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Moving On

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About one person in a hundred will be diagnosed with schizophrenia at some time in their life. The condition can be severe and debilitating with symptoms such as delusions, hallucinations and the loss of concentration, motivation and social skills. But schizophrenia is not a degenerative or life-threatening condition and in recent years improved knowledge and understanding, psychological treatments and more tolerable medication have greatly increased people's ability to manage their symptoms and live a 'normal' life. This straightforward, accessible and inspiring guide provides information on: - The myths and misconceptions surrounding schizophrenia- The possible causes and how the illness is diagnosed- Medication and other treatment options; sources of support- Improving health and well-being- Employment - paid and voluntary- Complementary therapies - Counselling and psychotherapyThe guide also includes the latest research findings and personal accounts of recovery by people with the diagnosis.

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CHAPTER ONE: What is schizophrenia?

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Schizophrenia is a psychiatric term, used when a person has symptoms that arise from extensive and severe disturbance in their thoughts, perceptions, emotions, and behaviour. Schizophrenia was originally formulated and classified as a disease by two nineteenth century psychiatrists, Emil Kraepelin (1856-1926) and Eugen Bleuler (1857-1939), and the diagnosis has been used by the medical profession for almost a hundred years. However, there are several misconceptions about what psychiatrists mean when they use the term, and about the people who are diagnosed with schizophrenia.

What schizophrenia is not

Schizophrenia does not mean that someone has a split, or double personality, as in Robert Louis Stevenson's novel about the man who alternated between being good Dr Jekyll and evil Mr Hyde. There is a psychological condition known as multiple personality disorder, but research suggests that it is rare (Davison &Neale, 1990).This particular misconception may stem from the word schizophrenia itself, which was coined by Bleuler in 1911, from the Greek word schizen meaning split and phren meaning mind. Bleuler believed the symptoms indicated that a person's mind was psychologically split, or fragmented, from various parts of itself and from reality. Nor is schizophrenia about someone being ambivalent or undecided on an issue, though people talk of being “schizophrenic” about things.

 

CHAPTER TWO: What are the causes?

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despite being one of the most widely researched mental health problems, exactly what causes schizophrenia—if there is a definitive cause, or even if it is a specific illness— is not known, although throughout the ages there have been countless theories, some of which now appear ridiculous. For instance, the Greek physician Hippocrates, born in the fourth century BCand known as the Father of Medicine, attributed mental illness to organs which had taken to wandering around the body, or to defects in the body's fluids, or “humours”.

In the Middle Ages, mental illness was often interpreted as a sign of demonic possession and the person might be cruelly punished, imprisoned, or sometimes put to death. Even today some religious sects believe that auditory hallucinations are caused by benevolent or, more usually, evil spirits.

People's sexuality has also been blamed. At one time it was thought that masturbation drove people mad. Kraepelin claimed that schizophrenia was due to poisons secreted from the sex glands that affected the brain. The psychologist Sigmund Freud (1856-1939) believed schizophrenia was due to repressed homosexual impulses.In Surviving Schizophrenia: A Manual for Families, Consumers and Providers (2006), Fuller Torrey, an American psychiatrist, lists numerous similarly odd and unsubstantiated theories, including the notion that schizophrenia is caused by “bad parents”.

 

CHAPTER THREE: Medication and other treatments

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Medication is the first-line treatment for people with a diagnosis of schizophrenia. These drugs are called antipsychotics, neuroleptics, or major tranquillizers and described as “typicals” or “atypicals”. (See Table 1.) Antipsychotics, like other psychiatric drugs, affect chemicals in the brain and other parts of the body which carry messages between the nerve cells. These chemical messengers are called neurotransmitters and act on sites in the nerve cells, known as receptors.

Research and personal accounts show that medication helps many people to manage their symptoms and is decisive in their recovery. A Mind survey, Roads to Recovery (2001) reported that forty-two per cent of respondents who felt recovered, or were coping, said psychiatric drugs first helped their recovery, and three-quarters of the people in a study by Sullivan (1994) also cited medication as the most important factor in their recovery.

However, these drugs do not necessarily make someone feel any better and it is not unusual for people to be unaware of just how much medication affects their behaviour, though it may be apparent to their relatives and friends (Kuipers &Bebbington, 2005). Even so, only about half the people with “schizophrenic disorders”

 

CHAPTER FOUR: Sources of support

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Support is the cornerstone of recovery from severe mental health problems. If someone has been diagnosed with schizophrenia, NHS support will be provided by a multi-disciplinary team, known as the community mental health team (CMHT), although the first person people tend to contact with concerns about their mental health is a general practitioner (GP). Usually, it is by appointment at the surgery, though a doctor will sometimes make a home visit if the person has been a patient for some time. If GPs think that someone has a serious mental health problem they will refer him or her for a psychiatric assessment. This may take between two and three weeks. However, a home visit from a psychiatrist, or one of the mental health team, can be arranged within a day or two if a GP considers a person's symptoms require urgent attention.

When someone is diagnosed with schizophrenia their GP will be kept informed of their treatment by the person's psychiatrist. In addition to providing repeat prescriptions of medication, the GP will continue to take care of the person's general health. The leaflet “Getting the most from your GP practice” gives information on how people can receive help for their physical and mental health. It is available from GP surgeries and can be downloaded from the Rethink website: www.rethink.org/publications

 

CHAPTER FIVE: Health and well-being

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People with a diagnosis of schizophrenia are more than averagely unhealthy. Their symptoms and the effects of medication often result in a tendency to exercise little, eat unhealthily and smoke heavily, meaning that many individuals are unfit and vulnerable to physical illness (Connolly &Kelly, 2005). One study (Harris, 1988) indicates that they are more prone to infec-tions, heart disease, Type II diabetes (adult onset) and female breast cancer.

There is also evidence (Torrey, 2006, p. 115) that some people with schizophrenia have a higher than usual pain threshold. They are not so likely, therefore, to seek medical advice until a particular illness has reached a less easily treatable stage, or to get treatment for problems such as backache or asthma, which can undermine their morale and even lead to depression.

A possible first step for someone to improve their health is to have a medical check-up with their GP, who can also give dietary advice and support in tackling unhealthy habits such as excessive drinking and smoking, and ways to manage stress.

 

CHAPTER SIX: Employment— paid and voluntary

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Eighty-five per cent of people with a long-term mental illness are unemployed (Mental Health Foundation, 2002) and in the UK they have the highest unemployment rate of any group of people with a disability. A national Healthcare Commission survey (2006) found that only half the people who requested help from their community mental health services in finding a job received it.

Yet work can be a valuable coping mechanism for people, and provide a sense of purpose and value (Mental Health Foundation, 2000b) and returning to work after an absence due to illness may be a confirmation to someone that they have recovered.

In Graham's experience, work also often helps people's recovery.

I needed a reason to get out of the house and not sit in a corner all day and listen to the constant voices. I needed a reason to move on and work gave me that reason. It was just a minor admin role, but it helped me recover.

Graham coordinates a mental health users’ employment service. He believes that the mental health field can be an ideal setting for people to use their personal experience to help others and encourage them to take a positive attitude towards their mental health.

 

CHAPTER SEVEN: Complementary therapies

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Complementary therapies are not a substitute for orthodox Western treatments, but may be used to support and complement them. In 1997, a survey Knowing Our Own Minds (The Mental Health Foundation) of 401 UK-wide mental health service users reported that, while only a few respondents had experienced alternative or complementary therapies, those who had found that they benefited their mental health. Also, a high proportion of those who had not received such therapies were keen to be given the chance to try them.

A 2002 survey among members of the Schizophrenia Association of Great Britain (SAGB) revealed a similar story, with overwhelming support for a more holistic approach to treatment and for complementary therapies to be used as well as orthodox medicine. In the same year, a survey by Mind, My Choice, reported that over half the users of mental health services wanted more complementary therapies. More recently, a survey among readers of Perceptions magazine (2005) indicated that they wanted mental health professionals to provide more information on complementary therapies.

 

CHAPTER EIGHT: Counselling and psychotherapy

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Access to “talking treatments” frequently tops the list of priorities of people with mental health problems (Rankin, JL.2005). But it seems that sometimes GPs or psychiatrists are reluctant to refer someone for counselling or therapy. This may reflect the shortage of counsellors working in the NHS. It is not unusual to wait six months, or even longer for an appointment. (Though if someone's care plan includes counselling, Rethink believes it can be worth writing to the hospital trust, which may be able to speed up the process.) Alternatively, the apparent reluctance may reflect concern that the patient sees counselling as an alternative to medication, or possibly as a “cure”. Some health professionals also consider counselling inappropriate, or even dangerous, for people with schizophrenia.

Considerable research indicates that psychodynamic “insight” therapies, especially psychoanalytical therapy, which comprises intensive (two to three times a week) deep psychological exploration, can be experienced as traumatic and worsens people's symptoms. This was the finding of a review of the negative effects of psychotherapy (Drake &Sederer, 1986). The researchers also reported that people having these therapies with experienced practitioners were more likely to leave therapy, needed longer periods of hospitalization, and subsequently functioned less well.

 

APPENDIX I State benefits

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Britain's social security system has been described as the best in the world, but it can seem complicated when someone wants to find out their entitlements. Benefits may be means tested, others depend on the amount of National Insurance (NI) contributions made. At the time of writing, the following benefits are available, but as the entitlement rules and benefits will change, in order not to miss out it is important to check the eligibility criteria.

Statutory Sick Pay (SSP)

This is a taxable payment made to employees by their employers for up to twenty-eight weeks in any period of sickness which lasts four or more days. SSP does not depend on NI contributions. A person can be employed either full- or part-time, but he or she must earn at least the lower earnings limit, currently 84 a week. Unemployed and self-employed people are not eligible for SSP, but may be able to claim incapacity benefit instead.

Incapacity Benefit (IB)

Previously known as Sickness Benefit and Invalidity Benefit, IB is for people who cannot work because of illness or disability and who have not reached retirement age (sixty for women and sixty-five for men). Usually it is related to NI contributions and requires regular medical certificates (sick notes) from a doctor that state that the person is still unable to work. But this does not apply if the person was incapable of work before age twenty or, in some cases, twenty-five, and they claim in time. In that case the person claims “IB in youth”. For people aged sixty or over, IB has been replaced by pension credit.

 

APPENDIX II Legal rights and the Mental Health Acts

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Historically, people with mental health problems have been neglected and unfairly punished and imprisoned. Under current legislation, people who are severely mentally ill can be hospitalized against their will, but individuals still have rights, which by law have to be respected. Currently, proposals to introduce a new English Mental Health Act have been dropped, though it is anticipated that the government will seek to revise the existing legislation. In the meantime, the Mental Health Act (England) 1983 covers the admission, treatment, and rights of people with a mental disorder living in England, Wales, and Northern Ireland. A Code of Practice also provides guidance on the use of the Act and good practice. Scotland has its own act, The Mental Health (Care and Treatment) (Scotland) Act 2003.

The Mental Health Act (England) 1983

Someone who voluntarily admits him or herself is described as an “informal” patient. A person who is admitted without his or her consent is known as a “formal” patient and is often referred to as being detained or “sectioned”, the latter term being used because they are admitted under a particular section of the Mental Health Act.

 

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