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.