Commentary: Schizophrenia, a life increasingly detached from reality
Recovery from mental illness is a process of finding meaning and purpose in life, says one IMH peer support specialist who discusses her struggle living with the disorder.
SINGAPORE: It was a cold night in January. A sudden clap of thunder woke me up from a fitful slumber and disoriented me.
Somehow seized with the notion I was under surveillance, I thought to myself: “The world is ending”. Something moved near me. I bolted upright.
“Are you awake?” my sister whispered.
“What’s happening to me?” I responded, confused.
She crept up to my bed and put her arms around me; I hugged her close.
I was diagnosed with a brief psychotic disorder when I was 25.
A few episodes later, doctors revised their diagnosis to schizophrenia, a form of psychosis where an individual’s thoughts and perceptions become increasingly detached from reality.
Often misconceived as a person having a split personality, schizophrenia manifests itself in a variety of symptoms including visual and hearing hallucinations, delusions, distorted thinking and difficulties in communication.
These are signs I can attest to. When the illness hits, it is a struggle to hold onto my thoughts and put them together in a coherent manner. At the height of my last psychotic experience in December 2017, I was convinced that I was a test subject forced to participate in a scientific experiment.
Conspiracy theories loomed large, and my erratic thoughts were frightening to deal with. Yet, the symptoms subsided in a week and I went back to work in February after an extended break.
THE ROAD TO RECOVERY
It was encouraging to learn that more than half of patients who experienced psychosis recover completely or at least show significant improvements, according to studies from a number of countries in the 1970s to 1980s.
Many healthcare professionals are seized with “clinical recovery”, a remission from or reduction in symptoms, and restoration of functions in a patient with the disease. To doctors, schizophrenia is a medical illness, a result of changes in the prefrontal cortex, an area of the brain that controls language, abstract thinking and appropriate social behaviour, as a result of stress and other triggers.
But those who suffer from mental health issues favour the idea of “personal recovery”, and in rediscovering anew life’s meaning, purpose and hope while living with the disease.
A widely-cited definition of personal recovery by famed healthcare expert William Antony of the Boston University’s Centre for Psychiatric Rehabilitation describes the process:
Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills or roles. It is a way of living a satisfying, hopeful and contributing life even within the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.
Medical treatment and psychiatric forms of therapy, including widely used cognitive behavioural therapy, may help to reduce symptoms but those who suffer from it value the journey of recovery, including finding a purpose and their place in the community.
Sometimes part of this rehabilitation process includes re-engaging with work, in developing a repertoire of actions that aid with recovery.
A person who has lost a limb due to diabetes may not be able to grow one back, but may consider himself recovered when he adapts to the loss and finds ways to lead a productive life.
It is similar for people with mental health issues. I’ve met so many people in the course of my work who go on to live gratifying lives and form meaningful relationships, despite their struggles with mental health issues.
WHAT DOES RECOVERY MEAN TO ME?
For me personally, recovery is about taking control, changing my outlook on life, and adapting.
I have come to understand myself better than before and appreciate the importance of my emotional health. I have also grown more empathetic and sensitive towards people in emotional distress.
But recovery has not been an easy journey. There was a period in my life that was filled with negativity. At my lowest point, getting out of bed in the morning was an agony.
I wish I could say that I woke up one day and it all went away. But it didn’t. Recovery was a very slow, painful and non-linear process of transformation.
BARRIERS TO RECOVERY
The accompanying stigma remains a huge challenge for people living with mental health issues. A person struggling with, say, depression is more likely to be told to “get a grip” than to be met with empathy and concern. People are also more familiar with dealing with anxiety or depression than psychosis.
A mental health literacy study conducted in Singapore in 2016, Mind Matters, found that the majority of respondents think that persons with mental health issues are “weak, not sick”. Even a person suffering from depression may be telling himself to be stronger and more diligent about turning his life around.
Stigma prevents people from seeking the help or taking the rest they need. Can you imagine a person running a high fever struggling to get out of bed to go to school or work, yet refusing to see a doctor? Many people with mental health issues are doing exactly that.
In the Singapore Mental Health Study conducted in 2010, the time taken for patients to seek help for major depression was four years, and nine years for bipolar disorder. That is a long time to live with a disease.
IT TAKES A VILLAGE
No man is an island. It takes a lot of support and understanding from the people around to help someone recover from a mental health issue.
You may be a family member, a friend, or a co-worker to someone living with a mental illness. A word of encouragement, a simple meal, or a listening ear can make a world of difference. As Stephen King so eloquently wrote about mental health issues in The Body:
The secret stays locked within not for want of a teller but for want of an understanding ear.
From my experience, the simple act of someone providing a safe space for me to share my inner thoughts without the fear of judgment made the sum difference. It is okay to tell us you don’t know what to say, or just stay silent in the moment.
I did not get out of the terror of psychosis on my own. My family and friends’ unwavering support for me in the last five years played a huge role.
On another note, it is important for friends and family members to provide space for the person in recovery. Being overly concerned and getting on the person’s case may aggravate the situation.
Recovery from schizophrenia is a lifelong journey, a balancing act and those of us who once suffered from the terrifying grips of the disease know we need all the support we can get.
Lee Ying Ying is a certified peer support specialist at the Institute of Mental Health.