We are all creators of our inner world and as such we have the possibility of transforming it.

The resounding message is born from the experience of a person who was

dragged into unreality

, chaos and pain and was able to get out and regain control.

Basilio García Copín is 52 years old, he is a children's table tennis coach, an administrator in Ceuta and an activist for the rights of people who suffer from a mental disorder.

He was diagnosed with schizophrenia in his youth.

He suffered delusions and immense suffering

that confined him to his home for three years.

With medication and a deep will and level of consciousness, he was slowly taking back the reins of his life.

In her recovery, psychotherapy was key to understanding the episode of psychosis she had suffered and overcoming her limitations.

"The pills take away your delusional ideas but you stay in an existential void," he says, asking whoever is feeling it now, as it happened to him years ago, not to settle, to seek help and

express his "mental experience" no matter how "strange" it seems so that it can fade.

The pills take away your delusions but you are left in an existential void

Basilio García Copín, diagnosed with schizophrenia.

Today is World Schizophrenia Day.

The term meaning "split mind."

It could be said that when thoughts, emotions and sensory impressions overwhelm the person and he cannot handle them well, he deposits them outside of himself, in another reality.

"With the first symptoms, it may be that the mind begins to generate thoughts that

are not the result of your will

, it is what I call unreality. That is why it is very important to give that person a language so that they can build a narrative that explains their experience mentally, that the person becomes an observer and takes back the reins", he explains.

"Even the most unlikely paranoia is a natural phenomenon" that one must be able to express "without fear no matter how rare".

For 30 years, Carlos Cuevas has coordinated the Mental Health Rehabilitation Unit at the Virgen del Rocío University Hospital in Seville, which began its journey in the 1990s to support the patient deinstitutionalization process that occurred with the closure of the old psychiatric centers and their return to the family environment.

At the beginning, most of the patients they attended suffered from psychosis.

The goal of therapy with a patient with schizophrenia is above all

to reduce the intense disturbance

so that you can lead as normal a life as possible even if the symptoms do not completely disappear.

Despite its benefits, only one in ten people with this diagnosis go to psychotherapy, according to this expert, citing data from the British population that can be extrapolated to Spain.

When working with a person with a delusional idea, we do not try to make him see that this way of seeing the world is not adequate

Carlos Cuevas, psychologist.

The main reason for this absence is that most patients, especially at the beginning of the disease, do not recognize that they have a disorder, which delays access to health care.

This must be comprehensive, with the participation of various professionals such as

psychiatrists, clinical psychologists, nurses, social workers and occupational therapists

who individually address the capacities, needs and interests of the person.

In practice, the current ratio in clinical psychology in Spain (six professionals per 100,000 inhabitants compared to the European average of 18 per 100,000 inhabitants) makes care "deficit".

"There is a brutal scarcity of resources and with a 20-minute visit every four months, schizophrenia does not recover," explains Basilio, emphasizing the need to reinforce psychotherapy because

"until a person explains in words what is happening to them, they do not progress. "

.

The WHO has warned that by 2030 mental health problems will be the leading cause of disability.

And far from resigning himself to this "terrifying panorama", he draws hope: "It will be if nobody does anything. A prevention model is needed."

Change the environment to prevent these disorders from increasing.

And this happens, among other aspects, he assures to "prepare young people for an emotionality that supports frustration and adversities in life, promote self-esteem and security".

The therapy is adapted to the phase of the disease in which each person is.

It is not the same to treat someone who has just suffered a first psychotic episode and faces the confusion of a delusion or a hallucination as it is to treat a person who has been living with schizophrenia for years and is trapped, for example, in a deep apathy. vital.

Basilio García Copín, president of Ceuta Mental Health.

"We never start working on the symptoms directly, but we ask about their life, how their day is, what they do, what they don't do, what they would like to do and don't do and why.

There you have a door and they start talking about limitations:

'I'm afraid to go out on the street or I hear voices that tell me that if I go out something bad will happen to me'".

The most used techniques for the treatment of schizophrenia are the cognitive behavioral ones.

Detecting, understanding and transforming harmful thoughts is not easy, even for those who do not suffer from a mental illness, but achieving it is a big step towards regaining control of life and relieving pain.

How to help him stop believing in that reality that torments him?

For example, that someone wants to kill him or his family, that they persecute him, that someone can 'steal' his thoughts or 'insert' others into his brain.

Creating a climate of trust and offering alternatives that 'dismantle' this deeply rooted reality is a good way to reduce emotional disturbance.

To know more

Testimonies of relatives and affected.

"People with schizophrenia cannot settle for being second-class citizens"

  • Drafting: YAIZA PERERAMadrid

"People with schizophrenia cannot settle for being second-class citizens"

Mental health.

Another look at schizophrenia: "The diagnosis is the beginning of a story of overcoming"

  • Drafting: YAIZA PERERAMadrid

Another look at schizophrenia: "The diagnosis is the beginning of a story of overcoming"

"When working with a person with a delusional idea, we don't confront them, we don't try to make them see that this way of seeing the world is not the right one," explains Cuevas, who underlines the importance of approaching them empathizing with the emotional impact and the difficulties that this conviction causes them, that they can recognize that more easily.

The aim of therapy is to create, through a dialogue,

an iota of doubt

in the patient himself questioning not the delusion but the evidence on which it is based and "inconsistencies or excessive speculation" can be seen that make that delusion lose credibility.

For example, a young man with a diagnosis of schizophrenia who fears being killed for knowing the steps to build the atomic bomb may begin to doubt this if the therapist asks him if he really believes that with the knowledge acquired in school he can make it.

"Introducing doubt is very positive because it is no longer a single possibility, which is bad and negative (they persecute me and want to hurt me) but perhaps the other person is serious because they have personal problems and do not want to talk to them. Just visualize that even if you believe more in the first, it relieves", assures this expert.

Psychotherapists seek

to enhance the skills and abilities

of the person with a diagnosis of schizophrenia so that they are "active agents" in their recovery process and acquire tools to manage their discomfort, which translates into a greater sense of control of the disorder, acceptance and autonomy.

Their self-esteem, which is usually very damaged, is also reinforced

when they perceive that they themselves can act to reduce the impact of schizophrenia on their lives.

Crucial in this process is psychoeducation, both of the patient and their relatives, so that they know their disorder, the risk and protective factors, the most frequent psychotic experiences, the appropriate medications to alleviate the symptoms and the importance of self-knowledge to avoid relapses.

People with schizophrenia are more vulnerable to stress and hence the importance of learning certain relaxation and anxiety management techniques to deal with situations of intense emotional charge and knowing how their own body reacts to them so that the crisis does not progress .

Poor sleep, being more susceptible or lack of concentration can be warning signs.

A person who suddenly hears a voice is going to be surprised and the first thing they ask is who is the emitting agent of that voice.

Historically, delirium was understood as an element to take into account when establishing a diagnosis of schizophrenia, but since the 1990s, emphasis has been placed on the specific study of the symptom and what function it fulfills.

From a psychological point of view, these strongly held beliefs may arise as an attempt to make sense of disconcerting and even threatening experiences or to protect them from intense emotional disturbance arising from negative evaluations of themselves and others. others.

Sometimes these ideas are interrelated with other symptoms such as auditory hallucinations.

A young man, for example, claims to hear voices telling him "they are going to kill you."

This generates perplexity and he looks for the reason ( "

Delusions that seek meaning

"One hypothesis is that when people don't understand something we try to explain it," says Cuevas.

A person who has an unusual internal experience such as hearing voices or suffering from depersonalization - feels "separated" from the mental processes or body, as if one were an external observer -

will try to make sense of it with the knowledge he has gained in their culture and life.

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"A person who suddenly hears a voice is going to be surprised, surprised and the first thing they ask is who is the emitting agent of that voice. Then they are going to turn to their cultural knowledge. Who can speak without being present? "...God, the devil, an alien. And that is something important because if they are malevolent voices, as often happens in schizophrenia, we would be facing someone who is difficult to deal with, with whom little can be done because they supposed to be powerful beings, and from there

arise beliefs of submission

('I have to do what this voice says because it threatens to harm my parents or my children') and beliefs of purpose ('why does it do this to me) and that connects with vulnerability schemes", summarizes this psychologist who has treated people with intense suffering for nearly three decades. Many of them, he assures, have a history of mistreatment and abuse. Behind the delusions there may be a past of intense pain and they express the fears and concepts that a person has. person about himself and about people: "There is a correlation between physical and psychological abuse and delusions of persecution, and sexual abuse in childhood and auditory hallucinations in adulthood".

Self-esteem in people with schizophrenia is very deteriorated and the outbreak of the disease and the limitations that it entails, deals a new blow to personal evaluation.

Symptoms are a way of expressing the pain of what cannot or cannot be verbalized.

"Delirium is information in a psychotic key",

explains this psychologist, and for this reason in therapy it is about discovering what he reveals regarding his experiences and his difficulty in relating in his daily life.

"More efficient than treating the content of the delusion is treating that damaged self-esteem because the intensity of the delusion is reduced. When a person sees that they can relate, that they are capable of working, that they can go out on the street and nothing happens to them, they acquire security and decreases the strength of the delusion. If you are in your locked room and you lack external life, it feeds back and enhances the internal life that is being a morbid and painful reality at that moment. The fundamental objective of therapy is to reduce the disturbance emotional and improve social functioning. If you have achieved that, you have achieved a lot," he says.

Silence the 'voices'

One of the most disturbing elements for a person suffering from this disease are the auditory hallucinations or 'voices' that they hear and whose content usually causes a great emotional impact on them because that whisper or that order 'sounds' very real and is usually threatening and offensive and even 'forcing' you to act in a specific and even violent way, usually towards yourself.

The frequency with which the 'voices' are heard varies depending on the patient and the patient's circumstances.

They intensify when they do not perform any activity.

Basilio proposes to distract the mind and "feed on positive experiences" to be able to choose other thoughts and not leave "expression capacity" to schizophrenia.

Therapy cannot silence them, but

it can reduce the damage they cause

.

One of the techniques to do this is

awareness

, which causes that person to gradually expose himself to that sound that torments him until it becomes something 'neutral' and he does not feel anxiety when listening to it.

In these sessions, the professionals reproduce the voice that the person hears as closely as possible, with the same phrases and intensity, as a whisper, murmur or order, as he describes it.

When the patient begins to feel anxiety, the recording is heard for a few seconds and then interrupted.

She is instructed to focus his imagination on calming scenes and performing breathing exercises.

The sequence is repeated successively.

Each session lasts between 40 and 50 minutes.

As the sessions progressed, the length of time until the tape was listened to without anguish increased progressively.

Psychotherapy is not going to "produce a definitive eradication of the symptomatology", explains Carlos Cuevas, but it is not its ultimate goal either.

It is the well-being of the person and his life, his goals, his needs and emotions.

That inner world that she also has the power to change.

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