Great disabler
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World Schizophrenia Day passed on May 24 but comprehensive care for patients remains a dream. Dr. R. THARA
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Photo: K.K. Mustafah
All encompassing: Schizophrenia still carries a lot of stigma.
SCHIZOPHRENIA is one of the major disorders of the mind, affecting as it does 0.5-1 per cent of the population. It has been described as the “greatest disabler of youth”. Ubiquitous in its distribution throughout the world, it affects ali
ke men and women, rich and poor, literate and illiterate. Although the ages 15-35 years are the high-risk age for schizophrenia, children and elderly also suffer from it. Migrants, those living in very deprived environments, some ethnic minorities, children with one or both parents afflicted by schizophrenia seem to be at a higher risk of developing schizophrenia.
A leading public health problem, the personal and economic costs of schizophrenia can be staggering. The disability produced by schizophrenia is all encompassing, affecting as it does personal care and hygiene, interpersonal relationships, social interactions, the ability to work, difficulty in attention, concentration and memory. In developing countries, where most persons with schizophrenia live with families, the human and economic burdens are huge.
There are still unfilled gaps in our understanding of schizophrenia. Though recent research is largely focused on establishing the genetic causes, all details of such genetic transmission are still not clear. Similarly, biological changes in the brain have been well documented to the extent that schizophrenia is now termed a “disorder of the brain”.
Symptoms
Hallucinations, delusions, disorders of thinking, neglect of self-care and personal hygiene, difficulties in socialisation are all hallmarks of schizophrenia. Their content and nature could vary among different cultures and societies. Aggression is reported to be more in western patients than those in developing countries.
Being male and single, unemployed, delayed and irregular treatment, family history of psychoses, poor social and work functioning before the illness, use of alcohol or other addictive drugs, unhealthy family environment all seem to work towards a poor outcome.
Availability of effective medicines, better community care, increasing awareness about the illness seem to have improved the outcome in a substantial number of persons with schizophrenia. Persons with schizophrenia die young compared to the general population. Infectious disease, heart ailments and death by suicides are common.
One in ten patients with schizophrenia has an affected family member. Increased number of birth complications, infections during pregnancy and use of addictive substances such as cannabis during adolescence have all been associated with schizophrenia.
Disability and burden
Schizophrenia causes considerable disability in several areas of a person’s functioning. Self-care, care of personal space and environment, interpersonal relationships, ability to show emotions and carry on meaningful conversations, ability to find and keep jobs, faculties such as attention, concentration, memory and other cognitive functions may all be impaired.
The fact that mental disability is not visually apparent as in the case of other disabilities has resulted in its being marginalised among the disabilities themselves. Added to this is the fact that the mentally ill are not as articulate as the other disabled groups.
Schizophrenia still continues to be painfully stigmatised for several reasons. A host of stereotypes such as aggression, contagion, unpredictability and inevitable heritability exist. Compounding this is the reality that a small percentage of persons with schizophrenia do not improve and remain considerably disabled all through their lives, despite treatment.
For such disabling conditions, a network of services in the government, NGO and private sectors need to be in place and adequately linked. Only then can medical treatment, psychosocial rehabilitation and support, family support, housing, employment, stigma and human rights and discrimination be effectively dealt with. However utopian this may sound, it is mandatory for all developing countries to work towards this. Only then will comprehensive care for person with schizophrenia and their families become a reality.
The writer is the Director, Schizophrenia Research Foundation (SCARF), Chennai.
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