I liked how this blog[0] describes it. Schizophrenia itself isn't a spectrum, but rather you have varying levels of schizophrenia risk genes. They have positive fitness functions (creativity, cognitive flexibility, linguistic skill) until you cross the threshold to schizophrenia.

[0] https://www.psychiatrymargins.com/p/schizophrenia-is-the-pri...

> is schizophrenia a spectrum disorder like autism?

I'm a non expert but I believe some people are starting to see it that way. See: https://www.google.com/search?q=schizophrenia+spectrum+disor...

Also there's huge overlap in symptoms between bipolar I with psychosis, schizoaffective disorder, and schizophrenia. People sometimes move around between these diagnoses throughout treatment, different doctors have different opinions, patient behavior changes, etc.

I personally think these symptoms come about through many different causes and the labels are somewhat inadequate. They capture a symptom profile rather than a full understanding.

To this point, some cultures see schizophrenia as friendly, not scary.

https://news.stanford.edu/stories/2014/07/voices-culture-luh...

> In the United States, the voices are harsher, and in Africa and India, more benign, said Tanya Luhrmann, a Stanford professor of anthropology and first author of the article in the British Journal of Psychiatry.

You might be interested in this book: https://en.wikipedia.org/wiki/Doctoring_the_Mind

Not in the same way. The degree to which the symptoms manifest can range from mild to extreme, but it's dependent on the person, and each person can have symptoms exacerbated to more or less the same degree. A psychotic break can result in you believing you're chosen by god to shovel snow off the sidewalks for your neighborhood, and for the rest of your life, you will deeply and genuinely believe that to be true, and accordingly orient your life around it. You might be very normal appearing in almost every other way, but have that one singular delusion that overwhelms your capacity to think rationally about it. You might end up confabulating that you are individually responsible for making the weather warm during spring, summer, and fall, and responsible for the lack of snow.

Other delusions, hallucinations, hearing malicious voices, hearing voices which you feel you must obey, end up with individuals who have the same relative level of schizophrenic dysfunction, in terms of the way the brain operates, but the nature of the delusion can make them dangerous - "god told me to direct traffic on the freeway" or "god told me to slay demons disguised as humans".

The particulars of the case make a huge difference in how much medicine and treatment can help them live independent, normal lives. This potential treatment would be wonderful if it restores normal brain function. It also hints at why antipsychotic and other drugs which increase inhibitory signaling were partially effective.

Heck, it even has explanatory power for the different triggers of psychotic breaks - once a threshold of activity gets passed, the brain loses its ability to discriminate between legitimate, reality grounded signals and feedback that should have been inhibited, and once those neural connections are made and "configured" to operate as part of the default mode network, that person will have permanent cognitive problems.

Very cool research, and I hope it bears fruit.

Well, there's gotta be a line you can draw somewhere between "treating people who actually need it" and "treating people because that's what policy says and we don't care about the individual".

Sometimes, that line is whether or not the state is somehow involved through social services or the criminal justice system.

I have some primary care providers in the family and I've asked them since I often have differing opinions. I've asked if some people with bipolar and schizophrenia refuse specific medical treatment and just go on with their life. I've gotten the answer that many of them have learned to recognize what is happening and ride it out well enough that they can live with it. I'm sure it's highly dependent on the severity and the person.

I've noticed something similar with people on say heavy doses if hallucinogens. Some people just ride it out knowing it's the mind playing tricks on them, others hopelessly panic or make irreversible decisions.

No but it is a behaviourally defined disorder like autism. Which means it can and has many different causal patterns behind it.

That is there are many different things that can cause the behaviour.

Anyway on your main point, the definition of all psychiatric disorders has requirements of subjective suffering. So if you don't have subjective suffering you don't have the disorder.