By DR MIKE NEVILLE
THIS brain disease can be devastating for both the patient and their families.
It is very common affecting over one per cent of the world’s population. This is not as common as anxiety or depression but because of the difficulties in managing the illness it is far more devastating.
It is unclear what causes schizophrenia, there is a vulnerability to the illness which runs in families but the various things that can trigger the illness are widespread and at times unclear.
Schizophrenia is an illness surrounded by myths, fear and ignorance; it is not a split personality, it is not a character flaw caused by bad upbringing and people suffering from schizophrenia are no more likely to be dangerous than the general population. Schizophrenia does not affect intelligence, symptoms can affect ability to function, but when symptoms are controlled it is possible to lead a productive life.
The symptoms of the illness are best understood by looking at them under different headings.
Disorders of perceptions
These are problems with our senses it creates the experience of hearing voices, seeing things or strange smells. These senses are as clear as normal perceptions it is just that no one else can hear or see these things. The most common are voices that can talk about anything, they can speak to you or speak about you, they can be pleasant but are more likely to be rude, sexual or irritating. They can cause extreme distress.
Disorders of thought
The most common problems are delusions which are fixed, unshakeable, false beliefs. They can be paranoid or grandiose, no one else believes what you believe and they try to tell you that you are mistaken but you are convinced of your beliefs. They may even seem bizarre and impossible to your family and friends but despite all the evidence “You know better.”
Disorders of self
This group of symptoms describe changes with boundaries with the rest of the world, there is no insight into the illness, no idea that something is wrong; there is a loss of drive with little or no motivation to do anything. They may appear lazy but in fact it is the illness robbing them from the normal interests of life the drive that gets most of us out of bed each day is missing. They can be happy wandering around town talking to themselves and living on nothing. They may feel controlled by outside forces, compelled to carry out bizarre rituals.
These hallucinations and delusions are often culture bound, in some countries radio waves are blamed in the Bahamas it is more likely to have a spiritual explanation with complex religiosity. I struggle with the belief that demon possession is somehow more acceptable than a diagnosis of mental illness.
Treatment has improved, it used to be long admissions to a mental hospital where the help was primarily humanitarian; then the advent of medication transformed psychiatric approaches. The first wave of antipsychotic medication was very effective at controlling the hallucinations and delusions but did little for the apathy; they also caused tremors, stiffness and drooling, a zombie like effect. The newer atypical antipsychotics are much better in many ways but tend to cause serious weight gain with all the cardio vascular complications that come with the added weight.
The illness is chronic and treatment improves functioning but does not cure the underlying illness. It is important for families to develop a relationship with their mental health team, the patient is often oblivious to the fact that they have a serious illness so only a team approach can work. The only mental hospital Sandilands has had serious overcrowding problems for a long time; so families and professionals must struggle to work together to achieve the best outcomes possible.
The next time you see someone homeless on the streets instead of saying “Look at him, he is crazy,” remember he is probably mentally ill and once had a job and a home just like you and wonder instead what as a nation we should be doing about mental illness.
• Dr Mike Neville is a forensic psychiatrist who has practiced for more than 40 years in the Bahamas, working at Sandilands, the prison and in private practice. Comments and responses to firstname.lastname@example.org.