Help, I need somebody

Preeti* can be heard talking loudly to imaginary people while taking a bath or when she is alone in a room. In her late 40s, the Delhi resident imagines there are women who are chasing her and are out to get her. Almost on a daily basis, she screams at and abuses her mother and other family members. Though diagnosed with schizophrenia, Preeti insists there is nothing wrong with her and refuses to be treated.

And that, doctors stress, is a major problem in India — the fact that people either fail to recognise or ignore the symptoms of schizophrenia. About 50 per cent of schizophrenia cases go undiagnosed in India, says Dr Samir Parikh, director, Fortis National Mental Health Program.

Timely treatment, on the other hand, leads to good recovery, the health experts point out. Take the case of another Delhi resident, Sneha*. Her family refused to believe that her social withdrawal and bouts of depression needed medical intervention.

After finally receiving a diagnosis for schizophrenia, she underwent treatment and is on her way to recovery.

“Contrary to popular perception, schizophrenia is not incurable,” says Dr Parikh. The psychiatrist says he has found while treating patients that more than 60 per cent have a near-complete recovery and 20 per cent show partial recovery if treated on time. Fewer than 20 per cent patients require long-term treatment, he says.

Medicines are the main pillar of treatment; the earlier they are started, the better, he adds.

Schizophrenia is a brain disorder which can lead to hallucinations, delusions and disordered thinking or behaviour. It interferes with a person’s ability to think, act, express emotions and perceive reality. Patients may think someone is controlling their mind or trying to harm them. They may display child-like behaviour or sudden anger or agitation. They may have difficulty in performing daily activities and maintaining hygiene. Depression and anxiety are the leading causes for the high rate of suicide attempts by schizophrenics.

Among the youth, schizophrenia affects academic performance, and patients show signs of social withdrawal. But the doctors point out that they can lead normal lives after being treated for just a few months.

Nearly 30-40 per cent of cases can be traced to hereditary factors, says Dr Sidharth Chellani, a consultant psychiatrist in Delhi. Among other causes are an imbalance in the chemical reactions involving neurotransmitters in the brain, stressful or emotional life events combined with a predisposition to the disease.

Viral infections or malnutrition before birth or complications during birth are some of the other known causes.

In a country that still largely stigmatises mental illness, myths abound about such disorders. Many believe that schizophrenic patients are violent and cause harm to themselves and others. This is far from the truth, Dr Parikh says.

Pointing out that the disease occurs across all socio-economic backgrounds and affects men and women equally, especially those aged 15-35, Dr Chellani credits robust family support and follow-up treatment for significant levels of recovery.

In rural areas, the lifetime prevalence of schizophrenia is pegged at 1.05 per cent, according to a national mental health survey conducted by the Government through Bengaluru’s National Institute of Mental Health and Neurosciences (Nimhans) in 12 states.

Under the National Mental Health Programme (NMHP), launched in 1982, the Government supports the implementation of the District Mental Health Programme (DMHP) in 517 districts for the detection, management and treatment of mental disorders/illness. The programme involves providing counselling in schools and colleges, workplace stress management, life-skills training, suicide prevention services and IEC (inform, educate, communicate) activities for awareness building and removal of associated stigma.

Now, under the Mental Healthcare Act, 2017, there is a special focus on reducing the incidence of suicides and lowering the stigma attached to mental illness.

But doctors stress that there is also a pressing need for psychiatrists in the country. India, which along with the rest of the world marked Mental Health Day last month, lacks in trained mental health experts and psychiatrists.

Though there is a 6.5 per cent prevalence of serious mental disorder in India, the average national deficit of psychiatrists is about 77 per cent. According to government data, there are fewer than 4,000 psychiatrists in the country. “We should start with increasing the number of psychiatry seats in medical colleges,” Dr Parikh states.

A suitable increase in the number of psychiatrists, timely recognition of symptoms and subsequent treatment will help India tackle schizophrenia, the experts point out.

Dr Chellani says some of his schizophrenia patients have recovered enough to set up their own enterprises or take up jobs, including high-profile ones at MNCs.

Take the case of Prashant*. In his late 20s, he experienced severe hallucinations and saw colours, imagining them to be hostile and harmful. After he was diagnosed with schizophrenia, he began receiving treatment at a Delhi clinic. Well on the road to recovery, he is now in a full-time job.

(Names have been changed to protect identities)

Manisha Jain is a freelance journalist based in New Delhi

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