When mind is matrix of haze

Samir Parikh

Despite growing awareness in the field of mental health, it is still not uncommon to come across a mental illness being considered synonymous to madness. However, it is very important for us to be able to realize the fact that mental disorders are also medical conditions, with underlying medical factors, along with the contribution of other psychological and psychosocial stressors that interact and lead to the precipitation of the symptoms.

Schizophrenia is a psychiatric disorder in which the individual seems to be behaving in a manner that is difficult to comprehend within the real world. Further, such an individual is typically not aware of his or her own unusual behaviour. It is a condition that marks the diagnostic category of psychosis, in which the symptoms typically lead to a significant interference in the person’s ability to comprehend and respond to the world in a normal or expected manner.

Signs of concern

The key features that define psychotic disorders include hallucinations, delusions, disorganized thinking, grossly disorganized or abnormal motor behaviour and other negative symptoms such as lack of motivation or reduced emotional expressions. These symptoms of schizophrenia have originally been classified in the form of positive and negative symptoms.

The positive symptoms are so named because they are marked by the presence of some symptoms that are ‘abnormal’ or distorted mental processes, thoughts, perceptions, feelings or behaviour. Hallucinations are a person’s sensation, which is very vivid, but without the actual presence of a stimulus. They are most commonly auditory or visual, but can also be olfactory, tactile and even gustatory at times. A delusion is an individual’s false belief, which is firmly held and persists despite the presence of any contradictory evidence. Such delusions could be persecutory (believing that others are conspiring or plotting against the individual), referential (belief that external events or phenomena are being targeted at the individual), grandiose (believing that the person is a superior power), etc.

Individuals with schizophrenia typically speak incoherently and they might not be able to recognize the fact that others around them cannot comprehend what they are saying. Such a disorganised speech could manifest itself in various forms of formal thought disorders, including flight of ideas (rapidly shifting from one idea to another), word salad (random stream of seemingly unconnected words), neologisms (making up new words), etc. Finally, disorganised behaviour is one that is so unfocused and disconnected from a goal that the person cannot successfully accomplish a basic task, or the behaviour that is inappropriate in a particular situation. 

On the other hand, negative symptoms are symptoms of schizophrenia marked by the absence or reduction of normal mental processes, contents or behaviour. They could include a flattened affect (lack of or diminished emotional expression, often robotically), alogia (responding slowly or minimally to questions), and avolition (difficulty in initiating or following through with activities).

What leads to it

There is no single causative factor that has yet been clearly implicated in the etiology of schizophrenia. However, it has been well established that the disorder tends to run in families, thereby implying the evidence of genetic factors. Further, the role of an imbalance in the neurotransmitters in the brain (serotonin and dopamine) have been found to affect the way a person reacts to stimuli, and has been implicated in the etiology of schizophrenia.

Taking to treatment

The role of professional help for the management of psychotic disorders is irreplaceable. Pharmacological approaches to treatment are the evidence-based treatment paradigms that regulate the levels of dopamine in the brain, which thereby influence the individual’s cognition, perception and behavioural patterns. In addition, psychological support can be beneficial in helping not just the individual to lead a meaningful life, but can also help the family members and caregivers to learn to manage and cope with the condition better. Moreover, in some cases, especially those with a poor prognosis, psychosocial rehabilitation is very beneficial as it can help the person build on skills necessary for employment, socialising, problem solving and stress management. In some cases, residential treatment or hospitalisation may be necessary. Cognitive behaviour therapy can help a person learn to distinguish the symptom from reality, work on compliance and develop more effective coping strategies. Finally, the role of family therapy as well as group therapy is also extremely beneficial in improving the interaction patterns among the family members and building on their social skills training to improve their social skills.

Awareness helps

As we are increasing our awareness about the field of mental health, it is vital for us to overcome the stigma associated with it. Often people and their families may try to hide their symptoms in fear of embarrassment or stigma. We need to spread this awareness at a widespread level in order to overcome the hesitancy associated with reaching out to others, talking about the mental illnesses and seeking adequate and timely professional help. Psychotic disorders are a serious medical illness with physical and psychological consequences, but management is possible with the help of adequate psychiatric and psychological intervention.

The writer is director, mental health and behavioural sciences, Fortis Healthcare, New Delhi