When the primitive organization surges back in a first break schizophrenic episode, dopamine intensifies. This correlates to the onslaught of incoming stimuli to the perceptual system. Patients feel as if they’re being screamed at or bombarded by a horde of angry intruders. Unable to isolate a cogent brain space, the theater of their mind is overwhelmed. The reassertion of the primitive ‘paleo-cortex’ signals a regression of the mental organization with loss of structure, individuation of parts and hierarchical organization of mental functions. Since the brain regresses to the primitive organization in sleep, the forebrain acts as if it is in REM and sends out dream-like hallucinations. The addition of dopamine blocking agents can clear the brain space and restore some internal calm.

The primitive organization or ‘paleocortex’ enters into a battle royale with the ego, the purveyor of anti-primitivism. It is the ego that drags our minds away from childlike simplicity and toward a more differentiated, structured adult configuration. The primitive organization takes it as its imperative to degrade and berate the ego. To this end, it enlists the dream-like hallucinations and turns them into derogatory or self destructive invectives, including commands of a suicidal or self mutilating nature. The superego is unfound in this pre-verbal, pre-civilized mind set, thus offering no solace to the struggling ego. At this point dopamine has made a semi-successful reassertion. Intense positive symptoms ensue and this may go on for years as the ego resists being overwhelmed and dissolved by the more primitive organization. Antipsychotic medication continues to offer significant benefit.

Ultimately, however, under the endless pressure of the primitive organization’s tenacious, avaricious attack, the ego crumbles into a fragmented shell of its former self. At this point the person may experience a reduction in the virulence and intensity of the positive symptomatic bellicosity of the primitive ‘paleocortex’. They sink into a picture of avolition, alogia, anhedonia and low motivation with a collection of ongoing delusions and mild hallucinatory activity. This price, paid by the ego, such as Daniel Paul Schreber’s belief that he’d been turned into a woman, satisfies the primitive organization and brings the conflict to a stalemate. At the same time, dopamine makes a final plunge forward, finishing its dogged resurgence, corresponding to the residual picture we know as negative symptomatology. Antipsychotic medication loses much of its impact and there may also, at this time, be a fair amount of forebrain atrophy.

Published by Steven Lesk, MD

Board certified, adult psychiatrist for over 35 years. I have written a book on evolution and schizophrenia. It's call Neanderthal's Dream: How Changes In Evolution Brought Us Mental Illness and May Someday Take It Away Again.

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