”Do you know what mental illness is?” , “Would you like to be friends with someone who has a mental problem?” I believe that when faced with such questions, not many people can give a positive answer. Today’s society is fearful of mental illness, even fearful, as if these people are reincarnated demons, murderers, and unbelievable freaks.
Criminal Minds” is a very representative work, in which many of the murderers are mentally ill or have distorted psychological problems, how many people are addicted to it, think they can understand the criminal psychology of the murderers in detail, but do not really understand what the mentally ill patients and their families in a state of illness are suffering.
In China, and perhaps all of humanity, there is a lack of understanding and respect for people with mental illness. I once read a review by some American magazines about Zhao Benshan’s skits, which showed how incomprehensible it was for him to scandalize people with disabilities and the underclass to get a laugh from the public. As a Chinese who grew up watching Zhao Benshan’s skits, I did not have such an objective experience, but the review also made me reflect that Chinese people lack basic respect for the disadvantaged (including the mentally ill, the homeless, and beggars).
Perhaps it is because of this basic national attitude that it is not so easy to admit that you are a mentally ill person or a family member of a mentally ill person in China. Not to mention the fact that in such an era of information technology, high speed and increased psychological stress, going to a counseling or psychiatric clinic for psychological problems is a process that requires overcoming psychological barriers.
Although there are more and more psychological counseling TV programs to convey the concept of mental health to the public, it is still not difficult to find a shortage of general knowledge about mental illness in the process of contacting patients and their families.
1. “Neurosis” = neurological problem?
Neurosis is a familiar and insulting word that we always use in our daily lives to describe people whose behavior, words and activities cannot be understood by common sense. Should that be understood literally as a neurological disease? In fact, there is a different name for this type of person in medicine.
”Nerves” is an anatomical term in medicine, from the high command brain to the superficial layer of the skin, are densely packed with such network structures, if they are sick, it is not a manifestation of abnormal behavior. If they are sick, it is not a sign of abnormal behavior. It can cause you a lot of pain, such as the well-known “toothache is not a disease, it hurts like hell”, when the dental nerve may be at work.
Instead, a more appropriate term for this type of person would be “mental illness”. But such a discriminatory term has been abandoned in medicine, and with the gradual increase in theoretical knowledge and clinical experience, the modern medical classification of mental illnesses has become more and more perfect, and less and less familiar terms are derived from the territory of mental illnesses like weeds, so if you do not learn with respect and understanding, you may really be out!
What follows is a type of mental illness called “schizophrenia”, which is perhaps the often misunderstood “mental illness”.
2. Lifting the veil on schizophrenia
When asked the question, “What do you think schizophrenia is?” When asked such a question, the public’s mind immediately flashes to such adjectives as manic, strange, dumb, etc., but such expressions are not comprehensive enough.
In clinical practice, we often encounter a group of people who have abnormal perceptions, who feel that someone is communicating with them when there is no one around (hallucinations); who see small animals or the figures of people they used to know when they are alone in the room (hallucinations); and who have strange thoughts, who feel nervous and restless all day long, who cannot sleep, who feel that someone is following them (sense of being followed), and who talk about themselves behind their backs (relationship delusions). Some even feel that someone has installed a monitor to watch them and put spies around them, and that their behavior is being monitored (sense of being watched), and that their personal safety is being threatened (delusion of being harmed), which makes them irritable, nervous and irritable, and finally make impulsive beatings, suicides and other extreme behaviors. It should be added, however, that this group of people does not have the problem of unconsciousness and obvious intellectual impairment.
Imagine if we were in such a world, it would be as if we were experiencing a thriller movie or a spy movie. But the scary part is that they don’t realize that they are experiencing something wrong with their senses and thinking, or even that their emotions and behavior are abnormal.
Of course this is not a summary of all the clinical manifestations of schizophrenia patients. The abnormal sensations (hallucinations) and bizarre thinking (delusions) mentioned above are only some of the positive symptoms of schizophrenia. Positive symptoms, which are usually easy for people to detect in time, include, in addition to hallucinations and delusions, disassociation of language and conversation from reality (verbal confusion) and loss of control of behavior (extensive behavioral disturbances, catatonic or agitated behavior).
Since there are positive symptoms, there must be negative symptoms corresponding to them. Because symptoms are relatively hidden and easily explained, the detection of negative symptoms is always easier to overlook than positive symptoms. In medical science, the explanation of negative symptoms is diminished mental function and activity, which is commonly known as emotional retardation, withdrawal and incoordination, passive and indifferent social function (reduced work ability, reduced interpersonal communication, reduced self-requirement, etc.), as well as deficits in thinking (deficits in cognitive function, reduced abstract generalization and figurative thinking ability) and lack of initiative The symptoms of the deficits include
For example, a high school student with excellent academic performance, who is not very talkative, gradually declines in performance, cannot concentrate, cannot finish homework on time, and even becomes lazy in life, does not pay any attention to the external image, and finally spends the whole day doing nothing, is silent, and does not want to go out and communicate with others. In this way, it is easy to overlook the existence of mental abnormalities, and it is often difficult for people around you to accept the reality that you are mentally ill.
In practice, the clinical manifestations of schizophrenia are not as clear-cut as in textbooks, and often negative symptoms coexist with positive symptoms. The onset of schizophrenia is often a slow process, and the course of the illness is often prolonged, showing a pattern of repeated or gradual deterioration. More patients eventually experience decline and mental disability, while some patients can remain cured or basically cured with effective treatment.
3.What should I do in the face of schizophrenia?
It is not easy to summarize and understand the key symptoms of schizophrenia in its complex clinical presentation, but it is not something that the general public needs to understand in detail. However, the most important point to grasp as a matter of common sense is that patients with schizophrenia usually do not have self-awareness of their illness, in other words they do not think they have a mental problem. This is the key to why people with schizophrenia need to have a guardian in the legal sense.
Prior to the introduction of the Mental Health Act in 2013, there were many headlines in the national media about “being mentally ill,” but it is clear that it is not feasible for patients with mental illnesses to voluntarily seek medical treatment, which is not in line with the characteristics of the illness. The family of a person with mental illness is obligated to take him or her to a doctor if he or she becomes aware of psychotic symptoms that are getting worse, with the option of involuntary hospitalization if necessary (see mental health regulations for details).
As mentioned above, the outcome of schizophrenia is worrisome, and it is regrettable that untimely treatment can lead to a serious decline in social functioning or even mental disability. In current scientific research, the age of onset of schizophrenia is found to be 15-45 years old, and there is no significant gender difference between men and women.
Some reports indicate that 50% of schizophrenic patients have attempted suicide, 10% eventually die from suicide, and are more likely to suffer from unintentional injuries than the general population, shortening their average life expectancy by about 20 years. The 1993 national epidemiological survey in China reported a lifetime prevalence of schizophrenia of 6.5 per 1,000, and it is estimated that there are currently 7-8 million schizophrenics in China. About 2/3 of schizophrenia patients have obvious symptoms for a long time, and the national epidemiological survey of people with disabilities shows that schizophrenia patients account for about 70% of the number of people with mental disabilities and are the most important disease causing mental disability.
It is easy to see from such data that the presence of a person with schizophrenia in the family, whether it is a teenager, a young adult in his or her twenties, or a mature adult in his or her thirties or a pillar of the family in his or her forties, will undoubtedly cast a grayish tinge over the entire family. If left untreated or poorly treated and left with a mental disability, it can be a financial disaster and even a disillusionment of the family’s hopes.
Therefore, in order to prevent or delay such tragedies, early detection and implementation of effective full dose and full course of medication is needed. In other words, if you find someone with mental abnormalities around you, you should seek a clear diagnosis and cooperate with your doctor’s clinical guidance as soon as possible to carry out a reasonable, sufficient amount and full course of medication.
The first episode is often the key to treatment because it is when the response to antipsychotic medication is best and the dose required is low. If timely, correct, and effective treatment is obtained, patients have the best chance of recovery and the best long-term healing. The critical period affecting the prognosis of schizophrenia is the prodromal period and the first 5 years after the onset of psychosis, when the impairment of mental function is at a plateau and usually does not deteriorate further if properly managed. Therefore, correct and reasonable treatment during this critical period is crucial.
When thinking about this, I can’t help but think of the Chinese mentality of “breaking the can”. Should people who miss the critical treatment period for the first onset of the disease give up treatment completely? At this point, we need to talk about relapse in schizophrenia. Clinicians often warn patients’ families about the phrase “relapse-prone”, and some data show that 30-40% of patients who are effectively treated in an inpatient setting will relapse within a year of discharge. Relapse in schizophrenia is a major contributor to the high burden of illness, so relapse prevention remains a major issue in schizophrenia, and for most patients, medication is the most important treatment option, which is why schizophrenia patients need maintenance medication after discharge from the hospital.
Since this is maintenance treatment, one needs to understand the period of time that needs to be maintained. In clinical practice, treatment of schizophrenia is divided into three periods: acute treatment, consolidation treatment and maintenance treatment. The acute phase refers to the period when the psychiatric symptoms are very prominent and severe in patients with the first episode or acute deterioration, and the treatment course is at least 6 weeks; the consolidation phase is a relatively stable period after the effective control of psychiatric symptoms, and the course of treatment usually lasts 3-6 months; the maintenance phase is the third phase after the remission of symptoms and consolidation of treatment, and the length of treatment usually depends on the patient’s condition, and is usually not less than 2-5 years. For patients with a history of severe suicidal attempts, violent behavior and aggression, maintenance treatment should be extended appropriately, while for patients with multiple relapses, lifelong maintenance treatment is currently recommended.
Of course, in addition to pharmacological maintenance treatment, comprehensive psychological support is also necessary during this period, which includes family intervention, cognitive-behavioral therapy and timely intervention of psychosocial rehabilitation, which requires the mobilization of the whole family to accomplish this daunting task. Although mental illness may sound scary, it is important for the patient’s family and friends to accept and understand the existence of this illness and to accompany the patient in the fight against it for a short period of time thereafter, under the guidance of the clinician.
The last thing that we need to remind our patients’ families is that they must be seen in a psychiatric hospital, have regular follow-up appointments, and take their medications on time and as prescribed by their doctors. Do not go to the extreme of believing that you can cure schizophrenia by doing superstitious activities, taking some ancestral remedy or choosing surgery. These are currently not clinically proven, and taking patients as test subjects in this way may only result in economic damage, but in serious cases may lead to aggravation of the disease and delayed treatment, or drug poisoning, or even life-threatening or death.