Is there really an illness schizophrenia?

Split vote on existence of schizophrenia

Bob Axford reports on a Maudsley Debate

I arrived 10 minutes early but was one of the last people let in to the full lecture theatre, such was the level of interest in this debate on 29 January 2003. The motion was, “This house believes that schizophrenia does not exist”.

Supporting the motion were Jim Van Os, Professor of Psychiatry at Maastricht University, and Richard Bentall, Professor of Clinical Psychology at Manchester. Opposing it were Dr Peter McKenna, Consultant Psychiatrist from Cambridge, and Anthony David, Professor of Cognitive Neuropsychiatry at the Institute of Psychiatry. The chair was Professor Robin Murray, also of the Institute of Psychiatry in London – the venue for the debate.

Before and after the debate a vote was taken. Beforehand, out of a total of 264 people, 86 people (32%) were for the motion and 134 (51%) against the motion, with 44 (17%) abstentions/undecided. Each speaker had 7 minutes to put their case. The proponents of the motion talked about the need for care being important, not the diagnosis. Scales for positive and negative symptoms, and for affective, cognitive and motor skills were mentioned and it was proposed that these should take the place of diagnoses. Treatment could be based on symptoms.

The idea that there is a continuum of increasing severity of symptoms was accepted, and different systems will have different thresholds for making a diagnosis. Opponents of the motion maintained that the systems of diagnosis were robust and useful enough and supported by studies, while the proponents regarded them as flawed. In particular, studies which showed separate groupings of people with symptoms of either schizophrenia or mania were contradicted by those which showed a continuum.

A thread running through the discussion was the ugly connotations of the word ‘schizophrenia’, and how people would be better off without the diagnosis. Set against this were certain practical problems of what to tell Social Security, or the judge and jury in a case like the Christopher Clunis one. Would talking about having ‘care needs’ provide someone with sufficient protection, aid recovery and avoid stigma? A lot of the audience seemed to be convinced.

After half-an-hour’s discussion with audience participation, the vote was taken again. Out of 243 people remaining, 97 (40%) were for the motion and 97 (40%) were against the motion. 49 (20%) abstained or were undecided. There was, then, a swing indicating that proponents of the motion had swayed several people. The chair declined to use his casting vote saying that he was undecided! He defined the essence of the debate in this way – that people have symptoms is not in dispute, but is it valuable to diagnose?