Mentally ill persons stigmatised

Pastor Tawanda Mvere

WORLD Mental Health Day is observed on October 10 every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The theme for 2014 is “Living with schizophrenia”.

Mental health in Zimbabwe is sadly associated with a lot of stigma. Shame is attached to mental illness, this has sadly affected mental health patients from seeking treatment for this condition.

The majority of mentally ill persons go untreated not because of a disinterest in psychiatric care but because the resources to train and support psychiatric personnel are simply not available. As a consequence, many mentally ill persons are being supported by their families or simply wander untreated.

For most of the persons with mental illness, the progression of the illness involves a gradual increase of symptomatic behaviour. For many families the assumption is that witchcraft or ancestral spirits must have been involved, but some also attribute the onset of the illness to stress or some environmental factor. Public mental health policy has to date been almost completely directed toward the provision of hospital psychiatric services.

Such services are important and should be maintained and strengthened where necessary. This is where services often begin for a newly ill person brought for diagnosis and treatment. This is not where public services should end, but unfortunately it all too often is.
After-care of psychiatric patients is largely absent. There are too few programmes and support services for patients, and almost no attempts at respite for families. Under these circumstances frequent readmission to hospitals and the decline of patients into dependence and apathy can be predicted.

Schizophrenia is, by far, the most debilitating yet least understood of all of mental illnesses. Characterised by a range of symptoms that may make it difficult for those experiencing it to judge reality, it most commonly develops during late adolescence or young adulthood. It affects an estimated 24 million people worldwide, and has an enormous impact on the quality of life. While effective treatments are available, the tragedy of this disorder is that less than 50 percent of people with schizophrenia receive adequate treatment.

People living with schizophrenia have historically been the target of fear, stigma, discrimination and exclusion. Until recently, most individuals living with schizophrenia were confined to psychiatric hospitals or, all too often, in jails. The impact of the disorder is also deeply personal, affecting almost all facets of an individual’s life. In some cases, a diagnosis of the disorder prevents acceptance into society. For most, the disorder negatively impacts relationships with family and friends, and the ability to maintain employment and secure adequate housing.

But for all, the chronic nature of the disorder and tendency for multiple relapses means that they and their loved ones must put forth significant effort – on a day-to-day basis – to get and stay well. Though there is no cure for the disorder, effective treatments, including both therapy and medication, are now able to ease its symptoms. But millions across the globe are untreated, either lacking access to, or stigmatised by seeking needed care. Many people experiencing the early symptoms of schizophrenia ignore or suppress the need to seek help and early treatment – and too often, parents, friends, and teachers do not realise what is occurring or how they might help.

The name schizophrenia comes from the Greek words schizo (meaning split) and phrenos (meaning mind). It was chosen to reflect the poor connection or “split” between the thought processes (cognition) of a person with the disorder, and other functions of the mind such as emotion and behaviour. There is a common misconception that people with schizophrenia have a “split” or “multiple” personality. This is not true and refers to a different and extremely rare mental illness – dissociative identity disorder.

Not everyone who is diagnosed with schizophrenia has the same symptoms. The definition of the disorder is quite wide, includes many different possible combinations of symptoms, and can vary across countries. Schizophrenia will normally be diagnosed by a psychiatrist, but there are many symptoms which occur in schizophrenia that everyone can be aware of.  For some people, schizophrenia begins with an “early psychosis” or “prodromal” stage. Key features of this stage include:

– Sleep disturbance
– Appetite disturbance
– Marked unusual behaviour
– Feelings that are blunted (flat) or seem incongruous (inconsistent) to others
– Speech that is difficult to follow
– Marked preoccupation with unusual ideas
– Ideas of reference — thinking that unrelated things have a special meaning, e.g., thinking that people on the television are speaking directly to you
– Persistent feelings of unreality
– Changes in the way things appear, sound or smell.

Some people may experience early psychosis or a prodromal stage and never develop schizophrenia.

Others who develop schizophrenia never show signs of early psychosis/prodrome and therefore have no option for early treatment, while there are people who have symptoms and obtain early treatment but nevertheless go on to develop schizophrenia. Symptoms which may then occur are often grouped into three categories: positive, negative and cognitive. The terms “positive” and “negative” can be confusing. Essentially, positive symptoms suggest that something is present which should not normally be there. A negative symptom is something that is not present, but should be.

The late renowned novelist Dambudzo Marechera was once diagnosed with schizophrenia by an Oxford University psychologist after he displayed erratic behaviour. Marechera threatened to murder certain people and attempted to set the university on fire.
People with schizophrenia may experience stigma and discrimination, and may have physical health problems related to their mental illness and psychiatric medication.

However, people with schizophrenia can recover fully, and even if they continue to experience psychiatric symptoms or medication side effects they lead full and meaningful lives.

If you have schizophrenia, you are not alone. For the millions of people worldwide living with this disorder, there are treatments that can help to reduce symptoms and improve the ability to function at home, at work, and at school. For most people, long term medication is required to treat schizophrenia. A number of other treatment options/services may also be used including talk therapy, self-help groups, vocational rehabilitation, community programmes and peer-support.

Treatment for schizophrenia is most effective if it is begun early – as soon as possible after symptoms appear.

There are a number of medications especially designed to treat schizophrenia. It may take some “trial and error” to find the medication that works best for you with the least side effects but it is important to follow instructions of your mental health team exactly and take your medications consistently as directed. It may take some time – weeks or even months – before use of the medication has a positive and stable impact on your symptoms. These antipsychotic medications are not addictive and they do not take away your free will. It is particularly important to keep taking your medication, even if your symptoms seem to have gone away, to lower the risk of relapsing. Sometimes, however, the side effects of antipsychotic medication can be very troubling and can lead people to want to stop taking their medication.

You and your family and friends should prepare to be patient during the treatment process. As with any recovery processes, it is important that the person with schizophrenia has a well-balanced diet, adequate sleep, and regular exercise, even if the side effects of medication may make these goals challenging. Supervision of daily routines is often required.

If you are a person with schizophrenia, let your family and friends help you. If you have a relative, friend or peer who is acting “strangely,” be there for him/her. Go with him/her to the medical centre, talk to counsellors, and assure the individual that he/she is not alone. Be a good friend. Schizophrenia can happen to any of us. In Zimbabwe we have registered psychologists and psychiatrists who can be looked up in local directories.

In addition we have mental health services provided at government institutions such as Ingutsheni Hospital in Bulawayo and Annex in Harare.

The writer is a pastor at Balm of Gilead World Ministries and Executive Director of Christian Counselling and Depression Trust. Christian Counselling and Depression Trust is a non-profit making organisation based in Bulawayo, whose primary purpose is to raise awareness on mental health disorders as well as provide Christian counselling. For further information contact Pastor Tawanda Mvere on 0733 207 898/ email [email protected]