The Worst Part Of Schizophrenia Isn’t What You Think It Is – BuzzFeed News


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Brandon Staglin on his family’s
property in Rutherford, California. Andrew
Burton for Buzzfeed News

ID: 9249642

Brandon Staglin lost touch with reality in the summer of
1990, after his freshman year of college. His first serious
relationship had just broken down. Back home in Walnut Creek,
California, he was struggling to find a summer job.

That’s when the voices became impossible to ignore. “Baby
Brandon!” they taunted. “Mixed-up kid!”

Staglin couldn’t sleep and thought that a wall had come down
inside his head, leaving the right side hollow. “I felt I’d
lost half of my spirit,” Staglin told BuzzFeed News. So he
covered his right eye with his hand, fearful that a new
personality would fill the void if he let any experiences in.

Delusional thinking like this, often accompanied by voices and
other hallucinations, is a classic symptom of the psychosis
that grips people with schizophrenia.

Travis Webster’s lowest ebb also came when he was 18, back in
2013. Diagnosed with
schizoaffective disorder, which combines psychosis with
wild mood swings, he’d stopped taking his medication. That led
to a conflict with his parents: Webster thought they were
conspiring against him, despite their efforts to help. He was
filling out a restraining order against his family when two
police officers and a social worker knocked on his door in
downtown San Diego.

Things quickly got out of hand, as the former high school water
polo player resisted the officers’ attempts to restrain him. “I
am 6-foot-5, 220 pounds,” Webster told BuzzFeed News. “The cops
were so small.” He punched one of them in the face and was
sentenced to two months in the county jail.

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Travis Webster at his mother’s
house in La Jolla, California. Ariana
Drehsler for BuzzFeed News

ID: 9240472

Life has gotten better for both Staglin and Webster. Today,
their psychosis is controlled by medication, and they’ve become
advocates for mental health: Staglin helps run the One Mind Institute, a research
organization set up by his family, and Webster
speaks about his experiences in schools.

But silencing the voices and banishing delusions doesn’t mean
that everything is OK. Once high-flying students, both men’s
grades went into free fall when they were gripped by psychosis.
And even after those symptoms were under control, they found it
hard to concentrate on their studies.

Hallucinations and delusions may be the public face of
schizophrenia, but the hidden cognitive symptoms — which
include difficulty focusing on mental tasks, understanding
speech, and remembering what just happened — make it very hard
for people with the condition to live satisfying, productive
lives.

“They might hear voices and learn not to respond to them,”
Cameron Carter of the University of California, Davis, a
specialist in the cognitive aspects of schizophrenia, told
BuzzFeed News. But it’s hard to follow people’s conversations
if you literally can’t process what they’re saying. And there’s
no compensating for an inability to concentrate.

Staglin and Webster, together with dozens of other volunteers,
have found some relief, however, by playing computer games
designed to strengthen their mental abilities. They have
participated in trials led by Sophia Vinogradov and her
colleagues at the University of California, San Francisco
(UCSF), which draw from research into “neuroplasticity” — the
idea that the brain changes in response to how it is used. This
means that neural circuits can be strengthened through mental
training, much like an athlete builds muscle by pumping iron at
the gym.

The games are designed by a company called Posit Science,
launched by one of the pioneers of neuroplasticity, Michael
Merzenich, also at UCSF. They automatically adjust their
difficulty so that players succeed on only around 80% of the
tasks. Improve your performance, and the game gets harder. If
your concentration slips, the tasks get a little easier until
you’re back in the groove.

It’s like having a personal trainer in the gym, keeping you in
just the right zone to build strength and fitness, without
slacking or overtraining. And like a physical fitness regime,
improvement only comes with persistence — Vinogradov’s
experiments typically involve up to 50 hours of training, given
over 8 to 10 weeks.

“If you don’t do it intensively, you’re not going to get the
same results,” Vinogradov told BuzzFeed News. “You need to come
back every three days, and do your reps again.”

After his first psychotic episode, Staglin returned to
his classes at Dartmouth College in New Hampshire, but his
grades plummeted. He was eventually able to drag them back up,
but only by isolating himself socially to devote his mental
energy to his studies. Reading was an effort. He felt socially
awkward and struggled to make friends.

After college, Staglin worked for a satellite engineering
company in Palo Alto, California, and was applying to grad
school at MIT when the pressure became too much again. “I had
to resign from my job. I couldn’t focus. I couldn’t
concentrate,” Staglin said.

It wasn’t until the late 1990s that Staglin took part in some
of Vinogradov’s earliest experiments, which were designed to
help people with schizophrenia make sense of speech and other
sounds. Among other tasks, he had to tell whether a rapidly
played tone was rising or falling in pitch. Staglin diligently
did his reps and saw some benefits after many years of
struggling with the cognitive symptoms of schizophrenia.

Up or Down?

In one training exercise,
volunteers must recognize whether tones are rising or falling
in pitch. Posit
Science

ID: 9233414

For Staglin, realizing that he was getting better at the games
boosted his confidence. As his performance improved, he became
more outgoing. “I think it’s because of the cognitive benefits
of being able to perceive and understand conversations better,”
he said.

Despite the initial experiment’s benefits to Staglin and other
volunteers, it took several years to win funding for the work.
In their first
major study, published in 2009, Vinogradov’s team invited
people with schizophrenia to visit their lab and play a variety
of games to improve how they understood sounds. As well as
distinguishing the rising or falling tones, they also had to
distinguish between distorted syllables containing similar
sounds, such as “pag” and “bag,” and were given more complex
tasks including remembering details from conversations played
on the screen.

Pay Attention

People with schizophrenia often
struggle to follow conversations, but practice can
help. Posit
Science

ID: 9233434

The volunteers who’d trained on these tasks subsequently took
tests in which they had to recall words. They performed better
than a control group who had trained on computer puzzle games.
They also did better on general tests of cognitive ability.
Encouragingly, the gains were about twice as large as those
typically reported in previous cognitive training studies. And
the benefits could
still be seen six months later.

Since this initial success, Vinogradov and her colleagues have
experimented with different training games,
some targeting brain circuits that process social
information — for example, by asking volunteers to read the
emotions on pictures of people’s faces. The researchers have
also tried to intervene earlier in the disorder. (Like Staglin
and Webster, most people with schizophrenia experience their
first psychotic episode as young adults.)

Last year at the International Congress on Schizophrenia
Research in Colorado Springs, Vinogradov’s team
reported that the training did more than boost the
cognitive abilities of recently diagnosed young people: It also
seemed to reduce the severity of their psychotic symptoms,
measured six months later.

That doesn’t mean that brain training can replace the drugs
that keep hallucinations and delusions at bay. But it suggests
that the games may help to protect the brain from the disrupted
wiring that is thought to be the root cause of schizophrenia’s
symptoms.

The researchers want to turn the cognitive improvements into
real life-changers, but it’s not yet clear whether the training
can make a big difference to holding down a job and building
friendships. Vinogradov thinks this may require combining the
computer games with other treatments, such as occupational
therapy to help people with schizophrenia manage everyday
tasks, and low doses of stimulant drugs that can improve focus.

Webster got involved in Vinogradov’s research last year,
volunteering for a study to see whether the training would work
on an iPad — so that young people with schizophrenia can give
their brains a workout at home.

Like Staglin, Webster had struggled with mental tasks and felt
socially isolated. These problems were compounded, he said, by
several concussions during his time in jail, when he was beaten
by fellow inmates. Unfamiliar with the jail’s unspoken rules,
he first got into trouble by sitting in a part of the canteen
claimed by black prisoners.

After his release, Webster found it difficult to resume his
studies. “I would do homework and I would feel that I had to
get up and stop and go listen to music or something,” Webster
said. Trying to keep working wasn’t a good idea, he found: “I
get extremely frustrated when I’m in that state. I’ll start
slamming doors and stuff, and throwing things across the room.”

Webster felt that the iPad training helped. “I started noticing
that I was less anxious when I was in public,” he said. “My
thoughts became less disorganized.”

Games designed to help a patient understand what they are
seeing, in particular, seemed to boost his peripheral vision,
increasing his awareness while driving. And his mom noticed
that he responded more quickly when they talked — previously,
their conversations had been punctuated by long pauses.

Still, Webster would often quit the games before he was
supposed to, because he found the exercises boring. “I was
supposed to do five hours a week. I ended up doing three,” he
said. “With schizophrenia, it’s really common to have a lack of
motivation.”

Cameron of UC Davis, who has collaborated with Vinogradov’s
group, believes that the computer games industry — masters of
cliff-hangers and cinematic thrills — should be able to solve
that problem.

Vinogradov’s team is now concentrating on intervening
even earlier, in young people who haven’t experienced a
full-blown psychotic episode but are starting to behave oddly
or having trouble distinguishing dreams from reality. The
researchers have already shown
that the training helps young people rated at high risk of
developing psychosis get better at remembering words.

But the idea of starting treatment before people have
experienced a psychotic break is controversial. “Attenuated
psychosis syndrome,” intended to describe people at risk of
schizophrenia,
was rejected as a new psychiatric diagnosis in 2012.
Critics argued that more than 70% of young people who have
strange thoughts and minor hallucinations do not go on to
develop schizophrenia. If this diagnosis became mainstream,
they worried, it could lead to a massive and unwarranted
expansion in the prescription of powerful antipsychotic drugs.

Getting young people to play computer games doesn’t arouse
quite the same fears. “Cognitive training is probably benign
enough,” Allen Frances of Duke University, who led the
opposition to the proposed diagnosis, told BuzzFeed News by
email. But he remains worried about young people who may never
develop schizophrenia being stigmatized by an “at risk” label.

Webster would have welcomed the opportunity to seek early
treatment. He began to have problems concentrating from the age
of 14, and found it hard to socialize with other kids.

“I think my life would have different,” he said, “if they’d
caught this disease before I had a full-blown episode.”



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