Are you mad or just schizophrenic?

On 26th July, 2015, a gentleman by name Charles Antwi caused a stir in the country when he was arrested with a loaded firearm in a church where the president of Ghana, John Mahama, worships.

He subsequently confessed he had planned to assassinate the president because he thought he, Charles, and not Mr. Mahama, should have succeeded late President Mills.

The citizenry trembled at the thought of losing another sitting President. There was general concern about the potency of presidential security, but the discussion quickly switched to the mental state of Mr. Antwi, when each utterance after his arrest revealed a man operating in his own warped reality.

Sections of the Ghanaian public were quick to call him “mad”. That description is wrong, but what was being described was spot-on; Mr. Antwi was later diagnosed with a kind of psychosis, very possibly schizophrenia.

Schizophrenia is a mental health disorder in which a person interprets reality abnormally and has disordered cognitive, behavioural and emotional functioning.

The cause of schizophrenia is not known, but researchers have suggested that a family history of schizophrenia, being conceived by an elderly father, being born to a mother who was malnourished during the pregnancy, certain infections while in the womb and drug abuse are risk factors.

The major components of the presentation of schizophrenia are;

• Delusions, in which the individual has an entrenched false believe of something that is not real e.g. that he is being persecuted by aliens, or that people around him can read his mind, or that he is the President of Ghana, when all these are false.

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• Hallucinations, in which the individual hears, sees or feels things that are not present.

• Altered speech, where the person utters phrases and words that do not make sense, or cannot follow through a conversation.

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• Abnormal motor behavior, where the individual assumes awkward postures or makes repetitive, useless movements or stops moving entirely.

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• Mood disorders, where individuals have swinging moods that are sometimes difficult to understand; they are often depressed though.

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Schizophrenia usually commences in the 20s and is a chronic condition that requires lifelong treatment. Treatment typically involves the use of medicines known as antipsychotics, supported by social and behavioural therapy.

Schizophrenia is a treatable condition. It is thus a mystery that half of the 21 million people who are suffering from schizophrenia around the world do not receive treatment. The ratio is much bleaker in Ghana.

The WHO considers the following to be the strategies to curb this imbalance:

• appropriate training of the primary health care personnel;

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• provision of essential medicines;

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• strengthening of the families for home care;

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• professionals to provide support to peripheral levels, including referrals.

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• public education to decrease stigma and discrimination.

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With the persistent bemoaning of the paucity of psychiatrists in the country, the consistent agitations from mental healthcare nurses about conditions of service, the perpetual lack of beds at our psychiatric hospitals and the incessant breaks in the supply of antipsychotics used to treat schizophrenia and other psychiatric illness, it seems Ghana has a long way to go to meet the stated requirements.

Another significant problem, which will bring a great positive change if solved, is the stigma society attaches to mental health in general and schizophrenia in particular.

In a society where a family history of mental illness disqualifies a potential suitor from being allowed to marry into a family, where one suffering a hallucinatory episode would rather be chained to a tree in the back yard than be sent for medical attention, where it is believed mental illness has a spiritual cause rather than a biological one, you realize we need more than logistics and motivated health workers to curb the problem.

We all need to help turn things around; were media houses to open up their portals more for public awareness, were teachers to demystify mental illness to the children in their care from the earliest possible age, were our religious platforms used to advocate this paradigm shift, we would be halfway through the problem. The state too must do its bit.

In recent times, we have seen the setting up of the Mental Health Authority, a great first step by the state. We must empower this authority to be more than just another office where public servants pretend to work half the day and read newspapers the other half; it must be properly resourced to implement all the laudable provisions in the mental health act, which lays a strong emphasis on public education.

Like hypertension which requires drug therapy or acute appendicitis which requires surgical management, schizophrenia is an illness which can be controlled with appropriate treatment.

Since individuals with schizophrenia are usually not aware of their abnormal mental state, it behooves family and friends to help them seek healthcare and encourage them to comply with treatment. This is why a society which mystifies mental illness and shuns those suffering it can never have its streets rid of them.

It is difficult to prevent Schizophrenia since the cause is not known, but early treatment is crucial. We cannot avoid the very occasional Charles Antwi, who attempts a ridiculous feat like single-handedly overthrowing a government, but were all schizophrenics and people with mental illness in general able to receive treatment early, we could significantly reduce the number of people walking around naked on our streets.

All psychiatric illnesses, including schizophrenia, can be treated; the only madness in mental health is deciding as a society not to give it the attention it deserves.