Dear Thelma: I have schizophrenia and I fear for my future

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Those contemplating suicide can reach out to the Mental Health Psychosocial Support Service (03-2935 9935 / 014-322 3392); Talian Kasih (15999 / 019-261 5999 on WhatsApp); Jakim’s family, social and community care centre (011-1959 8214 on WhatsApp); or Befrienders Kuala Lumpur (03-7627 2929 / email / befrienders centres in malaysia).

Dear Thelma,

I'm a 26-year-old borderline depressed but high-functioning individual.

I've had three psychotic episodes. It has been one year since my last episode and yet my nightmare feels like it just happened yesterday.

Not one day goes by when I'm not reminded of what could have been if I did not have this disorder.

It's demotivating because I've worked so hard, had above average results – and I still do work hard. But now it seems my first-class honours degree, qualifications, and technical knowledge are worthless in the face of this illness and the aftermath.

All it takes is just one episode and I would lose my job and become a non-functioning individual because of how debilitating psychosis is. I hear voices, see things that are not there, and interpret every stimuli as a sign of something "greater".

Under the influence of these delusions, I have done so many things that I would never in my sane mind do. I have hurt my loved ones and even thoroughly tarnished my reputation by doing the most insane, out-of-character things at my previous workplaces.

When I was sick, nobody could tell I was until I did something ridiculous, and even then they would brush it off as me being weird.It did not matter how hard I worked or how well I performed before I got sick. I never got to explain myself to my employers and had to just up and leave because I was in no condition to speak to anyone or work at all.

I always felt like I owed everybody an explanation for my behaviour but by the time I had recovered, a month had already passed since my departure. I know I resigned from my work, but it never felt like it was voluntary. Everything just felt so out of my control. I lost my jobs twice due to this condition and I miss my old jobs.

The doctor tells me the illness is due to stress but even when I don’t feel stressed, I can still sometimes feel the onset of the psychosis. Now I have to keep reminding myself that they are not real, they are all illusions.

I feel so conflicted. I feel responsible for what I did even though I would never have done it if I were sane and I hate the "me" who was insane, the "me" who was sick. That wasn't "me". I can't reconcile all those experiences with my current self.

I am grateful my parents are loving and I can still lead a normal life relative to other victims with disorders on the schizophrenia spectrum.

I am also grateful I did not get violent when having an episode although I did have a lot of concerning and violent visions.

However, I'm so worried and scared of the future. Especially when my parents are no longer here to take care of me.

Of course, I can take care of myself when I'm not psychotic but the fear of losing touch with reality again is very real and I will have no support from anyone anymore when I grow older.

If I accidentally fall into another psychotic spiral in the future, will I end up in the mental ward, or worse, go on the streets wandering, or even worse, end up killing myself because of the voices? Just recently I saw a video on YouTube of a man suffering from a psychotic episode getting mistreated by first responders and was left alone at a gas station along the highway by the police. He ended up getting himself killed by wandering on the street with traffic.

It's not the same anymore, I don’t have the same spark and enthusiasm for life ever since my third relapse. I quickly rebounded after my first and second episodes but I feel so defeated after my third.

It doesn't feel like life gives you many chances. My first few failures have had a ripple effect on the opportunities available to me now.

I don't hear voices anymore nor do I have delusions or visions, however I do have flashbacks and these are so vivid and painful. It disturbs my everyday life, to the point where I spontaneously blurt out stuff like "It's about to rain", "Don't talk to me", just to ground myself to reality. There is no shortage of misunderstandings and weird glances I get from people when they hear me blurt out random things.

Almost everything triggers a flashback now because of the trauma – and the trauma is very real.

The future looks so bleak to me. Will I ever be able to live a normal life again? I miss the old days so much.

I want to start over somewhere new, maybe going to a new state, or even a new country.

I'm full of regrets, demotivated, tired, worried and lost in life.

Do you have any advice, Thelma?

How can I move on from all this? How can I heal?

If you have any books to recommend, I am willing to read them.


Dear Traumatised,

I’m so glad you wrote in. You shine a light on a very important topic, and that is brave and inspiring. Many people in this situation are too shy to speak up. Let’s kick off and see if we can set up a plan for steps to effective change. And maybe others will be inspired too!

First, you already know this, but for readers who are not familiar with this issue, schizophrenia disorders typically strike people in their early 20s.

This means young adults become aware of the health issue just after they have left home to go to college or for their first job.

It means a double whammy: You’re in a new environment, with people who don’t know you, and so it can be a while for the situation to become clear.

Plus, it can take a while to get proper help because most places are quite short-staffed in terms of psychiatrists, and other mental health practitioners.

So now to your experience. You had a bad time, and because of that, you describe several things happening today. You have flashbacks. You paint a picture of a doom-ridden future. You also suggest that everything you have achieved is no longer of value.

These sound like signs of post-traumatic stress, anxiety, and depression.

Please don’t worry about this! It is quite common for people who have just been diagnosed to have these reactions. After all, your life has been turned upside-down. You were terribly frightened.

So first things first: Sign up immediately with a therapist who specialises in anxiety, depression and PTSD. They will help you figure out what is going on and teach you effective tools to manage the catastrophising, the black-and-white thinking, the low mood, and the flashbacks.

In the sessions, you can unpack how this health issue has impacted on the way you feel about yourself. Or indeed, how you feel about identity in a more general philosophical manner.

Also, use the sessions to work out ways to manage common triggers so you come up with better stress responses than, "Don't talk to me."

Second, you have not hurt your loved ones or tarnished your reputation. If a person has dengue or Covid and blurts out a curse word when they are in a high fever, we assign it to the illness, not the person.

You did not choose to live with schizophrenia! So anything that happened when this hit is not on you. Please drop the guilt. It’s unwarranted.

Third, you are still feeling out of control, and you worry about your future. Let me point out the obvious: You are managing the schizophrenia with medication. This is excellent.

Your family and friends were there for you, and they will continue to be there for you. All you have to do is to be ethical about managing the health issue. That means you take your meds, consult at the proper times with your doctor, and have a safety plan in place.

The safety plan is a checklist of triggers and how to manage them, plus a list of support strategies for issues you think may come up. Generate it with your therapist and review it at least once a year.

Finally, work out a plan of where you want to be in the next 12 months. What kind of friendship circle do you have? What do you want from your relationships? Do you want to work part-time, full-time, remotely?

Examine your needs and opportunities, just for this year. This will include a conversation about what you want to share about yourself.

Look, some people will tell you that you have to share your story and educate people. I don’t agree. Sharing is draining. Also, you didn’t choose to live with this and so there is no onus on you to be responsible for the wider picture.

Share as much or as little with people as you feel is necessary or comfortable. Again, work out a sensible plan with your therapist. It may not be perfect first time, so think of it as a work in progress.

I hope this answer will help you on your way.

Know this: Your letter shows that you are brave and articulate. You’re also clever because you have a first-class honours degree. That is who you are. It doesn’t go away.

So please reach out, take these first steps and start building yourself up again so you can get the happiness you deserve. You can do this.

Know I’ll be thinking of you.

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Schizophrenia , depression , psychosis , delusions


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