(Extract from the Mind Publication "Understanding Schizophrenia ")

There's much disagreement about the psychiatric diagnosis of schizophrenia. This booklet introduces the various different theories and ideas about its diagnosis, cause and treatment. It also offers practical advice to anyone told they have this problem, and to their family and friends.

What is Schizophrenia?

The diagnosis schizophrenia is widely used in the mental health system and treatment is based on it. A psychiatrist may make this diagnosis on the grounds of various 'positive' and 'negative' symptoms.

'Positive' symptoms include:

• thought disruption
• auditory halucinations (e.g. hearing voices)
• delusions or other hallucinations

Thought disruption

A person is said to be experiencing thought disruption if he or she seems unable to follow a logical sequence of thought - if their ideas appear jumbled and make little sense to others.

Auditory hallucinations

Some people hear voices that others around don't hear. The voices may be familiar, friendly or critical. They might discuss the hearer's thoughts or behaviour, or they might tell them what to do. Hearing voices does not inevitably mean a label of schizophrenia. Indeed some research has shown that four per cent of the population hears voices. It appears that, for the majority, these voices are not a problem.

Those diagnosed with schizophrenia seem to hear predominantly negative voices, however. They may have heard voices all their lives, but a stressful life event might make the voices more negative and harder to deal with.

Delusions or other hallucinations

These are defined as beliefs or experiences that are not shared by others. Someone might believe, for instance, that they are being pursued by secret agents or controlled by external forces that are putting thoughts into their mind.

These positive symptoms mean schizophrenia is known as a 'psychosis' and it is treated with major tranquillisers. Most psychiatrists regard such symptoms as a psychiatric disorder, but others believe that such psychological episodes are logical or natural reactions to adverse life events - an extreme form of distress.

The negative symptoms of schizophrenia are less easily identified that the positive. They may include:

• feeling apathetic or emotionally flat
• being unable to concentrate
• wanting to avoid people
• feeling a need to be protected

It's difficult to say which may be symptoms of schizophrenia, and which are simply reactions to the way anyone experiencing mental ill-health may be treated by society. People with mental health problems are not generally treated well, so it's hardly surprising that isolation, depression or hopelessness can result.

Some people believe that, because psychiatric experts can't agree about the definitions and causes, and consequently the treatments for schizophrenia, it shouldn't be used as a diagnostic category at all.

Who is diagnosed with schizophrenia ?

About one in a hundred people may be diagnosed with schizophrenia at some point in their lives - usually as young adults. This figure is roughly the same for both sexes, but men tend to be younger when the diagnosis is made.

You may be more likely to be given this diagnosis if someone in your family already has been. It has been estimated that around a third of people diagnosed with schizophrenia experience only one episode. Another third may have further occasional episodes, while the last third live with schizophrenia as an ongoing problem.

Social and cultural differences

Many people prefer to look at schizophrenia 'holistically'. They stress the need to look at individual experience, and the importance of understanding what the voices or hallucinations mean to the individual. Hearing voices, for instance, holds a different significance within different cultures and spiritual belief systems.

A mistaken diagnosis can occur when a psychiatist has very different cultural, religious or social experiences to their patient's. For example, there is considerable concern in Britain about the disproportionately high number of young African-Caribbean men given the diagnosis, which has led to some experts to ask whether the entire theory of schizophrenia is based on racist ideas.

Are people diagnosed with schizophrenia dangerous?

The popular myth about schizophrenia is that people have a 'split personality' and swing between being calm and being out of control. There is more media misinformation about this than about any other psychiatric diagnosis. We are all aware of sensational stories about 'schizophrenics' who are dangerous unless drugged and kept in institutions. In fact, the number of homicides committed by people with any mental illness diagnosis has remained at the same low level for 10 years. In this same 10-year period the total number of homicides committed in Britain has considerably increased.

Research has found that people with drug problems (alcohol and illicit drugs) are twice as likely to commit a violent crime as someone diagnosed with schizophrenia. This shows that the relationship between schizophrenia and serious crime is so unsure that prediction of violence is 'virtually impossible'.

People are often very frightened of those who hear voices. It's important to remember that people who hear voices make choices about whether to act on them, just as anyone does when they are told to do something. It seems to be most common for voices to urge the person to kill themselves rather than to kill somebody else. Many of those diagnosed with schizophrenia who hear voices make the conscious choice to stay alive every day, despite the voices.

Topics also included in this leaflet are: