Feature

Schizophrenia: whose delusion?

People diagnosed as schizophrenic are not helped by the images of hopelessness and pity portrayed by the media, politicians and even charities, says Nigel Rose

When you hear or read the word ‘schizophrenia’, what images does it conjure up for you? Is it of a smelly, dishevelled, homeless person, piteous and pitied, or is it of a violent psychopath, prone to violent mood swings, hearing voices telling him or her to kill or maim? Is it of some ‘poor unfortunate’ locked away in the back ward or of an over-medicated, incoherent and isolated ‘schizophrenic’ living in a hostel, sharing a room with two or three other people? These are the common images of schizophrenia, the ones, on the whole, promoted by the media, the politicians and even the large schizophrenia charities. These are images of hopelessness, powerlessness and fear.

They have a devastating effect on the lives of people diagnosed as schizophrenic. Those who cannot hide their symptoms face discrimination in every part of life, and may face fear and rejection even from their relatives and friends. It is arguable that this very rejection feeds and exaggerates the feelings of persecution many people diagnosed as schizophrenic have.

The messages of fear and hopelessness are reinforced in the press. With few exceptions schizophrenia is associated with violence, (as in the Yorkshire Ripper stories), or with tragedy (as in the recent case of Benjamin Silcock, mauled by lions in Regent’s Park Zoo). On TV over the past few months there has been a series of documentaries about schizophrenia. These either expose the failures of community care or occasionally try to illustrate the successes. In both types of documentary people diagnosed as schizophrenic are invariably portrayed as passive recipients or victims. Their views and opinions on community care are drowned out by those of politicians, families and professionals.

The largest charities, NSF (National Schizophrenia Fellowship) and SANE (Schizophrenia a National Emergency), who represent, chiefly, the interests of the families of people diagnosed as schizophrenic, are more ambivalent about the images that they propagate. But in the effort to raise money or make their point, charities tend to use the most powerful images, which are invariably the most negative. In 1988, SANE plumbed the depths during its campaign to raise money for research into the biological causes of schizophrenia, with both newspaper and radio adverts bearing the slogans: ‘He thinks he’s Jesus, you think he’s a killer, they think he’s fine’; ‘He hears voices, you hear lies, they hear nothing’; ‘She thinks you want to kill her, you think she wants to kill you, they think she’ll go away’. Even SANE now admits to regretting this campaign.

National MIND, which might be expected to be a major force in countering these negative images, has been a less than forceful voice in recent debates around schizophrenia. It is hampered by its understandable reluctance to accept that schizophrenia actually exists as a distinct disease entity, and by its relatively poor contact with service users diagnosed as schizophrenic.

In the political arena schizophrenia has become a symbol of the ‘failure’ of community care. SANE, represented by journalist Marjorie Wallace, has been at the forefront of an emotive and ill-informed polemic on the ‘failure’ of the move to community care and the need to increase the number of hospital beds. It is notable that people diagnosed as schizophrenic have played little or no part in these debates.

In a knee-jerk response to the publicity surrounding the mauling of Benjamin Silcock, Virginia Bottomley is considering the introduction of a community supervision order, proposed by the Royal College of Psychiatry, to give increased power to health professionals to enforce treatment in the community. This is the second incarnation of the community treatment order, debated briefly three or four years ago and then dropped. This measure has more to do with community control than community care and reinforces the notion that people diagnosed as schizophrenic must be monitored and regulated.

The prevailing images of schizophrenia are maintained by an unspoken conspiracy between politicians, voluntary organisations, the media and the psychiatric profession. Between them they paint images of hopeless, pitiable and passive victims on the one hand, and psychopathic, violent, unpredictable maniacs on the other. Left in the middle are the majority of people diagnosed as schizophrenic who fall into neither category, and struggle to survive in a climate of vicious discrimination, the lucky few supported by a fragmented and inadequate community care.

Community care is about more than providing a home-help, a community psychiatric nurse, or enough money to live on, though these are of course important. It is about the cultural acceptance of people’s right to live in their community rather than to be warehoused in an institution. It is about being recognised by others as citizens with rights and responsibilities.

While schizophrenia is feared and those labelled with it rejected and unheard, community care can only become a partial reality. The government has failed entirely to recognise this.

A concerted campaign is needed to make those who reinforce and propagate negative images of schizophrenia realise and take responsibility for the damage that they cause. This campaign must provide alternative images of schizophrenia, realistic images of people struggling to live their lives while coping with a distressing and disabling condition. This campaign must make sure that the views of people diagnosed as schizophrenic are heard.