Si juju, si kutupa network. Who really ends up in Mathare Hospital? …….. Demystifying Schizophrenia

Many patients diagnosed with schizophrenia in Kenya have a similar story of how it all began. As a mother and an African, I understand how difficult it is to fathom or accept that your child might be suffering from a mental illness or a condition that can’t be explained solely by life stress, bullying or cannabis use. Schizophrenia, Bipolar Mood disorder and Substance abuse with psychotic features are among the top three diagnosis that will land one in a mental hospital especially when one is a danger to himself or to those around them.

 

The facts: –

 Schizophrenia is a mental illness that occurs in 1% of the population with no regard to ethnicity or social class.

The symptoms often begin with a prodromal period during the teen years characterized by; personality changes, isolation, increasing paranoia and often a noticeable drop in school performance.

Parents and teachers may become alarmed when the child starts talking to himself, having disorganized speech or behavior or reciting stories that don’t appear to make sense (delusions). This marks the first schizophrenic episode. The sufferer believes strongly in these delusions that often include feeling that people are following him, controlling him, and using hi-tech devices to read his mind or monitor him. A schizophrenic isn’t actually talking to himself but rather is responding to voices he hears in his head that in reality do not exist. Other people around them cannot hear these voices hence their medical term, auditory hallucinations. The family will often conceal this information until these auditory hallucinations become excessive. The suffering teenager may start becoming abusive, shout inappropriately, disrupt others or even become destructive in their bid to fight or escape the voices. At this point, many parents will start seeking spiritual intervention and may involve a pastor or priest for prayers or seek out traditional healers. Most Africans erroneously ascribe mental illness to witchcraft or some form of possession by spirits. The child may appear to calm down for a few days, weeks or months before the cycle repeats, often in a more severe form. In desperation, families start pondering where the curse may have originated from. Is it because we did not complete the dowry payments??

This is not helped by the fact that mental illness tends to be genetic and thus often runs in families. Such families end up being ostracized, labelled witches and considered cursed.

 

What can be done: –

 After prolonged, unsuccessful attempts at finding a solution, the patient’s carers may finally decide to consult a psychiatrist. Having tried prayers, breaking curses and traditional methods for anything from 6 months to as long as 10 years, carers accept the inevitable and the patient often acquires the unfortunate title of `a Mathare case’ (so-named after Mathare hospital, which is the largest mental health facility in the country).

 

 

The mainstay of medical management of schizophrenia is the administration of antipsychotic medicines. Unlike other medications that provide a quick fix, such as paracetamol that may relieve a headache in hours, antipsychotics, on the contrary, take quite some time to work. They are also associated with myriad side effects ranging from drooling to assuming odd postures. Users and carers will usually find these disturbing or even frightening.

 

Challenges with treatment

Those with better education or easier access to healthcare may present for treatment much earlier. However, they may also struggle with adherence to medication during the initial stabilization phases, mainly due to their debilitating side effects. The initial months of treatment/ illness may be very stormy. Research has brought about significant improvements in these medicines yielding newer generation drugs that are better tolerated, despite still having their fair share of side effects.

Patients will often hop from hospital to hospital and from one psychiatrist to another in the hope of having the illness cured as soon as possible. Unfortunately, schizophrenia is a life-long illness. As most patients will not have insight i.e. the understanding that they’re unwell, the prognosis (outcome) relies on how soon the next of kin accept the diagnosis, remain consistent with medication, follow-up and provision of full social support. While many other factors may complicate the picture, this is the best a parent or guardian can do to help the child once they start showing symptoms.

 

Take away messages about schizophrenia:

  • The earlier medication is instituted, the better the outcome.
  • It is a chronic illness just like any other such as diabetes, hypertension etc
  • It has a strong genetic component, however, there are other risk factors still under investigation
  • 55% of sufferers will respond to medication and live a near normal productive life if managed in a timely and appropriate manner. Approximately 20% of first episodes will not recur.
  • The cause of the symptoms is largely due to disturbances in the balance of brain chemicals (neurotransmitters)

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