One possibility is the rise of certain political and social factors that make paranoid schizophrenia much more common today. In the early part of the 20th century, the USA did not have the CIA, NSA, HSA, ATF, and the FBI was just getting started. We also didn't have UFO-phobia.

Conversely, I have heard that catatonic schizophrenia is still not uncommon in certain non-Western cultures. Any rebuttals, alternative hypotheses?

This is by no means a rebuttal to Dr. Krohn's comments nor does it serve as a viable alternative hypothesis. However, I am wondering whether the significant increase in drug abuse moderates this relationship. Especially given that users experience paranoid-like symptoms with particular recreational drugs. Thoughts?

Perhaps, as the DSM 5 summarizes, there never really were different subtypes of schizophrenia (though there may be different etiologies). Catatonia may have appeared more common in the past because 1) Catatonic behavior was more likely to lead to institutionalization rather than ostracizing or criminal punishment or just thinking of someone as "eccentric", and 2) early treatments for schizophrenia were more likely to cause catatonia- like stupor. Now that clinicians, especially therapists, are more often actually having conversations with people with schizophrenia, we're more aware of the "paranoid" delusions (which are often attempts to explain the hallucinations... if I'm hearing voices that no one else hears, maybe they're being broadcast into my brain somehow).

So... maybe the real change is not in the schizophrenia, but in our treatment and awareness of schizophrenia.

Like James suggests there is perhaps some mitigating factor. "Hysterical conversion" disorders appear to have been more common in times past than today as well. It is possible there are some sociocultural phenomena that also play a role and not primarily a biological role.

Hi William,

I don't believe changes in the per-capita rate of use of cannabis, cocaine or methamphetamine can account for this discrepancy.

James,

That's two excellent points you have made- or maybe actually three?

G'day Dale,

Do you think that is because less people suffer "hysterical conversion", or because that label has fallen out of fashion?

Sometimes the arbitrary labels we use to classify an individual's behaviour just get changed, or abandoned.

During the years between 1918 and about 1922 a diagnostic category emerged in Europe that is no longer recognised by psychiatry- it was called "Walking Man" or "Travelling Man" Disease.

I'd suggest this is an example of the sort of socio-cultural phenomena Dale has mentioned.

The sufferers of "Walking Man Disease" were WWI veterans who had adopted itinerant, "hobo" or "gypsy" like lifestyles. They would often travel in groups, and camp together on waste land near towns or villages. These were the "Walking Men". Nowadays we would say that most of these men were probably suffering PTSD, that they were heavily habituated to living under canvas and marching large distances, that they had not returned home when demobilised (or had returned home only to find nothing they valued there) and that they were simply seeking each others' company and avoiding normal society because of their untreated traumas.

Further to Neil's points about political and social variables, I'd suggest a related factor is that until very late in the 19th C, (and even into the first decade or two of the 20thC), the majority of people, (even in western, industrialised nations) lived in small communities where most people knew everyone else, and had done so for their entire lives.

The first case histories that describe what we would call paranoia and delusions of persecution come from major urban centres like London in the late 18th and early 19th C, as larger and more fluid populations were concentrating.

http://www.theairloom.org/text.html#

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http://www.forteantimes.com/features/articles/450/shadow_of_the_air_loom.html

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The types of delusional content people develop is heavily influenced by the physical and social environment they are living in.

Someone who is prone to delusional thinking, and has lived all their life in the same small village or suburb, will probably behave very differently, and will definitely be treated very differently by their extended family and neighbours, (who know and love, or at least have learned to tolerate, the person and their eccentricities), than a person who is subject to delusions but who lives in a large, impersonal modern city and who has no social supports, but is instead surrounded by crowds of strangers.

Paul.

Again I am going to throw in the 'humans are meaning making machines' thought. When life is suddenly not happening in a known and predictable way we default to looking for external influence. Perhaps in the past people who heard voices visited their pastor or spiritual leader to understand if these voices were demonic or angelic and what could they do with them. Perhaps they were socially conditioned to be still and prey. In the big historical picture they were only deemed as mad in the latter part of human history. By then the consequences of being in an asylum were so horrific would you not freeze ridged?

Neil you suggested that there are many external factors one could blame and given the number of movies that focus on this theme its not surprising the likes of the CIA get blamed. Catatonic appears to be a frozen in fear mode which many animals display, why should humans be any different? Its just a different choice of behavior for the person in total confusion about their subjective experience of life in the psychotic state. I can attest that there was still choice of behavior for me while psychotic, middle road expression, neither suppressing nor becoming a fully blown drama on two legs seemed to let the pressure off best.

Even when sane its hard not being paranoid if you look deeply at political movements, food, water and nature derogation, erosion of human rights, GMO, EMF and the behavior of companies such as Monsanto, DuPoint, Dow and cronies. Let alone trends in mental health care and its long term chemical frontal lobotomy strategies, diagnosing of children and every human emotion. How long before the men in black flack jackets are the ones turning up to every emotional domestic upset followed by ones in white jackets carrying hypodermic needles filled with psychotropics? Paranoid thinking? Look at Turkey this week and how the protests started with a a group of young people trying to protect a city park with 100 year old trees. Its the tear gas, water cannons and riot police that turned it into a riot.

Hi Heather,

Paul's essentially correct. Set and setting.

You do seem to like to expland nuerological inquiry into current events - but of course there were plenty of paranoid schizophrenics. Just no DSMs. Any of you who are interested can locate a touching poem written by Abraham Lincoln about a friend who descended into acute raving paranoid schizophrenia - we ALL know that we are dealing with a constellation of organic, read again, organic, read again organic disorders that usually crop up between the ages of 17 and 27 with disturbing to frightening results.

I have a friend who never seems to be able to plan well, she also can't remember as well as I do, has some impulse control issues, tends to blame others, neglects her apartment. That's your lowest level.

Notch it up and you have my tenant, finally diagnosed with shizoaffective disorder at 40 and medicated within two months of moving in - things had gotten worse and worse in college and she'd never been hospitalized but what a crappy life for 20 years, often

thinking a boss had it in for her (paranoia) and quitting, compulsive about boundaries (tight rule structure substituting for inability to process situational ethics), loose memory, inability to plan ,,,they also don't gow any "older" after onset so Jane is really a 21 year old with a lot of history.

Before medication she was sure the upstairs tenant was a danger and the course they put her through, you'd think they never reviewed after their medical school course in psychopharmacology.

She wasn't out of control but first was perphenazine (knocks you out) - it was really awful - then respidone (many doctors don't realize S-A sufferers don't volunteer - took them 15 years to realize that nearly 50% suffered from elevated prolactin and revised the online information) Her doc at BID never gave her the tests and for two months she was hormonally a six year old before I told him to GET ON THE STICK doc . So he put her on Abilify but didn't check for leg kicks at 18 months. Thank God I noticed, those can be permanent. I called a conference with the chief of psychiatry - now it's Geodone and a new doc - but he added Ambien for insomnia (he's a 70 year old geriactric specialist who must need patients - they all have to pay you know) rather than switching antipsychotics, overdosed her into a raging sleepwalker for eight months until SHE went online, got the data, he adjusted the dosage and she's better now.

This is the level of care we can expect in 2013. If we held some psychiatrists with over-used DSMs liable for their misakes and simply made them pay back for the hours they wasted we could all go to college with the cash.

There's a tendency here to try to define with names like "catatonic schizophrenia" and a weird fascination with diagnostic books that cleave definitions into ever smaller slivers. No mental illness is like that. It's simply not like that and it never has been. All of these maladies exist in any number of levels, they are idiosyncratic, they overlap, and they are in constant interaction with life events that can be exhilerating or depressing to any normal person. This drives many professionals who can't deal with uncertainty to near madness trying to pin it down for their own emotional satisfaction, and the DSM just keep getting bigger, and bigger, and bigger,.

To answer your question: Without any DSM's you had "madmen" you had "the village idiot" you have "crazy uncle Charlie" you had "demon possession" you and "went mad" ..it's all versions of the same constellation.

The only ones there were sure of, those who sat there and swayed back and forth, were the REAL sickos because none of the others had diagnostic manuals to separate the "odd" from "eccentric" from "really unpleasant irritable" from "watch out he's unstable" to "schizoaffective" to "mild paranoid schizophrenia" to "full blown thinks he's Napoleon or he's cooking up bombs in his apartment" and the Western media sends it around the world to let more people paste labels on them.

It only took two distrurbed young men with a deadly crock pot full of bb's and gunpowder to expose the over-the-top madness of a population so over-hyped to weapons of mass destruction that simply labeling them "terrorists: rarther than "two really screwed up guys" ,,, and everyone went totally berserk.

Swat teams, lock downs, Presidential visits and a new song from Billy Joel. Boston Strong? How about Boston Schizophrenic - it;'s just ike the witch trials! Thousands of people can't remember very well, no impulse control, wild imaginary dangers and compulsive emotional acting out. Of course every single police officer filed for overtime (now you get paid to call yourself a hero - 99.8 of those folks in unifiorm were no more heroes than they were Napoleon) talk about "The Madness of Crowds" but you could buy in to the angst by donating to the $40 million fund. Talk about avoiding direct action, we can pay for that too - today there's a story about the grief that they're finally taking down the memorials - more pandering to a local phenomena that accomplished nothing. The best part? The businessmen on that street are suing to have the word "terrorist" dropped. So they can get the insurance for their broken windows and lost business as they sealed off the street for a week while folks in hazmat yellow played CSI looking for parts of a pressure cooker. Actors in costumes. There's no danger from black powder or pressure cooker parts. We paid for the show,

Back to the diagnosed, If we simply spend time with some of these folks, notice the consistent problems they all seem to face in varying degrees, we get back to "they got whacked in the brain between 18-27 and the ticker has been off in characteristic ways ever since" - depending on the level, they are odd, strange, suffering, or dangerous to themselves and others" . We don't have to talk about social phenomena of the last 25 or 50 years. These disorders have always been there, we just called them witches or madmen.

Ultimately parsing and defining has nothing to do with healing and might I suggest it serves as a sort of intellectual pastime for some that allows them to avoid the more difficult business of wading in and doing something. Since I have been monitoring her medications and keeping the doctors feet to the fire Jane has not been fired in seven years - she now has a wide range fo social media friendships, old high school and work friends,volunteers for local causes, paid her debts, fixed her teeth, pays her taxes, actually arranged a trip to Norway and back, visited FaceBook friends, stopping off for her dream to swim in the Blue Lagoon of Iceland. When I met her, I thought that was crazy.,

You gotta admit for a woman if 46 who's really 21, that's one heck of a difference from a shelter. And once in a while she WILL fling a pizza all over the kitchen - it's organic - remember - organic. It can be treated, not cured.

I can only suggest that helping even one of these poor souls get back on their feet is worth 1,000 hours of chat on an exceedingly limited chat group populated mainly by amateurs and afficianados - which qualifies as a pastime perhaps, but can't by the very makeup of the audience result in anything more than passing the ball around like the conch in Lord of the Flies. The question is whether this is any more useful for mankind in general than if we were commmenting on the Huffington Post and I would suggest not. There are all sorts of mild mental aberrrations, and substituting chats for the discipline required for the advanced studies or professional experience is one way to avoid the emotional trauma of spending a lot of time helping them directly or the stress involved in getting the PhD , the MD or the other keys to actually getting one's hands on these people.

I have nothing at all against intellectual entertainment, I indulge in it all too often - but this is University of Phoenix level. We all know it. If I wasn't articulate you could say I was an irritable S-A myself but I'm not. If you really want to see how the world sees me, drop the words "absolutely productive" into Google and you can see a cartoon of me that took up 2/3 of the front page of the science section of the NY Times in 2005 - Ben Carey's article. Me, and Robin Williams, Richard Branson, Craig Venter and Alexander Hamilton ... NOT normal .., some of us are crippled, other use it as a springboard for extrarodinary contributions. I'm not sure where I fit yet, we also tend to narcisscism. You never hear of most of us of course ... but from my own personal viewpoint, my own place on that bell curve, it's interesting seeing everyone else being sort of slow and unable to put things together. I mean, really, it's so easy to get A's at Harvard, a little memorization, a little strategy,.. oooooops ... that's my mental problem!

Sorry. Back to you normal people. I'll be publishing my last book again with a new title and I think ... I just think .. you'll hear about it. "You're Going to to Heaven Whether You Like It or Not" ought to get them in the door. It did well enough as "Neurotheology: Virtual Religion in the 21st Century" (Amazon/Kindle) - but that established it and got me into Wiki. Now to popularize it - and it turns out it's still current. Wheee, FaceBook, You Tube, dedicated website ...let's see how many we can help. Sound crazy?

http://webmindful.org/BookReviews.htm

Yeah, it's the experience of brain death itself that's the eternal bliss ...which is why all the major religions have such similar heaven stories. Your trip during your last coma commences with the failure of the prefrontals so you lose all possibility of chronological time. Eternity first ...often a white light or tunnel, stage from the disinhibited visual cortex, and then regression to the overwhelming familiary of the simpler universal consciousness that we came from. The sense of self extends to brainstem .. so we DO experience it. But it takes 178 pages to soak the reader in enough sound basic neuroscience that the ending appears logical, believable, nearly inevitable and inescapable. Not easy to boil down history, psychology, theology, developmental neurophysiology and a few more, and spice it up with a lively reading style but I wanted help as many as I could. Like .. not fear death any more? Was I nuts to spend twenty years on that? But don't listen to me.

http://webmindful.org/BookReviews.htm

How many more people do you think will be happy to learn this? If you believe in God (I don't happen to, but God only knows), that's how we're designed, and ain't that nice? And thank goodness we have our guides to show us how to live on earth meanwhile. Oh - whatever you do, don't blow yourself up even for Allah, there's no regression in a brain blown to bits.

ooops, didn;'t mean to put in two links. I may err occasionally in my enthusiasm, but I don;t mean to use this place as a billboard. Sorry about that.