Quieting the Voices that Hound
The symptoms of schizophrenia are as discomforting as its effects on those afflicted and the way society regards them
By Dr. Sheila R. Alcantara
She thought that demons were whispering strange things to her ear, but she didn't want to hear them at all. She longed for them to stop, yet the more she pleaded, the louder they seemed to become. People around her were already suspicious, as if they can also hear what they were saying over and over again. Or was it really just in her head
The disability of the mind, is perhaps, the most disabling of all disabilities. For, where all thought, imagination, and will emanate, is also where the problem lies. It is made even more elusive by the mysteries imposed by the complex connections between the approximately 1012 neurons that lie hidden within the substance of the human brain. And unlike other diseased organs, such as a cancerous breast tissue or a failing heart valve, which are readily identifiable on routine imaging, an alteration of the mind cannot be recognized solely, at least for now, just by examining the brain.?
There are myriad forms of mental illnesses, but the one considered most devastating of all is still schizophrenia. Unknown to many, schizophrenia, which has been described in literature since 1806, is a fairly common disorder, affecting approximately one percent of the population worldwide. In the country, no such epidemiologic data exist, except for the 1986 study by a group from the Western Visayas State University, which showed a higher than global prevalence of 4.3 percent for all psychotic disorders. This translates to roughly 1.8M adult Filipinos who are severely mentally ill.
Before, they only visited her when she was alone. Now, they seemed to be everywhere, and she cannot seem to run away from them.
Although originally described as dementia precox by Emil Kraeplin in 1896, it was Swiss psychiatrist Eugen Bleuler who breathed life into the present day term schizophrenia, literally meaning "splitting" or "fragmenting" of the mind. This was meant to describe the schisms in thought, emotion, and behavior among patients with the disorder, and though popularly misconstrued, is completely different from split personality, a form of dissociative disorder.
The manifestations that characterize schizophrenia are varied and diverse, and there is no one single sign or symptom that can be sufficiently considered as defining or pathognomonic. Although patients are more often described as having hallucinations (false sensory perceptions associated with real external stimuli; say, talking to an imaginary best friend and his niece) and delusions or false beliefs (e.g. a very strong belief that there is a government conspiracy when there is none), the wide spectrum has been simplified by dividing them into "positive" and "negative" symptoms. The more familiar positive symptoms are typically those that signal the presence of the disease, such as hallucinations and delusions, while negative symptoms denote the loss of normal functions, for example, the loss of the sense of pleasure or ability to form meaningful relationships. The clue to recognizing these symptoms, however, is the pervasive pattern of behavioral change observed over a period of time; only then will the pathological be differentiated from normality.
She wondered why it was that, of all people, it had to be her who was experiencing all these demons in her head. Everyone must think her weird or strange. She felt isolated and alone.
Why schizophrenia afflicts an individual and not others is still not yet completely known, but studies have strongly suggested the role of heredity. Hence, a person who has relatives who are schizophrenic are at higher risk for developing the disease, compared with those with no such family history, and the risk is correlated with the degree of consanguinity. For example, if one parent has schizophrenia, there is a 10 percent chance that one of the children will get the disease, and this shoots up to 40 to 50 percent if both parents are ill. If it is indeed heritable, therefore, certain genes might also be involved. Presently, however, there is no single "schizophrenia gene" that has been implicated to consistently cause the disorder in all afflicted individuals.
On the other hand, it is also postulated that certain life stressors can push some genetic predisposition on the edge, but this, as well, has not yet been conclusively proved. Hence, a lot of experts consider the disease multifactorial, a belief that should prevent people from blaming it on any one person, influence, or environmental factor, in causing this debilitating illness.
On another front, evidence based on newer and more sophisticated imaging modalities are pointing to specific morphological changes in the brain that are associated with schizophrenia. Although it is probable that multiple parts of the brain are affected and that the disturbance lies more in the way that these regions are connected, these findings suggest that schizophrenia is a brain disease, an organic disease-much in the same way that diabetes and heart disease are. Strategies to control it, if not cure it eventually, are therefore possible. The use of antipsychotic medications that address specific neurotransmitter abnormalities in the brain remains the cornerstone of treatment. On the other hand, nonpharmacologic treatment, in the form of occupational therapy, psychosocial rehabilitation, and psychotherapy, also form part of the overall care given to these patients.
She told herself that she cannot, must not, tell her parents lest they shun her away, just like what they did to a relative several years ago. And besides, they would probably think that she's crazy and lock her up somewhere.
Humans have an inherent fear of the unknown. What we know now of this disease is probably just the tip of the iceberg; hence, it is wrought with so many mistaken beliefs and fallacies. For the longest time, people viewed schizophrenia, or mental illness in general, as a curse, the workings of evil spirits, a bad joke, or some variation in between, and people afflicted with it as different, incapacitated, outcasts. But with the fast-paced advances in neuroscience and genetics, the face of this seemingly elusive nightmare is increasingly being uncovered, and people are more and more becoming aware that schizophrenics are also humans who need compassion and understanding, much like any other patient.
The first step to destigmatization, therefore, is education, both of the public and the patients themselves and their families. Noted psychiatrist Maria Luz Querubin of the University of the Philippines-Philippine General Hospital, shares that relatives and close associations are especially crucial in identifying their loved ones who are manifesting with the symptoms of the disease. This way, prompt treatment, whether pharmacologic or behavioral, can be instituted in the earliest possible time. Families, on the other hand, must also find means to cope with the burden of taking care of a mentally ill patient, for example, by joining support groups and family programs, as well as the use of day-care or chronic care facilities.
On a broader perspective, Dr. Querubin also believes the government must look at health care-mental health care, in particular-as a direct investment for national development. Mental health, just like physical health, is important to complete well-being, and more especially so, she remarks, as the disability of the mind makes the body unable to do anything. Therefore, steps towards attaining mental health must be aggressively undertaken, and must also include the care of those who are already mentally ill. Health policies should be concretized into specific programs and subsequently evolved into systems with working infrastructure and manpower, a vision that can only be attained by a cooperation between both the public and private sectors. True, the process may be tedious and expectedly difficult, but it is nevertheless worth the number of lives that will be saved.
In the stillness of the night, the voices stopped. Was it something Mommy did when she at last told her what was tormenting her? She couldn't quite remember; she just knows that at long last, it was quiet again.
The mathematician and Nobel laureate John Forbes Nash is a living testament that the so-called
buangs and sira ulos can definitely be functional, if not extremely successful in their personal and professional lives. And so is a lot of other unknown souls who struggle each day to be in touch with reality despite the seeming betrayal of the foremost citadel of their being. Their illness may destroy even their own flesh, but the core of their humanity remains intact. Such is the power of the human spirit, the relentless drive of the human soul.
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