Truth-Telling in Disclosing a Schizophrenia Diagnosis to Families: Doctors’ Ethical Considerations in a Psychiatric Hospital

Disclosing a schizophrenia diagnosis presents significant ethical dilemmas due to stigma, caregiving burdens, and cultural norms. This study explored psychiatrists’ ethical considerations when disclosing this diagnosis to family members in Indonesia. Using a qualitative phenomenological approach, we conducted in-depth interviews with eight psychiatrists at a single-site private psychiatric hospital in Jakarta. Data underwent inductive thematic analysis. Four themes emerged: (1) preparing for truth-telling by assessing family readiness, roles, and cultural beliefs; (2) negotiating clinical uncertainty and emotional pacing through staged disclosure; (3) balancing ethical duties of honesty and patient confidentiality against safety risks and severe stigma; and (4) extending disclosure into continuous care via psychoeducation and crisis support. Overall, psychiatrists approach diagnostic disclosure not as a single declarative act, but as an ethically negotiated, relational, and continuous process. While practices like staged disclosure preserve therapeutic alliances, they require critical reflection to avoid paternalism. Adopting culturally responsive, family-inclusive approaches is essential to strengthen the ethical delivery of psychiatric diagnoses and ensure continuing care.