Yesterday I got a message from a young man, a part of which was- My whole life is put at stake. My parents are planning for divorce, all due to this paranoia and papa’s stubbornness. I was thinking to get some legal help but I think that will also be like going too hard for him.
Symptoms of distress that manifest as paranoia, hallucinations, delusions, or anything else are extremely taxing for families to deal with, and this message was written by a young man in his early twenties to me, as he desperately tries to hold the family together, in the hope that somehow they would jointly tide over the struggles of one person, and support him. however, the ‘papa’ is adamant both about treatment of any sort- medical, dialogic or anything else. He has a confirmed diagnosis- yet there is no way anyone can have a reasonable situation with him.
This brings me to the context of Nash’s story, dramatized for the world by the award winning film, A beautiful mind. What needs to be remembered about him is that notwithstanding his schizophrenia diagnosis, for which he was medicated for 25 years, he actually stopped his medication in 1970– and that is never brought out easily. His wife divorced him once, but married him again, at a later date. She played an important role and as someone said in a recent article that I read, she appealed to his emotional side, rather than his logical/mathematical brain.
I quote from the same article, as follows, while the whole article can be read from the link above, in blue-green.
Family and schizophrenia
Frieda Fromm-Reichmann was a psychoanalyst of German descent, who was forced into exile by Nazism and worked in the USA from 1935. At the end of the 1940s she presented a theory that schizophrenia was the result of growing up with a cold and distant mother. Her theory was never proved through empirical studies, which would not have been easy to do.
Later on this theory was criticised from different perspectives. People said that there could be a number of reasons for an unsuccessful interaction between a mother and her mentally ill child. In addition, by portraying a parent as the reason for their child’s schizophrenia is a way of attributing blame and can prevent a parent from giving the help and support that is required.
The view of schizophrenia as a result of unsuccessful family relationships had many advocates particularly in the USA in the 1940s and 1950s. However, this theory was later abandoned, partly because of subsequent empirical research.
When neuroleptics started to be administered in depot form, it was discovered that treatment could prevent relapses. In the 1970s a group of British researchers showed that the risk of relapse was also affected by the emotional climate in the home environment. A high level of expressed emotions (EE) could increase the risk of relapse, particularly if they were negative, critical expressions of emotions or excessive devotion.
As a result of these studies, a new kind of family therapy was developed that focussed on helping relatives find a supportive way of communicating. This kind of family work has shown to produce good results, unlike family therapy that focuses on conflict.
Returning back to the Indian context, in India we are at a stage of infancy in the advocacy about mental health, and bringing all sides of it to a level playing field. Those who work in mental health from past experiences themselves are only a handful in number and they are extremely marginalized- the dominant voices, understandably belong to psychiatry, which is always on a high tide, thanks to the media, which loves mental health, yet only knows psychiatry as its representative.
The reason for me writing this blog post is to highlight two facts about John Nash’s life which are pertinent from the point of view of caregivers- one that through a supportive environment and by focusing on the functional aspects of a person, rather than their dysfunctional side (and who does not have a dysfunctional side in their personality) one can overcome most symptoms of schizophrenia. Love is an important device to utilize intelligently- yet not in an overly controlled manner the way most people do.
The second fact of Nash’s story is that he was NOT ON MEDICATION since 1970. In other words- thanks to the fact that he could continue in his line of work (mathematician, academic), be socially acknowledged for it (what could be bigger than a Nobel), be supported by his family (wife divorced and remarried him later!). How many families are willing to let their loved ones go off medication? That is the trick question, which everyone needs to consider. So in addition to going off psychiatric medication he was also in an employment. Rehabilitation via finding work, appropriate to one’s skill-set are among the surest pathways for recovery. Everyone needs to work – please mark this.
On the other hand, on a parting note, I will say that even in families where I have been involved, the only real outcomes emerge when families as a whole come into therapeutic conversations, and not individuals come for therapy. In India we have yet to reach that stage in mental health, though it may have been reached in allied domains of children, domestic violence or feminist counseling. Unless families enter the process, of empowering everyone concerned within the family-fold their problems and ‘mistakes’ will continue haunting the most weak people- who will show mental illnesses of this or that classification. Family therapy is not even a concern in India, and that is my concern. And whatever two penny bit counseling is offered to families it is largely done by psychiatry, as psycho-education, whose very purpose is to ensure compliance to drug therapy, as a first line of treatment, rather than address the underlying distress, and its sources.