Changing the dialogue surrounding psychotic illness

By Emily Mogridge

At the suggestion of my supervising psychiatrist, I recently watched the film A Beautiful Mind, a dramatisation of the life of mathematician John Nash and his struggle with schizophrenia. While discussing the film with a friend, she responded asking me if I found the film ‘creepy’ – she had assumed it must have been a horror movie. At no point had I suggested it was a horror film; the only indication I had given was that I mentioned that the protagonist had schizophrenia. It was only a passing comment, but it’s something that has left me mulling over our collective perception of psychotic illness.

A quick online thesaurus search for schizophrenia reveals such so-called synonyms as ‘insanity’, ‘lunacy’ and ‘madness’. Another search using the more offensive term of schizophrenic results in the return of similarly unacceptable alternatives, such as ‘cracked’, ‘crazed’, ‘cuckoo’, ‘loony’, ‘nutty’, ‘screwy’, and ‘psychopathic’. Language has power, and knowing that that such ‘synonyms’ may be used interchangeably with more accurate terms, it appears that it our approach to these illnesses is well overdue for an overhaul.

Schizophrenia is a mental health condition that affects more than 21 million people worldwide. It is characterised by the individual experiencing psychotic features, such as delusions, hallucinations and disorganised or changed behaviour. It is one of several mental health conditions of which psychotic features may be present; others include, but are not limited to, schizoaffective disorder, bipolar disorder and some cases of major depressive disorder.

Artistic_view_of_how_the_world_feels_like_with_schizophrenia_-_journal.pmed.0020146.g001An artistic representation of how the world feels with schizophrenia by Craig Finn, a schizophrenia patient, 2005

Despite vast improvements in public acceptance of mental health conditions in recent times, there is still a long way to go before mental illness is viewed on the same plane as physical illness, and it seems that psychotic illness in particular still appears to be shrouded in misunderstanding and fear. Perhaps we shouldn’t be surprised; while there are a number of not-for-profits like beyondblue for the more widely understood mental illnesses of depression and anxiety, there are no psychosis-specific organisations in Australia.

It’s something perpetuated by popular culture, with a classic horror movie or video game trope being the haunted, abandoned psychiatric asylum. It’s a relic from times past where once our management of people with severe psychiatric illness, especially psychotic illness, was with isolation and restraint in institutions cut off from wider society. While evidence-based medicine has since come a long way since those days, we owe it to our patients to foster a more accurate perception and understanding of what it means to live with a psychotic illness.

I’d been in the tea room while on break at the hospital and overheard a conversation occurring from one staff member to another about a recent stabbing in the news, and how the perpetrator must have been “absolutely schizo”. All this occurred while I looked out the window where less than a hundred metres away I could see the mental health ward of the hospital, where I’d met so many patients living with psychotic illness not two months earlier. These are not isolated occurrences, however; when I talk about spending my elective on an inpatient psychiatric ward to friends, family and other medical students and doctors, I am met by eyebrow raises or tasteless jokes at my — and the patients’ — expense.

Living with a psychotic illness is certainly no grounds for jokes, where 67% of people with a psychotic illness have suicidal ideation at some point in their lifetime, and of this, 50% will make a suicide attempt. For those with schizophrenia in particular, 5% will die by suicide. For people living with these conditions, public scrutiny and misinformation, particularly seen in hyperbolised news stories painting people with psychotic illness as cold-blooded killers rather than people in need of help, only contributes to decreased self-esteem and self-worth. It affects the ability to form meaningful relationships, alienates old friends after receiving a diagnosis, and makes it harder to find and maintain gainful employment — especially when you need to explain the extended gaps in your resume when you’re receiving the psychiatric care you need.

Just as I helped clarify the true nature of schizophrenia to my friend, we all have a responsibility to do the same in the wider community. We need to drive the change of stereotypes that have developed from decades of ignorance and misinformation. Before we can expect society to change their views towards psychotic illness, we need to stop internalised bias and judgement towards those with psychotic illness, and that’s change that starts with you and me.

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