02 February 2011


 I was, initially, reluctant about addressing Schizophrenia in a public forum for an extended period and at one point, had considered a more conventional topic which is Depression.  I may still address that later, although  there have been numerous articles, papers and blogs about it.  It could be just the prognosis which is bleak and the few recorded cases of successful treatment outcomes that lends to this reluctance to want to even address the disease. Could it be the affect of these individuals or their behaviors that are bizarre to most of us? I remember during one of the treatment grand rounds, years ago, at a state psychiatric facility; a leading psychiatrist from Germany indicated that although their grimaces, ritualistic body movements and calls for help  make us uncomfortable to watch; they are necessary.  Human beings develop coping mechanisms to survive difficult circumstances.  These behaviors aid in reducing some of the horror and stress associated with whatever delusions or hallucinations they are experiencing.  Make no mistake, these people are suffering.  There is a virtual reality video that can give you some idea of what they are experiencing.  Please note that it varies in presentation, however, I've only encountered 2 or 3 cases of hallucinations that were pleasant.  Many psychotic episodes are frightening with directives that promote paranoia or delusions that one is in danger.  This can lead to nomadic, isolative,suicidal or homicidal behaviors.  It's a life long illness with no cure.  Managing symptoms and enhancing the patient's level of functioning that diminishes the ravages of the disease becomes the goal.  There are different types of Schizophrenia and the presentations are far more complex than I can do justice to in this format.  

During the span of my career (25 yrs.), Schizophrenia has been the most difficult to treat by mental health professionals and the major treatment modality has and continues to be pharmacotherapy.  The insidiousness of the illness and when it strikes most of its victims (early adulthood) lends to how devastating it is to the patient and their family. The latter become life long caretakers and require support, counsel and resources as well.  There is also late-onset and much earlier symptoms, classified as Autism; a form of Childhood Schizophrenia,  which was a previous and much used diagnosis.  As a therapist, the approach has been to find more creative ways of "support therapy", e.g., cognitive-behavioral to aid the client when they've stabilized on medication to challenge those delusions or "voices". To challenge them in a gentle and demonstrative way is one approach I used, yet, for some time I wasn't convinced as to how effective it was until a former patient returned for day treatment.  He advised that he appreciated when I would gently challenge him when he thought he heard snakes in my desk drawer rather than silently listen to him go on about it. He wanted to be disabused of his concerns.  Of course there are exceptions given the complexity of this illness.  Some therapists believe that challenging is usually of no consequence.  I beg to disagree and the talk I had with this young man confirmed it for me.

The above, is a memoir of Lori Schiller who overcame in an exceptional way, the severe and long battle with the disease. It is an example of the relatively few successes of becoming a highly functional and a relatively contented person with this illness.  She had a good support system, intellectual gifts,a drug that worked and an inner strength to continue on when she had reached the lowest point during its course.  It is recommended reading for anyone, interested in understanding Schizophrenia or for those whose love one has been recently diagnosed. In the epilogue; there are still some residual symptoms of her illness, however, she can manage them and her new set of coping skills are more effective in maintaining a level of functioning that is comfortable and allows her to continue teaching and developing new interests and hobbies.

My wish is that those reading this blog will become more sensitive and less judgmental to those we see talking to themselves or making gestures that are strange in public places.  They really need our compassion and support--not pity!


Nel said...

The blog is very good!

Shane said...

I couldn't agree more on the point that what mental illness victims need are our strong support and understanding about their situation. Many sufferers have been judged unfairly by many people who are not fully aware about this matter.

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