Schizophrenia is a widely-known but often misused term to describe various psychotic states. Unlike the popular perception, it has nothing to do with 'split personality' but refers to a condition where a person has difficulty in distinguishing what is real and what is imaginary, making them behave bizarrely.
People with schizophrenia may have dramatic mood swings but they are rarely violent. However, on the rare occasions when they are, these instances often receive widespread media publicity. The primary offenders are the British tabloids.
My interest in this subject stems from the fact that a close friend has had the condition for over 20 years and I, along with other journalists, doctors, and healthcare experts, am participating on a committee aimed at developing greater understanding of schizophrenia in Ireland.
Films of a certain genre have promulgated myths about schizophrenia. The 'Jekyll and Hyde' characterisation, originated by Robert Louis Stevenson, promotes the idea that there is a split between good and evil, or a certain Satanic, possession which is not true.
Among the most enduring images of mental illness are undoubtedly from films such as Alfred Hitchcock's classic, 'Psycho', the 'Halowee'n' and 'Friday the 13th' series and 'Nightmare on Elm Street' series. In 'Psycho' Norman Bates is presented as a split personality, where the dominant dead mother's personality has taken over. In 'Psycho' and 'Halowee'n' we have the psycho-killers who escape from prison or a psychiatric institution.
In 'Psycho II' Norman Bates is released by psychiatrists who have apparently 'cured' him. He then goes on to brutally murder a dozen people! While many of these films undoubtedly provide entertainment, they also promote a certain stereotype and add to the confusion and stigma surrounding mental illness. These images are enduring.
Schizophrenia affects one in every 100 people in Ireland. Family history is the strongest known risk factor for the condition but there are possibly others such as season ot birth, early spring and winter, a history of obstetric complications, a history of head injury, influenza infections and urban place of birth. Much valuable research into the condition is underway in Ireland and the work of psychiatrists and the support organisation, Schizophrenia Ireland in trying to dispel myths is to be commended.
The commonly held view, promoted by numerous films and dramas, of the dangerously unbalanced violent person with schizophrenia is a cliche, with little basis in reality. The risk of violent behaviour among people with schizophrenia is only marginally greater than among the rest of the community and only then if someone is experiencing acute, untreated symptoms.
There are terms used in the media, on TV and in films which hinder understanding. While cinema is generally there to entertain and not educate, we should be cautious of labels such as 'madman, maniac, looney, psycho, schizoid, split personality' and the like. These terms may be humorous to some, but hurtful to others.
It is important to emphasise that what is being advocated is a greater understanding for a difficult illness, not censorship of debate or reporting, or political correctness.
Irish psychiatrist, Dr Peter Byrne, has extensively researched the media and mental illness. He cited in a recent study a headline in The Examiner in March 1997 concerning the murders of two former psychiatric patients. With the absence of any supporting evidence or a suspect it declared. "Psycho murderer a cannibal". It was reminiscent of Hannibal Lector in The Silence of the Lambs'.
Such language is likely to provoke widespread fear among the general public, promote discrimination and add to the anxiety of families who have members with schizophrenia. Critically, it is also likely to discourage those with the condition to seek treatment.
Many popular movies and some media exaggerate the link between mental illness and violence. Mental illness so often equals 'homicidal maniac'. In some movies, there is no differentiation between mental illness, psychosis and psychopathic, which are lumped together into the all-embracing generic term, Psycho.
Perhaps the debate is confused by real events which colour people's perceptions. In 1996, during the trial of the triple murderer Brendan O'Donnell, three eminent psychiatrists told the Central Criminal Court that he suffered from the rare condition of 'disorganised schizophrenia'. But three other psychiatrists disagreed that he was suffering from the condition when he killed Imelda and Liam Riney and Father Joe Walsh. This adds to public confusion over mental illness, yet the media can only and must report the proceedings of such court cases.
We have all witnessed many tragic court cases where the alleged perpetrator of a murder is reported to have been mentally ill. But after they are convicted and sent to a psychiatric hospital, they later claim that the illness was a temporary aberration and that they are cured.
Some of these cases have provoked cynicism among the public a concern that mental illness is being faked or used unacceptably to explain certain actions. When the best doctors disagree in open court, then the public can become confused. There is a need for doctors to address this matter as it contributes to public perception on the mentally ill.
Issues surrounding mental health and the media have been examined in much more detail in other countries. In particular, there is an excellent document produced by the Association of British Editors, the Scottish Mental Health Working Group and the Scottish section of the National Union of Journalists. It notes that people with mental health problems are not usually deemed newsworthy unless linked to something spectacularly negative. On the rare occasions they are elevated to the headlines, it is usually for the wrong reasons. In Britain, it was the level of media coverage of violent incidents involving schizophrenia patients which highlighted the need for cautious reporting of mental health problems. It is something that can similarly be pursued here with the Irish NUJ.
The language we all use, media, health professionals and the public is so important and revealing. Just think for a moment about the difference between the term 'schizophrenic' and 'person with schizophrenia'. The former implies a labelling although it may be used without that intention.
A recent Irish survey of over 1,200 adults found that most people perceive 'split personality' as the most appropriate description of schizophrenia. Faced with the situation where an acquaintance was diaqnosed with schizophrenia, one quarter of people would be more worried about their own safety.
The survey found there was much work to do to improve the public understanding of the disease. Part of that work must start with a greater examination of how the media and the entertainment industry portray mental illness.
F Bowers Chief Reporter Irish Medical News