Patients suffering from this form of mental illness can lead a fulfilling life with a supportive atmosphere, proper diagnosis and timely treatment

ONE FINE morning, Raghu called Shikhar (names changed) asking if he was free to accompany him to AIIMS (All India Institute of Medical Sciences) for his routine check-up. Shikhar knew that Raghu was battling mental illness but was unaware of the details. Raghu had informed Shikhar that he was in Delhi for a check-up and had been advised to come along with someone from his family or friends.

The next day en route to AIIMS, Raghu told Shikhar, that he was suffering from schizophrenia. He had once mentioned that the coaching institute where he worked had him under surveillance affecting his mental peace. He couldn’t concentrate on anything, and his motivation had dried up. He told Shikhar that he had been diagnosed with schizophrenia the previous year. Now, he was on medication and the illness was under control. He also requested Shikhar to tell the doctor that he was quite normal and since this seemed to be the case, Shikhar agreed.

Schizophrenia is associated with unusual perceptions of reality. The condition is often cause for disruptions in the patient’s social and occupational dealings.

In the case of Raghu, an inability to concentrate on his work and reading disrupted his professional and personal life. He said, “I read sometimes but after a point, I feel like throwing my book or tearing it up.” He is still lives under the fear of legal action as he had left his job without completing the contractual obligations with his employer. While he was teaching in the coaching institute, he became paranoid about things, started seeing things through a prism, he thought that every event was related to him. Things came to such a pass and he became so scared that he stopped taking calls from even his family.

He confided, “For at least an initial 10-15 days at the onset of schizophrenia, I was scared of everyone, even of loved ones. Since I was working in Hyderabad and it was the summer season, the situation became worse.”

Shikhar had known him for almost 15-years now. Famous in their hometown, Raghu had cleared IIT— one of India’s toughest exams and used to tutor Shikhar during his school days. Shikhar had known him as a reserved, hardworking introvert and took inspiration from him. To reckon whether he was normal or not was, therefore, very tough for Shikhar.

Upon their arrival at AIIMS, they continued talking about Raghu’s illness. Raghu told Shikhar that one of his uncle suffered from some kind of phobia. This intrigued Shikhar, bringing to him the thought that maybe schizophrenia was a genetic illness.

Psychotherapist Indrani Guha addressing the perception said, “The opinions of experts differ regarding it. Many believe that there is a genetic element but it has not been absolutely established.” While talking about triggers, she said, “Any physical and mental illness can be triggered by external factors (physical or social environment). But the origin is either in the mind or in case of schizophrenia the origin can also be the genes.”

On the same note, Professor Naved Iqbal of the Psychology Department at Jamia Milia Islamia said, “Serious illnesses such as schizophrenia can be caused by various factors —biologic, psychosocial, and socio-cultural. It can be triggered by anything. There is a model in psychology, the Diathesis-stress model—a predisposition towards a given disorder, for example, suppose there are two persons and both have an equal likelihood to develop schizophrenia. And the predisposition generally happens in the genetically vulnerable—due to a family history of symptoms of schizophrenia. So, if the person with such predisposition leads a stressful life they are more likely to develop schizophrenia.”

In the absence of proper knowledge of mental illness, friends and family can aggravate the condition. Sunil, who lives in a village, had been struggling with schizophrenia for the past 25 years before he got proper medical attention. “Our father married him off thinking, it would make things good for him, which never happened. We took him to various doctors, babas and hakims but nothing changed.” It was only recently that a proper diagnosis was made and scientific treatment started. A typical example of how wrong interventions can be detrimental to the patient’s treatment.

Shikhar’s interactions with Raghu’s family and friends revealed that Raghu had been fearful of a lot of things since his childhood and though he never discussed his childhood, Shikhar knew about some of his fears. Having lost his mother at a young age Raghu never really trusted his step-mother or his father’s family and had spent most of his years like a loner.

When they finally met the doctor, the doctor didn’t delve deep and told Raghu to keep taking his medicines and avoid stress. The doctor was quite positive about his recovery and said, “You are recovering well.”

After the consultation, Shikar asked Raghu when the first diagnosis had been done.

Raghu replied, “I was diagnosed in Jaipur and underwent various tests,  it was then that the doctor confirmed I have schizophrenia.”

There is, in fact, a lot of confusion around right diagnosis, which is very important in schizophrenia, as per the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), 2013, there must be once a month occurrence of active symptoms and for 5-6 months a few occurrences of symptoms, only then a patient can be considered a schizophrenic. Due to a lack of knowledge amongst doctors, many patients are misdiagnosed, hindering their treatment and recovery. According to statistics from the Centre for Disease Control and Prevention (CDC) of the United States of America, schizophrenia affects between 0.6-1% of the world population. Many psychiatrists believe that it cannot be cured thoroughly but people with schizophrenia can still lead a normal life.

Talking about whether a patient can lead a normal life, Dr Indrani Guha says, “In foreign countries, many schizophrenics lead a normal life. They can do so by regularly taking medicine (under the care of psychiatrist) and by also taking psychotherapy. Their views might sometimes appear odd to others but they will still be able to lead normal lives if they take both psychotherapy and psychiatric help. And this will have to continue, it can’t be stopped if symptoms improve.”

Studies suggest that psychotic or schizophrenic episodes increase the chances of substance abuse especially that of alcohol. However, there is no cause-and-effect relationship that proves that substance abuse causes schizophrenia or vice versa. The easy availability of alcohol is the reason for it being one of the most abused substance among psychotic patients. Substance abuse makes diagnosis as well as treatment of patients very difficult and increases the patients suffering.

The treatment for schizophrenia is lengthy and difficult, it cannot be cured completely. Dr Guha adds, “Till now no absolute cure has been found, but it can be kept under control.” Raghu was lucky that he was diagnosed properly and received timely support from doctors and his family.

Support for mental patients is very important. Those with symptoms are often stigmatised by society. Proper diagnosis with medication and acceptance by society will all go a long way in ensuring that patients suffering long term mental illnesses have the chance to lead a normal life.          ■