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

Abstract

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.

1. Introduction

Truth-telling in healthcare is the ethical practice of honestly communicating relevant medical information to patients so they can make informed decisions, respect their autonomy, and maintain trust with healthcare professionals [1]. While this is vital for all medical conditions, schizophrenia often impairs a patient’s insight. Therefore, truth-telling must also extend to the family, whose involvement is crucial in the diagnostic disclosure process to facilitate understanding, treatment engagement, and ongoing support. Clear diagnostic communication helps families accept illness, engage with care, and adapt to caregiving responsibilities [2].

Some psychiatrists may find schizophrenia disclosure challenging because they must balance honesty with competing clinical and relational duties [3]. Schizophrenia disclosure may occur amid uncertainty about diagnosis, treatment, prognosis, and information clarity [4]. It is also possible for the patient’s diagnosis to evolve with time. The heavy stigma surrounding schizophrenia, especially in Asian settings, can also complicate disclosure and cause burden to family caregivers [5,6]. Compared with Western settings, stigma of schizophrenia in many Asian settings is more strongly driven by moral attributions and concerns that disclosure will negatively affect the family’s social reputation, relationships, and future opportunities. Consequently, the diagnostic label functions not only as a clinical explanation but also as a marker of potential family-level social disadvantage, increasing pressure to conceal the diagnosis and complicating disclosure [7]. As a result, the disclosure of schizophrenia diagnosis requires a more cautious, relational, and context-sensitive approach than many general medical encounters [8].

Despite growing scholarships, empirical research on psychiatrists’ perspectives in family-focused schizophrenia disclosure remains limited [2]. Existing studies more often examine caregiver experiences, stigma, or family burden rather than components psychiatrists may consider during schizophrenia diagnosis disclosure to patient’s family members [6,9]. Consequently, the internal clinical reasoning and practical considerations that psychiatrists navigate remain poorly understood. Understanding these underlying factors is crucial for establishing clinical best practices; without this insight, developing evidence-based guidelines or training for future practitioners remains highly challenging.

Therefore, empirical research is needed to explore psychiatrists’ perspectives and decision-making processes regarding the disclosure of a schizophrenia diagnosis to patients’ families. This study aimed to explore how psychiatrists reasoned through and made decisions when disclosing a schizophrenia diagnosis to family members in a psychiatric hospital. It examined their perspectives on confidentiality, family involvement, stigma, emotional readiness, and continuing care throughout the disclosure process.

2. Materials and Methods

A qualitative study using thematic analysis was undertaken to explore psychiatrists’ perspectives on truth-telling in clinical practice. Thematic analysis was selected because it enabled the identification and interpretation of recurring patterns in participants’ accounts concerning honesty, confidentiality, family involvement, stigma, and the emotional implications of disclosing a schizophrenia diagnosis.

The study was conducted in the outpatient service of the only private specialist psychiatric hospital in Indonesia, located in Jakarta. The hospital primarily serves patients from middle- to upper-socioeconomic backgrounds and routinely manages individuals with schizophrenia. In this setting, family members commonly accompany patients to outpatient consultations, allowing family involvement to be integrated into routine clinical communication and diagnostic disclosure. This setting was selected because it enables psychiatrists to engage in more extensive discussions with caregivers during outpatient visits than is typically feasible in many public hospitals, where consultation time may be constrained by the requirements of Indonesia’s universal health coverage system. Consequently, disclosure practices observed in this study may differ from those in public hospitals, rural healthcare facilities, or community psychiatry settings.

Psychiatrists were selected from the eligible psychiatrist pool practicing in the outpatient psychiatric service and were approached directly by the principal investigator. Eligible psychiatrists had at least one year of outpatient clinical experience, were willing to participate in an in-depth interview, and provided informed consent. No psychiatrists declined participation or failed to respond. All participating psychiatrists had a pre-existing professional relationship with the principal investigator, who also practiced at the study hospital.

Recruitment initially included five psychiatrists to facilitate preliminary coding and theme development. Subsequent interviews were conducted iteratively, with transcripts coded after each interview. Recruitment ceased after eight psychiatrists, when the qualitative research team judged that thematic saturation had been achieved because no new codes or themes emerged. Saturation was determined through an iterative coding process conducted after each interview by a qualitative analysis team comprising three study researchers and three external researchers experienced in qualitative research and thematic coding.

Family interviews were conducted to corroborate and refine interpretation of the psychiatrists’ accounts rather than to provide an equivalent perspective on clinician–patient–family communication. Accordingly, the findings primarily reflect psychiatrists’ perspectives on diagnostic disclosure, and the study cannot fully assess whether disclosure practices respected patient autonomy because patients themselves were not interviewed.

Data were collected through face-to-face semi-structured, in-depth interviews using a researcher-developed interview guide adapted from a source. All interviews were conducted in Indonesian by the principal investigator, who had received formal training in qualitative interviewing. Interviews were conducted during participants’ clinical working hours in a private setting at the study hospital. No financial compensation or other incentives were provided for participation.

A total of 11 interviews were conducted, comprising interviews with eight psychiatrists and three family members. Each interview lasted approximately 40–60 min. The interviews explored participants’ experiences of schizophrenia diagnostic disclosure, ethical tensions surrounding truth-telling, and approaches to communicating with family members. Example questions for psychiatrists included: “How do you usually convey important medical information to families?”, “How do you assess family readiness to receive diagnostic information?”, “What makes the way of disclosing a diagnosis feel right, fair, safe, and honest?”, and “What should not be done when explaining a diagnosis?” Probing questions were used, where appropriate, to clarify responses and explore emerging issues in greater depth.

With participants’ permission, all interviews were audio-recorded and transcribed verbatim in Indonesian. The transcripts were subsequently coded and thematically mapped in the original language before being translated conceptually into English for reporting purposes to preserve the intended meaning rather than relying on literal translation. The translation was performed independently by two investigators other than the interviewer, with discrepancies resolved through discussion among the research team. The English translations were subsequently reviewed and validated by the study supervisor to ensure conceptual accuracy and fidelity to the original transcripts. Field notes were maintained throughout data collection to document contextual observations and support interpretation of the interview data.

Data were analyzed using thematic analysis following Braun and Clarke [10]. Analysis was inductive and iterative. After all interviews had been transcribed verbatim, the transcripts were imported into NVivo software (version 15, Lumivero, Denver, CO, USA) to facilitate data management and coding. The research team first familiarized themselves with the data through repeated reading of the transcripts before collaboratively coding meaningful segments across all interviews. Coding and thematic mapping were undertaken by an external qualitative analysis team comprising three experienced qualitative researchers. Throughout the analytic process, codes with conceptual similarity were grouped into broader categories and progressively refined into themes through repeated comparison and discussion. Theme boundaries were reviewed and revised where overlap or ambiguity was identified, and the final themes were defined and named to capture distinct patterns of meaning relevant to the study objectives. Any disagreements regarding coding or theme development were resolved through discussion, with final decisions made by the principal investigator. Thematic saturation was assessed collaboratively by the research team during the coding process after each interview. Recruitment ceased when no substantially new codes or themes emerged and additional interviews no longer contributed meaningful analytical insights. No contradictory or deviant cases were identified that substantially altered the thematic framework developed during analysis.

To enhance the trustworthiness of the findings, the study applied Lincoln and Guba’s framework of credibility, transferability, dependability, and confirmability. Credibility was strengthened through in-depth interviewing, member checking, and peer debriefing. Transferability was supported by providing a detailed description of the study setting, participant characteristics, and the use of illustrative verbatim quotations. Dependability was enhanced through a systematic thematic analysis process, collaborative coding by the external qualitative analysis team, and documentation of analytic decisions throughout the study. Confirmability was promoted through consultation with qualitative research experts, and continual comparison of emerging interpretations with the original interview transcripts to ensure that the findings remained grounded in participants’ accounts.

Ethics approval was obtained from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (KE-FK-2042-EC-2025). All participants received information about the study aims, procedures, benefits, and possible risks before interview, and all provided written informed consent. Participation was voluntary, and confidentiality was protected through the use of participant codes and removal of identifying information.

3. Results

A total of 8 psychiatrists participated in the in-depth interviews. Most were female, and ages ranged from 34 to 71 years. Their years of practice ranged from 2 to 32 years, providing a rich variance between early-career (junior) and highly experienced (senior) clinicians. Most had a background in general psychiatry, with one participant identified as a psychiatric subspecialist and one as a professor (

Table 1. Characteristics of participants.

Participant	Group	Sex	Age	Years of Work	Educational	Relationship to Patient
P1	Psychiatrist	Female	71	32	Psychiatric Subspecialist	—
P2	Psychiatrist	Female	35	2	Psychiatrist	—
P3	Psychiatrist	Female	35	3	Psychiatrist	—
P4	Psychiatrist	Female	34	2	Psychiatrist	—
P5	Psychiatrist	Male	61	25	Psychiatrist	—
P6	Psychiatrist	Male	55	22	Psychiatrist	—
P7	Psychiatrist	Female	67	30	Professor	—
P8	Psychiatrist	Male	43	8	Psychiatrist	—

). Analysis generated four interrelated themes (

Table 2. Thematic structure of data analysis.

Theme	Category	Codes
Preparing the Ground for Truth-Telling	Mapping family roles and decision-making actors	Primary caregiver identification; Family as care partner; Tailored communication for vulnerable relatives
	Assessing readiness, literacy, and emotional capacity	Baseline understanding; Readiness for diagnostic information; Emotional distress affecting uptake
	Reading stigma and non-medical explanatory frameworks	Stigma and label sensitivity; Label negotiation; Non-medical causal beliefs
Negotiating Truth-Telling under Clinical Uncertainty	Staged disclosure through timing, pacing, and emotional priming	Gradual disclosure; Timing and channel management; Emotional priming
	Diagnostic uncertainty and risk-sensitive communication	Evolving diagnostic certainty; Criteria-based confirmation; Safety-prioritized disclosure
Ethical Work in Telling the Truth	Honesty and the moral duty to disclose	Truth-telling as duty; Deception as misleading; Harm when deception is discovered
	Privacy, confidentiality, and boundaries of family disclosure	Patient permission; Entitlement to know; Private setting for disclosure
	Preserving hope without deception	Realistic hope; Avoiding false reassurance; Balancing optimism and truth
	Relational ethics in therapeutic alliance	Non-blaming stance; Trust-building; Maintaining co-operation
Extending Truth-Telling into Continuing Family Care	Psychoeducation as a continuation of disclosure	Plain-language explanation; Responding to information needs; Actionable understanding
	Supporting adherence and long-term care planning	Adherence as relapse prevention; Continuity of therapy; Symptom monitoring and planning
	Building post-disclosure support pathways	Follow-up pathways; Educational media; Consultation channels

): (1) Preparing the Ground for Truth-Telling, (2) Negotiating Truth-Telling under Clinical Uncertainty, (3) Ethical Work and Contradictions in Telling the Truth, and (4) Extending Truth-Telling into Continuing Family Care. Collectively, these themes show that disclosing a schizophrenia diagnosis was not a straightforward transfer of clinical information. Instead, psychiatrists navigated significant ethical tensions, balancing the duty of honesty against clinical uncertainty, stigma, and safety risks. Analysis also revealed that participant variation—specifically years of clinical experience—shaped how these ethical dilemmas were managed.

3.1. Theme 1. Preparing the Ground for Truth-Telling

Psychiatrists described disclosure as beginning before the schizophrenia diagnosis was explicitly named. An early task was to identify which family members were most involved in care and which should be engaged in communication. One psychiatrist explained, “History taking may come directly from the patient or through collateral information from family members or other reliable close contacts” (P4). This mapping process also required attention to vulnerable family members, particularly children. As one participant stated, “The most challenging situation is when I have to explain the condition to the patient’s child, especially when the child is still underage” (P3).

A further preparatory task involved recognizing stigma and non-medical explanatory frameworks. Psychiatrists acknowledged that schizophrenia remained a highly stigmatized diagnosis and that family members could be sensitive to the label itself. Non-medical explanations were also present. As one psychiatrist noted, “They initially thought the patient might have been bewitched” (P2).

A notable variance emerged based on clinical experience during this phase. Senior psychiatrists tended to rely on clinical intuition to gauge family readiness and proactively adjusted their communication style to bypass cultural stigmas. In contrast, junior psychiatrists expressed more apprehension during preparation, frequently worrying about unguided information-seeking by the family: “Sometimes I wonder whether they have already searched for information online” (P3).

3.2. Theme 2. Negotiating Truth-Telling Under Clinical Uncertainty

The concept of “staged disclosure” emerged strongly, but analysis revealed it was not a singular practice. Instead, psychiatrists utilized staging for two distinct clinical reasons: managing epistemological uncertainty and pacing emotional readiness.

First, staged disclosure was utilized to manage clinical and diagnostic uncertainty. Psychiatrists emphasized that diagnosing schizophrenia is a longitudinal process. One participant stated, “A diagnosis is something we continue to evaluate from month to month” (P2). Another explained that establishing schizophrenia required both patient self-report and collateral information: “We rely on both autoanamnesis and collateral history; if the criteria for schizophrenia are met, then the diagnosis can be established” (P8).

This evolving certainty created a profound conceptual tension with the ethical duty of honesty. If a psychiatrist highly suspects schizophrenia but the criteria are not yet fully solidified, what constitutes the “truth”? In this context, withholding the diagnostic label was not considered deception, but a commitment to non-maleficence (avoiding harm from premature labeling). However, junior psychiatrists in particular reported ethical distress navigating this gray area. They occasionally felt that delaying the diagnosis bordered on deception, as reflected by one participant’s hesitation: “In the end, I chose to remain silent for a moment first” (P2). Second, staged disclosure was used for emotional pacing even when the diagnosis was certain. One psychiatrist stated directly, “To be honest, it has to be disclosed gradually” (P2). This practice prioritized the family’s emotional readiness (beneficence) over the immediate transfer of complete factual information (veracity).

3.3. Theme 3. Ethical Work in Telling the Truth

Psychiatrists faced acute ethical contradictions when navigating truth-telling, confidentiality, and severe cultural stigma. While they universally viewed honesty as a professional baseline—with one stating, “If we lie and say, ‘This is not schizophrenia,’ when in fact it is schizophrenia, that is clearly problematic” (P6)—their practical application of honesty was highly calibrated.

A crucial analytical finding emerged regarding how psychiatrists conceptualized “honesty” in the presence of requests to hide the diagnosis. One psychiatrist recalled, “Doctor, please do not write schizophrenia; just say acute psychosis instead” (P4). When psychiatrists complied with such requests or intentionally avoided the term “schizophrenia,” they did not interpret their action as a lie or an ethical breach, and reported no guilt. Instead, they operationalized truth-telling as a titration of information, strictly calibrated to what the family could emotionally digest.

The underlying motive for this titration was the preservation of the therapeutic alliance. Delivering the highly stigmatized label of schizophrenia prematurely risked overwhelming the family, potentially leading to treatment dropout. To justify this, psychiatrists employed a clinical rationale akin to explaining medication side effects: just as a physician emphasizes common side effects rather than overwhelming a patient with rare, severe risks (such as QT prolongation or seizures), psychiatrists prioritized actionable, functional information over a blunt categorical label. If explicitly asked, they would disclose the full diagnosis; if not, they provided enough truthful information to secure treatment adherence without triggering stigma-induced paralysis.

Another ethical tension occurred between respecting privacy and ensuring safety. Ideally, psychiatrists sought consent before disclosure: “I would first ask the patient’s permission to involve the people around them” (P3). However, when severe symptoms posed a risk, autonomy was overridden. One psychiatrist explained, “This patient clearly needed admission because the condition was highly aggressive and the patient had not slept for days” (P5). In such crises, psychiatrists prioritized safety and family intervention over strict confidentiality.

Truth-telling was also relational. Psychiatrists distinguished between preserving hope and offering false reassurance. Empty optimism was rejected (“We should not give empty hope” (P1); “We should not give false hope either” (P7)), and anchored instead to realistic therapeutic outcomes (“We still need to offer hope, but it has to be realistic hope” (P8)). Furthermore, maintaining a non-blaming stance was essential: “We should not blame the family or the patient” (P8). Trust was described as central to effective care: “The more the patient trusts me, the more I am able to help” (P2).

3.4. Theme 4. Extending Truth-Telling into Continuing Family Care

Psychiatrists described disclosure as incomplete if it ended with naming schizophrenia. Instead, they viewed it as the beginning of an educational and caregiving process. One participant explained, “What we can offer is pharmacotherapy, supportive care, and education” (P1). Disclosure was linked to adherence and long-term care planning. Psychiatrists framed schizophrenia as a chronic condition requiring continued treatment. One participant stated, “Adherence is the key; without it, relapse is likely” (P6). Another noted, “This is a long-term illness, so regular follow-up is necessary” (P8), and a third said, “Continuity of therapy is the main priority” (P2).

Finally, psychiatrists highlighted the importance of post-disclosure support pathways. Families needed clear guidance on what to do when symptoms worsened. One psychiatrist advised, “If there are signs of deterioration, they should come back immediately and not wait until it becomes severe” (P2). Another pointed to the usefulness of educational media: “It would be much better if there were videos or digital materials that families could revisit” (P5). A third emphasized ongoing access to help: “We let them know that they can contact us if they need help, so the family feels they have some guidance” (P7).

4. Discussion

The main findings of this study are that truth-telling in psychiatric practice extends beyond diagnostic disclosure and involves ongoing relational and practical support for families. Participants emphasized that honest communication was most meaningful when accompanied by clear guidance. This finding highlights truth-telling as a continuous relational process rather than a single communicative event. Communication in psychiatry carries therapeutic consequences because it shapes trust, engagement, understanding, and continuing family participation in care [11]. Family involvement increases complexity because relatives remain central to support, yet their presence creates tensions around confidentiality and autonomy [9,12]. Earlier work likewise describes diagnosis communication as a decisive moment for family adaptation, burden, and treatment engagement [2,13]. Recent Asian evidence further shows that the early illness period is marked by burden, uncertainty, and unmet support needs [14].

Honesty remained central, yet psychiatrists did not equate ethical truth-telling with immediate, blunt, or context-free diagnostic naming. Psychiatric ethics guidance likewise supports clarity while recognizing uncertainty, stigma, distress, fluctuating insight, and the relational risks of disclosure [11]. This perspective explains why disclosure was often gradual, timed carefully, and revisited across encounters instead of delivered once [15,16]. Decision-making capacity in schizophrenia spectrum disorders is dynamic and context-dependent, often requiring simpler language and additional time [17,18]. Uncertainty about diagnosis, prognosis, and professional explanations may itself become burdensome, making staged disclosure an ethical calibration [4]. However, we must engage critically with when staged disclosure functions as ethically appropriate pacing, and when it risks becoming harmful avoidance. Our data revealed that determining whether a family is “ready” relies heavily on the psychiatrist’s subjective judgment. Furthermore, avoiding the word “schizophrenia” in favor of terms like “acute psychosis” to prevent treatment dropout introduces significant ethical risks. While intended as beneficence, treating the diagnosis as a taboo may inadvertently reinforce the very cultural stigma clinicians seek to circumvent [7], and this paternalistic information control may limit the family’s capacity to make fully informed, long-term care decisions.

Confidentiality emerged as the most persistent ethical tension because families were necessary for care, yet never automatically entitled. Research on psychotic disorders identifies confidentiality as a major barrier to meaningful family involvement when interests diverge [12]. Review evidence further shows that these dilemmas often involve competing claims about welfare, trust, and professional defensiveness [9]. This tension is heavily amplified by power dynamics in family-centered cultures, where caregivers are deeply integrated into the patient’s life, frequently blurring the lines of individual autonomy and ethical obligations [1,3]. When patient insight or capacity fluctuated, psychiatrists in our study often bypassed consent for safety reasons, highlighting the real-world conflict between family wishes and patient rights. Therefore, as suggested by broader bioethics literature rather than emerging directly from our observational data, respect for autonomy must include attention not only to present wishes, but also to the patient’s future preferences and values once capacity is restored [19]. Ethical family disclosure requires negotiated boundaries in practice rather than unrestricted openness or rigid non-disclosure alone.

Relational aspects of disclosure were equally important because hope, blame, dignity, and alliance shaped whether truth remained usable. Open conversations, psychoeducation, and shared decision-making have been linked to stronger therapeutic relationships in schizophrenia care [20]. This helps explain why psychiatrists avoided blaming language and tried to preserve realistic hope without false reassurance. Diagnostic terminology may be experienced as inaccessible, inadequate, or negatively loaded within broader stigmatizing social environments [21,22]. Family stigma and caregiver ethical burden remain substantial when shame, blame, and social rejection become normalized [5,23,24]. Relational outcomes are also shaped by treatment climate, professional burnout, and culturally sensitive collaboration with relatives [25,26].

Preparation before disclosure mattered because family members did not enter consultations as neutral recipients of medical facts. Psychiatrists first identified caregivers, assessed readiness, and checked what families already understood about symptoms and prognosis beforehand. Earlier work similarly shows that diagnosis communication shapes acceptance, adaptation, and unmet support needs among caregivers [2]. Families also play a pivotal role in help-seeking and continuing care under conditions of urgency and uncertainty [8,27]. Family acceptance at home may be undermined by stress, shame, communication barriers, and burdensome daily care [28]. Ethical preparation therefore involves negotiating emotional readiness and the social meaning of schizophrenia before disclosure occurs formally.

Disclosure became ethically meaningful only when it opened a pathway towards psychoeducation and continuing family care afterwards. Families in previous studies described needing clear explanations, tailored support, and help making sense of schizophrenia afterwards [2,13]. Psychoeducation and shared decision-making may improve insight, alliance, and practical engagement through accurate, understandable information for families [20]. Family psychoeducation has also been associated with better quality of life, improved adherence, and greater hope overall [29,30]. Educational interventions may further improve schizophrenia literacy, reduce personal stigma, and support earlier recognition and help-seeking [31]. Culturally adapted family interventions in Indonesia further emphasize communication skills, relapse prevention, blame reduction, and belief-sensitive support [32].

These findings imply that psychiatrists may benefit from structured but flexible guidance for family-focused schizophrenia disclosure practice. Training should address timing, consent, confidentiality, emotional reactions, and plain-language explanation within ordinary outpatient consultations more consistently [11,12]. Psychoeducation should follow disclosure so families receive relapse guidance, practical follow-up advice, and opportunities for questions afterwards [20]. Family support in Indonesia should translate culturally adapted principles into practical follow-up after disclosure and ongoing care [32]. Structured digital tools may also strengthen person-centered care, while implementation depends on user involvement, training, and ethical safeguards [33,34]. Service-level communication will additionally depend on interprofessional conditions such as leadership, workload, trust, and communication adjustment [35,36].

This study has several important limitations. First and most critically, it entirely lacks the perspectives of patients and their families. Without observing actual disclosure encounters or interviewing the recipients of the diagnosis, our findings reflect only the psychiatrists’ rationalizations and intended actions, which may not align with how families actually experience or interpret these conversations. Second, the reliance on self-reported clinical reasoning introduces a high risk of social desirability bias; psychiatrists may have framed their actions in ethically favorable terms and recall bias may have affected their accounts of past clinical encounters. Furthermore, power imbalances during the interviews, as well as the principal investigator’s identity and professional background as a colleague within the same hospital, may have influenced the transparency of the participants’ responses. Finally, the study was conducted in a single private psychiatric hospital in Jakarta serving a specific socio-economic demographic. The findings cannot be broadly generalized; disclosure practices observed here may differ substantially from those in public hospitals governed by universal health coverage constraints, rural settings, or acute inpatient units.

5. Conclusions

In this single-site qualitative study, psychiatrists described schizophrenia disclosure to families as a gradual, relational, and ethically negotiated process rather than a single act of diagnostic naming. Their accounts suggest that ethical disclosure requires a continuous balancing of honesty against confidentiality, patient permission, family readiness, entrenched stigma, and the preservation of realistic hope. Furthermore, psychoeducation and follow-up support are integral to this process, ensuring that truth-telling translates into actionable care. Because patient and family perspectives were not included and the context was limited to a single private hospital, future research must examine actual disclosure encounters directly, incorporating patient, family, and clinician perspectives across diverse psychiatric and socio-economic settings.