r/collapse

76.2% of Gary, Indiana is black….

Submission Statement:

While many regular readers here at r/collapse are already familiar with the intersections between climate change and public health, this recent article piqued my curiosity due to its visual showmanship, its detailed descriptions, and in its particular "close to home" familiarity - starting in the emergency room of St. Paul’s Hospital, right in the heart of downtown Vancouver, B.C., during the midst of the 2021 PNW heat dome.

As it turns out, those who suffer from schizophrenia are particularly susceptible to becoming a mortality statistic during exceptional heatwave events. Of the 619 heat-related deaths resulting from the 2021 British Columbia heat dome, those living with schizophrenia (about 1 percent of the population) accounted for a remarkable 16~ percent of deaths during the event.

To quote the WIRED article, written by Hilary Beaumont:

>For years, public health advisories warned that extreme heat was most dangerous to older adults, infants, and people with chronic illnesses like heart disease, respiratory disorders, and diabetes. But in 2023 a study revealed that schizophrenia was associated with a threefold increase in the odds of mortality during the heat dome. “That's when it became very clear that schizophrenia was the outstanding chronic condition in terms of risk,” says [Dr.] Sarah Henderson, scientific director of environmental health at the BC Center for Disease Control, who coauthored the report."

>A flurry of studies followed, and in 2025 a group of interdisciplinary experts, including Henderson, published a review of the literature explaining the phenomenon. What they found were layers upon layers of risk factors.

These risk factors include (again, quoting the article):

(1) Dysfunctional Thermoregulation: “People with schizophrenia have wonky thermoregulation—their bodies are less able to cool themselves for a variety of reasons. They have a harder time regulating dopamine, which is associated with our body’s ability to manage its temperature, explains the study’s coauthor [Dr.] Nathalie Kirby, an applied climate and heat-health scientist.”

(2) Imbalanced Sympathetic and Parasympathetic Nervous Systems: “A related hallmark of schizophrenia, Kirby says, is an imbalance between the sympathetic and parasympathetic nervous systems, often called the “fight or flight” and “rest and digest” systems, respectively. Typically, these systems are in balance, but someone experiencing psychosis is caught up in a vicious cycle: They may experience hallucinations, tied to a dopamine imbalance in the brain, that make neutral experiences seem scary. This suppresses the parasympathetic nervous system, which in turn produces a fight-or-flight response and worsens the initial psychosis. Along the way, someone with increased fight-or-flight activity is predisposed to adverse cardiovascular events. It becomes harder for them to control the blood vessels and sweating that help with thermoregulation.”

(3) The Physical Side Effects of Antipsychotic Medication: "Another challenge that faces people with schizophrenia—one that [Dr. Jeff] Yoo was already aware of in the ER back in 2021—is that treatment for the disorder can include antipsychotic medications that prevent people from sweating, further depressing their ability to dissipate heat. “A lot of the antipsychotic medications have an anticholinergic effect,” Yoo says, describing physical side effects that include increased heart rate and decreased sweating. “That means they’re going to be at even higher risk of cooking their organs.”"

(4) Heat As A Trigger: “Heat can also cause schizophrenia symptoms to flare up, even for someone whose symptoms are well managed. They may feel increased anxiety, dread, and fear, which further aggravates the fight-or-flight system, Kirby says.”

(5) Insufficient Insight: “Beyond internal dysregulation, people with schizophrenia often show a lack of insight into their own health (though this can be improved with medication). In a heat wave, they may not be aware that their body is heating up, so they don’t drink water or attempt to cool themselves. They may do just the opposite—wearing multiple layers instead of shedding them.”

(6) Paranoid Thinking & Social Isolation: "Paranoia, another marker of schizophrenia, may also cause some people to avoid exposure to media, including news. “They are left in the dark, they don't know that a heat wave is coming,” says [Dr.] Liv Yoon, an assistant professor at the University of British Columbia’s School of Kinesiology. She led a study interviewing dozens of people with schizophrenia who survived the heat dome. “I cannot have news,” one woman told the authors. “News is triggering for me, impacting my mental health a lot. I don't own a radio, I don't watch TV, or the internet or anything.” When the heat dome arrived, the woman had no warning."

While the above is a summary of the article's contents, I still recommend that everyone give it a proper read - it's quite an interesting review of an emergent issue that will likely worsen for decades to come. Great work, Ms. Beaumont!