PSYCHOSIS
Broadcast starting week of November 29, 2000

Psychosis: It's the frightening state of mind that most of us equate with "madness": delusions, paranoia, hearing voices. In truth, as many as 120 different conditions can cause psychosis, including drug and alcohol abuse, metabolic disorders, thyroid malfunction, head injuries, Alzheimer's and reactions to prescription medication. In this hour, we'll hear from an actively psychotic person, from successful individuals who've experienced psychosis and recovered, and from experts. Later in the program, we change directions to hear about new developments in neuroscience. Guests include: singer/songwriter Dory Previn, political consultant and former New York Times reporter Bob Boorstin, psychiatrist Dr. Murray Claytor; graduate student Leslie Greenblat, Dr. Wayne Fenton of the National Institute of Mental Health and Nature Neuroscience editor Dr. Charles Jennings.

The program begins with a visit to Hillside Hospital in New York, where we hear from a man who checked himself in to a psychiatric ward because he was experiencing psychosis marked by paranoia. He talks about his feeling that he's being watched and followed and that people are plotting about him behind his back.

Next, Bill Lichtenstein, president of Lichtenstein Creative Media and executive producer of The Infinite Mind, hosts a panel discussion with three people who have recovered from psychosis. Lichtenstein, a former ABC reporter, founded the company after his recovery 10 years ago from manic depression. His guests include political consultant Bob Boorstin, a former New York Times reporter and aide to President Bill Clinton; psychiatrist Dr. Murray Claytor, who now works with people with psychosis; and Leslie Greenblat, a graduate student at Johns Hopkins School of Public Health. Mr. Boorstin, like Mr. Lichtenstein, has manic depression; both Dr. Claytor and Ms. Greenblat have schizophrenia. The four discuss and compare their experiences with psychosis, which emerged gradually but eventually completely obscured reality for all of them. "You construct your own reality … over time what you've done is built an alternate reality," Mr. Boorstin says.

Next up, host Dr. Fred Goodwin talks to Dr. Wayne Fenton, a deputy division director for clinical affairs at the National Institute of Mental Health www.nimh.nih.gov and a researcher in schizophrenia, a leading cause of psychosis. Among his other accomplishments, Dr. Fenton wrote much of the material on psychosis for The Merck Manual www.merck.com/pubs/mmanual, a diagnostic tool for doctors and the world's most widely used medical text. Dr. Fenton explains that psychosis is a symptom of more than 120 different conditions, including kidney disorders, substance abuse, reactions to prescription medication, hyperthyroidism, deafness, head injuries and Alzheimer's, as well as depression, manic depression and schizophrenia.

Dr. Fenton discusses auditory hallucinations, in which affected persons hear "voices" in their heads, so clearly it's as if they were real. The volume of the voices can be tremendous, he says -- often the equivalent of 8 or 9 on a scale of 10 on a stereo. He says that this inner turmoil is only visible in 10 to 15 percent of psychotic people in whom the hallucinations are most severe, and that most people keep them hidden for months or even years before they seek treatment. The first sign of difficulty on the outside is often that the affected person pulls back, shunning contact with the outside world while they deal with the noise within.

Another hallmark of psychosis are delusions, he says, false beliefs that the person believes completely, without doubt. They can range from believing the have tremendous special powers or hatching huge business schemes to believing that a spouse is unfaithful. A common delusion is the feeling that they are being watched by a powerful force such as the CIA or the Pope.

Drs. Goodwin and Fenton discuss the public image of psychosis and compare it with the research on that subject. Dr. Fenton says that people who are psychotic are far more likely to be the victim of violence than a perpetrator. Public opinion is shaped, he says, by a few high-profile cases like the man who shot up the Capitol building. For every one case like that, he says, there are probably two or three million people quietly dealing with a psychotic condition.

Next, Dr. Fenton discusses what's going on in the brain during psychosis. He says there is evidence that psychosis springs from a defect in the brain's filtering system, probably located in the thalamus, which distorts the mind's ability to determine whether information is coming from inside the body or from an outside source. The neurotransmitter dopamine appears to be involved; in fact, psychoses arising from met amphetamine or cocaine abuse can be treated successfully with agents that block dopamine. Those same agents are also effective in treating psychosis in schizophrenia and manic depressive illness, he says.

The two psychiatrists talk next about new medications now being used to treat psychosis, which are far more effective and have fewer side effects. The new medications are helping millions of people recover from psychosis, Dr. Fenton says, people who perhaps spent 20 years in a psychiatric hospital hearing hallucinated voices, afraid to speak for fear of attack.

Next up, The Infinite Mind's June Peoples chats with singer/songwriter Dory Previn, who has schizophrenia. Ms. Previn was nominated for an Academy Award in 1969 for the theme song of the movie "The Sterile Cuckoo." Ms. Previn reads three of her songs: "Mythical Kings and Iguanas," "Mr. Whisper" and "20 Mile Zone," all of which were written in a psychiatric hospital. Mr. Whisper is about her "wild imaginary friend" who speaks to her, one of the "voices" of her schizophrenia. Ms. Previn says she became much healthier when she was able to integrate her four "voices" -- which she still hears -- into her life, mental processes and work. She has just completed a new stage play "Schizoo," based loosely on her life. The play incorporates much of her previously recorded music as well as some new songs.

Changing directions, Dr. Goodwin's next guest is Dr. Charles Jennings, editor of the scientific journal Nature Neuroscience. Dr. Jennings talks about new research from Princeton's Dr. Joe Tsien, whose genetically engineered "smart mouse" made headlines a few months ago. Dr. Jennings says Tsien's latest mouse was engineered with a defective memory. Although the mice were created genetically incapable of forming new memories, the inherited defect was cured by placing the mutant mice into a giant mouse playground. Most interesting, Dr. Jennings says, is that the mice were the equivalent in age of a human teenager, tending to cast some question on the current thinking that birth to three years is the most critical time in childhood for learning.

Next, they talk about research that provides new information about the underlying cause of a brain disorder that sent 700 Japanese children to the hospital two years ago after watching an animated cartoon, "Pokemon." (which shortly thereafter became a phenomena in the U.S.) The condition, which caused reactions ranging from headaches to convulsions, is called "photo-sensitive epilepsy," and affects perhaps one in every 200 children. The new research indicates the children are vulnerable as a result of a defect in the brain's "contrast control" function, rendering them less able to compensate for differences between very bright and very dark visual cues. Dr. Jennings says photo-sensitive epilepsy is becoming an increasing problem due to the high contrast and rapid flickering of many animated video games.

They also discuss the results of recent research stemming from an experiment that was part of the Neurolab space shuttle mission. The study explored the effects of zero gravity on the function of the hippocampus, the part of the brain that monitors spatial orientation and helps us know where we are at any given time. Researchers suspected that spatial orientation would be negatively affected by the loss of feedback about gravity from the inner ear. But surprisingly, the brains of mice showed they were able to overcome that, and navigate normally through a maze. Click here to visit the Neurolab website. Neurolab researchers were guest on The Infinite Mind's program "Better Living Through Chemisty," which originally aired in May, 1998.

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