What is Schizophrenia?

What is Schizophrenia?
By Jennifer Ehidiamen

Schizophrenia, one of the major mental disorders, is commonly misunderstood to mean that people suffering from it have a split personality. However, in this interview with Jennifer Ehidiamen, Dr. Olugbenga Owoeye, a Consultant Psychiatrist at Federal Neuro-Psychiatrist Hospital Yaba, gives a clear insight into what Schizophrenia entails and its prevalence in Lagos State.

For how long have you been practicing?
In fact I have been in Psychiatric since 1997 but became a Consultant in 2003.

From your vast experience in the filed, how would you define Schizophrenia?
Schizophrenia is one of the major Psychiatric disorders. It is a disorder of the mind. But in a layman’s definition, it is like a Psychological condition in form of a shattered mind. Just like how a shattered glass looks. It is a chronic recurrent major psychiatric condition that tends to deteriorate with time. As a result of which the individual will not be able to function socially and emotionally.

When you say it is recurrent does it mean it doesn’t ever get cured?
It can be treated but cannot be totally cured. It has to be managed for a reasonable period of time.

What is the major cause of this mental disorder?
When you talk about the causes of Schizophrenia in particular, they are also related to the causes of mental illness in general. And these causes can be divided into 3 groups, which are referred to as factors because the exact causes of Schizophrenia are unknown. So among these factors, there is the Predisposing factor, Precipitating factors and the Perpetuating factors.

The Predisposing factors are factors operating in the early life of the individual that tend to make the individual vulnerable to the development of a major mental disorder. For example, during pregnancy the mother may fall ill, suffer from malnutrition or the child might suffer some injury or infectious at childbirth. Also, early in life, the person may have suffered from a major illness like severe infections either due to virus or bacteria infection. These could be a major access to the brain. Aside those, other Psychological factors can also lead to Schizophrenia, such as someone not having any Parental attachment or closeness early in life. Schizophrenia can also be transferred from Parents to Offspring, that is to say that it is also hereditary.

When you talk about the Precipitating factors, those are factors operating in the life of individual around the time that the illness started and thus, appeared to have caused it or precipitated it, thus making the person mentally vulnerable. This varies from Physical condition to social situations.

Finally, we also have the Perpetuating factors. These are factors that help to maintain the illness that will not allow the person fully recover even after treatment. For example, where you have a family that is too emotionally over-involved with the individual. Or those families that run critical comment that discourages the person suffering from Schizophrenia from taking medication. Also, when educated individuals find out the extent of the illness, they feel demoralized and become socially withdrawn. As a result, the illness perpetuates further.

What are the major signs and symptoms of this mental illness?
The major signs and symptoms of this illness vary. But the major one is that the individual will start experiencing auditory hallucination, hearing voices of unseen people either discussing the person in a third-person among themselves or commanding the person on what to do. They may have strong paranoid delusions. For example, they may believe the family member is responsible for their problem or believe they own the whole world and become so grandeur. Apart from that, they may also execute some bizarre behavior. Sometimes, these believe may be so bizarre that it will be difficult to comprehend. They experience a situation where their thought is being spoken aloud to them, thus causing them to believe that their thoughts, actions or plans are being made known to everybody without them informing anybody. These are the major symptoms associated with these individuals.

Do they get to a point where they become violent?
Sometimes, they tend to act on their abnormal behavior and attack those people they believe are their enemies.

What effect does our religious background have on the Psychiatric trend in our society?
When we look at the issue of religion, we must take it from the general cultural perspective. As a result of our cultural background and beliefs, it is discovered that a lot of people may not believe that the illness needs treatment. So they go to all sorts of unorthodox places like “Babalawo”, spiritual homes, Churches etc., because they believe that the illness is Spiritual, their approach to treatment is spiritual. This sometimes also contributes to the delay in treatment. But in some of these Churches, whose leaders are educated, the moment they recognize the symptom, they pray for the person and aks him/her to go for medical attention.

From your experience in dealing with Schizophrenia, will you say the illness is on the increase or decrease?
The prevalence is not so much. Schizophrenia only affects 1 to 1.5% of the general population. The only thing is that it has a devastating effect that tends to run a deteriorating course in the life of the people concern.

Is there a particular age group that is most affected?
Yes. You know, we have different types of Schizophrenia. There is the paranoid Schizophrenia which is the commonest. This type affects people in their 20s and 30s. Then we have the Epiphrenic Schizophrenia and the simple Schizophrenia. With these ones, if you are not a professional Psychiatrist you may not know that they are sick. The only sign is that they may not be socially active but in their dressing they look normal and make no trouble with anyone. But they lack the ability to move up in life, they lack motivation, they refuse to associate with people and are unable to function socially and occupationally. They may not aspire to set up their own family, they just eat and live. Another type is the Catatonic Schizophrenia. Those are the ones that may be reckless or aggressive and hyperactive on one hand and be socially withdrawn and mute on the other hand.

What are the major challenges most Psychiatrist face in curbing the mental illness or trend?

The major challenges we face right now is the lack of adequate infrastructure to manage the people. Our Psychiatric facilities are not adequate. We do not have rehabilitation home for them, Vocational center is not adequate and in the area of personnel, we do not have enough of the personnel to take care of the patients. The few we have need training and re-training. All these need government intervention. There are some of these patients who cannot live in the community; there is need for accommodation for such people. If we have such, those people you see living under the bridge or walking naked along the road won’t be there. They are Schizophrenics, the Epiphrenic type, which are those ones that hoard rubbish. So the challenges we face are in the area of infrastructure, personnel and facilities/equipment.

The challenges listed above are more of government’s responsibilities. Is there anything the public can do to support?

Yes. The Non-Governmental Organizations can help along these lines in establishing these foster homes, I mean the hosted accommodation. They can encourage community participation in the management of these patients in their rehabilitation back into the community. In some of the Psychiatric Hospitals where they lack one or two things, they can come up with a Structure to help the Psychiatric home; individuals can also do that to help.

Are there current Schizophrenic patients you are currently treating?
Yes, we have so many of them in the wards. This is the major center where they refer them to.

Over the past years, have you been recording successful treatment of these patients?
Yes. They get well with our medication but the only thing is that most of these medications are very expensive. Thus, the patients face the challenge of sustaining the medication and rehabilitation process. Some of them are very poor and there is a limit to which the government can subsidize these drugs. There is no Social Security System to cover them. I don’t think they are included in the National Health Insurance Scheme. Some of these conditions require a long term treatment which is quite expensive so their families are left to do all the running around to raise fund.

From a professional perspective, what is your overview of the mental health status of Lagosians? Are they more at risk of being psychotic?

No, most people in Lagos are not at risk of being Psychotic. It is just the problem of Urbanization that make people react aggressively towards their environment. Thank God the recent development in the infrastructure is improving the situation. The challenge of Urbanization make people react violently to situations. Some of these challenges include poverty, unemployment, poor electricity etc., which are the basic things that can precipitate mental illness.

What is your advice to Nigerians in general that could help them remain healthy?
There are some basic things people need to do to remain mentally healthy. First, they must not go beyond limit. Don’t bite more than you can chew. Also, you must abstain from drugs and alcohol. Also, you must have an easy going attitude and be able to tolerate others to avoid bitterness and grudges. Nigerians need to learn how to be content with whatever God has given them. Don’t say because somebody is riding a Jet then you must ride a Jet overnight. Most importantly, you must try to avoid stressful situations. Although this may not be possible because you need some degree of stress to make it in life but one must try as much as possible to avoid unnecessary stress. By so doing, you can remain mentally healthy and live a fulfilling life.