Years back, while seeking answers about my mental well being, I stumbled upon a 2001 American movie titled A Beautiful Mind starring Russell Crowe as Professor John Forbes Nash Jr. Based on events from the Professor’s life and in part on the biography “A Beautiful Mind” by Sylvia Nasar, it tells the story of the Professor’s struggles with paranoid schizophrenia and how it affected his relationships with the people around him. What is amazing about the story is the raw portrayal of mental illness and how in the end, the Professor goes on to win the 1994 Nobel Memorial Prize in Economics in spite of his condition.
Schizophrenia is a mental disorder that affects a person’s ability to think, feel and behave clearly. Research has shown that there are more than 100 thousand cases per year in Nigeria. The exact cause of schizophrenia isn’t known, but a combination of genetics, environment and altered brain chemistry and structure may play a role.
Schizophrenia is characterized by thoughts or experiences that seem out of touch with reality e.g. false beliefs, hearing voices or seeing things others do not, confused thinking; disorganized speech or behavior e.g. may range from loss of train of thought, to sentences only loosely connected in meaning, to speech that is not understandable known as word salad; and decreased participation in daily activities. Difficulty with concentration and memory may also be present. It requires medical diagnosis and treatment is usually lifelong and often involves a combination of medications, psychotherapy and coordinated specialty care services.
About 30 to 50 percent of people with schizophrenia fail to accept that they have an illness or comply with their recommended treatment. Treatment may have an effect in insight. Take Professor Nash for example, frustrated with the side effects of the anti-psychotic medication he was taking, which made him lethargic and unresponsive, he secretly stopped taking it. This caused a relapse and he began to hallucinate again. This leads to an incident where he leaves his baby unsupervised in the bathroom, saying Charles one of his “imaginary friends”, had been watching him. The baby was almost drowning in the tub. Following the incident, his wife makes to leave the house but he jumps in front of the car and says, “she never gets old,” referring to one of the imaginary persons he sees who is a little girl of about 5,6,7. He realizes that she has never aged once since he met her and with this he accepts that all he had been seeing was in his mind and not real.
In essence, treatment goes a long way in helping the patient deal with the hallucinations e.g. voices they may hear in their heads. Positive symptoms of Schizophrenia include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis. These positive symptoms generally respond well to medication and so where there is a sudden stop in intake, there will most likely be a relapse.
The primary treatment of schizophrenia is anti-psychotic medications, often in combination with psychological and social supports. Like all medications, the anti-psychotics have side effects depending on which ones and may include considerable weight gain, diabetes, risk of metabolic syndrome etc.
A number of psycho-social interventions may be useful in the treatment of schizophrenia including: family therapy, assertive community treatment, supported employment, cognitive remediation, skills training, token economic interventions, and psycho-social interventions for substance use and weight management. Family therapy or education, which addresses the whole family system of an individual, may reduce relapses and hospitalizations.
This goes to show that an enormous show of familial support can greatly assist the patient. In Professor Nash’s case for instance, his wife Alicia Larde stood by his side all through his hard struggle with the condition. His Nobel Prize acceptance speech goes thus:
Thank you. I’ve always believed in numbers; and the equations and logics that lead to reason.
But after a lifetime of such pursuits, I ask,
“What truly is logic?”
“Who decides reason?”
My quest has taken me through the physical, the metaphysical, the delusional — and back.
And I have made the most important discovery of my career, the most important discovery of my life: It is only in the mysterious equations of love that any logic or reasons can be found. I’m only here tonight because of you [his wife, Alicia].
You are the reason I am.
You are all my reasons.
Coping with the negative voices in your head
- Talk therapy
- Support groups
- Vocalization (talking to oneself): Many people find that voices are less troublesome when they themselves are talking. It is thought that the act of talking somehow prevents the voices in the head being heard. So any activity that involves using the voice such as singing, humming or reading out loud can sometimes help to control the voices.
- Keeping a journal: Keeping a journal to record your thoughts is a very important tool in coping with these voices. Being able to assess how your voices have been each day and then at the end of the week to reflect on their effect on you will help you to understand the voices. Understanding them is the essential first step in coping with them. In your journal, you should record the following:
- How active have the voices been? Have you heard them a lot or just occasionally?
- Have the voices been critical or have they given you instructions?
- How have you felt because of the voices?
- Did anything appear to trigger particular episodes of voices e.g. stress?
- How anxious did the voices make you feel (on a scale of one to ten)?
- How compelled have you felt to carry out the voices’ instructions?
- Have you done anything risky because the voices told you to do it?
- What have you done to cope with the voices and how much did it help?
- Reality testing: This consists of asking your carer or friend if the voice in your head is correct. For example, if the voice in your head says ‘you’re smelling’, you can ask your friend if it’s true. The carer would then respond that it wasn’t true and that in any case you had showered that morning and that all your clothes were clean. This means that you’ll agree with your friend to tell them always about anything the voice says. It is important in this technique that the carer is completely honest and gives the person sufficient time to discuss it. By getting constant feedback, it helps in challenging and distrusting the voices over time.
- Distraction: You can distract yourself with work or music. Distraction is an effective way of managing them. Some use different songs with earphones to try to drown out the voices. Some people have found that this is even more effective if they listen in only one ear at a time. Reading or watching TV may not help as those activities often feed the delusions or hallucinations, however something simple like jigsaw puzzles, colouring books, or a arranging your room may be a good start.
- Relaxation: Like most of the other psychotic symptoms, voices will often get worse when the sufferer is under stress. Relaxation techniques help the sufferer by not only reducing the voices but also helping them to cope with the anxiety that goes with them.
Sadly, there are no easy answers to the problem of hearing voices, particularly the nasty ones. But it does help to be able to understand the way that the voices work and affect you, and being able to manage them.
-Hajara Hussaini Ashara