World Schizophrenia Day. The importance of Enriched Environment

Every year 24th May is observed as World Schizophrenia day. This is an occasion to improve our awareness of Schizophrenia – what we know and what more we should know.

What causes Schizophrenia?  No single factor can be assigned the responsibility of causing schizophrenia. It is multifactorial. The most important is the interplay between the gene (nature) and environment (nurture). The environment is constantly impinging on us from the time the sperm from father fuse with ovum from mother. The ongoing Nature – Nurture interaction (NNI) alters the chemistry of brain cells, directs how genes should work and results in disruption of the neural network in the brain.  Right mental health needs a well-oiled neural network. The aftermath of faulty network plays crucial role in causing psychiatric disorder like schizophrenia.

The greatest among the many disadvantages of persons with schizophrenia is their oddity of thought process and behaviour, which are unfortunately interpreted even by educated as a wilful, obstinate and deliberate act by the affected persons.

Neuronal mechanism to differentiate between real and unreal fails to function in schizophrenia. As a result unreality rules the roost like an iron dome around them, impenetrable to normal logic and reasoning when an individual develops schizophrenia.

 Thought process becomes disorganised and muddled. He is unable to think rationally, logically and most importantly to apply reality check on his thought process and behaviour thus making him an odd man out of the ordinary.

Unless treated properly the disease will become chronic and intractable. The sufferer will turn out to be an object of ridicule, laughed at, socially isolated and stigmatised for no fault of him. Members of the society, including educated and even some medical personnel do not understand the “Reality” that it is his brain which is making him so. It is a futile exercise blaming the patient. Fault lies with ignorance and reluctance of the society to understand what more they should know about schizophrenia.

Effective treatment is available. ‘Comprehensive’ approach involves more than administering medications though medicines are absolutely essential to attain remission and to arrest the progress of illness. Equally, if not more, important is to provide Enriched home Environment (EE) to the patient.  

Why EE is important? Persons with schizophrenia are often confronted by High Expressed Emotion (HEE) from the members of the family who turn highly critical and hostile, blaming them for any problems in the family and become intolerant of the patient. Improvement of schizophrenia cannot go together with high expressed emotion in the family. Because the coping mechanisms in schizophrenia are inadequate to meet with such situations. This sets in motion a vicious cycle with more frequent relapse, more hospitalisations, more financial burden, more emotional and physical exhaustion of the family members, all the more worsening the onslaught of high expressed emotion. It would be like all the roads lead to very poor prognosis.

Hence the ideal approach would be to combine medical treatment and provide an enriched home environment. The Family and society has a major role to play if we aim at betterment of persons with schizophrenia. There is a fundamental need for change in outlook of relatives, society and the government mechanisms to improve the welfare of persons with schizophrenia. But then who cares! The schizophrenics do not constitute a vote bank.

– written by Dr. M. Chandrasekharan Nair