Schizophrenics are selfish?

June 16, 2006 3:48 PM

Are schizophrenics really selfish? (warning: spoilers to an old episode of House)

So I was watching House on DVD a while ago and there was the episode with a woman who they thought was schizophrenic, but eventually they decide she's not because she called protective services on herself, so that her son could have a more normal life. And they decide she can't be schizophrenic because she did something selfless.

I had never heard this before and it seemed like kind of an odd thing to be part of a diagnosis. Is it accepted wisdom? Is it backed up by anything? Or is it a plot hook?

posted by dagnyscott to science & nature (15 comments total)

My schizophrenic uncle is incredibly generous, so that doesn't jibe with my experience. Are you sure the question wasn't one of self-awareness rather than selflessness?
posted by jacquilynne at 3:52 PM on June 16, 2006

The writing staff of House freely admit to fudging medical facts in the interest of plot. Just throwing that out there.
posted by Zozo at 4:00 PM on June 16, 2006

Er, did they mean schizoid?
posted by fleacircus at 4:08 PM on June 16, 2006

I remember that episode. I think it was because her self-sacrifice meant that she was being rational. Schizophrenics can't be rational. Or so that episode would imply.
posted by moonshine at 4:22 PM on June 16, 2006

This is ridiculous. It is called stigma, and it's not just the marks on Christ's hands. People with schizophrenia are people. Schizophrenic is an adjective, not a noun. And people, being that they are people, are capable of a myriad of emotions and behaviors, even if they have been diagnosed with schizophrenia.

However, I hope this episode of "House" sold a lot of consumer goods via commercial interruptions! TV is very important for our society.
posted by ikkyu2 at 4:22 PM on June 16, 2006 [2 favorites]

He watched it on DVD, man: no commercials!
posted by mr_roboto at 4:35 PM on June 16, 2006

So, Doctor, schizophrenics have astigmatism?

I'll back up ikkyu2's hard-won medical expertise with a useless anecdote: I have an aunt who is paranoid schizophrenic, and she's perfectly capable of being basically rational.
posted by ROU_Xenophobe at 5:17 PM on June 16, 2006

Complete BS. My aunt had schizophrenia, and was possibly the most kind, generous, selfless, patient person I have ever known. And yes, capable of rational, intelligent thought.
posted by moira at 5:24 PM on June 16, 2006

The answer to the question is no, but in the shows defense, the diagnosis turned on her rationality not on her selflessness. The question was not whether she was too selfish to call protective services, but whether she was in touch enough with reality to do it.
posted by OmieWise at 5:31 PM on June 16, 2006

Stigma is not the same thing as Stigmata, BTW.
posted by I_Love_Bananas at 6:08 PM on June 16, 2006

Television (and movie) portrayals of various kinds of mental disorders are, to put it generously, rather wide of the mark. You won't learn anything important about any such illness by watching popular entertainment.

Schizophrenia has nothing to do with generosity or selfishness. (It also has nothing to do with competing personalities. That's a different disorder entirely, and there's actually some dispute as to whether it even exists.) Schizophrenia is a breakdown in the basic processing mechanism of higher brain functions which makes it difficult for the person to differentiate useful/relevant information and conclusions from useless/irrelevant information and conclusions. No one knows what causes it.
posted by Steven C. Den Beste at 6:18 PM on June 16, 2006

Schizophrenia is a breakdown in the basic processing mechanism of higher brain functions which makes it difficult for the person to differentiate useful/relevant information and conclusions from useless/irrelevant information and conclusions.

This is not the worst definition I've seen, but I think it's fundamentally flawed. First of all, I don't agree that schizophrenia is a breakdown in the basic processing mechanism of higher brain functions. What are those functions? What mechanism is basic to the processing of those functions? What else is involved in processing of those functions, besides their basic mechanism? Point to this mechanism. Where is it? What does it involve? Where is it located?

Also, while people with schizophrenia do have trouble with selective attentiveness and other manifestiations of what neuropsychologists call executive function, it's not necessarily clear to me that the trouble is specifically differentiating relevant from irrelevant information. People with schizophrenia often have strong opinions about relevance; often their worldview is consistent enough and bizarre enough that these opinions aren't prima facie wrong in its context.

However, I understand that this was an attempt to condense schizophrenia into a brief, jargon-free paragraph. I think people are too complex to shoehorn them or their ailments into brief, jargon-free paragraphs, let alone sitcoms.
posted by ikkyu2 at 6:53 PM on June 16, 2006

Our subjective experience of thought (for most people as an "inner voice") is an illusion. Thought in fact is a highly organized form of associative memory access and filtration. We think about something and our memory tries to bring out anything which might be relevant. Then there's a filtration step which examines all those things and decides which ones really make sense. The whole process is highly parallel, which is why the "inner voice" illusion is so misleading; that suggests there's a single serial process involved, which isn't true. (It can't be; neurons simply aren't fast enough to do this kind of thing serially.)

When we're trying to make plans, there are things which suggest possibilities, and there's a filtration step which decides which possibilities are worthwhile and which should be rejected. (Understand that just as before this is a serious condensation and abstraction of the process which isn't totally correct etc.)

Alcohol affects this. Alcohol is a depressant, but initially it's selective and tends to affect the filtration step most strongly, making it so that more stuff gets through than usually would. That's why it makes you "uninhibited" and actually makes you feel more energetic in the early stages of intoxication; it lowers the threshold of things which you think of that you might do which actually make it past the rejection filter and become actual behavior.

Schizophrenia is a failure of that rejection/filtration process. In some cases it can act consistently -- consistently wrong -- and in some cases it is inconsistent. Borderline cases amount to a judgment call: is someone insane, or merely eccentric?

Sometimes the result is warped, and sometimes it's outright incoherent. It can make sense to others, even though they realize that the result is incorrect, but sometimes it makes no sense at all to others.

It's not the same as alcohol, but it's still a disfunction. No one knows what causes it, or how it takes place. Some schizophrenics can be helped by certain drugs, but like nearly all drugs developed to help mental illness no one has the slightest idea just what it is that the drugs do which helps. Virtually all of psychopharmacology is the result of trial and error and a degree of serendipity. (It's possible to measure things like changes in reuptake rates of various neuro-transmitters, but no one has any idea why or how changing those things affects mental illness.)
posted by Steven C. Den Beste at 7:09 PM on June 16, 2006 [1 favorite]

I am a psychiatrist. I work treating schizophrenia every day. There is no association between schizophrenia and selfishness. On the other hand, one of the frequent features of the illness is the sufferer's nonrecognition of thier illness (anosognosia). So some psychiatrists used to reassure patients who worried that they were schizophrenics that that was evidence they couldn't be. That may be the basis of the plot device you are asking about.
posted by emg at 4:48 AM on June 17, 2006

Isn't flat affect one symptom of schizophrenia? Maybe that's what the scriptwriters were getting at.

People with schizophrenia often have strong opinions about relevance; often their worldview is consistent enough and bizarre enough that these opinions aren't prima facie wrong in its context.

I sometimes get emails and court pleadings from people seeking legal assistance who I assume are schizophrenics, detailing the elaborate way people and things are persecuting them. They're quite amazingly lyrical and fluent, and if you suspend disbelief they almost seem to make sense.
posted by footnote at 10:56 AM on June 17, 2006