Tackling schizophrenia


May 24 is observed as World Schizophrenia Day. This year’s theme, ‘Do what you can do’, focuses on fighting the stigmas associated with the disorder. NT NETWORK sheds light on this condition


In the simplest words, schizophrenia is a mental condition that makes it difficult to tell the difference between real and unreal experiences. It hinders the ability to think, act, and feel.

While some patients recover and get well over a period, others tend to live a prolonged life with the illness where symptoms can be rather distressing.

According to World Health Organisation (WHO), over a lifetime, about one per cent of the population will develop schizophrenia. It currently affects 20 million people worldwide.

“The first symptoms tend to start in young adulthood at the age of about 18 years in men and at 25 years in women,” says clinical psychologist Durga Chari of District Health Mental Programme. She adds that the condition may result in a combination of self talk, irrelevant talk, delusions, hallucinations, and extremely disorganised thinking and behaviour.

While, schizophrenia is treatable with medicines, psychosocial support is effective. Facilitation of assisted living, supported housing and supported employment are all effective management strategies for people with schizophrenia as listed out by WHO.

Lets understand the symptoms

There are two kinds of symptoms associated with schizophrenia – postive and negative.

Positive symptoms

These present as symptoms where a person can’t tell what is real and not. The person may also start speaking nonsense.

The symptoms could manifest as:

Hallucinations: These usually involve seeing, hearing, smelling, or feeling things that don’t exist. Yet, for the person with schizophrenia, they have the full force and impact of normal experience. The most common of these involve a person hearing things that aren’t real.

Delusions: These are beliefs that seem strange to most people and are easy to prove wrong. The person affected might think someone is trying to control their brain through the televisison or that the FBI (Federal Bureau of Investigation) is out to get them. They might believe they’re someone else, like a famous actor or the president, or that they have superpowers.

Confused thoughts and disorganised speech: People with schizophrenia can have a hard time organising their thoughts. They might not be able to follow along what you tell them. Instead, it might seem like they’re zoning out or distracted. When they talk, their words can come out jumbled and not make sense. “There were time I would jumble up words and have garbled thoughts. I was awaren that I wasn’t making sense when I would see a confused look on the other person’s face,” says a student who was diagnosed early with the mental condition.

Movement disorders: “People with schizophrenia seem reserved and pretty introverted in public spaces. One can easily make out that there is something not normal based on their movement, mannerisms, gestures, etc,” says a counsellor from Panaji.

Some people with schizophrenia can seem jumpy. Sometimes they’ll make the same movements over and over again. But sometimes they might be perfectly still for hours at a stretch, which experts refer to as ‘being catatonic’. Contrary to popular belief, people with the disease usually aren’t violent.

Negative symptoms

Negative symptoms refer to an absence or lack of normal mental function involving thinking, behaviour, and perception. Here, a lot of things stop happening in a person which can be noticed, and thus it might be helpful to seek proper diagnosis and required treatment.

Lack of pleasure: The person may not seem to enjoy anything anymore. “At parties or gatherings, the person might be there physcically, but can be clearly seen not enjoying the moment and being there for the sake of it,” says the counsellor.

Trouble with speech: They might not talk much or show any feelings.

Withdrawal from social activities. This might include no longer making plans with friends or becoming a hermit. “I used to love being around people, talking and entertaining people, but slowly I realised I wasn’t feeling normal. I would find reasons to not mix and mingle with people, I stopped answering calls, would retire into my bedroom earlier than normal time, and want darkness,” says the student.

Struggling with the basics of daily life: They may stop bathing or taking care of themselves. The counsellor tells us that it becomes easy to understand a person suffering from the illness by observing the the lose of interest in grooming, dressing up or losing interest in life and living for the sake of it.

No follow-through: People with schizophrenia have trouble staying on schedule or finishing what they start.

Schizophrenia also affects the cognitive ability of a people, that display as problems with concentration and memory. These include

Trouble concentrating: People with schizoprenia may lose track of what’s going on in a television show that they’re watching. It is also hard for them to organise their thoughts and make decisions

Memory problem: Someone with schizophrenia might have a hard time with their working memory. For example, they may not be able to keep track of different kinds of facts at the same time, like a phone number and instructions and have to go back and forth seeing, asking and memorising it.

“When the disease is in full swing and symptoms are severe, the person with schizophrenia can’t tell when certain ideas and perceptions they have are real or not. This happens less often as they get older,” says Chari.

Causes of schizophrenia

According to studies around one in 100 people develop schizophrenia at the same time in their lives. Most of these people are treated until their late teens or early 20s. However, it has been ascertained that there are several reasons or causes for schizophrenia.

Genetic inheritance: If there is no history of schizophrenia in a family, the chances of developing the mental illeness are less than one per cent. However, a person’s risk rises if one of their parents has a diagnosis of it.

A chemical imbalance in the brain: Schizophrenia appears to develop when there is an imbalance of a neurotransmitter called dopamine, and possibly also serotonin, in the brain.

Environmental factors: Environmental factors that may increase the risk of schizophrenia include:

trauma during birth

malnutrition before birth

viral infections

psychosocial factors, such as trauma

Certain drugs: Schizophrenia may make a person more likely to use cannabis in the beginning.

Through information gathered and from first hand accounts of people, stress and abuse of drugs like marijuana and LSD can also increase risks of schizophrenia.

There’s treatment

Schizophrenia is a life-long condition, but effective treatment can help a person manage the symptoms, prevent relapses, and avoid hospitalisation. Against myths and beliefs, treatment of schizophrenia helps in reducing, and even entirely eliminating symptoms of schizophrenia.

“When there is a combination of medicines and emotional support people can win the battle against schizophrenia,” informs the counsellor. While proper medication aids in restoring the chemical balance in the brain, a lot of cure is effective when it comes through emotional and community support. Here, patients become more informed and aware about their condition.

However, Chari through her studies and experience of dealing with patients tells us that each person’s experience is different, and thus the doctor will tailor the treatment to suit the individual.

1. Medication: It is essential for a person to continue with their treatment plan, even if the symptoms improve. If a person stops taking medication, the symptoms may return.

2. Behavioural social skill training: This helps patients in managing their daily activities, teaches them communication skills and other skills, that facilitate in managing living their individual lives. Chari states that skills taught are broken down into steps to make it easier for them to understand and follow.

3. Psychoeducation for the family: The family members and caretakers should know about the illness and understand the problem of the patients. According to Chari, this helps to fight the stigma asociated with schizophrenia and work to improve the lives of all people who go through mental illness.

4. Self-help groups: Support groups help people with schizophrenia and their families feel less lonely. Group members offer each other emotional support, acceptance, and advice. “ When there is a self-help group or support group, it becomes cohesive and everyone feels bonded through the similarities they go through,” informs the counsellor.

5. Psychosocial therapy:Psychosocial rehabilitation focuses on social and vocational training. Here, people learn skills that they need for interacting with others, living in the community, and assists them in getting a job and retaining it. “For example, someone might learn how to apply for a job, use public transportation, budget money, and remember appointments,” says Chari.

6. Role of caregivers: In any illness, the caregiver role is the most important. They should be passionate and compassionate towards the patient. They shouldn’t be too critical, nor should they pamper the patient too much.

Many a times mental illness is ignored because of myths surrounding it and the stigma attached. Mental health is not given as importance as physical health. But this needs to change, say experts.

“Schizophrenia is like hyper tension or diabetes where the treatment is lifelong and if proper treatment is adhered to, sans missing out on follow ups with the doctor and skipping medication, a person living with schizophrenia will be able to live a normal life”, says Chari.