By Abigail George

Whilst not as common as other mental illnesses, schizophrenia does affect an estimated 24 million people around the world. Unfortunately there is a lack of prevalence data in South Africa, but a study from 2006 estimated that 1% of South Africans were living with schizophrenia at the time. People with Schizophrenia represent a vulnerable population often neglected. Poor socioeconomic status, lack of insight, stigma, and other extrinsic barriers to care significantly impact the quality of life and life spans. People diagnosed with schizophrenia usually experience a combination of symptoms: positive (hallucinations, delusions, racing thoughts), negative (apathy, lack of emotion, poor or non-existent social functioning), and cognitive (disorganized thoughts, difficulty concentrating and/or following instructions). The cultural context of schizophrenia is this. Western societies tend to view schizophrenia symptoms as a medical issue, while Eastern societies treat it as a spiritual or supernatural phenomenon. The challenges of working with mental disorders in South Africa are the following.

The major challenges identified include: the lack of officially endorsed mental health policy; the continued low priority of mental health; limited intersectoral policy integration; stigma and discrimination. Since schizophrenia is a disease of the mind, the cultural context it occurs in can have a serious impact on how it manifests. Cultures in which the family is more important will have delusions centred around their family, cultures in which religion is important often have religious delusions. As many as one in six South Africans suffer from anxiety, depression or substance-use problems (and this does not include more serious conditions such as bipolar disorder or schizophrenia), according to statistics released by the South African Depression and Anxiety Group (SADAG).

Differences in income among groups of people are related to many harmful health effects. Countries that have a large gap between rich populations and poor populations might have a higher risk of schizophrenia cases. Income inequalities poorly affect social cohesion. Schizophrenic patients have problems with their interaction with other people and their integration in society. These problems seem to be due to specific impairments in social processing rather than consequences of general cognitive alterations. In a 2017 literature review of forty studies from eight countries, Chidarikire et al. concluded that people living with schizophrenia in SA were mainly treated by faith, traditional healers and modern psychiatry, if treated at all. Risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone and amisulpride are effective in first-episode psychosis patients. For multi-episode patients, consider risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone and amisulpride. Haloperidol and chlorpromazine may be considered as alternatives to FGAs.

Schizophrenia causes psychosis and is associated with considerable disability and may affect all areas of life including personal, family, social, educational, and occupational functioning. Stigma, discrimination, and violation of human rights of people with schizophrenia are common. The results of our study revealed that the three most frequently encountered barriers to accessing mental health services in Africa are: a preference for traditional/alternative and complementary treatments (33.33%), followed by stigma (25%), and a lack of knowledge/unfamiliarity with the mental health condition (25%). Four barriers relate to accessibility: lack of transport, lack of information, stigmatization, and traditional cultural beliefs of the community. Two barriers relate to acceptability: lack of cross-cultural understanding among staff and traditional cultural beliefs of staff. In South Africa, in addition to a lack of resources, there is a stigma attached to mental illness. People living with mental illnesses are perceived as crazy, under a spiritual curse, weak, or simply misunderstood.

Numerous studies over decades have shown that Black Americans are diagnosed at higher rates of schizophrenia than White Americans. Schizophrenia, one of the most misunderstood mental disorders in human society, is often confused with other conditions or is written off with degrading myths. How people with schizophrenia view the world? Their reality is not your reality.

People with schizophrenia perceive the hallucination as very real and can describe it as running commentary or criticizing remarks. These false beliefs may include fears that others are “out to get them” or that the TV or radio is broadcasting special messages just for them. Cultural differences may influence the course and outcome of illness for people with schizophrenia. These may be the result of differences in understanding of mental illness, and different attitudes and treatment approaches towards these disorders.

The place where a person lives and grows up may increase the likelihood of schizophrenia. People living in urban areas are more vulnerable. Childhood trauma, such as abuse, unstable home life, living in poverty, or exposure to racism, can increase the risk. Schizophrenia usually involves delusions (false beliefs), hallucinations (seeing or hearing things that don’t exist), unusual physical behaviour, and disorganized thinking and speech. It is common for people with schizophrenia to have paranoid thoughts or hear voices.

Social engagement that is important for health and well-being can be difficult for people with schizophrenia. Past research indicates that despite expressing interest in social interactions, people with schizophrenia report spending less time with others and feeling lonely.

The most common psychosocial disability faced by these patients was disability in social functioning (93.75%), followed by occupational problems (63.46%), poor personal health maintenance (48.08%), educational problems (21.15%) and divorce or other family problems (13.9%) while only 1.92% had no psychosocial impact.

It is well-established that poor social functioning in schizophrenia is caused, in large part, by behavioural deficits in social cognition – a suite of abilities, including emotion recognition, self-regulation, and theory of mind (ToM) (i.e. understanding the mental states of others).


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