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00:00:00and the arts and could you could it be a mistake could you be muddled about it
00:00:04no he's just said jesus christ i'm sorry he just said it just he just said you can see everything
00:00:10in this room you can see through my eyes he sees through your eyes yes when i look at the
00:00:17television
00:00:17the tigers he reads them there's a gospel truth oh i know i know i know
00:00:56and is a patient of dr ruth seaford at hackney hospital in london after five years of comparative
00:01:03equanimity she has returned to the hospital complaining that her thoughts are being
00:01:08infiltrated by another person is what he's saying to his sister the same as what he's saying to you
00:01:14no he has but he can't have much of a conversation with her but he can he can ask somebody
00:01:20can you
00:01:21tell me the time please and be talking to me at the same time so he can say two things
00:01:25at the same
00:01:25time yes yes if i said ann i mean a large number of people believe in telepathy a large number
00:01:32of very
00:01:33respectable people believe in telepathy but in general what you as far as dr seaford is concerned
00:01:39these are the symptoms of a disease called schizophrenia telepathy has to be concentrated
00:01:45on really very hard in order to send the telepathic message and i think i'd be right in saying that
00:01:52that it would be difficult for telepathy for someone to be chatting away and at the same time
00:01:58be able to get the doctor he's not chatting away no you say just like a sentence he'll say a
00:02:03sentence but
00:02:03at the same time concern yes because he used to say i'm talking he said i'm talking now now now
00:02:13this
00:02:13sounds facetious and but does he have normal broadcasting hours or does he does it happen
00:02:18all the time or does he have to announce that he's going on the air at some time no no
00:02:24he doesn't
00:02:24when i when i go to sleep um he can be awake and he knows i'm asleep the idea that
00:02:31these kinds of
00:02:32experience are the expression of an illness is a matter of controversy when you're going to talk
00:02:38about something like the the medical model you're using an analogy from physical medicine which
00:02:45really does prove things it really does prove rupture dependencies and broken legs and it's it's got
00:02:51blood tests and x-rays and hundreds of years have gone into make making verifiable proof of pathology
00:02:59we're dealing with real data but when you assume from somebody's behavior that they have some kind
00:03:07of a disease which you cannot prove any other way for which there is no pathological proof no proof in
00:03:14cell tissue and so forth then you're taking a situation and you're abusing scientific reason
00:03:20by saying it is an illness it isn't it's an analogy that doesn't hold
00:03:28at the end of the 19th century most of the medical profession took it for granted
00:03:34that the major forms of lunacy were the result of disease disease of the brain however they were
00:03:43frustrated by their inability to find any visible changes in the autopsy specimens which came to hand
00:03:57and yet the the english psychiatrist henry maudslay assumed that this would only be a matter of time
00:04:06in 1871 he wrote it's beyond doubt that important molecular and chemical changes take place in those
00:04:14inner recesses to which we've not yet gained access to conclude from the non-appearance of change
00:04:21to the non-existence thereof could be just as if a blind man were to claim that there were no
00:04:27colors
00:04:31by bloodlessly sectioning the living brain we now have the opportunity to see if maudslay was right
00:04:39these are the brains of identical twins one normal the other apparently suffering from schizophrenia
00:04:45i don't think you have to know anything about magnetic resonance imaging to recognize that these
00:04:49are not exactly the same brains and that this scan there are dark regions the so-called spinal fluid
00:04:54spaces are bigger in this patient in this subject which is the affected twin than in this subject at
00:05:00exactly the same spot in the brain and this is the healthy twin and so there's been brain shrinkage
00:05:05then of some sort yeah i think the assumption would be that there's some process a pathological
00:05:10process some disease process that has affected this brain to produce an over a reduction in the overall
00:05:17volume of this brain and that the the inside of this of the head which has not changed in volume
00:05:23now has greater spinal fluid spaces to take up for the loss of the volume of brain tissue
00:05:32it's now possible to visualize the physiological function of the brain as well as its anatomical
00:05:38structure well we can make images of the brain that reflect activity that at the shortest time frame is
00:05:46about 60 seconds in duration and with other chemicals range up to about 30 minutes in exposure time but
00:05:5360 seconds is about as quickly as we can freeze the activity in the brain and if you compared that
00:06:00to
00:06:01looking at a scene of a busy intersection then you would have certain strategies that would give you
00:06:08specific information and others that wouldn't for example if you had an exposure of 60 seconds looking
00:06:15down at that intersection you could see the traffic pattern at that time say at rush hour
00:06:19when we look at the traffic flow between all the cells of the brain and despite the fact that 60
00:06:26seconds is an order of magnitude that's a thousand times faster than the actual individual events
00:06:34we have good sampling of the the whole system so we look at the whole traffic network and we can
00:06:40tell where differences occur when a subject does one task versus another
00:06:44the fact that we can now visualize the living brain in action means that we have one more
00:06:50technique for comparing normal people with schizophrenic patients so we have a normal subject
00:06:56here now what exactly are we doing with him okay well he has been uh put in our single photon
00:07:02emission
00:07:03scanner and is at the moment performing he's making key taps as you can see there uh a task called
00:07:09the
00:07:09wisconsin card sort he's looking at the screen and seeing a number of perceptual figures that he has
00:07:15to try and decide how to sort out and press the right key the rules are not given to him
00:07:20all he's told
00:07:21is whether or not there's a right or wrong the screen flashes to indicate that uh and what we're
00:07:27interested in doing is seeing what areas in the brain are activated by this type of task
00:07:36okay what you're going to be doing today david's the card sort just like you've done before okay
00:07:42not going to be any different
00:07:47it'll be the exact same thing you've done before you're fine you're fine there i got lines on your
00:07:54face i'll take those off and you're all done so you won't go back looking funny so here we've got
00:07:58a
00:07:58patient undergoing the same test now what would you expect to see then if we were to look at the
00:08:04scan right well what we'll see is that in the normal we will have seen an increase in blood flow
00:08:09in
00:08:09the frontal lobe regions due to the task due to the demands made by this task on the brain the
00:08:15difference
00:08:15that we've seen between the schizophrenic and the normal will be the result of his failure to activate
00:08:21that region which we think is what is necessary in order to do the task properly i see
00:08:31in order to see what is necessary in order to see what is necessary and once again the study of
00:08:34identical twins provides a more controlled basis for comparison now these specs again this is actually
00:08:40a pair of our twins and what they show is that when patients are engaged in a particular behavior
00:08:46that puts a premium on function from the prefrontal part of the brain the the affected twin is
00:08:52consistently shows consistently less activity in that part of the brain than does the healthy twin and is
00:08:57that accompanied also by a lower performance of the test yes it is yes it is now in this set
00:09:03of
00:09:03scans the area of the brain that is activated by doing this particular task which is the wisconsin card
00:09:09sorting task is this left prefrontal region of the brain over here and what you can see is that this
00:09:14part
00:09:15of the brain is consistently more activated in this particular twin pair this is the healthy twin
00:09:20mm-hmm this twin shows this activation pattern in a way that is not seen in this which is the
00:09:27unaffected so
00:09:27the red and orange patches are the activated parts correct and these uh bluer and colder things are
00:09:33relatively inactive correct it is quite conspicuous the difference now whatever these differences mean
00:09:39the notion of disease seems to imply a physical cause and some experimental psychiatrists claim that this
00:09:46cause may lie in the variable expression of a single as yet unidentified gene obviously the question
00:09:53that you ask is what is the nature of this gene and what i suspect is that it's a gene
00:09:58that is very
00:09:59important for being human there are perhaps variations in this particular gene between people that are not
00:10:07only responsible for some people uh having the sort of problem that we describe as psychosis but they're
00:10:12also responsible for the normal variation in in in personality between different individuals that i
00:10:19think is an interesting possibility and you can see then that if you have if you once identified that gene
00:10:26then you know you have the potential to know a great deal more about the genetic structure of human personality
00:10:37theories of this sort have always aroused moral misgivings since they seem to encroach upon the
00:10:43mystery of human free will even in the 18th century the french philosopher lametri was alarming his
00:10:51contemporaries with the claim that man was after all nothing more than a machine inspired by the clockwork
00:10:57automata which were then coming into fashion as toys lametri suggested that biological function was simply a more
00:11:04complicated version of these amusing mannequins
00:11:07so
00:11:38so
00:11:47so
00:11:48so
00:11:48so
00:11:49so
00:11:49so
00:11:50so
00:12:09for many people the discoveries of modern neuropathology are just as sinister perhaps more so
00:12:18in the future since they could be taken to imply that if the behavior of mad people is determined by
00:12:24the
00:12:24malfunction of the nervous system it might be that the behavior of normal people is just as determined
00:12:31by the proper function of the healthy nervous system in which case there's no free will
00:12:38and that i think is one of the reasons why the late 20th century has witnessed such a strong objection
00:12:44to the idea that madness might be a physical disease but apart from the dread of our being reduced
00:12:50to the status of mechanical toys or robots there's an ideological reservation about identifying mental
00:12:59trouble as an illness they have this thing called the medical model of mental illness
00:13:04and if you go along with that
00:13:07then
00:13:07you really get to the place where
00:13:11oh alcoholism is a disease
00:13:13pretty soon homelessness will be a disease
00:13:15uh
00:13:15children who move around too much in grade school have a disease
00:13:20um
00:13:21this is absurd
00:13:22this is not to look at circumstances or individuals
00:13:25but it's a way certainly in which we can obfuscate reason and scientific method and operate through
00:13:33superstition but we can also control people in the late 50s now to all intents and purposes
00:13:39kate millet is paraphrasing the psychiatric theories of ronald lang which became fashionable in the early 60s
00:13:47with the publication of his book called the divided self
00:13:50well if you're interviewing a patient in a mental hospital
00:13:55then you have a key in in your pocket to get out and the patient hasn't
00:14:04the gulf in in power uh in position is enormous
00:14:10lang who started his professional life as an orthodox psychiatrist
00:14:14rejected the medical model of mental disorder
00:14:17and insisted that the major psychosis had nothing to do with the brain as such
00:14:23but represented instead the reaction of an otherwise normal personality
00:14:28to the strains imposed upon it by the sometimes intolerable demands of family life
00:14:33you're really good about the premise
00:14:34will you or will you not promise not to hit people not to hit richard again not to hit lee
00:14:39again
00:14:40you've been hitting them because you're angry and jealous of their relationship with me
00:14:47you're you're uh you're hitting the other brothers you're angry at their arrival either we consider
00:14:52you responsible for your own actions or we consider you not responsible for your own actions now if you're not
00:14:56responsible for your own actions they can't stay here if there are a few people around who have
00:15:03got themselves together sufficiently they're not going to be
00:15:08thrown into states of panic or alarm or anxiety by other people's distress and suffering
00:15:15uh if they are perhaps prepared to give the help that people want which is um
00:15:22the provision of an asylum as to say a safe place to be when you're a bit scattered
00:15:30as far as lang was concerned the only reason why the language thought and behavior of the mad were so
00:15:36unintelligible was that psychiatrists and indeed family members found it difficult to attend to the
00:15:44reasonable appeal that was being expressed in a coded form through these symptoms
00:15:58a comparable view was put forward by the french historian michel foucault who argued persuasively
00:16:04that by identifying mad people as the victims of illness the authorities felt that they had a license
00:16:11to incarcerate them and that although this masqueraded as a humanitarian initiative
00:16:18as far as foucault was concerned it was simply a way of controlling socially unmanageable people
00:16:44in the era of woodstock and vietnam protests the medicalized mad were emblematically
00:16:51affiliated with all the other forms of protest and subversion
00:17:08although the anti-psychiatry movement has retreated and fragmented since then
00:17:12and the orthodox profession likes to think that it has triumphed over a brief and regrettable folly
00:17:17one can still identify permanent results of that original upheaval
00:17:27and these are images taken from the psychiatry hospital as it was as it was
00:17:34yes they're classically the same sort of images that you've seen in america or in england
00:17:39in 1968 the italian psychiatrist franco basalia succeeded in persuading the national authorities
00:17:47that the mental hospitals should be closed and that alternative accommodation and treatment should
00:17:52be made available although basalia himself died in 1980 the somewhat tattered remnants of his regime are
00:18:01still to be seen in trieste under the supervision of his ideological successor franco rotelli
00:18:07we think that the folly exists and has always existed in all the world but I believe that the psychiatry
00:18:16in
00:18:17all the world have received a delegation from the part of the society to manage the social exclusion of people
00:18:29and the psychiatry
00:18:35why should we be more reluctant to accept medical denominations and categories as applied to
00:18:43mental illness than we are to disorders of other parts of the body
00:18:49I believe because there is a social interest in cataloging people and to hide behind these
00:19:02etiches of these problems I want to say these etiches are very reduced because they don't realize the complexity of
00:19:14the
00:19:14problems that people carry with themselves. They are simplifying etiches. I don't say that they can't use
00:19:22simplifications. The question is that on the basis of these simplifications diagnostics
00:19:29is the destiny of a person. There are laws that say that a schizofrener does not have the same rights
00:19:38of another person.
00:19:41The mental health system in Trieste today has been described as a humane shambles. Around the city are
00:19:48seven mental health centers, private houses in which in the late 60s psychiatrists and their patients
00:19:54squatted until they were given the legal right to remain. Here those whose clinical labels might otherwise
00:20:04have condemned them to life in an asylum are expected to look after themselves and help each other.
00:20:14They drop in when they feel like it and go home when they choose.
00:20:18And even when they are in residence there is very little evidence of institutional authority.
00:20:30And yet for all that, these centers do not entirely reject the use of psychiatric labels
00:20:35or indeed of psychotropic drugs.
00:20:39Do you keep a record here of all the drug therapy, do you?
00:20:43Yes, these are the records of them.
00:20:45Do you, on the whole, try to avoid using drugs and prefer to manipulate social circumstances?
00:20:54Yes, but mainly we use both approaches because we don't like to be ideological in a way.
00:21:00We, uh, we prefer to be pragmatic in the approach. We know that drugs can be also useful sometimes to
00:21:09reduce the personal suffering or to reduce some kind of, uh, disturbed behavior and so on.
00:21:16Yes.
00:21:18Presumably, in order to make a difference in the use of the drug, you must have made some sort of
00:21:24decision
00:21:24about these, about the clinical category.
00:21:27Yes, of course.
00:21:28So the labels are being used here in spite of a reluctance to use labels. It's very hard to avoid
00:21:33using them, isn't it?
00:21:34It depends on, on the value you, uh, you give to these labels. So if you think that these labels
00:21:41are the reality,
00:21:42if you think that this label totalizes the person, we disagree with this point of view.
00:21:47The final thing is that you have in front of you, you have a person, a concrete person,
00:21:51all these problems as a person, as a human being. In psychiatry, the problem is you can't objectify.
00:21:59What, what do you want to, to give a name and to objectify is a subjectivity. This is a contradiction
00:22:05in terms.
00:22:07In other parts of the city, the local authority has subsidized residential accommodation.
00:22:13And since these apartments are indistinguishable from those which are occupied by normal people
00:22:18in the same block, the stigma which is so often associated with anyone identified as a mental patient
00:22:24is considerably diminished.
00:22:28The claim is that, as the result of making the accommodation as normal as possible,
00:22:33and by reducing supervision to a single mental health volunteer, the behavior of the residents
00:22:39becomes more or less indistinguishable from that of ordinary people.
00:22:44Instead of forcing the mentally afflicted to embark on the career of psychiatric patient,
00:22:50with all the behavioral idiosyncrasies that such a role entails, Trieste, with the assistance of a
00:22:56European Community Grant, has provided ample opportunities for self-determination,
00:23:01and the possibility of employment in any one of a number of profit-making work cooperatives.
00:23:09It would be hard to find an official regime in America which was as radically opposed to the
00:23:14concept of mental illness. Although in many states, the patients' rights movement has succeeded in
00:23:20ensuring that anyone who is likely to be committed to a mental hospital, even for a short period,
00:23:25is provided with someone to represent his or her interests at a formal hearing.
00:23:30I'm not crazy.
00:23:31Well, there's going to be...
00:23:31I'm having some life problems.
00:23:33There's going to be a hearing tomorrow to see whether or not there's any legal basis
00:23:38why you have to stay here.
00:23:40I'm not crazy.
00:23:41If it was up to you, would you like to leave the hospital tomorrow?
00:23:44I'd like to leave the hospital tomorrow because I've got things I've got to do.
00:23:48Okay, well, I'm...
00:23:49It's the first of the month, and there's a lot of rent to be paid and all that.
00:23:52Right.
00:23:52Okay.
00:23:53Um, I'll be representing you at the hearing, and I'll be trying to assist you in getting released.
00:23:58Okay.
00:23:59Uh, the way it works is first the doctor or the therapist will speak at the hearing
00:24:06and read from the record and say why they think you need to be here.
00:24:09Okay.
00:24:10And then when the doctor is finished, you'll have your chance to respond, and I'll also be speaking
00:24:15on your behalf.
00:24:16Okay.
00:24:17Uh, then the hearing officer will make a decision about whether or not it's okay for you to leave.
00:24:23Okay.
00:24:24So, um, what brought you into the hospital?
00:24:27I turned myself in on a 5150 because I felt like killing myself.
00:24:31Okay, so you came here voluntarily.
00:24:33Mm-hmm.
00:24:33So I could stop from killing myself.
00:24:36And what was going on that you felt like killing yourself?
00:24:38It was three o'clock in the morning.
00:24:39I couldn't sleep.
00:24:40All the same thoughts kept racing through my mind over and over and over again.
00:24:43I just wanted them to stop.
00:24:45Mm-hmm.
00:24:45Period.
00:24:46And I thought, well, if I kill myself, I'll stop thinking.
00:24:49And I thought, well, that isn't too good of an idea either because you've got friends
00:24:52and people around you who love you.
00:24:54So I stopped that thought and I said, well, who am I going to call?
00:24:57And I called up Ghostbusters.
00:24:59I mean, no, that came out wrong.
00:25:01It's a joke.
00:25:03I didn't call Ghostbusters.
00:25:04I called up Crisis Intervention Center and talked to them on the phone.
00:25:09They said there was nothing they could do for me for one night.
00:25:11So I wound up here by ambulance.
00:25:14Paid an ambulance to take me there.
00:25:16Uh-huh.
00:25:16Okay.
00:25:17Because the crisis intervention couldn't do anything for me.
00:25:19Have you ever made any suicide attempts?
00:25:21Oh, yeah, I have.
00:25:22A couple of them when I was 19.
00:25:24Okay.
00:25:26Are you usually able to ask for help when you start feeling like that?
00:25:29No, I was never able to ask for help before.
00:25:32Okay.
00:25:32So this is a new thing.
00:25:34This is a new thing for me.
00:25:34You're coming into the hospital.
00:25:35Yeah, the way I came in here is unlike any other way I've ever come into a hospital.
00:25:39I'm asking people to please help me so I do not kill myself.
00:25:43That's all the questions I have for right now.
00:25:45Can I go back in now?
00:25:46Yeah, I'm getting very uncomfortable out here.
00:25:48I think somebody might be trying to shoot me.
00:25:58Although Greg was reluctant to let his committal be filmed,
00:26:02he did allow us to record the sound.
00:26:04That he was sorry that he hadn't killed his wife prior to getting in here
00:26:08because he intended to kill her.
00:26:10I'll respond now.
00:26:11There's a lot of lies in that report there.
00:26:14My wife left me for no good reason.
00:26:16She took off from the house.
00:26:17The house was a total mess when I came back.
00:26:20So I started kicking the damn cat.
00:26:23I wish it was her.
00:26:25I was wishing it was her when I did it.
00:26:27I'm not violent.
00:26:28I want to break her spirit though so that she can get well again.
00:26:32Well, I'm going to go ahead and end the hearing and I'm going to find, Greg,
00:26:37that there is probable cause for you to be here on the grave disability only.
00:26:43Oh, that's wrong.
00:26:46If you don't think I can make it on my own, you're crazy.
00:26:48I need a conservator though.
00:26:52I don't think anyone would tell me what to do anymore.
00:26:55No one was ever going to tell me what to do anymore, ever.
00:27:03A few miles away in Berkeley is a drop-in center where you will find opposition to the notion of
00:27:10mental illness as a disease.
00:27:12And this is reflected in the fact that the establishment is not run by psychiatrists at all,
00:27:17but by people who were once patients.
00:27:20It's a self-help drop-in center, drop-in and advocacy center.
00:27:25We are beginning to create what we think would be helpful and would be a caring environment.
00:27:31And they are totally client run.
00:27:33That means from the board of directors to the administrators, to the people that keep the
00:27:38money and sign the checks and make the budget, as well as all the workers and the clients,
00:27:43they are run by and for the people that use the center.
00:27:46And when those people, when the people that use the service define what they want,
00:27:51it is much different than what the mental health system has in place.
00:27:55They cut it to 400.
00:27:56Oh, I do that.
00:27:58I don't think that's fair.
00:27:59What they're doing is, I wanted to come back Saturday night because I wanted to stay a Sunday.
00:28:03Mental illness is, in my view, a fictional concept.
00:28:10It's a way of labeling another person in order to justify various psychiatric interventions
00:28:17that are imposed as a way of controlling that individual's life.
00:28:24If the freedom of thought is to mean anything at all, it should imply that people also have the
00:28:31right to hold false beliefs, false ideas, no matter how ridiculous they may appear.
00:28:36People should have the right to think exactly what they believe.
00:28:39And there shouldn't be any political interventions.
00:28:41There should be no way that the government has of intervening in the life of a human being,
00:28:46unless that person violates the law.
00:28:49We're talking now about thought control.
00:28:52Give me 20.
00:28:5220 like that.
00:28:53We like it.
00:28:54Yes, we all remember.
00:28:55It was not for this place here.
00:28:58Sally and Nate, they really helped me out.
00:29:02They wanted to put me in a locked facility.
00:29:05I told my brother to be back out on the streets, you know.
00:29:10I said, why am I in here?
00:29:12It was like being kidnapped.
00:29:14They're supposed to be professionals, and they don't really know how to talk to people.
00:29:18They talk to them like they're little kids or like they're dogs.
00:29:22They put me in this isolation cell where you don't get to go outside.
00:29:27And also I'm court ordered to go through psychotherapy in order to regain my children back.
00:29:33I was in and out because they was giving me these pills, Tegretol, Cogitin.
00:29:40They gave me one to compensate for the side effects for the other.
00:29:45What I'm doing in Berkeley is I'm surviving.
00:29:50This place means a lot to me.
00:29:52I can come in here and drink coffee.
00:29:54I can slam dominoes.
00:29:56I can throw a chair.
00:29:58I can really be myself here.
00:30:01Well, as you'd expect, there are many psychiatrists who regard these attitudes with deep suspicion,
00:30:06and not just because they see their jurisdiction threatened.
00:30:10They argue that by refusing to recognize the extent to which madness is a disease,
00:30:16it could be that instead of liberating the insane, we're actually depriving them of the only available opportunity for improvement.
00:30:25And this is the issue.
00:30:26What exactly are we saying when we refer to someone as the victim of a disease?
00:30:32And by the same token, what are the implications of claiming that what we call madness is not an example
00:30:38of one?
00:30:38Ever since Hippocrates, we consistently find references to idiocy, dementia, mania and melancholy.
00:30:47And indeed, even in the earliest times, there was the implication that they were diseases.
00:30:53The interesting point is that the supposedly basic psychiatric categories survived virtually unchanged until the end of the 19th century.
00:31:02Of course, as time went on, some new denominations were added, and then some of the additions were melted down
00:31:09and blended with others,
00:31:11so that we get vague and rather transient conditions such as hypochondria and neurasthenia.
00:31:17And there's no doubt that from time to time, psychiatrists have shown a regrettable tendency to annex territories which don't
00:31:24necessarily belong to them.
00:31:26For example, in 18th century America, slaves who habitually escaped were sometimes said to be victims of drapetomania, a morbid
00:31:35desire for liberty.
00:31:36But more recently, and rather more alarmingly, homosexuality had an entry in DSM II, the Diagnostic Manual of the American
00:31:45Psychiatric Association.
00:31:47And although it was prudently dropped in the next edition, you wonder how it ever got included in the first
00:31:53place.
00:31:54The important point is, however, that the broad outlines of the psychiatric panorama remained more or less the same for
00:32:022,000 years.
00:32:05But from about 1900 onwards, the psychiatric landscape underwent an almost volcanic geological upheaval.
00:32:13It was as if the community woke up one morning to find two snow-capped peaks on the horizon.
00:32:19The German psychiatrist Emil Kreplin had grouped together the majority of severe mental disorders under two big headings,
00:32:28which soon came to be known as schizophrenia on the one hand and manic depression on the other.
00:32:34Now, in spite of the literal meaning of the word schizophrenia, which does seem to imply that the mind is
00:32:38split,
00:32:39Eugene Bloyler, the Swiss psychiatrist, who in re-examining Kreplin's category did in fact christen it as such,
00:32:47described the schizophrenic mind as being extensively subverted,
00:32:52so that the person suffering from the disease displays thought processes which are dramatically fragmented and often unintelligible.
00:33:01Now, incidentally, manic depression doesn't describe a person who's manically depressed,
00:33:04but someone who might be either depressed or manic or both alternately.
00:33:11Anyway, since that time, schizophrenia has almost monopolized the professional imagination.
00:33:18It is, to all intents and purposes, the psychiatric Everest.
00:33:22Indeed, there are some who've been heard to say that madness actually is schizophrenia.
00:33:30The question is, is there anything there?
00:33:34Or is it, as some critics have suggested, a mirage rather than a mountain?
00:33:41Certainly, when Kreplin and Bloyler inaugurated the concept of schizophrenia,
00:33:46they did so in the belief that it was caused by something in the brain,
00:33:49and that by that token, it was a disease.
00:33:52But, strictly speaking, it didn't, and it still doesn't,
00:33:57require the identification of a brain disorder for the condition to pass muster as a disease.
00:34:03After all, epilepsy and Parkinsonism were accepted as reputable instances of diseases
00:34:08long before anyone found any visible lesions in the brain.
00:34:13What made them qualify was the fact that there was a consistent cluster of signs and symptoms
00:34:20whose collective peculiarity was such that it was reasonable to assume
00:34:24that a physical cause would be found.
00:34:27Now, the question is, is there or isn't there a consistent cluster of mental peculiarities
00:34:33which justify our looking for some neurological cause for what was and still is called schizophrenia?
00:34:42From the impressive technology we saw earlier in the program,
00:34:46one might be tempted to believe that there is.
00:34:49And, indeed, the psychiatric establishment the world over seems to be convinced.
00:34:54I was supposed to liberate one's feelings, and that didn't help.
00:34:56In spite of this conviction, there are those who find it quite hard to accept the claim
00:35:01that schizophrenia should be regarded as a single, coherent illness.
00:35:05I've had it as a fairy friend from childhood.
00:35:06I don't see how drugs should be given to you to kill a friend in one's dreams.
00:35:12The psychologist David Hill, who works at the Mind Drop-In Centre in Camden, London,
00:35:18is quite scathing about its intellectual pedigree.
00:35:21I think what happened was that during the 19th century,
00:35:24when what I would call real medical disciplines were discovering real medical illnesses
00:35:29and sometimes with real medical treatments,
00:35:31psychiatry had fallen quite seriously into disrepute.
00:35:34And it was actually in sufficient crisis that it was at risk of going out of existence,
00:35:39and the pressure, therefore, to actually come up with something new was quite enormous.
00:35:44And I believe that, quite simply, what happened is that they put together
00:35:47everything that they couldn't explain in any other way,
00:35:51and certainly any of these other, this myriad of illnesses
00:35:55that they'd invented throughout the 19th century had not helped at all.
00:35:58They simply lumped together hundreds and hundreds of different types of behaviour
00:36:02and caught them something.
00:36:04I mean, could I just read you some of the original symptoms of this illness?
00:36:09And perhaps it becomes clear that we're talking about broken social norms
00:36:12of many different kinds.
00:36:13They're not even located in one specific area of behaviour.
00:36:17These are the original symptoms, and there are hundreds of pages of them.
00:36:20These are from Krappelin, aren't they?
00:36:21Yes, yes, Krappelin and Bloyler, who don't know.
00:36:24They do not suit their behaviour to the situation in which they are.
00:36:28They conduct themselves in a free and easy way.
00:36:31They laugh on serious occasions.
00:36:33They are rude and impertinent towards their superiors.
00:36:36They challenge them to duels.
00:36:38They lose their deportment and personal dignity.
00:36:40They go about in untidy and dirty clothes, unwashed, unkempted,
00:36:44and they go with a lighted cigar into church.
00:36:48And yet, to be fair, this is a highly selective list.
00:36:52And anyway, the diagnostic criteria by which schizophrenia is identified
00:36:57is constantly being updated and revised.
00:37:01Now, this impressive volume here is the DSM-3.
00:37:06It's the latest user's manual published by the American Psychiatric Association.
00:37:11And now, the entry on schizophrenia is the result of a series of professional committees
00:37:17in their attempt to produce some standardised definition
00:37:20in order to guarantee some sort of agreement about the identity of the condition.
00:37:25Well, it defines schizophrenia as a mental disorder with a chronic tendency
00:37:29which impairs function, characterised by psychotic disturbances
00:37:32of thinking, feeling, and behaviour.
00:37:34It then goes on to list a group of symptoms,
00:37:37things like delusions of control, thought broadcast,
00:37:40thought insertion, thought withdrawal.
00:37:42And then there are things like formal thought disorders,
00:37:44such as incoherence, loose associations, and so forth.
00:37:47Although these aren't regarded as diagnostic
00:37:50unless they're accompanied by flattened mood,
00:37:53hallucinations, or delusions.
00:37:55Well, there are many more, and it all looks very cut and dried.
00:37:58But is it, though?
00:38:01Here, James, a patient of Dr. Ruth Seifert,
00:38:04is displaying symptoms which have led some psychiatrists in the past
00:38:08to diagnose him as hypermanic.
00:38:11It's been Mr. Parkinson's, the Parkinson's disease,
00:38:13too, it's shaking, and Mr. Parkinson's,
00:38:16I mean, the doctor hasn't done anything yet.
00:38:19I've got in his lane.
00:38:21That's a scarf, it's always a scarf.
00:38:24And now, the doctors have settled on a diagnosis of schizophrenia.
00:38:29But all the same, one way or another,
00:38:31they would all consider that he was suffering from an illness.
00:38:36Illness is recognised in the human population by change.
00:38:40James did not start out his life like this.
00:38:43He started out his life in a different way,
00:38:46being able to function.
00:38:48And he then changed quite dramatically.
00:38:51But so did St. Paul.
00:38:53St. Paul, probably, yes.
00:38:55Well, I think that's a very good point, you see,
00:38:57because a large number of people have religious experiences,
00:38:59but they keep it internalised.
00:39:02They can integrate that in their lives.
00:39:04It may change their lives fundamentally,
00:39:06but it doesn't stop them leading a life.
00:39:09He has no wish to be like this.
00:39:10He asked to come into hospital
00:39:12because he felt himself, a few days ago,
00:39:15getting very, very, very much worse.
00:39:17The first session is...
00:39:19You were telling me about your belief
00:39:21in the goddess and god Krishna.
00:39:24I don't know what you want to talk about.
00:39:26Well, I'd like to talk about that, James,
00:39:27but if you don't want to...
00:39:28Well, I just made you rather Krishna, didn't I?
00:39:30You did.
00:39:31That's right.
00:39:31If you wanted to play a little game,
00:39:33which a lot of people do like playing,
00:39:35I don't know why they play.
00:39:36I wouldn't question for a minute
00:39:37that some small percentage of what is called schizophrenic at the moment
00:39:41or psychosis or mental illness,
00:39:43some small percentage probably can primarily be explained
00:39:46in some sort of physical causes.
00:39:48What I'm saying is that it is silly and damaging
00:39:52to lump everybody together and say,
00:39:54it's all biochemical or it's all a genetic predisposition
00:39:57and we will find it one day.
00:39:59There's going to be a small percentage
00:40:01where you can identify nutrition as the primary cause,
00:40:04another percentage where you can identify family interactions,
00:40:06another percentage where there's child abuse,
00:40:09another percentage where it was just loneliness,
00:40:11and so on.
00:40:12Can someone be as badly damaged as James obviously is,
00:40:18as pushed out of society,
00:40:21as the result of a purely mental experience?
00:40:24Could such a disorder be the result of something non-organic?
00:40:28Yes, I think that does happen to people.
00:40:30I think that does happen to people,
00:40:31but their monumental and terrible experiences externally can stop people.
00:40:38But I think people who are very pressed, very disturbed,
00:40:42can't go on any longer,
00:40:43do not produce disintegrated delusional systems or hallucinations.
00:40:48Once that has happened, they've become mad.
00:40:50And that's what's happened to Anne,
00:40:52the patient diagnosed as schizophrenic,
00:40:55who we saw at the beginning of the programme.
00:40:57Do you feel you get better in hospital?
00:40:59He's talking to me now.
00:41:00Bessie, what's he saying?
00:41:01He said, yes, you did, Sarah Britton.
00:41:03He talked to you just then?
00:41:04Yes.
00:41:07And it was recognisably his tone of voice, wasn't it?
00:41:10He swore at me then.
00:41:11He said, I'm inside your poxy head.
00:41:15I didn't mean it, Anne.
00:41:17He just said...
00:41:18But it was a voice rather than a thought.
00:41:20It's a voice, Dr Miller.
00:41:22It drives me crazy.
00:41:24You know, it's him.
00:41:26He drives me crazy.
00:41:27How ever pressed a normal human being is,
00:41:30they don't disintegrate in that way.
00:41:32Most of us, with all the most appalling human stress,
00:41:37will not produce that conglomeration of symptoms.
00:41:40And people who are ill produce them without any push.
00:41:45So that hearing your own voice echoed,
00:41:48hearing people discussing you in the third person,
00:41:50like poor Anne having someone else's thoughts
00:41:53filling her head, interfering with her own thoughts,
00:41:56it is distressing.
00:41:58But people who have come and tell me
00:42:01the most terrible stories,
00:42:03things that I personally feel
00:42:04I could never survive as a human being,
00:42:07don't produce that sort of symptomatology.
00:42:10In bed, in Brett Ward,
00:42:13the other day, he sent a picture of himself.
00:42:15I was half asleep and half awake,
00:42:18and he sent a picture of himself saying,
00:42:21Anne, Anne.
00:42:23But he was saying the voice.
00:42:24How do you mean a picture, Anne?
00:42:25A picture of himself.
00:42:26He's doing it now.
00:42:27What, like a photograph?
00:42:28Yes.
00:42:29Is his photograph between you and me?
00:42:32Are you seeing me through a transparency?
00:42:34No, no, I'm not.
00:42:35But it's sort of.
00:42:37He's doing it through my eyes.
00:42:39He can see you.
00:42:40And he's done to a picture between the two of us.
00:42:45But I know it's in my mind.
00:42:46I'm not seeing it.
00:42:48He's doing one of the sky now.
00:42:51Our Lord is waiting for you.
00:42:54Is that what he's just said?
00:42:55No, that's what he's just done.
00:43:01And you find it very distressing to have these?
00:43:03Yes.
00:43:04Yes.
00:43:05Why is it so painful, Anne?
00:43:06Because it's taken over my whole life.
00:43:11You know, it's tormenting me.
00:43:14Well, are you then saying that there is no such thing as schizophrenia?
00:43:19Yes, I am.
00:43:20From a scientific point of view, I'm saying it doesn't make any sense to lump together all of these different
00:43:24types of behaviour and call them something.
00:43:27It is very damaging to people who are trying to understand what all this behaviour means, and it leads us
00:43:33up useless alleyways.
00:43:35And over and over again, if you throw in all the symptoms, all the possible physical causes, the physical symptoms
00:43:42and so forth, and class, sex, race, and everything else,
00:43:45the one that is the best single predictor of who is labelled schizophrenic and who is not, is class, followed
00:43:52by race, followed by gender.
00:43:55And somewhere down the list comes, way down the list comes, the actual supposed symptoms, hallucinations and so forth.
00:44:02Firstly, he's correct in saying that there are class distinctions in diagnosis, but he's incorrect in confining this to psychiatry.
00:44:10It's the human factor that creeps in between doctor and patient.
00:44:14But because diagnosis is still quite poor, and because we don't have pathological slides like the physicians, and we don't
00:44:23have x-rays, and we don't have those tools,
00:44:26that's not a reason to say the pathology doesn't exist, oh, this person's perfectly normal. Let us disregard it.
00:44:33But the problem is that now we do have rather more sophisticated tools than we had, well, certainly 15 years
00:44:38ago.
00:44:38The physicians do.
00:44:39Well, but even in psychiatry, we do have PET scans, we have CAT scans, we actually begin to have biochemical
00:44:47tests.
00:44:48Yes, they're very inexact, and we have EEGs, that's quite true, but that's looking at the structure of the brain.
00:44:54And what we're looking at as psychiatrists is the function of the brain.
00:44:57The structure, as we know, for many people can be normal.
00:45:00And the other interesting side of the coin is that the structure of the brain can be quite damaged, and
00:45:04people function normally.
00:45:06So our diagnostic tool is very limited, and all that he illustrates is that the diagnostic machinery,
00:45:14when you haven't got pathology slides, leaves a lot to be desired, but one must go on trying,
00:45:19and go on helping these people, because they're very unwell.
00:45:24I am not saying that there are not people in deep, deep distress, despair, loneliness.
00:45:31Experiencing something that no one else in the world can experience is extremely frightening in the first place,
00:45:37before somebody comes along and tells you, this doesn't mean anything, you are mad, you are subhuman,
00:45:44you need to be on drugs for the rest of your life to control this madness, even before you get
00:45:48to that point.
00:45:48It can be extremely frightening, alienating, and can lead to suicide.
00:45:56The sad thing is that if we step back a little bit from these useless labels and the useless illusion
00:46:03that there's something biochemical that explains all of this, and the search for the genetic predisposition,
00:46:08if we stepped back from that and took each individual person who was in distress,
00:46:13as some people try to do, where I work and where others work, there is that approach going on,
00:46:18then you can actually get to why people are in that terrible state,
00:46:22and you can do something to reach them as a human being,
00:46:26and help them understand what is going on in their life.
00:46:30It may be something different for each individual person.
00:46:32Show me a hundred people labeled schizophrenic,
00:46:35and I'll show you a hundred different reasons why that person has got into that dreadful state.
00:46:40The members of this discussion group have been variously diagnosed and variously treated.
00:46:47They regularly meet to share their experiences and to discuss their attitudes, both to treatment and diagnosis.
00:46:54What do you feel about that diagnosis?
00:46:57Well, it's very fashionable to say that everybody's schizophrenic,
00:47:00so I guess I'm fashionable.
00:47:07I certainly had experiences, I don't think, that's in the run of the mill.
00:47:11That what?
00:47:12I've thought I was various religious figures,
00:47:15ranging from the devil to God to Buddha to Jesus, all those people, you know.
00:47:21Did you mind feeling that?
00:47:24I certainly minded it when I thought I was a devil, because that was a horrible feeling.
00:47:30That was, that, that, that was a terrible feeling, but others say it's, uh, a better, you know.
00:47:35If you, if you think you're Jesus, you really do feel gentle and mild and good and blessed.
00:47:44I thought we would come to the Day of Judgment and I'd have a role to play.
00:47:49Did that feel good?
00:47:51It felt rather nerve-wracking.
00:47:52I was not being unsure as to what judgment I would pass, not knowing what judgment I would pass, yeah.
00:48:01Do you feel that the drugs have taken something away from you,
00:48:03or do you feel that they've given something to you?
00:48:07Uh, they've taken away all those high states.
00:48:11Do you regret that?
00:48:15Well, no, because if I ever want to go back there, I can always stop taking the drugs and, and,
00:48:22uh...
00:48:22Do you look back on that as a sort of liberty of some sort, which has been taken away from
00:48:26you?
00:48:27Oh, yes. Yes, I do, yes, yes.
00:48:30But it's, it's not nice, it's not, generally, it's not nice hearing voices.
00:48:34Generally, generally, they're pretty critical.
00:48:37Are you talking about the drugs?
00:48:39You were, what do you want to say?
00:48:41What causes voices, then?
00:48:44Sounds in the environment.
00:48:45Is it spirits?
00:48:46Echoes. Echoes.
00:48:49Eh?
00:48:49Echoes.
00:48:50Echoes.
00:48:52I hear voices, and it doesn't bother me, I just take, I just have conversations with them, yeah.
00:48:58On one side of the brain relies on a word kit, and on the other side of the brain relies
00:49:02on a vocabulary.
00:49:03An archive is on the left, but the engineering facility is on the right.
00:49:07How do you know it's all in perfect working order?
00:49:09He's perfectly visible to everybody on the, on the screen, as Gnome Thomas, and I'm Gnome David.
00:49:17David, stop it.
00:49:19He's the, uh, my animus, to use a Freud, Freudian and Jungian term.
00:49:23Now, why do you think that he ought to be on drugs?
00:49:25Sometimes he goes off, he goes off, he goes off, he goes off the subject, he's not on the subject
00:49:30of drugs sometimes, he just winders off.
00:49:32So you think drugs help him to keep on the subject?
00:49:34Yes, yes, yes.
00:49:35But he's sleeping all the time on drugs, Pat.
00:49:38Dave, do you feel better now that you're only on the one drug?
00:49:40Yes, I do.
00:49:41That you're not sleeping all the time.
00:49:42Yeah, not sleeping all the time.
00:49:43He's no longer mad, but he drives everybody else mad.
00:49:46But is that a good reason for us to say he should be on drugs?
00:49:49He's actually saying he feels better without them.
00:49:51Oh, I can put up with him.
00:49:53I rather like him, actually.
00:49:54The alternative is to walk away from him.
00:49:57I think it's up to other people to have a bit more patience, and to actually listen sometimes, even though
00:50:02Dave does tend to wander off the point, we can always bring him back.
00:50:05People are saying that when you're on a lot of drugs, you sleep a lot, but when you're awake, you
00:50:12do stay on the subject.
00:50:13Which would you rather?
00:50:16Which would you rather have?
00:50:17Sleeping a lot and staying on the subject, or being more awake?
00:50:20I'm sleeping a lot and being awake because I feel that I've got a fairy friend I had in childhood
00:50:25who got very anxious over the word people.
00:50:29And that's Yuletide.
00:50:30He took the resolution, I don't like people.
00:50:32And my reply this Yuletide is mad chicken.
00:50:35It's a question of whether you can clearly distinguish between what is normal and abnormal.
00:50:42And the way I am now convinced that they're illnesses is when a patient comes in, like James, incredibly disordered,
00:50:49very unwell, he has medication, and they go home better.
00:50:54They're restored to their family as someone that their family recognise, that they recognise themselves, that they're back to who
00:51:01they are.
00:51:02Can you foresee a time when a more accurate knowledge of neurophysiology and the function of the brain
00:51:14will lead to such subtle understanding of mental disorder that it will eventually yield to organic treatment?
00:51:26Well, I think it's a dream that we all have to be able to simplify the problem.
00:51:34It would be very nice if so we could find solutions simple, but simple causes.
00:51:43I think that when we talk about foolishness, we talk about the contrary.
00:51:49We talk about everything that doesn't have a simple cause.
00:51:55And we talk about everything that represents the limit of our reason.
00:52:00Do you know that they're not there, the voices, or do you think that there's someone there?
00:52:04Where do you hear?
00:52:05Sometimes I think that there's someone there.
00:52:07Yeah, do you turn around to see?
00:52:09Yeah.
00:52:10As I come to the end of this series, I feel some sort of obligation to state my position on
00:52:17this matter.
00:52:19And I wish I could tell you that I'd discovered exactly what it was.
00:52:23All I can say is that trained as a doctor, I find it impossible to believe that the brain is
00:52:30mysteriously immune
00:52:32to the sort of influences which every other bit of flesh is heir to.
00:52:37So I believe that madness exists, and I also suspect that much of it will turn out to be a
00:52:42disease comparable to things like,
00:52:44well, heart failure or disease of the liver.
00:52:47I also think that the reason why the clinical picture of conditions such as schizophrenia is so inconsistent
00:52:53is not, as some people suggest, that no such thing exists,
00:52:57but rather that the brain, unlike organs such as the heart or liver,
00:53:02expresses many of its functions through the medium of the person or self.
00:53:06We don't meet brains, we meet people.
00:53:08On the other hand, I also think that in the name of a belief in the reality of mental disease,
00:53:17atrocious injustices have been inflicted on our fellow human beings,
00:53:21both those who may actually have been ill and those who may merely have been socially inconvenient.
00:53:27In fact, research has shown again and again that the destiny of people who are assigned the role of mental
00:53:33patients
00:53:34depends on the extent to which those around them recognise and respect how normal they are rather than how ill
00:53:41they are.
00:53:43It's for that reason that the arguments of those who insist that the concept of mental illness is a label
00:53:49with dehumanising consequences
00:53:51can't be dismissed as frivolously sentimental.
00:53:55Because the issue of madness forces us to confront a much larger philosophical enigma.
00:54:02And that is, how is it possible for something made of matter to yield something which is composed of ideas,
00:54:11beliefs and wishes?
00:54:15I'm not suggesting that the mind is independent of the brain or that the brain is simply a mechanical instrument
00:54:22through which the immaterial mind executes its designs.
00:54:26What I am saying is that the way in which the mind is dependent on the brain is not perhaps
00:54:32penetrable by human understanding.
00:54:34And although there are scientists who claim that this is simply a soluble problem,
00:54:40I suspect that it may be a mystery which, for purely logical reasons, is beyond our grasp altogether.
00:54:48Meanwhile, and by meanwhile I mean forever, being human, whatever that is, is something we have to survive as there's
00:54:56no prospect of rescue.
00:54:57And since madness and misery seem to be an inescapable risk of having our particular sort of constitution,
00:55:05the measures which we take to deal with it had better take account of the fact that we don't,
00:55:11and perhaps never will, know exactly what sort of thing we are.
00:55:41THE G đầuce
00:55:44As-950-6
00:55:47As-950
00:56:54But does he have normal broadcasting hours or does it happen all the time or does he have to announce
00:57:00that he's going on the air at some time?
00:57:02No, no, he doesn't. When I go to sleep, he can be awake and he knows I'm asleep.
00:57:41But when you assume from somebody's behavior that they have some kind of a disease, which you cannot prove any
00:57:48other way, for which there is no pathological proof, no proof in cell tissue and so forth,
00:57:55then you're taking a situation and you're abusing scientific reason by saying it is an illness, it isn't. It's an
00:58:03analogy that doesn't hold.
00:58:08At the end of the 19th century, most of the medical profession took it for granted that the major forms
00:58:15of lunacy were the result of disease, disease of the brain.
00:58:21However, they were frustrated by their inability to find any visible changes in the autopsy specimens which came to hand.
00:58:36And yet the English psychiatrist, Henry Maudsley, assumed that this would only be a matter of time.
00:58:45In 1871, he wrote, it's beyond doubt that important molecular and chemical changes take place in those inner recesses to
00:58:55which we have not yet gained access.
00:58:58To conclude...
00:58:59...a thousand times faster than the actual individual events, we have a good sampling of the whole system.
00:59:06So we look at the whole traffic network and we can tell where differences occur when a subject does one
00:59:12task versus another.
00:59:14The fact that we can now visualize the living brain in action means that we have one more technique for
00:59:21comparing normal people with schizophrenic patients.
00:59:24So we have a normal subject here. Now, what exactly are we doing with him?
00:59:28Okay, well, he has been put in our single photon emission scanner and is, at the moment, performing, he's making
00:59:36key taps, as you can see there, a task called the Wisconsin card store.
00:59:40He's looking at the screen and seeing a number of perceptual figures that he has to try and decide how
00:59:46to sort out and press the right key.
00:59:48The rules are not given to him. All he's told is whether or not there's a right or a wrong.
00:59:53The screen flashes to indicate that.
00:59:56And what we're interested in doing is seeing what areas in the brain are activated by this type of task.
01:00:06What you're going to be doing today, David, is the card sort, just like you've done before, okay?
01:00:12Not going to be any different.
01:00:17It'll be the exact same thing you've done before. You're fine, you're fine.
01:00:22There, I got lines on your face. I'll take those off and you're all done so you won't go back
01:00:26looking funny.
01:00:27So here we've got a patient undergoing the same test. Now, what would you expect to see, then, if we
01:00:33were to look at the scan?
01:00:35Right. Well, what we'll see is that in the normal, we will have seen an increase in blood flow in
01:00:39the frontal lobe regions due to the task, due to the demands made by this task on the brain.
01:00:44The difference that we've seen between the schizophrenic and the normal will be the result of his failure to activate
01:00:50that region, which we think is what is necessary in order to do the task properly.
01:00:55Ah, I see.
01:01:01And once again, the study of identical twins provides a more controlled basis for comparison.
01:01:08Now, these specs...
01:01:09...and the arts.
01:01:11Could you, could it be a mistake? Could you be muddled about it?
01:01:14No, he's just said, Jesus Christ, I'm sorry.
01:01:16He just said it, just...
01:01:18He just said it.
01:01:19You can see everything in this room.
01:01:21Oh, my dear.
01:01:22You can see it through my eyes.
01:01:23He sees through your eyes.
01:01:25Yes.
01:01:26Well, look at the television, the titles.
01:01:28I do.
01:01:29He reads them.
01:01:30There's a gospel truth about my family.
01:01:32Oh, I know, I know, I know.
01:01:33He says, all my friends.
01:01:36And he feeds them.
01:02:00He's叫做 of hisRegRich and hisRyanIC.
01:02:01And I know he knows.
01:02:06Anne is a patient of Dr. Ruth Seaford at Hackney Hospital in London.
01:02:11After five years of comparative equanimity,
01:02:14she has returned to the hospital complaining that her thoughts are being infiltrated by another person.
01:02:20Is what he's saying to his sister the same as what he's saying to you?
01:02:24No, no, he can't have much of a conversation with her,
01:02:28but he can ask somebody, can you tell me the time, please,
01:02:31and be talking to me at the same time?
01:02:33So he can say two things at the same time?
01:02:35Yes, yes.
01:02:37If I said, Anne, I mean, a large number of people believe in telepathy,
01:02:41a large number of very respectable people believe in telepathy,
01:02:45but in general...
01:02:46As far as Dr. Seaford is concerned,
01:02:49these are the symptoms of a disease called schizophrenia.
01:02:53People often think that telepathy has to be concentrated on really very hard
01:02:57in order to send the telepathic message,
01:02:59and I think I'd be right in saying that it would be difficult for telepathy
01:03:05for someone to be chatting away and at the same time be able to get...
01:03:09No, no, doctor, he's not chatting away.
01:03:10No.
01:03:11He'll say just like a sentence.
01:03:12He'll say a sentence, but at the same time, can say...
01:03:15Yes.
01:03:16Because he used to say, I'm talking.
01:03:19And this is actually a pair of our twins,
01:03:21and what they show is that when patients are engaged in a particular behavior
01:03:25that puts a premium on function from the prefrontal part of the brain,
01:03:30the affected twin is consistently,
01:03:32shows consistently less activity in that part of the brain
01:03:35than does the healthy twin.
01:03:37And is that accompanied also by a lower performance of the test as well?
01:03:40Yes, it is.
01:03:40Yes, it is.
01:03:41Yeah.
01:03:42Now, in this set of scans,
01:03:44the area of the brain that is activated by doing this particular task,
01:03:48which is the Wisconsin card sorting task,
01:03:50is this left prefrontal region of the brain over here.
01:03:53And what you can see is that this part of the brain
01:03:55is consistently more activated in this particular twin pair.
01:03:59This is the healthy twin.
01:04:01And this twin shows this activation pattern
01:04:04in a way that is not seen in this twin,
01:04:06which is the unaffected.
01:04:07So the red and orange patches are the activated parts.
01:04:10Correct.
01:04:10And these bluer and colder things are relatively inactive.
01:04:14Correct.
01:04:14It is quite conspicuous, the difference.
01:04:16Now, whatever these differences mean,
01:04:18the notion of disease seems to imply a physical cause.
01:04:22And some experimental psychiatrists claim
01:04:25that this cause may lie in the variable expression
01:04:28of a single, as yet unidentified gene.
01:04:31Obviously, the question that you ask is,
01:04:33what is the nature of this gene?
01:04:35And what I suspect is that it's a gene that is very important
01:04:39for being human.
01:04:41There are perhaps variations in this particular gene
01:04:44between people that are not only responsible
01:04:47for some people having the sort of problem
01:04:50that we describe as psychosis,
01:04:52but they're also responsible for the normal variation
01:04:55in personality between different individuals.
01:04:58That, I think, is an interesting possibility.
01:05:00And you can see then that if you once identified that gene,
01:05:05then you have the potential to know a great deal more
01:05:10about the genetic structure of human personality.
01:05:16Theories of this sort have always aroused moral misgivings,
01:05:20since they seem to encroach upon the mystery of human free will.
01:05:25Even in the 18th century,
01:05:27from the non-appearance of change
01:05:29to the non-existence thereof,
01:05:31could be just as if a blind man were to claim
01:05:34that there were no colours.
01:05:39By bloodlessly sectioning the living brain,
01:05:42we now have the opportunity to see if Maudsley was right.
01:05:46These are the brains of identical twins.
01:05:49One normal, the other apparently suffering from schizophrenia.
01:05:53I don't think you have to know anything
01:05:54about magnetic resonance imaging
01:05:55to recognise that these are not exactly the same brains.
01:05:58And that this scan, there are dark regions,
01:06:01the so-called spinal fluid spaces,
01:06:02are bigger in this patient, in this subject,
01:06:05which is the affected twin,
01:06:07than in this subject, at exactly the same spot in the brain,
01:06:10and this is the healthy twin.
01:06:11So there's been brain shrinkage then of some sort?
01:06:14Yeah, I think the assumption would be
01:06:15that there's some process, a pathological process,
01:06:19some disease process,
01:06:20that has affected this brain to produce
01:06:22a reduction in the overall volume of this brain.
01:06:26And that the inside of the head,
01:06:29which has not changed in volume,
01:06:31now has greater spinal fluid spaces
01:06:34to take up for the loss of the volume of brain tissue.
01:06:40It's now possible to visualise
01:06:42the physiological function of the brain,
01:06:44as well as its anatomical structure.
01:06:47Well, we can make images of the brain
01:06:49that reflect activity
01:06:51that, at the shortest time frame,
01:06:53is about 60 seconds in duration.
01:06:55And with other chemicals,
01:06:57range up to about 30 minutes in exposure time.
01:07:01But 60 seconds is about as quickly
01:07:03as we can freeze the activity in the brain.
01:07:07And if you compared that to looking at a scene
01:07:10of a busy intersection,
01:07:13then you would have certain strategies
01:07:15that would give you specific information
01:07:17and others that wouldn't.
01:07:19For example,
01:07:20if you had an exposure of 60 seconds
01:07:23looking down at that intersection,
01:07:24you could see the traffic pattern at that time,
01:07:26say, at rush hour.
01:07:28Well, we look at the traffic flow
01:07:29between all the cells of the brain.
01:07:30And despite the fact that 60 seconds
01:07:34is an order of magnitude
01:07:36that's a thousand...
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