The term schizophrenia literally means “splitting of psychic functions”. It is a psychiatric illness like any other illness that includes the breakdown of the integration of emotion, thought and action of an individual. It is a group of mental disorders that changes the way an individual perceives his/her world. The term schizophrenia was first coined by a Swiss psychiatrist Eugen Bleule who recognized and emphasized the psychological aspect of the disorder.
It is a mentally debilitating disorder that is characterized by gross disturbance in thinking, behaviours, emotions and loss of touch with reality. Schizophrenia affects around 1% of the population at some point in their life and 24 million people worldwide are predicted to be affected with this disorder. It occurs 1.4 times more frequently in males than females. Its onset is usually adolescence or early childhood with peak onset at 18-25 years of age, causing impairment in the socio-occupational functioning, social communication and personal care.
According to the international diagnostic classification systems that are DSM-5 and ICD-10/11, schizophrenia spectrum diagnostic criteria entails 3 predominant symptoms:
Positive symptoms that include –
- Hallucinations – Hearing voices in the head without any real physical stimuli. It’s a distortion of perception and sensory experience that seems real to the person having it but occurs in the absence of external perceptual stimulus such as hearing and seeing people and voices or feeling something that is absent in reality. There are different types of hallucinations, auditory being the most common.
- Delusions – Meaning a false unshakable belief which is not in keeping with a patient’s socio-cultural and educational background. There are different types of delusions ( persecution, reference, somatic and grandiose, etc.) These erroneous beliefs are fixed and are firmly held despite clear contradictory evidence.
- Thought disturbances – These are another hallmark feature of this disorder which means that the affected person fails to make sense despite seeming to conform to the semantic and syntactic rules. Thought distortion is manifested in the form of speech which is often incoherent, the incongruent and rapid shift of ideas from one topic to another, the speech is grossly disorganized in the sense that either there will be the poverty of speech or blocking or perseveration or forming new words altogether that doesn’t make sense or an autistic speech. The thought disorder is not attributable to low intelligence, poor education or cultural deprivation. The disturbance is in the content of the thoughts that are manifested through language and it turns out to be the same grossly disorganized. The listener would not be able to make sense and derive meaning-making out of their communication.
These refer to an absence of normal behaviours found in healthy individuals. They may appear months or years before positive symptoms. Negative symptoms include –
- Loss of interest in everyday activities
- Appearing to lack emotion
- Reduced ability to plan and organize, and carry out daily activities
- Neglect of personal hygiene
- Social withdrawal
- Loss of motivation
Goal-directed activity is disrupted, impairment in areas of routine daily functioning such as work, social relations and self-care. Disorganized catatonic or psychomotor behavior which means the affected person shows strange facial or postural expressions, grimaces and actions. There is an unusual increase in the overall level of activity. These patients have bizarre mannerisms or odd caricatures of gestures, speech or behavior. There are different forms of catatonic behaviours such as posturing, catalepsy or stereotypes, etc.
People having schizophrenia have a confused sense of self and magical thinking or autistic thinking, have lowered cognitive functioning, they lack insight regarding the intensity of the illness. The symptoms and their combinations are unique in each patient. There are different types of schizophrenia as well. According to diagnostic criteria, there must be continuous signs of disturbance that persist for at least 6 months so on and so forth.
Having given a brief description of what schizophrenia is and entails, let’s focus on the challenges that people who experience schizophrenia spectrum disorders and other psychotic related disorders face. We will not dig deeper into the technicality of the disorder rather we want to express and convey the stigmatization of the illness that society has labelled these people with.
How can we as a society and community de-stigmatize the labeling and name-calling of combatants?
It is a well-known fact that schizophrenia or any other psychiatric disorder is the most feared and misunderstood illness since generations. People, in layman terms, use the word “crazy” for schizophrenics which is a myth.
- First of all, we all need to understand that it’s an illness like any other mental illness and is absolutely treatable. The outcomes of the treatments are effective and favorable. Any disease would worsen if it goes untreated and same is the case with this one.
- Stigma is one of the greatest challenges that people with a psychiatric diagnosis face. There happens to be a prejudiced attitude and discrimination towards the patients. Isolation and avoidance are common reactions to those experiences.
- The amount of shame, embarrassment and unfriendly responses and treatment these people have to withstand is too much. Their illness is not their fault and they shouldn’t be blamed for it and looked down upon because of the battles that they are fighting.
- Unfortunately, religious practices in the name of treatment of psychotic illnesses have been a commonplace incident, especially in India. People used to be frightened and assumed that there is some sort of supernatural evil or negative energy possessed in the body of the individual. Today, with the advancement of medical and scientific research, discoveries and progressive outcomes, mentally illnesses are taken solemnly and are treated effectively.
- Since the magnitude of schizophrenia is severe, it is perceived in a negative light instead, it should be normalized and received with sensitivity. The kind of indifference and disgust that comes from the patient’s own family members and extended family makes the situation even worse.
- It is socially unjustified to show imprudence, alienation and hostility towards people suffering from a psychotic disorder. This is not a chosen and deliberate act. It’s a psychological ailment, a brain disorder which can be managed incredibly.
- The categorization, negative stereotype, labelling and discrimination from the general public ruins the case of the individuals. Stigmatized individuals often deplete adaptive coping mechanisms and it breaks their self-esteem while already managing a devalued identity which in turn engages them in maladaptive emotional regulation strategies thereby increasing the risk for other adverse health outcomes.Further, the stigmatized fear that publicises the illness will decrease job opportunities and social status, cause more shame and will lead to involuntary hospitalization resulting in delayed and poor treatment care outcomes.
De-stigmatizing the ordeal of psychotic illness
- The most important protective factor is the support system which goes a long way in treatment as well as eradicating stigma. It is extremely healthy and imperative to provide support, care and genuine empathy to the patients. Being patient and consistent with the care and recovery process is unimaginably beneficial.
- Engaging in a collaborative and empathic relationship focused on patient empowerment and emotional, psychological and social support in response to daily hassles reduces the intensity of the symptoms.
- Sensitivity training to family members and friends proves to be very helpful in the process.
- Psychoeducation of the disorder and its associated risk factors, protective factors, comorbidities and procedures and therapeutic intervention – all of it to the public is the first step towards spreading awareness and alleviating the unwanted challenges that patients have to deal with.
- Awareness programs and campaigns through different platforms, shared efforts at the individual, interpersonal (schools, workplaces, hospitals clinics, mental health professionals), and institutional levels(media, advocacy groups, policy changes, new legislation.)
- Role of support groups in the eradication of stereotypical attitudes is also one of the ways by which we can ensure the improvement of individuals by increasing informal relationships, and non-judgmental, safe and warm space.
- Changing perspectives by engaging in volunteering activities definitely substantiates to lessen the impact of stigmatized beliefs towards people with mental disorders.
- Development of more employment opportunities, providing high-quality facilities and rehabilitation services with low cost and affordable expenses is also helpful. Not only work alternatives but also a welcoming, positive and comfortable work environment.
These are few integrative strategies that can help eradicate the stigma and we must help one another with compassion. Thankfully, today as times are changing, a large section of society is progressing and evolving in the context of normalizing mental health and seeking required treatment interventions. Encouraging mental health awareness training will always be the first and foremost purpose.
Let’s make our community a peaceful and stronger place to live in.
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