Schizophrenia: Drugs, empathy have limits

PHOTO: Schizophrenia: Drugs, empathy have limits

Of the major mental illnesses, schizophrenia is probably the most disabling and disruptive. Mental functions are affected such that illusions, delusions, hallucinations, disturbed personal behaviour and erratic interpersonal interactions happen, sometimes seemingly at random.

There is a whole spectrum of schizophrenic disease, ranging from patients who have some degree of introspection and who know they should be medicated if they want to integrate into society, to others who are no longer grounded in reality and whose illness is made quite intractable by loss of all introspection with a refusal to take prescribed medication.

One understands the embracing, non-discriminatory and non-stigmatising stand adopted by Silver Ribbon executive director Porsche Poh ("Reflect on attitudes towards those with mental health issues"). It is in accordance with a humane and enlightened approach to all illnesses and disabilities.

But I also empathise with Mr Lee Chiu San's views and share his apprehension over the enlistment of those with schizophrenia into national service ("Hard to integrate mentally ill soldiers into active SAF units").

Dereliction of duty is anathema in the armed forces, with the possible consequence of loss of lives. Dealing with ordnance is dangerous, even for those who are mentally steeled. Must we make it more unpredictable by drafting those who are mentally vulnerable?

The clinical course and prognosis for schizophrenia vary according to its severity. Despite the best efforts of doctors, friends, relatives and well-meaning organisations like Silver Ribbon, over 30 years, only about 60 per cent of patients can fully recover, with the rest still requiring a wide network of support or permanent hospitalisation. Disturbingly, a disproportionate number have died through suicide. It is obvious medication, empathy and compassion have their limits.

Letter by Yik Keng Yeong (Dr)

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