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Split personality disorder? You've got it all wrong

ONE day she heard voices and thought the television was talking to her -- the next she believed the police suspected her of the Omagh bombings.

The hallucinations that plagued Sheila* from mid-adolescence into her 20s turned her life into a dizzying whirl of terror and confusion which lasted for years.

A former heroin addict, Sheila believes drug addiction played a major role in her diagnosis as a paranoid schizophrenic at the age of 19.

By then she'd been taking drugs for five years -- she started at 14 -- and injecting heroin for four of these. She'd also been sleeping rough.

"When I started to come off heroin, I went on a methadone programme. I gave that up after a few days. That was when I became highly paranoid," recalls Sheila, now in her late 30s.

She tried to drown herself in a city fountain and believed that she was on the run from the police who suspected her of the Omagh bombings.

"I went into a police station and I jumped over the counter to try to hit the policeman because I thought the police were making up lies about me. They sent me home and I ended up in a psychiatric hospital for nearly a year."

Throughout this period she was hallucinating constantly.

"I thought the television was talking to me. I could see myself on the telly. I could see people trying to knock me down with cars. But it turned out that what I was actually looking at was a programme about crash test dummies.

"I thought that I was going to be the next crash test dummy. It was terrifying."

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Her family were very frightened by her condition, she says.

Right through her late teens and early 20s Sheila heard voices -- loud, hectoring voices and creepy, insinuating whispers that told her the people around her were going to kill her and, when she was finally hospitalised, advised her to steal tablets from the nurses and commit suicide.

"Once the voices told me to kiss a particular man. They told me he was the devil and that if I kissed him I could rule the world with him."

To this day, she says, she's uncertain whether there even was a man or whether she kissed him.

"Maybe it was all an hallucination. I don't know."

Household word

Schizophrenia may be a household word but much of what we believe about it is wrong.

If asked, many people would confidently describe schizophrenia as a condition which causes split personalities and makes people aggressive, violent and dangerous.

Yet these are just some of the myths and inaccuracies which have sprung up to cloud the reality of this very debilitating illness.

"The popular understanding of schizophrenia has nothing to do with the reality of the illness," says Patricia Casey, Professor of Psychiatry at UCD and the Mater Hospital and Health & Living columnist.

One of the problems, she believes, is that the word is bandied about in a casual, careless, unthinking away: "It can be used in stories, for example, which claim that someone whose style is unpredictable has behaved in a 'schizophrenic' fashion.

"It's used to describe ambivalent or unpredictable behaviour. The term schizophrenic is often used for someone who is inconsistent -- which is a complete misuse of the term."

It's also used to mean a 'split' personality, making the assumption that there are two sides to a person's personality.

Another problem is that the public often wrongly links schizophrenia with aggression, says John Saunders, director of Shine, formerly the Schizophrenia Association of Ireland.

The Shine helpline responds to about 6,000 people a year on the issue of schizophrenia and other mental health problems.

The organisation, which has regional development officers based in Dublin, Kilkenny, Cork, Ennis, Galway, Tullamore and Dundalk, boasts 52 support groups in various parts of the country.

Saunders believes that about 140,000 families in this country has a loved one with schizophrenia. "Last year we dealt with about 8,000 people either individually or in groups or through our counselling services."

He, too, believes that a lot of the inaccurate assumptions about schizophrenia are continually reinforced by the news media and the entertainment industry.

Saunders points to the non-stop stream of films and books portraying the mentally ill as aggressive.

"It's quite the opposite in reality. I've been working in the area of mental health for 11 years and I've never come across people with schizophrenia who are openly aggressive.

"You'll meet people who are confused and disorganised in their appearance and who may seem aggressive, if someone is acutely unwell."

However, despite a much-hyped association between aggression and schizophrenia, research carried out in New York in the last 10 years found that only about 0.4pc of the perpetrators in homicide cases were people with mental health problems.

"This misconception about aggression contributes hugely to the stigma which surrounds this illness," he warns.

The condition is, however, extremely disruptive. Parents and siblings are hugely affected when someone in the household begins to manifest the symptoms of schizophrenia, he says.

"What many parents have said to us is that when a diagnosis happens they feel as if a stranger has come into the house who is very differently behaved."

Often people don't eat enough, he says, or they may eat too much. Ordinary patterns of life are disrupted -- someone who might have been very interested in sport will drop it.

"Hobbies will go and their health may deteriorate because they don't look after their hygiene," says Saunders.

It can be extremely upsetting for families, he says.

"Someone who might have been quite sociable begins to cut themselves off from their friends and their work or their social activities suffer. The family gradually notices a change in lifestyle and behaviour.

"Family members may think it's drink or drugs or some problem at school and often the patient is so confused he or she may be afraid to share it."

So what is Schizophrenia? Schizophrenia, explains Casey, is a condition in which there is a loss of touch with reality.

"This manifests itself in delusions and hallucinations. A delusion is a false belief that is unshakeable and that is out of context with the cultural beliefs in which a person lives."

These delusions are associated with dysfunctional behaviour and problems in day to day living.

For example, a person may not be able to go to work, or their relationships may break down because of delusions of persecution or serious illness.

Despite the constant references to it in the media, schizophrenia is not common -- only about one per cent of the population has the condition, she says.

"The word schizophrenic is bandied about but the illness itself is just one per cent."

"Schizophrenia is primarily about the thought process becoming disorganised," adds Saunders.

"If you have the condition, your thinking pattern is chaotic and frenetic."

Often, he explains, the person will have a strong degree of paranoia. "They may think that other people are out to hurt them or they may have very false beliefs about things."

People with the condition may also believe that those around them assume different identities.

Cannabis

What causes it? A number of factors have been linked to this condition, which typically begins in the late teens and early 20s.

"There is a genetic component. Links have also been made with the abuse of amphetamines and cannabis.

"There are theories relating to certain viruses but these have not been substantiated," says Casey.

However, she emphasises, there is no evidence that difficult relationships within families may cause schizophrenia, a theory which was widespread in the 1960s and 1970s.

"Schizophrenia is treated with anti-psychotic medication and most people do well, but a small proportion go on to develop negative symptoms which consist of social withdrawal, apathy, poor self-care, lack of motivation.

"Clozapine is used to treat this stage of the illness, but it is first important to identify the acute illness as early as possible in order to prevent the transition to negative symptoms."

Generally, she says, about one-third of patients do well and experience a complete recovery. About one-third do moderately well and can function but, she says, perhaps not to the level they previously did.

"A further third do badly, although that figure has probably improved in recent years with the availability of Clozapine and the realisation that early detection of the illness itself and aggressive treatment is crucial."

Shine strongly believes in the benefits of Cognitive Behavioural Therapy (CBT).

"Research has shown that a combination of medication and CBT can help on the road to recovery.

"CBT helps you to understand what is going on and teaches you to develop ways of coping with it.

"There are many techniques people can employ to help them manage the problem of voice hearing, for example."

Medication alone may "dampen" the symptoms, he acknowledges, but CBT can also help a patient manage their symptoms and help them recover by understanding what is going on.

For Sheila, the medication worked well.

"When I came home from hospital I had improved. They had put me on medication and I got a very good doctor who put me on a course of tablets that helped me to cope better. Once I was on the medication all my relationships improved.

"I still have bad days but I have a lot of good days. My advice to the family of someone with schizophrenia is not to be worried about the stigma.

"Go to a group were you can get support and find out as much as you can about the condition."

For patients, she has this advice.

"Go to the doctor. Listen to what your doctor says. Tell the doctor what is going on in your head.

"If you're offered medication, take it -- it could change your life."

* Not her real name


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