Psyche & Soul 35: SCHIZOPHRENIA - 2: Hallucinations

 Podcast link:

https://anchor.fm/boscom/episodes/2-35-Psyche--Soul--77-er52ns

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

Last week I presented one major symptom of schizophrenia, namely, delusions. In this edition I shall explore hallucination and other symptoms.

Hallucinations

In hallucination the person experiences an auditory (hearing voices), visual (seeing imaginary sights), tactile (feeling sensations on the body), or olfactory (related to smells) sensation that has no basis in reality, that is, happening without an external stimulus. Auditory hallucinations are the most common.

The nature and content of both delusions and hallucinations are influenced by a person’s values and personal experiences. Thus, religious people often have delusions and hallucinations with a religious content. An illustrative example is that of Sr. Florence.

 

Sr. Florence’s community members noticed that she had been behaving oddly for some days. She spent most of the time in her room, not coming for community prayers and even meals. When she did spend time with community, she would talk about Jesus appearing to her and giving her messages for the Pope. She insisted that she had to go to Rome and give the message personally to the Pope. She was spending more time in her room because it is there that Jesus was appearing to her. The superior, who had some psychology background, suspected some mental derangement and wanted to take her to a doctor. But Florence insisted there was nothing wrong with her, but that she was a chosen person. Fortunately the superior remembered that Florence had complained of severe headaches sometime earlier. On pretext of taking her to see a doctor for her headaches, she tried again to get Florence to see a psychiatrist. One morning the superior went to Florence’s room to convince her to go to a doctor. She was surprised to see Florence kneeling in front of an empty chair in the corner, her face animated. “Sister, please kneel down. Jesus is sitting in that chair. Don’t you see him?” she said. … Florence was suffering from full-blown schizophrenia with visual and auditory hallucinations and having the grandiose delusion of being a specially chosen person by Jesus.

Catatonia

Those suffering from schizophrenia may also engage in bizarre posturing and inappropriate behaviour. In what is known as catatonic schizophrenia, a person, for example, may remain in a freeze position, with no movement at all, with a fixed stare, arms raised in an awkward position, and so on, for a very long time, resisting any attempt by others to stop them. There can be a complete lack of verbal or movement responses. On the other hand, the person may keep repeating the same gesture or movement for a long time meaninglessly. Classic portrayals of these are found in the movies “One Flew Over the Cuckoos’ Nest” and “Patch Adams.”

Disorganized Schizophrenia

In disorganized schizophrenia, a person may burst into laughter, grimaces, or giggles without an appropriate stimulus. Another example is of a person on the street talking to himself or herself, gesticulating to no one in particular, or directing the traffic even when a police person is doing it, sometimes imitating the police. Or, we may find the person looking up to the sky, gesticulating and castigating God. Persons affected by this form of schizophrenia may look markedly disheveled, dress in unusual manner, or display clearly inappropriate sexual behaviour in public. Their behaviours can also be unpredictable, suddenly becoming agitated, for example, swearing and screaming loudly.

Primary Dynamic: Distorted Cognition

The cognitive processes (perception, interpretation, judgment and so on) of persons suffering from schizophrenia are seriously impaired.  They may have trouble organizing their thoughts or making logical connections. Their mind tends to jump from one unrelated thought to another in a confusing and bewildering sequence. They may assign special meaning to seemingly everyday words, which only they understand. Those listening to them will have great difficulty in making sense of what they are trying to say. Delusions, hallucinations and behavioral difficulties, as also affective and emotional turbulence, have their roots in impaired cognitive processes. This cognitive impairment is the primary dynamic in schizophrenia.

 

Negative Symptoms

There are also what are known as “negative symptoms.” These are so called because they are an absence as much as a presence. These include inexpressive faces, blank looks, monotone and monosyllabic speech, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously. Schizophrenia can exist only with these “negative” symptoms without the more florid “positive” symptoms described above. In this case, the term “simple schizophrenia” is sometimes used. These symptoms, though not as incapacitating as the positive symptoms, can affect occupational life and relationships. These negative symptoms are the main reason those who suffer from them find difficult to live independently, and manage everyday life.

Introspection and Prayer

The description of hallucinations and other symptoms of schizophrenia above will show us how these can be cause of much suffering and relational difficulties. May be we have come across people afflicted by the disorder. We may be living with family members or others who suffer from it, or taking care of them.

A number of persons presented ion the gospels as being possessed by demons and whom jeus healed, were probably suffering from schizophrenia or other mental illnesses. The Gerasene demoniac (Luke 8, 26-39) as possible example. We could recall one of these stories and focus on Jesus’ compassion for those suffering from these illnesses and his eagerness to heal them.

 

We could then stay for a while with whatever the information provided in this podcast and Jesus’ healing stories evoke in us and share these with that same Jesus who is with us in the here and now extending to each of us the same compassion, or in the presence of  our compassionate God – seeking healing for ourselves and others.

Have pleasant weekend. Be safe. Be healthy. Be blessed.

Thank you for listening/reading.

Pictures: Courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

 

 

Psyche & Soul 34: SCHIZOPHRENIA

 Podcast link:

https://anchor.fm/boscom/episodes/2-34-Psyche--Soul--75-eqjv4e

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul.

 

In this edition I shall explore another major mental illness, namely Schizophrenia.

 

Edward came to therapy because he could not get along with his wife. He believed his wife does not want him to be happy. “She does everything possible to make sure I am not happy,” he said. “I am the most unfortunate person to have married her. She is ruining my life.” As an example he narrated how his wife would deliberately rattle the dishes in the kitchen so that he could not sleep. He believed that she is actually the devil in disguise. As he unfolded his story in subsequent sessions, it became quite evident that he had misgivings not only about his wife, but with almost everyone around him as well. He believed that all south Indians were against him because he was a north Indian and were trying to get him into trouble. The woman he worked with at the office was deliberately plotting to get him dismissed from the job. Auto-rickshaw drivers were honking as he passed them on the road to deliberately annoy him. His cousin was turning his aunt against him.  His mother-in-law was sending him bad vibes, so that he would get sick and die….

Edward was diagnosed as suffering from and being treated for paranoid Schizophrenia.

What is Schizophrenia?

Schizophrenia (literally splitting of the brain) is the most serious of all mental disorders. Although not as common as the other major mental disorders, it debilitates people more than the others affecting their educational and occupational performance, as well as everyday life and relationships.  Most beds in mental institutions are filled by patients suffering from this type of disorder. Those who suffer from it are 2-3 times more likely to die early than the general population. An estimated 5%-6% of individuals with schizophrenia die by suicide, a rate that is far greater than the general population, with the highest risk in the early stages of illness. About 20% attempt suicide on one or more occasions, and many more contemplate suicide, even if not attempt it.

According to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of schizophrenia typically emerge between the late teens and the mid-30’s. Onset prior to adolescence is rare. 

The onset of the disorder can be sudden, although in most cases there is a slow and gradual development of a variety of significant signs and symptoms.

Full-blown psychosis is often preceded by milder warning signs such as: problems in sleeping, difficulties in concentration, increased anxiety or depression, isolating oneself, increased paranoid (suspicious) expressions, negligence of normal work and schedules, neglect of personal hygiene, increased sensitivity to sounds, lights, smells, or other sensations and overall apathy. Gradually the more severe symptoms will manifest and become more and more pronounced.

 

The major dynamic in schizophrenia is disruption in an individual’s capacity to differentiate fantasy from reality. Fantasy becomes the reality. This leads to a variety of emotional, relational and occupational difficulties and affects daily life significantly.

Those who suffer from schizophrenia may hear voices, see imaginary sights, or believe other people control their thoughts. These sensations and beliefs can confuse and frighten the person and lead to erratic, and sometimes very bizarre, behaviour. There can be disturbances in the regulation and expression of affect or emotions, and difficulty in experiencing any pleasure. They have few friends and have difficulty in relating to others, and tend to withdraw from normal socialisation and seek comfort in their inner world of fantasy. They often harbour hostile and angry feelings which they may express in inappropriate ways that alienate those around. All this can lead to a very lonely and unhappy life.

Major Symptoms

Two of the most vivid and conspicuous symptoms of schizophrenia are delusions and hallucinations. In this podcast I shall focus on delusions and leave hallucinations and other symptoms for the next podcast.

Delusions

Maryann was brought to therapy by her husband. He had been noticing strange behaviour in her since a year. She believed that building contractors in the town were out to poison the water supply. She has to protect people against them. God had chosen her specially to do this. She only had the power to thwart their attempts. She does this with her own specially concocted water that she carries around wherever she goes. She intrudes into the houses of her neighbours and blesses them, assuring them that they will be protected from an impending disaster. Maryann was suffering from delusions of grandiosity.

Delusions are unsubstantiated or incorrect, but deeply held, beliefs about self or others that are sustained in the face of evidence that normally would be sufficient to destroy them. The content of delusions may include a variety of themes, such as persecutory, referential, somatic, religious or grandiose.

In persecutory delusions (also known as paranoid), the belief is one is going to be harmed, harassed, and so on by an individual, organization, or group. One might believe, for example, that a plot is being hatched to kill him or her, or that someone is keeping them under surveillance, and following them everywhere while remaining invisible. In delusions of grandiosity one might believe that he or she is really the president of the country, a king/queen, or the Pope, or even God, or, as in the case of Maryann, the recipient of special privileges not given to others, or has exceptional and exclusive powers. In what are called referential delusions one believes that certain gestures, comments and so on are specifically directed to himself or herself. For example, one might believe that the news reader on TV is providing coded messages to him or her. In somatic delusions one’s focus is on preoccupations regarding health and organ functions.

Delusions are deemed bizarre when their content is clearly implausible. One may, for example,  believe that someone is removing thoughts from his or her brain (thought removal) and replacing them with other thoughts (thought insertion) or that a stranger has removed their internal organs and replaced them with someone else’s organs without leaving any wounds or scars.

 These beliefs may sound bizarre to others, but are very real to those who suffer from them, and no one can convince them about their bizarreness or improbability.

One form of delusion that occurs especially among women (also religious women!) is that of being specially loved by someone. This form is known as erotomanic delusions. The delusional system becomes fixated upon one individual, usually an older male, and usually of a higher status, but can also be a complete stranger. The woman feels that this man has fallen in love with her and is communicating this love through various secret signs and signals. Paradoxically, she may also experience intense rage against the object of her delusion, at imagined perception of rejection, or as reaction to even trivial slights.

Delusions, as can be seen from the examples given, are distorted and improbable but rigid hbeliefs, held by who those suffer from them.

In the next podcast I shall present hallucinations and other major symptoms, the roots of schizophrenia, and available treatment options.

Introspection and Prayer

The description of delusions above will show us how these can be cause of much suffering and relational difficulties. May be we have come across people afflicted by the disorder. We may be living with family members or others who suffer from it, or taking care of them.

We could stay for a while with whatever the information provided here and our own experiences evoke in us, and turn to our compassionate God and share what is evoked in us. We could pray for healing for ourselves and others.

Have pleasant weekend. Be safe. Be blessed.

Thank you for listening/reading.

Pictures: courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

 

Psyche & Soul 33: MAJOR DEPRESSION

 Podcast link:

https://anchor.fm/boscom/episodes/2-33-Psyche--Soul--73-eq9ip5

 

Hello, this is Jose Parappully, Salesian priest and clinical psychologist at Sumedha Centre for Psychospiritual Wellbeing at Jeolikote, Uttarakhand, with another edition of Psyche & Soul. 

In this edition I shall explore Depression.

Major depression, commonly known as clinical depression, is the most common mental disorder in the general population.

According to data developed by the Global Burden of Disease study, major depression is the leading cause of DALY or the years of healthy, productive life lost to an illness, be it through early death or through disability worldwide.

Symptoms

Major depression is characterised by a pervasive sense of profound sadness, low energy, disturbances in eating and sleeping, feelings of guilt, low self-worth, hopelessness and meaninglessness, even despair, poor concentration and problems with memory. Most people suffering from it feel worst in the morning, and the mood seems to lighten a bit as the day goes on.

Although profound sadness is the salient features of depression, some individuals suffering from it emphasize somatic complaints (e.g., bodily aches and pains) rather than reporting feelings of sadness. While depressed persons are low on energy and not very active, many of them report or exhibit increased agitation, restlessness and irritability - which is a contributing factor to sleeplessness.

When persons are depressed, it is very difficult for them to be interested on anything. They would prefer to stay in bed, even if they have desire to get out and do something worthwhile. It would be too much of an effort to get out, and so they often stay on in bed. They stop watching TV, stop reading, become silent and incommunicative. Those around them may label them lazy. But they are not. They would prefer to be active, but they just can’t bring themselves to do that.

Depression affects both mind and body. Depression can raise risk of heart disease. People who are depressed are three times more likely than those who do not suffer from it to experience pain, especially intense, disabling neck or back pain and headaches. One study has shown that people with major depression are three times more likely to have migraines, and people with migraines are five times more likely to get depressed. Depression can affect the stomach too -- causing nausea, indigestion, diarrhea, or constipation

Suicide

Thoughts of suicide or actual attempts are quite common. The risk of suicide is about 20 times greater among those diagnosed with major depression in comparison to those without it. Two-thirds of those who commit suicide are found to have struggled with depression. Women are more often affected by depression than men, by a two to one ratio. However, more depressed men (7%) than women (1%) commit suicide. One reason for this is that women are more likely to seek treatment and take medication.

Bipolar Depression

One form of depression is known as bipolar, also known as manic depression. A person suffering from bipolar depression has periods of depression preceded or followed by periods of mania in a cyclic fashion. The mania phase is characterized by excessive elation, activity, talkativeness, inflated self-esteem or grandiosity. The person may throw himself or herself into ceaseless activity or show indiscriminate enthusiasm for interpersonal, and sometimes sexual, involvement. Almost invariably, there is a decreased need for sleep. In extreme cases, a person may go on for days without sleep and yet not feel tired. But after a while he or she sinks back into the lethargy of depression. The duration of the depressive and manic phases can be very short or long.

Roots of Depression

Depression is a complex illness with biological, personal and environmental contributors. In the biological understanding, depression is caused by imbalances in the brain chemistry.

Often, depression runs in families, giving credence to the impact of hereditary factors. In this understanding, depression is considered to be “endogenic,” that is, as arising from a constitutional (inborn) disposition that is relatively unaffected by external events.  

However most often depression arises from personal experiences, especially of loss and setbacks in life. An unsupportive and unhealthy social environment exasperates the disappointments and distress as response to external factors.

There are many personal experiences that can lead to depression. Physical, sexual, or emotional abuse can increase the vulnerability to depression. Interpersonal conflicts, especially family disputes, feeling of being unwanted, prolonged grief after death of a dear one, especially when the death is unexpected or tragic, can turn into depression.

According to Roger MacKinnon and Robert Michels, authors of the classic text “The Psychiatric Interview in Clinical Practice,” the loss of a love object is the most common precipitant of depression. This loss is usually the death of or separation from a loved one. In other circumstances, it is an internal psychological loss resulting from unfulfilled expectations, or loss of self-esteem and self-image. For depression-prone individuals self-esteem is based upon continuing input of love, respect, and approval from significant other figures in their life. When this is missing or disrupted, depression is precipitated.

 Treatment

The most common approach to treatment is biological - use of antidepressant medications. When depression is deep seated, the medical approach can help to restore some stability of mood, and provide help to return to some sense of normality and involvement in society, and is often necessary.

Depression, however, is more of a “soul sickness” – than a biological disease. The root causes of feelings of hopelessness, existential despair, and crippling lack of motivation cannot be healed by popping pills. Medication may help reduce symptoms but do not address the underlying causes of depression. This is done through psychotherapy, which is a time-consuming process, but helps one to sort out the complicated emotions and anxieties that lie at the root of depression.

The results obtained by the drugs, can be obtained by exercise as well. What medicines do is to restore the bio-chemical balance in the brain by working on molecules and hormones. Exercise does the same, but at a much slower pace. Research suggests exercise releases chemicals in the brain that make a person feel good, improves mood, and reduces sensitivity to pain. Exercise done along with others, increases human connection, and helps especially to lift oneself from the morose feelings that accompany depression.

Reaching out to others in kindness and compassion, also help to lower depression. Researchers at the University of California Riverside, and Duke University, for example,  have found that engaging in these acts of kindness and compassion which they have labelled Positive Activity Interventions (PAI) help to reduce depression. These help persons suffering from depression to move out of their morose self-absorption, create positive feelings and help energise them, just like exercise does. They create a feeling of connectedness to others, bring meaning in their lives, increased perception of self-efficacy and competence, all of which we know alleviate depression.

Introspection and Prayer

Have you ever been depressed? If yes what was it like? What helped you to get out of it?

Have you lived with anyone who is depressed? What was that like?

Prophets and saint too have been depressed. The prophet Jeremiah was depressed and even wished to die because of the unresponsiveness of people to his message and their attacks on him. The prophet Elijah too sunk into hopelessness and despair and wished he were dead. Jesus struggled with his feelings of despondency in the Garden of Gethsemane.

We could stay with whatever is evoked in us now as we recall these experiences, yours and of others,  or what is triggered in us by this podcast and spend some time in payer.

Have pleasant weekend. Be safe. Be blessed.

Thank you for listening/reading.

Pictures: Courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com 

Psyche & Soul 32: THE BURDEN OF MENTAL ILLNESS

 Podcast link:

2.32 Psyche & Soul # 71
https://anchor.fm/boscom/episodes/2-32-Psyche--Soul--71-epvtoa

 

The last few podcasts have been on mental health and wellbeing. This weekend I shall focus on the burden of mental illness, that is prevalence of mental illness globally and especially in India.

THE BURDEN OF MENTAL ILLNESS

Mental illness is a reality in the lives of many people and is on the increase.  There has been a 13% rise in mental health conditions and substance use disorders between 1997 and 2017. Latest pre-Covid data available (The Global Burden of Disease Study 1990–2017, a massive  collaborative work of World  Health Organization, World Bank and Harvard University) showed that globally 970 million people (10.7 percent, that is a little more than 1 in 10 people)  worldwide had a mental health or substance abuse disorder in 2017. Of the population affected by mental illness Anxiety is the most common mental disorder, affecting 284 million people worldwide. Next is depression affects 264 million people. Schizophrenia affects 20 million people.

Around 20% of the world’s children and adolescents have a mental health condition. Globally, mental illness affects more females (11.9%) than males (9.3%). The mortality rate of those with mental disorders is significantly higher than that of the general population. It is estimated mental disorders are attributable to 14.3% of deaths worldwide, or approximately 8 million deaths each year. One emerging reality that is of some concern is that more and more young people are reporting mental illness.

 

The Indian Situation

According to the GBD Study cited above, a little more than one in seven Indians (7.5 per or about 197.3 million) suffer from some mental disorder, ranging from mild to severe.  The study had predicted that by end of 2020 roughly 20 per cent of Indians will suffer from mental illnesses.

 As at the global level, depressive and anxiety disorders are the more common form of mental illness in India.  According to data collected, 47.7 million Indians suffer from depression and 44.9 million Indians suffer from anxiety disorders. The prevalence of depressive and disorders was significantly higher in females than in males. This could be related to gender discrimination, violence, sexual abuse, antenatal and postnatal stress, and adverse socio-cultural norms.

 

Suicide

There was also a significant, but modest correlation between the prevalence of depressive disorders and suicide. India accounts for 36.6 per cent of suicides globally. Indian women have double the global rate for death by suicide of women. Latest (2020) data released by the National Crime Record Bureau had shown that India reported an average 381 deaths by suicide daily in 2019. As many as 1,39,123  people died by suicide in India in 2019, marking a 3.4 per cent increase compared to 2018. Notably, over 90,000 of the people who died by suicide in 2019 were aged between 18 and 45.

 

Shortage of Mental Health Workers

A WHO Report (2018) had stated that the mental health workforce in India is not up to the mark and there is a huge shortage of psychiatrists and psychologists in the country as compared to the number of people suffering from mental health issues. WHO states that in India, per 100,000 population, there are only 0.20 psychiatrists, 0.07 psychologists, and 0.36 other mental health workers available. This means many needing psychological and psychiatric help would be deprived of it.

Increase through Corona Pandemic

The situation has been exasperated by Covid-19. An American Psychological Association  survey, conducted between Aug. 28 and Oct. 5, 2020,  found that nearly 3 in 10 psychologists (29%) said they are seeing more patients overall since the start of the pandemic. Of psychologists who provide treatment for anxiety disorders, nearly three-quarters (74%) reported an increase in demand for such treatment, and 60% of those providing treatment for depressive disorders saw an increase. The enforced home isolation has led to increased stress and anxiety in families. In some studies up to one third of families have reported feeling very or extremely anxious. A growing body of research is raising concerns about the impact of loneliness during the pandemic.

This is also true of India. A survey by the Indian Psychiatric Society showed a 20 percent increase in mental illness due to Covid-19. More recently Dr. Rajesh Sagar, professor of psychiatry at the All India Institute of Mental Sciences (AIIMS), New Delhi, India’s premier psychiatrist institute, said there is a 50% increase in cases of psychological distress, as also the number of people reporting symptoms of anxiety than before (Times of India, Dec 31, 2020)

Increasing demands of meeting patient needs are affecting mental health providers too. In the American Psychological Association survey mentioned above, more than four in 10 psychologists (41%) said that they felt burned out, and 30% said that they have not been able to meet the demand for treatment from their patients.

Unlike physical disorders which can be verified by objective criteria and test, as is the case with Covid-19, most mental health disorders cannot be tracked with a test or tangible sign. Hence there would be a large group of silent sufferers, whose illness would go unnoticed.

Genetic (inborn) vulnerabilities to psychiatric disorders, which have been kept in abeyance through a nurturing environment, can be activated when experiencing prolonged and high levels of stress. This is especially true of schizophrenia and major depression.

Mental health experts warn that the impact of Covid-19 on mental health would be felt for years after the virus has been brought under control. Dr. Adrian James, president of the Royal College of Psychiatrists, for example, warns that Covid-19 “is going to have a profound effect on mental health. It is probably the biggest hit to mental health since the second world war. It doesn’t stop when the virus is under control and there are few people in hospital… [there are] long-term consequences.”

Introspection and Prayer

What is your reaction and response to the data on mental illness presented on this podcast? What does it evoke in in you?

-----

Jesus of Nazareth was concerned about eliminating suffering from human lives. During his life ion Palestine he encountered many who were suffering from all sorts of mental illness. He showed great compassion for them of their afflictions.

May be we can recall one of his healing encounters with the ill and rest for while in his company in that scene. We could then bring before him all those who suffer from mental illness, especially those we know, praying for their healing, or begin a fantasy journey of healing with him.

Have pleasant weekend. Be safe. Be blessed.

Thank you for listening/reading.

Pictures: courtesy Google Images

Jose Parappully SDB, PHD

sumedhacentre@gmail.com