Growing up, my family moved a lot. By age 18, I had lived in all of Rwanda’s five provinces. While each place was unique with its own way of life, one thing remained remarkably consistent. There was always someone known as the “madman” of the neighbourhood. Typically homeless, such an individual often roamed the streets scantily dressed and would always talk to themself. They would collect random objects and sometimes, when provoked, throw stones. The whole community avoided them. Still, they were arguably among the most recognisable people in town, even though we knew very little about their identities. What was their name? How was their life like before? Were the stories about them being poisoned, cursed or bewitched even true? Later, when I learnt about mental health disorders, I was struck by how their behaviours closely matched the symptoms of schizophrenia. However, contrary to the widespread belief that those afflicted were condemned to irredeemable madness, I discovered that schizophrenia can be treated. But demystifying the condition, requires us to identify what is schizophrenia, its risk factors, and what can be done to help people living with the condition. What is schizophrenia? Schizophrenia is a mental health disorder that affects the way a person thinks, perceives and experiences the world. It is characterised by psychosis which includes delusions, disorganised thinking and speech as well as hearing or seeing things that others do not. There is no single known cause of schizophrenia. It is thought to arise from a complex interaction between genetic and environmental factors. Researchers from the Prince of Wales Clinical School in Australia found that individuals with a first-degree relative with schizophrenia were nearly eight times more likely to develop the condition than those without such a family history. However, genetics is only a part of the story; life experiences also play a role. For example, a 2019 multicentre study across Europe and Brazil revealed that daily users of cannabis were five times more likely to develop a psychotic disorder than never-users. Additionally, a 2021 study in Ethiopia found that roughly four in ten patients with schizophrenia struggled with alcohol use disorder. This suggests that some life choices can increase one’s vulnerability to the condition. What can we do to help? Thankfully, schizophrenia is treatable. Antipsychotic medications can reduce hallucinations and delusions. Meanwhile, psychological interventions such as cognitive behavioural therapy can help people make sense of their symptoms, recognise patterns and triggers, and develop healthy coping strategies. Although, the longer schizophrenia goes untreated, the poorer the outcomes. Thus, recognising the symptoms from early is crucial. If a loved one begins seeing things, hearing voices, or develop unusual beliefs that seem detached from reality, encourage them to seek medical care. Taking protective steps is equally important. People with a family history of schizophrenia are particularly vulnerable to environmental risk factors. They should therefore be cautious about alcohol and substance use. Also, seeking mental health support is essential to protect their wellbeing in the case of a traumatic event or during periods of severe stress. Why should we care? My experience growing up is not unique. Globally, over 23 million people live with schizophrenia and in Rwanda, it is among the most common psychiatric conditions. In 2024, 60% of all psychiatric hospitalisations in the Ndera Neuropsychiatric Hospital were attributed to psychotic disorders like schizophrenia. While more than 23,500 cases were recorded in outpatient care. Given these findings, seeking early treatment and taking proactive steps to reduce the risk of schizophrenia could emancipate thousands from its burden and ultimately enable those impacted to lead fulfilling lives. The writer is a Rhodes Scholar and a PhD student in Clinical Neurosciences at the University of Oxford’s Centre for Global Epilepsy.
