Schizophrenia: Seeking help and seeing beyond the diagnosis

Trigger warning: This article mentions schizophrenia, suicidal ideation, and other mental health conditions.

Second of two parts

Schizophrenia is a "long-standing medical condition" that affects a person's sense of reality and logical thinking, according to Makati Medical Center psychiatrist Dr. Constantine L. Yu Chua.

In Part 1, Yu Chua, alongside psychologist and psychometrician Anne Gladwyne Vanguardia-Batanes (Los Baños Doctors Hospital and Medical Center) and clinical psychologist Juan Rafael Opisima, highlighted how stigma, limited access to mental health professionals, underdiagnosis, and cultural beliefs such as "kulam "and possession can affect how schizophrenia is recognized and treated.

READ PART 1: Understanding Schizophrenia, from symptoms to stigma

Beyond these barriers, however, are persistent misconceptions about schizophrenia. The three medical experts stressed that the condition is treatable and does not define a person living with it. Moreover, its diagnosis does not automatically make a person violent, dangerous, or incapable of living a meaningful, fulfilling life.

Just as importantly, families play an important role for those living with schizophrenia, from recognizing when to seek urgent medical help to supporting their loved one on the path of treatment and recovery.

Not ‘split personality,’ not automatically dangerous

One of the most persistent misconceptions about schizophrenia is having multiple personalities. Another misconception is that people with schizophrenia are inherently aggressive or dangerous.

According to Opisima, however, most people with schizophrenia are not aggressive and may instead become withdrawn.

Yu Chua likewise belied the notion that people with schizophrenia are dangerous.

“This is rarely the case. More often than not, they are experiencing suffering because of their symptoms and are prone to being victimized,” he explained.

The medical experts emphasized that while untreated or poorly managed symptoms can increase risks, including self-harm or harm to others, this does not mean that violence is an inherent characteristic of schizophrenia.

What families should and should not do

When a person with schizophrenia is experiencing hallucinations or delusions, family members may instinctively argue with them or try to convince them that what they are experiencing is not real.

The medical experts advised against this.

“Number one is do not judge them,” Vanguardia-Batanes reminded.

Families should avoid isolating, imprisoning, chaining, shouting at, or physically harming a person experiencing psychosis.

At the same time, relatives should not reinforce or validate beliefs that are not based in reality.

“We should never reinforce these beliefs,” Opisima said. “Rather than [validate], you just listen.”

This includes listening to how the person feels and acknowledging their distress without necessarily agreeing with what they see or hear.

“Focus on their emotions. That’s what you should acknowledge. Don’t focus on what they see. Acknowledge the emotions they are experiencing,” Vanguardia-Batanes added.

Simply dismissing the person by saying “That’s not true” may also make them feel misunderstood.

The goal is to listen, keep the environment safe, and seek professional intervention. Just as importantly, potentially dangerous objects, such as sharp items, must be secured when necessary.

Meanwhile, Yu Chua noted that families with a loved one suffering from schizophrenia have to contend with the challenge of being a caregiver, which can be heavy to bear.

Caregivers may experience emotional distress, burnout, financial difficulties, and the pressure of monitoring medication, establishing routines, and helping their loved one maintain personal care.

Aside from caregiver burnout, he added that families may also face stigma, lack of resources, limited opportunities, and out-of-pocket expenses in caring for their loved one with schizophrenia.

Treatment is crucial

Schizophrenia is a long-term condition, but experts stressed that it can be treated and managed with proper care.

“It is treatable. But there's no complete cure,” Vanguardia-Batanes said.

Treatment may include antipsychotic medication, psychiatric consultations, psychotherapy, and family support.

Yu Chua said maintenance medication can help control symptoms such as hallucinations and delusions, while psychotherapy can help patients understand their experiences, build self-esteem, and develop healthy coping strategies.

Meanwhile, Opisima said patients can seek help from facilities such as the National Center for Mental Health (NCMH) and mental health units in some regional and provincial hospitals, which offer low-cost services.

Vanguardia-Batanes also noted that mental health services may be covered through PhilHealth’s YAKAP program, provided the psychologist or psychiatrist is accredited.

“Through YAKAP, ordinary citizens can now access mental health services without breaking the bank,” she said.

Lola Alynn, who was featured on "I-Witness" in 2019, has been suffering from schizophrenia since the 1960s. She was chained up by her family when she was 18 years old, as they did not know how to deal with her psychosis.

After finally receiving medical and psychiatric help, Lola Alynn showed signs of recovery in just two years: She was no longer chained up, she could converse with the people around her, and take walks in the field.

Both Vanguardia-Batanes and Yu Chua underscored that recovery is not simply about reducing symptoms.

“The goal here, recovery is not only about reducing the symptoms, but also helping the person to function, maintain relationships, and have a meaningful life,” Vanguardia-Batanes said.

“Recovery means getting back to a productive, connected life and not just the absence of symptoms,” Yu Chua added.

Early intervention is also crucial. The longer psychosis remains untreated, the more difficult the situation may become.

Delayed treatment can contribute to worsening symptoms, deterioration in daily functioning, and greater emotional and financial burdens for families.

“The sooner we help, the sooner we treat, the better they will cope,” Opisima said.

Early intervention can improve the chances of stabilizing symptoms, maintaining daily activities, and supporting social and occupational functioning.

While not every episode of unusual behavior requires an emergency response, it is important to know that certain situations demand urgent medical attention.

According to Yu Chua, it is advised to seek urgent psychiatric care when a person experiencing psychosis is at immediate risk of harming or being a danger to themselves or others; has suicidal thoughts or a plan; is severely agitated or aggressive; has difficulty sleeping or eating; and is unable to care for themselves normally.

People with schizophrenia can work and study

A diagnosis does not automatically mean the end of a person's education, career, relationship, or independence.

Per Yu Chua, many people with schizophrenia can live independently, work, study, and maintain relationships.

“There are many factors that influence outcomes of schizophrenia, such as how aggressive the condition is, how early treatment was initiated and the person’s response to it, or the presence or absence of aggravating factors such as stress, health problems, drug use any many more,” the psychiatrist explained.

Supportive families, workplaces, schools, and communities can make a difference. Possible accommodations may include flexible working hours, reduced workloads, hybrid arrangements, or other measures suited to the person's needs.

For students, continued treatment and appropriate support can also help them pursue their education.

“Many are able to live productive lives through good medication adherence and presence of a supportive, nurturing environment,” he said.

Beyond diagnosis

Perhaps the most important message from the medical experts is this: schizophrenia should not and does not define the person living with it. With the proper treatment and care, people with schizophrenia can recover, work, study, maintain relationships, participate in their communities, and live productive, fulfilling lives.

For families, the first step can begin with replacing fear with understanding and stigma with support.

“Let’s not allow stigma or fear of the diagnosis to become a barrier,” Vanguardia-Batanes advised.

A diagnosis, she explained, is a tool that helps medical professionals understand what a person is experiencing and determine the appropriate treatment.

“The diagnosis does not define who you are as a person,” she added.

Opisima also said there is no reason to treat a diagnosis as the end of a person's future, emphasizing, “This is not the end of everything for them and for their families.”

As for Yu Chua, seeking help, however difficult, is ultimately the "responsible" thing to do.

“Do not be so afraid of stigma because many people are becoming open-minded about mental health at this day and age,” he encouraged. “[Seeking] consultation is a responsible, admirable thing to do. Mental health consultations are confidential.”

The Philippines has several mental health hotlines and services.

• DOH-NCMH Hotline: 0917-899-8727 and 02-7989-8727
• Natasha Goulbourn Foundation Hopeline: 0917-558-4673, 0918-873-4673, and 02-8804-4673
• In Touch Crisis Line: 0917-800-1123, 0922-893-8944, and 02-8893-7603.

—CDC, GMA News