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Metamorphosis: A reason why many chronic schizophrenics get abandoned by their dear ones

Byline: James. Antony The famous novella “Metamorphosis” by Kafka has a special message for all of us.[sup][1] In that story, which was first published in1915, the central character Gregor Samsa was a traveling salesman, who toil hard to support his family, consisting of parents and a younger sister. One morning Gregor wakes up to a grim new reality; he has metamorphosed into a giant insect! From that day everything changed drastically, for that close-knit happy family. The bread-winner of the low middle-class home is no more there; but, the old parents and a naive adolescent daughter are required to look after an uncouth, ugly creature! A creature, which is unable to communicate, move around freely, or even to protect itself, from physical injuries! Yet, despite all hardships, the family made earnest efforts to cope up with their new reality. Initially, it was the sister who did the most, to take care of her metamorphosed brother. Mother supported her, while the father was just a distant onlooker. By and by, the attitude changed in everybody, and all three reached the same mindset; the “dear one” does not any more evoke any tender feelings in them. Finally, one day when the “despicable creature” dies in abject misery, the family feels a great sense of relief. No mourning for them, but together they have a lively discussion, planning for a bright future for the family! Kafka's piece is acclaimed as one of the seminal works of fiction of the 20[sup]th century.[sup][2] He wrote this after he went through a protracted illness. It has been commented that the sense of severe loneliness that Kafka felt during his illness would have made him believe that his family no more had any tender feelings for him.[sup][3] Many adaptations of this story have come up in various media, such as film, opera, and theater. In all such creative ventures, the attempt has mostly been to highlight a parallel between the pathetic predicament of the metamorphosed Gregor Samsa and that of many a modern man, who finds himself totally alienated from his own milieu. The symbol that Kafka uses here is indeed a very powerful one. A normal young man gets “metamorphosed” into an oversized worm! By this imagery, readers would be struck and quite moved by the pathetic predicament of the main character, Samsa. However, we, health professionals, can take another lesson from Kafka's story, if we look at it from a slightly different angle. As we know, when a serious illness affects a member, the family gives him tender care in the initial phase. But, we often fail to note that as it drags on and turns chronic, the positive attitude may change quietly, to one of apathy, rejection or worse! No one would ordinarily expect this change in the family: Blaming and distancing a dear one, merely because he behaves “badly” while sick! And as this kind of an attitudinal change is paradoxical, most of us are likely to miss it altogether. But in his classic style of story-telling, besides telling us about the pathetic plight of a young man, in an equally forceful manner Kafka tells us about the drastic attitudinal change that happened in his family. Here what the master story-teller has done quite beautifully is to bring out an ugly side of human nature. When an “illness” brings about significant changes in a person, as a reaction to it, the family attitude towards him also may change in a horrifying manner! A change that perhaps is as ugly and disquieting as a clumsy creature! Today, mental health professionals recognize the importance of family in shaping the course and outcome of schizophrenia. A “therapeutic alliance”[sup][4] between the treating psychiatrist and the patient's family is viewed as crucial. The manner in which too much of “expressed emotion”[sup][5],[6],[7],[8],[9] in the family would cause a high relapse rate is also recognized. …