Schizophrenia
A Critical Brain Disease

Dr.Niranjan Prasad Upadhyay

SCHIZOPHRENIA, a brain disease, is one of the most critical and emotionally devastating illnesses known to man. Like cancer and diabetes, schizophrenia has a biological basis. It is not caused by bad parenting or personal weakness. Schizophrenia is, in fact, a relatively common disease. Primarily, it is a chronic, severe, and brain disabling disease. Though schizophrenia (major mental health hazard) affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties.

Negligible

In Nepal, existing mental health service is negligible and mass of mentally ill patients either stay at home or they are under the care of traditional healers. Mental, neurological and psychological disorders comprise a huge public health burden. A comprehensive programme directed against their biological and social causes could substantially reduce suffering, the destruction of human potential and economic loss.

People with schizophrenia often suffer from symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms terrify them. Their speech and behavior can be so disorganised that they may be incomprehensible or frightening to others. Schizophrenia is characterised by profound disruption in thinking and feelings, affecting language, thought, perception, and sense of self.
World Health Organisation (2001) highlights that around 45 million persons world-wide above the age of 18 suffer from schizophrenia at some point in their lives. The disorder has been found in all nations where studies have been conducted. It begins at a young age and can impair functioning capacity of the victims as they lose acquired abilities. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness.

Recently, Discovery Health Channel stresses that the first signs of schizophrenia often appear as confusing, or even shocking, changes in behaviour. Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how vivacious the person was before he became ill. The sudden onset of severe psychotic symptoms is referred to as an "acute" phase of schizophrenia. Psychosis(major mental disorder) a common condition in schizophrenia, is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result from an inability to separate real from false experiences. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may be seen.

The symptoms that are most commonly associated with the disease are called positive symptom that denote the presence of grossly abnormal behaviour. These include thought disorder, delusions, and hallucinations. Delusions are common among individuals with schizophrenia.

Generally, hallucinations can be heard, seen, or even felt; most often they take the form of voices heard only by the afflicted person. Such voices may describe the person's actions, warn him of danger or tell him what to do. At times the individual may hear several voices carrying on a conversation. Less obvious than the "positive symptoms" but equally serious are the deficit or negative symptoms that represent the absence of normal behaviour.

While schizophrenia can affect anyone at any point in life, it is somewhat more common in those persons who are genetically predisposed to the disease. The first psychotic episode generally occurs in late adolescence or early adulthood. However, approximately 15 per cent of people with schizophrenia respond only moderately to medication and require extensive support throughout their lives, while another 15 percent simply do not respond to existing treatment.

An individual with schizophrenia may not be aware that he or she is ill, it is often indispensable for a friend or relative to make certain that proper treatment is sought. Once the person is released from the hospital, families are often left with the responsibility of ensuring that the person is taking medication and is continuing to receive whatever other treatment is necessary. The best way to treat a person with schizophrenia is with compassion, understanding, and support. The person should not be made to feel as if the disease is his or anybody's fault.

Schizophrenia is the only largest cause of admissions to mental hospitals. Various theories of the origin of the schizophrenia have centered on psychological, anatomical, biochemical, social, genetic, and environmental causes. There is strong evidence that genetic inheritance often plays a role in the disease. Mainly, stressful life experiences may trigger the diseases.

Necessary

Hospitalisation is often necessary in cases of acute schizophrenia. Treatments are both of a biological nature(e.g. medication)as well as psychosocial (e.g. psycho education of the family and rehabilitation). Depending on the seriousness of the disease, the person may use day programmes, rehabilitation facilities, and be treated in an outpatient setting. This allows the mental health expert to adjust medication dosages as necessary over the course of the disease. The person may also need assistance in readjusting in the society once his or her symptoms are controlled. Supportive counseling or psychotherapy may be appropriate for these individuals as a source of friendship, encouragement, and practical advice during this process. Relatives and friends can also assist in rebuilding the person's social skills.

Participatory Development

By Jhabindra Bhandari

SHIVA Shanker, 24, of Dalit Welfare Organisation in Bardia district is gradually learning about the needs of practical aspects of participatory approach to development. As a development worker with a strong commitment to raise the socio-economic status of untouchable caste or dalits in the communities, Shiva is determined that development is difficult without active participation of people.

Opportunity

Last year, it was an important opportunity for him to participate in a Participatory Rural Appraisal (PRA) training in Kathmandu that has been instrumental in identifying and ensuring the local needs and priorities in the communities for shared learning and action. "Now while planning any development programmes in the communities, we use PRA tools so that there is greater participation of people in terms of gender, caste and ethnic minorities, " he says, adding that the use of PRA is a must for social analysis and research.

Similar is the experience of Jamuna Bhatta, the chairperson of Nari Uttban Kendra- a local NGO in Banke district, that is trying hard to empower rural women through education, income generation programmes and training at the grass roots to improve their livelihoods in a sustainable manner.
"With the knowledge and skills of participatory approach to development through PRA, we are focusing on community participation and local resource mobilization in the development efforts so that their needs are addressed and choices are ensured," says she with a confidence.

Since early 1990s, the PRA and Participatory Learning Action (PLA) have been adopted by many development organisations in community development programmes. This was increasingly realised that conventional development approaches have almost failed in meeting the needs of resource-poor people. There are now many training organisations and development projects that offer PRA training to development workers throughout the country.

In the recent years, participatory approach to development is increasingly important for professionals and institutions to ensure that their efforts are harnessing community strengths through people's participation. The development workers at the grass roots claim that there is increasing acceptance of PRA among NGOs and INGOs to foster people's participation in development.

Local NGOs' important agenda, undoubtedly, revolves around participatory planning, implementation, monitoring and evaluation of community development programmes. In this context, the crux of the PRA is to empower people-particularly those who are poor, marginalised, disabled, older women and men including children through their active participation not only in information sharing, but also in decision making at all levels.

PRA is a continuous process of learning from communities. "The whole process of PRA thus heavily relies on attitude and behaviour of facilitator. And, we could see some of the model projects where people's participation in development have been key to raise their livelihoods in the communities," says Chet Nath Kanel, training specialist in Tourism For Rural Poverty Alleviation Programme.
PRA is now widely used in development research and planning. And the PRA training is taking place in all corners of the globe for community led and demand driven development. Over the decades, PRA is considered as a powerful and beneficial strategy for participatory development. The use of PRA has helped to empower marginalised communities and groups by encouraging them to analyse local conditions. More importantly, it offers the opportunity to assert people's choices and priorities for action.

The PRA offers a creative approach to information sharing, and learning from local people. The methods used in PRA comprise a range of field-based visualisation, interviewing and group work which promote interactive learning, shared knowledge and flexible yet structured analysis.

Furthermore, the use of PRA tools and methods enable both outsiders and insiders to have an integrated vision of livelihoods and well being. The common theme in participatory approaches is thus the full participation of people in the processes of learning about their needs and opportunities, and in the action required to address them.

Impacts

Ultimately, participatory development process has creeping impacts in the lives of poor people. As all know by now that most of the development projects have a success story as they adopted a participatory approach to enlarge people's choices. Be it NGOs' development programmes or that of the government, development efforts should bring a positive impact in the livelihoods of majority people who are poor, deprived and socially marginalised in the communities.

An Evening With Fatteman

By Bhimsen Thapaliya

AS DAYLIGHT faded, the historical Patan Durbar's one of the marvelous courtyards was embraced with quietness. Birds retired for the night's break on the nearby trees. It was the rendezvous of two great arts. The ancient palace displayed rare wood-carving and architecture of the Malla era while a contemporary popular singer was all set to bemuse the audience with his vocal talent.
It was the Gayak Fatteman Sanjh held on 30th of November. Fatteman is a singer who has been singing touching songs for decades. He continues to impress the listeners with the melody that has little faded in quality with his age. The night performance of the senior singer coincided with his 68th birthday.

With winter already set in, the breeze was rather cold as the venue of the performance was in the open. At 5:30 pm the flashlights were on with listeners, who included senior artistes, diplomats, businessmen and journalists, were waiting eagerly for the singer to appear on the stage. The moment of joy came with the appearance of Fatteman who greeted the audience as he entered the artistic platform.

"Narayan Gopal used to call this singer Maharaj or the King," introduced the announcer. He was here, in the ancient palace courtyard of Patan, after his performances in different parts of the country outside the capital. They included Hetauda, Narayangarh and Pokhara. A month or so ago, he had announced of his singing tour of different parts of country. Fatteman's moving melodies are familiar to the Nepalese audience. But little was known about his personality. The singer had not came out to perform before the public shows on 10th of August this year. The Fatteman Sanjh held at Birendra International Convention Centre was an overwhelming success. No one had thought that the septuagenarian singer, would enthrall the audience with his undiminished vocal quality.
Fatteman was brought from the unnoticed position to the public attention by young people who belong to his third generation. Before appearing in the BICC, he had never given a public performance. At Patan Palace performance, he launched his first audio cassette. This was, however, not a studio-recorded work but the record of his live performance. It is being marketed by Music Nepal, co-organiser of the Palace Performance with Nepa-laya. Senior icons present at the programme were musician Natikaji, poet Madhab Ghimire and lyricist Ratna Shumsher Thapa.

Fatteman launched his performance with a Bhajan, a devotional number. This seemed to have some meaning too. If we look at his singing career, one will find that it was the hymns that sprouted his singing talent. The singer said that as a boy of nine, he used to accompany his father to the band of spiritual singers at Pashupatinath.

H sang the popular numbers including Yasto Pani Hudoraichha and Marna Baru Garo Hunna drawing an appreciating ovation. The number Sannani Ko Galaima appeared to be the most romantic one. Some of the numbers he sang that evening such as Duniya Ko Mukha Herna were had a deep touch of sorrow and sadness.

"Some of my songs are 30 to 35 years old," said the singer at the short interval of his performance. Fatteman sang about nine numbers, concluding his session with the patriotic number Rato Ra Chandra Surya, Jangi Nisana Hamro. The audience were treated with tea after the performance.
The depth of Fatteman's vocal is said to represent the Nepalese life in diverse forms. His songs are simple but are full of aura and sweetness. The songs tell the stories of pain, love, sufferings, hope and laughter. They were evident at Patan performance on that evening.