How schizophrenia quietly enters ordinary homes

On a humid evening, a young software engineer sat in my consultation room with his parents. He had not slept properly for several nights. His eyes moved constantly — towards the door, then his phone, then the ceiling fan. “They are watching me,” he said softly. His father tried to explain. “Doctor, he has become stubborn. He was always introverted. Now he says strange things.”

The young man was frightened. He believed colleagues were planting messages for him in office emails. He thought strangers on the road recognised him. He had stopped eating food cooked at home because he feared it had been poisoned. His mother broke down.

This is often how psychosis begins, not like cinema — dramatic, chaotic and unmistakable — but as confusion inside ordinary homes. A son locks himself in a room. A daughter stops attending college. A husband becomes suspicious. A student becomes convinced that his classmates are talking about him.

Families search for explanations first: stress, laziness, heartbreak, mobile phones, substance use, bad company, black magic, arrogance. By the time they reach a psychiatrist, months, sometimes years, may have passed.

In recent months, schizophrenia briefly entered public conversation for an unexpected reason. US Health Secretary Robert F Kennedy Jr. drew attention after suggesting that a ketogenic diet could cure schizophrenia, a claim that goes far beyond current scientific evidence. Researchers are exploring whether metabolic interventions, including ketogenic diets, may eventually play a supportive role for some patients. But there is no credible evidence that diet alone cures schizophrenia. Standard treatment remains psychiatric, medical and multidisciplinary care.

The attention around those remarks reflects something larger than a disagreement about food. Schizophrenia has always attracted simple explanations and dramatic promises: stress, parenting, spirituality, personality, nutrition, willpower, one breakthrough treatment. Families facing frightening symptoms understandably want one clear answer and one clear solution. But schizophrenia rarely behaves that way.

What schizophrenia is & is not

Schizophrenia is a mental illness that affects how a person thinks, feels, behaves and experiences reality. It is not a split personality. It does not mean a person is weak, possessed, morally flawed or incapable of recovery.

In schizophrenia, the brain can begin to interpret the world differently. A person may hear voices that others cannot hear. They may hold fixed beliefs that are not grounded in reality: that they are being followed, controlled, poisoned or targeted. Their speech may become difficult to follow. Their behaviour may appear unusual or disorganised. Others withdraw. They stop studying or working. Hygiene slips.

Doctors often describe symptoms as positive and negative. These terms are misleading. Positive symptoms are not desirable symptoms. They are experiences added to ordinary mental life: hallucinations, delusions and disorganised thinking. Negative symptoms are losses: motivation, emotional expression, social interest, energy and initiative. Many people also experience difficulties with attention, planning, memory and decision-making.

Globally, schizophrenia affects a relatively small but significant proportion of people. The World Health Organisation describes it as a serious mental health condition associated with psychosis, disability and stigma, while emphasising that treatment and support allow many people to live meaningful lives.

Schizophrenia is treatable. Recovery does not always mean the complete absence of symptoms. More often, it means fewer relapses, stable relationships, meaningful work, greater independence and the return of ordinary life.

Early signs

The earliest signs are often easy to miss. A student who once performed well begins falling behind. A young professional stops returning calls. Someone warm becomes emotionally distant. Sleep changes, and suspicion creeps in. The person spends long hours alone, mutters to themselves, smiles without an obvious reason, becomes unusually preoccupied with abstract ideas, or starts saying that people are sending hidden messages. They may stop bathing, avoid eye contact and become fearful. 

In cities such as Bengaluru, these changes are often explained away. “It’s engineering pressure.” “It’s night shifts.” “It’s social media.” “It’s because she moved away from home.” Sometimes those factors matter. But when unusual beliefs, persistent fear, hearing voices or social withdrawal continue over time, families should not wait for a crisis.

Caregivers matter

The longer psychosis remains untreated, the harder it can become to return to studies, work and relationships. Early treatment reduces distress, prevents escalation and helps families understand what is happening. One challenge is that many people with schizophrenia do not realise they are unwell. This is not ordinary denial. The illness itself can affect insight. To the person, the voices are real. The fear is real. The conspiracy feels real.

Telling someone, “This is all in your head,” rarely helps. A better beginning is often: “I can see that you’re frightened. Let’s speak to someone who can help.”

Misdiagnosis and stigma

In India, schizophrenia is often misunderstood before it is recognised. Some families first visit temples, astrologers or faith healers. Others move from one physician to another seeking answers for headaches, stomach complaints or sleep problems. Young people may be labelled undisciplined, lazy or irresponsible.

Substance use complicates the picture. Cannabis and other drugs can trigger or worsen psychosis in vulnerable people. At the same time, not every person experiencing psychosis has used substances. Families sometimes hold tightly to a single explanation because it feels less frightening than a psychiatric diagnosis. But stigma remains the greatest barrier.

The word “schizophrenia” still carries consequences beyond illness. It can affect marriage prospects, employment, housing and social acceptance. Families may hide the diagnosis, delay treatment or stop medicines early because they fear being judged.

Urban India often appears modern while remaining deeply uncomfortable with severe mental illness. A young person hearing voices in a paying guest accommodation may still be called “mad” before they are helped. A family in a gated community may feel unable to explain why their son has been admitted to the hospital. The result is silence. And silence delays care.

Treatment and management

Treatment for schizophrenia usually involves more than one form of support: medication, psychological care, family education and rehabilitation. Medication is often necessary because psychosis is not simply a matter of attitude or willpower. Antipsychotic medicines can reduce hallucinations, suspiciousness, agitation and disorganised thinking. Treatment must be individualised, monitored and adjusted depending on response and side effects.

One of the most difficult moments in care comes after improvement. Many people understandably ask: If I feel better, do I still need treatment? For schizophrenia, the answer is often yes. Like diabetes, hypertension or heart disease, schizophrenia may require long-term management. Stopping medicines suddenly can increase the risk of relapse. Each relapse can interrupt education, employment, relationships and confidence.

But treatment is not only about tablets. A good care plan asks practical questions.
Is the person sleeping?
Are they eating?
Are they using cannabis or alcohol?
Can they return to college gradually?
Does work need temporary adjustments?
Is the family overwhelmed?
Would cognitive rehabilitation, counselling, occupational therapy, supported education or social skills training help?

Some people benefit from long-acting injectable medicines, especially when taking daily medication becomes difficult. Others may need hospital admission during severe episodes — particularly when there is refusal of food, severe self-neglect, suicidal thoughts, extreme agitation or safety concerns. Recovery, though, is rarely linear. There may be good months and difficult months. Progress should not be measured only by whether symptoms disappear. Sleeping through the night again, bathing regularly, taking short walks, returning to studying, and working part-time these can all be meaningful markers of recovery. 

There has also been a shift in how schizophrenia is understood. Researchers increasingly describe it as a condition involving brain function, cognition, perception and neurodevelopment, while recognising that psychological and social experiences influence both illness and recovery. Treatment today extends beyond symptom control. Antipsychotic medicines remain the foundation of care, but newer approaches increasingly include cognitive remediation and more personalised approaches that look at functioning and quality of life, not just symptom reduction.

Family support

In India, families often become the mental health system. They bring the person to the hospital, pay for treatment, supervise medicines and manage crises. In the process, they absorb all the fear, uncertainty and exhaustion. Which is way familes and caregivers need support. 

Spouses struggle with trust, responsibility and intimacy. Some families become overprotective, while others become critical or withdrawn. The most effective response, however, is calm, informed and consistent care. 

A more humane way forward

Schizophrenia tests not only the person living with it but also the humanity of the society around them. Do we see the individual behind the symptoms? Do we offer treatment before a crisis? Do we protect dignity? Do we leave space for work, relationships, recovery and ordinary life?

Schools and colleges must recognise early warning signs. Workplaces should make graded returns possible. Families should be able to seek help without shame. Media must stop using “schizophrenic” as shorthand for confusion, contradiction or danger. Most of all, we need to replace fear with understanding.

I still remember the young man in my consultation room. His recovery did not happen in one day. There were medicines, family meetings, and periods of intense doubt. But two weeks later, he was sleeping again, and six weeks later, he had returned to part-time work. Life was not perfect, but it became possible again. 

How to offer support

* Do not argue endlessly about delusions.
* Do not mock voices.
* Do not threaten hospital admission as punishment.
* Do not stop treatment because someone says medicines are habit-forming.
* Do not talk about the person as though they are absent from the room.
* Try to listen for the emotion beneath the symptom.
* A person saying, “People are following me,” may be expressing fear.
* Someone refusing food may be terrified, not difficult.
* Someone sitting silently may be overwhelmed, not lazy.
* Learn to recognise signs of relapse.
* A written crisis plan helps.
* Keep the treating doctor’s contact details, emergency numbers, current medicines, previous prescriptions and warning signs in one place.

If in doubt, seek help

* Tele-MANAS: Call 14416 or 1-800-891-4416 for free and confidential mental health support in India.
* Nimhans offers psychiatry and community mental health services, including multidisciplinary care.
* Schizophrenia Awareness Association: Provides awareness and support initiatives for people living with schizophrenia and caregivers.

The author is a senior consultant psychiatrist at Manas Institute of Mental Health, Hubballi.