Mr. Kumar is a 40 year old man employed in an auditor’s firm . His employment comes after more than two decades of suffering from the agonies of schizophrenia, multiple admissions to treatment facilities and years of fighting the forced compliance to a medication regimen.
Kumar was born the youngest of five siblings, with three older brothers and one sister. He grew up in a joint family and had, in his words, “a very conservative upbringing” with respect to socialization, recreational activities etc. After an academically brilliant track record at school, he undertook a graduate degree course in Commerce. Simultaneously, he also started preparations for the membership examination to the Institute of Chartered Accountants of India.
In 1981 when he was 19, Kumar failed in his intermediate Chartered Accountancy examinations and was very upset about it. His family too was upset as this was his first ever failure in any examination. Gradually the family noticed that Kumar became very irritable for small reasons. He made no attempt to go out of the home and kept complaining that his failure was a plot by the Institute of Chartered Accountants. Assuming that things would normalise in time, the family remained patient. Kumar did gradually get over being upset by the failure and took up a job in an Auditor’s firm. He worked there for about two years, during which time he cleared both his intermediate and final examinations. He however, continued to harbor the thought that people at the Institute were keeping a watch on him and would not let him progress in life.
He took up employment in the Finance Department of a leading Software company where he worked for about two years. During this period, he lived away from home in another city and did not kept in regular touch with his family, who were therefore not aware of any change in his behavior. In January 1984 he landed up at home one day saying that he had resigned his job. The only explanation he gave for this was that the people at the Institute of Chartered Accountants were responsible for his resignation. He told them that he would never ever take up employment again. Unable to comprehend his behavior, his family, especially his father, repeatedly tried to reason things out with him. He was unyielding.
Gradually, over a period of two months, the family noticed that he withdrew from any conversation or socialization. He did not participate in any family activity. He lay awake at nights, poring through his texts and vigorously writing page after page. He did not let his family see what he was up to, telling them that they had to patiently wait and watch for a miracle! His family however persisted in getting to know what was happening, resulting in his increasing irritability. On one occasion, he beat up his father for “colluding with the Institute to destroy his career”. That was when, his parents decided that a psychiatric consultation was needed.
The parents took him a psychiatrist in Chennai and treatment was initiated. There was a gradual improvement in his clinical condition over a period of 3 months. He soon landed a job in a Finance company. Prior to starting on the job, he purchased a motor bike with the money he had earned in the previous concern. His family was happy with his recovery. He continued to live with his family.
After about 4 – 5 months, Kumar started missing appointments with his doctor. He would also neglect taking medication periodically. The family did not notice that he was missing his dosing schedule, since he was regular to work. A day off from work once in a while also did not rouse any suspicion. However, Kumar gradually stayed away from work more frequently. When he did not go to work for over week, his family realized that something was wrong. He refused to tell them anything about his absenteeism. Enquiries at the place of work, revealed that he had resigned and had also collected all the money that was due to him. The manager at the work place also told Kumar’s father that Kumar was noticed to be behaving abnormally for over one month before he resigned. His personal computer at work showed several documents, which were letters charging the Institute of Chartered Accountancy for “conspiring to destroy his career in auditing”. Kumar had given as reason for resignation that he firmly believed that the Finance company was involved with the Institute of Chartered Accountancy in the conspiracy.
When Kumar’s parents tried to coax him to see his psychiatrist, he refused. On repeated persuasion, he reacted violently, beat up his father and broke the television set at home. He had to be forcibly admitted to a private psychiatric hospital for treatment, where he remained for over a month. As he refused to go back home, after discharge, the family rented a small apartment for him, where he lived alone, with daily supervision from his parents, who also monitored his medication schedule. He remained thus for about 6 months. With efforts from his family and a friend, a fellow professional, he took up small accounting assignments at home. He however refused to go out to work.
There was a rather unexpected turn of events, when his mother suddenly died. One of Kumar’s siblings observed, “Kumar seems to have lost his capacity to express his emotions. He was very close to Mom, yet did not even react to her death!” During this period of family crisis, no one supervised Kumar. He continued to live in the rented apartment. He refused to take part in his mother’s death ceremonies. The family also left him alone, too busy to supervise him.
He remained apparently well for a while. One day, the apartment owner complained to his family, that he had not stepped out of the home for 3-4 days, and that the daily newspapers had not been retrieved, and that there was no response to door knocks. The family reached there and forced open the door, only to find that Kumar was sitting in his room, in a daze. The room was in a mess, with papers strewn all over, the personal computer monitor broken and several packets of partially eaten, rotting food.
Kumar was once again admitted to the psychiatric facility, where he remained for one month. As he could not go back to the rented apartment and the family was in no circumstance to take him home, he was admitted to a residential facility. He stayed there for one year. He was discharged from the facility and referred to SCARF Daycare for further management. While at the daycare, he willingly participated in many of the rehabilitation programs. Interactions with his case manager revealed his intense desire to start his own auditing firm. He lived with his father during this period.
Six months later, he reported that one of his friend’s wanted his assistance to take on an assignment at Pune. Despite his father’s hesitation, he went to Pune , where he worked for about two months. He remained well throughout this period and was also compliant to medication. He maintained contact with the case manager at SCARF.
As he had continued to be asymptomatic for about two years, the family decided to get him married. He too was willing and the marriage took place with a lot of grandeur. Soon thereafter, problems cropped up in his relationship with his wife. She charged him and his family of having cheated her, by not telling her that he was under treatment. Inadequate sexual function resulted in the marriage not being consummated. The wife walked out on him , despite counseling by his case manager. Unable to cope with this turn of events, Kumar relapsed and had to be admitted to the acute care facility once again.
He went home after discharge from the facility, to live with his father. However, he remained hostile to his father and communicated very little to his siblings. He also refused to attend SCARF. He took his medicines, with great reluctance. He remained unproductive and did not involve himself in household tasks. He did visit the OP at SCARF for periodic reviews, but was unwilling to attend the daycare.
He relapsed once again about a year later. He was aggressive once again, “because my father is continuously nagging me”. He became delusional against the parent, whom he blamed for the failure in his career, as well as his marriage. This time, however, he was admitted to SCARF’s residential care facility at Mahabalipuram. He remained admitted for a year and a half. Over a period of time, he involved himself in all the activities at the facility. Individual Counseling focused on medication compliance. The occupational therapist also focused on the possibilities of job placement. Efforts were made to contact Kumar’s friend, who was running an auditing firm, even while Kumar was in the center. Kumar’s father was given the task. The friend agreed to take him on after discharge.
During the period he was admitted, efforts were made to involve the family in the rehabilitation program. The parent and the siblings attended SCARF’s Family education Program at the headquarters. They were also counseled on managing Kumar with focus his medication, his daily activity schedule, a job search and interpersonal interactions.
There was specific focus on his unpredictable violent behaviors.. The family expressed a good deal of reluctance to take him home from the residential facility on account of this. In fact, during the early period of Family Intervention, they were quite insistent of custodial care for Kumar’s life time. During the sessions, the family was educated on how they could identify possible aggressive outbursts early and on how to deal with it.
Kumar was eventually discharged home. He started working at the firm. He visited the out-patient services periodically for reviews. The rehabilitation officer also maintained contact with him regularly. Gradually, he settled down into a routine and was also compliant with medication.
During the past five years, he has maintained well, with no relapses of his illness. Living alone with his parent, he has also taken up a lot of the domestic tasks. Even during a period of family crisis, when his father took critically ill, he was able to manage well. He relates to his siblings, comfortably. He has been able to achieve a productive status at work and even takes on assignments outside the citys