Schizophrenia: A silent mental disorder ignored, misunderstood by society

A young woman with nervous breakdown expressions on background. [Courtesy/iStock] Schizophrenia is one of the most misunderstood mental health disorders in our communities. Often dismissed as witchcraft or demonic possession, the condition silently affects hundreds of thousands of people in Kenya. According to the World Health Organisation, schizophrenia is characterised by distortions in thinking, perception, emotions, language, sense of self, and behaviour. Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (false beliefs). The disorder can significantly impair personal, family, social, educational, and occupational functioning. Stigma, discrimination, and violations of human rights are prevalent challenges faced by individuals with schizophrenia. Lukoye Atwoli, a renowned psychiatrist, Dean of the Medical College East Africa at Aga Khan University, and Deputy Director of the Aga Khan Brain and Mind Institute, says schizophrenia is a chronic psychotic disorder characterised by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. "It is classified as a psychotic disorder because of symptoms like hallucinations and delusions," Prof Atwoli explained. Hallucinations occur when individuals perceive things that aren't present - hearing voices no one else can hear, or feeling sensations without a physical cause. Delusions, on the other hand, are deeply held false beliefs. "Someone may believe they are being monitored through a chip implanted in their brain or that people are plotting to harm them, despite clear evidence to the contrary," he noted. These symptoms deeply distort a person's understanding of reality. Some individuals experience voices providing a cruel running commentary on their actions or having entire imaginary conversations. Others might withdraw emotionally, becoming unresponsive or unable to connect socially. Schizophrenia most commonly begins during adolescence or early adulthood, typically between the ages of 15 and 25. However, there is a second peak in onset around age 40. "The illness may manifest early, but due to lack of awareness, diagnosis often comes years later," Atwoli emphasised. Globally, schizophrenia affects about one per cent of the population. Applying that estimate to Kenya's population of 58 million, approximately 580,000 Kenyans are living with schizophrenia or related psychotic disorders. Many remain undiagnosed and untreated, a situation exacerbated by stigma and misinformation. The National Institute of Mental Health says schizophrenia is among the top 15 leading causes of disability globally. Individuals with schizophrenia are more likely to die earlier than the general population, often due to preventable physical diseases. The causes of schizophrenia are multifactorial, involving a mix of genetic, biological, and environmental factors. "Genetics play a significant role. While not inherited in a straightforward manner, people with a family history of schizophrenia are at increased risk," Atwoli explains. He further adds that brain development-particularly irregularities in neural connections-can raise susceptibility, and environmental and social factors, such as high stress, poor family support, or traumatic events, can trigger or worsen symptoms. Atwoli stressed the importance of supportive environments. "They can delay the onset of symptoms, reduce severity, and significantly improve outcomes." Diagnosis of schizophrenia is based on a careful clinical assessment. Early signs include social withdrawal, a decline in academic or job performance, and unusual beliefs or behaviours. Treatment combines medication, psychotherapy, and social support. Atwoli explains, "antipsychotic medications help suppress hallucinations and delusions, and psychological interventions help patients identify delusional thoughts and distinguish them from reality," he says. He insists that family and social support systems are crucial in helping patients adhere to treatment and reintegrate into society. In severe cases where medications do not suffice, Atwoli explains that procedures like electroconvulsive therapy and other neurostimulation techniques may be used. These work by altering the brain's electrical signalling to reduce symptoms. "The brain is an electrical organ," Atwoli explained. "These therapies aim to regulate abnormal transmissions in the brain." Kenya has limited but growing resources for schizophrenia care. Mathari National Teaching and Referral Hospital, for instance, offers a wide range of treatments for mental health conditions. Public hospitals are gradually integrating mental health care, and major private institutions like Aga Khan University Hospital provide specialised services. However, Atwoli notes that access remains uneven, especially in rural areas. "There is a shortage of mental health professionals including psychiatrists, psychologists, and psychiatric social workers." Prof Atwoli acknowledged this gap but noted that the number of trained professionals is slowly increasing. "Counties that previously had no psychiatrists are now seeing some presence," he said. On cost Prof Lukoye says, schizophrenia treatment is not cheap. It involves ongoing medical care, psychotherapy, and sometimes social rehabilitation. Prof Atwoli urged a shift in the national conversation: "Instead of asking whether treatment is expensive, we should ask, who should pay?" He called for government investment in mental health, ensuring services are accessible regardless of a patient's socioeconomic status. Insurance schemes and public health funding must be strengthened to ease the financial burden on patients and families. Stigma remains a significant barrier. In many communities, unusual behavior is attributed to witchcraft or curses. Prof Atwoli insists that awareness is key. "These are real medical conditions. When someone starts behaving abnormally, the first step should be to see a mental health professional-not to rush to traditional healers." He warned against delayed treatment. "Schizophrenia is toxic to the brain. The longer someone lives with it untreated, the more irreversible the damage." For example, if a student drops out of school due to symptoms and stays untreated for years, their chances of returning and catching up academically diminish. To improve mental health outcomes, Prof Atwoli highlighted several priority areas for instance public education campaigns, to demystify schizophrenia, early detection through community awareness and screening, investment in mental health infrastructure, especially at the county level and expanding mental health workforce to underserved regions. A national mental health survey is currently being planned by a coalition including Aga Khan University, the Ministry of Health, KEMRI, and Mathari Hospital. This data-driven initiative will guide future policies and resource allocation. "People with schizophrenia are not broken or lost. With the right treatment and support, they can live full, productive lives. But we must act early, treat them with dignity, and build systems that work for everyone." Said Prof Atwoli.

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