A Tortuous Journey

A Tortuous Journey.

Abe was in her late 20s, and since her graduation from college, she had been staying with a friend who had kindly offered her accommodation. Estranged from her family, she nevertheless felt sad and uneasy being away from them, but this distancing was for her protection. She was in the midst of planning for her upcoming wedding when she presented for counselling, suffering from mild depression. Leaving her widowed father out of her nuptial ceremony was a tough decision.

One day, in her early 20s, she received a call from her older brother. Their mother had committed suicide. Her parents’ relationship was complicated; Abe’s mother was her father’s second wife, but they did not officially register their marriage. Instead, a simple Chinese tea ceremony formalised it. Fights between them were a norm, and it was always over his first wife, the other family, and money matters. In the next five months, in deep regret, Abe saw her father deteriorate from being a carefree individual to a deeply withdrawn and brooding person she did not recognise. Five months after her mother’s death, while she was preparing dinner for the family, her father came into the kitchen, took a kitchen knife and threatened her. Abe screamed. Her brother rushed out of his room and quickly disarmed their father. He was shouting incoherently and kept a threatening posture towards Abe. After some discussion with their neighbours, who had arrived at their home as a result of the commotion, Abe’s brother, together with another friend, took her father away to a hospital’s emergency department. He was diagnosed as having a psychotic break and warded for three weeks. Before Abe’s father was discharged, Abe moved out of her home.

Paranoid schizophrenia accompanied with dangerous behaviour is comparatively rare. Most people with schizophrenia are never violent and do not display any violent reaction. However, a small number do become violent when they are suffering from acute symptoms of psychosis due mainly to their hallucinatory and delusional thinking. When they do become violent and dangerous, studies indicated that it is their delusions that influenced them. If this does happen, the victim is usually someone from their own family or someone close to them, such as a carer. Attacks against strangers are incredibly uncommon. When the attacker is female, almost invariably she will attack her children. What one critical aspect of this condition modern research tends to agree is that co-morbidity with substance abuse is a precise predictor of violent behaviour. When a person with schizophrenia abuses alcohol or street drugs, their risk of engaging in dangerous conduct increases fifteen-fold. However, tragically, those with the disease more often harm themselves and usually they succeed in killing themselves.

There are a few risk factors that predict dangerous behaviour for a person who is suffering from this disease: (1) A previous history of risky behaviour or threats of such action indicate a good chance that it will happen again. Therefore, carers and practitioners should always take threats of suicide or violence seriously. (2) A history of drug or alcohol abuse puts the sufferer at risk of dangerous behaviour. (3) Non-compliance with the prescribed medication regime time after time often is a huge risk factor, as the person’s hallucinations and delusions will further deteriorate after they stopped taking their medication.

Abe’s father remained on medication when he was discharged but was regularly delinquent in keeping with his medication regime. She was supervised whenever she returned home for a visit.