Every 24 May is observed as World Schizophrenia Day. This commemoration encourages society to:

• increase understanding about schizophrenia,

• reduce stigma,

• and support the recovery process of people living with mental illness.

Because one of the greatest wounds in schizophrenia is not only the severe and debilitating symptoms, but also the stigma and social rejection experienced by those who live with it. Sometimes, these can be even harder to endure.

What Is Schizophrenia?

Schizophrenia is a serious, severe, and chronic mental disorder that affects:

• thinking,

• perception of reality,

• emotions,

• behavior,

• and the ability to function in daily life.

Schizophrenia is not “multiple personality disorder,” nor is it caused by lack of faith, lack of gratitude, or weak character. Schizophrenia is a complex psychiatric medical condition involving changes in brain function as well as biological, psychological, and social factors.

Prevalence

According to the World Health Organization:

around 24 million people worldwide live with schizophrenia, or approximately 1 in 300 people.

In Indonesia, data from the Ministry of Health of the Republic of Indonesia shows that psychotic disorders are among the severe mental health conditions requiring serious attention.

Schizophrenia often appears during:

• late adolescence,

• young adulthood,

• and the most productive years of life.

Therefore, its impact can affect education, employment, relationships, and long-term quality of life.

Schizophrenia Can Cause Disability

Schizophrenia is one of the leading causes of significant mental disability worldwide.

Not only because of hallucinations or delusions, but because the disorder can impair:

• the ability to work,

• social interaction,

• self-care,

• education,

• and independence.

Some patients experience:

• dropping out of school,

• job loss,

• social isolation,

• even physical restraint due to stigma and lack of access to care.

The fact is: many schizophrenia survivors actually have great potential when they receive timely and appropriate treatment and support.

Causes of Schizophrenia

Schizophrenia is not caused by a single factor. It develops through a combination of factors:

1. Genetic Factors

The risk increases when there is a family history of similar disorders.

2. Neurobiological Factors

There are disturbances in the brain’s neurotransmitter systems, especially involving dopamine, glutamate, and serotonin.

3. Psychological Factors

Childhood trauma, severe stress, bullying, or emotional pressure may trigger the disorder in vulnerable individuals.

4. Environmental Factors

For example:

psychoactive substance use, social isolation, family conflict, urban stress, and lack of social support.

What Happens in the Brain?

In schizophrenia, there is a disruption in how the brain processes information. Some studies show:

• excessive dopamine activity in certain pathways,

• impaired connectivity between brain regions,

• structural changes in certain areas of the brain,

• dysfunction in the prefrontal cortex, which plays a role in logical thinking, decision-making, and emotional regulation.

As a result, thoughts, perceptions, emotions, and interpretations of reality become disturbed.

Simply put:
“The brain struggles to distinguish what is real from what is not.”

Symptoms of Schizophrenia According to DSM-5

According to DSM-5, at least two main symptoms must be present, and one of them must be:

• delusions,

• hallucinations,

• or disorganized speech.

1. Delusions

Strongly held beliefs that are not based in reality.

Examples:

feeling watched,
believing someone wants to harm them,
believing they possess special powers.

2. Hallucinations

Perceptions without real external stimuli.

Most commonly:

hearing voices speaking or giving commands.

3. Disorganized Speech

Speech patterns that are difficult to understand:

jumping between topics,
irrelevant answers,
disorganized sentence structure.

4. Disorganized or Catatonic Behavior

Examples include:

aimless agitation,
remaining motionless,
strange behavior,
difficulty managing daily activities.

5. Negative Symptoms

These involve a reduction in normal functioning:

flat emotional expression,
social withdrawal,
loss of motivation,
reduced speech,
difficulty enjoying activities.

These symptoms cause significant impairment in social and occupational functioning.

Schizophrenia Management

1. Healthy Lifestyle

Helps maintain mental stability:

• adequate sleep,

• regular exercise,

• nutritious diet,

• avoiding alcohol and drugs,

• stress management,

• structured daily activities.

2. Psychopharmacology

Antipsychotic medications help reduce:

hallucinations, delusions, agitation, and other psychotic symptoms.

Medication adherence is very important to prevent relapse.

3. Psychotherapy

Helpful approaches include:

• CBT for psychosis,

• supportive psychotherapy,

• family therapy,

• psychoeducation.

4. Psychosocial Rehabilitation

Focuses on helping patients regain:

social functioning, work ability, learning capacity, and independence.

This includes:

life skills training, cognitive remediation, social skills training, occupational and vocational training.

5. Neurostimulation

Modern approaches that may be considered in certain conditions:

• Transcranial Magnetic Stimulation (TMS)
  Uses magnetic stimulation on specific areas of the brain.

• Neurofeedback
  Trains brain activity regulation using EEG feedback.

• Electroconvulsive Therapy (ECT)
  Used in severe conditions such as catatonia, severe agitation, psychotic depression, or cases resistant to other treatments.

The Role of Family and Society

Families are not the cause of schizophrenia. However, families can become an essential part of the recovery process. Patients need to be:

• listened to,

• understood,

• accompanied,

• not judged.

Important things families can do:

• support medication adherence,

• recognize signs of relapse,

• maintain calm communication,

• avoid stigma and violence,

• encourage positive activities.

Society also plays an important role by:

• stopping stigma,

• opening employment opportunities,

• building supportive environments,

• improving mental health literacy.

Recovery Is Possible

Many people think schizophrenia means life is over. In reality:

Many schizophrenia survivors are able to recover, work, study, build relationships, marry, raise families, and contribute meaningfully to society.

Recovery does not always mean “all symptoms disappear completely.” Recovery means:

• living a more meaningful life,

• becoming more independent,

• having hope,

• and being able to live with a better quality of life.

“What people living with schizophrenia need most is not only medication, but also hope, support, and other human beings willing to understand them.”