A few weeks ago we saw a man who was diagnosed with schizophrenia in 1982. At the time of my first diagnosis, I was a young psychiatrist setting up my practice.
There was a limited number of options for treating schizophrenia. This man was, at the time working as a clerical officer. He had excellent medical cover and a very supportive family.
He was, as he still is, an organised, almost obsessional person who had high demands of himself. He was honest to a fault and was responsible for the petty cash and banking activities of the company.
At his retirement, the then-CEO pointed out that there had not been a single act of disciplinary action against him in the 30 or so years he had worked for the company.
He had a perfect record at work despite a diagnosis of schizophrenia. For the record, he has a wife, and his children are all grown up.
In the same week, we saw a 24-year-old man who had dropped out of university, following a diagnosis of schizophrenia.
He was actively hallucinating, meaning that he was hearing voices commanding him to go run around Mount Kenya, he had delusions in that he believed that microwave signals were being sent from State House to control his thought process, and his behaviour was abnormal.
He had extreme agitation and restlessness that scared those close to him.
He was using cannabis in large amounts and was also drinking alcohol. His parents were separated, with his mother living in the US while his father had, a year ago married his third wife in a row and was unemployed.
He also drank heavily. His grandmother who brought him up had cancer and was partially blind.
The opinion on his prognosis was that he might not do as well as the man we saw in 1982, not necessarily because the condition he had was more severe, but because the family support was different.
What are the circumstances of the diagnosis made on your son? Are you able to give him all the social and medical support required?
There are many things that the doctor will discuss with you, starting with what is called psychoeducation. In this process, you and those close to your son will be educated about the condition.
Myths will be dispelled. You might for example be told about John Nash the famous mathematician who was diagnosed with schizophrenia and led a very productive life. You will also be advised on how to treat and how not to treat your son.
You will hear terms like highly expressed emotion which is bad for persons with the condition and the importance of regular follow-up and medication will be emphasised.
You will also be made aware of different treatment options ranging from daily oral medication to just twice-a-year injections.
Other treatments might include different forms of therapy including CBT (Cognitive Behavioural Therapy) which might help the patient better navigate negative thought patterns that are so common in mental illness.
Similarly, those with low self-esteem as a result of the condition would get appropriate help. Those with concurrent conditions such as drug abuse as a result of schizophrenia would also get the help they need.
Schizophrenia is not the same in every person. Some have very complicated presentations and absent support systems while others have mild uncomplicated varieties with excellent support systems and outcomes.
You may have to be patient and over months or even years see how he progresses. With adequate care, many people achieve good outcomes.
