Mental Health Care

Schizophrenia is a devastating mental illness. It imprisons the human consciousness in cobwebs of absurdity. The person loses contact with reality, and the thinking apparatus goes haywire. With thought processes going awry, the mind becomes a prisoner of private fantasies. Emotional expressiveness gets blunted, behaviour becomes odd, actions turn bizarre, the person becomes limited in his or her ability to interact with other people and often withdraws from the outside world.

Of all the mental illnesses, schizophrenia is probably the most difficult to understand for everyone involved. The first signs of illness typically emerge in adolescence or young adulthood. Most people suffer the illness throughout their lives, thereby losing opportunities for careers and relationships. Due to a lack of public understanding about the illness, people with schizophrenia often feel isolated and stigmatized, and are reluctant or unable to talk about their illness. This secretiveness comes as a major shock to families and friends. They feel acutely distressed and confused to see the effects of the illness on their relative, who they remember as being active and lively person before being taken ill. The economic burden and social stigma associated with supporting such a person can also complicate the situation, and family members may try to deny the existence of the illness. Earlier on, this illness was sometimes described as ‘cancer of the mind’ or even ‘living death’ because the person was totally lost to the ‘normal’ world. With modern treatment and management this is no longer true of the majority.

Modern antipsychotic medications can limit its symptoms quite effectively. More than 60 per cent people with schizophrenia can return to normal and lead active fruitful lives. There are a number of people, including some rich and famous and some who have given much to the world, who have flown over the cuckoo’s nest. The famous mathematician, John K Nash, who gave the framework of the Game Theory and received the Nobel prize in 1994, is just one of the many such success stories. In societies where the family network and support is robust, the outcome is even better as the sufferer is not able to totally withdraw into his or her inner fantasy world­the real world never loses its hold on the person.

Strangely though, the name schizophrenia is a misnomer. Its origin goes back to a Greek word which means ’split mind’. However, contrary to the popular belief, a person with schizophrenia does not have split or multiple personalities. Radler, the illness is a disorder of the thinking apparatus. A person with schizophrenia has difficulty in telling the difference between real and unreal experiences, logical and illogical thoughts, and appropriate and inappropriate behaviour. It is as if the electrical circuitry of the brain has gone haywire and wrong or random cross connections result in odd fragmented thinking. These characteristics were first noted by Eugene Bleuler, a Swiss psychiatrist, who wrote a classic paper on the subject, giving the illness its modern name.

Schizophrenia is not a disease of the new age. It merits description in several of the ancient texts, some as old as 1400 BC. The founder of modern psychiatry, German psychiatrist Emil Kraepelin, who devised the first scientific system to identifY and classifY mental disorders, gave it the name of dementia praecox in 1899. Schizophrenia causes an enormous cost to society, both in terms of treatment and lost productivity. Those who suffer from the illness occupy the largest number of beds in psychiatric wards. During an acute phase of the illness they may require hospitalization because of the danger they pose to themselves. Some 40 per cent people with schizophrenia try to commit suicide and 15 per cent end their lives this way. With nobody to take care of them, many people with schizophrenia wander around, homeless. The need in their case is the treatment of the illness, rather than letting them slip away.

One in a Hundred

Schizophrenia affects between one and two per cent of people during their lifetime. The illness is found all across the world. Race and culture do not affect the numbers, and men and women are at equal risk. Whereas most men face the onset of the illness between 16 and 25 years of age, women frequently develop the symptoms between the ages of 25 and 30. There are other differences as well between the two sexes. The illness generally takes a less severe course in women than in men-they need fewer hospitalizations than men, and function better socially in the community.

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