First Concepts.
WOB is Optimal

Schizophrenia is an enigmatic disease. Multitude of theories about its nature perplex the reader, and yet even this obscure disease reveals patterns which may guide the physician to a good therapy. In order to reveal them one ought to ignore non relevant information about the disease.   We  ought to  distinguish between two kinds of statements on the nature of a disease. Statements which suggests how to alleviate suffering, and those which do not. We shall be concerned only with the first.  For this purposes we created a framework in which these statements  may be investigated in an orderly fashion:

1. What drives the disease?
2. The three phases of its progression: compensation, decompensation , and death.
3. What is WOB-disease?
What is Mind-disease?

This framework was applied to the study of Diabetes mellitus, and Parkinson’s disease, and will be applied also in the elucidation of schizophrenia.  To start with,  let’s quote three similar views on the nature of disease:
”It is the value of all morbid states that they show us under a magnifying glass certain states that are normal – but not easily visible when normal.” (Nietzsche quoted in 1, p.45).

“ Every disease has a corresponding normal function of which it is only the disturbed, exaggerated, diminished or obliterated expression.” (Claude Bernard quoted in 1,p. 68)

” Disease reveals normal functions to us at the precise moment when it deprives us from their exercise” (Canguilhem ; 1 ,p. 101). (v. The Normal and the Pathological)

Before attempting to explain the pathogenesis of schizophrenia we ought to ask, what is the normal function which is altered in Schizophrenia?

Alternative state of consciousness (ASC)

An Alternative State of Consciousness (ASC) is a state in which the mind gives up its sense of identity or self. Listening to music may induce such a state. The mind immerses itself in the melody as if it ceased to exist as an independent entity. Dreaming is another form of ASC. When the mind sleeps it virtually ceases to exist and the body is controlled solely by WOB. Other forms of ASC are attained by meditation, guided imaging, trance, or ingesting hallucinogenic drugs.

Schizophrenia is a modern term for a specific alternative state of consciousness, known as madness,  which accompanies our civilization from its very beginning. Later we shall see  that there is a spectrum of alternative states of consciousness none of which can be regarded as abnormal.

Four Sages entered the Pardes (2)

The quest to  attain  an altered state of consciousness is common to mystics of all kinds. The following Talmudic story describes  four  Sages who entered the Pardes [literally "the orchard”, where they achieved a spiritual elevation through intense meditation]. They were Ben Azzai, Ben Zoma, Elisha ben Avuya, and Rabbi Akiva. Ben Azzai gazed [at the Divine] and died.  Ben Zoma gazed and was harmed [he lost his sanity]. Elisha ben Avuya [called Acher]  became a heretic. Rabbi Akiva entered in peace and left in peace.

This narrative illustrates the possible outcome of a spiritual experience. Modern psychiatrists will diagnose Ben Zoma as a schizophrenic. An unfortunate and harmful medical term. While  madness  always bordered on the divine, schizophrenia became a dreadful  stigma.  The hallmark of disgrace.

Four freaks experimenting with LSD

The post modern version of the above story took place in California. One freak discovered a new religion (Timothy Leary), the other , psychedelic art. The third became enchanted with  Krishna’s multitude of manifestations, and the last became schizophrenic.  Medicine celebrated an important discovery. From now on schizophrenia may  be induced and studied  under controlled laboratory conditions.

Yet all this research attempting to understand madness is no more than an  pile of  incoherent information which obscures medical reasoning. Cognitive scientists search for structural manifestations of the mystical experience and schizophrenia, using functional MRI, and PET.  Brains of Buddhists , mystics and freaks are scanned   in the hope to detect a religious brain center (religious nucleus) which might deteriorate into madness.

Using  DNA chips molecular biologists search for DNA expression patterns which might indicate who is prone to madness.  Chemists extract proteins from schizophrenic brains and compare them with healthy brains, hoping to detect a pattern typical of schizophrenia. None of these finding led to treatments that might  alleviate patient suffering.


There are two kinds of alternative states of consciousness: Mind induced, or Mind-ASC and WOB induced, or WOB-ASC. The experience of the four sages was induced by their minds. Yoga which is a WOB training  to attain Nirvana, is also initiated by the mind.  All along this training the yogi proceeds though different mind-ASC until his spiritual destination has been reached. This is also the essence of other spiritual training, like meditation, or the ancient  Chinese martial arts.


Fainting is an example of WOB induced ASC. When WOB experiences an acute oxygen shortage in the brain, it switches off consciousness. The individual collapses  and  blood is diverted from his body and extremities to the brain. Fainting is WOB solution to an acute oxygen shortage. It diverts the vital substance from a less oxygen dependent  periphery to the brain which cannot function without it.

Coma is a WOB solution to chronic oxygen shortage. An occlusion of a brain artery creates an oxygen shortage. First WOB applies the fainting strategy. However since oxygen shortage persists WOB reallocates oxygen to vital brain areas. Less vital regions start to hibernate. Their metabolism is reduced, which protects them from death (necrosis).  Thus, coma is not a pathology as medicine proposes. It is the most optimal solution created by WOB to an ongoing oxygen shortage.

Although both states are regarded as unconsciousness, they ought to be regarded as a diminished consciousness.  Even during coma WOB sends signals to the mind,  however since it is turned off, they do not reach us (the physicians).  The response of a pupil to light clearly indicates that the patient is somewhat conscious. And there are many more signals  from WOB to mind, during coma. Consciousness involves a spectrum of states. As long as WOB functions it manifests some degree of consciousness.   Unconsciousness marks death.     


Heroin initiates a WOB-ASC. The healthy WOB produces heroin-like substances, like endorphins, collectively called reward substances (RS). Initially when heroin  is supplied, RS blood level rises and the person acquires a new ASC manifested by euphoria. High  RS level is harmful and  WOB reduces  internal RS production by dismantling RS producing processes. In addition WOB degrades heroin more swiftly. Heroin becomes less and less effective (heroin resistance), and the addict depends  more and more on external heroin.   Such a WOB response to the supply of external resources is ubiquitous and deserves therefore additional elucidation. 

 Astronaut disease

At any time WOB maintains an equilibrium (homeorhesis) and  minimizes resource  expenditure. Take for instance  astronaut disease which was described elsewhere. Gravity determines the amount of our body mass. When an astronaut is sent to outer space, the pull of gravity diminishes. He now requires less resources to perform his daily activity. His tasks are easier and he feels good.  In the coming days WOB dismantles redundant processes. Muscles become atrophic and bones osteoporotic.

When returning to earth he lacks resources to perform his daily activities. WOB will make him feel weak  and force him to bed. Weakness is a signal from WOB to mind as is saying: Return to  low gravity. In other words, the astronaut became addicted to a low gravity.

By the same token, once WOB got used (addicted) to external heroin, whenever RS level declines, WOB signals the mind, weakness and prostration as if saying: “get more heroin.” Addiction is a dependency on an external supply of a resource, which WOB ceased to produce.
Hormone replacement therapy (HRT)

HRT is a  medical treatment for postmenopausal women who lack estrogen hormones. Menopause is regarded as a health problem  which results from estrogen deficiency and has to be corrected with hormone supplements.  Actually menopause is not at all a health problem. It is a WOB solution for the new life of a woman who stopped produce offspring.  WOB reduced hormone production because it is best for her. However since society regards menopause as a health problem, the woman contracts a mind disease, or mind-menopause, and demands HRT.

HRT results in serious complications, e.g., uterine cancer, and blood clotting problems, which convinced the health authorities, not to recommend HRT anymore. Actually  HRT damage is far more serious than that. When external estrogen is supplied, and  blood estrogen level rises above what WOB regards as optimal,  it cuts down estrogen production by dismantling  estrogen producing units in the adrenal until an  optimal estrogen level has been restored.  Since internal estrogen production was cut down,   the woman depends on the supply of external estrogen. It is an addiction to external estrogen. The stopping of estrogen supply results in an acute estrogen deficiency, whereupon WOB slowly restores new estrogen producing units. It takes some time until the optimal blood estrogen level is restored. During this period the woman may display estrogen withdrawal symptoms, e.g., weakness, and accelerated aging.

LSD trip

While heroin initiates a relatively narrow range of ASC, LSD produces a whole spectrum.  Actually LSD mimics acute  WOB-schizophrenia.  It harms certain processes and augments other. These changes are signaled to the mind and sensed by it as LSD trip. Each signal indicates which processes became deranged by LSD. An intricate language which waits to be deciphered. The outcome of a trip depends on how prepared WOB was for dealing with LSD. It’s like in athletics. If you prepared (trained) your body to lift heavy weights, you can do it. Otherwise you may harm yourself.  Tear a muscle or a tendon. When unprepared, WOB fails to sustain some essential  processes, and takes the chronic course of  WOB-schizophrenia.


It seems plausible that schizophrenia is driven by a  latent viral infection. It is first of all a WOB disease, or WOB-schizophrenia. Virus destroys processes, and WOB repairs them. All along disease evolution, WOB and virus maintain an equilibrium (homeorhesis). Schizophrenia proceeds from one equilibrium state to another. Each state is the best in circumstance, WOB most optimal solution. When process destruction (death) exceeds process creation (birth) schizophrenia advances, and vice versa.  Theoretically one could slow down disease progression, either by eliminating the virus which destroys processes, or boosting WOB. Since the driving process of schizophrenia is unknown we are left with the second option,  WOB boosting.

Catatonia  and coma

First we ought to realize that all schizophrenia manifestations are the most optimal solutions which WOB came up to repair the viral damage. In the same way as coma is a WOB solution to a protracted oxygen shortage, catatonia is its solution to  a protracted shortage of an unknown vital substance (process). This optimal WOB solution initiates signals to the mind which are perceived as hallucinations. Like in the LSD trip,  each signal indicates which processes became deranged.  An intricate language which waits to be deciphered.

Yet these optimal WOB solution may not be optimal to the mind, which demands a better life quality. The main task of the physician is to work out a compromise between WOB request to optimize, and  mind’s demand for a better life.  Each schizophrenia manifestation is a mixture of a WOB (most optimal) solution and its perception by the mind. On one end of this spectrum is catatonia in which WOB cuts off any message to the mind. ‘Hearing voices’, marks the other end  of this spectrum. Other manifestations are situated in between


A young adult wakes up in the morning and hears a clear voice asking him: ”Whom shall I send? Who will go for me?” and he answers: “ Here am I; send me. . .” Yesterday this voice told Isaiah to deliver the Lord’s message to the people of Israel (Isaiah, 6,8). Today this message makes him schizophrenic. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), hearing voices  is diagnostic of  schizophrenia.  

Suddenly he realizes that this gentle voice drives him into madness. His anxiety mounts and he sinks into a state called here Mind-schizophrenia. Hearing voices might be harmless. He simply hears his own thoughts, yet the society brands him as mad and he feels lost. Schizophrenia is a dreadful stigma which initiates a Mind-disease.  He is advised therefore to join ‘The hearing voices network’ ( Hearing Voices groups instruct their members how to live in peace with their voices.

While WOB-schizophrenia is driven by a virus, Mind-schizophrenia is driven by the society and its delegates the psychiatrists who are enslaved to their distorted view of madness. Actually “There is no clear boundary between the sick and the well” (3).


WOB sustains life at any cost and is unaware of death. It will therefore never commit suicide. The notion of death is a cultural creation which resides in the mind. Suicide is a manifestation of Mind-schizophrenia. It is initiated by the mind, and not by WOB.


The accidental discovery of phenothiazines  introduced a new dimension to schizophrenia treatment.  Since phenothiazines block dopamine function, psychiatrists postulated that schizophrenia is caused by a malfunction of dopamine metabolism. With the discovery of   “atypical” antipsychotic drugs which are effective despite their smaller dopamine blocking effect, this theory was replaced with the serotonin malfunction hypothesis.

Both theories fail to adequately explain the effect of anti-psychotic drugs. The issue is not how these drugs cause the disease, but whether they slow down WOB-schizophrenia progression, which they apparently do.  Slowing down disease progression  may be achieved in two ways: 1. By mobilizing dopamine and serotonin, anti-psychotic drugs may assist WOB  in repairing some vital processes. 2.  Anti-psychotic drugs filter out  some signals from WOB to mind.

Psilocybin mushrooms

Shamans treat madness with hallucinogenic psilocybin mushrooms. The rationale behind  this approach is to gently perturb WOB and so assist it in repairing damaged processes. This may be also the rationale for the application of anti-psychotic drugs. Yet medicine opposes this view. Anti-psychotic drugs are supposed to restore a deficiency of dopamine or serotonin, and not to perturb. High doses of anti-psychotic drugs are administered continually, disregarding their toxic effect, e.g., extra pyramidal symptoms, tardive dyskinesia, tremor, agranulocytosis, and obesity

The name of the game is not to repair a hypothetical deficiency but to attain remission, which may be achieved in many ways other than anti-psychotic drugs.


The therapeutic goal of psychiatry is to help  the patient   to get an insight into his situation, and understand it, which is utterly unrealistic. It’s  like rationalizing a mystic experience. The patient does not have a condition or the like. He simply woke up into a new reality  and has to live in it.  Instead of supporting him, society regards his new life as madness, and drives him into Mind-schizophrenia.

Mind- schizophrenia is nourished by the negative attitude of the society to the seemingly odd behavior of certain individuals.  Fortunately, the post modern culture becomes more and more   tolerant and provides support to the needy, like the above mentioned Hearing Voices Network.  On the other hand,  the post modern culture did not  reach the psychiatric ward yet. Which is still dominated by the Cartesian reductionism.


The mind is responsible for interpreting  signals originating in WOB. Some like  hunger and thirst are obvious. These are WOB signals asking the mind to get  energy resources and water. As WOB repairs the ongoing viral damage it sends signals which the mind has never encountered before, and has difficulty to interpret them. He is aided by the cultural symbolism, e.g., Sin and Evil,  Armageddon, and Redeemer.  The Paranoid might be aided by filtering out some WOB signals, preventing them from reaching the mind.


Apparently anti-psychotic drugs may filter out such undesired signals. It’s like taking aspirin for a headache. Headache is a WOB disease which is handled successfully by WOB. Nevertheless WOB sends a headache signal to the mind, which can be filtered out with aspirin. This may also be the merit of anti-psychotic drugs.  Filtering out may be achieved also with meditation, a technique for ignoring the mind and the messages reaching it. Yet Yoga has another advantage. The typical yoga posture may be regarded as a self induced catatonia, which might assist WOB in its quest for optimal solutions.


The Yogi suffix is used here to describe an individual who succeeds to live in peace (health) with his disease.  Following the example of the Hindu  Yogi, who masters many involuntary processes, like breathing and heart rate, one may train oneself to master other involuntary feats, like rope walking,  or athletics, which are called respectively Circus-Yogi, and Muscle-Yogi.

The renown mathematician  John Forbes Nash Jr. deserves this title. After a promising start to his mathematical career, Nash began to suffer from schizophrenia around his 30th year, an illness from which he has only recovered some 25 years later. He shared the 1994 Nobel Prize for economics with two other game theorists, Reinhard Selten and John Harsanyi (4).


1. Canguilhem G. Le normal et le pathologique. translated into English by Fawcett CR, Cohen RS. Zone Books New York 1991.
2. The Talmud (Chagiga 14b)

3. Bentall, Richard P.  Madness Explained: Psychosis and Human Nature
Allen Lane.

John Forbes Nash Jr. Wikipedia

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