The brain is one heck of a haystack to be searching if the needle was actually down the well all along.
Schizophrenia is a devastating condition, affecting more than 20 million people worldwide, with a huge cost to society both economically and in terms of human suffering. Treatment with anti psychotic drugs reduces symptoms for many, though they are rarely fully effective, and bring their own set of problems in the form of troublesome side effects and reduced longevity.
Psychiatrists and Psycho-pharmacologists have spent decades tweaking neurotransmitters, but are really no closer to understanding the nature of the illness. Much hope is centred around identifying genes common in those with the disorder, but unless the mechanisms triggered by these genetic differences can be identified, it is largely meaningless.
Schizophrenia is not, as has always been assumed, a disorder of the brain. Rather, the disruption to normal thought patterns and perceptual anomalies are symptomatic of the underlying physical disorder.
I’ll talk a little here about anxiety, because anxiety and schizophrenia are inexorably linked, and share common ancestry. The notion that someone is an anxious person, or that anxiety comes out of nowhere is palpable nonsense. Whether we are aware of it or not, anxiety and the physiological and psychological symptoms associated with it is simply due to us being unable to maintain a sufficient oxygen supply.
We’re often told that we can control anxiety with our breathing. Indeed, diaphragmatic breathing enables us to fill our entire lungs and reduces anxiety. However, if the integrity or function of the muscles involved in diaphragmatic breathing are compromised, with all the will in the world, we will still not be able to breathe optimally and relax. It is just not mechanically possible.
Inappropriate anxiety, then, is the result of restricted of oxygen intake or not being able to breath sufficiently to cope with demand.
The trapezius muscle runs from the back of the neck,across the shoulders and down the back and assists with breathing. Spasm or contraction restricts the lungs and intake of air.
Stressful situations, fear or trauma (physical or emotional) in which normal respiration is paused (waking apnoea) have the effect of shrinking, weakening or stiffening the trapezius, leading to chronic sub-clinical breathing problems and anxiety.
Chronic changes to muscle tone related to respiration may also lead to mechanical problems with breathing when sleeping. Insomnia, often seen during the prodromal period is the result of CO2 levels building and the heart kicking in (in the same way that the “kiss of life” kicks starts the heart and lungs into action), causing premature waking.
Anti psychotic medication regulates the rhythm of the heart, avoiding natural fluctuations, disrupting the signal to the heart that CO2 levels are too high. Although the heart remains in steady rhythm, blood oxygen levels remain low during sleep.
As is seen with central sleep apnoea, areas of the brain concerned with autonomous functions such as sleep may be those most easily disturbed by low oxygen levels, maintaining the disorder.
Psychiatric symptoms triggered due to brain dysfunction in this way are unrelated to the mechanism, and are of little significance. Once respiration returns to normal, it is hoped that symptoms will resolve, dependent upon the extent of the damage caused by chronic low oxygenation.
Anti psychotic medication may be actually maintaining the condition, masking its true nature, and ensuring that oxygenation remains low during sleep. This is why it may appear that a relapse, and indeed, a worsening of the condition occurs when medication is discontinued., when in reality, the symptoms return because of a lack of restorative sleep and reduced respiration due to anxiety feedback.
So, what of the dopamine connection? Dopamine controls how we think? I think it’s very unlikely. Dopamine is primarily involved movement and muscle contraction , and an excess of dopamine leads to over twitching of muscle fibre and an increase in muscle tension. The flooding of the brain with dopamine by substances such as amphetamine causes muscles to contract too much and too often, leading to restriction of optimal respiration. The only difference is that the muscle contraction is acute and returns to normal, rather than the chronic state seen in schizophrenia.
The increased tension restricts respiration and normal oxygen intake, which over time can lead to central apnoea by damaging the parts of the brain involved in autonomous functions like breathing. In this way schizophrenia appears progressive. Chronic oxygen starvation is what leads to disruption of cognitive, reasoning and perceptual systems within the brain.
Below are some of the questions often raised when considering the nature of schizophrenia, along with how I think they can be easily explained.
Q Why is first onset of schizophrenia more common in men of adolescent age than in women?
A During adolescence there is a broadening of male shoulders. If the muscles necessary for efficient breathing such as the trapezius across the neck, back and shoulders do not develop in sync it may lead to a restriction in optimal breathing.
Q Why is cigarette smoking more common in the sz population?
A Nicotine’s effect on muscarinic receptors relaxing smooth muscle tone sufficiently to cause increase in effective respiration and brain blood oxygenation.
Q The cannabis paradox: Why is it thought that cannabis can both cause and relieve symptoms of schizophrenia?
A It’s likely that the beneficial effects of cannabis (specifically CBD) experienced by some are due to its properties as a muscle relaxant (In the same way that it is used for pain relief and to prevent muscle spasms in multiple sclerosis sufferers).
It’s likely that psychosis triggered by cannabis use is the result of anxiety caused by a combination of unfamiliar and frightening sensations and the fact that people are afraid to discuss what they feel is happening to them due to the illicit nature of the substance; fear grows that they have somehow damaged themselves, and that it’s their own fault. This anxiety causes tension of the muscles involved in breathing, which in turn increases and maintains the anxiety state. Vicious circle. It seems a lazy assumption that because perceptual disturbances are common to both schizophrenia and cannabis use that they must somehow be related.
Q Why do relapses occur when anti psychotic medication is discontinued?
A Most likely loss of anxiolytic effect leading to muscle tension or spasm affecting breathing.
Q Why are benzodiazepines effective for some symptoms?
A Muscle relaxants allow small but significant increases in oxygenation by facilitating easier breathing. The body normalises to some degree and adapts. Medical screens for blood gases at any time may indicate normal, but the small changes are enough to have significant effect on brain function.
Q What about negative symptoms?
A The lines between depression, negative symptoms and medication side effects may appear unclear. Without going into the mechanism behind depression here, it seems likely that disruption of normal brain function disruption and poor energy levels due to low oxygenation, which may be maintained or worsened by anti psychotic medication are responsible for what are termed negative symptoms.
Q I once read that the toxoplasma gondii parasite spread by cat faeces may trigger schizophrenia.
A This link, if confirmed, may be the result of a complex mechanism. However, it seems likely that an allergy to cat dander is more common than reported. Symptoms such as slight respiratory dysfunction may even go unnoticed. The muscles involved in respiration may grow abnormally in a developing child with compromised breathing and predispose to environmental or emotional triggers in later life.
Q Why are traumatic experiences commonly implicated in schizophrenia development?
A Fear or trauma lead to tension and apnoea, resulting in chronic spasm or abnormal tension in the muscles which aid breathing.
PTSD may share a similar mechanism, with tension in the trapezius leading to apnoea and abnormal brain function, but does not progress to a clinical diagnosis of a schizophrenia spectrum illness unless it is treated with neuroleptics.
Q Why are such disparate symptoms associated with schizophrenia, and how is it possible that they share a common mechanism?
A All of the symptoms share a common mechanism in that dysfunction of the brain occurs due to oxygen starvation. How this manifests depends on which parts of the brain have been most affected. It is likely that there are many complex mechanisms at play, but these are really of no consequence. Once normal function is restored, it is hoped that the symptoms will resolve.
Q Why do anti psychotics often cause weight gain and raise blood sugar levels, sometimes leading to diabetes?
A Oxygen is needed for metabolism of food/glucose. Chronic low oxygen levels will lead to abnormal metabolism.
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