Mental Health Care

The illness usually develops slowly over months or years, and can surface at any time. In some people the symptoms may only last for a brief period, disappear, and then appear again in a cyclical fashion for a few years. The illness may then stop recurring and leave no residual effect. This is called the schizophreniform disorder. In most people the disease runs a long and continuous course. The severity of symptoms and the functioning of a person may however wax and wane. The disease may erupt and become severe, but may again become placid. Some people, as they grow older, are fortunate to experience a gradual decline in symptoms. About 25 per cent people with schizophrenia become symptom-free in their later lives.

The illness is marked by a variety of symptoms. The most prominent features are: disordered thinking-thinking becomes incoherent, disjointed and rambling; emotions get unrelated to the situation, actions and utterances become impulsive, and hallucinations overtake-the person begins to hear voices, often of unfriendly kind, or see objects that do not exist. Bizarre delusions is another common feature. The movements may become strange. Most people with schizophrenia cannot recognize that their mental functioning is disturbed or that they need help. They often do not understand that medication is a necessity for them and this worsens their suffering.

To develop a clearer understanding of the illness, let us take a closer look at its characteristic symptoms:

Delusions. Delusions are false ideas or beliefs that obviously appear untrue to other people. People with schizophrenia experience delusions of many kinds and are unable to appreciate why their ideas are unacceptable to those around them. Sometimes, these delusions are extremely grandiose. A person with schizophrenia thus may believe that he is the king, prime minister, or president of a country! Often, the delusions are persecutory in nature. He may believe that people are plotting against him, and are out to get him, or that he is being spied on. This condition is known as paranoia. The delusions may also be bizarre. A person with schizophrenia may thus believe that a stranger has removed his internal organs and has replaced them with someone else’s organs without leaving any wounds or scars. He may also believe that aliens are controlling his thoughts or that his own thoughts are being broadcast to the world so that other people can hear them.

Hallucinations. People with schizophrenia may also experience hallucinations (false sensory perceptions), and may see, hear, smell, feel, or taste things that are not really there. Auditory hallucinations, such as hearing voices when no one else is around, are especially common in schizophrenia. These. hallucinations may include two or more voices conversing with each other, voices that continually comment on the person’s thoughts or behaviour, or voices that command the person to do something. These are fairly characteristic of the illness. These hallucinations must occur when the person is clearly awake and not at the time when he is about to fall asleep or is waking up.

Disorganized Thinking and Speech. Since the thought process gets disorganized in people with schizophrenia, they may talk in an incoherent or nonsensical way and may jump from topic to topic or string together loosely associated phrases. They may also combine words and phrases in meaningless ways or make up new words. In addition, they may show ‘poverty’ of speech, in which they talk less and more slowly than other people, fail to answer questions or reply only briefly, or suddenly stop talking in the middle of a conversation.

Bizarre Behaviour. A person with schizophrenia may behave bizarrely. He may appear markedly dishevelled, may dress in an unusual manner (for example, wear multiple shirts, coats, scarves and gloves or use inappropriate makeup), may talk to himself, may shout or swear without provocation, may walk backward, laugh suddenly without explanation, make funny faces, or may display clearly inappropriate sexual behaviour. In rare cases, he may maintain a rigid, bizarre pose for hours on end, or may engage in constant random or repetitive movements.

Social Withdrawal. A person with schizophrenia may experience several negative symptoms, the most characteristic of them being social withdrawal. The person may thus begin to avoid others or act as though others do not exist. He may show decreased emotional expressiveness, and may talk in a low, monotonous voice, avoid eye contact with others, and display a blank facial expression. He may also have difficulty in experiencing pleasure and may not feel up to taking part in any work or social activities. This lack of volition stops him from initiating and pursuing goal-directed activities.

Other Symptoms. People with schizophrenia may face difficulties with memory, attention span, abstract thinking, and planning ahead. They commonly suffer from anxiety, depression, and suicidal thoughts.

They may experience physical tiredness for no valid reason, may oversleep or find difficulty in sleeping, suffer a loss of sexual interest, become overly dependant, and face problems in money management.

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