Friday, November 1, 2024

Schizophrenia: Crossing the sanity barrier

In his early thirties, the man goes about his daily routine of carrying around a backpack that emits a hideous stench. On his arrival at the psychiatric clinic, the orderlies and psychiatrist discover that he has for a while been carrying a dead bird, long rotten, in his bag. The young man in question suffers from schizophrenia, a mental disorder that takes the form of a severe, chronic and disabling brain malfunction.

Kefentse Mzwinila, a specialist clinical psychologist, profiles the nature of this mental disorder. “A disturbance that lasts for at least 6 months, it is characterised by hallucinations, delusions, disorganised behaviour, disorganised speech, and some emotional impairment.” According to Mzwinila, the disorder can in some cases be confused with schizoaffective and schizophreniform disorders, which are very similar in nature. “The subtypes of the disorder include the disorganised, paranoid, residual, catatonic, and residual types,” says Mwizinila.

Dr Noah Nguni, a psychiatrist at the Princess Marina hospital, explains that there are three degrees of schizophrenia which vary according to their symptoms and curability. The first level can be treated, while the second one can be managed by regular continuous treatment. But there is the third one which is completely incurable and totally uncontrollable.

There is no known single cause of schizophrenia. Scientists have deduced that like many diseases, it is a result of the interplay of genetic, behavioural, and other factors. However, scientists do not yet understand all of the factors necessary to produce schizophrenia, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness.

“People who have a close relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with the illness,” says Dr Nguni. In the case of identical twins, where one is diagnosed with schizophrenia, the other has a high risk ÔÇô rated at 40 to 50 percent ÔÇô of developing the illness. A child whose parent has schizophrenia has about a 10 percent chance. By comparison, the risk of schizophrenia in the general population is about 1 percent.

“It depends on the underlying causes in the person’s personality development and environmental considerations; genetic factors; the stressors in the person’s life; the triggers in the person’s life which could lead to development of the condition; coping resources of the person and the nature of the presenting problems,” says Dr Nguni. “The answer as to the causes also depends on the theoretical school the practitioner subscribes to, and also on the current research in the field.” Dr Nguni further explains actions of the people with this disorder. Patients, he says, can be delusional, which can be a primary, secondary or controlling influence. They may also suffer from auditory hallucinations. “Delusions have themes ranging from sexuality, religion and annihilation,” he says.

A schizophrenic may find themselves convinced that they are involved in a romantic relationship with someone who is completely unaware of their existence. This kind of delusion is the one with sexual undertones, and may lead to cases of the patient stalking the subject of their romantic affections. In the case of a religious delusion, patients find themselves thinking they can talk to God and other spiritual beings. In some instances, they may believe that they are gods themselves.
Patients develop forced beliefs that cannot be corrected even when they are presented with contradictory evidence. For example, if a patient is convinced they are HIV positive, they will continue to think so even if a number of tests are run with the results showing otherwise. In some patients, auditory hallucinations may occur. These are disturbances of perception that are common in people suffering from schizophrenia.

Hallucinations are perceptions that occur without connection to an appropriate source. They can occur in any sensory form, be it auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell). Hearing of voices that other people do not hear is the most common type of hallucination in schizophrenia. These ‘imaginary’ voices may describe the patient’s activities, carry on a conversation, warn of impending dangers, or even issue orders to the individual. Approximately 90 percent of hallucinations are auditory in cases of schizophrenia, says Dr Nguni.

After a person is diagnosed as schizophrenic, depending on the degree, there are mandatory forms that need to be filled by family members and a psychiatrist before the patient is committed for treatment to a psychiatric facility. However, many next-of-kin’s are often reluctant to sign these forms. The reasons for this reluctance range from denial to fear of stigma and other traditional beliefs. Such reluctance denies the patient the necessary treatment. Also, mental health facilities in Botswana do not cater for schizophrenics who are incurable because they merely pose as treatment centres where patients can go to get treatment and are ultimately discharged.

Patients who suffer from hallucinations have proven to be a danger to themselves and people around them depending on the nature of the voices they hear. According to Dr Nguni, these voices can be extremely aggressive and can go to the extent of instructing the sufferer to either commit suicide or they can even instruct them to kill someone else. Despite the patient-doctor confidentiality principle, there is a social responsibility on the part of psychiatrists to disclose specific information should the “voices” instruct the patient to kill someone.

Mzwinila is clear that family members should act positively in these cases. “People do not choose to have the disorder, thus there has to be an element of empathy towards the family member. The second consideration is to understand that those with the disorder can live very fulfilling, productive, happy, and meaningful lives; many individuals with the disorder are managing their condition, thus it is very important to avoid stigma and discrimination towards people with the disorder. Thirdly, the disorder is not contagious, cannot be transmitted, and most importantly is not a cause for any form of embarrassment.”

Schizophrenia develops in both men and women with equal frequency. The disorder often appears earlier in men than in women, usually in the late teens or early twenties. Women are generally affected in the twenties to early thirties. Though rare, it can also be diagnosed in younger children.

In Botswana any adult of a sound mind can bring a person in for psychiatric attention if they suspect they may be suffering from a mental disorder. However as it is common in many societies, if the person does not pose a threat they are often left to suffer and be humiliated. Voluntary admission proves to be near impossible as the organ that informs a person of an ailment (the brain) is the one compromised in cases of schizophrenia.

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