from stigma to support: promoting compassion and understanding for schizophrenia

JOHANNESBURG, July 8, 2024 ' Schizophrenia can be a frightening experience, explains Dr Bianca Brider of Janssen South Africa Medical Affairs. The patient starts hearing, and even seeing people, things, and events that are actually not present in reality, and the disempowering aspect of it is that the patients are unable to discern the difference between these imagined phenomena and what is real: What did I just hear? What did I just see? Is this real?

Schizophrenia is one of the less common mental conditions that affects approximately 24 million or 1 in 300 people (0.32%) worldwide. Onset takes place most often during late adolescence and the twenties, and it tends to happen earlier among men than women. Imagine how scary that is for the patient, Dr Brider continues. Youre still trying to figure out who you are and what you want to do with your life, and you have to deal with the daunting challenge of schizophrenia on top of all of that.

This merging of reality and the patients internal narratives is the most apparent symptom of the disease, although other symptoms may include destructive behaviours such as low motivation, and a difficulty with forming social connections. A schizophrenic patient may also display signs of disorganised thinking, which is often observed as jumbled, irrelevant, or very limited speech, or inappropriate emotional responses. The patient might also display extreme agitation or, on the other extreme, a slowing of movements.

At least one third of people with schizophrenia experiences complete remission of symptoms, while some experience a gradual worsening of symptoms over time. Then there are others who have to endure an ebb and flow; an ongoing cycle of worsening and remission throughout their lives.

Perhaps we have popular media to blame for societys shallow and largely inaccurate stereotypes of the schizophrenic patient, says Dr Brider. Schizophrenia is quite different from Dissociative Identity Disorder (DID), or what is commonly known as a split personality. The split, in the case of schizophrenia, isnt between various personae of the patient, but rather between reality and the false reality that plays out within the patients mind.

People living with Schizophrenia are often portrayed as being unpredictable and violent, though this fictional construct, so popular in movies and TV, is only true of a minority of patients. Unfortunately, its these popular misconceptions that lead to the stigmatisation of patients. The fear of being stigmatised is an unfortunate social consequence of this disease, says Dr Brider. It discourages people with schizophrenia from seeking help, and also leads to their social withdrawal. This could, in turn, compound their symptoms.

There is also a belief that schizophrenia is untreatable, and that patients are incapable of holding down a job, or that they will end up being hospitalised on a long term basis. While its true that schizophrenia is incurable, that doesnt mean that its untreatable, Dr Brider stresses. Medical interventions have made enormous progress in recent years. This means that most patients will indeed be able to pursue a career, enjoy a full and happy family life, and not have to be hospital or institution-bound.

Research has yet to identify a single cause of schizophrenia, although its understood to arise from an interaction between a genetic predisposition and a range of environmental factors. Psychosocial factors, such as childhood trauma, may affect the onset and course of schizophrenia, as might the frequent use of cannabis.

Further studies have shown that psychoactive drugs such as cocaine, LSD, or amphetamines, can also increase the risk of developing schizophrenia, psychosis or a similar illness, although it isnt entirely clear whether the drugs directly trigger those who are susceptible to schizophrenia, or whether its because schizophrenics are more drawn to drug use. Its clear, however that patients whove had previous episodes of psychosis or schizophrenia, may, through recreational drug use, bring about a relapse, or stop existing symptoms from getting better.

If theres one point that I cant stress enough, says Dr Brider, its that uncontrolled disease can, and will, ruin lives. Whether its a disease of the body, such as cancer, or a disease of the mind, such as schizophrenia, being silent can have devastating consequences. There is both medical and emotional support out there. Reach out for help. Make your voice heard; its crucial for you and those that are still to walk in your footsteps.

When it comes to medication, there are both oral and injectable options available, depending upon the recommendations made by the patients medical advisers. Also, apart from adhering to a careful medical regimen, its important to remember the vital role played by psychotherapy, family interventions, psychoeducation, cognitive-behavioural therapy, psychosocial rehabilitation (e.g. life skills training), and self-help/support groups. A recovery-oriented approach that gives people agency in their treatment decisions, is essential for people with schizophrenia, and for their families and/or caregivers. Support groups, Dr Brider adds, are utterly crucial, in that they remind patients that they are not alone on this journey.