SCHIZOPHRENIAdeepened, Chadwick continues: “it was as if I was not ‘thinking the delu-
sion,’ the delusion was ‘thinking me!’ I was totally enslaved by the belief
system.” Days later, Chadwick threw himself under a bus on New King’s
Road in what he thought at the time was a hugely symbolic act that would
see Jesus return to the world. He survived, was hospitalized and adminis-
tered anti-psychotic medication, which he has taken ever since.
An influential theory for the delusions associated with schizophrenia
is the aberrant salience framework developed by the psychiatrist Shitij
Kapur. It’s an approach that marries the psychological observation that
patients seem to find meaning everywhere with the neurobiological
observation that patients have an abundance of the brain-chemical
dopamine. This is a neurotransmitter that’s known to be involved when
we find something rewarding or meaningful. In an interview for The
Psychologist, Professor Kapur suggested that if you tested patients with
schizophrenia before they were ill, you’d probably find that they tended
to jump to conclusions. When you add to this “a biochemical fuel –
excess dopamine,” he explained, “you inflame this way of thinking”.
The drugs used to treat schizophrenia work by blocking the action
of dopamine in the brain. According to Kapur’s account, they “douse
the flames”. Thus, when Kapur asked patients on anti-psychotic
medication what effects their drugs had, they tended to say that their
outlandish beliefs – such as that the FBI were chasing them – were still
there, it’s just that they don’t care so much any more.
In 2008, Jonathan Roiser at UCL and
colleagues provided direct support for
the aberrant salience theory. In a learning
task, completed by medicated patients with
schizophrenia and by a healthy control
group, the participants had to press a button
as fast as possible in response to the appear-
ance of a black square on a computer
screen. Crucially, speedy performance on
some trials earned participants a financial
reward, while performance on other trials
did not. The learning aspect of the task was
based on the fact that certain images – an
image of a chair, for example – preceding
the black square, predicted the likelihood that fast performance on an
upcoming trial would be rewarded financially. Other images, meanwhile,
were irrelevant. Those participants who responded faster after a predic-
“The Voices swirled
around me, teaching
me their Wisdom ...
They told me their
secrets and insights,
piece by piece. Slowly,
I was beginning to
make sense of it all.
It was no delusion, I
knew – in contrast to
what the doctors said.”
Erin Stefanidis