Schizophrenia

More people of working age who are in hospital or disabled in the community suffer from schizophrenic illness than any other potentially handicapping condition. In the UK approaching 150,000 people are affected at any one time. The annual cost of their health and social care alone is some £200 million. Nevertheless, despite the importance of the conditions it encompasses the diagnosis schizophrenia remains in some respects poorly defined and public knowledge of and attitudes towards such psychiatric disturbances often appear ill informed. On the one hand, for instance, schizophrenia is still frequently confused with the rare (hysterical) 'Jekyll and Hyde' dual personality syndrome. On the other some people deny categorically the existence of schizophrenia as a disease, seeing it only as a socially defined or induced phenomenon. Much recent research has been aimed at firmly establishing the circumstances in which the label 'schizophrenia' may be legitimately applied to people displaying an unusual mental state. In general it may be said that in Britain today psychiatrists tend to stand more in the tradition of Kraepelin, using schizophrenia relatively narrowly to refer to a given set of observed 'signs and symptoms'. By contrast in countries such as the United States there is rather more sympathy with the broader, more theoretically based approach of Bleuler. Another central theme of modern investigations has been to ascertain the degree to which social and other environmental factors external to the individual play a role in the genesis and course of schizophrenic illness. Although Scandinavian psychiatry has a relatively long tradition of accepting that nearly all forms of mental distress have causally significant reactive aspects this understanding has only become fully established in Britain in the last two decades or so. This paper describes findings in these and other related areas and also examines developments in the system of care and treatment for people affected by schizophrenia. These include topics like the impact of modern psychotropic medicines in the field of mental health and the programme of 'running down' the traditional mental hospital system commenced at the beginning of the 1960s. It should be stressed that many questions relating to the nature of schizophrenic conditions and the outcome of various forms of treatment are still unresolved. For instance, no biochemical factor basic to any form of schizophrenia has yet been proven to exist. The long-term value of some modern forms of psychiatric rehabilitation is unknown. And there is even a dearth of information about how the overall population of people affected by schizophrenia is faring within the present structure of health, social and allied services. In the face of such fundamental uncertainties it is not possible to define clearly what would constitute a future ideal pattern of support and treatment or to pin point accurately how current plans and levels of financial investment depart from those necessary to achieve such services. Rather the objective of this report is to present an overview of schizophrenia which highlights key topics but does not attempt to quantify precisely the costs, risks and benefìts of the care approaches it outlines.