DMH 48 Memorandum from Schizophrenia Association
of Great Britain
The Schizophrenia Association of Great
Britain was founded in 1970 and was the first association for
schizophrenia in the UK.
Scope of the Committee's Inquiry
1
As the drafters of the Bill appear not to understand
psychotic illnesses and the approach that should be made to them
the answer to this question must be 'No'. Those drafting the
Bill should have made it simple for the layman trying to understand
it. The legalistic approach to a medical problem is daunting.
Lawyers do not understand mental illnesses and neither, very
often, do psychiatrists have a consistent or common approach to
such illnesses. A wholly medical therapeutic approach should
have been adopted in this bill with minimal legal input. If such
an important Draft Bill is put before the interested public it
should at least be intelligible. It strikes me as being largely
gobbledegook.
One wonders if the families of the patient and the
patients themselves understand what is happening to them. How
will busy psychiatrists understand easily what implications the
Bill will have for them? Will they be able to cope with the extra
work involved? Why should the law be able to so enmesh a branch
of medicine?
2
Diagnosis in psychiatry is often inexact. Patients
are often given different diagnoses over time. It seems that
some patients with an initial diagnosis of schizophrenia are being
discharged from hospital as having an 'untreatable personality
disorder' for whom treatment was thus not available. Everyone
with a schizophrenic illness has their personality altered by
their disease. This does not mean they have a personality disorder.
It could mean that the medical treatment given for their schizophrenia
has been only partially effective.
The one diagnosis, 'mental disorder', would satisfy
the inexact diagnostic procedures extant, but it would seem to
be absolutely essential for the drafters of the Bill to state
very clearly those diagnoses which would be included within that
very general term of 'mental disorder'. For example - are those
extraordinary terms Personality Disorder (PD) and Dangerous Severe
Personality Disordered (DSPD) to be included? Mr. Hilary Benn
wrote to me, when in the Home Office, saying that 'personality
disorder' was a clinical condition but that 'DSPD' was not. I
do not understand how adding two adjectives, dangerous and severe,
to personality disorder changes it from a clinical to a non-clinical
condition.
In the 20th century about half the patients
in the big psychiatric hospitals were diagnosed as having personality
disorder, of which the most severe form was said to be psychopathic
disorder (now called DSPD). They must have been considered ill
as they were hospitalised.
25.8% of 1524 members of the Schizophrenia Association
of Great Britain had their diagnosis of schizophrenia changed
to one of personality disorder or psychopathic disorder or both
during the course of their schizophrenic illness, sometimes before
and sometimes after that diagnosis had been made.
It is important therefore, to understand that diagnosis
is not reliable in psychiatry and that the diagnosis will often
change with the psychiatrist.
It is potentially very dangerous to be labelled DSPD.
If this label is applied (I hesitate to use the word diagnosed)
and that patient had committed a criminal offence he might be
whisked off to Frankland or Whitemoor prisons. After his sentence
had been completed he might either be discharged or, if thought
to be not well enough, sent to one of two top security hospitals
Broadmoor or Rampton, for an indeterminate time. If, on the other
hand, he had not committed a criminal act he might be sent for
an indeterminate time to Broadmoor or Rampton.
What hope have such patients? A cover-all diagnosis
of 'Mental Disorder', if not itself defined, could lead to much
confusion and this may, on reflection, do more harm than good
were such terms as PD and DSPD to be covertly applied to patients.
3.
Again - 'No'. The mentally ill have one need
and that is for their mental illness to be adequately treated
in a compassionate setting (ie hospital) until their most severe
symptoms have been controlled by minimal medication. Secondly,
they should be thoroughly physically examined in the search for
diseases affecting the body which might indirectly affect the
brain. If found, any such disease would be the probable cause
of their psychotic symptoms. It is known that gut disease, heart
disease, endocrine disease and infections have a raised incidence
in schizophrenia and a raised mortality rate from a similar list
of illnesses. Nevertheless the psychiatric establishment are
largely thinking of psychotic diseases as being confined in their
symptomology and pathology to the brain
It is highly likely that physical disease of the
body is undiscovered because it is unlooked for. Diseases of
the body are probably the direct cause of the psychiatric symptoms
in many cases.
To seek to inject powerful and frequently toxic,
always palliative, drugs into the patient in the community, even
in a clinical setting, is wholly wrong. Those who are injected
with those drugs should be observed closely (always in hospital)
and the dose adjusted to achieve the maximum stabilisation with
the minimum dosage. It is not known how these injected neuroleptics
exert beneficial effects. They have many serious, sometimes lethal,
side-effects. For example, they frequently cause huge weight
increases, especially the now more popular and hugely more expensive
drugs, olanzapine and clozapine. These weight increases, sometimes
causing a doubling of the patient's weight, can lead to diabetes
and consequent heart disease. As heart disease, as noted above,
already has a raised incidence in schizophrenia, these drugs are
likely to increase this risk greatly.
Hospital is the only place for patients who
are greatly disturbed. As to the balance between their human
rights and the safety of others it must surely be of much more
importance to give the patient back their mental health than any
concerns about their 'rights'. I don't think rights should come
into the picture. It is the need of the patient to be
treated in hospital until they are well without bringing rights
into it. A patient who is very disturbed will not understand
the severity of his illness. I know that lawyers in the mental
health field see it as their brief to 'liberate' patients from
hospital. This is totally wrong. Lawyers should be kept as far
away as possible from the problems of the mentally ill. It is
quite ridiculous to give patients the opportunity to ask for a
Tribunal for their 'release' soon after being hospitalised, when
their chief need is for medical care and not the liberty to be
free and very ill in the 'Community' where they may be at risk
also of harming others.
When made well in a hospital they will be able to
live happily in the community. The patients will then be thankful
that their worst psychiatric symptoms had gone. They can again
live stable lives.
Patients do not like being angry and violent.
They need urgent help and if hospital is necessary patients will
understand, when they are made well, how necessary it had been
for them.
4.
It is doubtful if the proposals are workable. They
are neither efficient nor clear. Their costs will probably be
phenomenal. If this money were used to improve the physical health
of the mentally ill it would be a better use of money.
6.
It has been my experience that parents with disturbed
children find it very difficult to get help from doctors. It should
be much more widely understood that, in the initial stages of
a psychiatric illness, whether it is a child or an adult, they
are not symptomatic for much of the time and parents may not be
believed when they seek help because the symptoms are not displayed
when confronted with those outside the four walls of home. As
one Senior Consultant said 'Intelligent patients are very good
at hiding their symptoms'. Families must always be carefully
listened to when they report disturbed children. Much can be
done to help. There is increasing evidence of a genetic relationship
between celiac disease and schizophrenia. The early institution
of a strict grain-free, milk-free diet plus a general vitamin/mineral
supplement plus fish oil may actually cure such a child.
Why are doctors so unwilling to consider such a simple
non-toxic therapeutic approach to the treatment, both of children
and adults, who are mentally disturbed?
Psychosurgery should never be performed.
It destroys brain tissue which, once removed, can never be replaced.
As one psychiatrist said 'Broadmoor is full of failed cases of
psychosurgery'. Such operations are always dangerous and
likely to fail. The brain symptoms should, in most psychotic
illnesses, be reversed when adequate attention is paid to the
physical health of the body.
ECT may occasionally be justified in adult cases
of very severe depression. In such patients ECT may produce miraculous
results.
Why go to all the trouble of introducing this
Bill, ostensibly protecting the human rights of the patients,
whilst it is obvious that the human rights of patients behind
bars in prison are denied theirs. There is no logic in it. Currently
there are 75,000 in our prisons. Nine out of ten of these are
mentally ill or suffering from drug or alcohol abuse.
Gwynneth Hemmings
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