Another manila folder has landed on his desk. A new donation has just arrived, and Anton* has work to do. He braces himself. The symptoms of schizophrenia usually leap off the page with such force that he must mentally prepare each time a new file crosses his desk. Each brain, each donated by a recently deceased schizophrenic patient, has a story to tell. It is Anton’s entry-level research job at one of the nation’s largest brain banks, with upwards of 2,000 individual brains, to find the threads that connect them.
Anton has his work cut out for him. Schizophrenia is by many measures the most radical malfunctioning of the human brain one can imagine. Patients suffer from more than 30 symptoms, ranging from hallucinations of all five senses, to paranoid delusions, to lack of functional working memory. Each folder contains a fresh combination of disorders for Anton to categorize and characterize as best he can.
Though schizophrenia is one of the most studied mental illnesses in the United States, it is still the least understood. According to a study done by the National Institute of Mental Health (NIMH) in 1993, the most recent population analysis of schizophrenics, it was estimated that approximately 1.1% of the American population—roughly three million people—suffer from schizophrenia. According to the same article, only 15% of the disease’s occurrence is directly related to genetics. At least two neurotransmitter pathways are implicated, and evidence is mounting that epigenetics, the ways in which genome expression is modulated by environmental effects like exposure to pollutants and brain traumas sustained during childhood, has an important role to play. Given the complexity of the disease, it is hard to know what all three million cases have in common. There are drastic differences in how each of these symptoms present themselves, but the key might actually be in the stories that schizophrenic patients and their doctors tell.
A few years ago, Anton was a college student studying biology and psychology. Back then he liked to indulge the illusion that he was too artsy to be a scientist, and so balanced his course load with creative writing and poetry classes. There was something about the thrill of dissecting a poem, only to glimpse briefly the ideas and feelings that motivate it, that shook him.
Of the many writers he encountered as an undergraduate, Anton found himself returning to the works of Sylvia Plath and William Blake, both notorious for their struggles with mental illness. Blake’s symbolism had an especially strong grasp on Anton. The imagery is evocative, mysterious, verging on the prophetic. Blake’s poems are brimming with mad visions of demons and trees with angel wings instead of branches. Over time, analysis of his poems has yielded the hypothesis that Blake was in fact schizophrenic, basing his writing off of his frequent delusions.
Anton recalls Blake’s aphorism “art is the tree of life, “In the retelling of his experience with Blake, Anton is keen to point out the oft-forgot second half of the saying: “science is the tree of death.” It is Blake’s appeal against thinking in absolutes. He wonders what is lost when scientific inquiry is deployed, his art putting in full view what is totally inscrutable to science. Nevertheless, it makes Anton nervous to talk about the link between schizophrenia and creativity, saying that mental illness doesn’t explain art away. Rather, mental illness becomes a text, and researchers’ understanding becomes a thorough literary analysis.
Scientists, including Anton, are frustrated by the disease’s diffuseness in the brain, so they’ve starting looking in new places. One of the many dimensions of the illness that might yield insight is the way in which schizophrenic patients communicate. A cottage industry has formed around language performance with schizophrenia. A study in 2004 found that a key marker of the condition is a poor grasp of linguistic pragmatics. Schizophrenic patients tend to communicate in symbols, images, and sentence fragments disconnected from their present context. A slew of similar studies followed, and now language-use analysis is increasingly used to investigate the many dimensions of the illness.
For example, patients will often string together similar-sounding words as if distracted by them, a process known as ‘clanging.’ This lack of self-monitoring suggests a defect in the region of the brain that regulates phonetic processing. Anton might analyze a clang like a poem with its own meter and phonetic makeup, examining its structure to pinpoint the precise location of the defect based on the particular sounds and rhythm the patient fixates upon. Such a detailed analysis of a patient’s arrangement of words lies between the literary and the scientific.
Although he speaks in vague terms about what he finds in those manila folders—out of respect for both the patient and the law—the idea is clear enough. Anton never knew these patients when they were alive, so he counts on doctors to do their damnedest to cobble together a complete image of a patient’s disease, scrawling out their ideas on the nature of truth, their relationships to other people, and representations of self. Patients’ motivations and intentions are just as valuable to Anton as those of an author to a literary scholar, so he reads quietly, patiently, waiting for patterns to emerge within and between files. What are the recurring themes in the patients’ delusions? How does each patient frame his or her relationships to others? What are their allegories for good and evil, God, and the Devil?
Taking his point of view, it becomes hard to resist the comparisons between the patient files and the work of Anton’s favorite poets. Each patient stands on the knife’s edge between real and unreal, reminiscent of the Gothicized anxieties in Plath’s poetry. Some of their hallucinations bear an uncanny resemblance to Blake’s apocalyptic visions. Their symptoms orbit an unseen prime mover that might actually be part of the brain’s hard wiring, as is suspected to be the case for other mental illnesses like depression and bipolar disorder. What that mover is precisely, no one knows. So for now, Anton is limited to thinking about the symbols and motifs that bind the many experiences of schizophrenia, with the hopes of getting a clearer picture of the disease as a whole.
Anton is still low in the research world’s hierarchy, but his unconventional approach is getting some attention. Recently he and a team of linguistic specialists were asked to pioneer a new protocol for schizophrenia, in which he’ll use his readings of patient files in conjunction with their genetic profiles. His close reading of the files of schizophrenic patients will try to connect their representational theories—as demonstrated in their metaphors and thought structure—to genetic markers and anatomical abnormalities. He hopes his work might put talk therapy and speech analysis at the center of the suite of treatment options currently available.
“As a man is, so he sees. As the eye is formed, such are its powers.” Blake made no distinction between perception and reality in his writing. For his part, Anton doesn’t find the distinction all that productive. To another researcher, schizophrenia’s stories might seem decoupled from the ‘real’ disease behind it. To Anton they are the disease. Each piece of loose leaf hastily stuffed into the manila folder is important. “There might be a ‘book’ of schizophrenia out there, he wonders, but someone has to bind it first.”
Once he is done sifting through the folder, Anton hops into his car. He is going to the main storage facility where the brain has been delivered. In order to make something of what he has gleaned from the file, he has to see the specimen attached to it.
The brain bank is sterile, quiet. The room is blank, save for the massive chest freezers storing the donations. Anton goes into one of the freezers and gently removes the newly arrived brain. It looks like someone has taken a melon baller to it. Specimen sampling from other labs. Because schizophrenia is delocalized in the brain—neuroscience-speak for “we don’t know where the hell it is”—multiple research teams are hunting in different regions. He collects his sample. Whomever this once belonged to, he thinks, is now sitting on his desk, scribbled on acid-free paper and slotted into a dossier. He replaces it gently and heads back to the lab to read.
*The researcher agreed to speak with me on the condition of anonymity. Anton is not the researcher’s real name.
RAILLAN BROOKS B’13 indulges one illusion in particular.