Archive | October 17, 2010

Schizophrenia: The Case for Psycho-Social Treatment

Schizophrenia: The Case for Psycho-Social Treatment (Originally written in 1999)

By Hwaa Irfan 

‘Schizo’ or ‘schiz’ comes from the Greek ‘skhizein’ meaning to split. Popularized on film as the double personality, it is in fact a conflict between the conscious an the subconscious mind, but unfortunately, many mental states of dis-ease are placed under the label of schizophrenia. A combination of clinical psychologists, consultant psychiatrists and psychiatric nurses in Western medicine view schizophrenia as effecting the most basic mental functions where the schizophrenic loses their sense of individuality, uniqueness and direction in life when in fact the dis-ease is because of a struggle for that uniqueness often denied by society. They may seem to hear voices, hallucinate when in fact they are hearing their own inner voices and the voices from their memory, but are unable to distinguish between the real and unreal because what mattered to them before the ‘split’ did not matter to others. They develop feelings of bewilderment and fear unknown deep thoughts, and feelings out of the belief that they are being controlled by others, because in their pre-schizoid state, they had no control over their own lives.

For the schizophrenic, a traumatic emotional disconnection would have taken place at birth and/or in childhood involving their parent(s) which would have put them at risk of any further experiences. In order to cope with the process of growing up, the child develops defense mechanisms which become habitual and active in any situation that makes them feel that their very existence is being threatened. 

This emotional and psychological defense mechanism impacts on the body causing tensions in the joints. The extremities become cold due to a withdrawal of life force from these parts of the body which represents action in the physical world. They develop uncoordinated movements with a twist in the spine as a result of not feeling grounded/connected to the earth, yet they are hyperactive in a desperate need to connect with that which does not connect with them.

 Schizophrenics  are in a constant battle between the unity of self and the conflict with “reality” which they perceive – it perceives them as not having the right to exist in that arrived at state. For the highly intellectual, reasoning part of themselves, the goal is to be released from their inner terror of annihilation and rage which materializes as rejection of others before they are rejected – a common mechanism, which many “normal” people today embrace in the increasingly secularized, individualized world that we live in today. 

As the Mental Health Acts in the U.K. increasingly views schizophrenics as wild animals to be extracted from the public domain in a society that has the label “The Prozac nation”, the public respond to them in the same manner as when a wild animal escapes from its denaturing environment, the local zoo. Yet, schizophrenics are loving, highly spiritual, and highly intellectual people with a profound sense of the purpose of life.  As a result of relinquishing the responsibilities that life brings by default in a society that sees them as incapable, they are free to and do live very creative, and spiritual lives out of a need to banish the mundane that makes life meaningless. However, modern treatments of schizophrenia has been evolved by modern pharmacotherapies over the past 50 years shaping contemporary psychiatry into framing these complexities of the mind as a biological disorder without insight into the persons relationship with themselves, their culture, their religion, and the exacerbating medium of rejection by a seemingly pluralistic society that in reality increasingly demands conformity to a type.

Seeking Alternatives 

Aware of the shortcomings and time-related treatments for recurrent or chronic major mental dis-ease, added to which is the back-lash from family and/or community members struggling to conform to the accepted types once diagnosed/labeled the societal reaction causes a further conflict/splitting; a call for change has brought about the search for alternative solutions. In the U.K., the mental health community outreach programs have helped to bring about solutions, with the internationally renowned Maudsley Hospital recognizing that certain communities have a significant role to play in creating long term solutions. 

When I knew of Dr. Lambo, I was intrigued because I held the same perception and experience of schizophrenics developed from counseling, running workshops with them, and being at one time a part of the outreach program for Maudsley Hospital. Nigerian psychiatrist, Thomas Adeoye Lambo in his life time, took a community approach in Nigeria, which per capita the incidence of  mental illness was once the same as New York (New York has now superseded). The difference is, is that Africans have treated so-called “crazy” people as a part of everyday life away from external interference. Dr. Lambo employed a fusion of Western and traditional ideas incorporating family members and villagers into his patient’s psychiatric treatments. He found reputable traditional healers to be adept in the many psychiatric techniques he had learnt at the University of London. 

Lambo said before the advent of Freud, traditional healers invented what is known as the “talking cure”, free association, group therapy, and behavioral modification. They also used an extensive pharmacopoeia of herbal and psychotropic drugs. Faster, more effective and costing one-fifth the price of a Western cure, Lambo’s village-based model for treating mental illness had been adopted by 60 countries throughout the “developing” world. Using his own money, Lambo hired a dozen traditional healers to practice alongside clinical staff. For 12 years, Lambo filmed and analyzed the healers at work. When interviewed by Omni Magazine, Lambo was asked why he had placed patients in the villages. He replied: 

“I wanted to prove that psychotic patients aren’t any more violent than normal humans. Their violence is caused by the way you look at them. You expect them to be violent, so before anything, you tie them down. I’d put one schizophrenic or psychotic in the hospital and one in the village at random. But I insisted that those going to the village be accompanied by outreach psychiatric nurses, and consultant psychologists for the benefit of a patient who because of their religion and culture could not be helped beyond a certain point”.

 Personally, I found myself incorporated into the mental health community outreach program in London, based on reputation. They would also send me out-patients without first establishing the feasibility of it. Given that, I was an active center manager that trained non-English women in counseling – it was unprofessional. However, it relieved them of their burden as my work seemed to have reached their ears. 

The relationship sometimes worked smoothly, and sometimes not, especially when a problem outside occurred between a client and another person or persons. This is when the police would be called in, the client sent back into hospital (temporarily), and their “medication” increased. This in fact caused regression in the client, and then I would be called into the hospital to bring things back into balance. They understood very little of what I did, but they understood that the client responded well to what I did, which first of all was to see them as being not a threat, and in fact ‘normal’ but going through a phase.

For the sake of building a truly pluralistic society, where no one is perceived as the “other”, the psycho-social method is the most productive, and rather than decrease in the nature of what makes a person tick or not tick, it increases understanding within the context of the community instead of isolating and exacerbating fears, as well as help to heal families. Dr. Lambo told Omni:

“I wanted to prove that the village cure would be faster, better, with fewer relapses. Rehabilitation would be smoother. During psychotherapy the mother or aunt would sit with us. So when the patient was discharged there was no [need for a] special follow-up to explain what was to be done… Unless they chose to be treated by a traditional healer, patients in both village and hospital had planned therapy, injections of psychotropic drugs, electro-shock, and so on. The only difference lay in the social dynamics.

“Someone in the hospital couldn’t talk to anyone but his psychotic neighbor, while those in the villages after getting their shots of thorazine, could go sit in the market and talk to anyone they wanted… All the psychotics didn’t regress to the bottom of the heap as I saw in the big hospitals in London. People buried away in the depths of the hospital could no longer put on their socks and shoes…” 

“Surely want is a trial, and having a sickness of the body is more difficult to bear than indigence, and having sickness of the heart is more difficult to bear than having sickness of the body…”  ‘Ali ibn ‘Abu Talib –  4th caliph.

Sources:

Irfan, H, “The Evolution of Western Psychiatry and How this is Modified in Caribbean Terms” (workshop) Ivydale Mental Healthcare, London, 2006

Department of Health, U.K. “Mental Illness – Health of the Nation” 

“Jung, C. J.  “The Undiscovered Self”. Routledge and Kegan Paul, U.K.  1996.

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Towards the Greater I

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