Schizophrenia, not a beautiful experience

Schizophrenia, not a beautiful experience

Hera Diani, The Jakarta Post, Jakarta

The ward of the psychiatric department of state Cipto
Mangunkusumo Hospital (RSCM) is no different from the rest of the
place: It's grim, old and dirty.

As the faded wooden gate is unlocked and opened, its
appearance, which is closer in resemblance to a refugee camp, is
quickly disclosed. The smell of dust and worn out furniture
permeate the air.

"This place is not really good enough for patients. We plan to
renovate, but we don't have much funding," the hospital's
psychiatrist, Martina Wiwie, explained on our visit to the ward
recently.

We passed the left wing, which is reserved for male patients,
and went straight to the right wing, where several female
patients had gathered in the hall and were chatting. On a bench
in a corner, a patient was talking to an intern in a firm tone.

"You know, I can see across thousands of kilometers. Wherever
my mother is, I can tell what she's doing," said the patient, who
said her name was Nelma.

A few minutes later she stood up hastily and walked away from
the bench, but then returned to talk to the intern.

"Let me ask you, what is your religion? Catholic? Well, I feel
so sorry for you, because you will never go to heaven. I know
that for sure because I know the Koran by heart, and prophet
Muhammad said so. Forgive me for saying this, but you guys will
never go to heaven!" Nelma, who is in her 40s, said angrily.

She became furious after the intern told her that she was
being paranoid. Nelma then said how religious she was and how she
had tremendous supernatural power.

"That is a case of schizophrenia," Dr. Martina whispered.

Nelma is among the estimated 1.2 percent of Indonesia's
population of more than 200 million who suffer from schizophrenia
-- a mental disorder of which there is still low public
awareness.

Like millions of other schizophrenics, Nelma is suffering from
a mental disorder in which the personality is seriously
disorganized, but not split as is often thought, and contact with
reality is usually impaired.

You probably still remember last year's film A Beautiful Mind,
which is a true story about schizophrenic mathematician John Nash
who later learns to handle his constant hallucinations and
delusions to win a Nobel Prize in physics.

While the severity of the illness varies greatly in
individuals, most people diagnosed with schizophrenia will
usually suffer from one or more of its symptoms.

The symptoms that require hospitalization occur during the
acute stage and they are: delusions, a false belief that cannot
be corrected by reason; hallucinations, usually in the form of
nonexistent voices; disorganized speech, with frequent
derailments or incoherence; and grossly disorganized or catatonic
behavior.

People living with schizophrenia are often robbed of the
pleasures in life, and they have less ability to experience
feelings.

Long-term impairments for people living with schizophrenia
include low levels of interest, motivation, emotional arousal,
mental activity, social drive and speech.

"They lose their social skills, their jobs and are expelled
from schools. They can be extremely aggressive, or unreasonably
silent. But the most common type is intense paranoia," Martina
said.

Schizophrenic patients are prone to saying things that do not
always make sense and their intellectual capacity also shows a
tendency to decline.

The disorder, however, is very individualistic, as no two
cases of schizophrenia are exactly the same.

It is believed that the main cause of the illness is a
neurochemical imbalance in the brain, although there are cases in
which nothing was wrong with the patient's brain.

Stress and complications in pregnancy can also be a trigger of
the disorder.

"When a parent is schizophrenic, the child has a 23 percent
chance of suffering from it, too. If both parents are
schizophrenic, that probability jumps to 49 percent," Martina
said.

However, there are studies that suggest that an inherited
predisposition to the disease is not necessarily a dominating
factor.

While mental illness can hit at any age, symptoms of
schizophrenia are most prevalent between the ages of 15 and 30.

"It is usually more distinguishable in men, because society
puts extreme pressure on them. So they become stressful, which
could trigger the disease," Martina said.

She said that it did not cause too much disruption to the
lives of people who are introverted.

"They usually turn to religion or the supernatural. But when
it becomes a full-blown case, patients may think that they are
prophets or messengers from heaven. And others, who are unaware
of the disease, think that the patient just can't handle that
kind of knowledge (of religion and supernatural stuff)," Martina
said.

The situation turns serious, however, when patients become
extremely aggressive or the voices they hear urge them to become
violent. As a result, many sufferers are confined to their homes
by family members or have their legs shackled.

While the story of John Nash is heavily romanticized in A
Beautiful Mind, the reality of a schizophrenic's life is harsher.
The portrait of a faithful and patient wife of a schizophrenic,
played by Oscar winner Jennifer Connely, is also a rare case.

Often, like what happens to so many patients at RSCM,
sufferers of the disorder are discriminated against, their rights
are violated and they are shunned by family members.

Saring Hadiono, who is in his 40s, said that he often wanted
to kill his schizophrenic brother, Hariadi, who has been living
with the disorder for over 12 years.

"I felt like it would have been better for him to die than to
make the whole family suffer. My mother even said that it would
be OK to dump him somewhere," he said.

Hariadi had been a smart, multitalented man who held a decent
job, Saring said. He later turned obnoxious toward others, and
that cost him his job and his family. The drastic changes in his
behavior ranged from taking other people's food, excreting in a
mosque to burning the television and even the house.

"I didn't think that he was mentally ill. I thought he was
just plain annoying. We had tried many things, including putting
him in an Islamic boarding school," Saring said.

It was only a couple years ago that the family discovered he
was ill, and took him to a hospital where he was diagnosed with
schizophrenia and treated for it.

"He is much better now. We should have brought him to the
hospital a long time ago," Saring said.

Martina said the main cause of the illness was a chemical
imbalance, and it needed to be countered with medicine to
eliminate symptoms.

"The medicine has to be taken continuously at least for two
years. There is no such thing as an addictive effect. It's just
like diabetes, where you have to constantly take medicine. It
might be expensive, but the patients can function normally and
continue to hold a job," she said.

But the most important thing, she added, was to create a
conducive and supportive environment for patients.

"The whole treatment is useless if a patient goes back to his
or her family and is always criticized or mocked. Occupational
therapy and sports are also important," Martina said.

Above all, she added, it has to be underlined that
schizophrenics should not be feared and are important members of
society.