew over the Cuckoo's Nest and watching Danny Devito (I think) go ballistic when he lost his cigs.
posted by selton at 11:24 AM on September 29, 2009

I'd love to know the correlation between dyslexia/dyspraxia and smoking. I've been self-medicating with tobacco and caffeine all my adult life: I'm dyspraxic, and while I don't have any attention deficiency, my focus is more diffuse without a smoke.
posted by MinPin at 11:35 AM on September 29, 2009 [1 favorite]

i cannot understand why anyone could look at that mask and immediately not see that it's just the inside of a mask. i had to watch that video like 10 or 15 times before i finally 'saw' that optical illusion.

my experience in mental health field makes me agree with the smoking/jail/boredom angle.
posted by lester's sock puppet at 11:35 AM on September 29, 2009

Agree the article is disingenuous, you'd have to have put your head under a rock not to be aware of this. It's a Bad Thing, insofar as schizophrenia does not preclude intelligence, so a normally intelligent schizophrenic person may well be aware of the deleterious effects of smoking and feel bad as a result, mentally and/or physically.

An inexpensive and worthy use for a grant of some kind would be to buy a bulk supply of electronic cigarettes and see if they met schizophrenics' demand for nicotine doses while possibly improving their overall health. I've found them very helpful in that regard. (I'm not affiliated with any company that makes or sells these products.)

A multi-pack/day smoking habit is so hard on the body that I think it's cruel not to investigate this; short-term clarity for mental patients should not have to come at the likely cost of serious heart & lung disease. I doubt these substitutes are entirely risk-free but when the alternative is heavy smoking (vs not starting in the first place), I don't see how it could possibly make things worse.
posted by anigbrowl at 11:38 AM on September 29, 2009

Aren't a high percentage of people with schizophrenia homeless or institutionalized, either in a mental hospital or prison? It's been my impression that cigarette smoking is one of the few luxuries/relaxants people get in those settings, and that it's the norm for prisons and institutions to at least allow smoking in some situations (ie outside, in a smoking lounge, etc).

I suspect it's probably 40% culture (everyone they're with smokes, and smoking is a privilege, so it's normal and considered a reward) and 60% self medication (it relieves stress and symptoms).

Also, the inside of the mask totally looked like a face was sticking out, so I think I'm normal. That's a relief, and it's kind of freaky. I was expecting it to be a bit like that left-brain/right-brain ballerina animation that floated around the net, where you can easily force yourself to see it either way, but my vision was certain there was a face sticking out. It seems like schizophrenia is definitely going against some deep mechanisms in the brain to overcome that.
posted by mccarty.tim at 11:39 AM on September 29, 2009

It is going to be prohibited in state prisons here beginning October 1.

What shall be used for money?
posted by rough ashlar at 11:39 AM on September 29, 2009

The SA article is amazingly disingenuous. . .

It's well known that you can cook up some b.s. with faked statistics. It's less well known that you can refute a likely theory with impassioned and minute demands for answers to questions not raised in the thesis.
posted by nervousfritz at 11:41 AM on September 29, 2009

Schizophrenia, apart from the trauma and heartbreak, is fascinating in that you can see how often science has taken a swing and a miss at it. Lithium, ECT, and so forth. Other kinds of patients benefit from these discoveries, but not schizophrenics. The disease (if it is just one disease) seems like the Cantor Dust of mental illness, the ever-reducing, but still present, remainder after we remove everything else.
posted by adipocere at 11:53 AM on September 29, 2009 [1 favorite]

"If I bring back the ashtrays, can I have my prefrontal?" --PKD
posted by rabbitrabbit at 11:53 AM on September 29, 2009 [1 favorite]

I think the hollow mask illusion is not actually an illusion. The image of the inside of the mask clearly and objectively is an accurate rendering of a lit face. It's not as if our brains are fooling us into thinking that looks like a face. That really does just look like a face. e.g. if you painted the outside surface the same color as the inside, and took images of the outside and inside surfaces in the same orientation and then put the images side by side, they will look almost the same. So no illusion is involved.

I think it basically must be just a geometrical fact that the lit inside surface of a hollow mask resembles closely the lit outside surface.

Though, I suppose it's possible that the inside surface has subtly "unnatural" lighting, which we with normal brains ignore more easily than schizophrenics. Still, covering bits of the image up with my hands, it doesn't seem unnaturally lit.
posted by snoktruix at 12:04 PM on September 29, 2009

Richard Klein says, "smoking is bad for you; that's why it's so good."
posted by fourcheesemac at 12:10 PM on September 29, 2009

There's also a pretty strong link between schizophrenia and the toxoplasmosis parasites commonly found in cat poo.

Here's an excellent Radiolab episode on parasites, which includes a segment on toxo parasites and schizophrenia, with special emphasis on the parasites' fascinating mind control powers over rats. Evidently the disease was much rarer until owning cats as house pets became fashionable.
posted by middleclasstool at 12:12 PM on September 29, 2009 [1 favorite]

After starting antidepressants a few months ago, I was overcome with an incredibly powerful urge to smoke.

Same thing happened to me on Paxil. I had to quit both when I got pregnant. I blamed my fuzziness on "baby ate my brain".

I've got dysgraphia, and I use caffeine to get my focus on.

So yeah, water's wet, sky's blue, etc.

What's interesting to me are the protein and genetic factors. It'd be very exciting and mean a lot to people if therapies could be developed to help folks before it manifests. I've got friends who are scared to death that they'll "get it" because a parent or close relative is schizophrenic.

But then there's the looming specter of insurance discrimination. Ain't life grand?
posted by lysdexic at 12:13 PM on September 29, 2009

All these physical manifestations should help make it possible some day to identify what is chemically wrong and hopefully find a chemical solution to this very devastating condition. The current pharmaceuticals available are not so hot.
posted by caddis at 12:13 PM on September 29, 2009

I look at 3D CAD models all day long on the screen. It is easy to be fooled into thinking a transparent model is flipped just like the Chaplin mask. I've done this work long enough though that I can immediately flip the thing back in my mind. Same with the mask- it appears positive at first but I can make it go negative. With some effort. I wonder if Schizophrenics make good 3D modelers?
posted by Mei's lost sandal at 12:20 PM on September 29, 2009

Well, OK, I suppose the point is that we can't force ourselves to see it as hollow (I can't anyway). As the guy in the video says:

"Your brain refuses to see it as hollow, simply because it is so unlikely".

This obviously is a concave shape that looks more "natural" as a convex shape. OK, brain weirdness is involved, I'm sorry.
posted by snoktruix at 12:21 PM on September 29, 2009

What I can't figure out with that Chaplin mask illusion is how they managed to make it concave on both sides.

Magic or something.

Kidding aside, isn't there some kind of drug that causes people to see faces inverted? I vaguely remember reading something about how people experiencing it found the whole effect to be deeply disturbing.
posted by quin at 12:22 PM on September 29, 2009 [1 favorite]

It is going to be prohibited in state prisons here beginning October 1.

What shall be used for money?

Mackerel.
posted by snofoam at 12:59 PM on September 29, 2009 [3 favorites]

10 mack for a bag of smack.
posted by PeterMcDermott at 1:23 PM on September 29, 2009

I'm sure in this "enlightened" age institutionalized patients can't smoke any more

Um..yeah, at least in the US they can and do.

No, not in Texas they can't. A few years ago they could have smoke breaks at certain times when they went outside, but couldn't smoke in the hospital. As of three years ago the State Hospitals banned smoking period. They provide nicotine patches. After that many private hospitals also banned smoking.

Aren't a high percentage of people with schizophrenia homeless or institutionalized, either in a mental hospital or prison?

It depends on what you mean by "high." More than the general population? Sure. But there's also lots and lots of people with schizophrenia who aren't. I can't find any firm numbers right now, but it's rare for someone who isn't convicted of a serious crime to be institutionalized, in my experience.
posted by threeturtles at 1:29 PM on September 29, 2009

Found some statistics:

Where are the People with Schizophrenia?
Approximately:
6% are homeless or live in shelters
6% live in jails or prisons
5% to 6% live in Hospitals
10% live in Nursing homes
25% live with a family member
28% are living independently
20% live in Supervised Housing (group homes, etc.)

(Source: Surviving Schizophrenia : A Manual for Families, Patients, and Providers (5th Edition) by E. Fuller Torrey (Author), Publisher: Quill; 5th edition (April 1, 2006) ISBN: 0060842598)
posted by threeturtles at 1:39 PM on September 29, 2009 [1 favorite]

I dont buy the whole "there's nothing else to do" argument. Why smoking? Why not munching on Cool Ranch doritos or playing checkers? Or writing angry letters to the editor?

When I worked at a mental institution there were regular smoke breaks--I want to say hourly, but I don't exactly recall the schedule--that were built in to the day to day life. Everyone was in the smoke room for those. It was one of the ways that the inmates patients were given a structured day, which is very important for a number of reasons, not least among them that it makes it easier for the guards staff to manage them. It also gave some patients incentive to behave and take their meds; if they were good, they would eventually be able to go outside for their smoke breaks.

When you look at the people that were most likely to be in this hospital on a regular basis, you are basically talking about the bi-polar and schizophrenics folks--their illnesses tend to promote a real rollercoaster-like experience of life. Thusly, they were most accustomed to the routines of the institution, and I'm sure this affected their lives outside the hospital environment too.

Obviously this is just anecdotal, but I would be surprised if similar structures weren't practiced all over the U.S. (Texas being the exception, I guess) and even the rest of the world, smoking included.

Where are the People with Schizophrenia?

I think these statistics are a bit misleading--at least on their own--because they don't address the fact that schizophrenics (and other mentally ill) move in and out of various types of living situations and institutions throughout their lives. Things can shift for them quite rapidly.
posted by dubitable at 3:59 PM on September 29, 2009 [1 favorite]

I just asked my schizophrenic son, who by the way is a heavy smoker who quits smoking when he is hospitalized and resumes immediately after he is released, if he saw a convex or concave face.

His answer? Convex. There goes the theory!
posted by francesca too at 4:27 PM on September 29, 2009

I was surprised to discover that I respond differently to the cigs than before. They used to be just a little pick me up. Now they are incredibly powerful mood lifters. If I go a few hours between cigs, sometimes the next one gives me an incredible rush, something very close to a two minute long orgasm. Really.
posted by Xoebe at 1:28 PM on September 29

yup. after months on being on wellbutrin if i smoked
a ciggy, i'd get as high as with marijuana but
without the disorientation (or munchies).
posted by liza at 4:48 PM on September 29, 2009

One of the schizophrenic abnormalities that smoking treats is an inability to block background noise. That nicotine alleviates some of these has been known for a long time and the mechanisms have been mechanistically worked out. Here's a PDF review of Sensory Gating from 1998.
posted by benzenedream at 4:51 PM on September 29, 2009 [1 favorite]

My self medications of choice:
dark chocolate & Drambuie
posted by notreally at 5:08 PM on September 29, 2009

It is going to be prohibited in state prisons here beginning October 1.

What shall be used for money?
posted by rough ashlar

Postage stamps. And cigarettes, but the cigarette will just be worth a lot more. They can't keep booze and cell phones out of the prisons here, I don't know how they'll keep cigarettes out.
posted by marxchivist at 7:59 PM on September 29, 2009

I just read this article (found on a website I recently learned about through an FPP here) that suggests that quitting smoking does not exacerbate mental health problems, in fact, quitting might reduce symptoms of mental illness.
posted by serazin at 8:15 PM on September 29, 2009

If you've ever been to an AA meeting, you probably noticed the haze of cigarette smoke. One of my friends who is in neurobiology found that nicotine relieves some symptoms of brain damage due to alcohol (in rats).

I wouldn't be surprised if the same effect applies to schizophrenia.
posted by Jimmy Havok at 11:41 PM on September 29, 2009

Also, a study showed some years ago that 44% of the cigarettes consumed in the US are consumed by people with mental illnesses.
posted by acb at 4:11 AM on September 30, 2009