Even as Nigeria joins the comity of nations to mark the World Schizophrenia Awareness Day, Dr Jibril Abdulmalik a consultant psychiatrist and CEO of Asido Foundation, in this interview with SADE OGUNTOLA, says schizophrenia is very common, treatable and individuals living with the brain disorder shouldn’t be left roaming the streets.
TUESDAY was World Schizophrenia Awareness Day, what is schizophrenia? Is it the same as psychosis?
Schizophrenia is a brain disorder and it belongs to a group of disorders that are called psychotic disorders. What occurs in schizophrenia is that there are problems hearing or seeing things that are not there, which we call hallucinations. There are abnormal thought patterns, which we call delusions. For instance, the person may believe very strongly that everybody wants to harm or poison them. Now schizophrenia is the most severe form of psychotic illness that we have. It brings about abnormalities in the level of certain chemicals in the brain.
What causes schizophrenia?
It’s not possible to pinpoint one thing as the trigger or as the cause of schizophrenia. Like other chronic illnesses such as like diabetes, we know that there are factors that might increase the risk of developing or triggering schizophrenia. These include having a family history of schizophrenia, some could be pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development and abuse of hard drugs. For instance, there’s a strong relationship between taking cannabis and the development of psychosis. Cannabis distorts the equilibrium of the brain and they develop a psychotic illness.
Left untreated, schizophrenia can result in severe problems that affect every area of life. It can result in suicide, suicide attempts and thoughts of suicide; anxiety disorders and obsessive-compulsive disorder (OCD), inability to work or attend school; homelessness, social isolation and being victimised,
What are the pointers subjective of schizophrenia in individuals?
Schizophrenia involves a range of problems with thinking, behaviour and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganised speech, and reflect an impaired ability to function. None of these signs can be hidden. One of these issues alone when present in a person can be suggestive of the problem.
For example, they tend to be withdrawn, stare into space, lose interest in everyday activities, and talk to self alone by themselves or talk to voices that other people cannot see. They start to neglect their personal hygiene, look unkept and are not dressing well.
They may also have abnormal thinking; they think someone or their parent wants to harm or harass them, or even that certain gestures or comments are directed at them. Also, effective communication can be impaired, and answers to questions may be partially or completely unrelated. However, it is uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.
If stress is removed, can an individual with schizophrenia recover?
No, when someone has schizophrenia and you don’t treat the person, the person is never going to get well. Without treatment, the person will continue to deteriorate in functioning. Most of the homeless, mentally ill persons, whom we call mad people in quotes are people with schizophrenia. They are on the streets, walking naked because they are not given care. That’s why schizophrenia is the most severe form of mental illness, generally speaking. Once they get the right treatment, they can recover. Unfortunately, many societies have come to accept seeing someone who is homeless and mentally ill on the street. We are no longer bothered seeing them on the road in many communities. Nobody cares that people with schizophrenia are abandoned on the streets. It is not okay, they are someone’s son, daughter, brother or sister. And we know that with the prescription of medications by a mental health professional at the hospital and if this is supported with social rehabilitation, social support and psychological therapy, they’ll get better and will return to normal functioning.
Is schizophrenia treatment going to be for life, as it is with hypertension, diabetes and other chronic illnesses?
Schizophrenia, like these diseases, is also a chronic illness. They will need to continue to take medications in order for them to remain well. They will also need hospital follow-ups to monitor their health.
Asido Foundation recently started a project called “project hope” to give hope to people who have been abandoned by society because they have schizophrenia. They have written them off that they can never achieve anything in life and that is not correct.
In Project Hope, we are doing voluntary fundraising and we are picking people with schizophrenia from the streets. During a drive around central Ibadan, we counted 57 homeless mentally ill persons. This is aside from those on the streets of the inner and the city’s outskirt.
We don’t have the resources to pick all the 57. But we are working in partnership with the state Ministry of Social Welfare and Women Affairs, as well as Health to foot their treatment so that we can showcase that they can recover.
And at the moment, we plan to pick two people with schizophrenia every quarter of the year so that in one year, we will pick eight. As at the end of June, we picked four people with schizophrenia. Two of them are receiving treatment at the UCH, Ibadan and the other two are on admission at Adeoyo Specialist Hospital, Ring Road, Ibadan.
We know we can’t do it alone but we just want to use this as a pilot project to demonstrate to people that these are human beings like you and me. It could have been anybody developing schizophrenia and none of us will like to be abandoned.
But people believe that this disease is rare?
Absolutely not. It is really common. In fact, one in every 100 people will have schizophrenia. Nigeria has a population of 200 million. So by extrapolation; about two million Nigerians have schizophrenia at a minimum. If it is rare, what about all these people we see around?
Are there grades or types of schizophrenia?
Well, there are different types of schizophrenia. Schizophrenia isn’t just one type of disorder. It is a term used to classify a series of mental health disorders that fall along the same spectrum. There are actually different types of schizophrenia depending on the person’s symptoms, but generally, the main types of schizophrenia include paranoid schizophrenia.
Paranoid schizophrenia is the most common form of schizophrenia. But you hardly find someone with paranoid schizophrenia roaming the streets. They can maintain some level of functioning. It is just that they will be very extremely suspicious. They are really paranoid beyond the level that everybody knows and it is clearly not normal.
Are all individuals with schizophrenia violent?
No, in fact, individuals with schizophrenia are 14 times more likely to be victims of violence than for them to be the ones perpetrating violence. In the village, children are more likely to go and throw stones at them and then when the person turns, they will start running. How many times have you seen a homeless mentally ill person on the road coming to attack anybody? Hardly ever, but people just believe they’re violent. Of course, they can get angry like every other human being if provoked and sometimes they can behave badly like every other person, you know. But that they are more violent, is not true.
Is Nigeria doing enough for people living with schizophrenia, how can we make the difference?
We are doing too little and that’s why it appears as if we have a conspiracy of turning our back on them. In every major city in this country, you will see people who are homeless and mentally ill roaming the streets. I can tell you that the diagnosis will be schizophrenia. Somebody with depression will not be roaming the streets.
We are not doing enough if people are left to be roaming the streets because they have a mental illness and there’s nobody willing to take responsibility for their treatment. They can get well and recover and function like every other person.
Schizophrenia starts usually at the age of 15 to 25, at a time when they are in school or learning a trade and not yet become fully financially independent.
We need to increase the awareness in the community that schizophrenia is a severe mental illness, but it is treatable. They can recover and they can return to normal functioning. They should not be abandoned to roaming the streets.