E15. Josef Parnas – Schizophrenia and Phenomenology

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Today we speak with Professor Josef Parnas, Professor of Psychiatry at the University of Copenhagen and a co-founder and Senior Researcher at the Danish National Research Foundation: Center for Subjectivity Research. Professor Parnas has been involved in research  into the schizophrenia spectrum for about 40 years, and by using a phenomenological approach, has come to focus on the anomalous self-experiences associated with the schizophrenia spectrum.

In this conversation we discuss how we should think about schizophrenia, phenomenology and the importance of clinical experience, and systems to classify psychopathology.

Show Notes

0:00 – On Josef’s background.

3:25 – Josef’s overview of what we know about schizophrenia.

10:30 – Contrasting the core of schizophrenia from the symptoms.

21:45 – On the compatibility of predictive Bayesian computation accounts and phenomenological accounts of schizophrenia.

26:10 – Are schizotypal traits adaptive?

33:25 – On the disorder of self in schizophrenia.

35:45 – On the scale that Josef published to measure anomalous self experiences: the Examination of Anomalous Self Experience.

36:50 – Does Josef find the research on meditation or psychedelics interesting, given his interest in alterations of self-experience?

38:20 – Why Josef is not hopeful that dimensional classification systems for psychopathology?

50:15 – Alternatives for students or researcher who do not have the option of gaining direct experience with schizophrenic populations.

52:00 – On what historical European psychiatry has to offer contemporary psychiatry.

0:00 – On Josef’s background.

Josef was trained as a medical doctor at the University of Copenhagen, and then completed his internship at a hospital running important studies that showed that schizophrenia has an important genetic basis. He has worked simultaneously in clinical and research capacities throughout his career.

He arrived at his interest in phenomenology because of his interest in psychopathology. The phenomenological perspective was the most mature account of psychopathology, and was very much mainstream until DSM-3.

3:25 – Josef’s overview of what we know about schizophrenia.

Thinks that schizophrenia is not well represented by the current medical model, which emphasises chronic psychotic symptoms, such as hallucinations and delusions. This is likely due to the desire of recent DSM efforts for reliability of diagnoses. The core features of the schizophrenia spectrum, which include distortion of subjective life and disorders or expressivity, are relatively neglected perhaps because they tend to require clinical experience to reliably identify.

Schizophrenia is more than just the chronic condition identified by the DSM. One piece of evidence that suggests schizophrenia is a spectrum rather than just the severe diagnosable condition is that only a minority of patients with diagnosable schizophrenia experience a deteriorating chronic course, many experience a remitting course and a significant proportion (20-25%) of those that would qualify for a diagnosis are never treated or seek medical help at all. Then there are milder parts of the spectrum that wouldn’t qualify for a schizophrenia diagnosis, which again, do not typically seek psychiatric help. Also, there are links between vulnerability to schizophrenia and creativity.

10:30 – Contrasting the core of schizophrenia from the symptoms.

There is something qualitative about the symptoms of schizophrenia. A schizophrenic delusion or hallucination is easily distinguished by the experienced clinician from the delusions or hallucinations symptomatic of other conditions. Josef considers the nature of these symptoms to be reflective of differences in the subjective experience, which he considers the core of schizophrenia colouring the manifest symptoms. Said differently, it is not the case that the symptoms in schizophrenia are not simply occurring to a person that otherwise experiences life as a neurotypical person does. The differences occur right down to a fundamental level of the person’s subjective experience, and these differences pre-date and may give rise to the more obvious clinical symptoms.

Josef tells a story of a client of his that was surprised to learn that most people experience thoughts as their own, as opposed to existing in some sort or collective space as experienced by the client.

Therefore, to understand schizophrenia, we need to be thinking in terms that are pervasive and fundamental, rather than modular.

21:45 – On the compatibility of predictive Bayesian computation accounts and phenomenological accounts of schizophrenia.

Intuitively, Josef is attracted to such accounts.

26:10 – Are schizotypal traits adaptive?

People with schizotypal traits often don’t share the naturalness with which neurotypical people relate to the world. And if you don’t take the obvious for granted, this may facilitate a curiousity about the world and lead to greater creativity. And indeed, there is a documented link between schizophrenia (and relatives of those with schizophrenia) and creativity.

Here is a link to the study Josef mentioned on the prevalence of schizophrenia in the relatives of university scientists.

Robert Sapolsky’s lecture on schizophrenia: https://www.robertsapolskyrocks.com/schizophrenia.html

Josef’s translation of Hans Gruhle’s 1929 work, ‘The schizophrenic basic mood (self-disorder)’.

33:25 – On the disorder of self in schizophrenia.

Josef thinks that the disorders of self-experience in schizophrenia, are coming to be increasingly recognised. In fact, disorders of self-experience will be mentioned in the new ICD-11.

35:45 – On the scale that Josef published to measure anomalous self experiences: the Examination of Anomalous Self Experience.

The above link contains not only the measure itself, but also courses on the measure. There is also a self-report version, recently published the Inventory of Psychotic-Like Anomalous Self-Experiences.

36:50 – Does Josef find the research on meditation or psychedelics interesting, given his interest in alterations of self-experience?

Josef published a paper on the relation of mystical states and schizophrenia, but doesn’t follow the meditation or psychedelics fields closely.

38:20 – Why Josef is not hopeful that dimensional classification systems for psychopathology?

Clinicians say that they only need ~25 diagnostic categories, not the ~400 in DSM-5. The reliance on well defined diagnostic criteria (in the DSM and ICD) and the discarding of phenotypic/prototypic descriptions, has resulted in an unending proliferation of diagnoses. Josef is also sceptical that a dimensional approach will be adopted by clinicians – “clinicians like categories”.

Instead, Josef thinks the best solution might be to have different classification systems depending on the context/purpose.

50:15 – Alternatives for students or researcher who do not have the option of gaining direct experience with schizophrenic populations.

Josef recommends a number of books to gain insight into the phenomenology of schizophrenia, including;

Madness & Modernism by Louis Sass

The Center Cannot Hold by Elyn Saks

The Psychiatric Interview for Differential Diagnosis

52:00 – On what historical European psychiatry has to offer contemporary psychiatry.

All European psychiatry was somewhat phenomenological until the domination of psychiatry by American research, following DSM-3. But there has been a recent revival of phenomenology. For example, Oxford University Press has recently published The Oxford Handbook of Phenomenological Psychopathology and Cambridge University Press has recently published The Maudsley Reader in Phenomenological Psychiatry.

E13. Vince Polito – Microdosing

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Today I speak with Dr. Vince Polito (@vincepsy), Research Fellow in the Department of Cognitive Science at Macquarie University. Vince works on developing better measures of self representation and investigating how this capacity is altered in different contexts, clinical conditions and states of consciousness.

Vince and I discuss microdosing, which refers to regularly taking very small doses of psychedelic substances. Earlier this year, Vince published one of the most rigorous studies conducted on microdosing to date.

This is an interesting topic because of its link to the promising therapeutic psychedelic studies currently being undertaken, the positive reports of microdosing in the media, and the lack of empirical research into the practice. We discuss these preliminary investigations and the outlook for this field.

Show Notes

1:10 – On Vince’s research background

7:20 – How Vince came to be interested in microdosing

13:30 – On the methodology and findings of Vince’s microsdosing paper.

22:00 – On the plausibility and continuity of microdosing effects with higher dose psychedelics

25:30 – On how to square the reported benefits of microdosing with the fact that the therapeutic effect of psychedelics are related to the intensity of experience (eg. Griffiths et al., 2017).

31:50 – What do altered states of consciousness, more broadly, have to offer cognitive science?

36:50 – Advice to students interested in similar areas.

39:10 – On meditation as an altered state of consciousness.

43:00 – What’s coming up for Vince in terms of research.

1:10 – On Vince’s research background

Vince’s work has included studying cognitive processes involved in self-representation (how we make sense of the world and where our bodies are in the world) and sense of agency (the feeling of intending things to happen in the world). In studying how sense of agency can be disrupted, Vince has looked at hypnosis, flow states and passivity phenomena in schizophrenia.

7:20 – How Vince came to be interested in microdosing

Vince has also done studies on belief formation – both how delusional beliefs come to be held and how beliefs spread through groups of people. Microdosing was an interesting topic from a belief formation perspective due to a combination extremely positive media coverage, the costs involved and virtually no empirical research. And so, apart from the effects of microdosing itself, Vince’s study investigated the impact of prior beliefs on reported effects.

13:30 – On the methodology and findings of Vince’s microsdosing paper.

Given the barriers to studies involving actual microdose administration, Vince thought that the most rigorous way to proceed would be to find people who were already microdosing and track their experience systematically.

The first part of the study tracked the immediate effects of microdosing through daily ratings of connectedness, contemplation, creativity, focus, happiness, productiveness, and wellbeing. Results suggested a broad positive impact on dosing days, but no residual positive impact on the following days.

The second part of the study looked at the longer term effects. At baseline and again after 6 weeks of microdosing, participants completed a battery of questionnaires assessing effects that are often talked about in connection with microdosing as well as with high dose psychedelics, including mental health, attention, wellbeing, mindfulness, mystical experience, personality, absorption, creativity and agency. Depression, stress and mind-wandering decreased, while absorption and neuroticism increased.

The third part of the study involved comparing expected effects to reported effects. People did have very positive expectations, but it didn’t seem like the observed effects were driven by expectations. For example, creativity was the trait that people most expected to increase yet this was not found in the actual results.

22:00 – On the plausibility and continuity of microdosing effects with higher dose psychedelics

Yes, broadly the findings are consistent. However, the finding of higher neuroticism seems inconsistent with higher dose research and the finding of unchanged creativity seems inconsistent with other studies of microdosing.

25:30 – On how to square the reported benefits of microdosing with the fact that the therapeutic effect of psychedelics are related to the intensity of experience (eg. Griffiths et al., 2017).

Firstly, despite some instructions that microdosing should be imperceptible, microdosing is generally accompanied by noticeable changes in cognitive functioning. Still, these effects are orders of magnitude lower than those reported on high doses of psychedelics, which Vince likens to a positive version of trauma. Because of this, it is difficult to square the reported benefits of microdosing with how we conceive of the therapeutic mechanisms of high doses of psychedelics. Presumably the effects of microdosing result from a more direct pharmacological effect, perhaps relating primarily to effects on the default mode network.

31:50 – What do altered states of consciousness, more broadly, have to offer cognitive science?

We are so bound to our normal waking consciousness, that altered states of consciousness offer an important tool to separating out the dimensions that are part of normal waking consciousness. This is basically a neuropsychological approach. Meditation and virtual reality are other related technologies of consciousness.

36:50 – Advice to students interested in similar areas.

Some good advice might be not try to build a career around psychedelics of altered states of consciousness, but to find a topic that is important and respectable, then use altered states as a case study of how your topic might be effected. This is what Vince has done with sense of agency.

39:10 – On meditation as an altered state of consciousness.

I propose to Vince that the best way to consider meditation might be not necessarily as an altered state of consciousness, but as an attentional practice that can give rise to altered state of consciousness. Vince agrees and reaffirms the legitimacy of deep states of meditation as altered states of consciousness.

43:00 – What’s coming up for Vince in terms of research.

Vince will be working on better measures of self-representation – measures that capture sense of agency, embodiment and presence. He doesn’t have immediate plans for follow-up psychedelic research, but stay posted.

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Episode References

Robin Carhart-Harris and Karl Friston’s recent (2019) paper proposing a relaxing of prior beliefs within a hierarchical predictive coding framework as a model of how psychedelics have their effects. “REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics“.