Hope and Intervention in Schizophrenia

BY SUCHITRA INAMDAR

Smita, a brilliant software engineer, had some strange experiences while driving in New Jersey. She knew that she was being followed and sometimes there were more than one vehicles following her. She mustered her courage. She wanted to call the police but she suspected that her phone was also being tapped. She went through sweating, palpitation and a dry throat. The half consumed cola in her bag shouted out loud “Do not trust me”. As soon as she reached home, she used to lock herself up, curtains drawn, lights turned out. She went through sleeplessness for 3 days. She was brilliant at work, quiet and delivered results. So though colleagues noticed that she didn’t seem alright, they chose to let it pass. On the 4^th day, as Smita was driving to her cousin’s place about 100 miles from work, she again saw the vehicles that were following her. But now she also felt that each vehicle had lights that were zoning in and zoning out. She felt that these lights were entering her thought. At one such moment she realized that something about her fear did not add up. She was again sweating and palpitating and the lights became brighter and brighter. That moment she decided that she would keep reminding herself that she needs to concentrate on driving for 50 more miles and then she would be truly safe.

Smita came back to India because in times of terrible economic recession in the USA around 2002, her company got an excuse to relieve her of her duty. She was diagnosed with paranoid schizophrenia. When she came to me, she was stable because of medicines. But complete emptiness, loss of confidence in her abilities and a sense of loss of time while she had episodes broke her down. She said “I feel as if I am constantly in the twilight between reality and unreality”. In the first session, when she narrated her experiences to me I told her, “You know, I am really interested in the 50 miles travel that you achieved. How did you know it was you who needed help?” Her eyes full of consternation and she said, “something deep inside told me that I need help and whatever it is, I can fight it. My brain HAS TO work when I need it the most”.

Helping Smita understand schizophrenia and helping her to find her life back was a rewarding journey. I will always remember this experience.

Most schizophrenia patients, however, are nowhere close to the prognosis that this case achieved. If we look at this narration carefully, the aspects that worked in Smita’s favour were – She was truly brilliant, she loved life, she was good with her life skills, she trusted at least some persons in her life completely (E.g. her cousin), she had a strong inner voice and she had money to fund her own treatment. In addition to that, Schizophrenia struck her in her late twenties. That means her personality was formed, she already had the experience of successfully moulding her environment and achieving malleability.

Managing schizophrenia is truly a challenge across countries and across cultures. In India, what should be the focus while treating schizophrenia? The focus should be manifold. My excellent teachers and lots and lots of patients and clients throughout my 19 years of practice taught me a few rules.

1. Medicines to control symptoms are a must – a foundation of the prognosis. The medical treatment is of such importance that without medicines nothing can be achieved and nothing can be achieved ‘only’ with medicines as well.
2. Psycho-education to manage treatment and symptoms. One has to start living with schizophrenia by understanding how the illness manifests in her. In today’s world say complete no to ‘Dr Google’ for your answers. I say this to many clients, diagnosed with severe mental illness who at some point come to me to enhance their quality of life and manage their symptoms, “Google will tell you all you need and don’t need about Schizophrenia, BPD, OCD, Addiction, etc. but it will definitely not provide any insight into how this illness manifests inside you and how you could win over it. So stop Google and talk to a real, human doctor”.
3. Helping the patient to be confident of being independent in managing the illness. Responsibility is a prerequisite of independence. It pays off in many ways to inspire, co-create responsibility. This is a hard task both for caretakers and the patient and they need to learn ‘tough love’. Having a good therapist to hand hold and steer this long journey is a very good emotional investment.
4. Symptoms are not life. In fact, life comes to light and out of the veil when symptoms are managed well. A deep understanding of the unique biography is the only way to help the patient in this crucial but decisive phase of prognosis. Most patients who are not able to find ‘life’ beyond these symptoms keep going back to difficult symptomatic episodes.
5. Support groups and community work is something in my experience that works very well for integration. What doctors can’t achieve sometimes is achieved by compassion from a co-sufferer.

*Names of clients/patients are changed to maintain confidentiality in all the articles published by APARA