Schizophrenia Rehabilitation: Value of Family support and Sense of Purpose
A hapless woman, abandoned by her husband and wracked by a killer mental illness called Schizophrenia, Bano is the story of immense effort to overcome the travails and the invaluable role of a supportive family in the rehabilitation process.
Bano (not her real name) is 28 and her story began almost a decade ago. The youngest of eight children, Bano completed secondary schooling but didn’t pursue her education after that. Her four elder sisters and three elder brothers are married and live with their own families. She lives with her aged widowed mother on the family property, and the family runs a hardware business.
Bano was only 20 when she first became ill, shortly after her engagement was called off as the result of an inexplicable misunderstanding. She was often irritable and her family, who did not understand her behavior, attributed it to acute disappointment. Not much later, Bano was married to a businessman based in Mumbai. But less than six months after the wedding, Bano’s new family sent her back to her parental home, complaining that she was very ‘problematic’ and ‘unmanageable’. Her mother-in-law complained that she was constantly irritable and did not show any initiative to help with work at home.
It was at this point that her family- mother and brothers- realized that she need professional help. Bano was taken to a psychiatrist and was diagnosed with schizophrenia. She began treatment and showed really good improvement for almost a year. At this point however, her family, assuming she was fully cured, insisted she stop her medication and everything spiraled out of the control once again. At the same time, Bano also received divorce papers, further worsening her state of mind. And sure enough, her irritability, restlessness, sleeplessness and anger all returned. She began treatment again improved once again, and in an identical conclusion to the pattern of events, was told to discontinue her medicines. The reason? Her family felt the ‘sleeping tablets’ caused her to lie in bed all the time, not helping her mother with any household work.
One year later, Bano was first brought to SCARF by her family. She had been severely agitated and violent for two days and not surprisingly, refused any medication. On examination, we found that she had auditory hallucinations and heard voices abusing her and threatening to kill her. She was convinced that her family was plotting against her and consequently became very violent. She was hospitalized in an acute care facility for a week, before being transferred to Bhavishya Bhavan at Thiruverkadu, where she remained for six months.
We identified three priority areas to help Bano get back on her feet – initiating a sense of routine through a daily schedule of activities, ensuring she took her medication regularly and instilling a sense of purpose through appropriate work. Bano was introduced to a structured schedule including personal care activities, group work and vocational training. She needed considerable persuasion at the beginning but soon followed the routine without prompting. Bano also participated in group therapy sessions, giving her an opportunity to talk about her early experiences, particularly her failed marriage.
She also learnt about the early symptoms about relapse. Finally, Bano learnt the art of Batik painting at the center’s workshop. She of course also continued to attend one -on -one counseling sessions.
During the period that Bano stayed at Bhavishya Bhavan, her family remained involved in the rehabilitation process. Although her mother was the primary caregiver, her worsening health made difficult for her to visit the centre regularly. Bano’s younger brother and his wife became secondary caregivers; her sister-in-law was keen to learn more about schizophrenia and symptom management in particular. She also took the time to understand the medication, its intended effects and dosage. Most importantly, the couple attended regular family education sessions at SCARF learning all about the signs and symptoms of schizophrenia, about long-term treatment, and the potential triggers for a relapse.
Six months after Bano entered the residential centre, she was discharged but continued to attend our daycare centre regularly for a further six months. Here, she worked in the handicraft unit and the canteen and attended individual counseling sessions with our social worker who stressed the importance of taking her medicines regularly as well as the need to remain active. Bano was also given a structured work schedule at home, which was monitored by her sister-in-law.
Bano soon expressed a desire to take up a course in tailoring and dress designing, and enrolled in a nearby women’s polytechnic college for one year. She attended the course three days a week and came to the daycare centre on the remaining days. Though she completed the course, she was reluctant to take the exams but continued to work at the tailoring unit we operate at SCARF. Her family was delighted at her improvement and she would take her medication on her own regularly although her mother and her sister-in-law remained vigilant. Soon, her sister-in-law found her a job as a helper at an export garment factory.
Since then, Bano has adhered to her treatment, taking medication regularly and also attending scheduled reviews. It has now been five years since her last relapse.
Bano’s determinations to venture back into the world is testimony, most of all, to her own courage and resolve. For us, Bano’s story exemplifies the difficulties faced by a young woman who is abandoned by her husband, and the invaluable role of a supportive family in the rehabilitation process.