Schizophrenia often goes untreated in UAE because of stigma

Schizophrenia, a chronic, severe and disabling brain disorder that can cause people to hear 'voices', is going under-reported in the UAE, say doctors.

Deema Sihweil, clinical director and psychologist at Dubai’s Carbone Clinic, says cases of schizophrenia go unreported. Antonie Robertson / The National

ABU DHABI // Schizophrenia can go undiagnosed in the region because of a lack of education on mental illnesses and the stigma they carry, professionals say.

This means sufferers can miss out on treatment, without which the disorder can be debilitating.

Local professionals believe the prevalence of the severe brain disorder is about 0.7 per cent of the adult population in the UAE, in line with global statistics from the World Health Organisation (WHO).

“Incidences of schizophrenia are probably under-reported and undiagnosed in the region,” said Dr Deema Sihweil, clinical director at the Carbone Clinic in Dubai.

“Due to the lack of psychoeducation in the region, stigma and cultural and religious ideologies, psychiatric illnesses are often misunderstood and under-diagnosed and many people are probably living without treatment.”

Untreated, schizophrenia can have dire effects, Dr Sihweil said.

“Those who suffer from schizophrenia are often quite aware that something is wrong with their brains, and experience great levels of distress in knowing that they cannot control their thoughts, behaviours and emotions,” she said.

“Living with schizophrenia, especially when untreated, has often been described to me as ‘a living nightmare’ or ‘like being on drugs without ever getting back to reality’.

“It rarely is a disorder that can go untreated without profoundly affecting the lives of those afflicted.”

Symptoms of schizophrenia, which are quite distinct, most commonly appear in late adolescence and early adulthood.

Dr Sihweil has treated 10 patients with the disorder at the Dubai clinic in recent years. It is characterised by delusions, hallucinations, severe confusion as to what is real in one’s mind, disordered speech and sometimes paranoia. The disease can be widely misunderstood, she said.

“It is classified as a psychotic disorder, which is often wrongly associated with aggression and violence, making it a disease that is feared by those who do not fully understand the nature and symptoms.”

A small percentage may be violent but this is typically due to substance abuse as a form of self-medication.

“Substance abuse or dependence is the most common disease that befriends schizophrenia because people often attempt to self-medicate to numb or dampen the symptoms,” Dr Sihweil said.

Depression, anxiety, post-traumatic stress and obsessive compulsive disorder can also be part of it.

Among the patients Dr Sihweil has treated, “about half were men and most expressed having traumatic histories, substance abuse issues and family psychiatric histories”.

Dr Veena Luthra, a consultant psychiatrist at Abu Dhabi’s American Centre for Psychiatry and Neurology, agrees that the disorder is under-reported.

An Al Ain study questioning 1,394 Emiratis found a prevalence of about 0.7 per cent, Dr Luthra said.

“These numbers are likely an underestimate given the stigma related to mental illness and lack of epidemiological studies at a national level in UAE,” she said.

“It is one of the most severe mental illnesses but also the most fear-ed and misunderstood.

“Widespread cultural beliefs are that severe mental illnesses are due to demon possessions, bewitchment by evil spirits, ancestors’ spirits, or the evil eyes. Affected people or their families often seek help from religious and traditional healers rather than health facilities.”

This stigma can affect self-esteem, recovery from the illness, social relationships, treatment adherence and willingness to seek help.

As the onset of schizophrenia often coincides with adolescence, it can be mistaken as a phase, said Dr Luthra, leading to a delay in diagnosis of up to nine years.

“This leads to a missed opportunity of early treatment that has a better outcome,” she said. “I have treated some cases of young adults with their first psychotic breakdown.

“Schizophrenia can often have a profoundly negative effect on a person’s life, on their families and communities if not addressed.”

“It prevents young people from attaining their full potential. That includes work, marriage and raising a family. Individuals with schizophrenia are more likely to be unmarried, jobless, homeless or incarcerated.”