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1 Schizophrenia Schizophrenia is a chronic, severe, and disabling brain disorder which affects the whole person s day-to-day actions, for example, thinking, feeling and behavior. It usually starts between the ages of 15 to 35 and affects about one in every 100 people during their lifetime. People with the schizophrenia disorder may hear voices that other people don t hear. They believe unrealistic things which are not normal for others such as someone reading their minds, controlling their thoughts, or trying to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated and so-on. Most of the time people with schizophrenia may not make sense when they talk, because of hallucinations or delusions and disorganized thoughts or cognitive disturbances. They can sit in the same place for hours and hours without moving or saying anything. Sometimes they might talk to themselves because of the hallucination. Of course someone who doesn t know about their illness wouldn t be able to understand or estimate who they are because sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking. Symptoms of schizophrenia can be positive, negative and cognitive. Positive symptoms mean symptoms which are added in the life journey, for example hallucinations, delusions, thought disorders and mood disorders. These symptoms take the person away from the reality; sometimes they are severe and at other times hardly noticeable. But positive symptoms are psychotic behaviors not seen in healthy people. Hallucinations are things a person sees, hears, smells, or feels that no one else can see or hear. But it is true for the patients because they believe; sometimes the voices are very strong for them. The voices are controlling, commanding, warning, making patients panic etc. Hallucinations can be in a different form. The patients smell, see, the objects and feel the invisible fingers. 1

2 Delusions are false beliefs that are not part of their real-life. The person keeps on believing his delusions even when other people prove that the beliefs are not true or logical. It s seems bizarre. Thought disorders are dysfunctional ways of thinking. The patients are very hard to understand and sometimes they stop in the middle of a thought. Patients with a thought disorder might make up meaningless words. Negative symptoms are associated with disruptions to normal emotions and behaviors; examples would be flat affect, lack of pleasure in everyday life, lack of ability to begin any activities, speaking little and the most severe thing is losing relationships and jobs. The cognitive symptoms may be difficult to recognize as part of the disorder. Only tests can detect the symptoms, such as poor ability to understand information and use it to make decisions, trouble focusing or pay attention, the ability to use information immediately after learning it. These symptoms often make it hard to lead a normal life and earn a living. Sometimes people with schizophrenia can be violent because of irrational thoughts such as delusions of persecution. Also substance abuse may increase the chance a person with schizophrenia becomes violent. But the risk of violence among people with schizophrenia is small. However, the risk of attempted suicide is much greater than other risks especially for young adult males. Also people who have schizophrenia are much more likely to have a substance or alcohol abuse problem. The relationship between smoking and schizophrenia is complex. Also it makes another problem for the treatment because in addition to its known health hazards, several studies have found that smoking may make antipsychotic drugs less effective. Quitting smoking may be very difficult because nicotine withdrawal may cause psychotic symptoms to get worse for a while. What causes this illness? How does it come about? At what age does this usually occur? Schizophrenia affects men and women equally. And the symptoms start between ages 16 and 30. Men tend to experience symptoms a little earlier than women. After age 45 2

3 people usually do not get schizophrenia, also it rarely occurs in children. It can be difficult to diagnose schizophrenia in teens because of several reasons; first signs are the change of friends, sleep problems, irritability behaviors, and hormonal changes. Also women have the greater risk to have depression because their body chemistry changes which can lead to severe chronic psychotic disorders. But the scientist says schizophrenia runs in families; if someone has the family history they have the risk to get schizophrenia. Some research says that the twin of a person can have a great risk; but actually schizophrenia is not only the result of our genes, it is a combination of genes and environmental factors. The modern scientists believe that no one gene causes the disease; but several genes are associating to make rare genetic mutations. These genetic differences disrupt brain development. The other research says that in the brain there is some chemical imbalance; for example, the dopamine level is less or too much. Thus the pathologist suggests that the normal human brain and the brain of the person with schizophrenia are very different in chemistry and structure. Also, interrelated chemical reactions of the brain involving the neurotransmitters dopamine and glutamate, and possibly others, play a role in schizophrenia. In my country the causes of schizophrenia are still not well-known, I m quite sure that many people have this illness but caregivers are clever enough to manipulate or deliberately misinterpret the mental health symptoms and sometimes attempt to give them religious significance; and the society isn t aware because they don t have much knowledge in the field of psychiatry. For example, after 30 years of war and the tsunami, the result is that a lot of people became depressed and disabled with various kinds of illness including schizophrenia. This was especially true for woman because most of the fighters are male and head of the family; and when they pass away women must take the responsibility of the family. It is quite a challenge for them. When I look through the data of the World Health Organization (W.H.O) or health department I see that in increasing numbers people are committing suicide, crimes and becoming addicted to drugs. The reason is that coping mechanisms and knowledge are not enough. Culture makes them 3

4 ashamed; they aren t ready to accept that their beloved ones have problems, so the people with disability can t be treated at an appropriate time. Also in the hospitals there is a small unit for mental problems but the professionals or doctors are very few, so it seems that schizophrenia is not well treated. Schizophrenia can be stabilized with antipsychotic medications and various psychosocial treatments but cannot be cured. In 1990 s new antipsychotic medications were developed. These new medications are called second generation or atypical. Antipsychotics medications are usually in pill or liquid form. Some antipsychotic injections are longacting so they can be given once or twice a month. One of these medications, clozapine is an effective one that treats psychotic symptoms such as hallucinations, delusion and agitation. Usually some of the symptoms go away within a few days and symptoms like delusions go away within a few weeks. After about six weeks, many people will see a lot of improvement. People respond in different ways to antipsychotic medications. No one can tell beforehand how the person will respond. Also persons need to try several medications before finding the right one. Doctors and patients can work together to find the best medication, but these medications sometimes cause a serious problem; there are some other medications available nowadays which can give very minor side effects, but the person should wait until the professional finds out the effective medications. Some medication can work but the others don t, so it s impossible to treat schizophrenia like organic diseases. Giving medication is not enough, knowledge of the disease on the part of the patient and the family members is very important to maintain a healthy life. Psychosocial treatments can help people with schizophrenia who are stabilized on antipsychotic medication. This treatment helps the patients deal with the everyday activities within the illness, such as self care, work, keeping relationships, communication and so-on. Today we have more advanced therapeutic styles. We have illness management skills, rehabilitation, family education, cognitive behavioral therapy and self help groups which can help with their professional skills. 4

5 Finally people with schizophrenia can have electric shock treatment; most of the time people are panicked over this treatment, but of course it can be an effective support. Sometimes people who had this treatment can have some other problems such as short term memory loss or unconsciousness for a while. However still these treatments are used in the mental health field, although very rarely. On the other hand treatments at the hospitals provide a special structure; there is safety, a comfortable environment, and structure for their chaotic life. An individual approach for each person is used as well as respect for their autonomy. In other words freedom to the patient if he wishes; these matters involve voluntary and involuntary actions. For example, someone who does not wish to be hospitalized must be admitted in the hospital if he is a danger to himself and others. According to the law he can t make any decisions, so this is a time of need for someone to make the decisions for him, for example, the family members. Laws are a very important aspect of the treatment process. The outlook for people with schizophrenia continues to improve. Although there is no cure, treatments that work well are available. Many people improve enough to lead an independent life. The behavioral and neuroscience are giving support to help the people with this severe illness; still scientists are discovering many more new interventions and support for families, so that individuals achieve their full potential. For prevention as well, the research is still continuing but we have just a few strategies. Most of the people believe that we have to educate the young generation to prevent them from this severe illness; for example, coping mechanisms such as taking care to eat healthy food and not to smoke or abuse substances because sudden chemical imbalance can make problems. More approaches to prevention are visiting doctors and following the advice, continually following the medication and the family support. Also the social supports are very important to make a strong coping mechanism. People with schizophrenia are mostly able to deal with their life with the help of medication, psychotherapy and another therapy; the medication or psychotherapies is not 5

6 helping100%, so they are still disabled somehow. Because of psychotic moods they can be very weak, aggressive; they cannot take care of themselves and may be addicted to some substances. When they are dependant on substances then it makes another problem for them, the entire family and for the society. Of course in the family it is very hard to approach the problems of people with schizophrenia. They must pay special attention to their members with a disability; and they should take care of daily activity and look after the medications. Sometimes it s very painful to accept this heavy task in their long life. The community has to contribute their part as well, because people with schizophrenia aren t able to work. This can be so difficult for the family and for the society. However they should respect the person s dignity and autonomy. I have been working around one and half years in a mental health institute. When I reflect on my experience in that field what can I do to help the patient? I must make sure that he or she has a safe and protected healthy environment, an approach for each individual according to their situation or the level of illness. Because it is most important to make sure the people might be able to trust me, and I must respect the autonomy of person, at the same time I should give enough time to make healthy social contact with me. It s very important to be in touch, and understand him or her. I m sure that will take quite a long time but I have to be calm and try to listen to them. By doing this they might be able to experience the value of their life. Because my presence is important for them and they trust me so I have to be honest with them. My each and every movement with them should be very conscious or it can lead to misunderstanding. On the other hand I should give them some space so they may able to have their private things etc.. But I must take into account their autonomy. The structures of their life should be organized in an easy way so I can make sure that they can follow the structure in the time 6

7 of need, for example, taking medication or doing some activities to achieve their goals and so-on. Finally, acceptance of their reality is very hard to explain; however I should be able to guide them in a proper way, not only the person but family members too because I can t just support with my own self. It should be a holistic approach; I should try to see the whole picture. If I just see the illness and focus only on that I will fail because it s a whole life experience that must be addressed. I must encourage them to go through the misery of their life; when they escape from that misery it will give them pain for their whole life long. They aren t able to neglect the misery any more so it makes them worse and worse. The other thing is grieving. I see the actual need to grieve of the people with schizophrenia or mental problems. I realize that our society should educate the people to learn the coping mechanism because everyone has the possibility to become ill so in the time of need we should be able to manage and to be able to recover. I remember once a young intelligent man who affected by schizophrenia brain disorder said to me, I believe I cannot become a normal person and I have lost my life. Of course he is correct in a sense, but to make him understand the reality of life it s not that easy. We have to accept and deal with it. As a Brother of Charity I should help my brothers because they are wounded in their human capacity, I have the capacity to help them so I must help them in a proper way or I will lose the meaning of my existence. References: Schizophrenia (U.S. Department of health and human services) Psychiatric Nursing fifth edition by Keltner, Schwecke, Bostrom. 7

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