Considering Immune Response as a Factor in the Development of Schizophrenia and Bone Marrow Transplantation as Treatment

In 1927 a man named Julius Wagner-Jauregg did something fascinating, he began treating patients with severe psychiatric illness by inoculating them with malaria virus. He went on to win the Nobel Prize in 1927. And while Jauregg mainly treated patients with illnesses like syphilis and dementia, he was the first to identify how immune response and fever affected psychiatric illnesses like psychosis and catatonia. The patients who survived long enough for the treatment to work eventually recovered or had significantly improved quality of life.

It would be a leap to say that he cured them. He didn’t. What he did do, however, is set the stage for later research into the immune response is a factor in the development of Schizophrenia. Further, it may no longer be an unwarranted leap to suggest that bone marrow transplantation and low dose antibiotic treatment may help or even eliminate Schizophrenia and its symptoms.

If you’ve ever known anyone with Schizophrenia or, like me, have it yourself, you understand how difficult the condition can be and what it can take away from you. Most frequently developed in a person’s early twenties, the condition is one of the most disabling diseases documented and for some may even be degenerative.  Ranging from effective to severe and manifesting in several subtypes including catatonic, paranoid, disorganized, early onset (childhood), and Schizoaffective Disorder, it affects everyone equally with no racial or sexual preference. Schizophrenia can have genetic components, with the chances of development increasing in the children of parent(s) who have it but can also affect a person with no family history of psychiatric illness.

Until recently, the typical treatment for Schizophrenia consisted of antipsychotic medication, sedatives, mood stabilizers, and antidepressants. These medications, while integral to the process of recovery, often come not without severe and/or damaging side effects. Antipsychotics can have lasting damage to the body if taken over a long period of time. Antipsychotics can also cause significant weight gain which can lead to cardiovascular disease risk and diabetes. However, scientists now have a new treatment to consider: bone marrow transplants.

Incredibly, in 2017, a man who had been diagnosed with Paranoid Schizophrenia at twenty-three, developed cancer at twenty-four, and in an effort to treat his cancer, a bone marrow transplant ended up curing both his cancer AND his schizophrenia. Similarly, a man without schizophrenia developed the illness after receiving a bone marrow transplant from his schizophrenic brother. If a bone marrow transplant can cure or induce psychosis, naturally, the immune system must play a role in the development and symptomology of schizophrenia and other psychotic disorders, as bone marrow transplants essentially reboot a person’s immune system.

Historically there is a great deal of evidence that points to the immune system playing a huge role in schizophrenia.  In their case report, which reviews the evidence that supports a bone marrow transplant causing a remission of schizophrenia, Miyaoka wrote, “Although schizophrenia is regarded as a syndrome with different biological backgrounds, involvement of immune system disturbances could be one of the common mechanisms. The association between maternal infection and neurodevelopmental disorders is long-standing but not without controversy. After the 1964 rubella pandemic, the incidence of schizophrenia rose from less than 1% in the unexposed population to about 20% in the exposed population. Subsequent studies charting historic outbreaks of flu, measles, mumps, chickenpox, and polio have revealed an association with schizophrenia.” The New York Times has even reported about a recent study in which a woman with schizoaffective disorder was relieved from her psychotic and depressive symptoms after a dangerously high fever. 

But this doesn’t come without risk, as bone marrow transplants are extremely risky and require weeks of chemotherapy and isolation. This idea of treating schizophrenia with something other than heavy medication and long-term hospitalization feels like a step in the right direction. Furthermore, the possibility that we might come to fully understand the mechanism behind the development of schizophrenia would, automatically, help us to understand how to prevent people from developing it all.  Of course, scientists can’t confirm if the immune response is the cause of all types of schizophrenia. Some schizophrenias maybe be driven solely on the dysfunction of serotonin and norepinephrine, while other types may be autoimmune diseases masquerading as schizophrenia or psychosis. In the previous case study highlighted, Miyaoka wrote, and it is important to remember that, “…[a] single case report, we apparently cannot confirm an immune pathogenesis of schizophrenia. However, several reports support the theory that immunological system is one key factor of pathogenesis of schizophrenia.” As time goes on people with or affected by schizophrenia can only hope that these possibilities become more solidified.

Psychosis can be beautiful, but there isn’t a single day I wouldn’t prefer to live without it. Would I try something as risky as a bone marrow transplant to cure me? I’m relatively high functioning. But I’m only high functioning on my medications. Off my meds and I’m sure many people wouldn’t even recognize me. I would very much prefer not to have to take all of these medicines for the rest of my life. And even on my medications, I’m still hearing voices constantly. I’ve been hearing voices for so long now I don’t even really remember what it was it was like to not hear them. I would risk a procedure like this if it meant security and protection from schizophrenia. If I wouldn’t ever have to worry about my medications stopping working. If the world could be quiet again. Then I’d do it.

I can’t imagine living in a world not haunted by mental illness, not stalked by twinges of paranoia, not exhausted by an utter lack of motivation to do anything more than breathe, not living a noisy life even when it’s actually quiet, not living under the thumb of psychosis, or held down by the big, wet blanket of depression, not waiting to be tossed into a manic episode. To avoid never having another hallucination or delusion again I’d do anything.

These are things someone with schizophrenia lives with. We live with the fear that our symptoms bring and fear of stigmatization. Schizophrenia and it’s related disorders impact every part of the person who has it.  And any glimmer of hope, any sign of a cure, is reason enough to pursue the possibility to its end.

 

 

Chen, S., Tvrdik, P., Peden, E., Cho, S., Wu, S., Spangrude, G., & Capecchi, M. R. (2010, May 28). Hematopoietic origin of pathological grooming in Hoxb8 mutant mice. Retrieved April 6, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/20510925

Miyaoka, T., Wake, R., Hashioka, S., Hayashida, M., Oh-Nishi, A., Azis, I. A., . . . Horiguchi, J. (2017, September 21). Remission of Psychosis in Treatment-Resistant Schizophrenia following Bone Marrow Transplantation: A Case Report. Retrieved April 6, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613125/#B26

Sommer, I. E., Bekkum, D. W., Klein, H., Yolken, R., Witte, L. D., & Talamo, G. (2014, October 06). Severe chronic psychosis after allogeneic SCT from a schizophrenic sibling. Retrieved April 6, 2019, from https://www.nature.com/articles/bmt2014221?draft=journal

Velasquez-manoff, M. (2018, September 29). He Got Schizophrenia. He Got Cancer. And Then He Got Cured. Retrieved April 6, 2019, from https://www.nytimes.com/2018/09/29/opinion/sunday/schizophrenia-psychiatric-disorders-immune-system.html

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Radical Acceptance is cool

“It’s all in your head.”

I’ve been fighting chronic health conditions for years.

Every day when I didn’t want to get up I knew I couldn’t give in. But it wasn’t always so easy for me. When the voices started I listened to them. When they told me to hide I hid. When they told me to stay in bed I pulled the pillow back over my head. When they told me that there was a higher power, unnamed though it was, that whispered when the wind blew, I prayed to the wind. When they told me I was a piece of shit I believed them. When they told me my medicine was poison I dumped them down the toilet. I ate when they said I could and didn’t eat when they wouldn’t let me. I counted the patterns in the colors of the cars that drove by me.

When they suggested I kill myself I gave it my best shot.

Now I’m glad I’m here, alive, breathing, thinking, writing and creating. I’m glad to see the sunrise and the wind doesn’t whisper like it used to.

I used to have visual hallucinations. More real than you in front of me. More real because that’s what my brain told me. So real that I felt their breath sometimes, felt their fingers on the back of my neck, saw their eyes move as they watched me. You can’t know what it’s like to hallucinate until you have.

My last visual hallucination was of an alien set upon reading my mind by sticking his fingers in my brain. That was three years ago. My brain’s last attempt at lying to my eyes. Though sometimes it still plays tricks and I see red cats out of the corner of my eye.

But the voices, they never stopped. They’ve been a constant part of my life for about five years now. It’s never quiet. There is never an instant of silence. It sounds like a beehive inside my head. Like a congested subway. Like a too full elevator. It sounds like panic and sadness and mania and anger. Some I can understand and some I can’t. Some sound like a radio in the other room. Some voices sound like voices sound. Some sound like dull hum of white noise. Some come from outside my head and make me turn around, scan the landscape or the crowd. There’s never a source, at least not one other than my own head.

Not to be confused with, “It’s all in your head.” One thing I’ve learned is to never let anyone get away with saying that. As if your brain isn’t part of your body. As if they don’t function as a whole. As if they don’t work together to create absolutely every experience you’ve ever had, every feeling you’ve never felt, every movement you’ve never made, any sound you’ve ever heard, every taste you ever tasted. You cannot have one without the other. The brain and body exist together, one thing that has one goal. When you are sad it’s the whole body that is sad, and when you cry it’s the whole body that cries. It’s the whole body that becomes tired. It’s the whole body which achieves happiness. It’s the whole body which becomes sick. You cannot have the oceans without the moon, or day without night, or spring without winter.

It’s with my entirety that I have Schizoaffective Disorder, it’s my entirety with which I fight. It’s my entirety with which I breathe. This how all things exist. With their entirety.

I’ve learned that my hallucinations are part of me. It’s who I am. Illness is a part of me. But life is a part of me too. Happiness is a part of me. And my body and my brain, they are me.

“It’s not all in my head.”

“It’s all of me.”

You cannot fight a war against yourself. Instead, you’ve got to learn to live with yourself. You’ve got to learn to be gentle with yourself. To let yourself breathe and sleep and wake and you’ve got to move and experience. But that’s all. If you can’t bare anything else today, just exist. Exist from where you are. Life can’t ask anything more from you.

Just exist and tomorrow try and exist a little bit more.

Wise Mind

“I’ve seen Schizophrenics do great things and then crash,” he said, a quiet voice in a quiet room. Quiet dust settled on a thin sunlit window sill. Hot tension settled, “Avoid anything that gives you any stress at all.”

I looked at the doctor but didn’t say a word, angry words trapped behind my teeth.

Great things aren’t done by avoiding hardship. I thought about the upcoming school year. It’s wasn’t going to be easy. But then, to defeat your diagnosis is a brave thing. It’s scary, and all along the way, people will like to tell that you can’t overcome what you have set out to do. Schizophrenics being gravely disabled aren’t only faced with challenges that any disabled person might face, but we are stigmatized too. Most recently I’ve been told  I won’t be able to be aggressively intelligent, a skill I will apparently need to do well in college.

The first time I was ever told there was something wrong with me it was third grade. The smell strawberry scented markers filled the air. I held my marker clumsily in my hand. I don’t remember what I’m writing with it but I remember the wind blowing lazily through two purple curtains. The breeze is warm so it must still be September. The class pet, a white mouse, is sleeping in his cage. It’s close to the end of the day.

There is a fuzzy nagging at the back of the head. Like a string being tugged on. Then there is a voice. A voice which only I can hear. Creeping up my body like a ghost and leaving thoughts in my brain.

There was a great stillness in my throat.

I couldn’t draw a straight line. I couldn’t adhere to the margins of a page, all my writing coming out crooked. Mixed with my poor handwriting it became a problem for the teachers.

An Occupational Therapist came twice a week and tried and help. Holding my hands still and making me solve mazes. She thought that maybe there was a disconnect between my brain and my hands. She always wore skirts with animals on them. Blue skirts with dolphins and pink ones with pigs. By the time I stopped speaking the school didn’t know what to do with me so they decided to hold me back. I guess I was awkward socially. I don’t remember a whole lot of that year, just that the voices started.

By the sixth grade, I believed I had magical powers that my friends didn’t. Most of my school day was spent staring at the classroom door and wondering what might come through it. Monsters, aliens, a demon sly on two black wings. Math was an issue for me, the voices reciting lists of numbers as I tried to work through problems. I saw a six and all I could hear were lists of twelves.  A thirteen and I could only hear sevens and eighteens. I never had a problem with the written language though, the voices inciting phrases and words for me. Helping my sentences to flow.

The third time I learned there was something wrong with me I was looking over the shoulder of a police officer. I was watching a grainy tape of myself, interacting with nothing. My blue Rite Aid work uniform black and white. Surrounded by shampoo bottles. Not a person in sight, though apparently, I thought so. I was in high school and although I had started speaking years ago, so had the visual hallucinations.

The fourth time I ever learned that something was wrong with me. I burst into tears in the middle of math class. Unable to breathe. A pale darkness surrounded me and outside the classroom window, I saw the same man I had seen at Rite Aid. Suddenly I was being escorted down to the Social Worker’s office. Then an ambulance with giant lights and loud sounds. Then a hospital. But this hospital was a different kind. It had doors that locked you in. In this hospital, they take the shoelaces from your shoes. All of your belongings are tied up in plastic bags. There is an old pay phone on the wall. Grimy from years of use. There are empty rooms. And there are crowded rooms where all the patients huddled around windows that looked out onto empty parking lots. Nurses come by and give you medications. Food gets brought up to you. There is a security guard with a taser. And a nurses station behind a wall of glass.

It wasn’t a healing environment.

I stayed there for three weeks.

That fall I went to college. I’d been living on my own since my first hospitalization. After six more hospitalizations, a bad psychiatrist, and a dozen or so medications I had grown accustomed to how many things were wrong with me.

“You’re sick, you need to be here right now.”

“Take this med or we’ll make you take it.”

“There won’t be any beds for a week, but you’re too sick to go home.”

“Don’t tell anyone about your diagnosis.”

“You’re not safe to be on campus.”

“You’re a liability in the classroom.”

“You’re diagnosis is a death sentence.”

Dust settled on my textbooks, heavy doses of anti-psychotics dulled my mind. Turning it to a beehive, amess with chatter but sticky with honey. I couldn’t think. I couldn’t move. So I dropped out of college. And became the image of the person my doctor claimed I would become.

For three years I let myself heal. Body and mind. I found a dose of a medication that worked for me. Finding that medicine was the catalyst that calmed the storm. A riled sea slowed inside of me. I could now pick up the debris which littered my brain.

I turned back to writing for the first time in years. I used writing to create a reflection of myself that I could understand. Coming to terms with being sick. Even though Schizoaffective Disorder is life-long, it’s still a life worth living.  I learned that I could use my voices as a gift, letting them express themselves through words. After a few publications, I realized that it works. I started a blog to allow my voices to stretch their legs. They’re part of me, I can’t keep them cooped up forever.

As my brain slowly clears, I’ve made the big decision to return to school. To pursue something which I’ve was told I’d never reach. I’m braver now than I’ve ever been. Any life is a life worth living, and any knowledge is knowledge worth learning. I learned in Dialectical Behavioral Therapy that to function properly one has to balance rational mind with emotional mind. Doing this creates a calm that exists between the two: wise mind. A place we can all find peace. School teaches me the same thing. I’ve learned to balance my school work with my illness. The best example of emotional mind and rational mind that I encounter on a daily basis. Academia and Schizophrenia, place in which I find peace.