Category Archives: Schizophrenia & Psychotic Disorder

A Beautiful Mind (2001/film)

I categorised this post under “book review”, though there is a book under this same title, I’m writing about the 2001 film, directed by Ron Howard.

The book/film is based on the life of John Nash, a Nobel prize winner in Economic sciences, who was diagnosed as having paranoid schizophrenia, with delusions and hallucinations.

I started to watch the film without knowing it has anything to do with mental illnesses, just thought it’s just another biographical film (like one that I just watched last week, “The man who knew infinity”, based on the life of Srinivasa Ramanujan, an Indian mathematical genius).

It is a film portraying paranoid schizophrenia well, so well that when we, as audience see things through the eyes of Russel Crowe (John Nash), we might not even realise that those are all delusions and hallucinations, and couldn’t differentiate that those are not even reality.

The film also emphasises the importance of family supports and continuation of medication (which according to some sources of the web, is not based on what John Nash really did). During the later part of his life, he got on without taking any medicine, would still hallucinate but just do not respond to them. This is the part that I personally like in particular, sometimes medicine may not stop all the hallucinations completely, but when you’re aware which is reality and which aren’t, you can carry on with life, with them being there. There was a scene when a man approached him, and he had to ask his student who walked past, “Can you see him?”, to make sure that the man was real, not his hallucination!

I’d recommend it to family and friends of those who are diagnosed as schizophrenia, it does help understanding the illness better to quite an extent, and of course for those who’d like to understand the illness better.

Introducing “Recovered Grace: Schizophrenia”

by Harris Ng Yoke Meng

This book was bought from MPH at RM38 many years ago. It is now no longer available in most of the major bookstores in Malaysia, but I believe it’s possible to order it at MPH or Kinokuniya.

The book serves as an inspirational story to sufferers of mental illness and their caregivers, and for me, more importantly and personally as a mental health professional, it helps us to care for the mentally ill more sensitively and effectively.

I remember Harris talked about revealing his illness to his then 3 month girl friend Violet, on a Valentine’s day, how she was shocked and then willingly going to see his psychiatrist together. This reminds me a lot about the patients in our clinic, who sometimes bring their new partner to see us, wanting their partner to understand their illness better and sometimes planning their future based on that. You might guess that experience like this would scare them off, but no, quite often, those partners are just like Violet in the book, having deep love and attachment for the patient that they can also accept this part of them.

Towards the end of the book there was also some discussions on the media’s portrayals of the mentally ill committing crimes, which often end in homicide, murder or suicide.

Such bizarre stories, though real, often stigmatise the sickness. Although there are hundreds of thousands of mental health cases, perhaps only one in a thousand end up in such a mess. The press much provide follow-up reports. What happened after that? … Should society continue to view mental illness with deadly fear?

What to do when one who suffers from mental illness committed crimes due to his mental states?

Introducing “The Quiet Room”

By Lori Schiller

By Lori Schiller

It is brilliant book, very informative, from the views of different persons (the patient herself, parents, brother, close friend/housemate during the onset, attending psychiatrist etc). It gave me a feeling that I could go into her head and understand, for example, why certain patients who clearly do hear voices denied it so strongly; how one might interpret those voices, so differently from practitioners’ way. In addition, it suggests the insight of how immediate family members handle the fact that their closed one is a “schizophrenic”, and not just pretending, manipulating or attention seeking.

Also here’s a great quote from her psychiatrist,

A long time ago I realized that, as psychiatrists, we had to have a healthy respect for our own humanness, and our own smallness in the face of what we were dealing with. If a person got better, we could appreciate that we had done a great job, but we also needed to realize that God – or luck – was on our side. If the person got worse, we had to keep ourselves from feeling that we hadn’t done enough. For the truth is, we were powerless in so many of these situations. We did what we could, but sometimes the illness was just bigger than we were.

And from the mother,

How many times over the past few years had I wondered why we had fought so hard to keep Lori alive. She was so miserable. She was so unhappy. She was only staying alive to please us. …

Religious Experiences and Psychotic Symptoms

I was recently having a conversation in the clinic and a patient back in the time when I was working in North London Forensic Service popped up in my mind. This is a big black man with a diagnosis of schizophrenia, he also assaulted his ex girlfriend and hence was in the inpatient security ward that I worked at.

From day one I met this man, he was in good order and discipline, never exhibited any of the psychotic symptoms, abusive language or aggressive behaviour of any sort, unlike many other patients there. He was also doing an MBA course through the Open University. So most of the staffs in the team believed that he would make his way out soon, to the community, starting a new life. However, his stay was extended. To our surprise, it was due to a note recorded by a nursing staff (what each patient does every day is recorded on every shift). The nurse got along quite well with the patient, on one occasion, the patient shared with the nurse his experience of seeing white light in his room coming from the sky, and an angelic human coming to him and passing him some positive messages.

The patient surely didn’t know this was recorded in the note. However, this was used against to the patient in the court as evidence of him still experiencing psychotic symptoms (both visual hallucination and delusion) and  was not well enough to leave the ward to the community. The patient came to know the details only after the hearing, from his solicitor. He didn’t get to defend himself on his experience, which he later expressed that this was completely a religious experience, which he found amazing and intriguing, and in no way is related to mental illness. He came from a very religious family.

This was at least 4 to 5 years ago. I still remember it because until today I still cannot be sure whether that decision made by the team was correct. I am not a religious person (few years ago I was turned down as a volunteer in an NGO because I told the interviewer that I have no religion!), I can’t truly understand how a very religious person’s experience with god is like. I did complete the Alpha course in the church when I was doing postgraduate in Brighton. I met a lot of very nice persons, some I still keep in touch today. Sometimes I could be quite shocked by their presentations and behaviour during the services, but I respect that it’s their belief, and I learnt from them although I have not experienced it at all.

If it was a so-called normal person experiencing and sharing their religious or cultural experience, we might or might not believe them, but we wouldn’t think they are having hallucinations. How if a religious person with a history of mental illness experienced and shared such encounter? This is like when I worked there, sometimes we had to do night shifts, and many of those African nurses wouldn’t stay on the ward alone no matter what (we shouldn’t anyway, but there are times of emergency etc). They have had so many encounters of “ghosts” and “spirits” and scary stuff, it’s a hospital afterall, it’s easily linked to deaths (and then “ghosts”). But when this was expressed by a patient, even the African nurses would suspect that he was just having hallucination!

I can’t really have any say about these, I have experienced none, spiritual, religious, or thrilling (to be honest I’m happy and keen to experience them). We were told that we should pay attention to cultural influences and backgrounds before we “judge” someone diagnose a patient. It’s true, I now think it was wrong to hold the big man back solely based on that.

Substance-Induced Psychosis & Addiction-Linked Divorce

When I was doing my master back in the uni, I remember one of the presentations I did was about substance induced schizophrenia. That was just about 4-5 years ago, but I can’t quite remember the details, though I’ve always remembered that one of the triggers of schizophrenia was illicit drugs, I had a diagram in my powerpoint showing how much it contributed to the population with schizophrenia and related illness.

After starting to work in the clinic in KL, I’ve encountered quite some patients who have had a history of taking ecstasy pills or other drugs and have led to psychotic episodes. For the majority of them, their family members took charge and managed to stop them from continuing taking illicit drugs (by stopping them from mixing with so-called “bad friends”, moving to different or new environment, cutting off their finances, threatening to cut off their relationship with the subject etc).

Recently I’ve had this big man, who has had a long history of taking aramine and ecstasy pills, and is seeing the psychiatrist for his anxiety (no, he didn’t show signs of psychosis). He once told me that everyone has their way to release stress, some people go exercise (like me), some go shopping, some watch movies, some do gardening, some just need a good sleep, and for him, he hangs out with his friends, singing karaoke, and… taking pills, spending their nights high. During Chinese New Year, he could be drugged for over a week continuously. Though on normal days, he works, he goes gym (hence he’s called big man, as he’s not just fit, but muscular – like a staff always says, he doesn’t look like a typical drug abuser), he looks after his wife and children. Oh yes, I didn’t mention that he has a family. The wife is lovely, supportive, and all good qualities you can expect from a traditional Chinese woman.

Each time he tries to quit the pills, he would experience a moody state which lasts for two to three weeks, with fears, insomnia. Normally the psychiatric medicine that he’s taking will bring him back to normal and functional. The last time I heard from him after Chinese New Year, he said this round he would definitely quit it, he would stop seeing those friends (I later learnt that it’s much harder because one is actually his business partner), he wouldn’t want to have relapse again and again, and he doesn’t know when those drugs are going to destroy him (his brain/mind), and his family… because the wife said if he takes it again, she’s leaving him (I still remember he said “妻离子散”, such powerful words). I believed what he said, for I know how much he loves his wife.

On last Monday I encountered a motor vehicle accident and had to take the day off. On this very day, big man’s sister called up to the clinic saying that he was really unstable, as the wife brought the kids back to her parents’ house, big man was threatening to cut his wrist (which he did later on). The family members were advised to admit him to psychiatric wards in general hospital. On Thursday when I was at work, big man came with his father (who is also our patient but is in good remission and maintaining with a minimal dosage). The wife called to tell me what had happened this week. She said big man has become really paranoid and delusional recently, always suspecting that she is unloyal to him. On the Sunday before, he went outstation with his business partner (aka one of the bad friends), and spent the night being high, and had called her on 5am, questioning her about the man she kept, threatening that he would do her harm when he came back later. On the next day, he beat her up after being really angry for “what she has done behind him”. That’s the day she had to run away from him with the children, even after he sliced his wrist twice, she didn’t go back, she knows the children’s safety is the utmost important and her husband is not her husband anymore.

What the man presents, is what we call Morbid Jealousy, or Othello Syndrome (an old case study here). He was never delusional or paranoid during the years he was seeing us. He was just having anxiety and fear over some life issues, and is a perfectionist. I believe morbid jealousy is related to paranoid schizophrenia or other psychotic illnesses, and so I can’t help thinking the links between his history of substance use, and the development of his morbid jealousy. From a lot of cases that I have observed, suffering from schizophrenia or other mental illness don’t usually make your partner leave you, quite often the partner can even tolerate morbid jealousy despite how frustrating it can cause and how destructive it is to the relationship; but being mentally ill, having addiction yet refused to go into rehabilitation, and beating wife, that’s the bottom line for any woman, I believe.

N.B. this post was written in March 2016. According to the sister, big man passed away jumping off from a building at the end of March, after calling the wife and speaking to her. 

The need to maintain with psychiatric medicine

He’s a long-standing patient with paranoid delusions, all the while maintaining with medicine and depot injection. Though, past 2-3 years, he started to reduce his medicine, and at one point, he stopped them all completely, didn’t come back for follow-up and injection.

Within half a year, he had relapsed, with agitation, insomnia, sensitivity and sometimes he could be violent. He isolated himself from the family, spending all the time in his room. When the parents talked to him, he either ignored them or responded angrily.

So the mother started to put the medicine in his dinner, over time he got more stable, at least willing to listen to family, going out with them, and having better temper.

Few days ago his sister called up, saying patient’s condition has got so bad, he was threatening, paranoid and picking on the mother, throwing away her stuff, very agitated and always scolding the family members, also he has spent all his time awake.

The sister said the mother stopped giving him medicine since three weeks ago, as patient was listening to some calming religious musics, and was so much better — better-tempered and didn’t appear sensitive or paranoid at all. The mother thought he’d recovered, decided that he didn’t need the medicine anymore.

Now with his very much deteriorated condition, the family members have no ways to bring him to see a psychiatric doctor and for injection, also no way to make him take the medicine. The mother has also been threatened so much that she was afraid her life could be in danger, and is in the dilemma of whether to move out from the house (which then means nobody can help him).

This is not to say that calming religious music, chanting or prayer, relaxation exercises, meditation etc couldn’t help with one with psychotic disorders, quite often they can be very soothing and calming, at times they can even prevent mild relapses, but they cannot be a complete replacement of medicine. It’s always practical to at least let the patient (with schizophrenia or psychotic disorders) to maintain with a mild dose of psychiatric drugs, so that the condition will be more manageable even when a relapse takes place. (though for patients with good insight of their conditions, especially those with anxiety disorders or depression [but not psychotic disorders], it’s possible to stop all the medicine and only take back when needed).

 

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