Read Other Mental Health Articles UNDERSTANDING SCHIZOPHRENIA [The ghostly illness “OOPRI KASAR / HAWA”]   DR.   AMBRISH SINGAL M.D [PSYCHIATRY] MIPS, MAPA, AIASP, MIAPP, MCSEPI CONSULTANT PSYCHIATRIST CONTACT  +91-9815333660     INTRODUCTION  There is precisely a reason why I had written this article. As a Psychiatrist, I had understood and felt the pain and difficulty the schizophrenic and his family has to bear during the phase of illness and I am sure nobody would like to see ones near and dears suffer the way a schizophrenic does. By writing this article I had made an attempt to avoid, the misery that the illness may bring to you. I felt it  is my duty to narrate about this disease and it is essential for everyone to know about it. For, schizophrenia is treatable/controllable [as there are quite effective medications available nowadays; ] I hope your loved one to be part of the society as anybody else. Some people are lucky to get back to the normal stream of life. Many others are not Here, I share some of the important information about this illness. SCHIZOPHRENIA Being a Psychiatrist I can relate well to this illness and I shall try to explain about it. I shall be able to share only the basic and most desirable information that will make you and everyone aware about this dreaded illness and will enable you to help a schizophrenic patient around you. It is not possible to note all of the symptoms and tell everything about this illness as it’s symptoms have got a vast variations and it is beyond the scope and purpose of this article. Therefore I shall be narrating some of the most commonly found types and symptoms. WHAT IS SCHIZOPHRENIA? Schizophrenia is a mental disorder. Our doctors have known it for almost 2000 years. The incidence of schizophrenia is1% world over i.e. every one of the 100th person is suffering from schizophrenia, so today, there are100 lakh sufferers in our country.   THE SAD PART OF THE STORY The presentation of the illness is such that at the first instance the relatives of the patient feel that it is due to some “oopri kasar/hawa” and the first step is they take the patient to some faith healers (BaBa ji) to get the so called ghost off the patient .It is not that the family members are to be blamed for this ,the reason is the lack of knowledge and the deep rooted false beliefs prevalent in our society. What ever which appears fearful., strange appearing and cant be understood and explained rationally by most of people carries the tag  that its due to some black magic effect [tuna], or entry of a ghost or  alike beliefs.    It is only that after wasting a lot of precious time and money they manage to reach doctor ,but still not the Psychiatrist. Till then the illness has progressed and patient is in bad shape and had turned highly suspicious or uncooperative. SYMPTOMS /FEATURES It is a complex disease to explain and make our readers understand it. I have made an attempt to explain it in a very lucid language and not using much of technical words. Actually schizophrenics have a problem of fantasy overlapping with reality. All the symptoms of schizophrenia are difficult to mention here, but I shall narrate some of the important symptoms.  (A) HALLUCINATIONS It is one of the commonest symptoms seen in patients suffering from schizophrenia. During an attack of illness, one may hear voices or see people /ghosts/images/dead men /relatives /or even God, when they are actually not present there. These are called hallucinations. These are commonly of two types, hearing and seeing i.e. of hearing of voices or seeing of images   1. HEARING OF VOICES The voices are from some where outside ie from people in other city, of dead people, or even voices of people around him [when they are not talking], or even from other world /"aliens”. Patient actually hears that they are passing comments on him. There can be wide variation in the type of voices the patient hears. Some may hear very positive voices, praising for deeds the patient is doing. Or the voices can abuse the patient, saying bad names to him. They can be of commanding nature, thus forcing the patient to do certain types of jobs which he does not want to do like he may hurt others, commit suicide, may go out of the house, may not take food for days as the voices stop him from doing so. Or they can be in the form of an unnecessary conversation going on between some unknown people and it is audible to the patient. Voices can be in the form of a running commentary on patient, s behavior in which the voices go on commenting what ever the patient is doing. These voices may range from absolute clarity to just an irritating noise.  On asking the patient gives some explanation as where the voices are coming from, sometimes he is unable to give some reply. When the patient has just started hearing voices, he had varied reactions like he may get fearful as where they r coming from, who is producing the voices, who is commanding him he gets terribly disturbed. In some cases he may even enjoy the voices. In long standing cases they become part of patients life and he learns to live with them and does not show excessive reactions as in the beginning.   2. SEEING IMAGES/PHOTOS/GHOSTS The images seen by schizophrenics are clear, as real and colorful as normal people. The schizophrenics believe that the images are real, part of his life or are affecting his life. He acts and behaves according to the images he sees. Like he may go on talking to them, he may get fearful, he may run away of fear, he may cry or laugh loudly. To others it appears that he is doing without any reason and thus can come to know that he has gone mad.  A schizophrenic fully believes in his images, as according to him they are real. The images can be in the form of normal people roaming around him, can be of the people who are dead, can be people of his village/city, can be his relatives, can be ghosts, God himself.             The person thus goes on talking and behaving in context to the voices he hears and the images he sees. The interpretation that the people around him will make is according to their education and experience. An educated person may know that he has gone insane and is to be taken to a Psychiatrist but a man in a village may take it as the person is under the effect of some ghost and may take him to a Baba Ji /A Dera /to a Tantrik or any similar kind of person. In Some cases it takes many months or even years for such people to reach the proper place and doctor for the treatment. Till then the illness had worsened and the person had reached an advanced stage of illness    (B). DELUSIONS [FALSE BUT FIXED AND FIRM BELIEFS] It’s the second important feature of Schizophrenia Delusion is a fixed, false and unshakable belief and the person cannot be convinced even with the most rational explanations. i.e. the person start believing strongly in some context and the belief is so strong that it is impossible to convince him out of it. The thing in which he believes is of course totally wrong/absurd and baseless. It cannot be proven in any way and is actually not true. For example 1)    The person may start feeling that there are some people /police/CID, or people from outer world are after him and are going to kill him. So he may find it difficult to walk alone on the streets. He will try to hide, run here and there to save his life, will get fearful. He can try to commit suicide to get rid of this unsolvable problem and which no other person understands and which he cannot share with everybody.  2)    One may start suspecting his own family members that they have join hands to kill him. They are trying to poison him, in his food. So he stops taking food or water from other people or start preparing his own food. He may also beat ones family members of the belief that they want to kill him. 3)    He/she may suspect his /her spouse that one is not faithful to him/her. So he/she may file a divorce against him/her, can abuse or beat the spouse. One may think that the spouse has physical relations with his/her brother /sister, or mother or father. Or one may think about any of the family members that he /she wants to have sexual relations with him/her. 4)    Schizophrenic will say that other people can now read his thoughts and what ever he thinks everybody comes to know about it. He may say that his thoughts are being broadcasted in air, on radio or television. 5)    The delusions can be related to ones body like he may believe that there are worms in his head or throat, and they are biting him and he actually feels the pain and not sleeps for whole night due to pain. He may believe that the brain has rotten or the intestines had shrunken etc etc.. 6)    The schizophrenic believes that other people sitting around him talk about him make fun of him, abuse him in their own ways. What ever happening around him has got special meaning, what ever gestures other people around him make, have got a special meaning and the patient start giving his own interpretations to these instances. The list can be very long and it differs according to thought of the patient, but these interpretations can be something like this [it is not necessary that below given examples occur commonly, these are only for the sake of examples]: a)   If some person sitting in front of the patient moves his spectacles, patient feels that in this way he is calling bad name to him/abusing him. b)   If somebody is offering him a biscuit, it means he is calling him homosexual as the biscuit is long and like a penis. c)   He may say that all the community is against him and they are continuously watching him wherever he goes. d)   He says that whenever he thinks something bad, the cars passing by him blow horns and stop him from thinking like this. e)   He may stop watching television or radio and say that these programs /news are on him they are talking about him, spreading rumors about him. f)  He believes that if any one is talking about taxi/hole /well or any such word, it means he is abusing his wife.   (C) OTHER SYMPTOMS OF SCHIZOPHRENIA ARE :  1.   The patient shows no emotions on his face while talking or according to the circumstances. The face is dull without emotions most of the times. 2.   He may weep or smile /laugh very loudly when alone or may remain talking to oneself in his mouth in very slow voice which can not be heard by others, and he may go on making gestures with hands, or may point in air as if talking to somebody. 3.  Patient may remain standing or sitting in one posture or in a strange and difficult to maintain posture for a very long time. 4. The manner of talking is strange sometimes as one may not come to know what he is talking about as the talks are just a mixture of words and does not carry any meaning. 5.  Patient may go totally silent for hours or days together and may not even eat anything. 6. In some of severe subtypes schizophrenia, patient does not remain aware about even the basic necessities of life like: a) He may not demand for food for days together and will eat only on asking that too after several times b)  He may not show awareness towards the season, like he will not wear anything in winters and will bath with cold water or will wear a sweater and take a quilt and will remain standing in sun in the summers. c) He may remain roaming here and therein streets with torn clothes, without shoes, without food or water [means in a real bad state] d) He may pass stools and toilet at inappropriate places, or may not wash hands after the toilet. e) He may play with garbage or can even eat it. f) He can leave the house without telling any body and can remain out for hours to months and years All these feelings lead the person to withdraw from the family, work and the society. He is now no more a part of the society. He started remaining in his own world. After reading this article one can well understand a schizophrenic and his way of thinking and can do something for them.  One thing is very important that a schizophrenic himself or herself does not believe that something is wrong with him or her. As I had already told that according to the patient everything they feel [see or hear] is absolutely true and real!   IT CAN BE DEVASTATING FOR THE FAMILY AND THE PATIENT! It is important to identify and manage schizophrenia as early as possible. From the above given symptoms, One can now well understand the kind of effect a schizophrenic can have on his family. If not done, it can harm the family members very badly in all the ways emotionally, financially, socially and physically, even more than the patient because= a) The patient while he is ill cannot decide that what ever he is doing is wrong, that he should not behave in this way. After one becomes normal, then only one realizes that whatever he has done was wrong and he had not treated his family and friends properly when he was ill. b) One is always suspicious of all his friends. c) One did not do even the basic activities at home. d) On ones own, he is not interested in taking a bath or changing clothes.                                              MYTHS ABOUT SCHIZOPHRENIA 1.  Unlike the common belief, one does not have split personalities. 2. Once a schizophrenic does not necessarily mean, always a schizophrenic. 3. Schizophrenia is not caused by bad parenting, trauma, abuse, or personal weakness. 4.Most schizophrenics get back to the normal life. Very few require constant hospital care. 5.Unlike the common belief, marriage is not a solution for schizophrenia. 6. Going to Mandirs, Darghas, Churches alone will not help, they give a moral support to your mind. A Psychiatrist is the best person person to go to.   EARLY DISCOVERY AND MANAGEMENT IS THE KEY 1. It is very important to start treatment at the early stages of the disease. 2. In addition to this regular intake of medicine is very important, which will keep you safe from falling into the dreaded disease again 3. Some of the patients start consuming alcohol, which can only make problems worse. Early management can prevent this 4. Some of patients can commit suicide or can hurt others due to their deranged thought process. This can and should be prevented with early help. 5. A patient can continue to enjoy a normal family life with their near and dear ones, if treatment is started early. The disruption in the family is reduced with early diagnosis and help. IDENTIFY THE EARLY SIGNALS As I have mentioned above identifying the signals early leads to early help and better results. You can identify these signals now with the help of this article. The patient alone can also visit the doctor on his own whenever he sees and can identify these signals. Signals such as: Getting increasingly suspicious Being over-anxious about people talking about me Increased irritability Being highly withdrawn Feeling uncomfortable while interacting with others Having bizarre ideas Patients and families can help each other by identifying these and other signals. FAMILIES AND FRIENDS NEED TO HELP Schizophrenia in one of your near and dear ones can have a profound effect on your life. It is better to share it with others. You need understanding, love and support from others. So, do not hide it from others. Instead, try to understand and explain the nature of the disease and the best thing is that it can be treated. Remember: NO ONE CAUSES SCHIZOPHRENIA, LIKE NO ONE CAUSES DIABETES YOUR ARE NOT ALONE WITH SUCH A DISEASE YOU ARE NOT TO BLAME FOR THE DISEASE   HOW CAN YOU HELP? 1.   You need to know about the disorder, to be able to maximize the help that you give to a schizophrenic. 2. In many cases the patient  does not agree to  go the doctor and even does not take the medicine, as he does not agrees that he is ill, and what ever he is seeing or experiencing is truth. 3. In such case the Psychiatrist ids the best person who can help. He is swell equipped to deal with such type of problems and can suggest you one or the other solution to deal with such type of patients. 4.  Help the patient in taking him to a Psychiatrist and encourage him to take the treatment. 5. Work with your loved one to make him stick to the medication. It is sometimes very difficult in making the patient understand that medicine is very necessary and he has to take it regularly and for a long time. Sometimes the   family has a hard time in making the patient comply with the medicine. In such cases Psychiatrist is the best person who can find a solution to this 6. For a patient, the voice and images (hallucinations and delusions) are real. The near and dear ones should not argue, or make fun, or criticize the behavior. It can make the patient more withdrawn and so he will not discuss the illness with you. Thus the illness can worsen. 7. You should not act alarmed, do not panic, be calm and believe in your psychiatrist. 8. Once an attack is over, you should, with the doctor, try to develop plans to manage future episodes. Understand the first signals of warning and the need to take the patient to the Psychiatrist.  9. The relief starts after only few days, of treatment, its does not occurs on the same day. This should be explained to the family members and the patient [if possible] this will decrease their worry and increase their cooperation in treatment. 10.  Do things with the patient rather than for him. This helps to develop the patient’s social skills and helps him to get settled in day-to-day life and thus increases his confidence. CONCLUSION I want to share with all of you that medical scientists, all over the world are working hard continuously in order to provide better ways of understanding and managing schizophrenia.. There are new techniques and new medications under development. In the past 3 years a lot of new drugs have become available in the Indian market, which were not available before. These drugs are more effective and have got fewer side effects .so that now the treatment of schizophrenia is more acceptable as newer drugs have got less side effects and had resulted in a better quality of life in comparison to the older drugs Things are likely to be much brighter in the coming months and year.  There is hope!