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Dublin: 16 °C Friday 14 August, 2020

Schizophrenia is not a split personality - there are four main symptoms

Such phrases mean people with mental illnesses are less likely to seek the help they need, writes Stephen McWilliams.

Dr Stephen McWilliams Consultant psychiatrist

MENTAL ILLNESS HAS always had an image problem. A surprising number of people still regard schizophrenia as a “Jekyll and Hyde” split personality, while the inappropriate term “schizophrenic” is still commonly used as a label to define people with mental illness.

Public misinformation, negative attitudes and media-fuelled fear mean that such individuals are perceived as weak, lazy, selfish, attention-seeking or even dangerous.

They encounter discrimination in terms of education, employment and housing. Mental illness affects one in four but the stigma, it seems, is still everywhere.


Those bearing the brunt are people with schizophrenia – the commonest type of psychosis. Far from being a split personality, it is a complex psychological illness in which an individual’s thoughts and perceptions become detached from reality.

It has four key symptoms, namely delusions (firmly believing things that aren’t true), hallucinations (seeing or hearing things that aren’t there), thought disorder (mixed-up thinking, making it hard to communicate) and negative symptoms (speaking less, withdrawing from society and dropping out of work or education).

Schizophrenia is a very treatable condition with a combination of medication, cognitive behaviour therapy (CBT), structured rehabilitation courses, family support and the avoidance of street drugs such as cannabis. Early treatment enhances recovery.

Sadly, we don’t even need to look beyond the health service to see stigma in relation to psychosis. The WHO recently highlighted the fact that individuals with schizophrenia die 10-25 years earlier than the rest of us. Suicide accounts for a proportion of this, but physical health issues are the main contributor.

People with schizophrenia are 2-6 times more likely to smoke heavily and roughly half are obese, while 10-15% have diabetes and 19-58% have hypertension. Paradoxically, such individuals receive poorer medical care for their physical problems than do the general population. Their medical ailments are all too frequently overshadowed by their schizophrenia and delayed diagnosis often prevents effective care.

TV portrayals 

According to the WHO, the reduced life expectancy of people with schizophrenia is the result of “a society socially and functionally biased towards the population living with severe mental disorder”. They add that “people with schizophrenia die earlier not because schizophrenia per se is fatal but rather because of the discrimination and lack of access to good health services”. The WHO has also stated its belief that stigma is the biggest barrier preventing people with severe mental illness from receiving effective care.

But what do we expect when stigma is so pervasive? Recent research in the UK highlighted by Time to Change examined 74 television programmes with storylines on mental health issues over a three-month period.

Although some of the portrayals were accurate, some 63% of references in television soaps and drama were “pejorative, flippant or unsympathetic”. Terms such as “crackpot”, “sad little psycho” and “basket case” were commonly used in dialogue. Moreover, there were 33 portrayals of people with mental illness using violence against others.

Sensationalist headlines 

Newspapers are certainly no better. On Monday 7 October 2013 the Sun newspaper carried the headline “1,200 killed by mental patients”. With unsurprising melodrama we were told of a “shock 10-year toll” emerging days after a “schizophrenic” was locked up for a stabbing.

Little context was provided, such as the overall number of homicides in the UK during the same decade. It was 7,000. Had they bothered to do the sums, the editors would have realised that citizens without mental illness (75%) had committed a disproportionately high number (83%) of the homicides.

Indeed, people with psychosis are more likely to be the victims of crime. But I suppose this does not sell newspapers.

Let’s be clear about this. In 2009, a large and rigorous study in the Archives of General Psychiatry found that severe mental illness alone did not predict violent behaviour.

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Effective treatment reduces the risk even further. But when newspaper editors refer to an alleged criminal as a “psycho”, “nutter” or “madman”, they wrongly assume that mental illness provides the only explanation for a violent event. Ordinary people with mental illness – and there are so many – feel stigmatised and are less likely to seek the very help they need for their psychological difficulties.

Too embarrassed to talk

And we know this to be true. See Change (the national stigma reduction partnership) recently surveyed more than 1,000 adults in relation to their attitudes to mental illness. Fifty-six percent stated that, if they had a mental health problem, they would not want others to know.

Forty-one percent and 24% respectively said they would hide their mental health problem from a friend or their family, while 57% believed that openness about a mental health problem at work would damage their career prospects. People with mental illness still feel too embarrassed to talk about it and media-fuelled public attitudes are partly to blame.

So, can the media do anything to help? Some time ago, Shine (in collaboration with the National Union of Journalists) issued their Guide for Journalists and Broadcasters Reporting on Schizophrenia. They commented on the stereotypes associated with schizophrenia being harder to challenge in the context of loose terminology such as “psycho” and “schizo”.

In response, they implored journalists to use the correct terminology whenever possible, while also avoiding language that may lead to fear, bigotry or distress. An example given was the term “schizophrenic”, which they discouraged along with the suggestion that an individual “suffers from” a mental illness. They cited the use of humour as the inappropriate trivialisation of serious mental illness, and pointed out that the misconception of schizophrenia as a “Jekyll and Hyde” illness needed to be rectified as a matter of priority.

Helping to ensure these guidelines are followed are Headline, Ireland’s national media monitoring programme for mental health and suicide. Funded by the National Office of Suicide Prevention, they review daily all national and regional publications to promote responsible and accurate coverage of mental health issues. No doubt they look forward to the day when tabloid newspapers will stop telling us to be afraid of “schizophrenics”. Because, in the end, people have a tendency to believe what they read.

Dr Stephen McWilliams is a consultant psychiatrist and author.  He is clinical lead of the Psychosis Programme at Saint John of God Hospital, Stillorgan, Co Dublin. 

Useful websites and helplines:

  • Aware 1890 303 302 (depression anxiety)
  • Pieta House 01 601 0000 or email - (suicide, self-harm, bereavement)

  • Teen-Line Ireland 1800 833 634 (for ages 13 to 19)

  • Childline 1800 66 66 66 (for under 18s)

Read: ‘The young man I saw in my outpatient department recently had changed his life around’>

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About the author:

Dr Stephen McWilliams  / Consultant psychiatrist

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