Schizophrenia is a serious mental illness that affects about one person in a hundred. It usually develops in the late teens or early twenties, though it sometimes starts in middle age or even much later in life. The earlier it begins, the more damaging to the personality it can be. Although it is treatable, relapses are common, and it may never clear up entirely. It makes working and studying, relating to other people and leading a full, independent life very difficult, and causes families much distress.

There a many people that have the idea that someone who suffers from schizophrenia can appear perfectly normal at one time and be a deranged killer at another. This is total nonsense, people who suffer from schizophrenia are rarely dangerous, this is much hyped be the media. Some people think that schizophrenia is someone who has a split personality, again this is wrong.

Thoughts, feelings and actions are somewhat disconnected from each other, so that what a person says may be out of keeping with what they feel or do, or what they do may be out of keeping with what they say or feel. This may be easier to illustrated by describing the symptoms. These are divided into positive symptoms, which are abnormal experiences, and negative symptoms, which are more an absence of normal behaviour.

Positive Symptoms - we normally feel that we are in control of out thoughts and actions, but schizophrenia interferes with this feeling of being "the captain of the ship". It may feel as though thoughts are being put into the mind or taken out by some outside, uncontrollable force. The body may feel as if it has been taken over, like a puppet or a robot under outside control. At worst, the whole personality seem under the influence of an alien force or spirit. This is a terrifying experience, which the person tries to explain according to education and upbringing. In high-tech societies, invisible influences capable of working over a distance may be put down to radio, television or laser beams, or a computer somehow installed in the brain. In traditional and religous communities, witchcraft angry spirits, God or the Devil may be help responsible. The word hallucination refers to the experience of hearing, smelling, feeling or seeing something, without there actually being anything there to hear, smell, feel or see. Hearing voices when there is no one there is the commonest hallucintion in schizophrenia. The voices sound so real that the hearer is convinced that they come from outside - perhaps from hidden microphones, loudspeakers or the spirit world. Voices are heard in some other mental illnesses, but in schizophrenia they typically talk about, as well as to, the person. Visions and hallucinations of smell, taste or being touched also occur in schizophrenia, but much less oftem than voices. Delusions are false and usually unusual beliefs, which cannot be explained by the believer's culture or changed by argument. People talk about paranoid ideas. This is really just another word for persecutory - "I know what everyone's thinking". On the other hand, delusions may be fantastic - "I'm God's messenger", "I'm the richest person in the world", "I'm persecuted by men from Mars", or apparently reasonable, "My husband is unfaithful", "Everyone at work is against me". Persecutory delusions are especially distressing for the family if they are seen as the persecutors. Delusions may come out of the blue or may start as an explanation for hallucinations or the sensation of being taken over.

Negative Symptoms - These affect interest, energy, emotional life and 'get-up-and-go'. As a result, the person may not bother to get up or go out, may not wash or tidy up, and may never get excited or enthusiastic about anything any more. The person will tend to avoid meeting people, will say little or nothing, and may appear emotionally rather blank. Negative sypmtoms upset families, who feel that it is a matter of 'won't' rather than 'can't', or as if the person they knew had been replaced by a stranger who just won't do anything. It is important for the family to understand that this is as much a part of a crippling illness as are delusions and hallucinations.

Speech and Behaviour - Sometimes schizophrenia interferes with a person's train of thought, so it may be difficult to follow what they say. Behaviour may be affected by hallucinations - talking or shouting back at the 'voices', or doing what they say (which my even mean self-harm or suicide). Often false beliefs do not affect behaviour - the 'Messiah' does not spread the Word, the 'Archduke' lives quietly on social security - but persecutory delusions may lead to the person accusing members of their family or strangers and, rarely, to attacks which may be dangerous. When such incidents occur they understandably cause much concern. Special follow-up arrangements have been devised to make these occurences ever rarer, although there is no consensus to their possible effectiveness.

No-one as yet know for sure what causes schizophrenia. However, approximately one in ten people with schizophrenia have a parent who suffers from the illness. This is more than the general population, where the risk in one in a hundred. This is likely to be due to heredity (genes), not upbringing. For example, if twins are identical (which means that their genes are also identical) and one has the illness, the other is very likely to have it too, even if they are raised apart. If they are not identical then the risk to the other twin, if one has schizophrenia, is no greater than to any other brother or sister. It is believed that heredity provides about half of the explanation of the illness. But the gene, or combination fo genes, responsible has yet to be discovered. New ways of producing pictures of the brain show that some people with schizophrenia have larger spaces in the brain that people who don't suffer from the illness. This suggests that parts of the brain may not have developed quite normally. The two main theories to explain this are complications during birth and a virus infection during the early months of pregnancy.

Stress, arising from sudden events like a car accident, bereavement or moving home, often occurs shortly before and episode of schizophrenia, and, though it cannot be the cause, it may help bring the illness on. Long-term stress, such as family tensions, may also make it worse.

Sometimes families feel that street drugs like ecstasy, LSD, amphetamines and marijuana can bring on schizophrenia. It does seem that smoking marijuana can make matters worse in those who already suffer from the illness.

Before 1950, many people with schizophrenia spent most of their lives in mental hospitals. Things have changed since then and most people with the illness are treated outside hospital for most of their lives. After the first episode of schizophrenia, about a quarter make a good recovery within 5 years, two thirds will have multiple episodes with some degree of stability between episodes and 10-15% will develop severe continous incapacity. Although the illness is severe and disruptive, many people who suffer from it are eventually able to settle down, work and make lasting relationships.

When a person first becomes ill they are usually treated in hospital in order for a full assessment and diagnoses to be made. Afterwards, they can often be treated whilst living at home, especially if they have a supportive family. Drug help to alleviate the most disturbing symptoms of the illness. However, they do not provide a complete answer. Support from families and friends, other forms of treatment and services such as supported housing, day care and employment schemes also play a vital part.

People with schizophrenia do not always realise they are ill and may refuse treatment when they badly need it. In these circumstances, the Mental Health Act permit compulsory admission to hospital if the person is a danger to him or herself or others or are in urgent need of treatment. Such an admission may last for up to 6 months and may be renewed, but the person detained has the right to appeal against this to an independent tribunal.

Since 1954, a number or drugs have been available for the treatment of schizophrenia. Most work by blocking the path of a particular chemical messenger, dopamine, in the brain. The drugs usually suppress positive symptoms, delusions and hallucinations gradually go away in a few weeks. There are, however, side-effects, especially stiffness and shakiness, like Parkinson's disease (which can be reduced by giving anti-Parkinsonian drugs). Anti-schizophrenia drugs may also cause slowing up, sleepiness and putting on weight. The worse consequence is unwanted and lasting movements of the mouth and tongue - tardive dyskinesia (TD for short) - which affects a number of people who have taken anti-schizophrenia drugs for a year or more, and may not go away even if the drugs are stopped.

Fortunately, new drugs are now available which block different chemical messengers and are much less likely to cause side-effects. They may also help the negative symptoms, on which the older drugs have very little effect.

Because of the risk of repeated episodes, it is usually advisable to take drugs for years, if not for ever. Although the dose is less than for an acute episode, it can still cause side-effects. Long-term drugs can be given by an injection (depot) which lasts for a month or more. Families and those suffering from the illness often prefer this because it avoids having to to reminded to take tablets every day. On the other hand, taking tablets gives the person with the illness more control over their medication. However, people need to understand the implications if they discontinue taking their tablets.

Schizophrenia makes it difficult to deal with the demands of everyday life. Ordinary activities like washing, answering the door, shopping, making a phone call or chatting with a friend can seem like huge hurdles. To some extent drugs help to overcome such problems. However, treatment is more effective in the long run when it includes the support given by nurses, occupational therapists and other members of the community mental health team, and there is access to a wide range of services.

After an acute illness, it is often helpful to attend a day unit, starting with physical activities, like ball games or keep fit, and going on through creative pursuits, like painting and pottery, to more demanding worklike activities. The idea is to help people get into or back to work - though obviously this is less likely if there is a lot of unemployment. Other services such as employment initiatives and sheltered work, supported accommodation schemes, drop-in centres, and day care facilities also play a vital part. Cognitive and other talking therepies may also help. For those whose illness is more prolonged and severe, a specialist rehabilitation service, including residential care my be available.

How do families react if a son or daughter, a brother or sister develops schizophrenia and becomes odd and unpredictable? They may regard the change in behaviour as rebellious, perverse and unacceptable without at first realising that it is due to mental illness. When they do, it can be very hard to digest - "was it our fault?", "Who else could be affected?", "What happens next?". Families need as much help and information as possible from the psychiatric team and the various voluntary organisations concerned with schizophrenia. They also need advice on the management of the illness, and how best they can help. Since schizophrenia increases sensitivity to stress, it is helpful to avoid arguments and keep calm, perhaps easier said that done!. The psychiatric team can also help by listening to worries and concerns and advising on drugs and their side-effects as well as suggesting small, manageable tasks which may aid rehabilitation.