Trigger warning: This article mentions schizophrenia, suicidal ideation, and other mental health conditions.
First of two parts
In April 2026, the Supreme Court (SC) acquitted a mother diagnosed with schizophrenia of parricide in connection with the death of her five-year-old daughter, recognizing that her mental condition had affected her ability to understand the wrongfulness of her actions at the time of the incident.
In a decision penned by Associate Justice Samuel H. Gaerlan, the SC Third Division overturned the mother’s parricide conviction after finding that she was legally insane due to schizophrenia.
Under Philippine law, legal insanity may exempt a person from criminal liability when a mental disorder prevents them from fully understanding the nature or wrongfulness of their actions.
The case stemmed from an incident in which the mother jumped off a bridge into a river with her young daughter. A man aboard a styrofoam boat was able to rescue the mother, but the child could not be located. The girl’s body was recovered from the river the following day.
The mother later said she was not in her right state of mind when the incident happened. She recalled walking with her daughter but could not remember what happened afterward, saying she only regained awareness while she was already floating in the water.
During the proceedings, a licensed physician from the National Center for Mental Health (NCMH) testified that the mother was suffering from psychosis classified as schizophrenia.
But what exactly is schizophrenia, what are its symptoms, and when should a person seek professional help?
‘A long-standing mental health disorder’
According to Dr. Constantine L. Yu Chua, a psychiatrist from Makati Medical Center, schizophrenia is a “long-standing mental disorder where a person loses touch with reality and has a breakdown in logical thinking.”
“Someone with this condition may experience hallucinations, such as hearing or seeing things that are not there, or delusions, which are fixed false beliefs—for example, believing that other people are out to harm them,” Yu Chua told GMA News Online in an interview.
“They may also experience disorganized speech or behavior, such as saying things that are difficult to understand or behaving in ways that may seem illogical. Some, but not all, may also become withdrawn, passive, quiet, or emotionally less expressive over time,” he added.
According to registered psychologist and psychometrician Anne Gladwyne Vanguardia-Batanes of the Los Baños Doctors Hospital and Medical Center (LBDHMC) delusions refer to beliefs that are not consistent with reality, while hallucinations can involve hearing voices that other people do not hear.
“These are beliefs that are not consistent with reality,” she said in a mix of Filipino and English.
Experiencing hallucinations or delusions, however, does not automatically mean that a person has schizophrenia.
Clinical psychologist Juan Rafael Opisima noted that psychosis, which involve hallucinations and delusions, can also occur in conditions such as bipolar disorder and major depressive disorder.
“There’s no one single reason why a mental health disorder develops,” Opisima said in a mix of Filipino and English, explaining that diagnosis considers multiple factors, including genetics, prolonged or extreme stress, environmental influences, and biological or brain-related factors.
Why the numbers may be unclear
The Global Burden of Disease Study 2023 (GBD 2023) estimated that schizophrenia accounted for 226,292 cases of death or injury in the Philippines in 2023.
Meanwhile, citing the World Health Organization (WHO) and the Department of Health (DOH), a 2021 study published in Frontiers in Psychology said that an estimated 1 million Filipinos suffered from schizophrenia in 2018.
Obtaining official consolidated data on Filipinos with schizophrenia may be challenging due to several factors, including underdiagnosis, stigma, limited access to mental health professionals, the uneven distribution of medical specialists, and the absence of a unified system for recording and tracking cases.
Vanguardia-Batanes said that many psychologists and psychiatrists are concentrated in urban areas, leaving people in remote communities with fewer options for professional care.
Atom Araullo’s cover story, “The House Between the Trees,” for example, followed the case of two brothers with schizophrenia in Negros Oriental, and illustrated these challenges. On the one hand, it showed that medical treatment, even in its delayed arrival, made a significant improvement in the patients’ conditions; on the other, mental health professionals and support can indeed be difficult to access in the province, and that stigma persists even within the very health institutions meant to serve patients.
Yu Chua also noted that stigma and the lack of a unified reporting system could result in undiagnosed or “hidden” cases of schizophrenia.
“It may be underrepresented in the statistics,” he said.
Meanwhile, Opisima echoed that stigma surrounding schizophrenia contributes to the lack of reliable data.
Some families may be hesitant to disclose that a relative has the condition out of fear of being discriminated against by their community and thus choose to keep the condition private.
“When we talk about stigma, it can feel like a death sentence. Many families are ashamed to have a family member with schizophrenia,” Opisima said. “At the end of the day, they would like to protect the integrity of their family.”
For families dealing with schizophrenia, however, the condition itself is just one part of the challenge.
It is not unheard of for some people with schizophrenia to be subjected to derogatory labels, such as “crazy (baliw, siraulo, may saltik)” or “addict,” or to be viewed as “defective” or “dangerous.”
Per Vanguardia-Batanes, stigma in mental illness may cause people to hide their symptoms, delay seeking professional help, and even avoid treatment altogether. Stigma can also affect opportunities after recovery, including employment and social relationships.
Yu Chua shared that some patients seek professional help only months or even years later out of shame, or lack of knowledge that schizophrenia is actually a treatable medical condition.
By then, he said, their condition may have deteriorated further and become more difficult to treat.
Meanwhile, Opisima said that some people, particularly in far-flung areas, may not recognize schizophrenia as a mental health condition.
He noted that more familiar terms such as “depression,” “anxiety,” or even “crazy (baliw)” may be more commonly used.
To help in the proper data collection of schizophrenia cases, Opisima suggested strengthening mental health education at the barangay level, including training local officials to recognize mental health conditions, respond appropriately to those suffering from the condition, and refer patients to doctors, hospitals, or mental health centers.
Recognizing early symptoms of schizophrenia
Schizophrenia does not necessarily suddenly appear in its full form.
According to Opisima, early symptoms in a person with schizophrenia may include social withdrawal, increasing isolation, developing a world centered around one’s own perceptions, hearing voices, or developing beliefs that appear disconnected from reality.
Such changes may signal the need for a professional medical assessment.
“Usually, it develops gradually. It doesn’t immediately become full-blown,” he said.
Vanguardia-Batanes underscored that families should consider seeking professional help once symptoms begin affecting a person’s daily functioning, including their ability to socialize, work, study, eat, or care for themselves.
The presence of suicidal thoughts or a risk of harming oneself or others also requires immediate medical attention.
Yu Chua similarly advised families to promptly consult a mental health professional when psychotic symptoms appear in their loved one.
“If any of these are present, the person should promptly consult since these are not normal experiences,” he said.
When ‘kulam’ and possession enter the conversation
In the Philippines, experiences associated with schizophrenia and other mental health conditions may sometimes be understood through cultural or spiritual beliefs.
For some communities, unusual behavior or experiences may be attributed to being cursed (kulam), possessed (sanib), or even encounters with supernatural entities such as duwende and nuno.
But mental health professionals say these beliefs should be understood within the context of a person’s culture and background, and not simply mocked, dismissed, or immediately pathologized as symptoms of a disorder.
Vanguardia-Batanes emphasized that culture plays an important role in how people make sense of what they are experiencing.
“I wouldn’t dismiss this idea because it is part of culture, our beliefs,” she said.
She explained that the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, recognizes the concept of “cultural concepts of distress,” which acknowledge that a person’s cultural background can influence how they understand, describe, and experience distress.
“This means that a person’s culture can influence how they understand and describe their experiences and how they live,” Vanguardia-Batanes said.
“That’s the importance of recognizing a person’s culture. Before we diagnose someone, we first need to understand their background and upbringing. They may come from a specific culture that is different from ours or from the environment we are familiar with. This also includes their religious beliefs.”
Mental health professionals, thus, need to consider a person’s cultural and religious background when assessing their experiences. This helps them distinguish between beliefs that are accepted within a particular culture and experiences that may be signs of a mental health condition.
For some families, seeking help from a faith healer (albularyo) or religious leader may also be part of that sociocultural practice.
Vanguardia-Batanes cited a 1995 study published in the International Journal of Social Psychiatry involving six Asian countries, including the Philippines. It found that some families may turn to traditional or religious sources of help, such as faith healers and religious leaders, before consulting psychiatrists or psychologists.
“This is why it is very important for us, as mental health professionals, to understand a person’s beliefs. We cannot tell them that what they did was wrong or that they should not have gone to an albularyo. No, we don’t say that,” she explained.
Meanwhile, Yu Chua said spiritual practices and professional mental health care can coexist as part of a person’s overall well-being.
“Psychiatry and spirituality are not two opposite things but are unified concepts that lead to the holistic well-being of a person,” he said.
For example, prayers and other spiritual practices, which are sources of comfort for some people, can continue alongside appropriate medical and psychological care.
“If a person finds it meaningful or comforting to pray to God, psychiatrists encourage that. Professionals will try their best to meet a patient in the context of their culture,” he added. “It is just important to approach the condition from a biological, psychosocial, and spiritual perspective and not solely fixate on one dimension.”
The Philippines has several mental health hotlines and services.
DOH-NCMH Hotline: 0917-899-8727 and 02-7989-8727 Natasha Goulbourn Foundation Hopeline: 0917-558-4673, 0918-873-4673, and 02-8804-4673 In Touch Crisis Line: 0917-800-1123, 0922-893-8944, and 02-8893-7603.
—CDC, GMA News