by Dayal Mirchandani

Schizophrenia is a severe mental (psychotic) illness and affects nearly one per cent of the population. Who estimates that it affects 60 million people worldwide and may cripple them for life. This tragedy is worsened by the fact that the disorder primarily strikes young adults.

People often have misconceptions that schizophrenia causes split-personalities like Dr Jekyll and Mr Hyde. What happens here is a split between thinking and emotion and the affected person often suffers from hallucinations and delusions. For example, the person may hear voices, believe that someone is following him or is out to kill him. Alternatively, he may even feel that someone is interfering with or reading his thoughts. In some instances one may behave in a bizarre and violent manner.

The real cause of schizophrenia is really not known, but there is a certain genetic component because of which children of schizophrenics tend to have a higher risk of developing this disease. Many schizophrenia researchers consider it to be a group of diseases with similar manifestation. In an earlier column in this magazine I mentioned how people having spiritual and mystical experiences are often misdiagnosed as suffering from schizophrenia.

Without treatment about one third of sufferers recover fully, about a third remain impaired to some degree (say being unable to work) and the remaining continue to deteriorate to the extent that some of them cannot even look after themselves.

Anti-psychotic drugs discovered in the 1950s have changed the course of this disease radically. Violent and withdrawn patients in mental hospitals suddenly stopped hearing voices, ceased talking to themselves and many were able to leave the institutions where they were incarcerated, to pick up the threads of their lives.

	‘Our greatest blessings come to us by way of madness, provided the madness is given us by divine gift.’ —Plato in ‘Phaedrus’

There are, however, costs involved in terms of side effects. Several patients gain weight or they might develop liver dysfunction, diabetes, ticks and other disfiguring and uncomfortable involuntary movements. Some patients feel so sedated that they are unable to lead a normal life. But at this point of time these drugs are the best that psychiatry can offer. To my mind there is no doubt that they reduce the suffering of both the patient and his family. Nevertheless, by themselves, they are not enough and patients need additional psychotherapy, which is aimed at recovery.

There are a number of studies that show there are other ways of helping these patients, apart from drugs. In July 2002, Dr R Raguram, professor of psychiatry at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, with his team reported the results of one such study in the prestigious British Medical Journal.

They studied a group of severely ill psychiatric patients, including many schizophrenics, at the Muthusamy Temple in Tamil Nadu. This is a famous place of traditional healing for people with serious psychiatric problems. Patients are not tied up or restrained as is common in mental hospitals and other healing temples in India. They are encouraged to take part in the normal routine of the temple such as cleaning and gardening.

At the end of three months, the level of clinical improvement observed was similar to that achieved by modern anti-psychotic agents. The authors attributed these changes to a supportive, engaging, non-threatening, and reassuring environment. Even if one doubts the possibility of spiritual healing, this study shows that many patients can get well without medication in a humane and kindly environment.

While going to a healing temple may not be a practical solution, there are many other methods as well. Psychotherapy and family therapy are the most accessible, as they can be used along with medication. A scientific study in Western Lapland, Finland, was started with mobile teams to provide immediate psychotherapeutic care at a patient’s home with the minimal use of drugs.

	In a therapeutic setting, patients underwent a process of falling apart and then emerged on the far side of madness

The results over a 10-year period showed that in this province the need for long-term hospitalisation had fallen to near zero. Moreover, the incidence of new cases of schizophrenia decreased significantly from as high as 24.6 per 100,000 (of total population) prior to the open dialogue therapy in 1985 to just 10.4 in 1994. This again shows that medication is not the only answer in the treatment of schizophrenia. Psychotherapy is equally, if not more, important to prevent disability.

In the 1970s the late Dr John Weir Perry, a Jungian psychiatrist and author of The Far Side of Madness, ran an experimental home called Diabasis. Here, young adults experiencing an ‘acute schizophrenic break’ lived in a supportive therapeutic environment. He found the results amazing: patients underwent a process of falling apart of their personality, followed by a reintegration, and emerged ‘on the far side of madness’. ‘Weller than well’’ is how Perry described it. He found that after a few months the majority were able to resume a normal life with more energy and enthusiasm than before the onset of the problem !

These studies certainly give hope to the caregivers of patients suffering from this life-destroying disorder, rather than giving in to any form of psychiatric nihilism when conventional medicines do not work. They also point to the need for an open mind to complementary approaches such as the use of diet, high doses of vitamins, homoeopathy and other forms of healing. Let us not forget that in tribal cultures the schizophrenic is often revered as a wise man.