By Yinka Shokunbi
Not many people understand that certain issues of mental health pose health challenges that affect every facet of the society. A lot of times, experts say sicknesses associated with mental health are unrecognised because of the associated stigma attached to this aspect of health.
Olugbile
October 10 was World Mental Health Day (WMHD) a day set aside by the World Health Organisation (WHO) with the overall objective of raising awareness of mental health issues around the world.
Speaking on the 2014 theme of WMHD, ‘Living With Schizophrenia’, former Permanent Secretary, Lagos State Ministry of Health and Consultant Psychiatrist, Dr Femi Olugbile described Schizophrenia as “an illness, or a group of illnesses, in which the individual loses touch with reality, and may experience a variety of strange feelings, such a conviction that he is being controlled by others, or his thoughts are being ‘broadcast’ and made available to other people, or that thoughts are being put in his mind or taken away from him. He may hear voices of people running commentaries on his actions”.
He noted that there are a whole range of other symptoms that a person suffering from the illness may experience which include some types which manifest with so-called ‘Negative Symptoms’ such as flat facial expression, lack of motivation, etc.
“Schizophrenia is an illness that probably has been with man from the beginning of times. It is slightly more common in men than women. It may affect any age group, from childhood to late old age, although it most commonly begins in people in their twenties and thirties”, said Olugbile.
Being a relatively common illness, he pointed out that about one out of every hundred human beings may expect to suffer the illness at some time in their lives.
“For instance, many of the obviously mentally ill destitute who wander about on the streets of Nigerian towns are suffering from long-standing Schizophrenia. In a similar way, many of the clients who are admitted to long-stay mental health facilities are suffering from Schizophrenia”, he noted.
But then what are the causes of Schizophrenia?
Some of the identifiable causes according to Olugbile are:
Genetics – a person with one parent who suffers from Schizophrenia has a higher risk of developing the illness than another person who has no such history. The risk is significantly increased if both parents suffer from the condition.
Family and Social Environment – some early theories suggested that certain patterns of family interaction could predispose some people to developing Schizophrenia in later years. Mothers especially were made to feel guilty if their children went on to develop the illness. There is no conclusive evidence on the matter. On the other hand, certain events such as Emigration, and belonging to an alienated minority are associated with a relatively higher incidence of Schizophrenia.
Drugs – some drugs of abuse such as cannabis (indian hemp) may cause symptoms similar to Schizophrenia as an acute illness, while long term use may lead to symptoms indistinguishable from Chronic Schizophrenia.
Factors such as Stress may precipitate the onset of Schizophrenia in a person who is vulnerable to the condition.
Abnormalities in Brain substance: certain physical changes in the brain are found on MRI and CT scan in many people who have had the condition for a long time. Whether this is ‘cause’ or ‘consequence’ of the illness has not been fully established.
Abnormalities in Brain Chemistry: the effective activity of the first generation of drugs discovered for treating the condition was found to be due to reduction of activity at dopamine receptor sites in a part of the brain known as the ‘meso-limbic’ system. This suggested that excessive neurochemical activity at these sights might be responsible for the symptoms of Schizophrenia. Again, whether this is ‘cause’, ‘consequence’ or ‘incidental’ is not fully established, though the fact that the medicines that target those sites have the effect of improving the symptoms suggest a strong relationship.
Recognising person with Schizophrenia:
A person with Schizophrenia may be observed talking aloud as he responds to voices he is hearing. The speech may be incoherent. There may be a variety of false beliefs (for example that his life is in danger) and unusual experiences as earlier described. Because the individual is out of touch with reality, he may not be aware that he is ill and in need of treatment and so may resist any effort to help him.
Helping a person with Schizophrenia:
The first important requirement is that a person who is showing obvious disturbance in behavior or thinking should be assisted
Living with Schizophrenia entails:
For the Client: It is a tough life even in the most enlightened societies. There are a variety of problems, starting with the illness itself. It is an unpleasant illness to have. It is difficult for other people to imagine how scary it must be for someone to feel that he is being controlled by outside forces, or to hear voices talking about his most intimate actions when he cannot see anybody. When he gets into treatment, the Drugs have some side effects (such as a frequent tendency to put on weight) which may be a nuisance. Some may cause drowsiness or sluggishness. After treatment and discharge there is the prospect of taking medication for several years, which is hard to accept. There is, of course, the cost of the hospital and the drugs over all those years. Then there is the stigma. Marriage break ups, jobs are lost as a consequence of stigma.
For The Family – it is tough having a son, daughter, wife, or husband who has Schizophrenia. It places a significant burden on family relationships. And yet it is a proven fact that persons who are in close, caring family relationships have a far better outcome in the long term if they have Schizophrenia than people who are solitary, such as single or divorced individuals. Professor Adeoye Lambo, the father of Nigerian Psychiatry, recognised the importance of the family in the care of the person with Schizophrenia hence the concept of the Aro Village scheme, whereby persons who were admitted for treatment were allowed to stay with members of their families in circumstances similar to their natural environment.
For The Society– A lot of misinformation and frank nonsense about the origin and nature of mental illness, especially Schizophrenia, is daily directed at the willing public in Nigeria from Nollywood. A research effort carried out some time ago at LASUTH surveyed about two hundred Nollywood movies of the Yoruba language genre. It found that at least half of them included one or more scenes of mental illness very similar to Schizophrenia. Invariably the cause was of metaphysical origin, the treatment was ‘metaphysical’ too, and the outcome was dubious at best.
What to do:
It is necessary to accept that this is a problem for all of us, and it will not go away. There needs to be more mental health workers employed and deployed at the grassroots for the care of the populace. The best place for a person with any mental illness to live ultimately is the community and not the hospital, so even if a person with Schizophrenia is admitted for treatment in a specialist facility, it is necessary that a system of Community Care be developed to help him ultimately fit back seamlessly into the community. (Lagos State is developing such a system and has committed itself to a Mental Health Policy that emphasizes the need). Mental wellness and the anti-stigma message must be propagated everywhere, including the schools. All the media, including Nollywood, must be recruited to drive home the message. Mental Health workers and all caregivers must approach their work with compassion and a positive spirit.
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