Mini ethnography about Mental cases

Schizophrenia is a term used to describe a group of mental illnesses which are qualified according to a range of symptoms. Symptoms are categorized as psychotic symptoms and symptoms of cognitive impairment. Psychotic symptoms include hallucinations and delusions. Symptoms of cognitive impairment include memory loss and/or disfunction and impaired information processing such as difficulty in making sense of spoken words. For years professionals thought that schizophrenia was a result of the patient’s parental influence and childhood experiences. Now psychiatrists and psychologist look to physical defects in the brain processes as causes for schizophrenia. Though parental influences are no longer blamed for the development of schizophrenia, environmental stress is seen as a factor that can exacerbate already existing problems. Medicine is used at varying success rates to treat schizophrenia. The research reports that there are more cases of schizophrenia in developed nations. The research also notes that children born during famines are more likely to develop schizophrenia. There appears to be a gap in the research as to the role that culture plays on the reporting of schizophrenia. In developing nations where traditional medicine is more accessible than modern medicine, schizophrenia may be diagnosed differently. Some cultures totally discount the validity of mental health care often diagnosing mental cases as a spiritual malfunction though mental illnesses are treated with actions that positively affect the psyche and/or crude medicines from local trees and plants. Thus the statement on the higher rate of cases in developed nations tends to have little substance. Much research has been done on the coping strategies for schizophrenia. Psychologists have forwarded various theoretical models whose ultimate goal is to explain how the patients seek to decrease the occurrences of symptomatic episodes. Among these models are stress coping techniques as well as stress protection where the patient decreases his/her contact with potentially stressful situations. Many patients have enveloped themselves in behaviors that are designed to remove much of the negative social stigma thereby improving their quality of life. Our subjects come from cultural backgrounds that frown on Western medicine’s attempt to diagnose and treat mental illnesses. All of them live in the West, but have not superseded their cultural limitations regarding mental illnesses and their treatment. The fact that their behaviors have brought them negative attention is problematic for their existence to such a degree that they were forced into treatment. Coming to another country has already put them at an unusual level of stress. The concern of this study is to examine their attitude towards their illness and their coping strategies for dealing with the inevitable negative stigma. From our observation, it is clear that their cultural backgrounds have given them competent coping strategies thereby insuring them a comparatively comfortable psycho-social existence in spite of schizophrenia. The social stigmatization of patients of schizophrenia in developed and developing nations is still an unavoidable problem. For this work a group of women with schizophrenia were observed independently carefully taking into consideration their ages, socioeconomic backgrounds, and severity of symptoms. Three of the women were interviewed all living in a developed nation and receiving treatment for schizophrenia. Though none of them were reluctant to speak of their illness and the treatment, all spoke to the issue of the negative stigma which created problems at work and school as well as within each one’s family. All three women come from immigrant communities. Two of them are from the Carribean community and one is a Rwandese genocide survivor. Each woman was diagnosed after strange behavior, unexplained depression, mood swings, and paranoia were observed. One woman is Sandra, 42; the other two are Mary Ann 31 and Christelle 32 respectively. The treatment of schizophrenia and other mental illnesses among immigrant communities is good as long as the illnesses are reported. Because many immigrants come from developing nations where mental health care is at a minimum as above stated, mental illnesses often go unreported unless symptoms are reported to the authorities. When mental illnesses are reported and the patient is a documented immigrant, he/she is treated with the best methods available. This is the case for our subjects. Two of our subjects, Mary Ann and Christelle, refused to take the prescribed medicine citing the negative side effects. They are, however, able to function with minimal problems as their symptoms are limited to pronounced depression and occasional mood swings. The third takes her medicine religiously as her symptoms include delusions and paranoia. Sandra and Mary Ann were diagnosed after others noticed symptoms. Sandra was sent to a medical facility for observation after her family noticed strange behavior. Mary Ann was sent for a psychiatric evaluation after having experienced episodes of crying for no reason at work and threatening to kill a co-worker. The Rwandese genocide survivor Christelle went for an evaluation after having thoughts of suicide and extreme bouts of depression. Thinking it may be post traumatic stress disorder, she went for evaluation and was diagnosed with schizophrenia. None of the women offer up unsolicited information about their illnesses, however they seem not to be ashamed. Sandra’s behavior prior to diagnoses was so appalling that it was a source of embarrassment to her family and friends. Though the community in general frowns on the mental health establishment, Sandra’s social circle encouraged her family to take her in to “find out what is wrong with her” according to Sandra. In this situation, the presence of bizarre behavior coupled with the absence of adequate native medical establishment leads to acceptance of the Western medical establishment not as an obvious choice, but rather as a last resort. They were not disappointed as her treatment through medication and counseling has returned her to an existence that makes her comrades, though still uneasy, more comfortable in her presence. Noting that the medication has side effects and has been changed for various reasons over the years, Sandra is happy and relieved that her treatment is working. She does, however, mention that high stress situations can negatively affect her stability. She and her family work to shield her from such situations. Some things are unavoidable such as the rigors of being a single parent and functioning on the dating scene. Sandra has developed a strategy of coping whereby she can actually feel with the stress level is pushing her into a symptomatic episode. She then quickly retreats from the situations and usually avoids the negative episode. Mary Ann’s behavior was never, by her own estimation, “as bad as others.” As stated above her family and friends were never aware of her illness. On the contrary it was her supervisor who noticed that she was having crying spells on the job. Of course the proverbial straw that broke the camel’s back was her death threat to a co-worker. She was immediately sent for psychological evaluation. Mary Ann was in an extremely stressful position within her personal life. She was facing the potentially imminent departure to the conflict in Iraq as a member of the military medical corps. She had already missed her youngest child’s first birthday celebration due to training. From the initial diagnoses, she was doubtful of its veracity citing an overload of stress. She did take the prescribed medication but noticed that for the first time in her life, she was having suicidal thoughts. Her counselor explained that suicidal thoughts are a recorded side effect for the medication. Mary Ann then stopped taking it. Mary Ann proclaims that she remembers acting out violently in anger as a child. A school counselor told her these expressions of anger were unacceptable. The counselor went on to advise Mary Ann to repre
ss her desires to act out in anger. Mary Ann said that she has followed this advice throughout her life, though certain stressful situations have caused her to act out in ways disproportionate to the given circumstance. This coping strategy however, has served her well. She has now applied to other symptoms of her illness. Just as Sandra does, Mary Ann says that she can predict schizophrenia related symptom and thusly adjusts the situation in order to effectively avoid the symptom or otherwise handle the situation. Unlike Sandra, only Mary Ann’s mother and boyfriend know of her illness. She has effectively hidden it from other colleagues, friends and family noting that most of them wouldn’t believe that “anything was really wrong with her at all.” Seeing that the symptoms sighted in her diagnoses have plagued her throughout life, Mary Ann sometimes struggles accepting the diagnoses herself. She has carved out a comfortable existence without the aid of drugs through her coping techniques and regular visits to a counselor. The potential negative stigma attached to mental illnesses in Mary Ann’s community has prevented her from sharing the diagnoses with people outside her immediate circle of intimacy. Christelle’s experience is quite different from Sandra and Mary Ann’s. Christelle lost both her parents and all her siblings except one in the 1994 genocide in Rwanda. Her maternal uncle rescued her and her brother immediately following the genocide and sent her to study in America. She was plagued by paranoia often times fearing to be alone at night thinking that the Hutu killing squads would emerge from the American forests to kill her. Being that her community frowns upon the mental health establishment, Christelle’s uncle never took her or her brother for mental evaluation. He did, however, take them in for a thorough physical medical evaluation. Once she was studying in America, Christelle began to experience extreme paranoia as stated above in addition to crying fits and social withdrawal. She eventually abandoned the idea that the Hutu death squads had followed her to America, but was soon plagued with the ideal that everyone who saw her knew that she had experienced the tragedies of the genocide. She had fits of crying coupled with sever depression which lasted for days at a time. She eventually went to the psychologist at her university. She was there diagnosed with schizophrenia. Christelle was happy at last to have a name and description of her illness. She took the medicine for a while, hiding all this from her friends and family including the cousin with whom she shared an apartment. The medicine had negative side effects and she quickly abandoned it as well as the counseling sessions and her studies just on the eve of graduation. Christelle’s situation went from bad to worse as she experimented with drugs and lived a life of promiscuity. Eventually, she read more about schizophrenia and sought another counselor. She never again took medication, but has since carved out a comfortable existence without her family and friends ever knowing about the diagnosis. She cannot avoid stressful situations, but has learned through counseling to confront her catastrophic experiences and in turn cope with the stress of life. She has found the courage to openly discuss her genocide at conferences and is presently writing a book describing her experiences. The above women and other immigrant women come from cultural backgrounds that minimize the importance of the individual and concentrate on the primacy of the group’s welfare. As such the women with schizophrenia have had to learn to live with their illness attracting the least negative attention. Coming out publicly and acknowledging their illness is usually not an option as it threatens the public image of their family and their communities at large. On the other hand strange behaviors can also have the same effects. Thus the women finding themselves caught between the proverbial rock and a hard place have relied upon their cultural backgrounds to develop competent coping strategies. Knowing that medication is sometimes necessary, some of the women take it and continue. Most however, like Christelle and Mary Ann, avoid medication at all costs. The end result, however, is a cadre of individual women of Africa descent who have maintained centuries old cultural norms and relied upon the norms as source of strength in creating coping strategies for schizophrenia. Our study has shown through observation that the attitude toward mental illness and treatment is invariably negative. Mental illness is something to be hidden whenever possible. However, strange behaviors must also be avoided even if it means seeking mental health treatment.