Schizophrenia is a grossly misunderstood mental illness, with a terrifying public perception. Occupational therapy could be just the intervention it needs. (The Beauty of the Mind)
There is a strange fascination with schizophrenia in the media, especially in film and television. Horror plays the trope like a violin, exploring the darkness associated with schizophrenia and its dangers; Roman Polanski’s Repulsion, the cult classic Donnie Darko, and James McAvoy in Split depict the mental illness as something terrifying and sinister, even deadly. These portrayals aren’t exactly helped by the media’s fetishization of criminals who live with schizophrenia: Ed Gein famously escaped the death penalty after being deemed unfit to stand trial upon his diagnosis, and David Berkowitz, the so-called Son of Sam, was thought to be suffering the effects of untreated paranoid schizophrenia when his delusions took the form of his neighbour’s dog and drove him to murder.
While of course there is space in the world for these works, they don’t accurately depict schizophrenia, much in the same way Indiana Jones doesn’t accurately portray what it’s like to be an archaeologist. Despite a 2012 study showing that 80% of the films featuring people with schizophrenia between 1990 and 2010 displayed violent behaviour, and almost a third engaged in homicidal behaviour, it doesn’t accurately show what it’s really like to live with the mental illness. Considering there are around 220,000 people in the UK who live with schizophrenia, you would think there would be just a few more Ed Geins kicking around if the media’s portrayal was anything like real life.
Treating schizophrenia can involve a number of interventions, dependant on the symptoms experienced by the patient. Schizophrenia tends to be categorised, simply put, by the patient experiencing a combination of delusions and hallucinations, but the nature of either of these aspects can differ greatly. Delusions can range from paranoia to delusions of grandeur; a patient can live in a constant, overwhelming and pervasive fear of the end of the world, or believe that they are a deity and walk around blessing people.
While the traditional route has seen antipsychotics as the mainstay treatment – sometimes in combination with CBT if the patient feels that’s helpful or it’s relevant to their symptoms – but there’s evidence that occupational therapy could be key to helping those with schizophrenia. As far back as 1985, an article was included in the journal Occupational Therapy in Mental Health which highlighted how multiple different intervention types could help within the treatment of schizophrenia: sensory integration, activity groups, social skills training, and living skills training.
Specifically, the data which formed the basis of the study showed that social integration therapy was a significant motivator, and introducing schizophrenic people to structured activity programs could help contribute to a reduction in positive symptomatology. It also showed that social and living skills training showed promise as an intervention to promote community integration, but that the study needed further testing in order to establish how different patients and symptoms responded to the treatments, to see if they were a viable option for both occupational therapists and people with schizophrenia.
Professor Rajani Kelkar wrote in the Indian Journal of Occupational Therapy that occupational therapy could also complement the use of medication and have significant benefits for patients who experience hallucinations – a trademark symptom of schizophrenia. Kelkar summarises that a number of different interventions, including working with the patient to identify specific dysfunction resulting from their hallucinations, implementing simple coping strategies and assisting the patient in identifying personal meaning in these techniques, and providing support to educate family members and monitor progress can help people with schizophrenia greatly.
In her two case studies where she applies her clinical model, Kelkar demonstrates how the use of occupational therapy interventions can positively affect patients. Patient A lives with paranoid-type chronic schizophrenia; he was a resident in a psychiatric hospital and had been prescribed anti-psychotics, but presented persisting symptoms of suicidal ideation and anhedonia, and the derogatory nature of his hallucinations had negatively affected his self-esteem.
With intervention from an occupational therapist, they assessed that engagement in short-term, structured activities and therapeutic sessions where personal meaning was involved would help with his schizophrenia. The interventions taught him coping mechanisms, which he found beneficial in decreasing the hallucinations, and their effect on him greatly decreased, which resulted in his discharge from the medical facility.
The IOSR Journal of Nursing and Health Science supports the findings of Professor Kelkar through the findings of M. Ramakrishnan, who understood a similar case study involving a 42-year-old man with schizophrenia. Similar to the other study, he was schizophrenic, and experienced hallucinations, poor self-care and poor socio-occupational functioning. Occupational therapists identified a number of issues which could be improved through behaviour modifying intervention and the model of human occupation. While the patient was originally sceptical, saying he was not capable of the activities, he persevered, and the combination of interventions resulted in a reduction of his hallucinations and improved behaviour and self-care routines.
Introducing occupational therapy into the treatment schedule for a person with schizophrenia has been shown to greatly help improve their lives and lifestyles. Improving and expanding the treatments afforded to people with complex conditions will help them now only live improved lives, but improve the social perception of a mental illness which is significantly less dangerous than the media leads us to perceive it.
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