Those who suffer from this disorder are more likely to be victims than to be executioners. But society doesn’t want to see it.
It may sound paradoxical, but people with schizophrenia have a better prognosis in India, with public spending on health of only 17 euros per person, than in the United States, whose investment per capita exceeds 8,000. The reason? “The protective factor of a family and a society that does not demand to be producing all the time makes the diagnosis better.”
Whoever says this knows what he is talking about. Celso Arango has been investigating the relationship between this disorder and violence for more than 30 years and affirms, “without any doubt, that people with schizophrenia who are stable are not more violent than the general population and are one hundred times more likely to suffer violence.”
Bullying, physical and sexual harassment… “They cannot defend themselves, they are much more at risk of being abused,” explains the director of the Institute of Psychiatry and Mental Health of the Gregorio Marañón Hospital and president of the Spanish Society of Psychiatry.
Even those who are not and still have symptoms are more likely to be victims than to be perpetrators. However, what usually transcends public opinion are the exceptions, such as the man, supposedly with this disorder, who has sent a letter with a bloody knife to Minister Reyes Maroto. And this reinforces the stigma and, like a whiting that bites its own tail, fuels the social exclusion of these people when their best treatment, precisely, is integration.
One pill a month
Antipsychotic medication allows these people (more than 300,000 in Spain) to control their symptoms, which usually have to do with a break in reality: voices that do not exist, thoughts that they are being persecuted or are being poisoned, etc. Today that becomes as simple as taking one pill a month.
However, there is another crucial factor: close support, from the family and the environment, “that is understanding and does not blame”, explains Arango. This support is crucial because manifestations such as apathy (lack of motivation to carry out any type of activity) are more difficult to understand in relationships that are not so close.
“Because the prognosis of someone who lives in a town is better than if he lives in Madrid: it is a less hostile environment, with less pressure and less urgency” and where affective ties are closer.
This social requirement excludes them from being a labor force: 90% of people with schizophrenia in Spain are unemployed. And work provides self-esteem, vital in a condition where up to 15% of those who suffer from it end up committing suicide.
“There is a lot of substance abuse, depression, sleep problems, sexual dysfunction, eating behavior disorders… The life expectancy of a person with schizophrenia is up to 20 years less than that of the general population because there is also a high incidence of heart disease, diabetes, etc.” It is, without a doubt, the most disabling mental illness.
Disappearance of psychiatric hospitals
Arango points out that this high percentage of unemployment does not correspond to that of other countries in our environment, where there is more flexibility when it comes to working. “If the person cannot work 40 hours, he does 20; if he can’t carry out a complicated task, he does another simpler one… In Spain, either you work at all or you don’t work at all”.
Despite all the difficulties, there has been a remarkable improvement in the care of people with schizophrenia in the last half century. Proof of this is the progressive disappearance of internment centers, which the World Health Organization considers to violate human rights.
“The General Health Law says that there should be no psychiatric hospitals, it is something to avoid, and in Madrid we still have two”, claims this specialist. “They were left in these remote centers so they wouldn’t bother them, but there they couldn’t access other types of medical care they need.”
Another difficulty is intrinsic. “The greatest predictor for a relapse is that they abandon treatment, and this is frequent because one of the symptoms of schizophrenia is lack of awareness of the disease“.
Despite this, the data is clear. The style guide of the Spanish Confederation of Groups of Family Members and People with Mental Illness, Feafes, indicates that less than 3% of people with schizophrenia and other psychoses commit acts of violence. The tip of an iceberg that society still seems to refuse to see in its entirety.