The idea of boundary confusion issues in schizophrenia

My own working hypothesis about what might be happening in schizophrenia

Photo by Kenrick Mills on Unsplash

Most people have a clear sense of the boundary between themselves and other people. But I think this might be what is going wrong in the collection of signs and symptoms that has come to be called Schizophrenia. My ideas are based on a lot of thought that I have given to the conundrum of “schizophrenia” over the years following my own recovery from a major episode of what I prefer to call psychosis. (mostly because I made an almost complete recovery, rather than flatlining or even continuing to have many more episodes throughout my life)

I’m going to try to explain what I think goes wrong and how it goes wrong. Before I do that, I want to mention predictive or diagnostic tests for this particular condition. My understanding is that the biomarker testing available at present isn’t sensitive enough to pick up the clues of raised activity in certain neural pathways that could indicate serious disturbance or signals of distress in central networks and pathways. I do think improvements in technology could help to identify the metabolites or waste products of, say, something like cortisol in sweat (don’t worry if this isn’t a good example, I just want to give people an idea of the types of things that might be picked up in possible future tests).

For the moment though, I’m digressing into testing only because I want to talk about how extreme distress could be picked up in a blood, saliva or sweat test. I think that it will be difficult to find a biomarker for schizophrenia as such as a disease. What has been searched for so far perhaps is far too simple, a clue that the causes of these symptoms are what science calls multifactorial (i.e caused by many factors).

I honestly think that “schizophrenia” is the very extreme end of stress-induced central nervous system malfunction. The worst it can get. The most fundamentally ill that you can be with it. The most terrified you can be. The most frozen you can be. The “end game” where “existence” and “total destruction” merge. You feel alive but you sometimes wish you were dead. The amount of pain you are in can sometimes no longer be quantified or handled.

How does this manifest itself? You begin buffering. Your head switches itself on and off. Like a vending machine that hits itself in order to produce a necessary function, you hit yourself, harm yourself, drive your car into a wall, throw yourself off a bridge, attack yourself in the marketplace, anything, anything, to try to shock your system back into functioning. If these desperate measures are misread as a threat to others, then they are going to fail. That’s when schizophrenia, if it exists at all, really can set in. For me, it’s the very definition of total executive function failure, resulting in the visible symptoms of total despair. Why can’t anyone else see it the way I do? Maybe a few of you can be persuaded to think about my perspective on it.

So far I have described a process that most of you recognise as how schizophrenia goes in relation to how other people see it. But I want to look inside the person now.

The way that things go wrong when psychotic symptoms begin to manifest may work across every type of boundary that we have with the outside world. If assailed with its many symptoms, we cannot use our normal senses in order to protect ourselves. Why? Because they are unable do it. It’s a circular problem, and, untreated, it just buffers round and round with the patient in a no man’s land between asleep and awake to the real world around them.

What causes it? It starts, I think, with a fundamental amount of damage to our body or mind at some fixed real point in our lives, either in utero, soon after, or later. Something concrete triggers it into a problem at a point later in time, though. Something pops and spills, either functionally or chemically or both, and a dislocation domino effect begins, out from the centre. This dislocation can happen in the senses in all peripheral modalities, as well as the central areas that unite and process the information they provide.

The effects are disastrous. The perceptual barriers between self and other (in the widest sense of “other”) become loose and uncertain. This leads to feelings of being lost in our own selves among the very information that we have brought in. Our body and mind takes up the boundary space in between the two, instead of being a relay system between one and the other (which is how it functions normally. Our mind explores the retina, the surface and substructure of the skin, the information in the inner ear, proprioceptive clues, trying to understand what is coming in and whether it is a threat to the central person or not. For maybe the first time, they really aren’t sure. Being busy exploring liminal structures affects our own sense of self as it no longer feels discrete from other sensory information.

Why does it happen when it does? It’s hard to know. The damage to the central nervous system (that I think is at the root of the problem) might be manifesting itself (now at this moment) possibly because of some outside trigger or infection, or possibly due to brain changes that occur naturally at the point of development the sufferer has reached at that time in their lives.

Meanwhile, back inside the person, the person might be considering how their skin is an organ and if anything can get in through it at the microscopic level, and feel afraid. But why is this line of thought happening? Is it because they are triggering the processing of information stored in the multiple layers of the skin which connect to the central nervous system? This stuff is not normally in conscious awareness most of the time. Now it’s taking up the bandwidth the person normally uses for relating to everyone else around them instead.

Or they might be wondering how they can hear people talking, or why they first heard one voice but now can hear many voices coming through on multiple channels. Are they triggering real traces encoded between the substance of their inner ear and their temporal lobes, resulting in auditory hallucinations? This would also get in the way of them being able to concentrate on what you are saying.

All this activity that is not normally in conscious awareness is now affecting how the person is feeling in the world around them. Reinforced by looks of confusion and concern in the faces of the people around them, the person takes these further clues from the periphery and processes them again. This creates a negative feedback loop that things are indeed puzzling, wrong somehow, and getting worse. Reinforced by this extra information, the previously damaged area consolidates a feedback loop that the peripheral senses are a useless illusion, and the core cannot rely on them or be protected by them.

The important thing to establish is that it is the extent and severity of the damage that leads to really severe symptoms, rather than the trigger, or when or how it happened, since that can be unclear. (There may have been a lack of oxygen in utero, for example). There is no way that the person in front of you can know that about themselves. All you both know is that you are watching them suffering. They are literally lost in their own boundaries of perception, and cannot feel safe until they find their way out.

I hope that you like my ideas about boundaries being important in schizophrenia in every sense of the word from the chemical and even atomic to the personal and multi social. I hope that I will get some credit if ideas similar to mine become part of mainstream research due in part to the reading of this article. After all, I do know what I’m talking about, don’t I? Or do I? Maybe you have a better idea. New ideas are definitely needed, so I have started with some of mine. Hope this helps!