Creativity & Schizophrenia
Antonio Preti
PSI-MAN
First-rank symptoms are a group of symptoms that recurr in schizophrenia with a greater frequency than in any other mental illness. Kurt Schneider (1959) considered these symptoms characteristics of schizophrenia and their presence sufficient for diagnosis. These symptoms (table 1) include a well defined group of unusual subjective experiences belonging to the so-called “paranormal”.
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Table
1 - First-Rank symptoms, as described by Kurt Schneider in 1939 |
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A) |
The
hearing of one’s thoughts spoken aloud in one’s head |
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B) |
The
hearing of voices commenting on what one is doing at the time |
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C) |
Voices
arguing in the third person |
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D) |
Experiences
of bodily influence |
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E) |
Thought
withdrawal and other forms of thought interference |
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F) |
Thought
diffusion |
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G) |
Delusional
perception (an abnormal significance attached to a real perception without
any cause that is understandable in rational and emotional terms) |
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H) |
Everything
in the spheres of feeling, drive and volition which the patient
experiences as imposed on him/her or influenced by others |
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Source:
Trimble, 1990 |
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Patients report that
they believe they can read the thoughts of others or that others can read their
thoughts; they may have the impression that alien thoughts have been inserted in
their mind or that they have been
forced to make actions or pronounce phrases against their own will; they seem to
hear their own thoughts in the environment as though broadcast via radio.
Hallucinations of voices conversing or commenting on the patient’s acts
also belong to this group of symptoms. The nosographical status of
first-rank symptoms is still under debate (Trimble, 1990; Szazs, 1996, Roth et
al, 1996). Schneider isolated these symptoms as typical of schizophrenia only on
the basis of his clinical experience, without validating his intuition with
appropriate studies (Crichton, 1996).
Later
studies showed that not all schizophrenic patients refer to this type of symptom
(Carpenter et al, 1973; O’Grady, 1990; Malik et al, 1990), though it is
possible that the patients are reserved about describing sensations when they
feel that to communicate them may be detrimental.
Patients
with manic-depression or temporal epilepsy also refer to experiences like those
described by Schneider (Trimble, 1987; O’Grady, 1990). Some authors suggest
that when the abnormal cerebral functioning in severe mental illnesses involves
the temporal lobe, seemingly first-rank symptoms will appear (Trimble, 1987 and
1990). Other authors hypothesize a role for defective lateralization of inputs (Crow,
1990 and 1995). Whatever the hypothetical neurobiological basis of this
particular group of symptoms, the problem of their meaning still remains: are
they simply illusions, or are they delusional interpretations of real stimuli?
Most
schneiderian first-rank symptoms are of a “paranormal” type. Many people
think that telepathy or clairvoyance are real phenomena. Many individuals also
claim to have the ability to move objects without touching them, or to read the
thoughts of other people. Some of these individuals make a profitable business
from their “paranormal” abilities. Trust in the paranormal, of course,
cannot be considered an index of schizophrenia: individuals formerly diagnosed
as schizophrenic or with schizophreniform traits of personality are however more
prone to believe in paranormal experiences than the general population (Thalboourne,
1994; Pfeifer, 1994). Unusual and disquieting experiences in daily life are not
rare, but most people simply do not pay attention to them.
Particularly sensitive individuals draw from unusual events the drive to
explore generally neglected dimensions of reality. Faith in the afterlife is
common to many religious traditions, but this generally does not result in the
experience of contact with the deceased. Mediums, healers and clairvoyant use
their particular sensitivity to gain access to unconscious dimensions of the
mind of their clients. Some of these individuals state that they really
experience contact with hidden realms of the universe.
It
is possible that schizophrenic individuals can accede more easily, by virtue of
their peculiar style of thought, to the unconscious dimensions of their
interlocutors. In the past this advantage could have favoured the access for
schizophrenics with a level of preserved social adjustment sufficient to be able
to mantain interaction with interlocutors to “professions” such as wizard or
fortune teller (Stevens and Price, 1996). It is also possible that those who, by
chance or by access to particularly advantageous social resources, mantain the
ability to govern their peculiar style of thought can escape the degenerative
fate of schizophrenia (Preti and Miotto, 1997c).