13.3.1 Signs and symptoms of chronic psychoses
People with chronic psychoses may have difficulties with thinking rationally or with concentrating over a long period of time. They are likely to show disturbed speech, may hear voices, and have persistent unfounded beliefs, for instance that they are being persecuted or controlled. These symptoms can cause problems in managing work, studies or relationships, and lead to social isolation and/or hostility from other members of the community. During relapse, people with chronic psychoses may have symptoms similar to acute psychoses. A common form of chronic psychosis is called schizophrenia.
Schizophrenia is a severe, chronic mental illness that affects about one in a hundred people at some point in their lives. As with other psychoses, they experience episodes in which they perceive reality differently. They may have hallucinations or delusions (see Box 10.3 in Study Session 10). The first acute episode, when the symptoms are experienced for the first time, can be very stressful, because the people experiencing the illness and their family and friends are unprepared and have no idea what is happening to them (see Case Study 13.2).
Case Study 13.2 Mr Abebe’s story
Mr Abebe is a 25-year-old farmer and a married father of two children. He lives near his parents. Both his parents and wife were always proud because Mr Abebe was a well-liked and respected member of the community and known as a ‘good family man’. However, about a year ago, he started to behave in an increasingly strange manner. His wife reported to his father that Mr Abebe was ‘not himself any more’, becoming withdrawn, moody, inactive and unsupportive. Gradually, his condition became worse. He neglected his work and family and was often seen whispering to himself, smiling and laughing for no apparent reason when alone. When he talked to people, what he said no longer made any sense, so people began to avoid contact, leaving him even more socially isolated. His parents and wife were terribly worried and took him to a traditional healer to cure his strange ‘curse’. The healer gave him some herbs to drink and a ritual healing ceremony was performed, but there was no improvement.
Mr Abebe’s case illustrates the key features of someone who is suffering from a chronic psychosis: his illness started gradually without any clear cause and he progressively deteriorated over a prolonged time. Without treatment, people like Mr Abebe are likely to face a miserable future as their worsening condition leads to the loss of family and friends, and they become increasingly unable to support themselves. However, with treatment, about 60% of patients recover to lead full and useful lives. Ensuring access to such life-changing treatment is a key part of your work.