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Psychosis

Is Schizophrenia a Type of Neurodivergence?

An integrative perspective.

Key points

  • Neurodivergence is a word used to describe particular changes in brain wiring, such as ADHD and autism.
  • Psychotic disorders are linked to alterations in how individuals experience the world.
  • Consideration of psychosis under the neurodiversity umbrella may reduce isolation.

Neurodiversity could be broadly thought of as a celebration of the many ways of thinking, feeling, and interacting with the world. Neurodivergent individuals are those whose brains process information in distinct ways—for example, in the case of autism and ADHD. Most conditions traditionally associated with the term "neurodivergent" are present from birth. Still, some have extended the construct to include several mental health and neurological conditions that are acquired, such as those sustained by a brain injury. An interesting case of this may be psychosis.

Psychosis is an overarching term for both temporary and chronic experiences many have wherein one's touch with consensus reality changes. This traditionally shows up as hallucinations and unusual beliefs. Pathways to psychosis are diverse, ranging from sleep deprivation to mental health conditions.

It's been suggested that the mental health diagnosis most associated with psychosis, schizophrenia, be renamed with the Japanese term Togo Shitcho Sho, or integration disorder, highlighting the information processing alterations. In addition to delusion and hallucinations, many with schizophrenia face thought patterns that can appear scattered or disorganized, such as drawing loose associations or connections between ideas. Psychosis can cause someone to connect dots that others would not connect in ways that can at times be troublesome. For example, seeing a number on a license plate as a message from another world.

Schizophrenia is also associated with stark changes in what has been called "social cognition." A study tested social cognition in 44 people living with schizophrenia, 36 autistic people, and 41 neurotypical people. More similarities in social cognition were identified between those with schizophrenia and autism than either autistics or individuals with schizophrenia and neurotypical people (Couture et al., 2010).

Unlike autism, very few people develop schizophrenia in childhood, rather the average age of onset lies between late adolescence and early adulthood. Still, like autism, psychotic disorders, including schizophrenia, are associated with differential connectivity between brain regions (Skudlarski et al., 2010). There is also a higher-than-expected comorbidity between Autism and Schizophrenia (Chisholm et al., 2015).

Despite the many challenges faced by those diagnosed with neurodivergence as well as embracement of certain interventions to improve quality of life in some cases (for example taking medication for ADHD), the neurodiversity movement has maintained an appreciation for the difference in perspective granted by these conditions. This has not often been the case with psychosis, as individuals often report feeling dismissed or that their ideas may be discredited regardless of whether they are currently experiencing psychosis. Yet, research has suggested that some schizophrenia traits can be associated with creativity (Ascar et al., 2018).

While psychotic disorders typically are not the first to be identified in terms of neurodivergence, if any set of conditions affects one's experience of the world, it would be psychotic spectrum disorders. Sensory alterations, changes to information processing, social differences (and misunderstandings), and even changes to thought alterations are components of psychosis. It is, by all means, a type of neurodivergence.

This is not to imply that psychosis does not merit treatment. Interventions, including psychiatric interventions, community support, and/or psychotherapy can be both life-changing and saving in the case of psychosis. Still, expanding definitions of neurodiversity to encompass psychosis may give a more encouraging view of the experience while opening those living with these conditions to the support of the neurodiversity community.

Social isolation and loneliness are common among those with psychotic disorders and they are known to worsen quality of life. In addition, unwarranted shame among individuals with mental health conditions regarding the diagnosis is common, leading to a low sense of self-worth and lessened engagement with valued goals. Reframing psychosis as a type of neurodivergence may serve to help us to also appreciate the different perspectives of those living with psychotic disorders.

References

Acar, S., Chen, X., & Cayirdag, N. (2018). Schizophrenia and creativity: A meta-analytic review. Schizophrenia research, 195, 23-31.

Chisholm, K., Lin, A., Abu-Akel, A., & Wood, S. J. (2015). The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neuroscience & Biobehavioral Reviews, 55, 173-183.

Couture, S. M., Penn, D. L., Losh, M., Adolphs, R., Hurley, R., & Piven, J. (2010). Comparison of social cognitive functioning in schizophrenia and high functioning autism: more convergence than divergence. Psychological medicine, 40(4), 569-579.

Skudlarski, P., Jagannathan, K., Anderson, K., Stevens, M. C., Calhoun, V. D., Skudlarska, B. A., & Pearlson, G. (2010). Brain connectivity is not only lower but different in schizophrenia: a combined anatomical and functional approach. Biological psychiatry, 68(1), 61-69.

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