Mental health issues generally pose a daunting challenge to patients, their families, carers, mental health professionals and society at large. Of all mental aberrations, Schizophrenia is most intimidating because it robs the affected person of his or her productive years in life and the sooner the condition is identified and treated the easier it will be for the person to recover and return to normal life. Schizophrenia does not discriminate between race, sex, age, color or creed and affects the population universally. It generally presents after adolescence and only rarely affects children. Its frequency is however more in men than in women. Schizophrenia affects approximately 1% (or 1 in 100) of the  world population. The numbers in India are unknown as we have no data, however in United States there are over 2 million people suffering from the condition.

Hungarian psychiatrist and Professor Emeritus at State University of New York Health Science Center in Syracuse described this condition very briefly saying – “If you talk to God, you are praying. If God talks to you, you have schizophrenia.”

Scientists have often felt that that the term ‘Schizophrenia’ should be abolished as the label stigmatized these sufferers as being violent, dangerous and untreatable.

Medindia interviewed Dr. R.Thara, MD, Ph.D, Director of SCARF (Schizophrenia Research Foundation), the only WHO Collaborating Center in India for Mental Health Research and Training. SCARF makes available a broad spectrum of interventions in different settings including day care, outpatient, community and in patient residential centers. Dr. Thara has published many scholarly papers on mental health and is known for her use of simple and clear language to enlighten laypeople on mental health issues particularly Schizophrenia.

Q. Please tell us something about SCARF for our readers’ benefit?

SCARF is a not-for-profit, non- governmental organization started with modest beginnings in 1984 in Chennai by philanthropists and mental health professionals led by Dr. Sarada Menon. This is our silver jubilee year. SCARF was started with the main objectives of delivering low cost, comprehensive care including rehabilitation for persons suffering from schizophrenia. SCARF is equally active and well known in research and academics, training and teaching, building awareness and lobbying for mental health awareness. It is also a specialized center for psycho social rehabilitation, which means employing various techniques to reduce disability, improve the functioning of these persons and help them join the mainstream in society. 

Schizophrenia affects persons in their most productive years 18 to 35. Hence, in many countries it is called the “Greatest Disabler of Youth”. Very bright and highly qualified young men and women can develop the disorder thwarting their ambitions and goals in life. We therefore target school and college students in our awareness programmes so that they can detect early the symptoms of schizophrenia in themselves or in their peers. Early detection and regular treatment are key to recovery and improvement.

Q. Considering that Schizophrenia affects people in their most productive years, how does SCARF organize their rehabilitation after treatment?

Rehabilitation is the process by which the disabilities in a person are reduced so that he /she is able to regain some of the lost skills and integrate themselves with society. In the case of schizophrenia, the disability may be poor social skills, difficulty in communication and forming relationships and doing everyday tasks. So, training is provided either singly or in groups to help these people regain the skills. Psychological methods such as behaviour modification and cognitive training are also used.

The most important aspect of rehab programmes in India is work. Since we do not have any social security benefits for the mentally ill, it becomes essential for them to resume work soon. So, we have sheltered workshops where they are asked to work for a few hours everyday. This inculcates in them a work habit and a discipline which helps when they take up outside jobs. More people in the industry should come forward to give jobs for such persons, many of them being quite skilled. Holding a job also raises their self esteem and helps in the recovery process.

Q. India being a conservative society, how does SCARF de-stigmatize the issue of mental disorders? Can you tell us some tested strategies that SCARF can vouch for in creating awareness on mental health issues?

Stigma is one of the greatest barriers to seeking treatment and this delay leads to the condition becoming gradually more severe reducing the chances of complete recovery. Stigma also impairs social adjustment and acceptance by the community. SCARF is the Indian coordinating center for the anti stigma program of the World Psychiatric Association. The SCARF-WPA anti stigma program was launched in 2004 by the President of India then, Dr. Abdul Kalam.  SCARF has used multiple strategies to deal with the stigma—using  all forms of media such as print, radio, TV etc, traditional methods like folklore in rural areas and even a skit in Tamil enacted by improved patients of SCARF. 

For the last three years, we have been conducting a film festival “Frame of Mind” in which national and international films on the subject of mental health were screened over a 3 day period for the general public, followed by discussions with professionals. This was a unique experience since many patients and family members disclosed the fact of mental illness openly and discussed issues of concern. There is also a competition of short films based on a theme announced by us. The first three winners get cash awards. The next festival will be in October 2010.( www.frameofmind.in)

Apart from the popular Hollywood movie Beautiful Mind which had a worldwide audience, there are some good Indian Films on schizophrenia namely, 15 Park Avenue (English language Indian film), Woh Lamhe in Hindi, Devrai, Ratra Arambh in Marathi and Kudaikul Mazhai in Tamil and the recently released Pathaam Nilayile Theevandi in Malayalam, to name a few. Many films however use mental retardation and mental illness interchangeably and this increases the confusion in people’s minds. Traditional stigma attached to mental disorders can be aggravated if scientifically sound messages are distorted by the media. Film media can be more careful, perhaps use the Censor Board, to check erroneous messages related to mental disorders conveyed to the public.

Q. Do some antipsychotic drugs hinder recovery as believed widely?

In schizophrenia, there are structural and biochemical changes in the brain. So, medicines are required to set this right. This is how anti psychotics work by correcting the chemical imbalance in the brain. Some of them can cause side effects like drowsiness, dryness of mouth, weight gain and menstrual irregularities. But used in right dosages, these drugs are an absolute requirement for persons with schizophrenia.