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Are People With Schizophrenia Living a Dream?

How cutting-edge brain research is shedding light on schizophrenia

When I lay my head down at night to go to sleep, I, like many of you, enter a fantastical dream world. In these worlds, American Idol contestants sing in tune, bright redheaded women are fighting for my affection, and every street corner is full of panhandling turtles with Viking hats singing Carmina Burana in perfect harmony.

Once I awaken, I, also like most of you, quickly lose the vividness inherent in the dreams. The turtles' chants die down, the red hairs aren't as intense, and the positive emotions I felt actually hearing good singing in a singing competition quickly fades away. Sure there are still traces in my system of these emotions and sensations, but they quickly disappear as I set out to accomplish the (mostly not nearly as interesting) tasks before me. As I go along my day, flashes of images from prior dreams may enter my consciousness, but many of these images and feelings only serve to sadden me because I almost instantly realize they weren't and therefore aren't real. They were "just a dream". Quite frequently, when I try to be creative during the day I have difficulty getting into the same frame of mind as my dreams: uninhibited, spontaneous, and rich in imagery that are really, really vivid. It's as if my consciously controlled "reality-self" is getting in the way of my automatic "fantasy-self". Sometimes I really do want the reality-self to just go away!

But is this the case for everyone? Could there be a sub-group of individuals whose waking streams of consciousness are every bit as vivid and creative as their night-dreams? Does our society label such individuals "schizophrenic"?

In the most recent issue of Psychology Today (March-April 2009), Josie Glausiusz wrote a terrific piece ("Devoted to Distraction") about the potential adaptive benefits of daydreaming and the default network in the brain that is active during such flights of fancy. Glausiusz even dips a bit into the aberrant, briefly discussing the abnormal default brain network functioning of people with autism and Alzheimer's. I think it is wonderful that Glausiusz represented these ideas, considering the main focus of the article was on the adaptive benefits of daydreaming for the population at large.

The article got me thinking though about some recent research on the relation between the default network and schizophrenia. As Glausiusz notes, the default network lights up like a firecracker when people are engaging in fantasy. The default network is not just limited to fantasy, however. The default network is active whenever we are engaging in internally focused tasks. In other words, our default network comes alive when we are fondly (or perhaps not so fondly) recollecting past summer vacations with the family, when we are envisioning future escapades with a loved one, or when we are trying to figure out the intentions of someone else. The default network consists of multiple interacting subsystems that together enable us to dip into the depths of our internal stream of consciousness.

When properly connected, the default network has an automatic shut-down mechanism that kicks in when it is necessary for us to direct our attention outward. For instance, when people with a "properly wired" default network are concentrating on a task, blood flow leaves the default network and areas of the prefrontal cortex that are needed to focus become more active. After all, it is mighty difficult to concentrate on things going on outside when there is so much going on inside.

So what does the schizophrenic brain look like? As it turns out, people with schizophrenia have an overactive default network without the important connections that allow them to shut off the network. This overactivity in the default network is present when people with schizophrenia are just chilling as well as when they are trying to focus on an external task.

Many commonly reported schizophrenic symptoms may be a result of this different connectivity in the brain. Have you ever been in a state of mind where thoughts are racing through your head a million miles a second and all you want them to do is go away? Often this happens when you've had a lot of caffeine (which consequently increases the symptoms of schizophrenia by increasing transport of the neurotransmitter dopamine) right before you go to bed and these racing thoughts are preventing you from getting to sleep. Well imagine what that would be like 24/7! Further, imagine if your default network's connection to the controlled areas that shut off the wandering thoughts have been severed.

Various lines of converging evidence are now suggesting that this is precisely what's going on in the brain of the person with schizophrenia. According to Randy Buckner and his colleagues, "The complex symptoms of schizophrenia could arise from a disruption in this control system resulting in an overactive (or inappropriately active) default network. The normally strongly defined boundary between perceptions arising from imagined scenarios and those from the external world might become blurry, including the boundary between self and other."

The overactive default network found in people with schizophrenia has some deep implications. Further understanding of the default network can increase our understanding of theory of mind breakdowns in people with schizophrenia and autism (people with schizophrenia seem to have an overactive theory of mind, whereas people with autism seem to have an underactive theory of mind), Alzheimer's, as well as moral reasoning.

But for now, let's just consider dreaming and creativity. Glausiusz quotes Yale Psychologist Jerry Singer in saying "There seems to be continuity between day-dreaming and night-dreaming." Could it be that there is a lot more of this continuity in people with schizophrenia? In a normal default network, there is a dividing line between internally generated thoughts, sensations, emotions and external perceptions of reality. Therefore, when most people wake up, the prefrontal cortex wakes up from standby mode (it needs the sleep because it works so hard during the day controlling things), re-connects itself to the rest of the default network, and installs the boundary between internal perceptions and external perceptions.

But for people with schizophrenia, the boundaries between imagination and reality become disrupted. Abnormal default network connectivity in people with schizophrenia is related to the ability to perform a task that requires concentration on the external environment as well as auditory hallucinations, paranoid and bizarre delusions, and disorganized speech (some of the most common "positive" symptoms of schizophrenia). The common theme here is "altered perceptions of reality".

But all of this has me thinking. Many times I have awoken from a vivid dream with surprisingly (at least surprising to my conscious self) creative connections and the intense emotional drive to write it all down. But many times I simply cannot write it down because it all goes away too fast too soon. If there is more continuity between night-dreams and day-dreams for people with schizophrenia, I wonder if instead of giving medications to people with schizophrenia that shuts off their overactive default network, we should focus more on techniques (both with medicine and psychotherapy) to increase their ability to re-connect the reality centers of their brains with the fantasy regions. I honestly fear that we may be unintentionally squandering a lot of creativity by conceptualizing such thinking as "aberrant".

After all, if I wrote a blog post bragging about how, just last night, I held hands with a group of redheaded Opera singing female turtles and sang "I Want it That Way" by the Backstreet Boys perfectly in tune while Simon Cowell gave a standing ovation, you'd almost certainly think I had an altered perception of reality.

But, maybe, just maybe, you'd also give me a couple points for creativity?

© 2009 Scott Barry Kaufman, All Rights Reserved


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