Grace was an orphan. As an intelligent 13 year-old student, she was made a monitor for her class, and soon, became a favourite with her maths teacher, Miss Tan. The latter took a special interest in Grace’s studies and provided her with free Maths tuition lessons after school hours. Whenever Grace ran out of pocket money and skipped her meals and Miss Tan became aware of it, she would buy her lunch. As she progressed through her high school studies, Grace considered Miss Tan to be like a surrogate mother to her, bring her problems to her teacher whenever she needed some advice. Grace was doing consistently well in her schoolwork and would always be within the top 2% in her cohort exams. One day, six months prior to her final year high school exams, having secured extremely good grades for her mid-year exams, Grace gushing with appreciation for all that Miss Tan had done for her, spontaneously embraced her along a school corridor, in full view of some of her own classmates. Miss Tan, in shock, pushed Grace away with a stern reprimand for her behaviour. Grace apologised immediately, but from that moment, she felt that Miss Tan became cold towards her. Overnight, her teacher’s attitude towards her changed, and Miss Tan became ‘a stranger’ to Grace. For an impressionable 16 year-old, Grace began to unwind emotionally. Within a month, she had a mental breakdown and was hospitalised for a couple of weeks.
Grace soon graduated from high school, but was not able to hold on to a permanent job. With no one to supervise her daily medication regime, her compliance became patchy, with frequent psychotic relapses, further jeopardising her recovery. After a few years, her psychiatrist switched her medication to a monthly long-acting antipsychotic injectable.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. Symptoms of schizophrenia usually start between ages 16 and 30 and can be very disabling. In rare cases, children have schizophrenia too. The symptoms of the illness fall into three categories: positive, negative, and cognitive. Positive symptoms are psychotic behaviours not generally seen in healthy people. People with positive symptoms may lose touch with some aspects of reality, like having hallucinations, delusions, thought disorders (unusual or dysfunctional ways of thinking), and movement disorders (agitated body movements). Negative symptoms are associated with disruptions to normal emotions and behaviours, including flat affect (reduced expression of emotions via facial expression or voice tone), reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities, and reduced speaking. For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking; these include poor executive functioning (the ability to understand information and use it to make decisions), trouble focusing or paying attention, and problems with working memory (the ability to use information immediately after learning it).
When Grace was referred to me, she was in her late 40s. Supportive counselling was provided, which included an orientation towards her particular symptoms, the side effects of her medication, and stress management. Her pastor assigned a church member for Grace to be accountable to, as she moved on in life. Eventually, she was able to fulfil a part-time role as an office assistant.