Monday, May 19, 2008

Autism and Schizophrenia: Chris Frith on my side

I was reading the excellent new book by Chris Frith titled " Making up the mind: how the brain creates our mental world" and was delighted to discover that Chris Frith, a leading world authority on Schizophrenia (and whose wife Uta Firth is a world authority on Autism) also contrasts Autism and Schizophrenia along the social, mind-reading dimension.

To quote from his book:

We understand that people’s behavior is controlled by beliefs even if these beliefs are false. And we soon learn that we can control people’s behavior by giving them false beliefs. This is the dark side of communication.

Without this awareness that behavior can be controlled by beliefs, even when these are false, deliberate deception and lying are impossible. In autism this awareness seems to be lacking, and people with autism can be incapable of deception. At first thought the inability of the autistic person to lie seems to be a charming and desirable trait. But this trait is part of a wider failure to communicate, which also makes people with autism seem rude and difficult. It can often make them lonely and friendless. In practice, friendly interactions are maintained by frequent little deceptions and circumlocutions that sometimes hide our true feelings.

At the other extreme from autism lies the person with paranoid schizophrenia who is aware of intentions that are invisible to rest of us. For the person with paranoia every statement can be a deception or a hidden message that has to be interpreted. Hostile statements can be interpreted as friendly. Friendly statements can be interpreted as hostile.

One person heard voices saying “Kill yourself ” and “He’s a fool.” He described these voices as two benevolent spirits who wanted him to go to a better world. Another person heard voices saying “Be careful” and “Try harder.” These were “powerful witches who used to be my neighbours . . . punishing me.”

This hyperawareness of the intentions and feelings of other people can be so intense as to be overwhelming.

The walk of a stranger in the street could be a “sign” to me that I must interpret. Every face in the windows of a passing street car would be engraved on my mind, all of them concentrating on me and trying to pass me some kind of message. . . . The significance of the real or imagined feelings of people was very painful. To feel that a stranger passing on the street knows your innermost soul is disconcerting. I was sure that the girl in the office on my right was jealous of me. I felt that the girl in the office on my left wanted to be my friend but I made her feel depressed. . . . The intensity with which I felt [these impressions] made the air fairly crackle when the typists in question came into my office. Work in a situation like that is too difficult to be endured at all. I withdrew farther and farther.

In such a state the possibility of meeting other minds has been temporarily lost. This vivid experience of the minds of others no longer corresponds to reality. Like the person with autism, the person with paranoia is alone.

It is important to pause here and note that there are two issue involved in the concept of the social brain. In words of Frith himself:

Perhaps the most important attribute of the social brain is that it allows us to make predictions about people’s actions on the basis of their mental states. This assumption that behaviour is caused by mental states has been called taking an ‘intentional stance’ (Dennett 1987) or ‘having a theory of mind’ (Premack & Woodruff 1978). The largely automatic process by which we ‘read’ the mental states of others is called mentalizing.

Thus, the deficits (and the excesses) in Autism (and schizophrenia) with relation to the social mind may arise from deficits in both of the processes involved. I have argued earlier that Schizophrenics/ Psychotics have too much of an intentional stance and have an animistic bias, while the reverse is true of Autistics. Similarly others , based on Mirror Neuron deficits have argued that the capacity to mentalize or infer mental states of other is impaired in Autism. The capacity to infer mental state sof others may be enhanced in schizophrenics/ psychotics (thus making them better artists/ writers).

To me having the Friths on my side is very important. Chris Frith is a very engaging author and I highly recommend his book Making up the Mind to all the readers of this blog. He doesn't tackle the question of consciousness; but on the other hand shows brilliantly - how, effortlessly and unconsciously, our brain helps us navigate the physical as well as the social world.

Sphere: Related Content


concerned heart said...

I think autism and childhood schizophrenia are the same. See 1994 DSM IV where childhood schizophrenia was removed as a diagnosis and autism to its place. On a molecular level they are identical according to Daniel Geschwind and Brett Abrahams.

"Could autism and schizophrenia be cousins? New research shows that people with schizophrenia have rare variations in genes that control brain development and that each person has a unique pattern of mutations. The finding is startlingly similar to new research on autism. Since April 2 is the first-ever World Autism Awareness Day, it's a good time to ponder what this odd conjunction says about building human brains—and, perhaps, how to fix them.

Tolstoy famously wrote that happy families are all alike, but that each unhappy family is unhappy in its own way. Thomas Insel, a psychiatrist who heads the National Institute of Mental Health, calls the new understanding that disorders like schizophrenia and autism have unique origins in each person a "Tolstoy moment" in mental health. Until very recently, the theory on diseases like these that run in families has been that people who get the disorders have the same genetic mutations. Scientists have spent years looking for a "schizophrenia gene" and an "autism gene," but the search has been frustrating. They have ID'd genes that make people susceptible to the disorders, but none of those genes are shared by enough people that they have proved useful for diagnosis or treatment. Given that, it's no wonder that activists in the autism and schizophrenia communities lose patience with scientists' fixation on genes and accuse them of slighting research on possible environmental causes.

In the past few years, scientists have started looking for disease genes in a totally different way. Using a new technique called whole-genome scanning to browse almost all of a person's DNA, researchers compared family members and other people with and without the disease, looking for shared patterns. They found that 15 percent of people with schizophrenia had rare deletions or duplications in their DNA, compared with 5 percent of people in the general population. The difference was even more pronounced in children with early-onset schizophrenia: 20 percent had mutations. "They're not random," says Insel. "They tend to cluster around genes that are important for brain development."

But the big surprise is that the variations differ so much from one person to the next. Each person, in other words, becomes schizophrenic in his or her own way. (There were similarities within families, however. In a group of children with early-onset schizophrenia, more than half of the children had inherited the genetic mutations from a parent.) This notion of a "personalized" disease—that there are many ways to end up with schizophrenia—is also, increasingly, how researchers are thinking about autism.

At first glance, autism and schizophrenia seem to have little in common. Autism shows up in early childhood and is characterized by problems with social interactions and communications, including understanding nonverbal cues or the inability to talk. Schizophrenia, by contrast, usually doesn't manifest itself until early adulthood. Its symptoms can include hallucinations and delusions but also what are called "negative symptoms": lack of emotion, inappropriate social skills, and impaired thinking. Both disorders can be disabling, and for each there is no known cause and no cure.

But Judith Rapoport, chief of the child psychology branch at the National Institute of Mental Health and one of the researchers, sees a similarity. She's spent the past three decades studying how children's brain development is affected by disorders like schizophrenia. The brains of children with early-onset schizophrenia are much larger than normal in the first few years of life, for instance. Children with autism also have an unusual amount of brain growth before age 3. In this new work, she and her colleagues found that two places where variations in genes tended to cluster in people with schizophrenia were also more common in people with autism. "We're very excited about the link to autism," Rapoport says. "You have to see these as risk factors, very intriguing ones."

Rapoport is convinced that there are more genetic links between schizophrenia and autism, and the researchers are now going through their data with a finer comb, looking for more correlations—and, perhaps, stronger clues as to where the brain's path goes so grievously astray. There's no insta-cure here, alas. But having a clearer view of what the genes are up to makes it more likely that genetic diagnoses and treatments could someday be created. It also could help move the debate from arguing over whether there are environmental triggers for autism to finding them and coming up with ways to protect people who are genetically susceptible
Labels: autism is the same as childhood schizophrenia

Sandy G said...

Hi Concerned Heart,
I believe you are mistaken in your conclusion that Autism and Schizophrenia are the same. Pls see my latest post regarding the same where I have commented on your comment.