Schizophrenia used to be thought of as a psychological disorder brought on by cold, uncaring mothers. But that was a terrible misconception because it is really an organic neurological disorder with psychological symptoms.
Because some brain circuitry is improperly tuned, the individual's thoughts are disconnected from reality. His inner world is altered, which is why his behaviour changes, depending on whether the disease is in a passive or acute phase.
During the passive stage, he may be socially withdrawn. He can't say how he feels, and fails to take care of himself. He may be anxious, depressed, even suicidal. At this stage, he may be easily misunderstood, appearing to others as a dishevelled, lazy good-for-nothing.
During an acute bout of schizophrenia, however, his bizarre behaviour will be unmistakable and may alarm those around him.
He may ramble illogically, become angry or violent over an imagined threat because he may be deluded, suspecting that others are conspiring against him or controlling him. Or he may believe he has super powers. He may also hallucinate - hearing voices or, more rarely, seeing things. His thinking becomes disordered, he jumps from one thing to another. His speech may become disorganised, his reasoning muddled.
These symptoms may frighten others, not just strangers but even family members and co-workers.
The Institute of Mental Health, as the national centre, sees cases of depression, schizophrenia and anxiety the most frequently, in that order.
Last week brought tragic news from a coroner's inquest into the death of a full-time national serviceman (NSF) who had schizophrenia. Private Ganesh Pillay Magindren's camp supervisor had been informed about his condition, but she never tried to find out what it was or how to manage him. Instead, the coroner heard, she was consistently strict and harsh towards him, aiming to make a better soldier of him.
Last July 4, she punished him for tardiness by giving him 14 extra weekend duties. Pte Ganesh, 23, killed himself the next day.
The key question this death raises is whether a youth with schizophrenia ought to be enlisted at all.
Writing on his Facebook page, Dr Ang Yong Guan, a psychiatrist in private practice who headed the Psychological Care Centre at the Military Medicine Institute up to 2003, says a male with schizophrenia is exempted from NS if he has "symptoms of the illness at the time of his medical check-up at the Medical Classification Centre of the Central Manpower Base". But if he is symptom-free, he may be enlisted "as a non-combatant... on a case-by-case basis".
Pte Ganesh's sad end suggests that known schizophrenics should be exempted from NS regardless of whether or not they display symptoms at the check-up. Here's why.
A person with this brain disorder needs powerful drugs, which have severe side effects, to keep his condition in check. He requires medication for life and is never cured as drugs don't rewire the brain. Acute bouts recur if he stops taking his medication when he feels better, not least to avoid the side effects.