Sunday, October 17, 2010

Getting Through - Surviving Mental Illness 4

A Note on Schizophrenia

I have for some ten years been interested in schizophrenia as I know three adults with this disabling mental illness, one of whom I was in a close relationship with.  That any one human being could live in a world where the borderlines between reality and non-reality were so blurred as to render existence in this world very difficult to negotiate is quite literally mind-blowing to use a rather inappropriate metaphor.  I have written about schizophrenia in these pages before as hitting the label link on the right of this blog will show.

Once again, if we need any reminders at all, mental illness was a taboo subject for many years in many societies. Unfortunately taboos (and vestiges of taboos) still remain even if we are loathe to use that particular word. Let's use the words "perception" and "prejudice" instead.  That there is a "damaging perception" (Dr Muiris Houston's formulation of words - again in the wonderful Irish Times supplement on mental health) out there in Ireland at least with regards to schizophrenia in no way surprises me.  I still count the three individuals I have mentioned in my opening paragraph as friends.  That some others might not surprises me somewhat, but misinformation and skewed perceptions about schizophrenia, and most mental illnesses, still abound.

Among the positive symptoms of scizophrenia are those of delusion and hallucination.  The lovely woman with whom I had a relationship suffered from visual and auditory hallucinations.  One morning she told me that her twin brother had at that moment a knife held to his throat, and no words of mine could convince her that such was only an hallucination.  However, she did calm somewhat after some time, though I don't believe I ended up disabusing her mind of that hallucination.  Dr Houston mentions the fact that many sufferers of schizophrenia present with delusions.  None of the three people I know present with that particular symptom, at least to my knowledge.  One of the delusions he mentions is that of the young student (his first encounter with this mental illness) who deeply believed that he was Jesus Christ.  I've heard of others who believe they are Napoleon, Hitler, JFK etc  A delusion is defined as a fixed idiosyncratic belief unusual in the culture to which the person belongs.

However, we are more likely to meet the more negative symptoms, viz., reduced motivation, lack of interest in social contact, diminished emotional expression which is called a flat presentation or flat look in the literature.  This flat presentation was the most disturbing aspect for me as the person looks so drained of all emotion as to render her or him almost beyond real human contact.  I tried so hard to bring a smile to her cheeks and often in vain unfortunately.

However, it is the bad press given to the positive symptoms of schizophrenia that is the primary cause of the fear, the gross misconceptions and wrong perceptions of this illness among the general populace.  One can only agree with Dr Houston's contention that "sensationalist media reporting has fed the myth that people with schizophrenia are dangerous..."  Even the use of the term "split personality" is essentially wrong and totally inappropriate.  It is important to state clearly that violence is extremely rare among the sufferers of this very disabling mental disease.  Here below is an excerpt from Dr Houston's column outlining the nature of delusions and it will give you some insight into their sheer power over the individual and how disabling they can in fact be:

Once successfully treated, some people actually miss their delusions. Delusions of grandeur are not uncommon; in one case, a man who thought he had special powers and had been chosen to save the world felt bereft to the point that life as an ordinary person living in a homeless shelter had lost its purpose. Another patient described how the voices he was hearing were nice to him and now that they had gone he felt lonely without them.

However, many delusions are disabling. One woman wakes up every morning believing she is being called to a child protection trial and spends the day writing down the evidence she will give in court. She had an abusive childhood and so her delusions may be her way of working through her past. In another case, a woman has a fear of being attacked from behind and so will not sit with her back to any window; she won’t travel in the front seat of a car for the same reason.

Hypochondriacal delusions, especially those associated with de-personalisation and a loss of identity, can be especially disabling. And paranoid delusions usually centre on a conviction that the person is someone of great importance and, because of that, is being persecuted, despised and rejected. (Se the following link here: Houston Irish Times
However, there is hope for the sufferer because medical science is progressing all the time and new medications are constantly coming on the market and the latest antipsychotics have less disabling side effects.  The goal of these medications is obviously to dampen down the intensity of the delusions and hallucinations while at the same time promoting social interaction.  However, this appears to me to be a "big ask" for any medication.  Obviously, hallucinations and delusions must be stamped out to as great an extent as possible as they are so disabling, but there needs to be interventions by a whole team of experts like psychiatric nurses, psychiatric social workers and occupational therapists.  I'm not so sure as to how successful any intervention from talk therapy can have as schizophrenia is more at the psychotic/psychosis end of the spectrum as regards mental health.  Psychosis is an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur. Hence, it is indeed less likely to be amenable to talk therapy intervention.

Houston at the end of his insightful article mentions the fact that a lot of sufferers can live a fairly reasonable life - some managing to hold down a fulltime job, others a part-time one, still yet others who volunteer to help less fortunate others and teach them some skill.  Quite a number also manage to sustain relationships - often very hard for the schizophrenic - with the help of the supports mentioned above.  Also he refers to one young man who stated on his profile on an on-line dating site that he suffered from schizophrenia.  Bravo for him!

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