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More about schizophrenia and everyday life

Jan 27, 2018

The week after Tomiwa told me hears voices, I talked to my class (200-plus students) about schizophrenia. It wasn't the meeting with Tomiwa that prompted me to bring it up. It was scheduled on the syllabus to come up that next week.

After the lecture, a student comes to my office.  This guy's one of my favorites.  I'll call him "Bob". He's a musician, like me; kind of a lost soul, also like me  -- especially at his age.  He tells me he was interested during the lecture when I mentioned that people with schizophrenia sometimes see hidden meaning in things -- like thinking the TV announcer is conveying a message directly to you.

"But aren't meaningful coincidences sometimes meaningful?" he asked.  People often have a sense of meaningful coincidences in everyday life.  For instance, you're thinking of a friend you knew from years ago, and later that day the phone rings and the person's on the phone. It's common to see the events as linked in some meaningful way. 

I told Bob that, of course, I have no special insight about whether they're 'meaningful' in that sense. I told him that when I lived in California, I met a lot of people who were always on the lookout for meaningful coincidences.  Much more so than in NYC. I told him about the time I was walking with some friends in a mountainous area near San Francisco looking for a cafe'. When we turned the corner and saw a cafe', one of them looked up at the sky and said "Thank you, Universe."  Psychologists sometimes call this 'magical thinking'. There's nothing abnormal about it. (There is some evidence for an increased risk of schizophrenia among those who engage in magical thinking. But the vast majority of those who engage in magical thinking never suffer psychosis.) 

Bob tells me that he recently had what felt like a meaningful coincidence.  He'd been majoring in engineering at City College (here we just say "City"). Engineering wasn't for him.  He wasn't doing well in his courses, and didn't enjoy the work.  But he couldn't get himself to change majors. In part, it was that he didn't want to disappoint his parents. One day in the subway on his way home from City College, a homeless man holding a bag stumbled, the bag fell to the ground, and a book on Engineering fell out.  Bob saw it as a sign that sticking with engineering wouldn't end well for him. (The guy appeared to be homeless after all.)  It's what helped Bob finally decide to switch majors.

"What do you think about that?" he asked, meaning whether he'd really experienced a sign that day in the subway.  I told him that it sounded to me like he was already leaning toward dropping engineering before he got on the subway, but couldn't quite pull the trigger on the decision.  It seemed likely to me that the man in the subway had the Engineering book with him for reasons completely his own, and really wasn't there to provide a sign. Having said that, I can understand why it would feel so meaningful, and how it bolstered his resolve to switch majors.   Whether these kinds of coincidences are forced by the universe, of course I don't know - but it wouldn't be my assumption.

We talked about the fact that we often have to make decisions in life -- like staying with a field of study or a job we don't like. A change can feel risky.  Often we don't have enough information to know whether a particular decision will be best, and sometimes we have to make decisions without knowing.  Seeing that book fall from the homeless guy's bag helped Bob to go with his gut and make a change.  It was a helpful event. But it might also be good -- and of more lasting value -- for him to become more comfortable making those difficult decisions, the ones that feel right, even without a sign from above (or below, or inside, or wherever).

An Unusual Meeting

Dec 26, 2017

I was walking down the hallway to my office at City College, I saw a student from west Africa who'd taken a class with me. "Hello Professor" he said, smiling.   When I'm in the Psychology building, I often bump into students who've been in my class because one of my classes "Brain, Mind, and Experience" has over 200 students.  This student had a large shaved head and a kind face.   

"I was in your class and I received an A" he told me.

"That's great," I said.  I asked him his name, and we shook hands. Here I'll call him Tomiwa.

Soon I received an email from Tomiwa.  "Dear Professor, I saw you in the hallway last week. I told you I'd received an 'A' in your class, and you were delighted. I am applying to medical school and was wondering if you would write me a letter of recommendation."

I don't know about "delighted", but I did want to help. I emailed him that perhaps we could meet, and he could tell me more about himself before I write him the letter.  When we met, I learned that he arrived with his father to the United States when he was a teenager.   His mother and brother were already here.  He took courses at a community college in NYC, did well, and transferred to City College. He told me his interest in medicine came from seeing several of his family members deal with serious medical difficulties.  I liked him a lot, and told him to come back the next week for his letter of recommendation.

He showed up the next week, and I gave him the letter in a sealed envelope.  It spoke of a young man from Africa, mature and kind, who overcame difficulties to live and study in New York with great success.  "Thank you," he said.  "And professor, there's something else I wanted to tell you."

Sitting at a small round wood table in my office, he smiled and said "I wanted to tell you that I hear voices".  I looked at him and nodded as nonchalantly as I could, as if he'd told me that he likes his eggs poached rather than fried.  "Are you hearing them now?" I asked him.

"No.  I take a medication."

"And that reduces the voices?"

"Yes," he said.

We talked for about ten minutes about his experience with the voices, we shook hands, and he said goodbye.

I love cafes, and it's not about the coffee

Dec 3, 2017

It's chilly today. But outside the Silver Moon Bakery on Broadway uptown there's some sun.  In a down jacket with a cup of hot coffee you can sit at one of the little tables outside without feeling cold. And you can type on your laptop keyboard, and write about being outside the Silver Moon Bakery on a chilly day.

I was at the Hungarian Pastry Shop for breakfast this morning and saw a friend sitting at a table near the entrance. We talked about what makes one coffee place feel friendly and sociable, while another's cold and impersonal.

The Hungarian is friendly.  Often you share a table with a stranger because there are too many customers for everyone to sit at one of the fifteen tables alone. Most of the tables seat six, so you still have some personal space. But sometimes people start up conversations, say good morning, or just smile when they leave.  I almost always see a few people I know.  Not close friends, but people I can kid around with for a few minutes before we start to read or work.  In the mornings, I often have my coffee and croissant with guys I've come to know over the years. We talk about things we're reading about, thinking about, things we find funny or interesting, like "What makes the Hungarian so much friendlier than other cafes we've known?".

There's a Starbucks one avenue west of the Hungarian.  It's the same neighborhood, but hard to imagine ever having a conversation with anyone there.  At the Starbucks, I keep to myself  like most everyone else. The solitary norm doesn't just come from their small, individual tables. There's a large table too, but that's a last resort. It's where you sit when there are no other tables available. When you find yourself stuck there, you keep your eyes right in front of you, and don't shift your gaze to others.  Sometimes it makes me sad.  I'm surrounded by people seated nearby, and a part of my brain subconsciously expects a feeling of social connection.  But no.

At the Hungarian, when you order at the counter, they ask you your name, and when your order's ready, a waitress finds your table by shouting out "Jon?" Can you imagine someone at Starbucks bringing your coffee to your table? It would be a big change, and probably not the kind of change Starbucks is looking for. 

The Hungarian is much livelier than Starbucks, but it has no music.  At the Hungarian, the only sound is of people talking, laughing, a waitress shouting "Jon?", "Julliet?", two women at the table in front of me speaking French, the sound of the milk steamer, more talk and laughter,  "Bob?".  A minute later, again "Julliet?".  Julliet's at one of the tables outside.  The waitress carrying the almond croissant and cappuccino will find her.

But that was hours ago.  At the Silver Moon, where I'm now sitting outside in the cold and typing, there's no social interaction at all.  It's a take-out bakery with a few small outdoor tables. Anonymity, but just what I need right now to type this post.  As much as I enjoy feeling connected to others, it's nice to be able to titrate social interactions -- not too much not too little.  I'm adjusting my dose.

Humans aren't the only animals to titrate their rewards.  Rats will enthusiastically press a lever to receive intravenous cocaine, but they don't press as fast as they can to get as much cocaine as they can. Instead, they press for some cocaine, and wait until they're ready for their next dose before pressing again. Say a rat receives an injection of 1 milligram of cocaine each time it presses the lever, and presses the lever once each minute.  If the experimenter now delivers only half as much cocaine for each lever press, the rat will press the lever twice as often.  It adjusts its behavior to maintain its preferred level of cocaine. It likes cocaine. But it wants the amount it wants at the time it wants it.

Pleasure seeking doesn't have to mean identifying the rewards you like best, and gorging on them. 
Ideally you consume the amount you want at the time you want.

Right now, I don't need a high dose of social interaction. I'm glad to be alone, anonymous, sitting outside, typing this blog post.  And the truth is that, as I type, I imagine you reading this, an imagined 'you', and that does give me a feeling of social connection. It doesn't matter that you're not outside this bakery with me sitting in the cold, or inside the warm Hungarian Pastry Shop waiting for the waitress to bring us coffee.  It's still a friendly connection with another mind.  Maybe you feel a hint of the connection too, wherever you are.