Schizophrenia and Dissociative Disorders: Crash Course Psychology #32

It’s perhaps the most stigmatized and misunderstood
psychological disorder of them all, even among psychologists. Maybe because it’s pretty rare,
affecting about 1% of the population, schizophrenia causes more anxiety in the media, in the public, and
even in doctors’ offices than any other mental illness. As a result, its sufferers have often been
shunned, abused, or locked up. And among the many fallacies that surround the disorder
is simply what it means. The word “schizophrenia” literally means “split mind” but contrary
to popular belief, the condition has nothing to do with a split in personality or multiple
personalities. The term refers instead to what’s sometimes
called a “split from reality.” Multiple Personality Disorder, now known as Dissociative Identity
Disorder, is a totally different type of condition, a kind of dissociative disorder. And these
too, are shrouded in misconceptions, partly because they were the subject of, probably,
the greatest psychological hoax of all time. While many of us can relate on some level
to the emotional swings, nervousness, and compulsions that come with mood and anxiety
disorders, it can be a lot harder for those without direct experience to relate to the
symptoms of schizophrenia and dissociation. Unfortunately we tend to fear and avoid what
we don’t understand in each other, whether it’s a friend of family member or just some
stranger on the bus. But thankfully part of the psychologist’s job is to demystify the
things that can happen in our heads, and as is often the case, understanding may be the key
to compassion. Schizophrenia is a chronic condition that
usually surfaces for men in their early to mid-20s, and for women in their late 20s.
For some the disorder comes on gradually, but for others it could arise more suddenly,
perhaps triggered by stress or trauma, although no event can actually cause the disorder. Once thought of as a single discrete condition,
schizophrenia is now included in the DSM-5 as a point on a spectrum of disorders that
vary in how they’re expressed and how long they last, but they share similar symptoms. Schizophrenia Spectrum Disorders are currently
thought of as characterized by disorganized thinking; emotions and behaviors that are
often incongruent with their situations; and disturbed perceptions, including delusions
and hallucinations. They all involve a kind of loss of contact
with reality on some level. The resulting behaviors and mental states associated with
this break from reality are generally called “psychotic symptoms” and they usually impair
the ability to function. When someone’s experiencing psychotic symptoms,
their thinking and speech can become disorganized, rambling and fragmented. This tendency to
pick up one train of thought and suddenly switch to another and then another can make
communication painfully difficult. People exhibiting these symptoms can also
suffer a breakdown in selective attention, losing the ability to focus on one thing while
filtering others out. In extreme cases, speech may become so fragmented
it becomes little more than a string of meaningless words, a condition given a name that sounds
like its own kind of non sequitur, “word salad.” Classic schizophrenia is also often marked
by delusions or false beliefs not based in reality. These delusions can be rooted in
ideas of grandeur like “I’m the queen of England!” or “I won an Olympic gold medal for the luge!”
Or they can become narratives of persecution and paranoia, believing your thoughts and
actions are being controlled by an outside force or that you’re being spied on or followed
or that you’re on the verge of a major catastrophe. And there are some complicated variations
on these delusions, like feeling that you’ve died or don’t exist anymore or that someone is madly in
love with you or that you’re infested with parasites. Delusions of one kind of another strike as
many as four out of five people with schizophrenia. While some delusions can seem fairly logical,
they can also be severe and bizarre and frightening. Unfortunately maybe the most memorable examples
of people suffering from severe delusions come from serial killers and yeah, while Son
of Sam did claim that he was taking orders from his neighbor’s dog, that kind of stuff
is in the tiny, tiny, tiny minority. Brian Wilson of The Beach Boys and Syd Barrett
of Pink Floyd both suffered psychotic symptoms. And then of course there’s John Nash, the
Nobel Prize winning American mathematician and subject of the movie “A Beautiful Mind.” Through proper treatment, some people with
schizophrenia have not only learned to live with their illness but also made fantastic
creative contributions to the world. Maybe people with schizophrenia also suffer
from perceptual disturbances, or sensory experiences that come without any apparent sensory stimulation,
like hallucinations. This is when a person sees or hears something that isn’t there, often lacking
the ability to understand what is real and what isn’t. Auditory hallucinations, or hearing voices,
are the most common form, and these voices are often abusive. It’s as if you’re inner
monologue, that conversation that you have with yourself or the random things that float
through your head, were somehow coming from outside of you. It’s as if you couldn’t sort
out whether the voices in your mind were internal and self-generated, or external and other-generated. To me, it sounds terrifying. Other common symptoms include disorganized,
abnormal, or incongruent behavior and emotions. This could mean laughing when recalling a
loved one’s death or crying while others are laughing. Acting like a goofy child one minute, then
becoming unpredictably angry or agitated the next. Movements may become inappropriate and compulsive,
like continually rocking back and forth or remaining motionless for hours. Broadly, most psychotic symptoms fall into
three general categories traditionally used by psychologists: positive, negative, and
disorganized symptoms. Positive symptoms are not what they sound
like. They’re the type that add something to the experience of the patient. Like, for
example, hallucinations or inappropriate laughter or tears or delusional thoughts. Negative symptoms refer to those that subtract
from normal behavior, like a reduced ability to function, neglect of personal hygiene,
lack of emotion, toneless voice, expressionless face, or withdrawal from family and friends. Finally, disorganized symptoms are those jumbles
of thought or speech that could include word salad and other problems with attention and
organization. Symptoms like these are useful in diagnosing
a disorder on the schizophrenia spectrum, but there’s a physiological component too.
Like many of the disorders we’ve talked about, schizophrenia has been associated with a number
of brain abnormalities. Post mortem research on schizophrenia patients
has found that many have extra receptors for dopamine, a neurotransmitter involved in emotion
regulation and the brain’s pleasure and reward centers. Some researchers think that overly responsive
dopamine systems might magnify brain activity in some way, perhaps creating hallucinations
and other so-called positive symptoms as the brain loses its capacity to tell the difference
between internal and external stimuli. For this reason, dopamine blocking drugs are
often used as anti-psychotic medications in treatment. Modern neuroimaging studies also
show that some people with schizophrenia have abnormal brain activity in several different
parts of the brain. One study noted that when patients were hallucinating,
for example, there was unusually high activity in the thalamus, which is involved in filtering
incoming sensory signals. Another study noted that patients with paranoid symptoms showed
over-activity in the fear processing amygdala. So, schizophrenia seems to involve not just
problems with one part of the brain, but abnormalities in several areas and their interconnections. But what might be causing these abnormalities? Earlier I mentioned how a stressful event
might trigger psychotic symptoms for the first time, even though it can’t actually create
the disorder. Psychologists call this the “diathesis-stress model.” This way of thinking involves a combination
of biological and genetic vulnerabilities — diathesis — and environmental stressors
— stress — that both contribute to the onset of schizophrenia. This model helps explain
why some people with genetic vulnerability might not always develop schizophrenia and
why the rates of schizophrenia tend to be higher with some degree of poverty or socioeconomic
stress. And it seems too that there is some kind of
genetic predisposition for the disorder. The one-in-a-hundred odds of developing schizophrenia
jumped to nearly one in ten if you have a parent or sibling with the disorder, with
about 50/50 odds if that sibling is an identical twin, even if those twins were raised apart. One recent landmark seven year study looked
at genetic samples across 35 countries, examining more than 35,000 people with schizophrenia,
and another 110,000 without the disorder. The study identified more than 100 genes that
may increase the risk of schizophrenia. As expected, some of these genes involve dopamine
regulation, but others are related to immune system functioning. Researchers continue to
tease out what is exactly going on here, but many are hopeful that these new findings will
lead to better treatment. Clearly, schizophrenia is a challenging disorder
to live with and one that’s hard for outsiders to understand, but maybe even more rare and
more elusive are the dissociative disorders. These are disorders of consciousness, called
dissociative because they’re marked by an interruption in conscious awareness. Patients
can become separated from the thoughts or feelings that they used to have, which can
result in a sudden loss of memory or even change in identity. Now, we might all experience minor dissociation
at times, like maybe the sense that you’re watching yourself from above, as in a movie,
or like you’re driving home and get so zoned out that suddenly you find yourself in front
of Taco Bell thinking, like, “How did I get here?” Those things would generally fall into the
normal range of dissociation, but most of us don’t develop different personalities. Dissociative disorders come in several different
forms, but the most infamous of the bunch is probably Dissociative Identity Disorder.
This has long been known as Multiple Personality Disorder and, yes, it is a thing. It’s a rare
and flashy disorder in which a person exhibits two or more distinct and alternating identities
and the best known case was that of Shirley Mason, whose story was famously rendered in
the 1973 best seller “Sybil” and later in a popular mini-series. The book was marketed as the true story of
a woman who suffered great childhood trauma and ended up with 16 different personalities,
ranging from Vicky, a selfish French Woman, to handyman Syd, to the religious and critical
Clara. The book became a craze and within a few years
reported cases of multiple personality skyrocketed from scarcely 100 to nearly 40,000. Many believe the book was essentially
responsible for creating a new psychiatric diagnosis. It turns out though, Sybil’s story
was a big fat lie. Yes, Shirley Mason was a real person and one
with a troubled, traumatic past and a number of psychological issues. As a student in New
York in the 1950s she started seeing a therapist named Connie Wilbur and taking some heavy
medications. And somewhere in there, maybe because she was coaxed, or maybe because she
wanted more attention, Shirley started expressing different personalities. Dr. Wilbur built a career and a book deal
out of her star patient, even after Shirley confessed that her split personality was a
ruse. The Sybil case is a powerful reminder that
we really don’t understand dissociative disorders very well or even know if they’re always real.
Indeed, some people question if Dissociative Identity Disorder is an actual disorder at
all. But some studies have shown distinct body
and brain states that seem to appear in different identities, things like one personality being
right handed while the other is left handed, or different personalities having variations in their eye
sight that ophthalmologists could actually detect. In these cases, dissociations of identity
may be in response to stress or anxiety, a sort of extreme coping mechanism. Either way, the debate and the research continue. Today we talked about the major symptoms associated
with the schizophrenia spectrum disorders, including disorganized thinking, inappropriate emotions
and behaviors, and disturbed perceptions. We also discussed brain activity associated
with these disorders and talked about their possible origins including the diathesis stress
model. You also learned about dissociative disorders,
and Dissociative Identity Disorder in particular, and the scandal that was the Sybil case. Thanks for watching, especially to all of
our Subbable subscribers who make Crash Course possible. To find out how you can become a
supporter, just go to This episode was written by Kathleen Yale,
edited by Blake de Pastino, and our consultant is Dr. Ranjit Bhagwat. Our director and editor
is Nicholas Jenkins, the script supervisor is Michael Aranda. He is also our sound designer
and the graphics team at Thought Cafe.

Comments 15

  • Don't dismiss the possibility of these people being infested with parasites, this makes a physicians job too easy and helps them to treat their patients with stigma! The patients skin didn't turn to silicone once the patient walked into the office! SCABIES DOES EXIST!

  • How about Moses talking to a burning bush and Saul of Tarsus communicating with a dead man?
    Exodus 3:2  And the angel of the LORD appeared unto him in a flame of fire out of the midst of a bush: and he looked, and, behold, the bush burned with fire, and the bush was not consumed.

    Exo_3:3  And Moses said, I will now turn aside, and see this great sight, why the bush is not burnt.

    Exo_3:4  And when the LORD saw that he turned aside to see, God called unto him out of the midst of the bush, and said, Moses, Moses. And he said, Here am I.

    Galatians 1:11  But I certify you, brethren, that the gospel which was preached of me is not after man. 

    Gal 1:12  For I neither received it of man, neither was I taught it, but by the revelation of Jesus Christ.

  • But, what if we know where the voice is coming from but we don't know how it got there?
    For example, I know that the voice came from inside my head, but it said something that I wasn't thinking of or it replied to me in a way that I wouldn't to myself. Or, even say something about a topic or person or thing that I didn't think of and would never have thought of.
    Is this just a subconscious thing or is this different?

  • Diavolo In dappio

  • Man you love reading !!!!

  • Thank you for making this video. We're definitely going to use it when trying to educate my family on whatever the hell is wrong with us.

  • i used to confuse hank for john green

  • i’m bored

  • i think a big part of what keeps people from understanding schizophrenia is not wanting to believe this thing exist, because just the existance of such illnesses threatens their reality

  • Is it possible for each alters inside a person afflicted with dissociative identity disorder to love different people?

  • I see what you did @ 10:17.

  • I have DID and life is a struggle just on a daily, but we do what we can to work together with one some what chaotic life. – Neikaru

  • My boyfriend thinks that he is fumigated from planes by the “elite”.
    And that there’s Archons energetic parasites that feed on his energy.
    And that sometimes the “Maras” in people manifest and are make others be nasty to him.
    As well as many other things LOL

  • I know that I'm late to the game in That my comment Is it very helpful at this point but I feel like putting schizophrenia and associative identity did sorter and the same video is a huge disservice to both disorders and those who suffer from them

  • I had a friend of mine had a pretty severe case of drug psychosis which in where he found it pretty hard to discern between the “real world “ and the world of his mind and over the time it went from him becoming a recluse to destroying his house. This isn’t a PSA or anything im honestly not sure why I’m even sharing this I guess if you feel like you need help mentally reach out to a friend or a professional before you hurt yourself or others.

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