Psyche & Soul 36: SCHIZOPHRENIA – 3: ROOTS AND REMEDIES

 SCHIZOPHRENIA – 3: ROOTS AND REMEDIES

 

Podcast link:

https://anchor.fm/boscom/episodes/2-36-Psyche--Soul--79-ernra1

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

Last week I presented some of the major symptoms of schizophrenia. In this edition I shall explore the roots of schizophrenia and the treatment options.

Roots of Schizophrenia

As with other mental disorders, biology, genetic (inborn) factors and environment, but more especially biology, appear to be involved. Biological theories include how active and how well certain areas of the brain work, as well as problems with brain chemicals such as dopamine and glutamate. There may be structural differences too, like loss of nerve cells that result in larger fluid-filled cavities or "ventricles” in the brain.

Although genetic factors appear to contribute significantly to the onset of the disorder, most individuals diagnosed with schizophrenia have no family history of psychosis. There is also research evidence that genetic factors alone are not responsible. For example, identical twins may have the same vulnerability to schizophrenia. However, when they are brought up in different environments, one of the twins may develop schizophrenia, and the other may not.

The vulnerability potential seem to get actualised when the environment is very stressful. Studies of families of those who suffer from schizophrenia reveal a high incidence of parental psychopathology and disorders of communication which lead to high levels of stress and confusion. In fact, from a psychodynamic perspective this family dynamic is considered the trigger that actualises the vulnerability.

The bio-psycho-social model is the best accepted theory for causation of all mental illness, including schizophrenia. That is, biology (mostly functioning of the brain), psychological dispositions (genetic factors) and socio-cultural realities (the environment), all contribute to mental illness. Even though an individual may be born with a biological vulnerability toward a mental disorder, whether he or she develops it depends very much on their experiences, and the environment in which they find themselves.  

Treatment

About 20 percent of those who suffer from schizophrenia appears to have a favourable course of recovery and a small number recover completely. However, most individuals with schizophrenia require assistance in daily living and many remain chronically ill, while some experience progressive deterioration.

Most often, once developed, schizophrenia becomes a lifelong condition, but it can be controlled, and in some cases as mentioned earlier, full recovery is possible. Even when the illness persists, many individuals who have the disorder are able to live normal lives, provided they are regular with their medication and therapy. John Nash, famous M.I. T., and later, Princeton University Mathematician (on whom the Oscar winning film A Beautiful Mind is based), suffered from paranoid schizophrenia for several years and then was able to continue to produce brilliant works and was awarded the Nobel Memorial Prize for Economics, the Abel Prize and other prizes and awards, and honorary doctorates from several universities.

Early intervention has a significant impact on people with schizophrenia. Schizophrenia symptoms are often worse in the early stages of the illness, which is when the risk of suicide is highest. The majority of people with schizophrenia get better over time, not worse. In fact, 20% of people will get better within five years of developing symptoms, provided treatment is sought early and maintained.

Medication

The primary mode of treatment is through medication. Prescription drugs, usually known as antipsychotics, can reduce symptoms such as abnormal thinking, hallucinations, and delusions. However, these medications often have troubling and sometimes dangerous side effects. These include: dizziness, headache, fatigue, nausea, insomnia, dry mouth, weight gain, constipation, tardive dyskinesia (repetitive involuntary movements), low blood pressure, abnormal heart rhythm. In some cases because of possible complications, blood levels have to be frequently monitored. Fortunately the newer antipsychotics have fewer and less serious side effects. Still, because of the side effects many who suffer from it stop taking medications after a while and they relapse into serious symptoms again. But in most cases, medication is a must to treat schizophrenia. The challenge is to convince those who suffer from it to be regular with their medications. When the person refuses to take medicines, caregivers often mix them with their food or drink.

Psychotherapy

Psychotherapy can help those who suffer from schizophrenia develop better ways to recognise and handle their problem behaviours, manage their thoughts, and improve how they relate to others. The earlier treatment is sought, the better the outcome. One of the of the most often used approach is cognitive behavioral therapy (CBT), in which people learn to test the reality of their thoughts and better manage symptoms, clarify confusion and overcome self-defeating thoughts. Family therapy helps to improve family members’ relationship with the person having the disorder as well relationships among members, especially to help families avoid both angry confrontations and equally harmful emotional distancing. Other forms of therapy take a psycho-educational approach that aim to improve self-care, communication, and behaviour and relationship skills in general.

Milieu Therapy

Among the treatment approaches one that shows most impact is what is known as milieu therapy, usually carried out in hospitals and community mental care centres. The idea here is to create an environment in which those who suffer from the disorder can practise number of social skills, engage in various activities including games, learn some handicrafts, and make themselves gainfully employed. They will be taught how to do everyday things, like use of public transportation, manage money, shop for groceries and other goods, or find and keep a job. They will also be taking medication and engaging in psychotherapy.

Food and Vitamins

Foods that contain important vitamins, minerals, and healthy fats are good for schizophrenia. These types of foods help support the brain and immune system, which can lower the intensity of the symptoms and enhance the body’s capacity to respond to medications.

 

There is some research that suggest certain vitamins can be helpful, especially Vitamin D, various B vitamins, Vitamin C and Vitamin E.

 

Schizophrenia can hit anyone, and the results are distressing. But great improvement or even complete recovery is possible in some cases, through a combination of medication, healthy diet, psychological support, and creating a caring environment.

Introspection and Prayer

 

Mental illness, particularly schizophrenia, can cause much distress to those afflicted with the illness and their dear ones, friends and colleagues. But as this podcast has shown it is possible for those who suffer from it to recover and lead normal lives.

We could stay for a while with whatever the information provided in this podcast and our own experiences related to the illness evoke in us, and turn to our compassionate God who has our health and wellbeing at heart, and pray for healing for ourselves and others, as well as for wisdom and guidance to deal with situations that the illness creates.

 

Have pleasant weekend. Be safe. Be healthy. Be blessed.

Thank you for listening/reading.

Pictures: Courtesy google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

 

 

 

Psyche & Soul 35: SCHIZOPHRENIA - 2 - HALLUCINATIONS

 Podcast link:

https://anchor.fm/boscom/episodes/2-35-Psyche--Soul--77-er52ns

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

Last week I presented one major symptom of schizophrenia, namely, delusions. In this edition I shall explore hallucination and other symptoms.

Hallucinations

In hallucination the person experiences an auditory (hearing voices), visual (seeing imaginary sights), tactile (feeling sensations on the body), or olfactory (related to smells) sensation that has no basis in reality, that is, happening without an external stimulus. Auditory hallucinations are the most common.

The nature and content of both delusions and hallucinations are influenced by a person’s values and personal experiences. Thus, religious people often have delusions and hallucinations with a religious content. An illustrative example is that of Sr. Florence.

 

Sr. Florence’s community members noticed that she had been behaving oddly for some days. She spent most of the time in her room, not coming for community prayers and even meals. When she did spend time with community, she would talk about Jesus appearing to her and giving her messages for the Pope. She insisted that she had to go to Rome and give the message personally to the Pope. She was spending more time in her room because it is there that Jesus was appearing to her. The superior, who had some psychology background, suspected some mental derangement and wanted to take her to a doctor. But Florence insisted there was nothing wrong with her, but that she was a chosen person. Fortunately the superior remembered that Florence had complained of severe headaches sometime earlier. On pretext of taking her to see a doctor for her headaches, she tried again to get Florence to see a psychiatrist. One morning the superior went to Florence’s room to convince her to go to a doctor. She was surprised to see Florence kneeling in front of an empty chair in the corner, her face animated. “Sister, please kneel down. Jesus is sitting in that chair. Don’t you see him?” she said. … Florence was suffering from full-blown schizophrenia with visual and auditory hallucinations and having the grandiose delusion of being a specially chosen person by Jesus.

Catatonia

Those suffering from schizophrenia may also engage in bizarre posturing and inappropriate behaviour. In what is known as catatonic schizophrenia, a person, for example, may remain in a freeze position, with no movement at all, with a fixed stare, arms raised in an awkward position, and so on, for a very long time, resisting any attempt by others to stop them. There can be a complete lack of verbal or movement responses. On the other hand, the person may keep repeating the same gesture or movement for a long time meaninglessly. Classic portrayals of these are found in the movies “One Flew Over the Cuckoos’ Nest” and “Patch Adams.”

Disorganized Schizophrenia

In disorganized schizophrenia, a person may burst into laughter, grimaces, or giggles without an appropriate stimulus. Another example is of a person on the street talking to himself or herself, gesticulating to no one in particular, or directing the traffic even when a police person is doing it, sometimes imitating the police. Or, we may find the person looking up to the sky, gesticulating and castigating God. Persons affected by this form of schizophrenia may look markedly disheveled, dress in unusual manner, or display clearly inappropriate sexual behaviour in public. Their behaviours can also be unpredictable, suddenly becoming agitated, for example, swearing and screaming loudly.

Primary Dynamic: Distorted Cognition

The cognitive processes (perception, interpretation, judgment and so on) of persons suffering from schizophrenia are seriously impaired.  They may have trouble organizing their thoughts or making logical connections. Their mind tends to jump from one unrelated thought to another in a confusing and bewildering sequence. They may assign special meaning to seemingly everyday words, which only they understand. Those listening to them will have great difficulty in making sense of what they are trying to say. Delusions, hallucinations and behavioral difficulties, as also affective and emotional turbulence, have their roots in impaired cognitive processes. This cognitive impairment is the primary dynamic in schizophrenia.

 

Negative Symptoms

There are also what are known as “negative symptoms.” These are so called because they are an absence as much as a presence. These include inexpressive faces, blank looks, monotone and monosyllabic speech, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously. Schizophrenia can exist only with these “negative” symptoms without the more florid “positive” symptoms described above. In this case, the term “simple schizophrenia” is sometimes used. These symptoms, though not as incapacitating as the positive symptoms, can affect occupational life and relationships. These negative symptoms are the main reason those who suffer from them find difficult to live independently, and manage everyday life.

Introspection and Prayer

The description of hallucinations and other symptoms of schizophrenia above will show us how these can be cause of much suffering and relational difficulties. May be we have come across people afflicted by the disorder. We may be living with family members or others who suffer from it, or taking care of them.

A number of persons presented ion the gospels as being possessed by demons and whom jeus healed, were probably suffering from schizophrenia or other mental illnesses. The Gerasene demoniac (Luke 8, 26-39) as possible example. We could recall one of these stories and focus on Jesus’ compassion for those suffering from these illnesses and his eagerness to heal them.

 

We could then stay for a while with whatever the information provided in this podcast and Jesus’ healing stories evoke in us and share these with that same Jesus who is with us in the here and now extending to each of us the same compassion, or in the presence of  our compassionate God – seeking healing for ourselves and others.

Have pleasant weekend. Be safe. Be healthy. Be blessed.

Thank you for listening/reading.

Pcitures: Courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

 

 

Psyche & Soul 34: SCHIZOPHRENIA

 Podcast link:

https://anchor.fm/boscom/episodes/2-34-Psyche--Soul--75-eqjv4e

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

In this edition I shall explore another major mental illness, namely Schizophrenia.

 

Edward came to therapy because he could not get along with his wife. He believed his wife does not want him to be happy. “She does everything possible to make sure I am not happy,” he said. “I am the most unfortunate person to have married her. She is ruining my life.” As an example he narrated how his wife would deliberately rattle the dishes in the kitchen so that he could not sleep. He believed that she is actually the devil in disguise. As he unfolded his story in subsequent sessions, it became quite evident that he had misgivings not only about his wife, but with almost everyone around him as well. He believed that all south Indians were against him because he was a north Indian and were trying to get him into trouble. The woman he worked with at the office was deliberately plotting to get him dismissed from the job. Auto-rickshaw drivers were honking as he passed them on the road to deliberately annoy him. His cousin was turning his aunt against him.  His mother-in-law was sending him bad vibes, so that he would get sick and die….

Edward was diagnosed as suffering from and being treated for paranoid Schizophrenia.

What is Schizophrenia?

Schizophrenia (literally splitting of the brain) is the most serious of all mental disorders. Although not as common as the other major mental disorders, it debilitates people more than the others affecting their educational and occupational performance, as well as everyday life and relationships.  Most beds in mental institutions are filled by patients suffering from this type of disorder. Those who suffer from it are 2-3 times more likely to die early than the general population. An estimated 5%-6% of individuals with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness. About 20% attempt suicide on one or more occasions, and many more contemplate suicide, even if not attempt it.

According to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of schizophrenia typically emerge between the late teens and the mid-30’s. Onset prior to adolescence is rare. Schizophrenia rarely starts during childhood or after age 45. Schizophrenia occurs equally in men and women, although at an earlier age in men.

The onset of the disorder can be sudden, although in most cases there is a slow and gradual development of a variety of significant signs and symptoms.

Full-blown psychosis is often preceded by milder warning signs such as: problems in sleeping, difficulties in concentration, increased anxiety or depression, isolating oneself, increased paranoid (suspicious) expressions, negligence of normal work and schedules, neglect of personal hygiene, increased sensitivity to sounds, lights, smells, or other sensations and overall apathy. Gradually the more severe symptoms will manifest and become more and more pronounced.

 

The major dynamic in schizophrenia is disruption in an individual’s capacity to differentiate fantasy from reality. Fantasy becomes the reality. This leads to a variety of emotional, relational and occupational difficulties and affects daily life significantly.

Those who suffer from schizophrenia may hear voices, see imaginary sights, or believe other people control their thoughts. These sensations and beliefs can confuse and frighten the person and lead to erratic, and sometimes very bizarre, behaviour. There can be disturbances in the regulation and expression of affect or emotions, and difficulty in experiencing any pleasure. They have few friends and have difficulty in relating to others, and tend to withdraw from normal socialisation and seek comfort in their inner world of fantasy. They often harbour hostile and angry feelings which they may express in inappropriate ways that alienate those around. All this can lead to a very lonely and unhappy life.

Major Symptoms

Two of the most vivid and conspicuous symptoms of schizophrenia are delusions and hallucinations. In this podcast I shall focus on delusions and leave hallucinations and other symptoms for the next podcast.

Delusions

Maryann was brought to therapy by her husband. He had been noticing strange behaviour in her since a year. She believed that building contractors in the town were out to poison the water supply. She has to protect people against them. God had chosen her specially to do this. She only had the power to thwart their attempts. She does this with her own specially concocted water that she carries around wherever she goes. She intrudes into the houses of her neighbours and blesses them, assuring them that they will be protected from an impending disaster. Maryann was suffering from delusions of grandiosity.

Delusions are unsubstantiated or incorrect, but deeply held, beliefs about self or others that are sustained in the face of evidence that normally would be sufficient to destroy them. The content of delusions may include a variety of themes, such as persecutory, referential, somatic, religious or grandiose.

In persecutory delusions (also known as paranoid), the belief is one is going to be harmed, harassed, and so on by an individual, organization, or group. One might believe, for example, that a plot is being hatched to kill him or her, or that someone is keeping them under surveillance, and following them everywhere while remaining invisible. In delusions of grandiosity one might believe that he or she is really the president of the country, a king/queen, or the Pope, or even God, or, as in the case of Maryann, the recipient of special privileges not given to others, or has exceptional and exclusive powers. In what are called referential delusions one believes that certain gestures, comments and so on are specifically directed to himself or herself. For example, one might believe that the news reader on TV is providing coded messages to him or her. In somatic delusions one’s focus is on preoccupations regarding health and organ functions.

Delusions are deemed bizarre when their content is clearly implausible. One may, for example,  believe that someone is removing thoughts from his or her brain (thought removal) and replacing them with other thoughts (thought insertion) or that a stranger has removed their internal organs and replaced them with someone else’s organs without leaving any wounds or scars.

 These beliefs may sound bizarre to others, but are very real to those who suffer from them, and no one can convince them about their bizarreness or improbability.

One form of delusion that occurs especially among women (also religious women!) is that of being specially loved by someone. This form is known as erotomanic delusions. The delusional system becomes fixated upon one individual, usually an older male, and usually of a higher status, but can also be a complete stranger. The woman feels that this man has fallen in love with her and is communicating this love through various secret signs and signals. Paradoxically, she may also experience intense rage against the object of her delusion, at imagined perception of rejection, or as reaction to even trivial slights.

Delusions, as can be seen from the examples given, are distorted and improbable but rigid hbeliefs, held by who those suffer from them.

In the next podcast I shall present hallucinations and other major symptoms, the roots of schizophrenia, and available treatment options.

Introspection and Prayer

The description of delusions above will show us how these can be cause of much suffering and relational difficulties. May be we have come across people afflicted by the disorder. We may be living with family members or others who suffer from it, or taking care of them.

We could stay for a while with whatever the information provided here and our own experiences evoke in us, and turn to our compassionate God and share what is evoked in us. We could pray for healing for ourselves and others.

Have pleasant weekend. Be safe. Be blessed.

Thank you for listening/reading.

Pictures: courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com