Media, December 2007

Muddier and Muddier

From time to time, schizophrenia hits the headlines, and typically it gets bad press, being too frequently associated with random attacks on passers-by. It got rather more considered treatment in The Guardian on 9 October in an article by Kate Hilpern entitled 'Muddy thinking'.

Speaking of schizophrenia, she states that it is 'time we got rid of this vague and stigmatized label'. I must admit to a feeling of déjà vu as I started to read this article. I remember these issues being hotly debated many decades ago, following the writings of R.D. Laing and Thomas Szasz, who challenged the existence of mental illness. However, it spurred me on to look at who is saying what in the media about schizophrenia and its causes, and whether things have progressed.

The article by Hilpern is interesting in that she considers a range of views from different experts. However, the emphasis tends to be on the kind of views typified by a campaign for abolition of the schizophrenia label, a campaign led by Paul Hammersley (a psychologist from the School of Nursing and Midwifery at Manchester University). Hilpern starts by describing the case of a man who had been diagnosed with schizophrenia but who eventually rejected this diagnosis. Against medical advice, we are told, he reduced his medication and used an unspecified self-help approach with, fortunately, a successful outcome. However, I can't help thinking that the description should have been accompanied by the usual warning of 'Don't try this at home!' She then goes on to quote the views of Paul Hammersley. In previous press reports he has been linked with controversial findings from a study which states that schizophrenic symptoms are caused by child abuse (e.g. New Scientist, June 2006). Here he is quoted as having stated that schizophrenia does not exist. This argument is backed up by information about the lack of consistency and reliability in the diagnosis of schizophrenia. Finally, he is reported as stating that psychotic episodes, which lead to a diagnosis of schizophrenia, are caused by trauma.

The piece goes on to present the views of Professor Mary Boyle (recently retired from the University of East London), who argues that what we need 'is not simply a different label but entirely different ways of thinking about those psychological experiences and behaviours that have been mislabelled and misunderstood as symptoms of schizophrenia.' From this, the article makes the slight leap to four dimensions of functioning (including such phenomena as hallucinations, withdrawal, scrambled speech and depression) which need to be considered independently of each other and placed on a continuum.

Professor Richard Bentall (University of Wales, Bangor), however, points out that psychiatrists and the government tend to favour categorical approaches. To emphasise this point Jeffrey Lieberman (Department of Psychiatry at Columbia University) is quoted as saying that the diagnosis is reliable and its usefulness is 'indisputable'. Furthermore, he said, there are abnormalities in brain structure and functioning and indisputable evidence that the condition is at least partly genetic.

However, there seems to be widespread agreement that there is no one simple cause, and a quick search of the media coverage over the past few years suggests that there is still scope for new alternative explanations. For example, in July 2001 (BBC News website) schizophrenia was linked to a lack of sun during mother's pregnancy (based on research by John McGrath, a psychiatrist based at the Queensland Centre of Schizophrenia Research). In February 2004 the BBC News website reported that schizophrenia was linked to exposure to too much lead petrol in the womb (research by Ezra Susser, University of Columbia). More recently still (July 2005) the BBC reported the findings of a review by Stanley Zammit (a clinical psychiatry lecturer from Cardiff University) which found that those who smoked cannabis were more likely to suffer psychotic conditions such as schizophrenia.

So where to now? From the press coverage we gather that some experts, such as Marjorie Wallace of Sane (quoted in Hilpern's article) wants the term kept so that we can raise awareness and fund research, others want it dropped to reduce the stigma. Some favour category diagnosis and others want continua. Has anything changed as a result of all the decades of research and press coverage? These diverse views both between psychologists and across the professions might well be confusing to any lay person following the stories.

However, I suspect, if nothing else, that there is greater awareness amongst the public of the complexity of the issues. Probably, few people now think schizophrenia involves having two personalities (a popular view in the past). Press coverage of our research does help inform the public if only to help them to understand that we don't have the answers yet and that the issues are complex. This awareness may also help reduce people's fear of the unknown and the stigma for sufferers. However, it is perhaps unfortunate that parents do seem to get rather more negative press than I suspect is justified from the current state of evidence. In the Laingian era it used to be that they were castigated because they supposedly provided confusing communication, now they may be suspected of inflicting more direct trauma – or too much prenatal sunbathing or driving!
    Fiona Jones