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The built Environment and schizophrenia

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Jan Golembiewski

on 20 May 2014

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Transcript of The built Environment and schizophrenia

The built environment and schizophrenia

Jan A Golembiewski BFA BArch MArch PhD
Affiliations:
Medical Architecture - Asia Pacific (MAAP)
Schizophrenia Research Institute
University of Sydney
UNSW
For Faris and Dunham, the term 'race' was a circumlocution of 'Italian;' and the Sicillian Mafia. Now it has been stripped of the language of prejudice and is bundled with genetics. For McGrath et al, race means UV reflectivity of skin, for Selten & Cantor-Graae it is in established racist mores.
VICE used to refer to illegal alcohol and gambling. Now it means
drugs
.
Caspi's 2005 study of epigenetic mutations of the COMT gene are a good example.
LACK OF SUNLIGHT

most researchers still see the urban environment as a proxy for something else...
All the usual suspects: but 80 years on
The medical model often fails to remember that the body is a singular thing, instead it represents a confluence of independent genetics, history and biology. Similarly, scientists try to disentangle the urban milieu from its parts... and in simplistic terms.



But the city isn't just a place where drugs are more available, where there is less sunlight and more social anguish...

The urban environment is the site of a concentration of demands: the demands of commerce, of messages - of emotional and physical promise...

'Access to the fountain is
PROHIBITED'
one of the ways to find respite is to ignore the negative demands and embrace the positive ones.
Golembiewski, J. (2012). Medical Hypotheses 78: 7-10.
Excess of excitability voxels in fMRI of whole frontal lobe. Catatonic (C) and paranoid (P) psychotic patients are compared to healthy controls (H) while being exposed to negative, positive and neutral images.
RACE
there are the demands of transport, housing, there are dangers everywhere.
Van Os, Rutten, et al. (2008). Suggest that the urban environment might contain unspecified epi-genetic triggers.
The built environment is also highly semantically coded.

Delusions are fed by experiences and perceptions. Paranoid types are particularly sensitive to negative environmental messaging. This urban scene contains one of many peculiarly salient 'messages' in the Camberwell area - an area of especially high concentration of schizophrenia. A 10 minute walk through this area makes all measures of paranoid psychosis
significantly
worse.
reading the urban environment
The social environment also makes demands
Utilization Behavior
(l'Hermitte 1986) is when people lose neural inhibition and can't prevent themselves from acting on objects they find. Here a patient has found a syringe and is giving her doctor a jab.
Shitij Kapur:
aberrant salience 2003

Roy Wise:
reward salience 1989
The living environment (home) provides the principal filter for the ecological effects the factors that urbanicity draw together: society, civic services, poverty, atmosphere, geography and collective identity. The living environment is also – and possibly more importantly, the primary milieu for self-expression and for behaviour, especially during childhood or whenever social networks are depleted.
The homes of patients with schizophrenia frequently become horrible places. This may causal as well as symptomatic of a deteriorating condition. A condition where a person's psychological defenses against the pressures of society, long winters, poor health, poverty and isolation simply fail.
Jan A Golembiewski PhD
Specialist in the psychopharmacology of the built environment and in passive treatment through mental facility design.

Medical Architecture
Specialists in psychological approaches to healthcare architecture - especially mental health facility design.

JG@medicalarchitecture.com
Papers: http://usyd.academia.edu/
JanGolembiewski/Papers
This paper is based on my papers in
Curēus
(2013) 5(3): e106 and
Facilities
(2013) 31(9/10): 427-448.
Psychosis has been linked
to urbanicity since 1939
and the urban incidence is increasing -
but not evenly.
Urban variation was the first 'risk factor' that was identified by Faris & Dunham in the 1930's. .

Their 'breeder factors' hypothesis reflected the moral values of the Chicago prohibition...
This has been appropriated by the vitamin D deficiency hypothesis of McGrath Et al.
The incidence of schizophrenia is highly variable, with cross-sectional data demonstrating as much as 900% variation between London boroughs.
Hypofrontality means a reduced capacity for self determination
the next question - is how are mental health facilities geared to allow respite?
Are the following
rooms appropriate?
Will they work?
Isolation
Seclusion
Quiet
De-stimulation

What's needed for respite?
A personalised space;
A place that is free from difficult demands - especially
negative
ones;
A place that can be attenuated easily.


And some people have no home at all... but what happens when demands are being piqued (even positive ones), but there is no ability to act on them?
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