Country: Malta – Publication: It-Torca – ID: 499_JA_MT

Type Award: General Award

Discrimination at the work place and in everyday life for persons

suffering from schizophrenia

“I used to think that the Communists were looking for me and wanted to capture me. When I was
walking and I used to see people walking behind me, I used to run aimlessly. At work I sometimes
used to hide from them because I feared being captured.”
“Once, at night, a light streamed through the window and I was convinced that it was the Lord’s light
telling me that the stormy weather outside was a nuclear war.”

“...he was a quiet boy and very prudent, … he was different from other young lads, he was more
spiritual and was not interested in mundane or common things … he ended up working as a cleaner
in a factory – an environment which did not suit him at all. Since he was not at ease there, he ended
up bullied, harassed and ridiculed continuously – because he was not the same as his colleagues.
These were 2 horrible years …he too was affected by the disease of schizophrenia.”
“We used to suffer sadness, lack of hope, abandonment and also the contempt of society. We were
emarginated....”

“What hurts me a lot is that a person who is mentally ill suffers twice as much. Besides suffering the
pain and destruction of the disease, he suffers at the hands of society too. Society emarginates him
and even ridicules him.”

These are experiences of persons suffering from schizophrenia. The stigma on these people which
still exists in our country is creating more suffering and discrimination on these persons in society and
at the work place.

Problems at the work place

Those suffering from schizophrenia or who used to suffer from this disease before receiving treatment
complain of big problems to retain their job. Their lack of communication together with the symptoms
of this disease – hearing voices or imagining things that are not real, leads their colleagues and
bosses to think that they are not fit for work, since they would be creating extra anxiety for their
colleagues, it would be difficult for them to follow orders, sometimes they are unable to maintain their
personal hygiene, at times they are unable to work independently and have problems related to
memory. Quoting those suffering from schizophrenia, the stigma itself that still exists in our country
with regards to this disease and the persons suffering from it, is a bigger problem than the disease
itself.

There is no structure in our country which provides vocational rehabilitation and work
People suffering from schizophrenia complain about a lack of any institution to help them find work,

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after having gone through a period of fighting and treating their disease. In our country, the Richmond
Foundation conducts a programme together with the Employment and Training Corporation (ETC) for
those suffering from mental health. But the work offered to these disadvantaged people is on a short
time basis and not long term. The positive experience from this programme is showing that our
country needs an institution which creates employment opportunities that are adequate, sustainable
and profitable for those suffering from mental health, including those suffering from schizophrenia.
The experience of what was achieved in the Compagne de Sporen and Ateljee Centre in Ghent,
Belgium, with regards to work provided to these people, is of interest to the Richmond Foundation, so
much so that similar centres are now on its list of priorities.

Mark’s experience
Mark Azzopardi is a person who used to suffer from schizophrenia and who recently got the courage
and talked about what he and his family had gone through.
He says that “I was the third child of four children. There was my older sister and brother, and
afterwards my younger sister was born. Since I started school I was a victim of bullying. Children used
to tease me, throw me on the floor, throw my school bag down or hide it from me and at times I also
ended up missing my school bus because of all this”.

“I was a victim of bullying from Kindergarten until I was 15 years old. Once during a football match, I
fell to the floor with a tackle and as I fell I hit my head against the goalpost. I lost consciousness and
when I regained consciousness I found the other children kicking me instead of helping me. Even as
an altar boy, I was victim of bullying. When I was at Tar a Gap school, at the age of 15, I used to end
up going home and sleep for long hours, something which I never did before”.

“At 17, I in turn became a bully. An example of this is when I used to go to Paceville, because even
though I got beaten up, I also beat others myself. At 19 I started feeling that I had something different.
I was agitated. I used to drink, smoke and had very low self esteem. Drinking used to help me not to
feel that bad and not to have such low self-confidence. As a matter of fact, since I was 14 years old, I
always used to get drunk at my village feast, something which I also carried on doing while going to
Paceville,” said Mark.

He emphasizes that “my older brother was the one who used to take care of me, since my mother
was incapable of taking care of us. My mother suffered from severe depression; she was very
agitated, did not do the house chores and did not even take care of her personal hygiene. My father
did not work, but he used to cook and take care of us. My older sister was raised by our grandparents
from when she was nine years old and so for me she was like a stranger. But we used to fend for
ourselves. I felt my mother’s neglect. My friends made fun of us and referred to our mother as ‘Strega
Negra” (Black Witch).

He adds that “at around eighteen years of age, I worked in a coffee shop, and from then on I felt
symptoms of depression and big stress. It was the boss’ own son who helped me start the process to
get professional help. At about 20 years of age, I had my first encounter with the psychiatrist when I
spent three weeks at the Psychiatric Unit. I refused to go home since everything was all in a mess
there and so I spent some time at the home of ‘Suret il-Bniedem’ organisation and afterwards I was
recommended to move to ‘Villa Chelsea’ which is run by the Richmond Foundation. I started my first
programme. All this was due to my depression and sadness and also because I felt very agitated.

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However, after four months I stopped taking the pills and had an argument with other clients. I
decided to leave and go back home.”

He emphasizes “by that time I was already paranoid, but I did not yet know that I had schizophrenia,
because the voices came afterwards, precisely when I was 21 years old. At that time I was admitted
to Monte Carmeli Hospital. When I was there I saw the devil and I used to hear a lot of voices from far
away. I was very scared of these voices and in fact I suffered from anxiety and fear which lead me to
a state of panic. I cried, felt afraid, lay on the floor, I thought they were going to kill my family and me.
I thought this because I used to hear the expression ‘oh my, what is he going to do to him’. These
panic attacks were due to a high level of anxiety which I had because of the voices I heard”.
Mark goes on to say “I changed my psychiatrist and he changed my medicine, after he diagnosed me
and found out I had schizophrenia. I started the programme at Villa Chelsea twice over and in all I had
undergone the programme three times. On my first attempt I left voluntarily after four months, the
second time it was not successful since I was not adhering to the programme and ended up drinking
and ended up at Monte Carmeli Hospital. On the third attempt, I managed to undertake the full
programme and after this I went to live in one of the apartments pertaining to the support schemes
conducted by the Richmond Foundation, and I still live there to this day.”

He points out that “in time, the pills started taking effect and today I feel much better. It’s as if I do not
have schizophrenia. But if I fail to take my medicine or if I start smoking or drinking, I will end up back
to square one. The disease is cruel and without the proper treatment, it could lead to suicide because
of all the threatening voices. I no longer hear the voices but there are still moments when I feel very
sad and I am not able to laugh. The fact that I have a low self confidence does not help. I feel full of
hope and courage that this time, with the help of these professionals as well as with God’s help, I will
remain in good health.

You cannot understand schizophrenia if you do not understand despair.

Dr R D Laing (an English Psychiatrist)

John Forbes Nash won the Nobel Prize in Economic Sciences in 1994 together with R Selten and J
Harsanyi. Nash is a mathematician, an economist and his theories are still used to this very day in
economics, computing, accounting and in military theory. Nash is the subject of the film A Beautiful
Mind. Nash spent a long time fighting schizophrenia.

What is schizophrenia?
Schizophrenia is a mental disorder which does not allow patients to distinguish between good and
bad. Patients find it difficult to control their emotions and have difficulty to think clearly, make a clear
judgment and communicate.

Patients with schizophrenia usually suffer from strange symptoms. They hear imaginary voices and
believe that these voices are controlling their thoughts and actions. They may also think that people
are working against them and therefore become scared and distance themselves from others. Their
communication and behaviour become disorganized. Other symptoms may be lack of interest in
studying, in family and friends, loss of appetite and sleep and in more advanced stages, lack of
interest in personal hygiene.

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In order to help people without schizophrenia to understand better what patients with schizophrenia
feel and see, the pharmaceutical company Janssen created a device to stimulate hallucinations which
patients with schizophrenia see and hear.
The beginning of schizophrenia is generally slow. It is rarely sudden. Certain symptoms develop
slowly while others develop more quickly and are easier to recognize.

Scientists divide symptoms of schizophrenia into positive and negative. Positive, because one can
recognize them more quickly and a patient responds better to medicine when he has hallucinations.
Negative symptoms are hard to recognise quickly and do not create social unrest. These include lack
of motivation, emotion and energy. Patients with these symptoms suffer because they are thought to
be lazy and do not try hard. Even family members sometimes blame them because of these
symptoms.

The cause of schizophrenia has not been determined yet. One of the major risks is genetics. The risk
of developing schizophrenia is greater if one or both parents or one of the siblings have
schizophrenia. Research should show us other risks for developing schizophrenia because genetics
is certainly not the only one. The family environment, the way in which one expresses his or her
emotions, were associated to the fact that a patient with schizophrenia will again have symptoms. A
change in culture and environment were all associated with an increased risk of schizophrenia. A
topic of interest to researchers is the association between complications during childbirth and
schizophrenia.

International figures
The World Health Organization (WHO) states that schizophrenia is a form of severe mental illness
that affects about 7 out of every thousand of the adult population mostly at the ages between 15 and
35. Schizophrenia affects 24 million people around the world. Schizophrenia is a disorder that can be
controlled especially in the initial phase. More than 50% of schizophrenic people are not receiving the
desired treatment, 90% of which are found in developing countries. The treatment of schizophrenic
patients may be given within the community with the help of family and the community itself.

Local figures
We asked Richmond Foundation to calculate how many people suffer from Schizophrenia in Malta.
Richmond Foundation said that schizophrenia affects approximately 1% of the population, so one can
estimate that around 4000 people may have this condition in Malta. Richmond Foundation told us that
there exists no research on a national scale and no local official statistics on mental health difficulties.

Discrimination?
We asked Richmond Foundation what kind of discrimination is faced by patients with schizophrenia in
Malta. They told us that stigma, fear and lack of information on the subject lead people to be
discriminated. 80% of people who have difficulties with mental health say that the biggest problem is
the stigma rather than the condition itself. Bullying is one of the difficulties that may be encountered.
There were several circumstances where persons refused or objected to having neighbours with a
mental health problem.... but later accepted the situation. There are still great difficulties for people to
find work and it is not the first time that children who have parents with mental health difficulties are
also bullied. Richmond Foundation also said that even when they actually find work, people with
mental health problems find people who are ready to help them but also find those who try to create

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obstacles. They added that there are employers who genuinely take interest and help as best they
can.

And help?
Richmond Foundation emphasizes that there’s the need for more services within the community to be
accessible for whoever has the need. They also added that the media also has an important role to
fight the stigma because unfortunately, most of the time, persons with mental health problems are
only mentioned when an incident happens and this only fuels more fear.

And the state?

When asked about state aid, Richmond Foundation replied that the government has committed itself
that by the end of this year, a new mental health act will be enacted which at the end of the day will
better safeguard the rights of persons with mental health problems. The government is one of the
stakeholders, apart from other associations, the Church, private entities, employers, relatives and
friends and other parties who after all, all have something to contribute.

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