islamabad - Schizophrenia is a serious mental illness. However, contrary to how this illness is portrayed in mainstream media, a person suffering from schizophrenia can lead a somewhat normal life. According to common misconceptions, schizophrenics are violent people who are hooked to alcohol, and narcotics and are known to act in a comical way. Although some schizophrenics could be behaving in a certain manner, all cannot be stereotyped as violent. In rural areas of Pakistan, people believe that this illness is a punishment from God for one’s immoral behavior. Some even believe that a schizophrenic is a person who is possessed and, therefore, subject that person to severe torture at the hands of faith healers and “pirs” (holy men). Schizophrenia is not as common as other mental illnesses but because it affects how a person feels, behaves and thinks, patients suffering from it can live disabled lives, due to lack of awareness, support, and a lack of medical facilities in developing countries. According to WHO, around 23 million people are affected by schizophrenia worldwide.

A number of factors contribute to the development of this disease, including genetics, environmental factors, brain chemistry and structure and psychosocial factors. However, the exact cause of the disease is still unknown so the treatment until now focuses on curbing the symptoms. Recently, however, researchers in Australia found that the immune system and inflammation could be linked to this illness.

Dr Osama Muslim said, “Studies have shown a greater risk of schizophrenia developing in people who frequently use cannabis, especially in their teens. The practice should be discouraged. Relatives of anyone affected are advised to keep a look out.” Patients are usually prescribed with antipsychotics, coordinated specialty care and psychosocial treatments. Due to the complexity of this illness, people tend to confuse it with multiple personality disorder or split personality, which is far from the truth. The word schizophrenia is derived from two Greek words “skhizein” i.e. split and “phren” i.e. mind, so this literal meaning tends to cause confusion, but it’s important to understand that the split in schizophrenia doesn’t refer to a split in identity but a split from reality when the patient is going through psychosis.  Therefore, one should make extra effort to understand and take care of a loved one or colleague suffering from this internal neurological chaos. There are four types of schizophrenia i.e. hebephrenic, catatonic, undifferentiated and paranoid. Paranoid schizophrenia is the most common one.

For the rehabilitation of schizophrenic patients, it is important for employers to create a safe environment at the work place, with the help of supported employment programs. Employers should avoid putting too much pressure on such employees as too much stress can trigger an attack. Due to the therapy options and treatment available to eliminate symptoms of this disease, employees suffering from this illness can be as productive as their colleagues if given the right environment. It is important for managers and supervisors to avoid using words like “insane” or “crazy” to address such employees. Having a therapist at every workplace for employees suffering from mental illness can help. In Pakistan, medical communities and policy makers tend to neglect the rights of those with mental disabilities because physical disabilities are taken more seriously. But there is a dire need for the government to create policies for the rehabilitation of such patients.

I talked to *Mashaal whose father suffers from Schizophrenia. She said, “Its not easy being on the receiving end of a schizophrenic, you need to constantly tell yourself that this is the illness talking and not the person you love. You have to find strength within yourself to be there for them despite their condition. Their condition will want you to run away as far you can and you will feel guilty for wanting to do so. The illness also affects your own well-being, and its okay to limit contact. Being a family member of a schizophrenic, you need to build a support system for yourself too, so you don’t lose your own sanity during this journey. Due to our ignorance, we’re often quick to brush off patients saying ‘ye tou pagal ho gaya hai’ but because a schizophrenic’s thoughts are their reality, telling them they’re crazy only worsens their condition. We need to show empathy towards schizophrenics.”

In rural areas, patients are often subjected to risky traditional therapies. A number of shrines in Pakistan host such patients, some of whom are left there by their families or simply kicked out of their houses for “abnormal and irrational behavior”. These patients often end up turning into drug addicts. Just like Hippocrates’s remedy for hysteria in the Age of the Pericles, female patients in rural areas of Pakistan are simply married off on the advice of quacks and faith healers instead of being taken to an actual doctor for treatment. 

A few years ago, veteran Pakistani artist Roohi Bano was diagnosed with schizophrenia, and was admitted to a rehab in Lahore. In a twist of events, she held a press conference and leveled allegations against her family for forcefully admitting her at the institution because they were trying to take over her property. This led to a debate on social media about the rights of such patients, as it is also common to forcefully admit relatives who are sometimes not even mentally ill, in mental institutions to seize their property.

In 2016, Pakistan’s apex court ruled that schizophrenia doesn’t qualify as a mental disorder under the country’s legal definition and allowed the execution of Imdad Ali, a man suffering from paranoid schizophrenia who had killed a religious scholar in 2002. The decision was severely criticized by international media and human rights organizations, under the Convention on the Rights of Persons with Disabilities, which Pakistan has ratified; the government is obligated to ensure effective access to justice for people with disabilities.

The SC had said that the plea of mental illness was discarded by subordinate courts, after which Ali’s wife challenged the SC’s order by filing review petitions. The Supreme Court stayed his execution in November 2016 and appointed a board to evaluate his mental fitness, after which the case was taken up by CJP Saqib Nisar early this year; the case is still sub-judice. The final judgment will also decide the fate of another case concerning a schizophrenic police officer Khizar Hayat, who was sentenced to death for killing a fellow police officer.The US Congress passed Rosa’s Law in October 2010, which changed references to “mental retardation” in specified Federal laws to “intellectual disability” and “mentally retarded individual” to an “individual with an intellectual disability,” it is vital for the Pakistani government, judiciary and civil society to learn from such examples and improve lives of those suffering from mental illnesses.

*The name has been changed to protect the privacy of the individual.