Why Do Congenitally Blind People Never Get Diagnosed with Schizophrenia?

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“A long-standing enigma in psychiatry has been why no-one has been able to find someone who has both congenital blindness and a diagnosis of schizophrenia,” writes Mind Hacks. And a new study into the phenomenon published in Frontiers of Human Neuroscience “raises more questions than it answers.”

“I have to say, I find the concept of schizophrenia to be fairly useless,” writes Mind Hacks. “But if the increasingly plausible hypothesis that congenital blindness protects against psychosis is confirmed, it has interesting implications for those that argue that psychosis is nothing but the result of marginalisation, stigma or difficult life circumstances where biological explanations are irrelevant.”

More on the enigma of blindness and psychosis (Mind Hacks, November 14, 2014)

39 COMMENTS

  1. Any MIA readers willing to taking on this question? My guess is that it has something to do with the congenitally blind being in a protective environment all their lives. They are not thrust unprepared into the world at age 18 and expected to be independent.

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    • Well, first of all “biological” explanations are not irrelevant since it’s well known that untreated vial infections and certain drugs can promote psychosis so it may well be possible that a certain part of the population is immune to it somehow. It does not negate the fact that so far most psychotic experiences are linked to chronic stress, neglect and abuse.
      The other thing which is entirely possible is that congenitally blind people have psychotic experiences that elude “diagnosis”.

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    • There are cases of congenitally blind people who developed schizophrenia. The important observation is that they are all of a specific type in terms of origin of the visual deficit. I am one of the authors of the original study in Frontiers in Human Neuroscience (the study that Mind Hacks presents) and this is one of the crucial points raised in the study. You can read more about it here http://journal.frontiersin.org/Journal/10.3389/fnhum.2014.00940/abstract. Thank you for your interesting comments on this topic.

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  4. The very idea that it could only be the environment that could cause something so profoundly altering as schizophrenia is more disturbing in itself than any abuse Psychiatry could think up in the last 40 years.

    Since there has been evidence of schizo-typical subtypes and other related, mental conditions along family lines, I assume there are also adoption studies supporting the same.

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    • In fact that is the case. However, a poor upbringing and trauma affect individuals with schizophrenia just as they affect everyone else. However such things have not been proven to cause schizophrenia, which is present from birth. Most of the people I have cared for with schizophrenia, had prodrome(mild symptoms) or very obvious symptoms from birth or very early on in life, including hallucinations, decades before obvious symptoms or diagnosis.

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      • “Most of the people I have cared for with schizophrenia, had prodrome(mild symptoms) or very obvious symptoms from birth or very early on in life”

        Have you published this information? Do you interview the mothers to tell you what Johnny was like in utero, as an infant, as a toddler, etc. ? No psychiatrist I ever came across was remotely interested in this type of information. And, that might be a good thing were it not the fact that their solution was to just hand out drugs.

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    • “The very idea that it could only be the environment that could cause something so profoundly altering as schizophrenia is more disturbing”
      Why? Environmental conditions can cause many serious health problems, without any well-defined genetic risks involved (nobody is trying to claim that susceptibility to strep infections or most types of cancer is a genetic trait though surely some people are more susceptible than others) so why do you think that “schizophrenia” cannot be environmentally triggered?
      The search for schizophrenia genes has brought nothing of value for clinical practice and the drugs are at best what pain-killers are for chronic pain so maybe it’s time to change the perspective.

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  5. Just more nonsense. People who are congenitally blind DO get diagnosed with schizophrenia. I’ve taken care of several individuals myself with exactly those two conditions.

    What a bunch of lies and nonsense MIA loves to spread around.

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      • They do nothing to evaluate the information to see if it is legitimate or makes sense before they post it. If it supports their agenda, they print it, without a single thought as to whether it makes any sense or not or has any backing.

        THAT is wrong.

        They ALSO publish everything they publish, without ANY effort to represent other opinions on the subject.

        THAT is also wrong.

        There is absolutely zero critical thinking involved. It’s all based on emotion and appealing to peoples’ impulses.

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          • No he only reports what he feels like reporting. The coverage is extremely bad – he only reports what supports his agenda. It is so one sided it is sick. It is disgusting. Everything else is ignored as if it doesn’t exist. To the severe detriment of those with schizophrenia.

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        • “If it supports their agenda, they print it, without a single thought as to whether it makes any sense or not or has any backing.”

          Maybe you should pay heed to your own criticism and provide some documentaion?

          Oh, and what was that “agenda” again?

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          • The agenda is very clear: to prevent people with schizophrenia from getting the help they need; to make SURE they do not get any effective help. In other words, to exterminate them. AND to convince them this disease is due to some trauma or inner flaw of theirs, which is absurd.

            You weren’t there when my friend went over to his father’s house to kill him, after reading claptrap that you publish against treatment. You’re not there when it comes to cleaning up the mess or mourning the dead. You’re conveniently busy at that time, the whole lot of you.

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          • “convince them this disease is due to some trauma”
            Trauma is one of the most predictive factors for “schizophrenia” so it’s not absurd – it’s a fact.
            “or inner flaw of theirs”
            That’s what the biological model entails – your brain is sick, it has some flaw in it’s chemistry, wiring or what not.
            Some people who write here have experienced psychosis themselves so what is their agenda? Are they trying to “exterminate” themselves?

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        • Tusu: A number of your assumptions are incorrect. I do in fact put thought into what I post on MIA. First, I am guided by MIA’s mission, which is to engage people in “rethinking” psychiatry while critically questioning dominant points of view in “mental health.” Second, I am guided by whether or not I think the point of view, opinion, news story, or scientific research that I am summarizing and linking to seems to me to be interesting, reasonably well formed, and something that MIA readers may wish to read and consider for themselves. And while doing that, I generally do not provide my own commentaries on or evaluations of those articles — “In the News” and “Around the Web” are to be distinguished from the MIA blogs in that way. (Though of course it is impossible to be completely neutral in how one summarizes someone else’s writing, so again, I am guided by MIA’s mission.)

          In this particular case, Mind Hacks seemed to me to be raising reasonable questions about some interesting extant facts, opinions and research on this topic, and about what they could mean. The original study cited by Mind Hacks also clearly raises many questions, while citing papers from a number of influential psychiatry, psychology and neuroscience journals. So that is just to say, if you think that I am not reflecting critically enough before I decide to relay for MIA readers’ consideration some people’s arguments that “congenital blindness seems to be protective against schizophrenia,” then I surmise you are by extension leveling the same criticism against the journals Frontiers in Psychology, Frontiers in Human Neuroscience, Behavioral and Brain Sciences, Schizophrenia Research etc, all of whom have published studies and discussions of that topic. If you are indeed meaning to criticize those journals as well for too often rashly rushing to publish spurious psychiatric research without sufficient critical thought, then on that we are in agreement — our society generally does not think critically enough about psychiatry. That said, though, the counter-evidence that you yourself have so far presented to make the argument that I should never have posted a link to this article — several cases that you personally diagnosed and a statistical analysis that should actually give us thousands of cases around the world if we could but find them — does not seem to me yet to be better than the evidence presented in some of those journal articles. Though you may want to consider writing your case studies up and publishing them? (Although on second thought, I realize your 1 in 10,000 number would actually translate into tens of thousands of cases of combined congenital blindness and schizophrenia in the US alone, wouldn’t it? — perhaps explaining why most people are expecting to find more than just a small number of cases here and there in the literature.)

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        • Gee, you seem to have a bit of an agenda of your own, Tusu. “People who live in glass houses shouldn’t throw stones.” I’d find it more helpful to read the research you shared without the snide anti-MIA comments. It’s kind of odd that you’d choose this article to pick on, however, since the article’s premise directly challenges the “agenda” you appear to be critiquing. If congenital blindness really does reduce the likelihood of a schizophrenia diagnosis, doesn’t that suggest a more physiological underpinning, which is just what you’re saying MIA is biased against?

          Anyway, I’d appreciate it if you’d keep your comments to direct responses to the article and any data you have that contradicts or fleshes out the picture. You already know that the basic agenda here, such as it is, would be to critically explore the current assumptions of psychiatry and to look at alternative viewpoints and approaches. If you don’t like that agenda, feel free to read some bloggers that support your views. There are plenty out there. Your need to make constant comments on the “agenda” at MIA is nothing but unhelpful trolling behavior, and it discredits your otherwise interesting information which you shared below.

          —- Steve

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  6. NB:
    There are other studies on this matter –
    The conclusion that there are no C/E blind people with schizophrenia is based on a small number of studies that involved relatively small samples. Clearly, this argument would be strengthened by larger, population-based studies. This is because, as a simple calculation demonstrates, a case of congenital blindness and schizophrenia would be extremely rare even if there was no protective effect of blindness: if schizophrenia occurs at a rate of 0.72% in the population (McGrath et al., 2008) and congenital blindness occurs at an estimated rate of 0.03% in people born in the 1970s and 1980s (based on Robinson et al., 1987), then the joint probability of a person having both conditions, if the two are independent, would be 0.02% or 2 out of every 10,000.

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  7. And in fact, I just found a Finnish study from 2007, that states they found that visual impairment(near or far vision), is actually rather common among people diagnosed with schizophrenia. So visual issues are hardly spared, and as I stated before, I took care of several individuals who were blind from birth who had schizophrenia – very clearly and obviously. No grey area. Further, since the schizophrenia diagnosis requires numerous symptoms to be present and is a fairly narrow diagnostic category, many individuals fall just outside criteria, and in past, were diagnosed with ‘Psychosis NOS’, when for all practical purposes they had schizophrenia – usually the difference being in the lack of ‘negative’ symptoms (not negative in the usual sense, but rather, lethargy, indifference).

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    • So, what do you think it means to “have a schizophrenia”? You seem to understand quite clearly when a person has a schizophrenia and when not. And you suggest there are perhaps other people, who also fall outside the narrow criteria, who also actually have schizophrenia, a disease which according to you is present with birth. No wonder some people these days prefer to say “schizophrenia” instead of schizophrenia.

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      • That’s a really irrational response, one that sounds clever, but means nothing.

        Schizophrenia has a very restrictive diagnostic criteria, that much is very clear. It is ‘difficult’ to get diagnosed with it, in the sense that some people are always going to just barely miss falling within the criteria. With many people, they got diagnosed with Psychosis NOS (not otherwise specified), chiefly because they had most of the symptoms of schizophrenia, but not all. This is inevitable with a disorder that is caused by many genes. Some people have only a few symptoms of schizophrenia, some have more

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        • Well, I actually got diagnosed with schizophrenia, apparently by what you call very restrictive diagnostic criteria. They also gave me diagnosis of bipolar, severe depression, etc, in a short span of time. Then I stopped taking drugs, “recovered” from “schizophrenia” and went back to work. The diagnosis for schizophrenia or psychosis did not seem strict at all.

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        • And since you are of the opinion that the diagnosis of schizophrenia (or psychosis, severe depression, or bipolar) is very restrictive and “correct”, and that schizophrenia and those other diseases are very severe, then it follows that I can go around telling people that I recovered from schizophrenia, bipolar and severe depression by my own means and techniques.

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          • Oh, and I can tell people recovering from schizophrenia wasn’t actually that hard. Or, alternatively, if I actually have schizophrenia, I can tell people it’s not that bad after all. Psychiatrists like to talk of schizophrenia like it’s their holy speciality. I can just sneeze and say, well, I had it and I recovered. Or, I have it, but it’s not as bad as people make it be, it’s actually quite nice.

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      • What does it mean to have schizophrenia? I don’t understand the question. A person can have some symptoms of schizophrenia, but not enough to qualify for diagnosis. The diagnosis requires not only several core symptoms be present, but also, some negative symptoms. Not negative in the sense of bad, but in the sense of things taken away or subtracted – so the person has lethargy, lack of goal behavior…sometimes this is so severe people don’t eat or move. I have seen several people who nearly starved to death, because they simply did not eat. That is severe negative symptoms. They are considered the most disabling, and at times the most deadly symptoms of schizophrenia.

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        • For me, neuroleptics caused almost exactly quite severe “negative symptoms”, such as sleeping 14-16 hours a day, and then being very tired and lethargic the rest of the day. I was only responding with single words, etc. Then the psychiatrist and psychologist perhaps somehow interpreted that as “schizophrenia negative symptoms” and “post-psychosis depression”. Their diagnosis were not “strict” and “objective” at all, they constantly used the diagnosis and other related concepts to validate their own delusional views. It was much worse in practice than what I had imagined it to be.

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          • I have a feeling that 90% of “negative symptoms” come from the “stigma” (people getting scared about going crazy and the reaction they will/are getting from others) as well as side effects of drugs.

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  9. Of our several senses the most externalizing is sight. A very fine presentation of blindness is found in And There Was Light by Jacques Lusseyran. Also Lawrence Durrell presents some interesting aspects of blindness in his Alexandrian Quartet–one of his characters (Pursewarden’s blind sister, Liza) is a blind woman. Myself I tend to associate blindness with inner-ness. Yogis tend to meditate with their eyes closed. In sleep we find Peace. The eyes are very connected with the ego, the I-thought and the world. Hearing is more personal. People tell us a great deal with their voices. And as we know appearances (sight) can be deceiving. Consider Tiresias the blind prophet of Apollo. I think blindness has always been associated with special knowledge and wisdom. But not for example deafness. I believe sight may be the first sense to go at the time of death.

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  10. I for one I’m grateful to Rob for bringing this to my attention – also, I fail to see how publishing this article can prompt accusations of one-sidedness when it is information that in fact challenges the “MIA line”- provided you bother to read the original article, of course.

    That aside, let’s try to rise the the challenge:

    I think tutsu is right in that the first problem is that the data is probably wrong and there are people who are both congenitally blind and exhibit symptoms which psychiatrists like to call “schizophrenia”. I hope tutsu realizes that this view is consistent with the “MIA line” and would neutralize the claims of the original research, which seem to somehow point to a biological aetiology of “schizophrenia”.

    But let’s assume for a moment that the data is more or less correct and that, at the very least, there is a huge disparity in the proportion of congenitally blind people who exhibit “schizophrenic” symptoms and non-congenitally blind people with those symptoms. A disparity which begs an explanation.

    The article in Mind Hacks is a good example of how operating within the confines of the disease model of “schizophrenia” can limit people’s reasoning, even people who rightly question psychiatric diagnostic categories such as “schizophrenia”. Let’s look at the problem form a different angle:

    First, let’s do away with the disease hypothesis and adopt a different working hypothesis, the “trauma hypothesis”, which states that psychosis and other traits usually associated with the diagnostic of “schizophrenia” are responses to trauma, particularly childhood or developmental trauma. This is just a working hypothesis so I will leave it wide, without further specifying trauma or what I mean by “response” (whether it is a defence mechanism, “brain damage”, etc.) For now, [developmental trauma > psychosis]

    To this working hypothesis we add the data, which we will assume to be right, that congenitally blind people do not develop psychosis.

    Now, if we were operating within the disease hypothesis we would be likely to think, like the article’s author, that congenital blindness “protects” from the “disease”. If however we are operating with the trauma hypothesis another possibility opens up: that congenitally blind people respond to trauma differently.

    This is a hypothesis that would be in principle easy enough to test: conduct a study on a large enough sample of congenitally blind people (and a control group, obviously; or even better, two control groups: one of sighted people and another of people who lost their sight in infancy but were sighted at birth), a study that looks for developmental trauma (e.g. sexual and physical abuse, bullying, neglect, etc.) and then tries to correlate it with possible responses or effects of that trauma. Then and only then could we start having a reasonable conversation about this.

    We might even find out that contrary to expectations (and the assumptions of the article’s author) congenitally blind people experience much lower levels of trauma, to the extent that this alone accounts for the disparity in rates of “schizophrenia”. I don’t think this would be the case, although it cannot be dismissed a priori. It is more likely, I think, that we would find out that congenitally blind people respond differently to trauma. This would hardly be surprising since many of the symptoms associated with “schizophrenia” are connected to the senses: hearing voices, seeing hallucinations, etc. (yes, there are also negative symptoms, but 99 times out of 100 they are not the clincher when giving a diagnostic) so it is logical to assume that people whose senses follow very different developmental paths from the norm will also exhibit different responses to the kind of trauma which causes what we call psychosis in sighted people. We must remember that there is a huge difference between people who were sighted, even for a short time, and then lost their sight, and people who never ever had sight: their brains develop differently (another study waiting to happen).

    What the different response to trauma in congenitally blind people might be I would not presume to guess,; “depression”? Who knows – but I’m sure we would find something. Or maybe we would find that the data was wrong after all and that congenitally blind people do develop psychosis after all.

    The possibility that congenitally blind people do not develop “schizophrenia” is fascinating, but it does not necessarily mean what people operating within the disease model assume it to mean – and sadly, the type of study they will design and conduct from within that model will (I predict) achieve nothing other than wasting resources and spreading confusion for the benefit of the usual suspects.

    In any case, thank you Rob for putting this article up.

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