RAMANDEEP KAUR | NT BUZZ
Even a slightest thought of being not able to understand reality can be very scary, isn’t it? So you can imagine what a person living with Schizophrenia goes through. This is a disorder of the mind that affects how one thinks, feels and behaves. World Health Organisation (WHO) website states that Schizophrenia is a chronic and severe mental disorder that affects more than 21 million people worldwide.
Its symptoms are described as ‘positive’ or ‘negative’. Psychiatrist, Ravindra Agarwal says that though symptoms of Schizophrenia can manifest at any time in one’s life, these are mostly observed in late teens to early adulthood. “Men tend to show signs of these symptoms slightly earlier than females,” he says.
Panaji-based counsellor and psychotherapist, Adolfo Castellino adds that the symptoms generally include delusions, hallucinations and sometimes a catatonic condition, together with conditions of depression. It manifests itself by the hearing of voices, paranoia, unwarranted suspicions, feelings of extreme persecution and the like. “Sometimes subtle other times extreme, confused state of mind and erratic behaviour, other times seemingly strange behaviour. Schizophrenia is different in different persons and easily confused with bipolar disorder, depression and other mental illness,” he says. Schizophrenic symptoms develop after puberty, generally between 15 and 35 or 40 the later ages especially where women are concerned.
Castellino says that initially schizophrenic symptoms are hard to diagnose and fix and the patient starts by avoiding social situations and stays aloof showing signs of aloofness and strange behavioural patterns and thought disorders. “Hostility and aggressive behaviour is also shown by some. Schizophrenia can also be triggered by use of alcohol or drugs as it creates an imbalanced mental condition hastening the condition,” he adds.
And just like there is no cure for illnesses like diabetes, hypertension, etc, there is also no cure for Schizophrenia. Through treatment that is palliative and though not curative, it is possible to get good control over the symptoms to lead a normal life. “With regular follow ups with the doctor and adequate family support, individuals suffering from Schizophrenia can remain productive members of the society,” says Agarwal. Castellino also clears out that usually people have a wrong notion about Schizophrenia wherein they blame parenting for its cause. “Whether ‘good’ or ‘bad’, parenting has no role to play in the development of Schizophrenia,” he adds.
Patients with Schizophrenia are a part of every psychiatrist’s practice and Agarwal, a private psychiatrist, does get individuals who are productive themselves, either on treatment (Rx) or those who work and are affluent.
Talking about the treatment he says that along with the need for medications it also requires lots of support. One area where support is needed is psychosocial and vocational rehabilitation. Agarwal says: “These services are minimal all over our country and Goa is not an exception.” He adds that the two district hospitals Asilo and Hospicio have psychiatric OPDs but lack rehabilitation/vocational support.
He further says that the NGO, COOJ, have a day care centre for psychological disabilities due to mental illness like Schizophrenia. Also there is a private facility ‘Chaitanya Mental Health Rehabilitation Centre’ at Thivim and since it is a residential facility, not everyone can afford it.
Elaborating on the Mental Health Care Act that has been passed by the Parliament and will be coming in force from July this year, Agarwal informs, “It has made provision for rehabilitation and makes it the government’s duty to provide these facilities. Since it is provided in the Act, public would be able to take the government to court (PIL) if it fails to provide these services.”
Caregivers and people in general should
l Understand that Schizophrenia is a form of mental illness and that the patient is not to be considered responsible for their actions and behaviour
l Create awareness amongst social and community members to understand and reduce unnecessary negative reactions
l Create an emergency or crisis plan amongst loved ones and helpful community members.
- a) Try and create a routine and predictable environment around the patient, reducing their stressors.
- b) Keep a watch on their medication intake.
- c) Try and introduce a normalising rationale. It helps in limiting the psychotic experience.
- d) Be extra watchful and observant as the likelihood of being suicidal is slightly higher.
Also people in general should realise that many wrong notions about schizophrenia have been spread around through different media especially movies, some of them are:
l That all Schizophrenia patients have similar symptoms.
l They are violent, dangerous and always out of control.
l That they are lazy by nature.
l That it is purely genetic. Though genes do contribute at times.
l They always need to be hospitalised.
l They can never lead productive lives.
l They can never regain normalcy in their lives.
l It cannot be treated.
Symptoms suggested by WHO
Schizophrenia is a psychosis, a type of mental illness characterised by distortions in thinking, perception, emotions, language, sense of self and behaviour.
l Hallucination: hearing, seeing or feeling things that are not there.
l Delusion: fixed false beliefs or suspicions not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary.
l Abnormal Behaviour: disorganised behaviour such as wandering aimlessly, mumbling or laughing to self, strange appearances, self-neglect or appearing unkempt
l Disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language
l Disorganised speech: incoherent or irrelevant speech
Sports day on ‘World Schizophrenia Day’
To celebrate ‘World Schizophrenia Day’, COOJ in association with ‘Chaitanya Mental Health Rehabilitation Centre’ is organising a ‘Sports Day’ for people with psychological disabilities. Explaining the reasons for conducting this event, director of COOJ, Peter Castelino says: “Firstly, we want them to enjoy themselves and secondly, to create awareness that people with disabilities can live a normal life if the right opportunities are given.”
From a counsellor and psychotherapist’s point of view
Adolfo Castellino uses Cognitive Behavioural Therapy (CBT) as an effective method for the treatment of Schizophrenia in conjunction with pharmacological intervention. “Being largely psychosocial in its form the involvement of Social Recovery Therapy (SRT) is essential,” he says. A section of CBT is the Social Recovery Therapy aspect that deals with imparting skills to the patient towards social interactions and building up confidence levels as a coping mechanism, creating a more competent and motivated mental state. Here, the timing of social recovery intervention is important as motivation to change is higher in the early stages of psychosis than later stages of Schizophrenia. Medication on its own generally leaves patients with persistent positive as well as negative symptoms, even when the patient is compliant with their medication instructions.
Castellino says that he formulates an agenda based on the form and duration of the illness along with the previous treatment as well focussing on their symptoms and severity.
With treatment what comes in one’s mind is the cost and commenting on the same, he says that working in conjunction with psychiatrists, psychotherapy can considerably help in creating a sense of normalcy as well as reduce the time to achieve the same which makes psychotherapy quite cost effective and efficacious. Generally around 14 to 18 sessions would be required with the provision of having a few more booster sessions.
As a psychotherapist for nearly fifteen years he has had five patients, most of them suffering from delusional and hallucinatory form of Schizophrenia. The patients came to him after prolonged psychiatric treatment and some also after hospitalisation. “Psychotherapy that involves talk therapy along with proper medication and its regulation as well as psychosocial rehabilitation can bring the life of a schizophrenia patient close to normalcy, enabling them lead a life of dignity and worth,” concludes Castellino.