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“It is all in your mind…” Understanding patients with schizophrenia.

“It is all in your mind…”

Understanding patients with schizophrenia.
by Jose T. Zaglul, M.D.
Imagine living in a world where you cannot be sure if what you see or hear is real. Seeing things or hearing voices that do not exist, but that you perceive as very real. Then, imagine trying to live always questioning what you hear or see, and trying to determine if is it true or not.

Imagine living with voices that comment on everything you do; voices that interrupt you while you are working or even having a conversation. Sometimes the voices give you orders and threaten you.

Imagine having a very important secret, but you are the only one that knows it. There are people that could kill you for that secret and they are after you. You tell your family and they tell you that you are crazy. You don’t want to talk about this because you know others will feel the same way. But how can you not talk about it if people can be hurt if you don’t do it?

By definition, individuals with schizophrenia, at least initially, don’t realize or recognize that they have an illness. They suffer from delusions; which are false beliefs that are firmly held and do not respond to logical reasoning. They have hallucinations; which are false perceptions in the form of voices or visions that frequently interfere with their daily activities. For them, these perceptions are very real, and they are difficult to distinguish from our normal reality.

For families of individuals with schizophrenia, this is very frustrating and a big barrier in the treatment of their loved one. When family members try to encourage loved ones to get treatment, the individual with schizophrenia frequently resists. They complain that their family does not understand or believe them. At times they accuse their relatives of being part of a conspiracy against them. Doctors usually fare the same. It frequently takes years of illness for the patient to recognize the need for treatment. It can take even longer to recognize the need to continue treatment once the symptoms are less intense.

In helping a relative with schizophrenia it is important to know that it is a long-term proposition. It is also important for your relative to know that even when you believe that what they are experiencing is part of their illness, you recognize that it is very real for them.

It is important to be there for them and to help them access resources that they may not be able to access on their own. Sometimes this may include requesting a judge to hospitalize them for an evaluation, or to get treatment against their will if you believe that without treatment, the person could be a danger to themselves, or others, or may suffer from life threatening neglect.  This is a difficult decision that the patient frequently resents, but that is sometimes needed.

Finally, it is important to reach out to other parents and community resources. Organizations like NAMI (National Alliance on Mental Illness) allow for individuals struggling with mental illness and parents to share their experiences. NAMI (www.nami.org) also offers support and can help find resources available in the community.

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