By Dr. David Laing Dawson and Dr. Giampiero Bartolucci
Our ability to see, hear, read, and correctly interpret pre-textual and contextual* information is a brain function independent of I.Q. This ability in the normal population continues to improve (from birth) long past the age that other skills fall off.
This ability allows us to hypothesize the intention and motivation of other people, that is, to be aware of (up to a point of course) the workings of the others mind. That includes the perception of others as having minds, feelings, intentions, motivations, roles, responsibilities, needs.
This allows us to experience empathy, to grasp from this information both what is likely to happen next and what is expected of us in any given situation.
It allows us to formulate an internal social map of which we are a part. It allows us to develop a rational appraisal of cause and effect in our social world. It allows adaptability. New contextual information can be used to modify our internal map.
This ability begins to develop before language. From the moment the infant smiles at mother and mother smiles back.
The brain is an analyzing and organizing machine. It will organize information to formulate cause and effect and predictability. If the information is contradictory or missing it will seek further information. Anxiety/arousal will spur this seeking. Anxiety will continue until the brain is satisfied with its cause/effect organizational answers.
One part of this ability allows us to perceive objects according to their function in the human world. We perceive a chair turned upside down as still a chair because we know the object’s function. A three year-old child with normal pre-textual/contextual ability will approach a toy car and push it along the floor. An autistic child may pick up the car and spin it’s wheels with his fingers. This action may be fascinating to him. For the other child, the human function of a car and car-toy is more important. This child with good pre-textual/contextual information processing skills may race the car, turn corners with the car, stuff a small model in the car, and crash it into another toy.
It is this contextual information processing ability that allows affiliation: Being one of a pair or group and then operating within that group in ways acceptable to that group.
As textual language develops it can complement non-textual skills. But non-textual skills are required to modify and modulate language in social context. The child without, or less adept at pre-textual communication skills, may develop impressive textual skills that lack contextual nuances. His words and sentences are heard as overly formal, and often devoid of cadence, and/or contain unusual cadence and prosody.
As textual skills develop without pre-textual skills and as these are used to understand and interpret the social world around us, and formulate an internal map of cause and effect and expectations, that map will become inflexible, black and white, as stark as the usual text message.
In our average social world, for example, the word “yes” can be spoken in many ways, and guided by many facial and body language cues, to mean anything from a clear affirmative to a hesitant “Maybe” and even, really, “No.” But in text, “yes” is “yes”.
It is possible to reduce the need for pre-textual, contextual information processing skills by social isolation. And, uniquely today, we can retreat to a virtual social world where meaning and organization can be found in text alone. The player of a computer game, even one with multiple players, enters that world as an expressionless alias, an avatar, and engages through text and basic actions. Strategizing may be involved but the actions range simply from aggressive to evasive. If an affiliation is developed it is developed through text and mission.
While isolation protects one from the anxiety of being part of an incomprehensible (unpredictable) social world, it leaves the brain with little to work with as it develops its maps of cause and effect, social organization, expectations of behaviour, and ways of understanding ourselves within this social world.
But for our human brains, this is an imperative. It must do this.
We have long hypothesized that some non-affective psychotic illnesses (setting aside those psychotic illnesses that can be clearly traced to seriously abnormal mood states – e.g.. feelings of exaltation, elation, power, invulnerability, extreme energy leading to a conclusion (an assessment of affiliation) that one must be a prophet, a messenger of God, or God himself) – that non-affective psychotic illnesses are the result of the brain developing a system of cause and effect, an internal map, from whole cloth as it were, because it is experiencing an inability or decay in the ability to process contextual information. The intervening state is anxiety, followed by compensatory behaviours. When these compensatory mechanisms fail, psychosis develops. **
These are the psychotic illnesses that often receive the diagnosis of schizophrenia.
Our survey used the internet to reach the family members of people who have developed psychotic illness and received the diagnosis of schizophrenia. 240 completed the survey though it required reading a long introduction and the choices were complicated.
The questions were designed to separate different pathways to psychotic illness, with five choices. Participants could choose one pathway or more than one if a combination was a better fit.
Choice one (1) implied a deficit in pre-textual/contextual information processing from infancy or childhood, with devolution to psychotic illness later.
36 chose this category alone, and 58 alone and in combination with others.
Choice two (2) implied a normal development of pre-textual/contextual information processing through childhood followed by a deterioration of this skill in adolescence.
43 chose this category alone, and 80 alone and in combination with others.
Choice three (3) implied a normal development of pre-textual/contextual information processing through childhood followed by over-interpretation of bits of information, finding meaning and linkages where none exist, or unable to filter out random and coincidental information.
16 chose this category alone, and 33 alone and in combination with others.
Choice four (4) implied a primary problem with emotional regulation: The emotional over reaction to interpersonal events followed by mistaken interpretations of them.
14 chose this category alone, and 56 alone and in combination with others.
Choice five (5) tried to separate those clinical situations in which hallucinations, hearing voices, might have been the first symptom of a developing psychotic illness.
22 chose this category alone, and 58 alone and in combination with others. Though in the comment section many stated that the confession to hearing voices came late in the illness and they then surmised it was an early symptom.
Those who did not choose a category and commented described unusual situations and/or late onset psychosis. (Onset age 40 for example, or many years of drug abuse)
Interpretation and conclusions:
A. Family members are eager to find answers and willing to spend time helping this pursuit.
B. The internet provides a very efficient way of collecting this kind of data and could be used for much wider studies.
C. The largest group of individuals diagnosed with schizophrenia followed a pattern of apparent social success in childhood, followed by developing social failure in adolescence, isolation and retreat, compensatory and seeking behaviours, and then delusions and disorganization.
D. The second largest group appears to have had pre-textual and contextual information processing problems throughout childhood, leading to various degrees of social failure. In adolescence this increases and devolves into psychotic illness.
Less common pathways to psychosis and the diagnosis of schizophrenia may not involve a failure to develop, or a loss of, contextual information processing skills, but rather begin with (3.) an affect regulation disturbance.
(4.) an uninhibited or excessive interpretive mechanism (search for meaning)
(5.) abnormal auditory, visual or tactile experiences.
Though usually 3 to 5 were observed in combinations with 1 or 2.
The diagnosis of schizophrenia is applied to psychotic illnesses that may have different causation and pathways. Our historical attempts to delineate these have relied, not on distinct pathways, but differences in the later psychotic state or outcome.
The results of this survey reinforce the need to consider the diagnosis of schizophrenia as encompassing several different illnesses. Each may have a different set of genetic and epigenetic etiological factors. If we can further delineate these pathways it will help us with early detection, screening tools, focused treatment, perhaps prevention.
Two pathways stood out:
Failure to develop pre-textual and contextual information processing skills in childhood, devolving into psychosis later.
A slippage or decay in this ability in adolescence. (Adolescence is the time of final development of the brain through a process of increasing and reinforcing neural pathways that allow adult function while pruning networks no longer needed.)
*Several words are commonly used to categorize the information being exchanged in human communication beyond, or other than, actual text (words): non-verbal, contextual information, pre-textual communication, pragmatics. The words used reflect the field of enquiry: e.g. ‘pre-textual’ in primate studies refers to forms of communication that precede the development of language (words). The linguists are fond of the word ‘pragmatics’.
We have chosen to use the words ‘pre-textual’ and ‘contextual’. Pre-textual to emphasize how this non-verbal communication precedes text and is primal. Contextual to refer to everything beyond actual text from cadence of text, choice of specific words, to facial expression, eye and pupil movements, to surroundings, situation, role, and history.
** Schizophrenia in Focus, Human Sciences Press, New York, 1983
David Dawson, Heather Munroe Blum, Giampiero Bartolucci